Using Acceptance and Commitment Therapy to Guide Exposure-Based Interventions for Posttraumatic Stress Disorder

Exposure is considered one of the most effective interventions for PTSD. There is a large body of research for the use of imaginal and in vivo exposure in the treatment of PTSD, with prolonged exposure (PE) therapy being the most researched example. Acceptance and commitment therapy (ACT) has sometimes been called an exposure-based treatment, but how exposure is implemented in ACT for PTSD has not been well articulated. Although support for the use of ACT in PTSD treatment is limited to a handful of case studies and open trials, research suggests ACT is particularly useful in flexibly targeting avoidance behavior—arguably the most important process in the continued maintenance of PTSD symptoms. The purpose of this paper is to explore the use of exposure within ACT in PTSD treatment. Through an overview of PE and ACT, and with the use of case examples, we describe how ACT principles and techniques may inform exposure-based treatments for PTSD in order to create more flexible approaches. In addition, understanding exposure within an ACT framework may also contribute to clarifying processes of change.     

Mood-dependent retrieval and mood awareness

Abstract

In six experiments, subjects were induced into happy or sad moods prior to studying a list of words, and then induced into either the same or different mood prior to freely recalling the list. In addition, subjects were administered various individual difference measures of mood states. The hypothesis was that subjects who profess to be most aware of their moods would be most likely to show disrupted performance when study and test moods were different. Mood-dependent performance was not generally observed, nor was there any evidence that it more consistently emerged for high-aware subjects.     

The ghost condition: imitation versus emulation in young children's observational learning

Although observational learning by children may occur through imitating a modeler's actions, it can also occur through learning about an object's dynamic affordances--a process that M. Tomasello (1996) calls "emulation." The relative contributions of imitation and emulation within observational learning were examined in a study with 14- to 26-month-old children. The effectiveness of a "ghost" condition, in which the effective operation of the means apparatus was seen to occur without human agency, was compared with that of a standard modeling procedure in which the child saw an experimenter demonstrate the means action. The ghost condition was as likely to encourage observational learning as was the modeling condition; indeed, performance in the ghost condition was significantly better. The role of emulation in the development of observational learning is discussed in the context of a possible form of goal directedness without agency.     

Obtained versus programmed reinforcement practical considerations in the treatment of escape-reinforced aggression

This investigation provides a preliminary examination of the difference between programmed and obtained reinforcement rates and its potential influence during treatment of aggression in a natural setting. Following a functional analysis that suggested that the aggression of a boy with autism was negatively reinforced, intervention was implemented by the boy's mother. Concurrent fixed-ratio (FR) 1 FR 1 schedules of escape were arranged for manding and aggression. When mands failed to compete effectively with aggression, obtained reinforcement ratios were calculated; these indicated that obtained reinforcement varied from the programmed schedule for aggression but not for mands. Increasing the rate of prompts for mands resulted in an increase in mands and a decrease in aggression to near-zero levels.     

A mechanism of implicit lexicalized phonological recoding used concurrently with underdeveloped explicit letter-sound skills in both precocious and normal reading development

These are findings of theoretical interest from: (i) follow-up of a case study of a precocious reader; and (ii) normally developing readers who served as comparison groups. The precocious reader was first reported when 2–3 years of age (Cognition 74 (2000) 177). From 3 to 7 years of age her precocious reading development continued, her word reading accuracy increasing from the 8- to the 16-year-level, although her phonemic awareness skills remained underdeveloped relative to word reading. Nonword reading continued to develop rapidly. Her word reading, however, was more than phonological recoding. At 5 years of age, in comparison with reading-level matched normal 11-year-olds she exhibited strong effects of semantic characteristics of words and evidence of well-specified lexical orthographic representations. In common with normal comparison 11-year-olds, who had not received instruction in explicit phonics, her explicit letter-sound skills were underdeveloped but she possessed high speed and accuracy in nonword reading, a result most theories of the acquisition of reading fail to explain. Her responses to irregularly spelt nonwords indicated higher proficiency than the 11-year-olds in acquiring lexical orthographic representations not predictable from prior phonological recoding knowledge. It is considered that this proficiency contributes to an explanation of her precocious reading development. A mechanism of implicit lexicalized phonological recoding is involved which explains the dissociation of skills in both the precocious reader and normally developing readers.     

