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.     

抑郁反刍的接纳承诺疗法理论与实践

从关系框架理论出发,通过接纳承诺疗法核心病理过程分析抑郁反刍,探究接纳承诺疗法治疗抑郁反刍理论意义上的可能性,并提出在临床中如何治疗抑郁反刍。首先,分析抑郁反刍的理论意义以及临床症状,通过接纳承诺疗法病理视角发现抑郁反刍可以被病理过程解构,指出接纳承诺疗法治疗抑郁反刍理论上的可能性。其次,根据理论分析提出接纳承诺疗法通过提升个体心理灵活性以及明确人生价值来治疗抑郁反刍的方法。最后,阐述接纳承诺疗法治疗抑郁反刍的未来研究方向和可能存在的问题。

     

接纳与承诺疗法的功能性语境主义解读

接纳与承诺疗法(ACT)是认知行为疗法“第三次浪潮”中最有代表性的疗法之一。依托功能性语境主义,探究ACT中的语境主义和实用主义。在功能性语境主义背景下,分析心理事件时要综合考虑其背景和功能及其相应的交互作用,提升分析的准确性、全面性。同时,以目标为导向,明确心理事件的内涵及其改善措施。基于此,在ACT的两大治疗过程中,充分渗透功能性语境主义,并通过灵活多样的治疗方法,提升个体的心理灵活性。     

Accept Yourself! A Pilot Randomized Controlled Trial of a Self-Acceptance-Based Treatment for Large-Bodied Women With Depression

A pilot parallel randomized controlled trial compared a self-acceptance, non-weight-loss intervention, Accept Yourself! (AY), to a weight loss program, Weight Watchers (WW), in order to provide preliminary safety, feasibility, and efficacy data in preparation for a definitive RCT of AY as an intervention to enhance the mental and physical health of larger-bodied women with Major Depressive Disorder (MDD). Adult women with MDD and a Body Mass Index ≥30 were eligible. Nineteen women were randomized by random number table into AY (n = 9) or WW (n = 10). Intake, pretreatment, posttreatment, 3-, 6-, 9-, and 12-month follow-up assessments occurred at a rural academic medical center. Primary outcomes included depression severity and cardiovascular fitness. Chi-square and t-tests assessed attrition and participant preferences for treatment; other analyses used intention-to-treat, linear mixed-effects models for repeated measures, including all participants’ available data. Both groups improved in self-reported, F(5, 43.81) = 7.45, p < .001, partial η² = .38, and blinded-clinician-rated depression, F(6, 62.03) = 10.41, p < .001, partial η² = .5. AY was superior to WW in self-reported depression, F(5, 43.81) = 2.72, p = .03, partial η² = .11. Neither group improved in fitness. Eating disorder symptoms and weight gain worsened in WW. AY appeared safe, feasible, and offered initial evidence of efficacy for depression; it should be investigated in a definitive RCT, with modifications to increase potency. WW may not be suitable as a comparator intervention for AY because of risk to participants.     

接纳承诺疗法的作用机制——基于元分析结构方程模型

接纳承诺疗法(Acceptance and Commitment Therapy, ACT)被认为是行为治疗“第三浪潮”的重要代表。本研究使用元分析结构方程模型, 考察ACT的作用机制。通过数据库检索与筛选, 最终纳入文献50篇。结果发现: ACT所假设的心理灵活性、接纳、此时此刻、价值的中介作用都达到统计显著, 认知解离这一中介变量并不显著; 中介机制在网络化干预中仍然得到检验; 相较之传统CBT, ACT在所假设的机制上有其区别于CBT的优势。后续临床研究应更全面地测量6大核心机制, 关注对美好生活提升的影响, 采用多点瞬时评价法, 并尽可能使用更高级、更先进的统计方法检验其作用机制。     

