Long-Term Follow-Up of a Randomized Controlled Trial Comparing Acceptance and Commitment Therapy and Standard Cognitive Behavior Therapy for Anxiety and Depression

The present study represents one of the first comparisons of the long-term effectiveness of traditional cognitive behavior therapy (i.e., Beckian cognitive therapy; CT) and acceptance and commitment therapy (ACT). One hundred thirty-two anxious or depressed outpatients were randomly assigned to receive either CT or ACT, and were assessed at posttreatment (n = 90) and at 1.5-year (n = 91) follow-up. As previously reported, the two treatments were equivalently effective at posttreatment according to measures of depression, anxiety, overall (social/occupational/symptom-related) functioning, and quality of life. However, current results suggest that treatment gains were better maintained at follow-up in the CT condition. Clinical significance analyses revealed that, at follow-up, one-third more CT patients were in the clinically normative range in terms of depressive symptoms and more than twice as many CT patients were in the normative range in terms of functioning levels. The possible long-term advantage of CT relative to ACT in this population is discussed.     

Beyond Acceptance and Commitment Therapy: Process-Based Therapy

The Psychological Record - This article describes process-based therapy (PBT) as a natural evolution toward more effective and efficient mental health care. Using acceptance and commitment therapy...     

Using Acceptance and Commitment Therapy to Treat Infertility Stress

Women and men diagnosed with infertility experience a variety of infertility-related stressors, including changes to their family and social networks, strain on their sexual relationship, and difficulties and unexpected challenges in their relationship. Infertility stress is linked with depression and psychological distress, and can lead to premature dropout from medical treatments and unresolved feelings of loss and grief. The current study examined the effectiveness of treating infertility stress using Acceptance and Commitment Therapy (ACT), a promising new behavior therapy that targets experiential avoidance through mindfulness, acceptance strategies, and value-directed action. This single-case study followed a couple experiencing infertility-related stress following a failed in vitro fertilization (IVF) procedure. The couple completed 6 self-report measures at 7 time points, including a second failed IVF attempt and a 1-year follow-up. Measures included both distress-focused instruments and therapy process-related questionnaires. The female participant reported higher pretreatment stress and depression scores compared to her partner. She reported significant decreases in global infertility stress, social infertility stress, sexual infertility stress, psychological distress, and depression from pretherapy to 1-year follow-up. She also reported a decrease in infertility stress following her second failed in vitro fertilization (IVF) attempt. The male participant reported significant decreases in sexual infertility stress. The study suggests that acceptance-based therapy shows promise in treating infertility stress in patients experiencing infertility who undergo medical treatments. The data from this preliminary case study also suggest that ACT may be helpful for couples following IVF treatment failure. Treatment gains were maintained 1-year posttherapy, indicating that an ACT approach to treating infertility has the potential to produce lasting change.     

A Comprehensive Examination of the Model Underlying Acceptance and Commitment Therapy for Chronic Pain

The therapeutic model underlying Acceptance and Commitment Therapy (ACT) is reasonably well-established as it applies to chronic pain. Several studies have examined measures of single ACT processes, or subsets of processes, and have almost uniformly indicated reliable relations with patient functioning. To date, however, no study has performed a comprehensive examination of the entire ACT model, including all of its component processes, as it relates to functioning. The present study performed this examination in 274 individuals with chronic pain presenting for an assessment appointment. Participants completed a battery of self-report questionnaires, assessing multiple aspects of the ACT model, as well as pain intensity, disability, and emotional distress. Initial exploratory factor analyses examined measures of the ACT model and measures of patient functioning separately with each analysis identifying three factors. Next, the fit of a model including ACT processes on the one hand and patient functioning on the other was examined using Structural Equation Modeling. Overall model fit was acceptable and indicated moderate correlations among the ACT processes themselves, as well as significant relations with pain intensity, emotional distress, and disability. These analyses build on the existing literature by providing, to our knowledge, the most comprehensive evaluation of the ACT theoretical model in chronic pain to date.     

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.     

Book Review: Acceptance and Commitment Therapy

Based on the model proposed by Morrison, Haddock &; Tarrier (1995) on auditory hallucinations, this study explores the relationships between certain metacognitive variables and number of thoughts, the discomfort they produce, number of auditory illusions and the quality with which they are perceived in a sample from a non-clinical population. After group administration of the Metacognitions Questionnaire, 61 participants were randomly assigned to a suppression group (n?=?31) or a focalization group (n?=?30) in relation to thoughts with different degrees of self-discrepancy. Forty-eight hours after the set task, a non-vocal auditory stimulus was presented, and subjects were required to say whether they heard any words and, if so, how clearly. The results show how the metacognitive factors studied are useful for predicting our findings only for the suppression group and not for that of focalization. These data are discussed in the light of Morrison et al.'s model of auditory hallucinations.     

