Skip to main content

Advertisement

SpringerLink
Log in

Applicability of acceptance and commitment therapy-based mobile app in depression nursing

  • Original Research
  • Published:
Translational Behavioral Medicine

Abstract

Due to the high burden of depression, new models and methods of mental healthcare need to be developed. Prior research has shown the potential benefits of using technology tools such as mobile apps as self-help or combined with psychological treatment. Therefore, professionals should acquaint themselves with evidence-based apps to be able to use them with clients and guide the clients in their use. The purpose of this study was to explore how an acceptance and commitment therapy-based mobile app was perceived as a self-management tool among nurses, and how it could be applied in the prevention and treatment of depression and other mental health issues. Sixteen Finnish nurses undergoing depression nurse specialist education used the app for 5 weeks and participated in semistructured focus group interviews. Interviews were analyzed by qualitative content analysis. In general, the nurses found the app suitable as a self-management tool and identified three models of using it in clinical practice. Having used the app personally, the nurses were eager to take it into use with various client groups, especially in occupational health but also in the treatment of mental health problems. However, they also raised concerns about the effort needed in familiarizing oneself with the content and pointed out specific client groups for whom the benefits of the app should be carefully weighed against the potential risks. Despite the small sample size, the findings suggest that involving technology tools as part of the nurses’ education could ease their adoption in clinical practice. The degree of professional support in the app use should be aligned to the severity of the mental health problems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. World Health Organization. Depression Fact Sheet No 369. http://www.who.int/mediacentre/factsheets/fs369/en/. Published 2015. Accessed 24 Feb 2016.

  2. Wittchen, H. U., Jacobi, F., Rehm, J., et al. (2011). The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol, 21(9), 655–679. doi:10.1016/j.euroneuro.2011.07.018.

    Article  CAS  PubMed  Google Scholar 

  3. World Health Organization N. The global burden of disease: 2004 update. Vol 2010, 2008. doi:10.1038/npp.2011.85.

  4. Expert platform on mental health—focus on depression. The depression challenge—Brussels declaration. http://www.depressionplatform.eu/the-depression-challenge. Accessed 24 Feb 2016.

  5. Isometsä E, Kinnunen E, Kivekäs T, et al. 2014 Depression: current care summary, http://www.kaypahoito.fi/web/english/guidelineabstracts/guideline?id=ccs00062.

  6. Rebello, T. J., Marques, A., Gureje, O., & Pike, K. M. (2014). Innovative strategies for closing the mental health treatment gap globally. Curr Opin Psychiatry, 27(4), 308–314. doi:10.1097/YCO.0000000000000068.

    Article  PubMed  Google Scholar 

  7. Katon, W., Von Korff, M., Lin, E., & Simon, G. (2001). Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse. Gen Hosp Psychiatry, 23(3), 138–144. doi:10.1016/S0163-8343(01)00136-0.

    Article  CAS  PubMed  Google Scholar 

  8. Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006). Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med, 166(21), 2314–2321.

    Article  PubMed  Google Scholar 

  9. Archer, J., Bower, P., Gilbody, S., et al. (2012). Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev, 10. doi:10.1002/14651858.CD006525.pub2.

  10. Jacob, V., Chattopadhyay, S. K., Sipe, T. A., Thota, A. B., Byard, G. J., & Chapman, D. P. (2012). Economics of collaborative care for management of depressive disorders: a community guide systematic review. Am J Prev Med, 42(5), 539–549. doi:10.1016/j.amepre.2012.01.011.

    Article  PubMed  Google Scholar 

  11. Thota, A. B., Sipe, T. A., Byard, G. J., et al. (2012). Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. Am J Prev Med, 42(5), 525–538. doi:10.1016/j.amepre.2012.01.019.

    Article  PubMed  Google Scholar 

  12. Ekers, D., Murphy, R., Archer, J., Ebenezer, C., Kemp, D., & Gilbody, S. (2013). Nurse-delivered collaborative care for depression and long-term physical conditions: a systematic review and meta-analysis. J Affect Disord, 149(1–3), 14–22. doi:10.1016/j.jad.2013.02.032.

