{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:47:42Z","timestamp":1792043262606,"version":"4.4.0"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Nursing Practice"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study aimed to evaluate the effects of Acceptance and Commitment Therapy, relative to usual care, on psychological flexibility, resilience, caregiving burden, anxiety and depression in primary caregivers of patients with decompensated cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Primary caregivers of decompensated cirrhosis patients face high rates of anxiety and depression due to long\u2010term caregiving stress, financial burdens and disease uncertainty. Acceptance and Commitment Therapy improves mental health in other chronic disease caregivers, but its effects on cirrhosis caregivers in China remain unstudied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This was a randomized, assessor\u2010blinded, parallel\u2010group trial comparing Acceptance and Commitment Therapy\u2010enhanced care with routine care alone in primary caregivers during hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      A total of 120 caregivers were recruited at a Chinese hospital (January\u2013April 2023) and randomly allocated to control (routine care) or intervention (routine care plus six\u2010session Acceptance and Commitment Therapy) groups. Validated scales assessed psychological flexibility, resilience, burden, anxiety and depression at admission, discharge and 1\u2009month postdischarge. Data were analysed using chi\u2010square tests, independent\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests for baseline comparisons and repeated\u2010measures ANOVA with Bonferroni post hoc tests for pairwise comparisons.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to controls, the intervention group showed significantly lower scores in caregiving burden, anxiety, depression and psychological rigidity, alongside higher psychological resilience at discharge and 1\u2010month follow\u2010up. No adverse events were recorded in either group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this single\u2010centre trial, Acceptance and Commitment Therapy reduced psychological rigidity and caregiving burden and improved psychological resilience. Its emphasis on accepting uncontrollable realities and acting on personal values may be well suited to the volatile context of cirrhosis caregiving, but multicentre trials with longer follow\u2010up are needed before wider implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Chinese Clinical Trial Registry: ChiCTR2600131432.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ijn.70189","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:14:53Z","timestamp":1792041293000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acceptance and Commitment Therapy as a Psychological Intervention for Primary Caregivers of Patients With Decompensated Cirrhosis: A Randomized Controlled Trial"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5803-4620","authenticated-orcid":false,"given":"Yinrong","family":"Ding","sequence":"first","affiliation":[{"name":"Department of Gastroenterology The First Affiliated Hospital of Wenzhou Medical University  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulu","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The First Affiliated Hospital of Wenzhou Medical University  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyue","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The First Affiliated Hospital of Wenzhou Medical University  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinhong","family":"Zhou","sequence":"additional","affiliation":[{"name":"College of Nursing Wenzhou Medical University  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6524-2155","authenticated-orcid":false,"given":"Xufei","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Hernia and Abdominal Surgery The First Affiliated Hospital of Wenzhou Medical University  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.18502\/ijps.v18i2.12373"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beth.2011.03.007"},{"issue":"11","key":"e_1_2_11_4_1","first-page":"873","article-title":"Psychometric Properties of the Chinese Version of the Acceptance and Action Questionnaire\u2010Second Edition in College Students","volume":"27","author":"Cao J.","year":"2013","journal-title":"Chinese Mental Health Journal"},{"issue":"5","key":"e_1_2_11_5_1","first-page":"664","article-title":"Current Status and Influencing Factors of Sense of Coherence in Primary Caregivers of Cancer Patients","volume":"27","author":"Chen L.","year":"2021","journal-title":"Chinese Journal of Modern Nursing"},{"issue":"11","key":"e_1_2_11_6_1","first-page":"2408","article-title":"Guidelines on the Diagnosis and Treatment of Liver Cirrhosis","volume":"35","author":"Chinese Society of Hepatology, Chinese Medical Association","year":"2019","journal-title":"Journal of Clinical Hepatology"},{"issue":"5","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1097\/00006199-200209000-00009","article-title":"The Reliability and Validity of the Chinese Version of the Caregiver Burden Inventory","volume":"51","author":"Chou K. R.","year":"2002","journal-title":"Nursing