The Application of Acceptance and Commitment Therapy to Obsessive-Compulsive Disorder

This paper is part of a case series illustrating the application of different therapies to a case of obsessive-compulsive disorder (OCD). It describes the hypothetical application of Acceptance and Commitment Therapy (ACT). This paper covers the philosophy and basic research on language and cognition that inform ACT. It also provides an ACT-based case conceptualization of this case and examples of therapeutic procedures. The goal of this paper is to familiarize clinicians with the use of ACT for OCD.     

Acceptance and Commitment Therapy and Implementation Intentions Increase Exercise Enjoyment and Long-Term Exercise Behavior Among Low-Active Women

The current study evaluated the long-term effectiveness of acceptance and commitment therapy (ACT) for promoting exercise behavior in comparison with planning in the form of implementation intentions (forming situational cues and action plans as to when, where, and how to incorporate exercise). We expected both interventions to increase exercise behavior (assessed using the Godin Leisure-Time Exercise Questionnaire; Godin and Shephard 1985) from baseline to 6-months post-intervention, but expected only ACT to also increase exercise enjoyment (assessed using the Physical Activity Enjoyment Scale; Kendzierski and DeCarlo 1991). A total of 32 women, randomized to receive a single session of either ACT training or instructions to form implementation intentions for exercise activities, took part in this study. The participants were contacted by email 6-months following the intervention to determine the amount of self-reported exercise. As expected, exercise amount increased in both groups. Contrary to our expectations, both groups also increased in exercise enjoyment. This study provides initial evidence that exercising can be increased through an ACT intervention. ACT and implementation intentions may both be effective and brief interventions for promoting exercise behavior and exercise-related enjoyment in low-active women. Future research needs to establish the psychosocial and personality factors that lead to the effectiveness of ACT and implementation intentions.     

Using Acceptance and Commitment Therapy to Guide Exposure-Based Interventions for Posttraumatic Stress Disorder

Exposure is considered one of the most effective interventions for PTSD. There is a large body of research for the use of imaginal and in vivo exposure in the treatment of PTSD, with prolonged exposure (PE) therapy being the most researched example. Acceptance and commitment therapy (ACT) has sometimes been called an exposure-based treatment, but how exposure is implemented in ACT for PTSD has not been well articulated. Although support for the use of ACT in PTSD treatment is limited to a handful of case studies and open trials, research suggests ACT is particularly useful in flexibly targeting avoidance behavior—arguably the most important process in the continued maintenance of PTSD symptoms. The purpose of this paper is to explore the use of exposure within ACT in PTSD treatment. Through an overview of PE and ACT, and with the use of case examples, we describe how ACT principles and techniques may inform exposure-based treatments for PTSD in order to create more flexible approaches. In addition, understanding exposure within an ACT framework may also contribute to clarifying processes of change.     

Acceptance and Commitment Therapy With Older Adults: Rationale and Considerations

Older adults are the fastest growing segment of the population. With these changing demographics, mental health professionals will be seeing more older clients. Additionally, older adults are an underserved population in that most older adults in need of mental health services do not receive treatment. Thus, it is essential that treatments for mental and behavioral health problems are empirically supported with older adults and that mental health professionals are aware of the special needs of older adult populations. Acceptance and Commitment Therapy (ACT) is an emerging approach to the treatment of distress. The purpose of this article is to provide a rationale for using ACT with older adults based on gerontological theory and research. We also review research on ACT-related processes in later life. We present a case example of an older man with depression and anxiety whom we treated with ACT. Finally, we describe treatment recommendations and important adaptations that need to be considered when using ACT with older adults and discuss important areas for future research.     

Rational Emotive Behavior Therapy and Cognitive Behavior Therapy for Elderly People

Several therapies have been adapted for use with elderly people, including Rational Emotive Behavior Therapy (REBT) and Cognitive Behavior Therapy (CBT). These two therapies emphasize the importance of irrational or dysfunctional beliefs in the creation of emotional disturbance, and tend to use a number of cognitive, emotive, and behavioral methods of disputing and changing these beliefs for more functional ones. Some of the main therapeutic techniques used in REBT and CBT are presented in this paper.     