    Article  PubMed  Google Scholar 

  13. Cowpertwait, L., & Clarke, D. (2013). Effectiveness of web-based psychological interventions for depression: a meta-analysis. Int J Ment Health Addict, 11(2), 247–268. doi:10.1007/s11469-012-9416-z.

    Article  Google Scholar 

  14. Aguilera, A., & Muench, F. (2012). There’s an app for that: information technology applications for cognitive behavioral practitioners. Behav Ther (N Y N Y), 35(4), 65–73.

    Google Scholar 

  15. Richards, D., & Richardson, T. (2012). Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev, 32(4), 329–342. doi:10.1016/j.cpr.2012.02.004.

    Article  PubMed  Google Scholar 

  16. Harrison, V., Proudfoot, J., Wee, P. P., Parker, G., Hadzi Pavlovic, D., & Manicavasagar, V. (2011). Mobile mental health: review of the emerging field and proof of concept study. J Ment Health, 20(6), 509–524. doi:10.3109/09638237.2011.608746.

    Article  PubMed  Google Scholar 

  17. Holahan, C. J., Moos, R. H., Holahan, C. K., Brennan, P. L., & Schutte, K. K. (2005). Stress generation, avoidance coping, and depressive symptoms: a 10-year model. J Consult Clin Psychol, 73(4), 658–666. doi:10.1037/0022-006X.73.4.658.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Taylor, S. E., & Stanton, A. L. (2007). Coping resources, coping processes, and mental health. Annu Rev Clin Psychol, 3, 377–401. doi:10.1146/annurev.clinpsy.3.022806.091520.

    Article  PubMed  Google Scholar 

  19. Ahtinen, A., Mattila, E., Välkkynen, P., et al. (2013). Mobile mental wellness training for stress management: feasibility and design implications based on a one-month field study. J Med Internet Res., 15(7), 1–13. doi:10.2196/mhealth.2596.

    Google Scholar 

  20. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther, 44(1), 1–25. doi:10.1016/j.brat.2005.06.006.

    Article  PubMed  Google Scholar 

  21. Biglan, A., Hayes, S. C., & Pistorello, J. (2008). Acceptance and commitment: implications for prevention science. Prev Sci, 9(3), 139–152. doi:10.1007/s11121-008-0099-4.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther, 44(2), 180–198. doi:10.1016/j.beth.2009.08.002.

    Article  PubMed  Google Scholar 

  23. A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychother Psychosom, 84(1), 30–36. doi:10.1159/000365764.

    Article  PubMed  Google Scholar 

  24. Öst, L.-G. G. (2014). The efficacy of acceptance and commitment therapy: an updated systematic review and meta-analysis. Behav Res Ther, 61, 105–121. doi:10.1016/j.brat.2014.07.018.

    Article  PubMed  Google Scholar 

  25. Carlbring, P., Hagglund, M., Luthstrom, A., et al. (2013). Internet-based behavioral activation and acceptance-based treatment for depression: a randomized controlled trial. J Affect Disord, 148, 331–337. doi:10.1016/j.jad.2012.12.020.

    Article  PubMed  Google Scholar 

  26. Levin, M. E., Pistorello, J., Seeley, J. R., & Hayes, S. C. (2014). Feasibility of a prototype web-based acceptance and commitment therapy prevention program for college students. J Am Coll Heal, 62(1), 20–30. doi:10.1080/07448481.2013.843533.

    Article  Google Scholar 

  27. Räsänen, P., Lappalainen, P., Muotka, J., Tolvanen, A., & Lappalainen, R. (2016). An online guided ACT intervention for enhancing the psychological wellbeing of university students: a randomized controlled clinical trial. Behav Res Ther, 78, 30–42. doi:10.1016/j.brat.2016.01.001.

    Article  PubMed  Google Scholar 

  28. Lappalainen, P., Granlund, A., Siltanen, S., et al. (2014). ACT internet-based vs face-to-face? A randomized controlled trial of two ways to deliver acceptance and commitment therapy for depressive symptoms: an 18-month follow-up. Behav Res Ther, 61, 43–54. doi:10.1016/j.brat.2014.07.006.

