Acceptance and Commitment Therapy for Depression: A Preliminary Randomized Clinical Trial for Unemployed on Long-Term Sick Leave

This preliminary study investigated the feasibility of a brief Acceptance and Commitment Therapy (ACT) in a Swedish sample of unemployed individuals on long-term sick leave due to depression. Participants were randomized to a nonstandardized control condition (N = 16) or to the ACT condition (N = 18) consisting of 1 individual and 5 group sessions. From pretreatment to 18-month follow-up the ACT participants improved significantly on measures of depression, general health, and quality of life compared to participants in the control condition. The conditions did not differ regarding sick leave and employment status at any time point. The results indicate that ACT is a promising treatment for depression. The need for further refinements of future ACT protocols for this population is discussed.     

Acceptance and Commitment Therapy Group Treatment for Symptoms of Borderline Personality Disorder: A Public Sector Pilot Study

A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current treatment (ACT + TAU; N = 21) or to continue with treatment as usual alone (TAU; N = 20). There was significantly more improvement from baseline for the ACT + TAU condition than the TAU condition on the primary outcome variable—self-rated BPD symptoms. The ACT + TAU gain was both clinically and statistically significant. The ACT + TAU condition also had significantly more positive change on anxiety and hopelessness, and on the following ACT consistent process variables: psychological flexibility, emotion regulation skills, mindfulness, and fear of emotions. For all but anxiety, the improvements for the ACT + TAU condition were significant, while the TAU condition had no significant changes on any measure. Follow-up was possible for only a small number of participants. The improvements gained by the ACT + TAU participants were maintained except for fear of emotions. Anxiety continued to improve, becoming significantly different from baseline at follow-up. Examination of mediators found that psychological flexibility, emotion regulation skills and mindfulness, but not less fear of emotions, mediated BPD symptoms. Psychological flexibility and emotion regulation skills also mediated hopelessness. There is a need for a larger trial, for comparison with other established treatments for BPD, and for conducting a trial of a longer intervention. Nonetheless, this pilot study suggests that a brief group-based ACT intervention may be a valuable addition to TAU for people with BPD symptoms in the public sector.     

Prevention programme for eating disturbances in adolescents. Is their effect on body image maintained at 30 months later?

We assessed changes in the body image of Spanish adolescents who participated in a programme aimed at preventing disordered eating, with a 30-month follow-up. 254 girls and 189 boys aged 12–14 were assigned to a control group (n = 201) or one of two possible experimental conditions: media literacy programme (ML, n = 143) and media literacy plus nutrition awareness programme (ML + NUT, n = 99). Body image was assessed with the Body Image Questionnaire (Qüestionari d’Imatge Corporal; QÜIC). Pre-test, post-test, 7- and 30-month follow-up measurements were taken. Linear model analyses were carried out with a 2 × 3 × 3 ANOVA (sex × group × phase), adjusted by the baseline level. At 30-month follow-up, ML and ML + NUT participants showed fewer body problems and more body satisfaction than the control group. There is a need for prevention programmes addressing eating and body image disturbances that involve both boys and girls.     

Wedding-related weight change: The ups and downs of love

The present study examined wedding-related weight change in 343 brides recruited from Bridal Expos in South Australia. Demographic measures and questions about weight were assessed over three time points: upon entry into the study (n = 343), 1-month pre-wedding (n = 130), and 6-months post-wedding (n = 112). Although close to 50% of brides-to-be indicated a desire to lose weight before their weddings, linear mixed modelling revealed that their average weight did not change in the lead up to their wedding. However, 6 months after their wedding, participants had gained approximately 2 kg. In addition, women who had been told to lose weight before their wedding gained significantly more weight post-wedding compared to participants who had not been told to lose weight. The findings demonstrate that wedding-related weight change may be an important factor in the body image of newlyweds and clinicians should be mindful of potential body dissatisfaction associated with post-wedding weight gain.     

