Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: study protocol for a randomised controlled trial

Susanne Amsberg, Ingrid Wijk, Fredrik Livheim, Eva Toft, Unn-Britt Johansson, Therese Anderbro, Susanne Amsberg, Ingrid Wijk, Fredrik Livheim, Eva Toft, Unn-Britt Johansson, Therese Anderbro

Abstract

Introduction: Integrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The aim of this study is to evaluate the impact of a stress management group intervention based on acceptance and commitment therapy (ACT) among adults living with poorly controlled type 1 diabetes.

Methods and analysis: This study will use a randomised controlled trial design evaluating treatment as usual (TAU) and ACT versus TAU. The stress management group intervention will be based on ACT and comprises a programme divided into seven 2-hour sessions conducted over 14 weeks. A total of 70 patients who meet inclusion criteria will be recruited over a 2-year period with follow-up after 1, 2 and 5 years.The primary outcome measure will be HbA1c. The secondary outcome measures will be the Depression Anxiety Stress Scales, the Swedish version of the Hypoglycemia Fear Survey, the Swedish version of the Problem Areas in Diabetes Scale, The Summary of Self-Care Activities, Acceptance Action Diabetes Questionnaire, Swedish Acceptance and Action Questionnaire and the Manchester Short Assessment of Quality of Life. The questionnaires will be administered via the internet at baseline, after sessions 4 (study week 7) and 7 (study week 14), and 6, 12 and 24 months later, then finally after 5 years. HbA1c will be measured at the same time points.Assessment of intervention effect will be performed through the analysis of covariance. An intention-to-treat approach will be used. Mixed-model repeated measures will be applied to explore effect of intervention across all time points.

Ethics and dissemination: The study has received ethical approval (Dnr: 2016/14-31/1). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders.

Trial registration number: NCT02914496; Pre-results.

Keywords: acceptance and commitment therapy; diabetes; psychological stress; self-care; type 1.

Conflict of interest statement

Competing interests: FL receives royalties from his own written books on ACT and income from training professionals in ACT.

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow of participants through the study.
Figure 2
Figure 2
Standard Protocol Items: Recommendations for Interventional Trials enrolment to assessment. AADQ, Acceptance Action Diabetes Questionnaire; DASS, Depression Anxiety Stress Scales; HFS, Hypoglycemia Fear Survey; MANSA, Manchester Short Assessment of Quality of Life; SAAQ, Swedish Acceptance and Action Questionnaire; SDSCA, The Summary of Self-Care Activities; Swe-HFS, Swedish version of the Hypoglycemia Fear Survey.

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