Comparing cognitive fusion and cognitive reappraisal as predictors of college student mental health

Transdiagnostic cognitive behavioral interventions target different cognitive processes to promote mental health, including cognitive fusion and cognitive reappraisal. Determining the relative impact of cognitive fusion and reappraisal on a range of student mental health concerns could help interventions target psychopathological cognitive processes more effectively. Therefore, this study examined the longitudinal impact of cognitive fusion and reappraisal on mental health and functioning outcomes. A series of hierarchical regression models tested the effects of cognitive fusion and reappraisal in a sample of college students (n = 339). When controlling for reappraisal and baseline symptoms, fusion predicted distress, depression, generalized anxiety, social anxiety, hostility, academic distress, and student role problems 1 month later. Reappraisal predicted only student role problems longitudinally when controlling for fusion. These results suggest that cognitive fusion is a stronger predictor than reappraisal for a range of student mental health concerns and may be a particularly important target for improving student mental health.     

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.     

Comparing in-the-moment skill coaching effects from tailored versus non-tailored acceptance and commitment therapy mobile apps in a non-clinical sample

Mobile apps are promising for teaching how to practice psychological skills in high-risk and in vivo momentary situations, but there has been minimal research on the immediate effects of app-based skill coaching on mental health in-the-moment. This study analyzed the mobile app data in a non-clinical sample of 39 adults participating in a larger randomized controlled trial, with participants randomized to an acceptance and commitment therapy (ACT) mobile app that tailors skill coaching based on in-the-moment variables (n = 17) or an app that provides randomly selected skill coaching (n = 22). Data were collected before and after each ACT skill coaching session on proximal outcome (depression, anxiety, and engagement in meaningful activity) and ACT process variables. Multilevel models indicated significant immediate improvements on average following ACT skill coaching sessions on all proximal outcome and ACT process variables, although with relatively small effects ranging between 0.17 and 0.27 SD units change. Larger immediate pre-to-post effects from ACT coaching sessions were found for anxiety, experiential avoidance, and cognitive fusion in the tailored app versus random app condition. Overall, results suggest that an ACT app can have immediate, in-the-moment effects on psychological functioning, which may be enhanced by tailoring skills to current context.     

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.     

The Development and Initial Validation of the Cognitive Fusion Questionnaire

Acceptance and Commitment Therapy (ACT) emphasizes the relationship a person has with their thoughts and beliefs as potentially more relevant than belief content in predicting the emotional and behavioral consequences of cognition. In ACT, “defusion” interventions aim to “unhook” thoughts from actions and to create psychological distance between a person and their thoughts, beliefs, memories, and self-stories. A number of similar concepts have been described in the psychology literature (e.g., decentering, metacognition, mentalization, and mindfulness) suggesting converging evidence that how we relate to mental events may be of critical importance. While there are some good measures of these related processes, none of them provides an adequate operationalization of cognitive fusion. Despite the centrality of cognitive fusion in the ACT model, there is as yet no agreed-upon measure of cognitive fusion. This paper presents the construction and development of a brief, self-report measure of cognitive fusion: The Cognitive Fusion Questionnaire (CFQ). The results of a series of studies involving over 1,800 people across diverse samples show good preliminary evidence of the CFQ’s factor structure, reliability, temporal stability, validity, discriminant validity, and sensitivity to treatment effects. The potential uses of the CFQ in research and clinical practice are outlined.     

Acceptance and commitment therapy (ACT) for people with dementia experiencing psychological distress: A hermeneutic single-case efficacy design (HSCED) series

Introduction

People with dementia have a high prevalence of psychological distress but are underserved with evidence-based psychological interventions. To promote choice and improve clinical outcomes, there is a necessity to test different psychological intervention options for this population.

Purpose

This study aimed to investigate the effectiveness and acceptability of acceptance and commitment therapy (ACT) for people with dementia, considering carer-supported, remote delivery and necessary therapy adaptations.

Methods

A hermeneutic single-case efficacy design series was used to analyse the therapy process and change for three clients with dementia and psychological distress. A matrix of quantitative and qualitative data was collated (“rich case records”) and subject to critical analyses by three independent psychotherapy experts (“judges”) who identified change processes and determined the outcome for each client.

