Analyzing change processes resulting from a smartphone maintenance intervention based on acceptance and commitment therapy for women with chronic widespread pain

PURPOSE: This study investigated change processes resulting from a smartphone maintenance intervention with daily electronic diaries and personalized written feedback based on Acceptance and Commitment Therapy following a rehabilitation program for patients with chronic widespread pain. METHODS: The RCT included 48 women who, during a 5-week period, completed electronic diaries 3 times daily, totaling 3372 entries. In response to the completed diaries they received daily feedback from a therapist during 4 weeks, except during weekends, totaling 799 feedback messages. To analyze the change processes resulting from the smartphone intervention, we explored the associations between feedback and daily ratings of participant’s physical activities, positive emotions, fear avoidance, acceptance and self-management. Commitment to physical activities and the participants’ evaluation of feedback were also analyzed. Multilevel models were used in the statistical analyses. RESULTS: Participants’ average “pain fear and avoidance” decreased over the intervention period (Mean -0.019, P = 0.05). Self-management, pain acceptance and positive feelings increased (Mean -0.030, P <.01, Mean -0.015, P = <.01 and Mean -0.011, P = 0.01). Participants’ performance of physical activities decreased slightly over time, but the level of commitment was high and they evaluated the feedback as supportive for staying sufficiently active. No correlation between diary contents and feedback messages was found, even though most of the participants evaluated the feedback as supportive. CONCLUSIONS: No support for a relationship between ACT consistent diary content and feedback was found. However, diary measures were consistent with the ACT model and may have influenced positively the change processes