Feasibility of acceptance and commitment therapy for repetitive negative thinking versus internet-based CBT: a pilot randomised controlled trial in Swedish primary care among patients with anxiety, depression and stress
- 1Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- 2University Clinic Primary Care, Skåne University Hospital, Malmö, Region Skåne Sweden
- 3Department of Psychology and Social Work, Clinical Psychology, Mid Sweden University, Östersund, Sweden
Abstract
Background: Repetitive negative thinking (RNT) is a transdiagnostic process relevant to common mental health problems in primary care. RNT-ACT is a brief acceptance and commitment therapy-based protocol targeting RNT in two sessions. This pilot study assessed the feasibility of RNT-ACT compared with therapist-supported internet-based cognitive behavioural therapy (iCBT) in Swedish primary care.
Methods: Thirteen participants were randomised: 7 to RNT-ACT and 6 to iCBT. The primary feasibility outcomes were recruitment rate, intervention non-completion, and patient satisfaction measured with the Client Satisfaction Questionnaire (CSQ-8). Symptom and process measures were secondary outcomes. Secondary outcomes were assessed at baseline and at 1- and 3-month follow-ups. Analyses were descriptive and exploratory, based on available observations without imputation of missing data.
Results: Thirteen of 20 eligible individuals were enrolled (65%), corresponding to 35% of all 37 individuals screened. All participants in the RNT-ACT group completed the intervention, whereas 4 of 6 participants in the iCBT group did not complete the intervention. Mean CSQ-8 scores were 27.8 (SD 3.7; n = 5) in the RNT-ACT group and 23.0 (SD 0.0; n = 2) in the iCBT group.
Conclusions: The small sample size and high iCBT non-completion limit between-group comparisons. Further investigation of recruitment, treatment engagement, and patient and therapist experiences is needed before determining whether and how to proceed to a full-scale RCT.
Trial registration: ClinicalTrials.gov NCT05946382 registered July 14, 2023.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s40814-026-01951-2.
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BibTeX
@article{bengtsson2026feasibility,
title = {{Feasibility of acceptance and commitment therapy for repetitive negative thinking versus internet-based CBT: a pilot randomised controlled trial in Swedish primary care among patients with anxiety, depression and stress}},
author = {Thor Bengtsson and Moa Wolff and Andreas Larsson and Peter Nymberg and Veronica Milos Nymberg},
journal = {Pilot and Feasibility Studies},
year = {2026},
month = oct,
doi = {10.1186/s40814-026-01951-2},
url = {https://doi.org/10.1186/s40814-026-01951-2},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Feasibility of acceptance and commitment therapy for repetitive negative thinking versus internet-based CBT: a pilot randomised controlled trial in Swedish primary care among patients with anxiety, depression and stress
AU - Thor Bengtsson
AU - Moa Wolff
AU - Andreas Larsson
AU - Peter Nymberg
AU - Veronica Milos Nymberg
PY - 2026
DA - 2026/10/31
JO - Pilot and Feasibility Studies
DO - 10.1186/s40814-026-01951-2
UR - https://doi.org/10.1186/s40814-026-01951-2
AB - Background: Repetitive negative thinking (RNT) is a transdiagnostic process relevant to common mental health problems in primary care. RNT-ACT is a brief acceptance and commitment therapy-based protocol targeting RNT in two sessions. This pilot study assessed the feasibility of RNT-ACT compared with therapist-supported internet-based cognitive behavioural therapy (iCBT) in Swedish primary care. Methods: Thirteen participants were randomised: 7 to RNT-ACT and 6 to iCBT. The primary feasibility outcomes were recruitment rate, intervention non-completion, and patient satisfaction measured with the Client Satisfaction Questionnaire (CSQ-8). Symptom and process measures were secondary outcomes. Secondary outcomes were assessed at baseline and at 1- and 3-month follow-ups. Analyses were descriptive and exploratory, based on available observations without imputation of missing data. Results: Thirteen of 20 eligible individuals were enrolled (65%), corresponding to 35% of all 37 individuals screened. All participants in the RNT-ACT group completed the intervention, whereas 4 of 6 participants in the iCBT group did not complete the intervention. Mean CSQ-8 scores were 27.8 (SD 3.7; n = 5) in the RNT-ACT group and 23.0 (SD 0.0; n = 2) in the iCBT group. Conclusions: The small sample size and high iCBT non-completion limit between-group comparisons. Further investigation of recruitment, treatment engagement, and patient and therapist experiences is needed before determining whether and how to proceed to a full-scale RCT. Trial registration: ClinicalTrials.gov NCT05946382 registered July 14, 2023. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s40814-026-01951-2.
SN - 2055-5784
ER -