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。     

Can Acceptance,Mindfulness, and Self-Compassion Be Learned by Smartphone Apps? A Systematic and Meta-Analytic Review of Randomized Controlled Trials

The potential health benefits of acceptance, mindfulness, and self-compassion are well-documented. However, interventions that teach these principles typically rely on face-to-face delivery, which can limit their dissemination. Delivering these interventions through smartphone apps could help overcome this. This meta-analysis examined whether principles of acceptance, mindfulness, and self-compassion can be learned through smartphone apps. Twenty-seven randomized controlled trials were included. Smartphone apps that included acceptance and/or mindfulness components resulted in significantly higher levels of acceptance/mindfulness than comparison conditions (k = 33; g = 0.29; 95% CI = 0.17, 0.41). These effects were moderated by the type of comparison and whether reminders to engage were offered. Smartphone apps also resulted in significantly lower levels of psychological distress than comparisons (k = 22; g = −0.32; 95% CI = −0.48, −0.16). Meta-regression revealed a negative relationship between the effect sizes for mindfulness/acceptance and the effect sizes for distress. Smartphone apps produced significantly greater increases in self-compassion than comparisons (k = 9; g = 0.31; 95% CI = 0.07, 0.56), although the quality of RCTs in this analysis was poor. Findings suggest that principles of acceptance, mindfulness, and self-compassion may be learned through cheap, easily accessible, and low-intensity interventions delivered via smartphone apps. However, the quality of available evidence is poor, as low risk of bias was noted in few trials (18%) and the observed effects were likely explained by a digital placebo.     

Relational frame theory,acceptance and commitment therapy,and a functional analytic definition of mindfulness

The present article interprets mindfulness from the point of view of the effects of language and cognition on human action. Relational Frame Theory is described to show how human suffering is created by entanglement with the cognitive networks made possible by language. Mindfulness can be understood as a collection of related processes that function to undermine the dominance of verbal networks, especially involving temporal and evaluative relations. These processes include acceptance, defusion, contact with the present moment, and the transcendent sense of self. Each of these components of mindfulness are targeted in Acceptance and Commitment Therapy, and there is some evidence that they underlie the therapeutic changes induced by this approach. The relation between the present approach to mindfulness and other approaches is discussed.     

Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes

Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal.     

Group acceptance and commitment therapy (ACT) for bipolar disorder and co-existing anxiety – an open pilot study

Previous studies have supported acceptance and commitment therapy (ACT) for reducing impairment related to various chronic conditions. ACT may possibly be beneficial for bipolar disorder (BD) with co-existing anxiety, which is associated with a poorer treatment outcome. Efforts are needed to identify suitable psychological interventions for BD and co-existing anxiety. In this open clinical trial, we included 26 patients with BD type 1 or 2 at an outpatient psychiatric unit specializing in affective disorders. The intervention consisted of a 12-session manualized group treatment that included psychoeducation, mindfulness, engaging in values-based behaviour, cognitive defusion, acceptance and relapse prevention modules. Participants completed four self-report questionnaires covering anxiety symptoms (Beck Anxiety Inventory - BAI), depressive symptoms (Beck Depression Inventory - BDI-II), quality of life (Quality of Life Inventory - QOLI) and psychological flexibility (Acceptance and Action Questionnaire - AAQ-2) before, during and after the treatment. At post-treatment, the participants reported significant improvements in all outcome measures, with large effects (Cohen’s d between 0.73 and 1.98). The mean reduction in anxiety symptoms was 45%. At post-treatment, 96% of the patients were classified as responders on at least one of the outcome measures. A limitation is that the trial is uncontrolled. The results suggest that ACT has the potential to be an effective treatment for BD patients with co-existing anxiety. Further randomized studies are warranted.     

