International Journal of Behavioral Medicine

, Volume 24, Issue 2, pp 215–229 | Cite as

Analyzing Change Processes Resulting from a Smartphone Maintenance Intervention Based on Acceptance and Commitment Therapy for Women with Chronic Widespread Pain

  • Andréa A. G. Nes
  • Sandra van Dulmen
  • Rikard Wicksell
  • Egil A. Fors
  • Hilde Eide



This study investigated change processes resulting from a randomized controlled trial smartphone-delivered maintenance intervention with daily electronic diaries and personalized written feedback based on acceptance and commitment therapy (ACT) following a rehabilitation program for patients with chronic widespread pain.


This study included 48 women who during a 5-week period completed electronic diaries three times daily, totaling 3372 entries. In response to the completed diaries, they received daily feedback from a therapist for 4 weeks (excluding weekends), totaling 799 feedback messages. To analyze the change processes, we explored the associations between feedback and daily ratings of participants’ physical activities, positive emotions, pain fear and avoidance, pain 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.


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 < 0.01; mean −0.015, P < 0.01; and mean −0.011, P = 0.01, respectively). 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.


No support was found for an association between diary content and feedback based on ACT. However, diary measures were consistent with the ACT model and may have influenced positively the change processes.


Smartphone maintenance intervention Acceptance and commitment therapy Electronic diaries Personalized feedback Chronic widespread pain 



A thanks to Ólöf Birna Kristjansdottir, Erlend Eide, and Arnstein Finset who contributed to the development of the pain intervention. A warm thank you to the patients participating in this intervention as well as to the rehabilitation center Jeløy Kurbad where the patients were recruited and treated in the rehabilitation program. Also thanks to Espen Brembo who helped in developing the coding scheme and analyzing the feedbacks.


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Copyright information

© International Society of Behavioral Medicine 2016

Authors and Affiliations

  • Andréa A. G. Nes
    • 1
    • 2
  • Sandra van Dulmen
    • 3
    • 4
    • 5
  • Rikard Wicksell
    • 6
    • 7
  • Egil A. Fors
    • 8
  • Hilde Eide
    • 3
  1. 1.Department of Nursing and Health Promotion Oslo and Akershus University College of Applied SciencesOsloNorway
  2. 2.Department of Behavioral Sciences in MedicineUniversity of OsloOsloNorway
  3. 3.Faculty of Health SciencesUniversity College of Southeast-NorwayDrammenNorway
  4. 4.NIVEL (Netherlands Institute for Health Services Research)UtrechtThe Netherlands
  5. 5.Department of Primary and Community CareRadboud University Medical CenterNijmegenThe Netherlands
  6. 6.Department of Clinical Neuroscience, Division of PsychologyKarolinska InstitutetStockholmSweden
  7. 7.Behavior Medicine Pain Treatment ServiceKarolinska University HospitalStockholmSweden
  8. 8.Department of Public Health and General Practice, Faculty of MedicineTrondheimNorway

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