Effectiveness of an ACT‐based rehabilitation program for the treatment of chronic fatigue: Results from a 12‐months longitudinal study

Acceptance and Commitment Therapy (ACT) is potentially effective for treating chronic fatigue. Given the paucity of studies on this topic, we aimed to assess long‐term trajectories of primary (fatigue, quality of life and functional abilities) and secondary outcomes (anxious and depressive symptoms) of an ACT‐based rehabilitation program for patients with chronic fatigue. Further, we examined if changes in potential process variables (psychological inflexibility, metacognitive beliefs, and cognitive and behavioral responses to symptoms) during ACT predicted change in all outcomes across follow‐up. One‐hundred ninety‐five workers on sick leave (mean age: 43.61 ± 9.33 years; 80.5% females) with a diagnosis of chronic fatigue were enrolled in a manualized, 3.5‐week intensive return‐to‐work rehabilitation program based on ACT. All completed a battery of questionnaires at pre‐, post‐treatment, 6 and 12 months follow‐up. We found significant longitudinal changes in most primary and secondary outcomes from pre‐ up to 12 months follow‐up. All process variables significantly decreased from pre‐ up to 12 months follow‐up, and pre‐to‐post changes in fear avoidance beliefs were most often associated with a greater change in outcomes across follow‐up. Depressive symptomatology showed a similar trajectory of change to fatigue, meaning that scores were correlated at each time point and tended to converge over time. This suggests that both symptoms influence each other substantially over a year following the treatment. Concluding, results lend support to the effectiveness of an ACT‐based rehabilitation program for patients with chronic fatigue and provide preliminary evidence for the role of process variables and depressive symptomatology on subsequent change in outcomes.     

Evaluation of a Brief Mindfulness Program for People with Multiple Sclerosis Delivered in the Community Over Five Years

This study evaluated the effectiveness, change mechanisms, and sustainability of a brief mindfulness intervention for people with multiple sclerosis (PwMS) delivered in the community through a frontline service over five years. Participants were 126 PwMS. A single intervention condition design was used with pre-intervention, post-intervention and 2-month follow-up assessments. The primary outcome was distress. Secondary outcomes were perceived stress, quality of life (QoL) and fatigue, and the proposed change mechanisms: mindfulness, self-compassion, psychological inflexibility. Intention-to-treat analyses showed the primary outcome, distress (Cohen’s d = .25), and all secondary outcomes improved: perceived stress (d = .38), mental health QoL (d = .39), physical health QoL (d = .47), fatigue (d = .30), mindfulness (d = .29), self-compassion (d = .37), psychological flexibility (d = .44). Distress, stress and perceived stress continued to improve post-intervention to follow-up. Mindfulness emerged as a temporal mediator of perceived stress (BCa 95% CI). Self-compassion mediated concurrent improvements in distress, perceived stress, fatigue and physical health QoL, while greater psychological flexibility mediated concurrent reductions in distress (BCa 95% CI). Mindfulness home practice was unrelated to improvements on all outcomes except a marginal association with mindfulness. Of the socio-demographic and illness factors, lower disease severity predicted improvements in physical health QoL (p = .046). Improvements in outcomes were supported by qualitative feedback and participant satisfaction ratings. Twenty-one groups were offered with good participant engagement and wide geographical reach, suggesting sustained feasibility of the Mindfulness for MS program over five years. Findings support the delivery of the Mindfulness for MS program through a community-based service in partnership with a local university.

     

Challenging anxious cognitions or accepting them? Exploring the efficacy of the cognitive elements of cognitive behaviour therapy and acceptance and commitment therapy in the reduction of children's fear of the dark

Anxiety is highly prevalent in pre-adolescent children. Distorted cognitions are characteristic for dysfunctional levels of anxiety. However, applying cognitive elements in pre-adolescent children cannot be fully ascertained, as it is not until adolescence before children can apply logical and abstract reasoning in a sophisticated manner. Cognitive behaviour therapy (CBT) and acceptance and commitment therapy (ACT) both target distorted cognitions. Whereas CBT encourages children to change the content of negative cognitions by applying cognitive restructuring, ACT stimulates youth to have a more accepting attitude towards these thoughts by applying cognitive defusion. The current study examined the efficacy of applying cognitive elements and compared the cognitive elements of CBT and ACT in pre-adolescent children. We included no behavioural elements to specifically study the developmental appropriateness of the cognitive elements in this age group. Highly anxious children, aged 8–12 years were randomised to a 30-minute cognitive restructuring (n = 21) or cognitive defusion intervention (n = 22). Subjective fear of the dark levels, behavioural darkness toleration, and comprehension and fun associated with the interventions were assessed. Both interventions had a significantly positive impact on children's fear of the dark. Cognitive restructuring led to more favourable results on subjective fear than cognitive defusion, no differences were found for darkness toleration.     