Results

Adjudication concluded that one client made positive changes, specifically reliable reductions in psychological distress, which were largely attributable to ACT. Two clients remained unchanged.

Discussion/Conclusion

Where change was achieved, the ACT-specific processes of values, committed action and acceptance, in combination with non-specific therapy factors, including a strong client–carer relationship, existing client interests and individualised therapy adaptations, were facilitative. Hence, ACT may be a feasible and effective vehicle for therapeutic change by helping carers to better meet the needs of their loved ones. Future research to optimise ACT delivery in this population may be beneficial. Furthermore, the assessment of carer factors (e.g., their psychological flexibility and the client–carer relationship) may strengthen the evidence base for systemic ACT use.     

Acceptance and Commitment Therapy for Self-Stigma Around Sexual Orientation: A Multiple Baseline Evaluation

This study evaluated the effectiveness of 6 to 10 sessions of Acceptance and Commitment Therapy (ACT) for self-stigma around sexual orientation linked to same-sex attraction (what has generally been referred to as internalized homophobia; IH) in a concurrent multiple-baseline across-participants design. Three men and 2 women showed sizeable reductions from baseline to posttreatment and to 4- and 12-week follow-ups in daily reports of the degree to which thoughts about sexual orientation interfered in their lives; distress associated with these thoughts also decreased. Positive changes were observed in self-report measures of IH, depression, anxiety, stress, quality of life, and perceived social support. Consistent with the theory underlying ACT, reductions in daily ratings of the believability of thoughts about same-sex attraction (a process variable) were greater than those observed for frequency of such thoughts. Improvements were also observed in questionnaires measuring ACT processes. Mixed regression analyses confirmed outcome and process effects that were apparent through visual inspection. Implications and the distinctiveness of ACT as an approach are discussed.     

A randomized trial of ACT bibliotherapy on the mental health of K-12 teachers and staff

The mental health challenges of some vocations present a challenge for current intervention models. Bibliotherapy focused on transdiagnostic processes that might both prevent and alleviate a range of mental health distress could be an effective and practical approach. K-12 school personnel (N = 236; 91% female; 30-60 years old) responding to a wellness-oriented program announcement were randomized to receive an Acceptance and Commitment Therapy (ACT) self-help volume or to a waitlist. Three-fourths were above clinical cutoffs in general mental health, depression, anxiety, or stress. Participants read the book for two months, completed exercises and quizzes, and after post assessment were followed for 10 weeks; waitlist participants were then also given the book with two months to complete it. Overall, participants showed significant improvement in psychological health. Significant preventive effects for depression and anxiety were observed along with significant ameliorative effects for those in the clinical ranges of depression, anxiety and stress. Follow up general mental health, depression, and anxiety outcomes were related to the manner in which participants used the workbook and to post levels of psychological flexibility.     

The influences of cultural values, ethnic identity, and language use on the mental health of Korean American college students

Little research has examined ethnic identity, cultural values, and native language maintenance as predictors of mental health in Korean Americans. The authors explored the influences of ethnic identity, maintenance of Asian cultural values, and maintenance of Korean language usage on self-esteem, anxiety, and depression in Korean American college students (N = 133). Findings indicated that Korean American men reported relatively high levels of state and trait anxiety and that the overall sample reported a relatively high level of depression. Whereas language and ethnic identity had a minimal influence on the mental health of students, greater cultural value maintenance was associated with decreased self-esteem and increases in state anxiety, trait anxiety, and depression. The positive relationship between cultural values and mental health problems may be indicative of being caught in an ethnic bind, in which the clash of traditional and modern values contributes to psychological distress. The authors discuss clinical implications of the findings.     

Decision-making styles and mental health—A person-oriented approach through clustering

Previous research examining the associations between decision-making styles and mental health has neglected to look at the configurations of styles. The study identifies mutually exclusive groups of people according to their combination of the five decision-making styles and examines the differences between them in mental health-related variables in two studies. In Study 1, decision-making styles, mental health indicators (well-being, depression, stress) and socio-psychological protective factors (resilience, optimism, social support) were examined in university students in two rounds 1 year apart. A cluster analysis revealed three distinct decision profiles—independent/nonintuitive, avoidant/spontaneous and rational/nonavoidant. The best values of mental health-related variables were found in the rational/nonavoidant profile and the most negative values in the avoidant/spontaneous profile. The decision-making styles were stable after 1 year although they were not able to explain changes in mental health-related variables. Study 2 identified three similar clusters in a more general sample—spontaneous/irrational, dependent/avoidant and rational/nonavoidant—with the lowest level of psychological distress symptoms in the rational/nonavoidant cluster. The study highlights the usefulness of combinations of decision-making styles with regard to mental health as well as noting their specificity according to sample characteristics.     