Implicit sequence learning: effects of level of structure, adult age, and extended practice

The influence of structure and age on sequence learning was investigated by testing 24 young and 24 older participants for 10 sessions in an alternating serial response time task in which pattern trials alternated with random trials. Individuals encountered lag-2 or lag-3 structure, and learning was measured by the difference (in response time and accuracy) between pattern and random trials. Both ages learned lag-2 structure, but the young learned more than the older participants. Only the young people learned lag-3 structure, and they did so more slowly and to a lesser degree than they learned lag-2 structure. These age deficits in higher order sequence learning after extended practice are consistent with simultaneity theory and with theories positing that age-related deficits in neuromodulation lead to less distinctive representations.     

Evaluating the convergence of muscle appearance attitude measures

There has been growing interest in the assessment of a muscular appearance. Given the importance of assessing muscle appearance attitudes, the aim of this study was to explore the convergence of the Drive for Muscularity Scale, Somatomorphic Matrix, Contour Drawing Rating Scale, Male Figure Drawings, and the Muscularity Rating Scale. Participants were 76 men and 103 women who each completed four measures of body image that were meant to evaluate two distinct domains of appearance attitudes: muscularity and body fat. For both genders, data indicated low convergence among muscularity measures, but high convergence among body fat measures. For men, the Drive for Muscularity Body Image subscale exhibited the greatest concurrent validity with behaviors used to increase muscularity. The results are discussed in light of the selection of methods for the assessment of muscle appearance attitudes.     

Self-injurious behavior and the efficacy of naltrexone treatment: a quantitative synthesis

People with mental retardation, autism, and related developmental disabilities who self-injure are treated with a wide array of behavioral techniques and psychotropic medications. Despite numerous reports documenting short-term and some long-term changes in self-injury associated with the opiate antagonist naltrexone hydrochloride, no quantitative review of its efficacy has been reported. We conducted a quantitative synthesis of the peer-reviewed published literature from 1983 to 2003 documenting the use of naltrexone for the treatment of self-injurious behavior (SIB). Individual-level results were analyzed given subject and study characteristics. A sample of 27 research articles involving 86 subjects with self-injury was reviewed. Eighty percent of subjects were reported to improve relative to baseline (i.e., SIB reduced) during naltrexone administration and 47% of subjects SIB was reduced by 50% or greater. In studies reporting dose levels in milligrams, males were more likely than females to respond. No significant relations were found between treatment outcomes and autism status or form of self-injury. Results are discussed with respect to future efficacy work related to study outcomes and the pharmacological treatment of self-injury.     

Decomposing retrieval and integration in memory for actions: a multinomial modeling approach

Typically, action phrases are recalled better if participants are asked to enact the phrases than if they are just asked to remember them. When investigating which processes constitute this enactment effect a difficulty is that observable effects in standard memory tests are ambiguous because such tests require several processes. In the present article, we introduce a multinomial model that decomposes observable memory performance into a retrieval parameter and a parameter concerning the item-specific processing and integration of an action phrase. These parameters are estimated from free recall and cued recall performance. The model fitted the data of two experiments designed to test it. Experiment 1 demonstrated the basic usefulness of the model by showing expected differences in the integration parameter in the absence of unexpected differences in the retrieval parameter. Experiment 2 extended the conditions under which the model is useful by showing expected differences in the retrieval parameter even in the presence of unexpected differences in the integration parameter. Together, these findings support our theoretical framework according to which enactment generally boosts integration of action phrases, but increases retrieval only for phrases with context cues.