human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED Support staff working with individuals with intellectual disability ( ID ) and challenging behaviour experience high levels of work-related stress . Preliminary theoretical and experimental research has highlighted the potential suitability of acceptance and mindfulness approaches for addressing support staff stress . This study examines the effectiveness of an acceptance and mindfulness-based stress management workshop on the levels of psychological distress and well-being of support staff working with individuals with ID and challenging behaviour . Support staff ( n=120 ) were r and omly assigned to a  workshop intervention condition ( n=66 ) or to a waiting list control condition  ( n=54 ) . Measurements were completed at three time points ( pre- , post and 6 week follow-up ) for : psychological distress , well-being , perceived work stressors , thought suppression , and emotional avoidance/psychological inflexibility . MAIN FINDINGS The intervention led to significantly greater reductions in distress in the intervention group than in the control group . This was largely maintained at 6 week follow-up . This effect was more pronounced amongst a sub sample that had shown higher levels of psychological distress at baseline . Thought suppression was found to reduce significantly in the intervention group between post intervention and follow-up , although no significant change was found in well-being or experiential avoidance/psychological inflexibility . Overall , results demonstrated support for the effectiveness of an acceptance and mindfulness-based intervention in reducing distress The present study examined the impact of a brief version of an acceptance-based treatment ( acceptance and commitment therapy ; ACT ) that teaches patients to accept unavoidable private events ; to identify and focus on actions directed toward valued goals ; and to defuse from odd cognition , just noticing thoughts rather than treating them as either true or false . Eighty inpatient participants with positive psychotic symptoms were r and omly assigned to treatment as usual ( TAU ) or to 4 sessions of ACT plus TAU . ACT participants showed significantly higher symptom reporting and lower symptom believability and a rate of rehospitalization half that of TAU participants over a 4-month follow-up period . The same basic pattern of results was seen with all participant subgroups except delusional participants who denied symptoms Acceptance and commitment therapy ( ACT ) interventions for persons with chronic pain have recently received empirical support . ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions , sensations , and thoughts . The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain . A total of 76 patients with chronic pain were included in the study and r and omized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum . Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness . Measurements were provided with the primary outcome variable Chronic Pain Acceptance Question naire which was in favour of the treatment group . Reductions were found on other measures of pain-related distress , anxiety and depressive symptoms . A six month follow-up showed maintenance of improvements . We conclude that an acceptance based internet-delivered treatment can be effective for persons with chronic pain OBJECTIVE We conducted a pilot r and omized trial of telephone-delivered acceptance and commitment therapy ( ACT ) versus cognitive behavioral therapy ( CBT ) for smoking cessation . METHOD Participants were 121 uninsured South Carolina State Quitline callers who were adult smokers ( at least 10 cigarettes/day ) and who wanted to quit within the next 30 days . Participants were r and omized to 5 sessions of either ACT or CBT telephone counseling and were offered 2 weeks of nicotine replacement therapy ( NRT ) . RESULTS ACT participants completed more calls than CBT participants ( M = 3.25 in ACT vs. 2.23 in CBT ; p = .001 ) . Regarding satisfaction , 100 % of ACT participants reported their treatment was useful for quitting smoking ( vs. 87 % for CBT ; p = .03 ) , and 97 % of ACT participants would recommend their treatment to a friend ( vs. 83 % for CBT ; p = .06 ) . On the primary outcome of intent-to-treat 30-day point prevalence abstinence at 6 months postr and omization , the quit rates were 31 % in ACT versus 22 % in CBT ( odds ratio [ OR ] = 1.5 , 95 % confidence interval [ CI ] = 0.7 - 3.4 ) . Among participants depressed at baseline ( n = 47 ) , the quit rates were 33 % in ACT versus 13 % in CBT ( OR = 1.2 , 95 % CI = 1.0 - 1.6 ) . Consistent with ACT 's theory , among participants scoring low on acceptance of cravings at baseline ( n = 57 ) , the quit rates were 37 % in ACT versus 10 % in CBT ( OR = 5.3 , 95 % CI = 1.3 - 22.0 ) . CONCLUSIONS ACT is feasible to deliver by phone , is highly acceptable to quitline callers , and shows highly promising quit rates compared with st and ard CBT quitline counseling . As results were limited by the pilot design ( e.g. , small sample ) , a full-scale efficacy trial is now needed OBJECTIVE The aim of this study was to design a trial that could evaluate the effect of acceptance and commitment therapy as a group-intervention for multiple sclerosis patients with psychological distress .  