Acceptance and Mindfulness Techniques as Applied to Refugee and Ethnic Minority Populations With PTSD: Examples From "Culturally Adapted CBT"

In this article we illustrate how we utilize acceptance and mindfulness techniques in our treatment (Culturally Adapted CBT, or CA-CBT) for traumatized refugees and ethnic minority populations. We present a Nodal Network Model (NNM) of Affect to explain the treatment's emphasis on body-centered mindfulness techniques and its focus on psychological flexibility. We explain the definition of mindfulness that guides our treatment, and we outline a typology of mindfulness states and show how many of the techniques in our treatment can be analyzed by these categories. We argue that acceptance and mindfulness are therapeutic for refugees and minority populations for several reasons. These include their increasing psychological flexibility, decreasing somatic distress, decreasing rumination, serving as emotion regulation techniques, decreasing the attentional bias to threat, and forming part of a new adaptive processing mode (which in CA-CBT centers on psychological flexibility). We describe the specific ways we teach acceptance and mindfulness with Latino and Southeast Asian refugee populations and present case examples of the treatment of a traumatized Latino and Cambodian patient.     

正念对压力的影响-基于监测与接纳理论

压力是对潜在威胁性事件产生的生理与心理反应。正念通过专注当下并保持接纳的态度缓解压力。然而以往关于正念缓解压力的研究并没有明确具体的机制,且忽略了正念影响压力过程中的复杂性与多样性。监控与接纳理论通过解构监控与接纳成分,更加清晰地呈现了正念的作用机制,因此本文依据监控与接纳理论,梳理正念对压力的影响效果及其心理神经机制。未来的研究在探讨正念通过监控与接纳成分影响压力的同时应重点关注监控作用效果与机制;重视压力刺激与压力评估的重要性;设计新的实验范式,直接探究正念监控与接纳对压力影响的心理与神经机制。     

What works in anti-bullying programs? Analysis of effective intervention components

Previous research has shown that many school-based anti-bullying programs are effective. A prior meta-analysis (Gaffney, Ttofi, & Farrington, 2019) found that intervention programs are effective in reducing school-bullying perpetration by approximately 19–20% and school-bullying victimization by approximately 15–16%. Using data from this prior meta-analysis, the aim of the current study was to examine the relationship between effectiveness estimates and specific elements of anti-bullying programs. Specific intervention components in line with a socio-ecological framework were coded as present or absent. Components were coded on the following levels: school, classroom, teacher, parent, peer, individual, and intervention. Meta-analytical subgroup comparisons analogous to ANOVA were computed to examine the relationship between the presence of specific components and the effectiveness in reducing bullying perpetration (n = 82) and victimization (n = 86). Results indicated that the presence of a number of intervention components (e.g., whole-school approach, anti-bullying policies, classroom rules, information for parents, informal peer involvement, and work with victims) were significantly associated with larger effect sizes for school-bullying perpetration outcomes. The presence of informal peer involvement and information for parents were associated with larger effect sizes for school-bullying victimization outcomes. Meta-regression analyses showed no significant relationship between effectiveness and the number of intervention components included in a program. The present report contributes to the understanding of 'what works' in reducing school-bullying perpetration and victimization. The impact of these findings on future anti-bullying research is discussed.     

Mindfulness and trauma: implications for treatment

Mindfulness, originally a construct used in Eastern spiritual and philosophical traditions, has found new utility in psychotherapy practice. Mindfulness practice has been recently applied to treatments of several psychological and health related problems, and research is showing successful outcomes in psychological interventions incorporating mindfulness practices. Several schools of psychotherapy have theorized why mindfulness may be an effective intervention. One population which would theoretically be benefited by mindfulness practice in treatment consists of those individuals who have experienced traumatic events and are exhibiting post-traumatic stress disorder and/or related correlates of past trauma. The present paper gives a general review of the application of mindfulness to clinical psychology interventions. Additionally, we explain how mindfulness is applicable to our integrative behavioral approach to treating trauma and its sequelae. Specifically, this paper will (a) give a general overview of the conceptions and applications of mindfulness to psychology and psychotherapy and provide a brief account of the concepts origins in eastern traditions; (b) discuss the theoretical conceptualization of clinical problems that may relate to the long-term correlates of trauma; (c) describe how mindfulness, acceptance and the therapeutic relationship can address trauma symptoms and discuss a modified treatment approach for trauma survivors that incorporates mindfulness and acceptance practices into traditional exposure treatment.