家庭暴力与中学生心理素质的相关研究

使用家庭暴力量表和中学生心理素质量表对广州市403名中学生进行测试,探索家庭暴力(包括肢体暴力、言语暴力、冷暴力)与中学生心理素质的关系。结果表明:家庭暴力是普遍存在的,对中学生心理素质的影响较大;家庭暴力的严重程度为冷暴力>言语暴力>肢体暴力;三种暴力与心理素质呈显著负相关,其中冷暴力对心理素质有更强的预测力,它具有较大的隐藏性和更多的伤害性,更应该引起重视。     

大学生幽默风格与精神健康关系的初步研究

目的:测试幽默风格量表在中国大学生中的信度和效度,探讨幽默风格与精神健康之间的关系。方法:354名大学生接受幽默风格量表和症状自评量表(SCL-90)的问卷调查,4周后74名大学生重新填写幽默风格量表。结果:幽默风格量表所提出的4个因子结构在中国人的样本中也存在,该量表的信度和效度可接受。中国被试在4个子量表的得分均低于加拿大被试的得分。亲和型幽默、自强型幽默得分与症状自评量表的子量表以及总体症状指数得分全部呈现负相关,而嘲讽型幽默和自贬型幽默得分与症状自评量表的子量表以及总体症状指数得分全部呈现正相关。结论:(1)该量表的初步测试效度和信度可接受,但须结合中国文化作进一步的修订;(2)亲和型和自强型幽默有益于精神健康,但嘲讽型和自贬型幽默有害于精神健康;(3)中国人与加拿大人在幽默风格、幽默对精神健康起作用的方式上存在一定的文化差异。     

亲子关系对中学生心理健康的影响:社会支持和心理素质的链式中介作用

为探究亲子关系、社会支持和心理素质对中学生心理健康的影响,本研究采用问卷调查的方式,对全国23个省（市）共10190名初一至高三年级的中学生展开调查。结果表明：（1）父子关系、母子关系、社会支持和心理素质两两之间呈显著正相关,且均与心理健康问题呈显著负相关;（2）相比于母子关系,父子关系对中学生心理健康的影响更大;（3）亲子关系通过三条中介路径对中学生心理健康产生影响：①是社会支持和心理素质的单独中介作用;②社会支持和心理素质的链式中介作用。本研究进一步明确了亲子关系和中学生心理健康之间的内在心理机制,同时能帮助教育工作者预防和干预中学生的心理健康问题。     

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.     

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。     

大学生心理健康教育教学模式的构建与实践研究

采用自然教学实验法,探索提高大学生心理健康水平的有效途径与教学模式。结果表明（1）开设心理健康教育课程并辅以心理咨询是眼下提高大学生心理健康水平的有效措施之一;（2）不同系科心理健康教育的效果不同,心理健康教育课程应根据学生的个别差异有针对性地进行;（3）大学生心理健康教育课程的教学模式为“面上集中释疑,线上互相解疑,点上个别辅导”。     

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.     

异地复学震区中小学生PTSD及心理健康状况的调查

创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）是指突发性、威胁性或灾难性生活事件导致个体延迟出现和长期持续存在的精神障碍,其临床表现以再度体验创伤为特征,并伴有情绪的易激惹和回避行为,影响患者的心理健康。采用创伤后应激障碍自评量表和症状自评量表对异地复学的震区中小学生进行测量,了解他们的PTSD及心理健康状况。结果表明：震区中小学生PTSD和SCL-90的检出率都较高;不同性别、不同年级学生受地震的负性影响不同,其心理健康状况也有差别     