Extending the Common Sense Model to Explore the Impact of the Fear of COVID-19 on Quality of Life in an International Inflammatory Bowel Disease Cohort

The aim of this cross-sectional study was to use an extended common sense model (CSM) to evaluate the impact of fear of COVID-19 on quality of life (QoL) in an international inflammatory bowel disease cohort. An online study involving 319 adults (75% female, mean (SD) 14.06 (15.57) years of symptoms) completed the Gastrointestinal Symptom Rating Scale, Brief Illness Perceptions Questionnaire, Fear of Contracting COVID-19 Scale, Brief-COPE, Depression, Anxiety and Stress Scale, and the EUROHIS-QOL. The extended CSM had an excellent fit (χ² (9)?=?17.06, p?=?.05, χ²/N?=?1.90, RMSEA?=?0.05, SRMR?=?0.04, CFI?=?.99, TLI?=?.97, GFI?=?0.99), indicating the influence of gastrointestinal symptoms on QoL was mediated by illness perceptions, fear of COVID-19, adaptive and maladaptive coping, and psychological distress. Interventions targeting the fear of COVID-19 in the context of an individual’s perceptions will likely enhance QoL during the pandemic.

     

Psychological Factors Associated with a Better Quality of Life Following Head-Up Tilt Testing

Quality of life (QoL) is reduced in patients with recurrent vasovagal (VVS) or unexplained syncope (US). Little is known concerning the natural evolution of QoL following diagnosis. Psychological factors contributing to QoL improvement, such as psychological distress and self-efficacy remain to be explored. The objective of this study is to examine whether QoL changes 2 months and 6 months following head-up tilt (HUT) testing as well as to determine whether psychological factors are predictive of changes in QoL. Seventy-three patients undergoing HUT for recurrent syncope were interviewed 1 month before as well as 2 months and 6 months following HUT, using semi-structured interviews and questionnaires. Pre-HUT QoL was significantly worse than at the 2-month (p = 0.000) and 6-month follow-ups (p = 0.000). Psychological distress at baseline was associated with worse QoL 2 months post-HUT (Beta = .280; p = .024), independently of socio-demographic and clinical factors. Improved self-efficacy at follow-up predicted improvements in QoL (Beta = −.186; p = .023). Two and 6 months post-HUT, QoL is mproved in patients with recurrent syncope. Better QoL is predicted by low psychological distress and a heightened sense of self-efficacy following HUT. Strategies for enhancing self-efficacy and reducing psychological distress could be an efficient way to promote QoL in patients suffering from recurrent syncope.     

Cognitive Mediators of Treatment for Social Anxiety Disorder: Comparing Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy

Objective

To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder.

Method

Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n = 25) or ACT (n = 25) for DSM-IV social anxiety disorder.

Results

Multilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms.

Conclusions

Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT.     

Can Exposure and Acceptance Strategies Improve Functioning and Life Satisfaction in People with Chronic Pain and Whiplash‐Associated Disorders (WAD)? A Randomized Controlled Trial

Although 14% to 42% of people with whiplash injuries end up with chronic debilitating pain, there is still a paucity of empirically supported treatments for this group of patients. In chronic pain management, there is increasing consensus regarding the importance of a behavioural medicine approach to symptoms and disability. Cognitive behaviour therapy has proven to be beneficial in the treatment of chronic pain. An approach that promotes acceptance of, or willingness to experience, pain and other associated negative private events (e.g. fear, anxiety, and fatigue) instead of reducing or controlling symptoms has received increasing attention. Although the empirical support for treatments emphasizing exposure and acceptance (such as acceptance and commitment therapy) is growing, there is clearly a need for more outcome studies, especially randomized controlled trials. In this study, participants (N = 21) with chronic pain and whiplash‐associated disorders were recruited from a patient organization and randomized to either a treatment or a wait‐list control condition. Both groups continued to receive treatment as usual. In the experimental condition, a learning theory framework was applied to the analysis and treatment. The intervention consisted of a 10‐session protocol emphasizing values‐based exposure and acceptance strategies to improve functioning and life satisfaction by increasing the participants' abilities to behave in accordance with values in the presence of interfering pain and distress (psychological flexibility). After treatment, significant differences in favor of the treatment group were seen in pain disability, life satisfaction, fear of movements, depression, and psychological inflexibility. No change for any of the groups was seen in pain intensity. Improvements in the treatment group were maintained at 7‐month follow‐up. The authors discuss implications of these findings and offer suggestions for further research in this area.     