DESIGN R and omized controlled trial with assessment at pretreatment , end of treatment , and at 3-month follow-up . SUBJECTS Multiple sclerosis out patients with elevated symptoms of anxiety and /or depression ( n = 21 ) . METHODS Patients were r and omly assigned to acceptance and commitment therapy or relaxation training . Both treatments consisted of 5 sessions over 15 weeks containing didactic sessions , group discussion s , and exercises . Outcome was assessed by self-rated symptoms of anxiety , depression , and a measure of acceptance . RESULTS At 3-month follow-up , the relaxation training group had a significant decline in anxiety symptoms whereas the acceptance and commitment therapy group showed a maintained improvement in rated acceptance at follow-up . CONCLUSION The results reflect the different emphases of the therapies . Acceptance and commitment therapy is aim ed at living an active , valued life and increasing acceptance , while relaxation training focuses directly on coping strategies to h and le emotional symptoms . The results are preliminary , but supportive of further study of brief group interventions for reducing psychological distress in patients with multiple sclerosis BACKGROUND The Internet provides us with tools ( user metrics or para data ) to evaluate how users interact with online interventions . Analysis of these para data can lead to design improvements . OBJECTIVE The objective was to explore the qualities of online participant engagement  in an online intervention . We analyzed the para data in a r and omized controlled trial of alternative versions of an online intervention design ed to promote consumption of fruit and vegetables . METHODS Volunteers were r and omized to 1 of 3 study arms involving several online sessions . We created 2 indirect measures of breadth and depth to measure different dimensions and dynamics of program engagement based on factor analysis of para data measures of Web pages visited and time spent online with the intervention material s. Multiple regression was used to assess influence of engagement on retention and change in dietary intake . RESULTS Baseline surveys were completed by 2513 enrolled participants . Of these , 86.3 % ( n = 2168 ) completed the follow-up surveys at 3 months , 79.6 % ( n = 2027 ) at 6 months , and 79.4 % ( n = 1995 ) at 12 months . The 2 tailored intervention arms exhibited significantly more engagement than the untailored arm ( P < .01 ) . Breadth and depth measures of engagement were significantly associated with completion of follow-up surveys ( odds ratios [ OR ] = 4.11 and 2.12 , respectively , both P values < .001 ) . The breadth measure of engagement was also significantly positively associated with a key study outcome , the mean increase in fruit and vegetable consumption ( P < .001 ) . CONCLUSIONS By exploring participants ' exposures to online interventions , para data are valuable in explaining the effects of tailoring in increasing participant engagement in the intervention . Controlling for intervention arm , greater engagement is also associated with retention of participants and positive change in a key outcome of the intervention , dietary change . This paper demonstrates the utility of para data capture and analysis for evaluating online health interventions . TRIAL REGISTRATION NCT00169312 ; http:// clinical trials.gov/ct2/show/NCT00169312 ( Archived by WebCite at http://www.webcitation.org/5u8sSr0Ty ) OBJECTIVE Recent studies support the efficacy of Acceptance and Commitment Therapy ( ACT ) with people with chronic pain . In addition , Selective Optimization with Compensation strategies ( SOC ) can help the elderly with chronic pain to accept their chronic condition and increase functional autonomy . Our aim was to analyze the efficacy of an ACT treatment program combined with training in SOC strategies for elderly people with chronic pain living in nursing homes . METHODS 101 participants ( mean age = 82.26 ; SD = 10.00 ; 78.6 % female ) were r and omized to the  intervention  