Acceptance and Commitment Therapy for Problematic Internet Pornography Use: A Randomized Trial

Problematic Internet pornography use is the inability to control the use of pornography, the experience of negative cognitions or emotions regarding pornography use, and the resulting negative effects on quality of life or general functioning. This study compared a 12-session individual protocol of acceptance and commitment therapy (ACT) for problematic Internet pornography use to a waitlist control condition with 28 adult males, all but 1 of whom were members of the Church of Jesus Christ of Latter-day Saints. Measures of self-reported pornography viewing, standardized measures of compulsive sexual behavior and related cognitions, and quality of life occurred at pretreatment, posttreatment, and 3-month follow-up. Results demonstrate significant between-condition reductions in pornography viewing compared to the waitlist condition (93% reduction ACT vs. 21% waitlist). When combining all participants (N = 26), a 92% reduction was seen at posttreatment and an 86% reduction at 3-month follow-up. Complete cessation was seen in 54% of participants at posttreatment and at least a 70% reduction was seen in 93% of participants. At the 3-month follow-up assessment, 35% of participants showed complete cessation, with 74% of participants showing at least 70% reduction in viewing. Treatment suggestions and future directions are discussed.     

Does the Animal Fun program improve social-emotional and behavioural outcomes in children aged 4–6 years?

Animal Fun was designed to enhance motor and social development in young children. Its efficacy in improving motor skills was presented previously using a randomised controlled trial and a multivariate nested cohort design. Based on the Environmental Stress Hypothesis, it was argued that the program would also result in positive mental health outcomes, investigated in the current study. Pre-intervention scores were recorded for 511 children aged 4.83–6.17 years (M = 5.42, SD = .30). Intervention and control groups were compared 6 months following intervention, and again in their first school year. Changes in teacher-rated prosocial behaviour and total difficulties were assessed using the Strengths and Difficulties Questionnaire, and data analysed using Generalised Linear Mixed Models. There was a significant improvement in prosocial behaviour of children in the intervention group six months after initial testing, which remained at 18-month follow-up. Total difficulties decreased at 6 months for the intervention group, with no change at 18 months. This effect was present only for the hyperactivity/inattention subscale. The only significant change for the control group was an increase in hyperactivity/inattention scores from pre-intervention to 18-month follow-up. The Animal Fun program appears to be effective in improving social and behavioural outcomes.     

Cognitive-Behavioral Therapy for Body Dysmorphic Disorder by Proxy

Body dysmorphic disorder (BDD) is a distressing or impairing preoccupation with a perceived defect in physical appearance. BDD by proxy (BDDBP) is a significant but understudied variant of BDD in which the primary preoccupation involves perceived imperfections of another person. Like BDD, individuals with BDDBP engage in time-consuming rituals to “fix” the other person’s appearance or alleviate distress. Avoidance is common and the impact of BDDBP on social functioning is profound. Cognitive-behavioral therapy (CBT) is the best-studied and most promising psychological treatment for BDD, but no studies have examined its generalizability to the BDDBP variant. We tested feasibility, acceptability, and treatment outcome of CBT modified for BDDBP in a sample of 6 adults with primary BDDBP. Treatment was delivered in weekly individual sessions over 12–20 weeks. Mean symptom severity (BDDBP-YBOCS) dropped from the moderately severe range at pretreatment to the subclinical range at posttreatment, t(6) = 10.7, p < .001, d = 3.3. One hundred percent of treatment completers were responders (≥ 30% reduction in BDDBP-YBOCS). Insight also improved. Treatment gains were maintained at 3-month follow-up. To our knowledge, this represents the first treatment study for BDDBP.     

Change in body image and psychological well-being during behavioral obesity treatment: Associations with weight loss and maintenance

This study reports on outcomes from a behavioral obesity treatment program, evaluating if treatment-related changes in body image and psychological well-being are predictors of weight change during treatment and after follow-up. Participants were 142 overweight/obese women (BMI = 30.2 ± 3.7 kg/m²; age = 38.3 ± 5.8 years) participants in a behavioral treatment program consisting of a 4-month treatment period and a 12-month follow-up. Psychosocial variables improved during treatment and these changes were correlated with 4-month weight reduction. Short-term changes in body size dissatisfaction (p = .002) and mood (p = .003) predicted long-term weight loss. Additional results suggest that there might be a predictive role of short-term changes in body size dissatisfaction and self-esteem on long-term weight loss after accounting for initial weight change (p < .028). We conclude that, along with weight changes, cognitive and affect-related processes influenced during obesity treatment may be related long-term success, in some cases independently of initial weight loss.     