Research"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/da.10113"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/17482631.2022.2066255"},{"issue":"7","key":"e_1_2_11_10_1","first-page":"592","article-title":"Effect of Acceptance and Commitment Therapy on Psychological Flexibility and Post\u2010Traumatic Growth in Stroke Patients","volume":"35","author":"Dai C. H.","year":"2020","journal-title":"Journal of Nurses Training"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010021\u201002078\u20100"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14614"},{"key":"e_1_2_11_13_1","first-page":"7","volume-title":"ACT Made Easy","author":"Harris R.","year":"2016"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2005.06.006"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj\u20102024\u2010081123"},{"issue":"1","key":"e_1_2_11_16_1","first-page":"84","article-title":"Application of Acceptance and Commitment Therapy in Borderline Personality Disorder","volume":"30","author":"Hu Z. Z.","year":"2021","journal-title":"Chinese Journal of Behavioral Medicine and Brain Science"},{"issue":"1","key":"e_1_2_11_17_1","first-page":"25","article-title":"Qualitative Study on the Needs of Continuity of Care for Primary Caregivers of Patients With Decompensated Cirrhosis","volume":"35","author":"Li Q. Q.","year":"2018","journal-title":"Nursing Journal of the Chinese People's Liberation Army"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/02692163221099610"},{"issue":"6","key":"e_1_2_11_19_1","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1093\/geront\/29.6.798","article-title":"Application of a Multidimensional Caregiver Burden Inventory","volume":"29","author":"Novak M.","year":"1989","journal-title":"Gerontologist"},{"issue":"3","key":"e_1_2_11_20_1","first-page":"363","article-title":"Research Progress of Networked Cognitive Behavioral Therapy in Breast Cancer Patients","volume":"57","author":"Pan M. Y.","year":"2022","journal-title":"Chinese Journal of Nursing"},{"key":"e_1_2_11_21_1","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2023"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/32.5.656"},{"issue":"14","key":"e_1_2_11_23_1","first-page":"1080","article-title":"Acceptance and Realization Therapy for the Influence on Disease Adaptation Ability and Self\u2010Perceived Burden in Early Peritoneal Dialysis Patients","volume":"38","author":"Wang B. Y.","year":"2022","journal-title":"Chinese Journal of Practical Nursing"},{"issue":"1","key":"e_1_2_11_24_1","first-page":"47","article-title":"Acceptance and Commitment Therapy for Short\u2010Term and Long\u2010Term Effects in Patients With Type 2 Diabetes Mellitus","volume":"36","author":"Wang L.","year":"2020","journal-title":"Chinese Journal of Practical Nursing"},{"key":"e_1_2_11_25_1","volume-title":"Rating Scales for Mental Health","author":"Wang X. D.","year":"1999"},{"issue":"23","key":"e_1_2_11_26_1","first-page":"2472","article-title":"Effect of Acceptance and Commitment Therapy on Pain and Negative Emotions in Patients With Rectal Cancer","volume":"18","author":"Wei H.","year":"2020","journal-title":"Cancer Progress"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2010.05.010"},{"issue":"1","key":"e_1_2_11_28_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2224\/sbp.2007.35.1.19","article-title":"Factor Analysis and Psychometric Evaluation of the Connor\u2010Davidson Resilience Scale (CD\u2010RISC) With Chinese People","volume":"35","author":"Yu X.","year":"2007","journal-title":"Social Behavior and Personality"},{"issue":"6","key":"e_1_2_11_29_1","first-page":"673","article-title":"Relationship Between Serum Sodium Levels and Liver Function and Complications in Patients With Decompensated Cirrhosis","volume":"40","author":"Zhang X. B.","year":"2019","journal-title":"Anhui Medical Journal"},{"issue":"3","key":"e_1_2_11_30_1","first-page":"30","article-title":"Effect Observation of Cognitive\u2010Psychological\u2010Social Support Intervention in Nursing Care of Patients With Decompensated Cirrhosis","volume":"34","author":"Zhang X. H.","year":"2021","journal-title":"Contemporary Clinical Medicine"},{"issue":"1","key":"e_1_2_11_31_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1001\/archpsyc.1965.01720310065008","article-title":"A Self\u2010Rating Depression Scale","volume":"12","author":"Zung W. W. K.","year":"1965","journal-title":"Archives of General Psychiatry"},{"issue":"6","key":"e_1_2_11_32_1","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/S0033-3182(71)71479-0","article-title":"A Rating Instrument for Anxiety Disorders","volume":"12","author":"Zung W. W. K.","year":"1971","journal-title":"Psychosomatics"}],"container-title":["International Journal of Nursing Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijn.70189","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ijn.70189","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ijn.70189","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:14:58Z","timestamp":1792041298000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ijn.70189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":31,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/ijn.70189"],"URL":"https:\/\/doi.org\/10.1111\/ijn.70189","archive":["Portico"],"relation":{},"ISSN":["1322-7114","1440-172X"],"issn-type":[{"value":"1322-7114","type":"print"},{"value":"1440-172X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2025-08-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70189"}}