condition ( ACT-SOC ) or to a minimal support group ( MS ) . Complete data are available for 53 participants  ( ACT-SOC : n = 27 ; MS : n = 26 ) . Assessment s of functional performance , pain intensity , pain acceptance , SOC strategies , emotional well being and catastrophizing beliefs were done preintervention and postintervention . RESULTS Significant time by intervention changes ( P = 0.05 ) were found in acceptance , pain related anxiety , compensation strategies , and pain interference in walking ability . Simple effects changes were found in acceptance ( P = 0.01 ) , selection strategies ( P = 0.05 ) , catastrophizing beliefs ( P = 0.03 ) , depressive symptoms ( P = 0.05 ) , pain anxiety ( P = 0.01 ) and pain interference in mood and walking ability ( P = 0.03 ) in the ACT-SOC group . No significant changes were found in the MS group . CONCLUSIONS These results suggest that an ACT intervention combined with training in SOC strategies could help older people with pain to improve their emotional well being and their functional capability BACKGROUND Depression is a highly prevalent disorder , causing a large burden of disease and substantial economic costs . Web-based self-help interventions seem promising in promoting mental health . AIMS To compare the efficacy of a guided web-based intervention based on acceptance and commitment therapy ( ACT ) with an active control ( expressive writing ) and a waiting-list control condition ( Netherl and s Trial Register NTR1296 ) . METHOD Adults with depressive symptoms from the general population were r and omised to ACT ( n = 82 ) , expressive writing  ( n = 67 ) or waiting-list control  ( n = 87 ) . The main outcome was reduction in depressive symptoms assessed with the Center for Epidemiological Studies - Depression scale . RESULTS Significant reductions in depressive symptoms were found following the ACT intervention , compared with the control group ( Cohen 's d = 0.56 ) and the expressive writing intervention ( d = 0.36 ) . The effects were sustained at 6-month and 12-month follow-up . CONCLUSIONS Acceptance and commitment therapy as a web-based public mental health intervention for adults with depressive symptoms can be effective and applicable Background Work-related stress is a significant problem for both people and organizations . It may lead to mental illnesses such as anxiety and depression , result ing in increased work absences and disabilities . Scalable interventions to prevent and manage harmful stress can be delivered with the help of technology tools to support self-observations and skills training . Objective The aim of this study was to assess the feasibility of the P4Well intervention in treatment of stress-related psychological problems .  P4Well is a novel intervention which combines modern psychotherapy ( the cognitive behavioral therapy and the acceptance and commitment therapy ) with personal health technologies to deliver the intervention via multiple channels , includinggroup meetings , Internet/Web portal , mobile phone applications , and personal monitoring devices . Methods This pilot study design was a small-scale r and omized controlled trial that compared the P4Well intervention with a waiting list control group . In addition to personal health technologies for self- assessment , the intervention consisted of 3 psychologist-assisted group meetings .  Self-assessed psychological measures through question naires were collected offline pre- and post-intervention , and 6 months after the intervention for the intervention group . Acceptance and usage of technology tools were measured with user experience question naires and usage logs . Results A total of 24 subjects were r and omized : 11 participants were followed up in the intervention group ( 1 was lost to follow-up ) and 12 participants did not receive any intervention ( control group ) . Depressive and psychological symptoms decreased and self-rated health and working ability increased . All participants reported they had benefited from the intervention . All technology tools had active users and 10/11 participants used at least 1 tool actively . Physiological measurements with personal feedback were considered the most useful intervention component . Conclusions Our results confirm the feasibility of the intervention and suggest that it had positive effects on psychological symptoms , self-rated health , and self-rated working ability . The intervention seemed to have a positive impact on certain aspects of burnout and job strain , such as cynicism and over-commitment . Future studies need to investigate the effectiveness , benefits , and possible problems of psychological interventions which 