Acceptance and Commitment Therapy for Eating Disorders: Rationale and Literature Review

Empirical studies using Acceptance and commitment therapy (ACT) and its components to treat eating disorders (EDs) were reviewed. Evidence suggests that emotional avoidance is a major component in the onset and maintenance of EDs. Acceptance and commitment therapy targets emotional avoidance and control strategies with six core processes. These core processes have been applied to EDs and demonstrated improvement in subjects’ functioning and reduction in disordered eating. There are several advantages of using ACT for treating EDs: ACT fundamentally equalizes the therapeutic relationship; experiential techniques in ACT may facilitate lasting treatment gains; ACT navigates the ego-syntonic nature of EDs; the ACT conceptualization based on experiential avoidance and cognitive rigidity in EDs is consistent with current literature. The six core processes of ACT can be further modified to fit the challenges of treating EDs. Specifically, concerns about client motivation for treatment can be addressed by emphasizing creative hopelessness and a values construction process earlier in treatment.     

Religious Coping and Cancer: Proposing an Acceptance and Commitment Therapy Approach

A cancer diagnosis is one of the most difficult diagnoses for any person to receive and cope with. Numerous individuals turn to religion or their spiritual beliefs to find meaning through the process of coping with such a serious illness. Therefore, in recent years research on religious coping has received increased attention. The aim of the present paper is to examine the area of religious coping, along with its dimensions and ways to assess it, as it relates to cancer. Moreover, this paper presents a relatively new approach to the psychological treatment of individuals with cancer. Namely, Acceptance and Commitment Therapy (ACT) is a spiritually and religiously sensitive treatment. This approach aims to first explore a person's values (including spiritual and religious values), to subsequently help the person accept any experience that the person has no control over in light of these values, and to then commit and take actions consistent with these values. Recent evidence providing initial support for this approach is discussed. Finally, a case example is presented to illustrate how ACT may be carried out to address religious coping in outpatient clinical practice with cancer patients.     

Cognitive Approaches to Pain Control: Common Factors Underlying Their Effectiveness

The author reviews the cognitive approaches to pain control and discusses how expectancy of success in general and self-efficacy in particular mediate successful outcomes.     

Acceptance and Commitment Therapy as a Treatment for Problematic Internet Pornography Viewing

Despite the prevalence of problematic Internet pornography viewing and the breadth of intervention approaches to potentially address it, no studies to address this problem have been reported to date. An emerging treatment approach, Acceptance and Commitment Therapy (ACT), holds promise as a treatment for Internet pornography viewing because of its focus on processes hypothesized to underlie this maladaptive behavior. In the first experiment on the treatment of problematic Internet pornography viewing, 6 adult males who reported that their Internet pornography viewing was affecting their quality of life were treated in eight 1.5-hour sessions of ACT for problematic pornography viewing. The effects of the intervention were assessed in a multiple-baseline-across-participants design with time viewing pornography as the dependent variable. Treatment resulted in an 85% reduction in viewing at posttreatment with results being maintained at 3-month follow-up (83% reduction). Increases were seen on measures of quality of life, and reductions were seen on measures of OCD and scrupulosity. Weekly measures of ACT-consistent processes showed reductions that corresponded with reductions in viewing. Large reductions were seen on a measure of psychological flexibility, and minor reductions were seen on measures of thought-action fusion and thought control. Overall, results suggest the promise of ACT as a treatment for problematic Internet pornography viewing and the value of future randomized trials of this approach.     

森田疗法与认知行为疗法的比较分析

阐述森田疗法和认知行为疗法的基本理论,在此基础上对两种疗法作比较分析。尽管这两种心理治疗方法在治疗程序和具体操作方法上迥然不同,但在发病机制的解释和治疗原理方面,它们又有很多相似之处,对存在这种现象的原因进行了探讨。     

Acceptance and Commitment Therapy and Habit Reversal Training for the Treatment of Trichotillomania

Trichotillomania is a behavioral problem, and is often referred to as a habit disorder, but it is important to consider the cognitive and emotional components of the behavior. Current treatment recommendations include a traditional behavioral approach (Habit Reversal Training; HRT) combined with an approach that addresses the cognitive and emotional components of the behavior (Acceptance and Commitment Therapy [ACT] or Dialectical Behavior Therapy [DBT]). Current evidence indicates a combination of ACT and HRT is an effective treatment for trichotillomania. The goal of this article is to replicate the effectiveness of the ACT/HRT treatment package for trichotillomania and to provide practical clinical guidance on how to deliver the treatment. This guidance is presented in the context of an empirical study in which 5 participants demonstrating high levels of pulling at pretreatment were treated with 8 sessions of a combination of ACT and HRT. Treatment resulted in an 88.87% reduction in pulling across participants from pretreatment to posttreatment, and all 5 responded to the treatment. At 3-month follow-up, 2 participants maintained the treatment gains, 2 lost half of the treatment gains, and 1 was at pretreatment levels. A discussion of the results is presented along with implications for clinical practice and future directions for research.