    Article  PubMed  Google Scholar 

  29. Ly, K. H., Dahl, J., Carlbring, P., & Andersson, G. (2012). Development and initial evaluation of a smartphone application based on acceptance and commitment therapy. Springerplus, 1(1), 11. doi:10.1186/2193-1801-1-11.

    Article  PubMed  PubMed Central  Google Scholar 

  30. van Limburg, M., van Gemert-Pijnen, J. E., Nijland, N., Ossebaard, H. C., Hendrix, R. M., & Seydel, E. R. (2011). Why business modeling is crucial in the development of eHealth technologies. J Med Internet Res., 13(4), e124. doi:10.2196/jmir.1674.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mann, E. G., Medves, J., & Vandenkerkhof, E. G. (2015). Accessing best practice resources using mobile Technology in an Undergraduate Nursing Program: a feasibility study. Comput Informatics, Nurs, 33(3), 122–128. doi:10.1097/CIN.0000000000000135.

    Article  Google Scholar 

  32. Farrell, M. (2016). Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses’ perspectives on iPhone use. JMIR mHealth uHealth, 4(2), e43. doi:10.2196/mhealth.5071.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Cook, J. M., Schnurr, P. P., Biyanova, T., & Coyne, J. C. (2009). Apples do not fall far from the tree: influences on psychotherapists’ adoption and sustained use of new therapies. Psychiatr Serv, 60(5), 671–676. doi:10.1176/appi.ps.60.5.671.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Doody, O., Slevin, E., & Taggart, L. (2013). Focus group interviews in nursing research: part 1. Br J Nurs, 22(1), 16–19. doi:10.12968/bjon.2013.22.1.16.

    Article  PubMed  Google Scholar 

  35. Doody, O., & Slevin, T. (2013). Preparing for and conducting focus groups in nursing research: part 2. Br J Nurs, 22(3), 170–173.

    Article  PubMed  Google Scholar 

  36. Lappalainen, R., Sairanen, E., Järvelä, E., et al. (2014). The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing: the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress. BMC Public Health, 14, 310. doi:10.1186/1471-2458-14-310.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lappalainen P, Kaipainen K, Lappalainen R, et al. 2013. Feasibility of a personal health technology-based psychological intervention for men with stress and mood problems: Randomized controlled pilot trial. J Med Internet Res, 15(1).

  38. Lappalainen, P., Langrial, S., Oinas-Kukkonen, H., Tolvanen, A., & Lappalainen, R. (2015). Web-based acceptance and commitment therapy for depressive symptoms with minimal support: a randomized controlled trial. Behav Modif, 39(6), 805–834. doi:10.1177/0145445515598142.

    Article  PubMed  Google Scholar 

  39. Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today, 24(2), 105–112. doi:10.1016/j.nedt.2003.10.001.

    Article  CAS  PubMed  Google Scholar 

  40. Lally, P., & Gardner, B. (2013). Promoting habit formation. Health Psychol Rev, 7(sup1), S137–S158. doi:10.1080/17437199.2011.603640.

    Article  Google Scholar 

  41. Muuraiskangas, S., Mattila, E., Kyttälä, P., Koreasalo, M., & Lappalainen, R. (2016). User experiences of a mobile mental well-being intervention among pregnant women. In S. Serino, A. Matic, D. Giakoumis, G. Lopez, & P. Cipresso (Eds.), MindCare 2015, CCIS 604 (pp. 140–149). Cham: Springer International Publishing. doi:10.1007/978-3-319-32270-4_14.

    Google Scholar 

  42. Muuraiskangas, S., Harjumaa, M., Kaipainen, K., & Ermes, M. (2016). Process and effects evaluation of a digital mental health intervention targeted at improving occupational well-being: intervention study. JMIR Ment Heal, 3(2), 1–14. doi:10.2196/mental.4465.

    Google Scholar 

  43. Kelders, S. M., Kok, R. N., Ossebaard, H. C., & Van Gemert-Pijnen, J. E. W. C. (2012). Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res, 14(6), e152. doi:10.2196/jmir.2104.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Wykes, T., & Brown, M. (2016). Over promised, over-sold and underperforming?—e-health in mental health. J Ment Health, 25(1), 1–4. doi:10.3109/09638237.2015.1124406.