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED Support staff working with individuals with intellectual disability ( ID ) and challenging behaviour experience high levels of work-related stress . Preliminary theoretical and experimental research has highlighted the potential suitability of acceptance and mindfulness approaches for addressing support staff stress . This study examines the effectiveness of an acceptance and mindfulness-based stress management workshop on the levels of psychological distress and well-being of support staff working with individuals with ID and challenging behaviour . Support staff ( n=120 ) were r and omly assigned to a  workshop intervention condition ( n=66 ) or to a waiting list control condition  ( n=54 ) . Measurements were completed at three time points ( pre- , post and 6 week follow-up ) for : psychological distress , well-being , perceived work stressors , thought suppression , and emotional avoidance/psychological inflexibility . MAIN FINDINGS The intervention led to significantly greater reductions in distress in the intervention group than in the control group . This was largely maintained at 6 week follow-up . This effect was more pronounced amongst a sub sample that had shown higher levels of psychological distress at baseline . Thought suppression was found to reduce significantly in the intervention group between post intervention and follow-up , although no significant change was found in well-being or experiential avoidance/psychological inflexibility . Overall , results demonstrated support for the effectiveness of an acceptance and mindfulness-based intervention in reducing distress The present study examined the impact of a brief version of an acceptance-based treatment ( acceptance and commitment therapy ; ACT ) that teaches patients to accept unavoidable private events ; to identify and focus on actions directed toward valued goals ; and to defuse from odd cognition , just noticing thoughts rather than treating them as either true or false . Eighty inpatient participants with positive psychotic symptoms were r and omly assigned to treatment as usual ( TAU ) or to 4 sessions of ACT plus TAU . ACT participants showed significantly higher symptom reporting and lower symptom believability and a rate of rehospitalization half that of TAU participants over a 4-month follow-up period . The same basic pattern of results was seen with all participant subgroups except delusional participants who denied symptoms Acceptance and commitment therapy ( ACT ) interventions for persons with chronic pain have recently received empirical support . ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions , sensations , and thoughts . The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain . A total of 76 patients with chronic pain were included in the study and r and omized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum . Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness . Measurements were provided with the primary outcome variable Chronic Pain Acceptance Question naire which was in favour of the treatment group . Reductions were found on other measures of pain-related distress , anxiety and depressive symptoms . A six month follow-up showed maintenance of improvements . We conclude that an acceptance based internet-delivered treatment can be effective for persons with chronic pain OBJECTIVE We conducted a pilot r and omized trial of telephone-delivered acceptance and commitment therapy ( ACT ) versus cognitive behavioral therapy ( CBT ) for smoking cessation . METHOD Participants were 121 uninsured South Carolina State Quitline callers who were adult smokers ( at least 10 cigarettes/day ) and who wanted to quit within the next 30 days . Participants were r and omized to 5 sessions of either ACT or CBT telephone counseling and were offered 2 weeks of nicotine replacement therapy ( NRT ) . RESULTS ACT participants completed more calls than CBT participants ( M = 3.25 in ACT vs. 2.23 in CBT ; p = .001 ) . Regarding satisfaction , 100 % of ACT participants reported their treatment was useful for quitting smoking ( vs. 87 % for CBT ; p = .03 ) , and 97 % of ACT participants would recommend their treatment to a friend ( vs. 83 % for CBT ; p = .06 ) . On the primary outcome of intent-to-treat 30-day point prevalence abstinence at 6 months postr and omization , the quit rates were 31 % in ACT versus 22 % in CBT ( odds ratio [ OR ] = 1.5 , 95 % confidence interval [ CI ] = 0.7 - 3.4 ) . Among participants depressed at baseline ( n = 47 ) , the quit rates were 33 % in ACT versus 13 % in CBT ( OR = 1.2 , 95 % CI = 1.0 - 1.6 ) . Consistent with ACT 's theory , among participants scoring low on acceptance of cravings at baseline ( n = 57 ) , the quit rates were 37 % in ACT versus 10 % in CBT ( OR = 5.3 , 95 % CI = 1.3 - 22.0 ) . CONCLUSIONS ACT is feasible to deliver by phone , is highly acceptable to quitline callers , and shows highly promising quit rates compared with st and ard CBT quitline counseling . As results were limited by the pilot design ( e.g. , small sample ) , a full-scale efficacy trial is now needed OBJECTIVE The aim of this study was to design a trial that could evaluate the effect of acceptance and commitment therapy as a group-intervention for multiple sclerosis patients with psychological distress .  