Living with spinal cord injury (SCI) can have a significant negative impact on an
individual's mental health and restrict participation in personally valued activities and
roles. About 40% of individuals with SCI report depressive symptoms and other mental
health symptoms, which are associated with negative long-term outcomes.
Acceptance and commitment therapy (ACT) is an empirically supported transdiagnostic
approach that can mitigate symptoms of mental health disorders and improve quality of
life through mindfulness and acceptance processes and behavior change processes for
valued living. ACT is based on the psychological flexibility model involving six
processes that serve as a mechanism of change (i.e., acceptance, cognitive defusion,
being present, observing self, values, and committed action). Evidence for ACT for
individuals with SCI, however, is limited to a very few studies that involved in-person
group-based ACT and did not focus on depressed individuals with SCI.
This project aims to test the efficacy of an 8-week videoconferencing ACT program for
improving mental health in depressed individuals living with SCI. The hypotheses are that
the ACT group will show improvements in depressive symptoms (the primary outcome),
secondary mental health outcomes (e.g., anxiety, stress, and grief), and ACT processes
(e.g., psychological flexibility and engaged living) at posttest and 2-month follow-up
compared to the wait-list control group. Also, the project aims to examine the mediating
effects of the ACT psychological flexibility processes on reducing depressive symptoms in
individuals living with SCI.
This study will use a two-arm parallel-group, randomized controlled trial design. The
investigators will recruit 120 depressed individuals living with SCI and randomly assign
them to either the ACT group or the wait-list control group. The ACT group will receive
eight weekly individual ACT sessions guided by a coach through videoconferencing with a
booster session at 1-month follow-up. The wait-list control group will maintain his or
her own care as usual during the study period and have the option to receive eight
individual ACT sessions after study participation ends. Data will be collected at
pretest, posttest, and 2-month follow-up. The investigators will use generalized linear
mixed-effects models to examine the relative impact on the ACT group compared to the
wait-list control group at posttest and 2-month follow-up. The mediation analysis will
consist of the outcome model and the mediator model. After fitting the models, the
investigators will estimate direct effect and indirect effect (i.e., the mediated
effect).
Managing uncomfortable or painful thoughts and emotions arising from functional
limitations and accepting changed lives while moving forward for valued living through
ACT skill practice will help individuals with SCI alleviate symptoms of mental health
conditions, promote engagement in personally valued activities, and improve quality of
life. The investigators expect the findings of this study to contribute to the limited
evidence for internet-delivered ACT in individuals living with SCI and lay the necessary
groundwork to provide important knowledge and guidance for future clinical trials and
practice.