Using Mindfulness- and Acceptance-Based Treatments With Clients From Nondominant Cultural and/or Marginalized Backgrounds: Clinical Considerations,Meta-Analysis Findings,and Introduction to the Special Series: Clinical Considerations in using Acceptance- and Mindfulness-based Treatments With Diverse Populations

A growing body of research suggests that mindfulness- and acceptance-based principles can increase efforts aimed at reducing human suffering and increasing quality of life. A critical step in the development and evaluation of these new approaches to treatment is to determine the acceptability and efficacy of these treatments for clients from nondominant cultural and/or marginalized backgrounds. This special series brings together the wisdom of clinicians and researchers who are currently engaged in clinical practice and treatment research with populations who are historically underrepresented in the treatment literature. As an introduction to the series, this paper presents a theoretical background and research context for the papers in the series, highlights the elements of mindfulness- and acceptance-based treatments that may be congruent with culturally responsive treatment, and briefly outlines the general principles of cultural competence and responsive treatment. Additionally, the results of a meta-analysis of mindfulness- and acceptance-based treatments with clients from nondominant cultural and/or marginalized backgrounds are presented. Our search yielded 32 studies totaling 2,198 clients. Results suggest small (Hedges' g = .38, 95% CI = .11 – .64) to large (Hedges' g = 1.32, 95% CI = .61 – 2.02) effect sizes for mindfulness- and acceptance-based treatments, which varied by study design.     

Augmenting In Vivo Exposure With Fear Antagonistic Actions: A Preliminary Test

The current study investigated the efficacy of an exposure augmentation strategy in which the phobic individual is encouraged to enact actions that are in direct opposition to the fear action tendencies associated with acrophobia. Participants (N = 88) meeting DSM-IV criteria for specific phobia (acrophobia) were randomized to (a) exposure with oppositional actions (E + OA), (b) exposure only (EO), (c) a credible placebo consisting of pulsed audio-photic stimulation (APS), or (d) a waitlist control (WLC). Treatment consisted of six, 6-min exposure trials. Participants were assessed with questionnaire, behavioral, and physiologic measures at pre- and posttreatment, and at a 1-month follow-up session. Participants receiving E + OA showed significantly greater improvement on behavioral and questionnaire measures than those in the other 3 conditions at both posttreatment and follow-up. Further, whereas treatment improvement generalized to an untrained context for those receiving E + OA, such was not the case for EO- and APS-treated participants. Findings suggest augmenting exposure with oppositional actions may enhance treatment outcome and thus warrant additional investigation with clinical samples.     

An Open Trial of an Acceptance-Based Behavioral Intervention for Weight Loss

Innovative approaches are urgently needed to improve behavioral treatment for weight loss. The weight regain that is so common after treatment may be a result of an environment that makes it challenging to adhere, long-term, to a dietary and physical activity regimen. This study was designed to test, via a 12-week open trial, the preliminary feasibility, acceptability, effectiveness, and possible mechanisms of action of a behavioral treatment that was modified to incorporate acceptance-based therapy components designed to (a) bolster participants’ commitment to behavior change, (b) build distress-tolerance skills, and (c) promote mindful awareness of eating behaviors and goals. Participants (n = 29) were overweight or obese women. Among completers (n = 19; 34% attrition), weight loss averaged 6.6% of body weight at posttreatment and 9.6% at 6-month follow-up (n = 14; 52% attrition). Intention-to-treat weight losses were 4.5% at posttreatment and 6.6% at 6-month follow-up. Psychological variables targeted by the intervention (e.g., cognitive restraint, disinhibition, urge-related eating behavior, emotional eating, eating-related experiential acceptance, mindfulness and motivation) changed in the expected directions, and many of these changes were consistent with decreases in weight loss. Moreover, despite the limitations of the single-group design, this pilot study demonstrated the preliminary feasibility, acceptability, and effectiveness of a novel, acceptance-based behavioral treatment for obesity. One potential implication is that behaviorally based weight loss interventions might be improved by overlaying an acceptance-based framework.     

Under what conditions do lay people and health professionals accept a breach of doctor-patient confidentiality regarding a patient with signs of terrorist radicalization?

