Internet-Based Acceptance and Commitment Therapy: A Transdiagnostic Systematic Review and Meta-Analysis for Mental Health Outcomes

Internet-based acceptance and commitment therapy (iACT) primarily targets the process of psychological flexibility. Its accessibility and low-intensity delivery are applicable across different treatment and prevention scenarios. This transdiagnostic meta-analysis reviews the effectiveness of iACT on anxiety, depression, quality of life, and psychological flexibility across individuals with different psychological and somatic conditions/complaints, or undiagnosed complaints. Seven databases were searched for randomized controlled trials that reported on anxiety, depression, quality of life, and psychological flexibility outcomes from iACT in any adult population. Engagement with iACT was summarized and methodological and population-related variables were investigated as potential moderators of effectiveness. Across 25 studies, small pooled effects were found for all outcomes at post-assessment and maintained at follow-up time-points. Interventions with therapist guidance demonstrated greater effectiveness in improving depression and psychological flexibility outcomes compared to nonguided iACT, and populations defined by a psychological condition or symptoms (e.g., depressed samples) demonstrated greater improvements in anxiety compared to nonclinical or somatic populations (e.g., chronic pain samples or students). Participants completed on average 75.77% of iACT treatments. While we found iACT to be effective in improving and maintaining mental health outcomes across diverse populations, there was limited evidence of reliable, clinically significant effects. PROSPERO registration number: CRD42020140086.     

Defining the Assessment and Treatment Competencies to Deliver Low-Intensity Cognitive Behavior Therapy: A Multi-Center Validation Study

Despite the vastly increased dissemination of the low-intensity (LI) version of cognitive behavior therapy (CBT) for the treatment of anxiety and depression, no valid and reliable indices of the LI-CBT clinical competencies currently exist. This research therefore sought to develop and evaluate two measures: the low-intensity assessment competency scale (LIAC) and the low-intensity treatment competency scale (LITC). Inductive and deductive methods were used to construct the competency scales and detailed rating manuals were prepared. Two studies were then completed. The first study used a quantitative, fully-crossed design and the second a multi-center, quantitative longitudinal design. In study one, novice, qualified, and expert LI-CBT practitioners rated an LI-CBT assessment session (using the LIAC) and an LI-CBT treatment session (using the LITC). Study two used the LIAC and LITC across four training sites to analyze the competencies of LI-CBT practitioners over time, across raters, and in relation to the actor/patients’ feedback concerning helpfulness, the alliance, and willingness to return. Both the LIAC and LITC were found to be single factor scales with good internal, test-retest reliability and reasonable inter-rater reliability. Both measures were sensitive to measuring change in clinical competence. The LIAC had good concurrent, criterion, discriminant, and predictive validity, while the LITC had good concurrent, criterion, and predictive validity, but limited discriminant validity. A score of 18 accurately delineated a minimum level of competence in LI-CBT assessment and treatment practice, with incompetent practice associated with patient disengagement. These observational ratings scales can contribute to the clinical governance of the burgeoning use of LI-CBT interventions for anxiety and depression in routine services and also in the methods of controlled studies.     

Losing My Religion as a Natural Experiment: How State Pressure and Taxes Led to Church Disaffiliations between 1940 and 2010 in Germany

The sociological literature has produced a remarkably consistent picture of the quantitative patterns of religious disaffiliations in Western countries. This article argues, and demonstrates, that strong changes in a social context may lead individuals to disaffiliate rapidly, leading to very different aggregate effects from those in the “western model.” We use the unique situation of the separation of Germany from 1949 to 1989 and its subsequent reunification as a “natural experiment” to show just how much the relationships routinely found can be disrupted under changed conditions. The state socialist “treatment” affected religious disaffiliations in East Germany profoundly as it (a) made disaffiliations 10 times more probable in the East than in the West in the 1950s and 1960s, (b) shielded East German church members from factors that led to mass disaffiliations in the West in the late 1960s and early 1970s, (c) reversed the education‐disaffiliation link in the East, thus making disaffiliation more likely among the less educated, and (d) led to an especially strong increase in disaffiliations in the East right after the reunification     

Changing the Criminal Justice System Response to Sexual Assault: An Empirical Study of a Participatory Action Research Project

In jurisdictions throughout the United States, thousands of sexual assault kits (SAKs; also known as a “rape kits”) have not been submitted by the police for forensic DNA testing. DNA evidence may be helpful to sexual assault investigations and prosecutions by identifying perpetrators, revealing serial offenders through DNA matches across cases, and exonerating those who have been wrongly accused. This paper describes a longitudinal action research project conducted in Detroit, Michigan after that city discovered approximately 11,000 untested sexual assault kits in a police department storage facility. We conducted a root cause analysis to examine individual, organizational, community, and societal factors that contributed to the development of the rape kit backlog in Detroit. Based on those findings, we implemented and evaluated structural changes to increase staffing, promote kit testing, and retrain police and prosecutors so that cases could be reopened for investigation and prosecution. As we conducted this work, we also studied how this action research project impacted the Detroit criminal justice system. Participating in this project changed stakeholders’ attitudes about the utility of research to address community problems, the usefulness of DNA evidence in sexual assault cases, and the impact of trauma on survivors. The results led to new protocols for SAK testing and police investigations, and new state legislation mandating SAK forensic DNA testing.     