Values-Based Practice: Linking Science with People

Values-based practice is a new skills-based approach to working with complex and conflicting values in health care. In this paper we outline the point of values-based practice (to support balanced decision making), its premise (in respect for differences of values) and the ten elements of the process by which it supports balanced decision making in practice. We give examples of how values-based approaches have been applied in the development of policy and practice in mental health in the UK and outline its potential applications for contemporary psychotherapy. In a brief concluding section we show how the development of values-based practice in mental health is leading the way towards linking science more effectively with people across medicine as a whole.     

Evaluation of a mental health treatment court with assertive community treatment

Without active engagement, many adults with serious mental illnesses remain untreated in the community and commit criminal offenses, resulting in their placement in the jails rather than mental health facilities. A mental health treatment court (MHTC) with an assertive community treatment (ACT) model of case management was developed through the cooperative efforts of the criminal justice and mental health systems. Participants were 235 adults with a serious mental illness who were booked into the county jail, and who volunteered for the study. An experimental design was used, with participants randomly assigned to MHTC or treatment as usual (TAU), consisting of adversarial criminal processing and less intensive mental health treatment. Results were reported for 6 and 12 month follow-up periods. Clients in both conditions improved in life satisfaction, distress, and independent living, while participants in the MHTC also showed reductions in substance abuse and new criminal activity. Outcomes are interpreted within the context of changes brought about in the community subsequent to implementation of the MHTC.     

Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process

Recent developments in CBT emphasize the promotion of psychological flexibility to improve daily functioning for people with a wide range of health conditions. In particular, one of these approaches, Acceptance and Commitment Therapy (ACT), has been studied for treatment of chronic pain. While trials have provided good support for treatment effectiveness through follow-ups of as long as seven months, the longer-term impact is not known. The present study of 108 participants with chronic pain examined outcomes three years after treatment completion and included analyses of two key treatment processes, acceptance of pain and values-based action. Overall, results indicated significant improvements in emotional and physical functioning relative to the start of treatment, as well as good maintenance of treatment gains relative to an earlier follow-up assessment. Effect size statistics were generally medium or large. At the three-year follow-up, 64.8% of patients had reliably improved in at least one key domain. Improvements in acceptance of pain and values-based action were associated with improvements in outcome measures. A “treatment responder” analysis, using variables collected at pre-treatment and shorter term follow-up, failed to identify any salient predictors of response. This study adds to the growing literature supporting the effectiveness of ACT for chronic pain and yields evidence for both statistical and clinical significance of improvements over a three-year period.     

Targeting Acceptance,Mindfulness, and Values-Based Action in Chronic Pain: Findings of Two Preliminary Trials of an Outpatient Group-Based Intervention

Cognitive behavior therapy (CBT) for chronic pain is effective, although a number of issues in need of clarification remain, including the processes by which CBT works, the role of cognitive changes in the achievement of outcomes, and the formulation of a coherent theoretical model. Recent developments in psychology have attempted to address these issues by focusing specifically on processes of acceptance, present-focused awareness (e.g., mindfulness), and values-based action. The present study evaluated the effectiveness of Acceptance and Commitment Therapy (ACT), perhaps the most widely researched of these developing approaches. Initial evidence suggests that ACT-consistent treatments for chronic pain are effective, although there is a need to study treatment in more traditional pain-management settings, where treatment is generally time-limited, unidisciplinary, and outpatient. Data from two pilot studies are presented. Results support the feasibility of treatment and suggest that effectiveness rates compare favorably with more established forms of treatment, in this case, CBT. Although these data are preliminary, they set a foundation upon which more intensive evaluations can take place.     

