Principal Findings
anger, anxiety, pain, cognitive defusion, depression
To the best of our knowledge, this study is the first to examine the improvement effects and mechanisms of web- and mobile-based ACT interventions on anxiety and depression symptoms in nurses. The results showed that nurses in the intervention group reported significant improvement in anxiety and depression symptoms after the intervention compared with the waiting control group, and the improvement persisted for 3 months after the intervention. The web- and mobile-based ACT intervention also demonstrated the potential to improve nurses’ sleep quality, burnout, and work performance. In addition, the results of mediation analysis demonstrated that psychological flexibility, cognitive defusion, and values served as mediators of the effect of the intervention on the reduction of anxiety and depression symptoms in nurses. However, no mediating effect of mindfulness was observed.There are few studies on ACT interventions for nurses with anxiety or depression symptoms. A study involving 22 intensive care unit medical and nursing staff found that ACT-based stress management training significantly improved participants’ levels of depression symptoms (effect size=0.280), but not anxiety symptoms (effect size=0.069) [Dropout rates and adherence are essential indicators of how well the study design aligns with participants’ needs and expectations, especially in the context of mental health among health care professionals. The high adherence in this study indicates that web- and mobile-based ACT interventions are feasible and acceptable for nurses. However, the dropout rate in this study was higher than the average dropout rate of 19.19% reported in a systematic review of internet-delivered ACT treatment for anxiety symptoms [In this study, we found that psychological flexibility mediated the improvement of anxiety and depression symptoms in nurses through the web- and mobile-based ACT intervention, and this finding is consistent with the theoretical framework of ACT and supports previous research results [Cognitive fusion occurs when individuals become so consumed by their thoughts that unhelpful thoughts dominate their behavior, leading to increased distress (sadness, anxiety, anger, depression, etc); limited range of behavior; and reduced ability to live a meaningful life [One of the main goals of ACT is to help individuals clarify their values and lead a rich, fulfilling, and meaningful life while accepting inevitable pain in life [Notably, no mediating effect of mindfulness was found in the intervention for improving nurses’ anxiety and depression symptoms, and this is inconsistent with previous research results [