DESIGN R and omized controlled trial with assessment at pretreatment , end of treatment , and at 3-month follow-up . SUBJECTS Multiple sclerosis out patients with elevated symptoms of anxiety and /or depression ( n = 21 ) . METHODS Patients were r and omly assigned to acceptance and commitment therapy or relaxation training . Both treatments consisted of 5 sessions over 15 weeks containing didactic sessions , group discussion s , and exercises . Outcome was assessed by self-rated symptoms of anxiety , depression , and a measure of acceptance . RESULTS At 3-month follow-up , the relaxation training group had a significant decline in anxiety symptoms whereas the acceptance and commitment therapy group showed a maintained improvement in rated acceptance at follow-up . CONCLUSION The results reflect the different emphases of the therapies . Acceptance and commitment therapy is aim ed at living an active , valued life and increasing acceptance , while relaxation training focuses directly on coping strategies to h and le emotional symptoms . The results are preliminary , but supportive of further study of brief group interventions for reducing psychological distress in patients with multiple sclerosis BACKGROUND The Internet provides us with tools ( user metrics or para data ) to evaluate how users interact with online interventions . Analysis of these para data can lead to design improvements . OBJECTIVE The objective was to explore the qualities of online participant engagement  in an online intervention . We analyzed the para data in a r and omized controlled trial of alternative versions of an online intervention design ed to promote consumption of fruit and vegetables . METHODS Volunteers were r and omized to 1 of 3 study arms involving several online sessions . We created 2 indirect measures of breadth and depth to measure different dimensions and dynamics of program engagement based on factor analysis of para data measures of Web pages visited and time spent online with the intervention material s. Multiple regression was used to assess influence of engagement on retention and change in dietary intake . RESULTS Baseline surveys were completed by 2513 enrolled participants . Of these , 86.3 % ( n = 2168 ) completed the follow-up surveys at 3 months , 79.6 % ( n = 2027 ) at 6 months , and 79.4 % ( n = 1995 ) at 12 months . The 2 tailored intervention arms exhibited significantly more engagement than the untailored arm ( P < .01 ) . Breadth and depth measures of engagement were significantly associated with completion of follow-up surveys ( odds ratios [ OR ] = 4.11 and 2.12 , respectively , both P values < .001 ) . The breadth measure of engagement was also significantly positively associated with a key study outcome , the mean increase in fruit and vegetable consumption ( P < .001 ) . CONCLUSIONS By exploring participants ' exposures to online interventions , para data are valuable in explaining the effects of tailoring in increasing participant engagement in the intervention . Controlling for intervention arm , greater engagement is also associated with retention of participants and positive change in a key outcome of the intervention , dietary change . This paper demonstrates the utility of para data capture and analysis for evaluating online health interventions . TRIAL REGISTRATION NCT00169312 ; http:// clinical trials.gov/ct2/show/NCT00169312 ( Archived by WebCite at http://www.webcitation.org/5u8sSr0Ty ) OBJECTIVE Recent studies support the efficacy of Acceptance and Commitment Therapy ( ACT ) with people with chronic pain . In addition , Selective Optimization with Compensation strategies ( SOC ) can help the elderly with chronic pain to accept their chronic condition and increase functional autonomy . Our aim was to analyze the efficacy of an ACT treatment program combined with training in SOC strategies for elderly people with chronic pain living in nursing homes . METHODS 101 participants ( mean age = 82.26 ; SD = 10.00 ; 78.6 % female ) were r and omized to the  intervention  condition ( ACT-SOC ) or to a minimal support group ( MS ) . Complete data are available for 53 participants  ( ACT-SOC : n = 27 ; MS : n = 26 ) . Assessment s of functional performance , pain intensity , pain acceptance , SOC strategies , emotional well being and catastrophizing beliefs were done preintervention and postintervention . RESULTS Significant time by intervention changes ( P = 0.05 ) were found in acceptance , pain related anxiety , compensation strategies , and pain interference in walking ability . Simple effects changes were found in acceptance ( P = 0.01 ) , selection strategies ( P = 0.05 ) , catastrophizing beliefs ( P = 0.03 ) , depressive symptoms ( P = 0.05 ) , pain anxiety ( P = 0.01 ) and pain interference in mood and walking ability ( P = 0.03 ) in the ACT-SOC group . No significant changes were found in the MS group . CONCLUSIONS These results suggest that an ACT intervention combined with training in SOC strategies could help older people with pain to improve their emotional well being and their functional capability BACKGROUND Depression is a highly prevalent disorder , causing a large burden of disease and substantial economic costs . Web-based self-help interventions seem promising in promoting mental health . AIMS To compare the efficacy of a guided web-based intervention based on acceptance and commitment therapy ( ACT ) with an active control ( expressive writing ) and a waiting-list control condition ( Netherl and s Trial Register NTR1296 ) . METHOD Adults with depressive symptoms from the general population were r and omised to ACT ( n = 82 ) , expressive writing  ( n = 67 ) or waiting-list control  ( n = 87 ) . The main outcome was reduction in depressive symptoms assessed with the Center for Epidemiological Studies - Depression scale . RESULTS Significant reductions in depressive symptoms were found following the ACT intervention , compared with the control group ( Cohen 's d = 0.56 ) and the expressive writing intervention ( d = 0.36 ) . The effects were sustained at 6-month and 12-month follow-up . CONCLUSIONS Acceptance and commitment therapy as a web-based public mental health intervention for adults with depressive symptoms can be effective and applicable Background Work-related stress is a significant problem for both people and organizations . It may lead to mental illnesses such as anxiety and depression , result ing in increased work absences and disabilities . Scalable interventions to prevent and manage harmful stress can be delivered with the help of technology tools to support self-observations and skills training . Objective The aim of this study was to assess the feasibility of the P4Well intervention in treatment of stress-related psychological problems .  P4Well is a novel intervention which combines modern psychotherapy ( the cognitive behavioral therapy and the acceptance and commitment therapy ) with personal health technologies to deliver the intervention via multiple channels , includinggroup meetings , Internet/Web portal , mobile phone applications , and personal monitoring devices . Methods This pilot study design was a small-scale r and omized controlled trial that compared the P4Well intervention with a waiting list control group . In addition to personal health technologies for self- assessment , the intervention consisted of 3 psychologist-assisted group meetings .  Self-assessed psychological measures through question naires were collected offline pre- and post-intervention , and 6 months after the intervention for the intervention group . Acceptance and usage of technology tools were measured with user experience question naires and usage logs . Results A total of 24 subjects were r and omized : 11 participants were followed up in the intervention group ( 1 was lost to follow-up ) and 12 participants did not receive any intervention ( control group ) . Depressive and psychological symptoms decreased and self-rated health and working ability increased . All participants reported they had benefited from the intervention . All technology tools had active users and 10/11 participants used at least 1 tool actively . Physiological measurements with personal feedback were considered the most useful intervention component . Conclusions Our results confirm the feasibility of the intervention and suggest that it had positive effects on psychological symptoms , self-rated health , and self-rated working ability . The intervention seemed to have a positive impact on certain aspects of burnout and job strain , such as cynicism and over-commitment . Future studies need to investigate the effectiveness , benefits , and possible problems of psychological interventions which 
    Output:
    