Prospective Examination of Self‐Regulatory Efficacy in Predicting Walking for Active Transportation: A Social Cognitive Theory Approach

Walking for transportation is associated with health benefits. Minimal theory‐based research has examined social cognitive and environmental predictors. This study examined social cognitions (self‐regulatory efficacy to plan/schedule and overcome barriers; distance and travel time cognitions) and an environmental factor (proximity) as predictors of walking for transportation. Participants (n = 105) were university students, faculty, and staff, living within a walkable distance to campus. Social cognitions and proximity measures were completed at baseline, followed by walking for transportation to/from the campus over 2 weeks. A hierarchical multiple regression analysis predicted walking (R²_adjusted = .55; p < .05). Self‐regulatory efficacy to plan/schedule and overcome barriers were independent predictors (p's < .01). Findings supported theoretical contentions that self‐regulatory efficacy predicts walking for transportation.     

Contributions of Cognitions,Psychological Flexibility,and Therapeutic Alliance to Suicidal Ideation in Psychiatric Inpatients

Although suicide treatment is an expanding area of research, there is relatively less in the literature with respect to how specific vulnerabilities to suicide are addressed by treatment. Utilizing measures of suicide cognitions, therapeutic alliance, and psychological flexibility, we compared their relative contributions to suicidal ideation during and posttreatment among a group of adult psychiatric inpatients (N  = 434). Results revealed that cognitions contributed considerably more unique variance to suicidal ideation than alliance and flexibility at discharge and at 2 weeks postdischarge, and to change in suicidal ideation over the course of treatment. Psychological flexibility explained a small amount of variance at the 6‐month time point. Factor level analyses also were conducted, with the unsolvability factor within suicide cognitions accounting for the largest portion of variance at both discharge and 2 weeks postdischarge. Study limitations, implications, and future directions are discussed.     

Anxious cognitions in children: An exploration of associations and mediators

To investigate sources of influences connecting mothers' and their children's anxious cognitions, 65 children (aged 10 to 11 years) completed self‐report measures of anxiety. Children and mothers responded to an ambiguous scenario questionnaire and measures of parenting style and life events. Mothers also reported expectations about their child's reaction to ambiguous situations. Mothers' and children's threat cognitions were significantly correlated (r = .31), and partially mediated by mothers' expectations about their child. Mothers' anticipated distress was associated with expectations for their child's distress, which was associated with the child's own anticipated distress. Parenting and life events were significantly associated with children's interpretative bias, but did not mediate the intergenerational association in interpretative bias. The results suggest influences on children's ‘anxious cognitive style’ and potential targets for preventing and reducing maladaptive cognitions in children.     

Stress and depression of facing death: Investigation of psychological symptoms in patients with mesothelioma

Cancer often results in psychological impairment, and lung cancer has been associated with greater morbidity and higher levels of psychological distress than any other form. Chronic exposure to asbestos is a significant risk factor for development of lung cancer, called mesothelioma. Few have studied the psychological consequences of chronic asbestos exposure and mesothelioma. This study investigated stress and depression symptoms in 49 men (M = 51.1 years, SD = 6.0) diagnosed with mesothelioma. Participants completed traumatic stress, depression and general psychological health questionnaires. All participants reported significant levels of traumatic stress symptoms, which was associated with increased symptoms of depression, anxiety, somatic complaints and social dysfunction. The results provide important suggestions for clinicians treating such terminally ill patients.     