Fostering Well‐being through Social Support: The Role of Evangelical Communities in the Lives of Dominican Women of Haitian Descent

Women of Haitian descent living in the Dominican Republic experience oppression due to their gender, ethnicity, and economic status. They also exhibit high rates of participation in evangelical Christian communities, a paradoxical finding given the restricted roles women have traditionally played in these settings. The goals of this study were to explore the perceived benefits of participation in evangelical communities and the setting characteristics that lead to these benefits. The research team interviewed 19 current and former church participants aged 18–59. Thematic analysis revealed three perceived benefits of congregational life. Participants viewed their participation as: (a) an opportunity for personal growth and development; (b) protective against negative social influences; and (c) providing social support in the face of life challenges. In addition, dependable, expected, and reciprocal relational support was a key characteristic of evangelical communities. Findings extend the current understanding of how religious communities enhance well‐being for marginalized women through social support networks. Findings also explore the dialectical nature of settings as both empowering and disempowering. Implications for future interventions are discussed.     

ADHD symptoms and callous‐unemotional traits as predictors of violent media use in adolescence

We investigated ADHD symptoms and CU traits as predictors of violent media use in adolescence, controlling for delinquency and ODD symptoms. The effects on of disinhibition and arousal to negative stimuli, core characteristics of ADHD symptoms and CU traits, and of gender were investigated. At age 15, 88 adolescents, 50 % boys reported on CU traits, ADHD symptoms and delinquency. Parents rated the adolescents’ CU traits, ADHD‐ and ODD symptoms. At age 16, adolescents reported on their media habits and performed tests of disinhibition and arousal to negative stimuli. Boys had higher levels of CU traits and violent media use and girls had higher levels of arousal to negative pictures. CU traits and inattention symptoms predicted violent media use, the latter association applying only to boys, with CU traits being the strongest predictor. Low arousal to threat pictures explained variance in violent media use, above CU traits. Attraction to violent media seems affected by problem behaviors, with CU traits coming forth as especially important.     

Students’ individual interest in physical education: Development and validation of a questionnaire

Identifying the specificity of students’ individual interest in physical education is necessary to capture the different facets of this construct. In contrast to existing questionnaires in education which assess the multidimensionality of individual interest, the current scale used in physical education consists of a single‐item measurement which rates students’ individual interest for multiple physical activities taught during lessons. Even if this single‐item rating provides a basis for classifying interest relative to others, it does not provide information about the nature and internal components of individual interest. Therefore, the purpose of this study was to develop a valid and reliable questionnaire measuring the multidimensionality of students’ individual interest in physical education. Four stages were followed: (1) the development of a preliminary version based on the findings of a literature review on individual interest and a committee process validation; (2) a first study conducted on 481 secondary school students to establish the factor structure, and internal reliability of this questionnaire; (3) a second study based on 243 secondary school students to confirm its factor structure and to test its temporal stability; and finally, (4) a third study with 253 students to test its concurrent validity. The final form of the questionnaire consists of a three‐factor structure based on 14 items that measure students’ individual interest in physical education: positive affect and willingness to reengage (five items), stored utility value (four items), and stored attainment value and knowledge‐seeking intentions (five items).     

Close‐knit ties through thick and thin: Sharing social exclusion and acceptance enhances social bond

Three experiments investigated whether and why sharing experiences of social exclusion or social acceptance with others strengthens social bonds. Participants experienced either social exclusion or social acceptance alongside another co‐participant who either also experienced the same outcome, or experienced a different outcome, as them. Multilevel modeling results showed that participant dyads who shared the experience of social exclusion or social acceptance felt closer to each other than those who experienced different outcomes, and that perceived similarity mediated the effect of shared experiences on social bonds. Interestingly, participants felt closer to one another after having shared social acceptance, more so than when they have shared social exclusion. Implications of the present findings are interpreted in light of theories of social exclusion, shared experiences, and social bonding.     

Adverse caregiving in early life: The trauma and deprivation distinction in young children

Knowledge and understanding about the impact of cumulative adverse experiences on the health and wellbeing of children, adolescents, and adults has rapidly expanded over the past 30 years. Despite the invaluable attention and support this proliferation has drawn to the importance of early childhood experiences, we believe that it is time to move beyond broad indices of risk and toward more specific and individualized understanding of how risk exposures are linked to clinical outcomes in young children. Within infant and early childhood mental health, there is a need for greater specificity in linking adverse caregiving experiences in early life to psychopathology in children. We highlight a framework distinguishing experiences of trauma from experiences of deprivation and use the examples of posttraumatic stress disorder and reactive attachment disorder to demonstrate how greater specificity in our understanding of early adverse caregiving can lead to more accurate and targeted diagnosis and treatment for young children. Both researchers and clinicians benefit from an approach to gain a greater appreciation of the links between specific types of experiences and outcomes in the children that we serve.