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Symposia

Technology/Digital Health

Advancing Digital ACT Interventions: Evidence-Based Strategies for Expanding Access to Care

2 - (SYM 52) Randomized Trial of a Multi-modal ACT Intervention to Increase Psychological Well-being and Advance Care Planning in Anxious and Depressed Adults with Likely Incurable Cancer

Friday, November 21, 2025

3:27 PM - 3:48 PM CST

Location: Bolden 6, Level 2

Keywords: Technology / Mobile Health, ACT (Acceptance & Commitment Therapy), Randomized Controlled Trial
Recommended Readings: Ong, C. W., Lee, E. B., Levin, M. E., & Twohig, M. P. (2022). Online process-based training for perfectionism: A randomized trial. Behaviour Research and Therapy, 156, 104152., Arch, J. J., Mitchell, J. L., Schmiege, S. J., Levin, M. E., Genung, S. R., Nealis, M. S., Fink, R. M., Bright, E. E., Andorsky, D. J., & Kutner, J. S. (2022). A randomized controlled trial of a multi-modal palliative care intervention to promote advance care planning and psychological well-being among adults with advanced cancer: study protocol. BMC palliative care, 21(1), 198. https://doi.org/10.1186/s12904-022-01087-z, Bowers, E. M., Capel, L. K., Woolley, M. G., Barnes, A., Twohig, M. P., & Levin, M. E. (2024). Efficacy and feasibility of web-based ACT-Enhanced behavioral treatment for skin picking in adults: A randomized waitlist-controlled trial. Journal of Obsessive-Compulsive and Related Disorders, 43, 100909., Donahue, M. L., & Levin, M. E. (2024). Pilot evaluation of a prototype online acceptance and commitment therapy program for adults living with a chronic health condition. International Journal of Mental Health, 53(4), 397–419. https://doi.org/10.1080/00207411.2024.2321432, Klimczak, K. S., San Miguel, G. G., Mukasa, M. N., Twohig, M. P., & Levin, M. E. (2023). A systematic review and meta-analysis of self-guided online acceptance and commitment therapy as a transdiagnostic self-help intervention. Cognitive behaviour therapy, 52(3), 269–294. https://doi.org/10.1080/16506073.2023.2178498

Speaker(s)

Joanna Arch, Ph.D. (she/her/hers)

Professor
University of Colorado Boulder
Boulder, CO, United States

Co-author(s)

Joanna Arch, Ph.D. (she/her/hers)

Professor
University of Colorado Boulder
Boulder, CO, United States
JM

Jill Mitchell, PhD, MSW, LCSW

Clinical Social Worker, Director of Psycho-Oncology Research
Rocky Mountain Cancer Centers
Boulder, CO, United States
SG

Sarah Genung, BA

Study Coordinator
University of Colorado Boulder
Boulder, CO, United States
MN

Madeline Nealis, MPH

Study Coordinator
University of Colorado Boulder
Boulder, CO, United States
SS

Sarah Schmiege, PhD (she/her/hers)

Biostatistician
Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus
Aurora, CO, United States
Michael E. Levin, Ph.D.

Professor
Utah State University
Salt Lake City, UT, United States
DA

David Andorsky, MD

Medical Oncologist
Rocky Mountain Cancer Centers
Boulder, CO, United States
RF

Regina Fink, PhD (she/her/hers)

Professor Emeritus
Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine
Aurora, CO, United States
JK

Jean Kutner, MD, MPH/MSPH

Professor of Medicine
University of Colorado Anschutz School of Medicine
Aurora, CO, United States

Abstract Body

Background: Due to advances in medical treatment, an increasing number of people are living longer with advanced, likely incurable cancer. High levels of anxiety, depression, and fear of dying are common among them. Also, planning for future healthcare decisions, known as advance care planning, remains a challenge. This study tests a novel, multi-modal acceptance and commitment therapy (M-ACT) group intervention delivered online in community clinics to increase psychological well-being and advance care planning among anxious and depressed adults with advanced cancer. By focusing on delivery by community providers to community patients, this study embodies the conference theme of “Bridging the Divide.”

Methods: Adults with advanced cancer and elevated anxiety or depression symptoms (N=249) were randomized 1:1 within cohorts to the innovative M-ACT intervention consisting of 5 weekly online videoconference ACT groups led by clinical social workers in community cancer care clinics plus online, self-paced ACT sessions, or usual care (UC). The primary outcome was total number of advance care planning steps reported as completed or updated by 2-month follow-up. Secondary outcomes included depression, anxiety, fear of death/dying, sense of life meaning, and broader advance care planning engagement.

Results: From baseline to 2-month follow-up, M-ACT led to significantly more advance care planning steps than UC (p< .01). In longitudinal modeling of group differences over time, M-ACT also led to more improvement in depression (p< .05), fear of dying (p< .05), spiritual well-being (p< .05), and broader advance care planning engagement (p< .01) than UC. Conditions did not differ on anxiety outcomes.

Conclusion: This large randomized trial provides strong support for the efficacy of the brief, online M-ACT intervention for improving psychological and spiritual well-being and advance care planning among anxious and depressed adults with advanced cancer. By embedding this trial in community clinics, this work yields findings that are relevant to the community settings where most US cancer survivors receive care.