Cognitive and emotional covariates of violence exposure among former prisoners: links to antisocial behavior and emotional distress and implications for theory

In this study, formerly incarcerated men (N = 123) were assessed for their experiences with violence in the community as well as their current behavioral and mental health status (antisocial behavior and emotional distress). Participants also completed measures of two constructs theorized to moderate relations between exposure to violence and outcomes: cognitive beliefs supporting aggressive responding and negative emotional reactivity to witnessed violence. Data on key social-demographic background factors affecting outcomes were also collected. Analyses showed that, after controlling the effects of background factors, relationships between experiences with violence in the community and behavioral/mental health were moderated by cognitive beliefs and emotional reactivity. At high levels of support for aggressive responding, significant positive links were observed between exposure to violence and antisocial behavior as well as emotional distress. At high levels of negative reactivity to violence, a significant positive link was observed between exposure to violence and emotional distress (but not antisocial behavior). Findings are discussed with respect to research and theory on the effects of exposure to violence in high-risk adult populations.     

Effectiveness of an empirically supported treatment for social phobia in the field

This study examined the effectiveness of individual exposure combined with cognitive restructuring for social phobia in a clinical setting as well as the influence of sample restriction criteria on the effect size. Participants were 217 unselected patients with a primary diagnosis of social phobia who were treated by 57 therapists in four outpatient clinics of the Christoph-Dornier-Foundation of Clinical Psychology in Germany. Results 6 weeks after the end of therapy showed highly significant reductions in social phobic fears and avoidance as well as in general anxiety and symptoms of depression. However, patients who dropped out during therapy reported a significantly higher degree of depression. Results did not differ between the four outpatient clinics and are comparable with the average effect-sizes reported by meta-analytic studies of controlled efficacy research, using selected patients. Also, restricting the sample according to the selection criteria often applied in research settings did not result in higher effect sizes for the applied outcome measures. We conclude that individual cognitive behavioural therapy for social phobia can be transported from research settings to the field of mental health.     

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 randomised worksite comparison of acceptance and commitment therapy and stress inoculation training

In this comparative intervention study, 107 working individuals with above average levels of distress were randomly assigned to one of three conditions: acceptance and commitment therapy (ACT; n = 37); stress inoculation training (SIT; n = 37); or a waitlist control group (n = 33). The interventions were delivered to small groups in the workplace via two half-day training sessions. ACT and SIT were found to be equally effective in reducing psychological distress across a three month assessment period. Mediation analysis indicated that the beneficial impact of ACT on mental health resulted from an increase in psychological flexibility rather than from a change in dysfunctional cognitive content. Contrary to hypothesis, a reduction in dysfunctional cognitions did not mediate change in the SIT condition. Results suggest that the worksite may offer a useful, yet underutilised, arena for testing cognitive-behavioural theories of change.     

Mediators of Posttraumatic Mental Health in Sexual Assault Survivors

The development of posttraumatic growth (PTG) and the relationship between PTG and distress outcomes in sexual assault is an important area of investigation. Recent research suggests that some forms of cognitive processing might be critical in the development, maintenance, and resolution of posttraumatic mental health among sexual assault survivors. The objective of this study was to examine factors associated with posttraumatic mental health among sexual assault survivors. Seventy-three participants who experienced sexual assault completed measures of trauma symptoms, PTG, changes in outlook, cognitive processing, and support and coping. Results revealed that significant levels of posttraumatic symptomatology and low levels of PTG were reported 3 years following sexual assault. A weak relationship was found between symptoms of distress and growth. Contrary to predictions, only ratings of hope and brooding rumination were mediators of the relationship between posttraumatic symptoms and PTG. Reflective rumination was not related to the development of PTG.     

高中生强迫思考与抑郁状态：压力知觉的中介作用及不反应的调节作用

青少年时期是抑郁的高发时期,也是抑郁预防的重要时间窗口。为探讨强迫思考倾向和抑郁状态的关系及其作用机制,采用问卷法对501名高中生进行调查。结果发现：（1）高中生强迫思考倾向完全通过压力知觉正向预测抑郁状态;（2）不反应在强迫思考倾向与压力知觉之间起调节作用,当不反应水平较高时,强迫思考倾向通过压力知觉预测抑郁状态的作用较弱。研究结果有助于揭示强迫思考倾向对高中生抑郁状态的影响及作用机制,对积极预防高中生抑郁具有一定的启示。