Acceptance and Commitment Therapy self-help intervention for depression in haemodialysis patients: a feasibility randomised controlled trial

<p>Objective: People with end-stage renal disease (ESRD) experience high rates of depression and this is associated with poorer health-related outcomes. Acceptance and Commitment Therapy (ACT) has shown promising results in a number of long-termconditions and has been translated into a variety of self-help formats. We aimed to determine the feasibility of a trial examining telephone-supported self-help based on ACT for individuals with ESRD who experience depression. A brief and extended account of theresearch is provided. This is preceded by a systematic literature review examining whether ACT interventions can improve quality of life in long-term physical conditions (see section for more information). Design: A feasibility randomised controlled trial comparing telephone-supported ACT self-help with treatment as usual. Methods: Participants were recruited from four outpatient haemodialysis units acrossNottinghamshire, UK. The Patient Health Questionnaire (PHQ-9), EuroQol (EQ-5D-5L) health-related quality of life measure, Acceptance and Action Questionnaire II (AAQ-II) andValued Living Questionnaire (VLQ) were completed at baseline and 2- and 4-months post-randomisation. Participants in the intervention arm were asked to complete an ACT self-helpmanual over six weeks with weekly telephone support. Following completion of the trial, six participants were interviewed to examine the acceptability of the trial procedure and intervention. Interview data was analysed using framework analysis. Results: In total, 99 (36.87%) of 276 screening questionnaires were returned. Of these, 30 (30.3%) met the cut-off for depression on the PHQ-9 with nine enrolling in the trial. AAQ-II scores of screened participants were positively associated with scores on the PHQ-9 and GAD-7, indicating a positive relationship between psychological inflexibility and distress.Interview data indicated that the recruitment and randomisation procedure, and assessment methods were acceptable. Only one in four of the participants in the ACT arm of the trial completed all chapters of the book with health problems the main barrier to completion. Conclusion: Our findings indicate that a definitive trial examining the effectiveness of a telephone-supported ACT self-help intervention would not be feasible. Many aspects of thetrial were acceptable to participants, including the main recruitment strategy, randomisation procedure and data collection methods. However, low recruitment numbers and poor adherence to the self-help manual indicate that a full-scale trial would not be viable. Factorsthat might account for low recruitment numbers are discussed and personal reflections on the research process are provided.</p>