IntroductionConfidentiality is crucial to the establishment of a strong patient-physician relationship. However, certain situations create a dilemma for the physician who is faced with the choice of either respecting medical confidentiality or protecting others from a serious risk of violence.ObjectiveThis study aimed to observe how lay people and health professionals assessed the acceptability of breaching confidentiality when a physician is confronted to a patient showing signs of terrorist radicalization.MethodA total of 228 participants (174 from the general population and 54 health professionals) judged the acceptability of 54 scenarios which were constructed through the orthogonal combination of 4 factors frequently mentioned in the literature: presence of a “Psychiatric disorder”; “Signs of radicalization”; “Projects of violence”; “Collegiality”. Variance and cluster analyses were performed on all the raw data.ResultsResults showed that all factors influenced the judgment of participants but that “Psychiatric disorders” had a weaker impact. Five clusters were identified: “Favorable if collegiality” (n = 23); “Favorable to breach confidentiality” (n = 77); “Unfavorable to breach confidentiality” (n = 26); “Sensitive to all factors” (n = 71); “Favorable if violence” (n = 31), respectively with mean ratings of 5.87, 8.42, 3.64, 6.30 and 7.16, on an acceptability scale of 0–10.ConclusionThe importance that the great majority of participants attribute to these factors indicates that they influence their judgments in this specific context.     

Evaluating the Effectiveness of ACT for Anxiety Disorders in a Self-Help Context: Outcomes From a Randomized Wait-List Controlled Trial

Rigorous evaluations of cognitive behavioral self-help books for anxiety in pure self-help contexts are lacking. The present study evaluated the effectiveness of an Acceptance and Commitment Therapy (ACT) self-help workbook for anxiety-related concerns, with no therapist contact, in an international sample. Participants (N = 503; 94% mental health diagnosis) were randomized to an immediate workbook (n = 256) or wait-list condition (n = 247). Assessments at pretreatment, 12 weeks, 6 months, and 9 months evaluated anxiety and related symptoms, quality of life, and ACT treatment processes (e.g., psychological flexibility). Participants in the wait-list arm crossed over to the workbook following the 12-week assessment. The workbook condition yielded significant improvements on all assessments from pre- to posttreatment relative to wait-list, and these gains were maintained at follow-ups. The pattern observed in the wait-list condition was virtually identical to the active treatment arm after receiving the workbook, but not before. Attrition was notable, but supplemental analyses suggested dropout did not influence treatment effects for all but one measure. Overall, findings provide preliminary support for the effectiveness of this self-help workbook and suggest ACT-based self-help bibliotherapy might be a promising low-cost intervention for people experiencing significant anxiety-related concerns.     

Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder

Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12 months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n = 69) or a wait-list condition (n = 70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination–Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d = 1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82 ≤ d ≤ 1.11). In the treatment group significant improvement was still observed for all measures 1 year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED.     

A Pilot Study of Acceptance and Commitment Therapy as a Workshop Intervention for Body Dissatisfaction and Disordered Eating Attitudes

Body image dissatisfaction is a source of significant distress among non-eating-disordered women, but because it is subclinical it is generally not treated. It remains stable throughout adulthood, and has proven resistant to many prevention interventions. This study presents a pilot test of a practical alternative: a 1-day Acceptance and Commitment Therapy (ACT) workshop targeting body dissatisfaction and disordered eating attitudes. Women with body dissatisfaction (N = 73) were randomly assigned to the workshop or to a wait list. Participants in both conditions also completed appetite awareness self-monitoring of hunger and satiety. After a brief 2-week follow-up, wait-list participants were also offered the workshop. Eating attitudes, body anxiety, and preoccupation with eating, weight, and shape improved in both arms of the study following the workshop. Participants in the ACT group showed significant reductions in body-related anxiety and significant increases in acceptance when compared to the wait-list control condition. ACT presented as a brief workshop intervention may be applicable for a broad range of women experiencing disordered eating attitudes and distress related to eating and body image; however, larger studies with longer follow-ups are needed.     

BodiMojo: Effective Internet-based promotion of positive body image in adolescent girls

This study tested the efficacy of an Internet-based health promotion program, BodiMojo, designed to promote positive body image in adolescents. Participants were 178 students (mean age 15.2 years, 67.6% ethnic minority) in three public high schools. Intervention groups used BodiMojo for four weekly health class periods, while controls participated in their usual health curriculum. Body image measures were given at baseline, post-intervention, and 3 months. Girls reported decreased body dissatisfaction (p < .05), decreased physical appearance comparison (p < .05), and increased appearance satisfaction (p < .05), relative to controls. Effects were not maintained at 3-month follow-up. No significant differences were found between the intervention and control groups with boys. Moderation analyses suggested positive effects for diverse adolescents as well as those who were overweight or indicated baseline high body dissatisfaction. BodiMojo appears to be modestly effective in decreasing body image concerns among adolescent girls in the short term.     