Religious Coping and Quality of Life Among Severely Ill Lung Patients in a Secular Society

This survey study investigated the prevalence of religious beliefs and religious coping and possible associations between religious factors and quality of life (QoL) among a group of severely ill lung patients (lung cancer and chronic obstructive pulmonary disease) in Denmark (N = 111). Almost two thirds (64.8%) reported having some belief in God and/or a spiritual power. Patients who reported believing in God and patients who believed in God and a spiritual power reported better QoL than patients who reported that they believed in a spiritual power only. Religious coping was prevalent; for positive religious coping strategies, those used from least to most often, respectively, were invoked 15% to 37% of the time; for negative religious coping strategies the percentages were 3% to 16%. Negative religious coping was associated with lower QoL (β = ?0.320, p < .006), whereas no associations were found between positive religious coping and QoL. Results are discussed in relation to the cultural context of secularized societies like the Scandinavian countries.     

Mindfulness Moderates the Relationship Between Disordered Eating Cognitions and Disordered Eating Behaviors in a Non-Clinical College Sample

Psychological flexibility and mindfulness are two related, but distinct, regulation processes that have been shown to be at the core of psychological wellbeing. The current study investigated whether these two processes independently moderated the association between disordered eating cognitions and psychological distress as well as the relation between disordered eating cognitions and disordered eating behaviors. Non-clinical, ethnically diverse college undergraduates completed a web-based survey. Of 278 participants (nfemale = 208; nmale = 70) aged 18–24 years old, disordered eating cognitions, mindfulness, and psychological flexibility were related to psychological distress after controlling for gender, ethnicity, and body mass index. Disordered eating cognitions and mindfulness accounted for unique variance in disordered eating behaviors. Finally, mindfulness was found to moderate the association between disordered eating cognitions and disordered eating behaviors.     

Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy

There are now numerous studies of Acceptance and Commitment Therapy (ACT) for chronic pain. These studies provide growing support for the efficacy and effectiveness of ACT in this context as well as for the role of ACT-specific therapeutic processes, particularly those underlying psychological flexibility. The purpose of the present study was to continue to build on this work with a broader focus on these processes, including acceptance of pain, general psychological acceptance, mindfulness, and values-based action. Participants included 168 patients who completed an ACT-based treatment for chronic pain and a three-month follow-up. Following treatment and at follow-up, participants reported significantly reduced levels of depression, pain-related anxiety, physical and psychosocial disability, medical visits, and pain intensity in comparison to the start of treatment. They also showed significant increases in each of the processes of psychological flexibility. Most uncontrolled effect sizes were medium or large at the follow-up. In correlation analyses changes in the four processes measures generally were significantly related to changes in the measures of depression, anxiety, and disability. In regression analyses the combined processes were related to changes in outcomes above and beyond change in pain intensity. Although in some ways preliminary, these results specifically support the unique role of general psychological acceptance in relation to improvements achieved by treatment participants. The current study clarifies potential processes of change in treatment for chronic pain, particularly those aiming to enhance psychological flexibility.     

Rethinking safety behaviors in insomnia: examining the perceived utility of sleep-related safety behaviors

Harvey's cognitive model of insomnia (2002a) proposes that sleep-related safety behaviors play a central role in the maintenance of insomnia because such maladaptive coping strategies are thought to reinforce threat-based appraisals of the likelihood and consequences of poor sleep. Research to date has assessed the frequency of safety behavior use in those with insomnia only; however, in addition to the frequency of occurrence, the function of safety behaviors (i.e., a belief that they will prevent a feared outcome from occurring), may be an important consideration. The purpose of this study was to examine sleep-related safety behaviors based on an expanded theoretical understanding of such behaviors across psychological disorders; that is, by examining both their frequency and perceived utility. Undergraduate students (N = 376) completed an online survey about their sleep, mood, and use of sleep-related safety behaviors. Insomnia severity was associated with a greater perceived need to use safety behaviors (i.e., utility) but not with frequency of safety behavior use. Higher perceived utility of safety behaviors was also associated with unhelpful beliefs about sleep, fear and avoidance of fatigue, and both general and sleep-specific helplessness. These results suggest that these behaviors and the associated underlying maladaptive beliefs may be important targets in cognitive behavioral therapy for insomnia. The current study extends the existing literature and refines the concept of safety behaviors in insomnia to include both the function and frequency of these behaviors.     

