Acceptance and Commitment Therapy for Treatment-Resistant Posttraumatic Stress Disorder: A Case Study

An adult woman with chronic posttraumatic stress disorder (PTSD) and major depressive disorder who was nonresponsive to 20 sessions of cognitive behavior therapy (CBT) is presented in this case study. Two months after her CBT trial, she was treated with 21 sessions of Acceptance and Commitment Therapy (ACT) for PTSD. Measurements of PTSD severity, depression, anxiety, psychological flexibility and trauma-related thoughts and beliefs were taken at pretreatment, after Sessions 8 and 16, and at posttreatment. Results showed significant reduction on all measures throughout treatment, except for trauma-related thoughts and beliefs, which did not decrease until near the end of treatment. Strengths, limitations, and future directions are 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.     

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.     

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...     

Brief Acceptance and Commitment Therapy and Exposure for Panic Disorder: A Pilot Study

Cognitive and biobehavioral coping skills are central to psychosocial therapies and are taught to facilitate and improve exposure therapy. While traditional coping skills are aimed at controlling maladaptive thoughts or dysregulations in physiology, newer approaches that explore acceptance, defusion, and values-based direction have been gaining interest. Acceptance and Commitment Therapy (ACT) involves creating an open, nonjudgmental stance toward whatever thoughts, feelings, and bodily sensations arise in a given moment, experiencing them for what they are, and moving toward them while inner experiences such as anxiety are present. This approach can be seen as consistent with exposure therapies and may be utilized to organize and facilitate engagement in exposure exercises. This study examines the feasibility and efficacy for combining a brief ACT protocol with traditional exposure therapy. Eleven patients with panic disorder with or without agoraphobia received 4 sessions of ACT followed by 6 sessions of exposure therapy, with data collected on a weekly basis. Acquisition of ACT skills and their application during exposure was monitored using a novel “think-aloud” technology. Treatment was associated with clinically significant improvements in panic symptom severity, willingness to allow inner experiences to occur, and reductions in avoidant behavior. Although preliminary, results suggest that our brief training in ACT only (as assessed prior to exposure exercises) and in combination with exposure therapy was acceptable to patients and offered benefits on the order of large effect sizes. Clinical and research implications are discussed.     

Acceptance and Commitment Therapy for Anger Dysregulation with Military Veterans: A Pilot Study

Anger dysregulation is a commonly reported problem by treatment-seeking military veterans that is associated with a range of negative outcomes. However, there is a paucity of studies examining interventions for anger and aggressive behavior in this population. Theory and empirical evidence suggest Acceptance and Commitment Therapy (ACT) may be a viable and effective treatment for anger dysregulation among veterans. The present study examined the feasibility and preliminary effectiveness of an open trial of an ACT group intervention for veterans reporting difficulties with anger and aggressive behavior. Twenty-three male military veterans (mean age?=?54.83) initiated a 12-week ACT intervention with assessments administered at pre-treatment, post-treatment, and 6-week follow-up. Treatment completers found the intervention favorable, and participation was associated with improvements in trait physical aggression and psychological flexibility, while significant changes in anger reactivity, quality of life, and verbal aggression were not found. Results suggest group-based ACT for anger dysregulation is feasible in a male military veteran sample, and warrants further investigation.     

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.     

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.     

Acceptance and Commitment Therapy for Anxiety Disorders: Three Case Studies Exemplifying a Unified Treatment Protocol

Acceptance and Commitment Therapy (ACT) is an innovative acceptance-based behavior therapy that has been applied broadly and successfully to treat a variety of clinical problems, including the anxiety disorders. Throughout treatment ACT balances acceptance and mindfulness processes with commitment and behavior change processes. As applied to anxiety disorders, ACT seeks to undermine excessive struggle with anxiety and experiential avoidance––attempts to down-regulate and control unwanted private events (thoughts, images, bodily sensations). The goal is to foster more flexible and mindful ways of relating to anxiety so individuals can pursue life goals important to them. This article describes in some detail a unified ACT protocol that can be adapted for use with persons presenting with any of the major anxiety disorders. To exemplify this approach, we present pre- and posttreatment data from three individuals with different anxiety disorders who underwent treatment over a 12-week period. The results showed positive pre- to posttreatment changes in ACT-relevant process measures (e.g., reductions in experiential avoidance, increases in acceptance and mindfulness skills), increases in quality of life, as well as significant reductions in traditional anxiety and distress measures. All three clients reported maintaining or improving on their posttreatment level of functioning.     

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.     

Acceptance and Commitment Therapy in Genetic Counselling: A Case Study of Recurrent Worry

I present a case study where the mother of a child with 22q11 deletion disorder appeared to be experiencing recurrent, intrusive worry associated with the inherent uncertainty of this highly variable condition. Counselling sessions are summarised followed by an in-depth reflection about the case with reference to the main therapeutic tenets of Acceptance and Commitment Therapy (ACT). Specific techniques which may have been of great benefit to the client and potential application in the genetic counselling setting are explored in the context of ACT.     

