Acceptance and commitment therapy for nurses’ sleep, rumination, psychological flexibility, and it's neural mechanism: A randomized controlled fNIRS study

IF 5.3 1区心理学 Q1 PSYCHOLOGY, CLINICAL

International Journal of Clinical and Health Psychology Pub Date : 2025-01-01 DOI:10.1016/j.ijchp.2025.100543

Difan Wang , Bingyan Lin , Jiaxue Du , Wenyu Liu , Tong Sun , Qingyi Li , Lijun Xiao

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Abstract

Background: Given nurses often face sleep problems, this study compares two internet-delivered Acceptance and Commitment Therapy (ACT) interventions to improve sleep quality (SQ), psychological flexibility (PF), reduce rumination, and explore neural mechanisms. Methods: 477 nurses were randomly assigned to ACT linear psychotherapy model (LINEAR), ACT loop psychotherapy model (LOOP) and wait-list group. SQ, rumination, and PF were assessed with questionnaires. Prefrontal cortical activation changes were measured using functional near-infrared spectroscopy. Results: The linear mixed-effects model demonstrated significant improvements in SQ, PF, and reduced rumination compared to pre-intervention for both models through enhanced psychological flexibility. LOOP showed a significantly superior effect compared to LINEAR. DLPFC activation increased following both interventions, with LOOP additionally stimulating the frontopolar area. Changes in the DLPFC mediated the relationship between intervention and outcome improvements. Frontopolar changes mediated SQ improvements but not rumination or PF. No significant changes in functional connectivity were observed during the verbal fluency task. Conclusions: Both interventions improved outcome variables, with LOOP being notably more effective, offering a novel approach. Mediation analyses highlight the role of DLPFC activation in understanding ACT's mechanisms and targeting insomnia treatment, while the mechanisms of LOOP's superior effect warrant further research. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2200063533). https://www.chictr.org.cn/

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来源期刊

International Journal of Clinical and Health Psychology PSYCHOLOGY, CLINICAL-

CiteScore

10.70

自引率

5.70%

发文量

审稿时长

33 days

期刊介绍： The International Journal of Clinical and Health Psychology is dedicated to publishing manuscripts with a strong emphasis on both basic and applied research, encompassing experimental, clinical, and theoretical contributions that advance the fields of Clinical and Health Psychology. With a focus on four core domains—clinical psychology and psychotherapy, psychopathology, health psychology, and clinical neurosciences—the IJCHP seeks to provide a comprehensive platform for scholarly discourse and innovation. The journal accepts Original Articles (empirical studies) and Review Articles. Manuscripts submitted to IJCHP should be original and not previously published or under consideration elsewhere. All signing authors must unanimously agree on the submitted version of the manuscript. By submitting their work, authors agree to transfer their copyrights to the Journal for the duration of the editorial process.