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.     

Genetic studies of stuttering in a founder population

Genome-wide linkage and association analyses were conducted to identify genetic determinants of stuttering in a founder population in which 48 individuals affected with stuttering are connected in a single 232-person genealogy. A novel approach was devised to account for all necessary relationships to enable multipoint linkage analysis. Regions with nominal evidence for linkage were found on chromosomes 3 (P=0.013, 208.8 centiMorgans (cM)), 13 (P=0.012, 52.6 cM), and 15 (P=0.02, 100 cM). Regions with nominal evidence for association with stuttering that overlapped with a linkage signal are located on chromosomes 3 (P=0.0047, 195 cM), 9 (P=0.0067, 46.5 cM), and 13 (P=0.0055, 52.6 cM). We also conducted the first meta-analysis for stuttering using results from linkage studies in the Hutterites and The Illinois International Genetics of Stuttering Project and identified regions with nominal evidence for linkage on chromosomes 2 (P=0.013, 180-195 cM) and 5 (P=0.0051, 105-120 cM; P=0.015, 120-135 cM). None of the linkage signals detected in the Hutterite sample alone, or in the meta-analysis, meet genome-wide criteria for significance, although some of the stronger signals overlap linkage mapping signals previously reported for other speech and language disorders. EDUCATIONAL OBJECTIVES: After reading this article, the reader will be able to: (1) summarize information about the background of common disorders and methodology of genetic studies; (2) evaluate the role of genetics in stuttering; (3) discuss the value of using founder populations in genetic studies; (4) articulate the importance of combining several studies in a meta-analysis; (5) discuss the overlap of genetic signals identified in stuttering with other speech and language disorders.     

Stigma,staring, and discomfort: A novel-stimulus hypothesis

Three experiments were conducted in order to assess the validity of the novel-stimulus hypothesis as an explanation for why people who are physically different (i.e., novel) are avoided. The hypothesis states that avoidance is mediated by conflict over a desire to stare at novel stimuli and a desire to adhere to a norm against staring when the novel stimulus is another person. In the first two field experiments, subjects viewed photographs of novel (handicapped or pregnant) and familiar (physically normal) people under conditions where staring was sanctioned or not. It was found that staring increased with novelty when staring was unobserved (sanctioned); however, the reverse obtained when an observer was present. In the third experiment, subjects interacted with a crippled, pregnant, or physically normal partner. Half of the subjects were first given the opportunity to observe their partner through a one-way mirror. The reduction in stimulus novelty for this group resulted in reduced avoidance. The question of whether such avoidance of the disabled results from feelings of dislike or disgust as previously suggested, or from discomfort created by novelty, is discussed.     

Transcendental meditation, mindfulness, and longevity: an experimental study with the elderly

Can direct change in state of consciousness through specific mental techniques extend human life and reverse age-related declines? To address this question, 73 residents of 8 homes for the elderly (mean age = 81 years) were randomly assigned among no treatment and 3 treatments highly similar in external structure and expectations: the Transcendental Meditation (TM) program, mindfulness training (MF) in active distinction making, or a relaxation (low mindfulness) program. A planned comparison indicated that the "restful alert" TM group improved most, followed by MF, in contrast to relaxation and no-treatment groups, on paired associate learning; 2 measures of cognitive flexibility; mental health; systolic blood pressure; and ratings of behavioral flexibility, aging, and treatment efficacy. The MF group improved most, followed by TM, on perceived control and word fluency. After 3 years, survival rate was 100% for TM and 87.5% for MF in contrast to lower rates for other groups.     

Protective buffering and emotional desynchrony among spousal caregivers of cancer patients.

OBJECTIVE: To examine protective buffering and emotional desynchrony among spousal caregivers of cancer survivors. DESIGN: Repeated measures; 42 caregivers engaged in 2 videotaped, oral emotional expression exercises: 1 in the presence of their patient and 1 in the absence of their patient. MAIN OUTCOME MEASURES: Felt emotion (self-report) and expressed emotion (lexical expression or words uttered and coder-derived facial expression). Other measures assessed mental and physical health, dyadic satisfaction, and dispositional emotional inhibition. RESULTS: Protective buffering differed by communicative channel (lexical vs. facial). Caregivers' facial expressions were more positive when the patient was present versus absent. In contrast, the valence of caregivers' words did not differ per patient presence. Facial protective buffering was unrelated to health and dyadic outcomes. Lexical protective buffering was inversely related to both caregiver and patient marital satisfaction. Dispositional emotional inhibition was inversely related to caregiver mental health and marital satisfaction. Desynchrony occurred when the patient was present but was counter to prediction; felt emotion was more positive than expressed emotion. CONCLUSION: Results provide behavioral evidence of facial protective buffering. To the extent that lexical buffering occurs, it poses a dyadic risk, and chronic inhibition poses both psychological and dyadic risks. Future research is needed to refine the operational definition of desynchrony and to examine the biopsychosocial sequelae of buffering.     

Contextual cueing under working memory load: Selective interference of visuospatial load with expression of learning

In a series of experiments, we investigated the dependence of contextual cueing on working memory resources. A visual search task with 50 % repeated displays was run in order to elicit the implicit learning of contextual cues. The search task was combined with a concurrent visual working memory task either during an initial learning phase or a later test phase. The visual working memory load was either spatial or nonspatial. Articulatory suppression was used to prevent verbalization. We found that nonspatial working memory load had no effect, independent of presentation in the learning or test phase. In contrast, visuospatial load diminished search facilitation in the test phase, but not during learning. We concluded that visuospatial working memory resources are needed for the expression of previously learned spatial contexts, whereas the learning of contextual cues does not depend on visuospatial working memory.     

Text processing and feedback: what have we learned?

In studies on the effects of feedback on text comprehension, it was determined that text content interacts differentially with the feedback provided. Specifically, the types of memorial representations sought must be considered in terms of type of text, feedback timing, frequency, and modality.     

Memory of the traumatic event as a risk factor for the development of PTSD: lessons from the study of traumatic brain injury

Traumatic memories, and the mechanisms by which they operate, continue to occupy a central role in the scientific investigation of risk factors for the development of posttraumatic stress disorder (PTSD). However, empirically based studies are constrained by practical and ethical considerations and are limited to naturalistic models. Consequently, the paradigms most appropriate for the exploration of the relationship between traumatic memories and PTSD have been identified in conditions involving traumatic events where memories may be compromised. Indeed, traumatic brain injury, a condition that is commonly associated with memory impairment, has often been utilized as a naturally occurring model for the study of traumatic memory and its contribution to the development of PTSD. This article presents a critical review of these research efforts and discusses their theoretical and clinical implications.