An Open Trial of Group Acceptance and Commitment Therapy With an Adjunctive Mobile App for Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is a common and debilitating condition. Effective treatments exist, but they are time- and resource-intensive. This study tested the initial efficacy and acceptability of a novel treatment protocol designed to increase efficiency: acceptance and commitment therapy (ACT) taught in groups and through an adjunctive mobile app. Participants were 21 individuals with GAD who received six weeks of 2-hour group ACT sessions as well as access to an adjunctive ACT mobile app. Significant improvements occurred in worry, anxiety, social functioning, and depression as well as relevant processes (psychological inflexibility, anxiety-related cognitive fusion). In-the-moment improvements were also observed in symptoms and ACT processes immediately after completing mobile app sessions. Treatment was perceived as credible and acceptable overall. However, rates of reliable and clinically significant change were low, and app usage did not correlate with change in worry. Overall, this study suggests that an efficient, brief ACT group intervention combined with a mobile app may lead to improvements in GAD but may not be sufficient for clinically significant change. A detailed overview of the treatment is included, and guidance for clinicians interested in implementing this protocol is discussed.     

An Open Trial of Acceptance and Commitment Therapy With Exposure and Response Prevention in an Intensive Outpatient Setting for Adults With OCD

Intensive outpatient treatment settings for adults with obsessive-compulsive disorder (OCD) are common, but data on their effectiveness are limited. The effectiveness of IOP treatment for adults with OCD using combined acceptance and commitment therapy (ACT) and exposure and response prevention (ERP) was studied with eight adults. The intervention was 15 hours per week for 3 weeks. Measures were collected at pretreatment, 1-week, 2-weeks, posttreatment, and at 1-month follow-up. At the end of treatment, all participants were in the mild range of OCD symptom severity with a mean symptom decrease of 58%. Psychological inflexibility, depression, anxiety, and stress significantly decreased through treatment and participants ended treatment below clinical range for psychological inflexibility and nonclinical to mild range for depression, anxiety, and stress. The results of this study provide preliminary support for the effectiveness of ACT and ERP in an intensive outpatient setting for adults with OCD. The focus of this paper is on the clinical application of this treatment.     

Randomized Controlled Trial of a Multilevel Intervention to Address Social Determinants of Refugee Mental Health

Understanding processes that support the well-being of the unprecedented numbers of forcibly displaced people throughout the world is essential. Growing evidence documents post-migration stressors related to marginalization as key social determinants of refugee mental health. The goal of this RCT was to rigorously test a social justice approach to reducing high rates of distress among refugees in the United States. The 6-month multilevel, strengths-based Refugee Well-being Project (RWP) intervention brought together university students enrolled in a 2-semester course and recently resettled refugees to engage in mutual learning and collaborative efforts to mobilize community resources and improve community and systems responsiveness to refugees. Data collected from 290 Afghan, Great Lakes African, Iraqi, and Syrian refugees at four time points over 12 months were used to test the effectiveness of RWP to reduce distress (depression and anxiety symptoms) and increase protective factors (English proficiency, social support, connection to home and American cultures). Intention-to-treat analyses using multilevel modeling revealed significant intervention effects for all hypothesized outcomes. Results provide evidence to support social justice approaches to improving refugee mental health. Findings have implications for refugees worldwide, and for other immigrant and marginalized populations who experience inequities in resources and disproportionate exposure to trauma/stress.     

Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center

Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.     

中小学生正念注意觉知与心理健康：情绪调节和积极重评的跨时间中介作用

本研究探讨中小学生正念注意觉知的发展及其与心理健康的关系,并考察情绪调节和积极重评在其中起到的中介作用。研究采用追踪设计,来自江西地区两所小学(4到6年级)和两所中学(7到9年级)的共1251名学生(男生691人,女生560人)在间隔半年的两个时间点分别填写了测量正念注意觉知、心理健康(生活满意度、抑郁、焦虑、学业压力)、情绪调节以及积极重评的问卷。结果表明：(1)中学生正念注意觉知显著低于小学生;(2)中小学生正念注意觉知与两个时间点的情绪调节、积极重评及心理健康均显著相关;(3)跨时间点中介效应检验结果表明,在中小学生正念注意觉知和各心理健康变量的关系中,情绪调节中介效应均显著,积极重评中介效应均不显著。结论：中小学生正念注意觉知与心理健康密切相关,正念注意觉知通过情绪调节能力间接作用于中小学生心理健康。