    Article  PubMed  PubMed Central  Google Scholar 

  45. van Velsen, L., Beaujean, D. J. M. A., & van Gemert-Pijnen, J. E. W. C. (2013). Why mobile health app overload drives us crazy, and how to restore the sanity. BMC Med Inform Decis Mak, 13(1), 23. doi:10.1186/1472-6947-13-23.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Boudreaux, E. D., Waring, M. E., Hayes, R. B., Sadasivam, R. S., Mullen, S., & Pagoto, S. (2014). Evaluating and selecting mobile health apps: strategies for healthcare providers and healthcare organizations. Transl Behav Med, 4(4), 363–371. doi:10.1007/s13142-014-0293-9.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. Int Rev Psychiatry, 23(4), 318–327. doi:10.3109/09540261.2011.606803.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Musiat, P., Goldstone, P., & Tarrier, N. (2014). Understanding the acceptability of e-mental health—attitudes and expectations towards computerised self-help treatments for mental health problems. BMC Psychiatry, 14(1), 109. doi:10.1186/1471-244X-14-109.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ahtinen A, Mattila E, Välkkynen P, et al. 2013. Mobile mental wellness training for stress management: Feasibility and design implications based on a one-month field study. J Med Internet Res, 15(7).

  50. Finland OS of. Use of information and communications technology by individuals. http://www.stat.fi/til/sutivi/2015/sutivi_2015_2015-11-26_tie_001_en.html. Accessed 7 June 2016.

  51. Oiva website. http://oivamieli.fi. Accessed 5 June 2016.

  52. National Institute for Health and Clinical Excellence. Depression: the treatment and management of depression in adults (NICE clinical guideline 90). 2009;(October):4–64. www.nice.org.uk/CG90.

  53. Timonen, M., & Liukkonen, T. (2008). Management of depression in adults. BMJ, 336(7641), 435–439. doi:10.1136/bmj.39478.609097.BE.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We thank the participants of this study for their valuable contributions. The assistance of Jussi Hannunen and Sanna Sintonen from Education technology services at Tampere University of Applied Sciences in the arrangements of the study is gratefully acknowledged.

Author information

Authors and Affiliations

  1. Headsted Ltd, Pyhäjärvenkatu 1 A, 33200, Tampere, Finland

    Kirsikka Kaipainen Ph.D

  2. Vincit Oy, Tampere, Finland

    Pasi Välkkynen Ph.D

  3. Tampere University of Applied Sciences, Tampere, Finland

    Nina Kilkku Ph.D

Authors
  1. Kirsikka Kaipainen Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pasi Välkkynen Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nina Kilkku Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kirsikka Kaipainen Ph.D.

Ethics declarations

Funding

The study was funded by the authors’ organizations. No external funding was received.

Conflict of interest

Dr. Kaipainen is the CEO of Headsted Ltd., which develops online interventions for mental health issues and maintains the web version of the Oiva app examined in this study. At the time of the study, she was employed at VTT Technical Research Centre of Finland. Dr. Välkkynen was employed by VTT Technical Research Centre of Finland at the time of the study. He is employed currently by Vincit Oy, a software company in Finland. Dr. Välkkynen and Dr. Kilkku declare that they have no conflict of interest.

Ethics statement

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

Additional information

Implications

Policy: Policymakers should consider including the use of self-help apps in the education curriculum of mental health professionals, both to improve the professionals’ own mental health and skills and to train them to use apps with clients.

Research: Further research should examine how the personal use of self-help apps during mental health professionals’ education influences the actual uptake in clinical practice.

Practice: Acceptance and commitment therapy methods can be delivered via a mobile self-help app that can be applied flexibly in nursing practice after initial training in its use.

The findings reported have not been previously published. The manuscript is not being simultaneously submitted elsewhere. The data have not been previously reported. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kaipainen, K., Välkkynen, P. & Kilkku, N. Applicability of acceptance and commitment therapy-based mobile app in depression nursing. Behav. Med. Pract. Policy Res. 7, 242–253 (2017). https://doi.org/10.1007/s13142-016-0451-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13142-016-0451-3

Keywords

Search

Navigation