A Stabilization Group Approach for Heterogeneous Populations of Trauma Clients

High prevalence and long-lasting implications of human-inflicted trauma call for effective treatment approaches reaching clients in need of trauma-specific treatment. Numerous approaches exist, but often with limited empirical support. There is also a tendency toward segregating treatment approaches depending on type of exposure history and presenting symptoms. This might exclude clients in need of trauma-specific treatment; therefore, treatment approaches that can reach more heterogeneous groups of clients are needed. In this article, a group-based treatment approach adjusted to include clients with a wide range of trauma-related problems and traumatic experiences will be presented. A brief outline of the approach is presented, together with the theoretical and empirical background, to facilitate implementation by practitioners and empirical testing.     

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.     

School-Based Acceptance and Commitment Therapy for Adolescents With Anxiety: A Pilot Trial

Anxiety disorders are one of the most prevalent diagnoses in youth, often resulting in impaired social and school functioning. Research on treatments for youth anxiety is primarily based in traditional clinical settings. However, integrating youth psychotherapies into the school environment improves access to evidence-based care. The present study is a pilot, randomized waitlist-controlled trial of a school-based, group Acceptance and Commitment Therapy–based (ACT) intervention for adolescents with anxiety. Students at two separate schools (N = 26) with elevated anxiety were randomized to a 12-week waitlist or to immediate treatment. Participants in the immediate treatment condition reported statistically significant decreases in anxiety and class absences at posttreatment and follow-up compared to the waitlist group. No statistically significant differences were found between groups for depression, psychological flexibility, positive mental health, and student well-being. However, medium within-condition effect sizes were seen in the treatment group for all outcomes. Participants reported the treatment as favorable with good acceptance ratings. Overall, this study supports ACT as a viable intervention for schools and other clinical settings providing services to adolescents with anxiety.     

Acceptance and Commitment Therapy as a Spiritually Integrated Psychotherapy

This article presents acceptance and commitment therapy (ACT) as a spiritually integrated therapeutic modality. ACT is a value‐driven therapy that involves facilitating transcendence of physical, mental, and emotional experience to alleviate human suffering; as such, ACT shares common ground with the domain of spirituality. Approached as a spiritually integrated therapy, ACT can help clients to access spiritual resources and create life meaning as well as aid in the resolution or transformation of spiritual struggles. Given that spiritual struggles, in particular, can have a significant impact on mental health and well‐being, this article provides guidance in how ACT can address such struggles.     

Incorporating Principles from Acceptance and Commitment Therapy into Cognitive-Behavioral Therapy for Insomnia: A Case Example

Although traditional cognitive behavioral treatments for insomnia have demonstrated efficacy for many individuals with primary and comorbid insomnia, not all individuals benefit from treatment and some experience a subsequent relapse of insomnia. Furthermore, many individuals experience difficulty in implementing the sleep restriction and stimulus control strategies, especially over the long-term. The current article describes ways in which principles from a newer type of behavior therapy, Acceptance and Commitment Therapy (ACT), can be integrated with traditional behavioral treatment strategies for insomnia. A major goal of ACT is to increase willingness to experience unpleasant thoughts, feelings, and physical sensations, and to promote engagement in personally-valued behaviors while non-judgmentally observing these unpleasant experiences. ACT has the potential to enhance the behavioral treatment of insomnia by fostering willingness to experience short-term discomfort (e.g., fatigue) that occurs while implementing sleep restriction and stimulus control strategies. A case example is presented to illustrate how these principles from ACT can be integrated with behavioral techniques in the treatment of insomnia.     

Exploring Compatibilities Between Acceptance and Commitment Therapy and 12-Step Treatment for Substance Abuse

Behavioral science research has appeared to conflict with the 12-step treatment approach, which is the prevalent practice in the treatment of addictions in the United States. Compatibilities between 12-step and Acceptance and Commitment Therapy, a contextual behavioral treatment, are explored with the aim of reducing this friction and better serving consumers.     

接纳与承诺疗法的理论背景、实证研究与未来发展

接纳与承诺疗法(Acceptance and Commitment Therapy, ACT)于上世纪90年代初由美国治疗师Steven C. Hayes提出。作为基于正念技术的第三代行为治疗理论之一, 该疗法以功能情境主义为哲学基础, 立足于人类认知和语言基本性质的实证研究, 旨在通过平衡接纳与改变来提高心理灵活性。临床研究已证明其在相当广泛的临床问题上都取得了良好效果, 并在与CBT等传统疗法的对比中展现优势。ACT的临床效果和技术细节可做进一步研究, 该疗法与CBT的融合及其在临床领域之外的应用也是未来的研究方向。     

Safety Planning Within Acceptance and Commitment Therapy

Acceptance and commitment therapy (ACT) is a contextual behavioral psychotherapy that helps clients build meaningful lives in the service of their own chosen values, rather than specifically focusing on symptom reduction or prevention of destructive behaviors. However, empowering ACT clients to navigate suicidal crises effectively is vital to ensuring the opportunity to build a life they will choose to live. Suicide safety planning is a widely used empirically supported approach to prepare clients to survive suicidal crises, and can be effectively incorporated into ACT. In this paper, we offer a contextual behavioral conceptualization of suicide as an extreme attempt to solve the problem of painful thoughts, emotions, and sensations, and provide an example of how this conceptualization and the necessity of safety planning can be introduced to clients. Use of chain analysis of suicidal behavior is introduced as a tool to inform the suicide safety plan. We describe how ACT processes can enhance safety plans and, in turn, create safety plans that will serve as means to develop skills associated with efficacious/effective ACT interventions. Finally, we discuss the ongoing evaluation and revision of the safety plan from an ACT framework.