Trait anxiety and trait anger measured by ecological momentary assessment and their correspondence with traditional trait questionnaires

Ecological momentary assessments (EMA) of anxiety and anger/hostility were obtained every 25–30 min over two 24-h periods, separated by a median of 6 months, from 165 employees at a university in the Northeast. We used a multilevel trait-state-error structural equation model to estimate: (1) the proportion of variance in EMA anxiety and anger/hostility attributable to stable trait-like individual differences; (2) the correspondence between these trait-like components of EMA anxiety and anger/hostility and traditional questionnaire measures of each construct; and (3) the test–retest correlation between two 24-h averages obtained several months apart. After adjustment for measurement error, more than half the total variance in EMA reports of anxiety and anger/hostility is attributable to stable trait-like individual differences; however, the trait-like component of each construct is only modestly correlated with questionnaire measures of that construct. The 6-month “test–retest” correlations of latent variables representing the true 24-h EMA average anxiety and average anger are quite high (r ? 0.83). This study represents the longest follow-up period over which EMA-based estimates of traits have been examined. The results suggest that although the trait component (individual differences) of EMA momentary ratings of anxiety and anger is larger than the state component, traditional self-report questionnaires of trait anxiety and anger correspond only weakly with EMA-defined traits.     

Childhood IQ and in-service mortality in Scottish Army personnel during World War II

The Scottish Mental Survey of 1932 (SMS1932) provides a record of intelligence test scores for almost a complete year-of-birth group of children born in 1921. By linking UK Army personnel records, the Scottish National War Memorial data, and the SMS1932 dataset it was possible to examine the effect of childhood intelligence scores on wartime military service mortality in males. There were 491 matches between World War II (WWII) Scottish Army fatalities and the SMS1932 database; 470 (96%) had an age 11 mental ability score recorded. The mean (S.D.) age 11 IQ score of those who died on active service in WWII was 100.78 (15.56), compared with 97.42 (14.87) for male Army survivors (p < 0.0001; Cohen's d = 0.22). Men who took part in the SMS1932 and who were not found in the Army database had a higher mean score (100.45, S.D. =14.97) than those men who had been in the Army, regardless of whether they died or survived (mean IQ = 97.66, S.D. = 14.94; p < 0.0001; Cohen's d = 0.19). Male soldiers with a higher childhood IQ had a slightly increased risk of dying during active service in WWII. Men who did not join the Army had a higher IQ than men who did. Further research in this area should consider naval and air force personnel records in order to examine more fully the complex relationship between IQ and survival expectancy during active service in WWII.     

Exploring the integration of thin-ideal internalization and self-objectification in the prevention of eating disorders

Analyses of thin-ideal internalization and self-objectification were conducted within the context of a cognitive dissonance based eating disorder prevention program implemented in an undergraduate sorority. Participants completed self-report assessments at baseline (n = 177), post-intervention (n = 169), 5-month (n = 159), and 1-year follow-up (n = 105). Cross-sectional path analysis indicated that thin-ideal internalization and self-objectification predict each other and both predict body dissatisfaction, which in turn, predicts eating disorder symptoms. A longitudinal examination conducted using hierarchical linear modeling indicated that participants showed significant reductions in thin-ideal internalization, self-objectification, body dissatisfaction, and eating disorder symptoms after participating in the prevention program. Reductions of symptoms were maintained 1-year post-intervention, with the exception of self-objectification, which was significantly reduced up to 5-months post-intervention. Collectively, results suggest that targeting both thin-ideal internalization and self-objectification simultaneously within eating disorder prevention programs could increase the reduction of eating disorder symptoms.     

Three-year-olds’ memory for a person met only once at the age of 12 months: Very long-term memory revealed by a late-manifesting novelty preference

This study examined three-year-olds’ verbal and non-verbal memory for a person met only once after a 28 month interval. Children in the Test group (N = 50) had participated in an earlier experiment at our lab at the age of 12 months where they met one of two possible experimenters. At this past event half of the children were tested by one, the other half by the other experimenter. At the follow-up, run by a naïve experimenter, the children were shown two videos from the original experiment in a visual paired comparison task: One with the specific experimenter testing them at the original visit (the Target) and one of the other experimenter (the Foil), with whom they had no experience. When explicitly asked, the children’s responses did not differ from chance. However, eye-tracking data revealed a late-manifesting novelty preference for the “Foil” person indicating memory for the “Target” person met once before.