Martin, Kristy-Jane
(2018)
Effectiveness of Acceptance and Commitment Therapy self-help for carers of people with multiple sclerosis: a feasibility randomised controlled trial.
DClinPsy thesis, University of Nottingham.
Abstract
Objective: Acceptance and Commitment Therapy (ACT) may be a feasible, accessible and effective intervention to ‘informal’ carers of people with Multiple Sclerosis (MS) who may be experiencing strain as a result of their caring duties. The aim of this study was to assess the feasibility of randomised controlled trial (RCT) of ACT self-help, telephone-supported ACT self-help, compared to usual care (UC). Study objectives related to feasibility and acceptability of the study design and the two chosen interventions and assessing potential effectiveness at both individual and group level.
Design: This study was a feasibility, mixed-methods, parallel three-armed RCT design. The three arms were: (1) ACT self-help workbook (SH), (2) ACT self-help workbook alongside weekly telephone calls (SH+), and (3) usual care. The SH group received an ACT self-help text over eight weeks, with chapters sent week-by-week via email or post. Those in the SH+ group received the intervention as those in the SH group, with the addition of weekly telephone support calls to guide them through the self-help text. Participants across all groups completed measures at baseline, at three-months and six-months post randomisation. Measures included were two measures of carer strain (Zarit Burden Interview; (ZBI) and Modified Carer Strain Index; (MCSI)), carer health-related quality of life measure (CAREQOL-MS) alongside two ACT process measures (Acceptance and Action Questionnaire; AAQ-II) and Comprehensive Assessment of Acceptance and Commitment Therapy; (CompACT). All participants randomised to the two intervention groups were invited to complete a feedback interview, which was analysed using a framework analysis to inform feasibility of the study.
Results: Twenty-four self-defined primary carers of people with MS were randomised to one of the three groups previously described above. Overall, participants found the RCT design of the study to be feasible, although there were difficulties with the self-help text itself, as well as the timing of the intervention. The measures were predominantly feasible with one notable difficulty, whereby a measure of service use was omitted from the analysis and was deemed not feasible in its current form. A mixed linear model analysis showed improvement on only one outcome measure for the SH group (ZBI at 6-month follow-up), and participants reported difficulties engaging with the SH intervention in its current format. The SH+ group showed improvements on both measures of carer strain (consistent across both follow-ups) and attributed improvements both to the text as well as the telephone support. Both groups showed multiple significant improvements on process measures.
Conclusions: A full trial of ACT-based, telephone-supported self-help is warranted, further to significant changes to the study design and protocol. Notably, the SH group (without telephone support) was not deemed a feasible intervention to progress to a full scale RCT, and therefore a two-armed RCT is recommended. Further work needs to be completed ahead of progressing to full trial, the major changes required would be to the intervention material and recruitment strategy. An internal pilot would, therefore, be necessary in order to assess the feasibility of the study after the suggested changes had been made. Personal reflections on the research process, chosen methodology, and intervention are offered.
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