Web-based Acceptance and Commitment Therapy (ACT) for adults with type 1 diabetes: A single case experimental design (SCED)

A randomised multiple-baseline single case experimental design (SCED) was used to examine feasibility, acceptability, and preliminary effectiveness of an online Acceptance and Commitment Therapy (ACT) intervention for adults with Type 1 diabetes (T1D). Consenting participants reporting diabetes-specific distress (n = 25) were randomised to baseline length (1–3 weeks) before completing a six-week online ACT intervention, followed by one-month follow-up (FU). The primary outcome assessed generic and diabetes-specific well-being, measured at pre, post, and FU using the Well-Being Questionnaire. Secondary outcomes were: diabetes-dependent quality of life (Audit of Diabetes-Dependent Quality of Life at pre, post, FU); mood and anxiety measured daily using visual analogue scales (VAS); diabetes self-management (daily self-management activities VAS, and pre, post, FU measurements using the Diabetes Self-Management Questionnaire); glycaemic control (information from continuous glucose monitoring devices and daily self-monitoring of blood glucose); and psychological flexibility (Multidimensional Psychological Flexibility Inventory at pre, post, FU). Nine participants completed all phases of the study, rating the intervention as highly acceptable. Most participants showed clinically significant improvements in generic well-being (n = 5) and diabetes-specific well-being (n = 7) at follow-up. Diabetes-dependent QoL reliably improved at follow-up for three participants. Improvements in mood (n = 7) and anxiety (n = 6) were observed across phase comparisons. Most participants reported a significant increase in physical activity (n = 5) across phases. A positive trend of increased time in blood glucose range from baseline to intervention was observed for four participants. Psychological flexibility significantly increased from baseline to follow-up for seven participants. Interpretation of the findings was considered in the context of limitations including high rates of attrition (55%).