Community‐based Acceptance and Commitment Therapy Programmes for rheumatic conditions: An acceptability and qualitative process evaluation study

Abstract

Purpose: Dissemination and implementation of socially prescribed community‐based programmes for individuals with rheumatic conditions remain rare. However, such programmes can help overcome key barriers, including limited access to evidence‐based psychological interventions, individuals' preference for psychosocial care outside of rheumatology clinics and the prevention of isolation and loneliness. Methods: This study presents a qualitative process evaluation of a community‐based Acceptance and Commitment Therapy (ACT) group intervention, delivered as part of a psychosocial service within a support organization for individuals with rheumatic conditions. We conducted 12 semi‐structured qualitative interviews following participants' completion of five in‐person ACT group sessions. Reflexive thematic analysis was used to assess acceptability and explore how participants conceptualized ACT's processes of change. Results: Four key themes emerged, offering practical considerations for planning and delivering ACT groups for individuals with rheumatic conditions: (1) the process of finding peace through mindfulness while managing practice‐related difficulties, (2) recognizing the importance of making values‐consistent choices, (3) navigating an ambivalent relationship with pain and (4) the dual nature of the group experience—both comforting and awkward. Conclusions: Findings highlight the implications of programme duration in planning ACT groups for individuals with rheumatic conditions in the community. The study suggests that acceptance and mindfulness may be time‐bound and context‐sensitive processes, influenced by the fluctuating symptomatology of rheumatic conditions. Mindfulness is best developed step by step, starting with body awareness, understanding symptoms and slowly bringing mindfulness into daily life. Pain acceptance should focus more on facilitating momentary patterns of activity engagement, rather than willingness towards the fluctuating symptoms.