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An open trial of mindfulness‐based stress reduction for young adults with social anxiety disorder

The present study investigated mindfulness‐based stress reduction (MBSR) for young adults with a social anxiety disorder (SAD) in an open trial. Fifty‐three young adults in a higher education setting underwent a standard eight‐week MBSR program. Eight participants (15%) did not complete the program. Participants reported significant reductions in SAD symptoms and global psychological distress, as well as increases in mindfulness, self‐compassion, and self‐esteem. Using intention‐to‐treat (ITT) analyses, effect sizes ranged from large to moderate for SAD symptoms (Cohen's d = 0.80) and global psychological distress (d = 0.61). Completer analyses yielded large effect sizes for SAD symptoms (d = 0.96) and global psychological distress (d = 0.81). The largest effect sizes were found for self‐compassion (d = 1.49) and mindfulness (d = 1.35). Two thirds of the participants who were in the clinical range at pretreatment reported either clinically significant change (37%) or reliable improvement (31%) on SAD symptoms after completing the MBSR program, and almost two thirds reported either clinically significant change (37%) or reliable improvement (26%) on global psychological distress. MBSR may be a beneficial intervention for young adults in higher education with SAD, and there is a need for more research on mindfulness and acceptance‐based interventions for SAD.     

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.     

正念冥想训练水平对情绪加工的影响

越来越多的研究表明,正念冥想训练影响情绪加工。本文从正念冥想训练水平（包括临时训练、短时训练和长期训练）角度出发,系统回顾了不同水平的正念冥想训练对情绪加工的调节效应。综述发现,不同水平正念冥想训练都能够提高个体情绪调节能力,临时正念冥想训练作为一种有效的情绪调节方法影响情绪加工,而短期正念冥想训练和长期禅修训练通过增加个体正念意识,增强个体情绪接受力影响情绪加工。未来的研究需进一步在区分正念冥想训练时间和正念冥想训练类别基础上,探讨正念冥想训练影响情绪加工的认知神经机制。     

正念对饮食行为的影响及作用机理

正念是一种以不批判的态度全然接纳当下体验的觉察力,正念训练对改善不良饮食行为的积极作用正日益受到研究者的广泛关注。本文对正念在改善不良饮食行为中的积极作用与机理,以及基于正念的不良饮食行为矫正方法进行了梳理与归纳。在已有研究的基础上,未来研究需要进一步探索正念对健康饮食行为的作用、从生命周期的视角考察正念对饮食行为的影响、基于思维压抑视角探讨正念的作用机制以及检验正念不良饮食矫正效果的边界。     

积极社会心态：正念培育的目标、机制与途径

正念培育积极社会心态,指运用正念的理论、方法与技术促进积极社会心态的培养、教育和引导,并将消极社会心态转化为积极社会心态的过程。其可能的机制为：通过正念养育、正念教育、正念社区与正念生产提高个体与情境正念,在复杂系统中经过循环反应、内隐互动和价值累加来培育和转化社会心态。未来应建构正念公共心理服务体系;区分世俗化与宗教化的正念;研究内隐正念和积极社会心态的关系;从东方传统文化中汲取营养。     

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.     

