Mechanisms of change in mobile app-delivered acceptance and commitment therapy for posttraumatic stress disorder in China: a secondary analysis of a randomized controlled trial.

TL;DR

Mobile app-delivered Acceptance and Commitment Therapy (ACT) improved PTSD symptoms in a Chinese RCT, with four psychological flexibility components (acceptance, self-as-context, cognitive defusion, committed action) acting as full mediators of treatment effects.

Key findings

• Four of six psychological flexibility components fully mediated IACT effects on PTSD: acceptance, self-as-context, cognitive defusion, and committed action
• Valued living and present-moment awareness were partial mediators rather than full mediators
• IACT group (n=78) showed significantly greater improvements versus waitlist control (n=67) across all six flexibility components
• Latent growth curve modeling with bootstrapped confidence intervals confirmed mediation pathways at baseline and after each of six intervention modules

Why this matters at the bedside

Identifies specific mechanisms through which mobile app-delivered ACT reduces PTSD symptoms, suggesting that clinicians should prioritize cultivating acceptance, self-as-context perspective, cognitive defusion, and committed action to optimize treatment outcomes in PTSD.