Translational Behavioral Medicine

, Volume 7, Issue 2, pp 242–253 | Cite as

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

Original Research

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.

Keywords

Depression Mobile app mHealth Acceptance and commitment therapy Nurse education Stepped care Mental health 

Notes

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.

Compliance with ethical standards

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.

References

  1. 1.
    World Health Organization. Depression Fact Sheet No 369. http://www.who.int/mediacentre/factsheets/fs369/en/. Published 2015. Accessed 24 Feb 2016.
  2. 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.CrossRefPubMedGoogle Scholar
  3. 3.
    World Health Organization N. The global burden of disease: 2004 update. Vol 2010, 2008. doi:10.1038/npp.2011.85.Google Scholar
  4. 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. 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. 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.CrossRefPubMedGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefPubMedGoogle Scholar
  9. 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. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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. 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.CrossRefPubMedGoogle Scholar
  21. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.CrossRefGoogle Scholar
  27. 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.CrossRefPubMedGoogle Scholar
  28. 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.CrossRefPubMedGoogle Scholar
  29. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 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.CrossRefGoogle Scholar
  32. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 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.CrossRefPubMedGoogle Scholar
  35. 35.
    Doody, O., & Slevin, T. (2013). Preparing for and conducting focus groups in nursing research: part 2. Br J Nurs, 22(3), 170–173.CrossRefPubMedGoogle Scholar
  36. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 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).Google Scholar
  38. 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.CrossRefPubMedGoogle Scholar
  39. 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.CrossRefPubMedGoogle Scholar
  40. 40.
    Lally, P., & Gardner, B. (2013). Promoting habit formation. Health Psychol Rev, 7(sup1), S137–S158. doi:10.1080/17437199.2011.603640.CrossRefGoogle Scholar
  41. 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. 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. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 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).Google Scholar
  50. 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. 51.
    Oiva website. http://oivamieli.fi. Accessed 5 June 2016.
  52. 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. 53.
    Timonen, M., & Liukkonen, T. (2008). Management of depression in adults. BMJ, 336(7641), 435–439. doi:10.1136/bmj.39478.609097.BE.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society of Behavioral Medicine 2016

Authors and Affiliations

  1. 1.Headsted LtdTampereFinland
  2. 2.Vincit OyTampereFinland
  3. 3.Tampere University of Applied SciencesTampereFinland

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