The effectiveness of acceptance and commitment therapy bibliotherapy for enhancing the psychological health of Japanese college students living abroad

International students often experience significant psychological distress but empirically tested programs are few. Broadly distributed bibliotherapy may provide a cost-effective approach. About half of the Japanese international students in a western university in the United States (N = 70) were randomly assigned to a wait-list or to receive a Japanese translation of a broadly focused acceptance and commitment therapy (ACT) self-help book. Although recruited without regard to health status, the sample was highly distressed with nearly 80% exceeding clinical cutoffs on one or more measures. After a 2-months period for the first treatment group to read the book and a 2-month follow up, wait-list participants also received the book. Students receiving the book showed significantly better general mental health at post and follow up. Moderately depressed or stressed, and severely anxious students showed improvement compared to those not receiving the book. These patterns were repeated when the wait-list participants finally received the book. Improvements in primary outcomes were related to how much was learned about an ACT model from the book. Follow-up outcomes were statistically mediated by changes in psychological flexibility, but not vice versa and were moderated by level of initial flexibility. Overall, the data suggest that ACT bibliotherapy improved the mental health and psychological flexibility of Japanese international students.     

青少年留守经历对网络成瘾的影响:病理性互联网使用的认知行为模型视角

基于病理性互联网使用的认知行为模型,本研究考察青少年留守经历对网络成瘾的影响,并检验非适应性认知的中介作用和粗暴养育的调节作用。以525名中学生为被试,采用非适应性认知问卷、粗暴养育问卷和网络成瘾问卷进行测试,结果发现:(1)有留守经历的个体非适应性认知和网络成瘾的程度更高,而且非适应性认知越强,网络成瘾程度越高;(2)留守经历通过非适应性认知的中介作用影响网络成瘾;(3)留守经历对非适应性认知的影响受到粗暴养育的调节。具体而言,经历较多粗暴养育的青少年,留守经历会增加非适应性认知;但是对于经历较少粗暴养育的青少年,留守经历不会对非适应性认知产生影响。本研究的结果表明,青少年留守经历会增强非适应性认知,进而增加网络成瘾的倾向。但是,如果青少年家庭中粗暴养育程度较低,青少年留守经历对非适应性认知的影响就会消失。     

A randomised worksite comparison of acceptance and commitment therapy and stress inoculation training

In this comparative intervention study, 107 working individuals with above average levels of distress were randomly assigned to one of three conditions: acceptance and commitment therapy (ACT; n = 37); stress inoculation training (SIT; n = 37); or a waitlist control group (n = 33). The interventions were delivered to small groups in the workplace via two half-day training sessions. ACT and SIT were found to be equally effective in reducing psychological distress across a three month assessment period. Mediation analysis indicated that the beneficial impact of ACT on mental health resulted from an increase in psychological flexibility rather than from a change in dysfunctional cognitive content. Contrary to hypothesis, a reduction in dysfunctional cognitions did not mediate change in the SIT condition. Results suggest that the worksite may offer a useful, yet underutilised, arena for testing cognitive-behavioural theories of change.     

Psychological Flexibility as Shared Process of Change in Acceptance and Commitment Therapy and Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Single Case Design Study

Changes in psychological flexibility were tracked in a combined protocol of exposure and response prevention (ERP) and acceptance and commitment therapy (ACT) for adults with OCD to assess if changes in psychological flexibility processes were unique to ACT intervention (e.g., not impacted by ERP). Using a nonconcurrent multiple baseline design, four participants received sessions of ERP and ACT while data was collected on psychological flexibility processes of change and OCD symptom severity. Results indicate treatment response for three of four participants based on OCD scores. Contrary to predictions, data suggest both ERP and ACT have positive effects on psychological flexibility. Implications of these findings are discussed in relation to recent research on ACT and ERP for OCD. This study also illustrates a type of research design that can be accomplished in clinical practice.     

Trait emotional intelligence,psychological well‐being and peer‐rated social competence in adolescence

The trait emotional intelligence (trait EI or trait emotional self‐efficacy) framework provides comprehensive coverage of emotion‐related self‐perceptions and dispositions. In this study, we investigated the relationship between trait EI and four distinct socioemotional criteria on a sample of Dutch adolescents (N = 282; 136 girls, 146 boys; mean age = 13.75 years). As hypothesized, trait EI was positively associated with adaptive coping styles and negatively associated with depressive thoughts and frequency of somatic complaints. It was also negatively associated with maladaptive coping styles, in boys only. Adolescents with high trait EI scores received more nominations from their classmates for being co‐operative and girls gave significantly more nominations to classmates with high trait EI scores for having leadership qualities. The discussion focusses on the operationalization of trait emotional self‐efficacy in adolescents.