Text anxiety in adolescents: the role of self-criticism and acceptance and mindfulness skills

The current study sets out to explore test anxiety in adolescent students. The effect of sociodemographic variables on test anxiety was controlled for and the relationship between test anxiety and other psychological constructs, such as self-criticism, social anxiety, acceptance and mindfulness, was examined. In addition, the predictive effect/power of these variables was analyzed and a comparative study between high and low test anxiety adolescents was conducted. Participants in this study were 449 high school students, 211 boys and 238 girls, with a mean age of 16.28 years. These participants completed a battery of self-report questionnaires composed by the Portuguese versions of Test Anxiety Inventory (TAI), Child Acceptance and Mindfulness Measure (CAMM), Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS), and the Social Anxiety and Avoidance Scale for Adolescents (SAASA). Results showed that gender, self-criticism and competencies for acceptance and mindfulness had a significant and an independent contribution on the prediction of test anxiety. The comparative study revealed that adolescents with high test anxiety score significantly higher in negative forms of self-criticism, social anxiety and lower in self-reassurance, acceptance and mindfulness, when compared to those with low test anxiety. Despite its exploratory nature, the current study adds to the existing knowledge on the influence of psychological processes, such as self-criticism and acceptance, on test anxiety. These findings might constitute a relevant contribution to psychological intervention with adolescents.     

Using Acceptance and Commitment Therapy to Treat Distressed Couples: A Case Study With Two Couples

Although the field of couple therapy has made significant strides in recent years, there continues to be a need for theoretically sound and empirically supported treatments. The current case study examines whether Acceptance and Commitment Therapy (ACT), an experiential acceptance-based behavior therapy, can be effective in treating distressed couples. Although ACT has demonstrated effectiveness in treating a variety of disorders in individuals, it has not been systemically applied to the treatment of couple distress, and the current study is the first empirical examination of ACT for the treatment of couples. Two married couples participated in the study. A number of core ACT interventions were modified to treat couples in a conjoint format. Cognitive defusion exercises were used to help couples reduce their fusion with and the believability of negative thoughts and feelings related to the relationship. Mindfulness and acceptance techniques were used to help couples increase awareness of their reactions to negative relationship cycles. Finally, value-directed action was used to help partners act in ways consistent with relationship values even in the presence of unwanted thoughts and feelings. The results of this preliminary case study suggest that ACT may be effective in increasing marital adjustment and satisfaction, and in reducing interpersonal and psychological distress in couples. Future studies with larger samples and more controlled designs are needed to build on the results from this single-case study.     

A Couple-Based Psychological Treatment for Chronic Pain and Relationship Distress

Chronic pain impacts individuals with pain as well as their loved ones. Yet, there has been little attention to the social context in individual psychological treatment approaches to chronic pain management. With this need in mind, we developed a couple-based treatment, “Mindful Living and Relating,” aimed at alleviating pain and suffering by promoting couples’ psychological and relational flexibility skills. Currently, there is no integrative treatment that fully harnesses the power of the couple, treating both the individual with chronic pain and the spouse as two individuals who are each in need of developing greater psychological and relational flexibility to improve their own and their partners’ health. Mindfulness, acceptance, and values-based action exercises were used to promote psychological flexibility. The intervention also targets relational flexibility, which we define as the ability to interact with one’s partner, fully attending to the present moment, and responding empathically in a way that serves one’s own and one’s partner’s values. To this end, the intervention also included exercises aimed at applying psychological flexibility skills to social interactions as well as emotional disclosure and empathic responding exercises to enhance relational flexibility. The case presented demonstrates that healthy coping with pain and stress may be most successful and sustainable when one is involved in a supportive relationship with someone who also practices psychological flexibility skills and when both partners use relational flexibility skills during their interactions.     

The Roles of Cognitive Flexibility and Experiential Avoidance in Explaining Psychological Distress in Survivors of Interpersonal Victimization

The long-term negative psychological consequences associated with interpersonal victimization are significant; however a history of interpersonal victimization alone does not necessarily lead to greater long-term psychological distress. The current study examined the relationship between cognitive flexibility, experiential avoidance, and psychological distress among 92 women who reported a history of interpersonal victimization. The findings indicate that both cognitive flexibility and experiential avoidance are significantly related to posttraumatic stress symptomology and depression in this sample. Preliminary evidence is also presented suggesting experiential avoidance maybe a potential mediator between cognitive flexibility and psychological distress in this sample. The current findings suggest that treatments targeting greater emotional acceptance and mindfulness might be useful approaches in working with survivors of interpersonal victimization.