Videoconference-Delivered Acceptance and Commitment Therapy for Individuals With Spinal Cord Injuries and Depressive Symptoms: A Qualitative Study

Abstract

Individuals with spinal cord injury (SCI) are at elevated risk for depression, yet little is known about how those with SCI and depressive symptoms experience acceptance and commitment therapy (ACT). This qualitative study explored the lived experiences of 13 adults within 5 years post-injury who completed an 8-week, therapist-guided, videoconference-delivered ACT program, using semi-structured interviews. Using interpretative phenomenological analysis, two overarching themes and six subthemes emerged. Theme 1, personal growth and resilience, reflected enhanced emotional well-being, practical coping strategies, empowerment through values-based goal setting, and strengthened social connections. Theme 2, program optimization and sustained impact, captured participants’ appreciation of a structured yet adaptable format, an empathic therapeutic relationship, and between-session accountability, which fostered consistency, motivation, and reduced isolation. Participants reported continued use of worksheets, summaries, and guided videos after program completion, emphasizing their role in sustaining ACT skills, and suggested refinements such as streamlined materials and SCI-specific examples. Convergence was evident in reports of improved mood, mindfulness, and values-based engagement, whereas divergence appeared in depth of change, delivery preferences, and brief increases in pain awareness during mindfulness. Overall, videoconference-delivered ACT was perceived as acceptable, feasible, and beneficial, supporting psychological flexibility and functional re-engagement in adults with SCI and depressive symptoms.