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.     

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.     

Commitment to a developing preference and predecisional distortion of information

People tend to distort their evaluation of decision-relevant information in favor of the currently preferred alternative. We test whether this predecisional distortion of information is amplified by increased commitment to that current preference. We manipulated commitment, without changing the preferred option’s content, by requiring participants to indicate their preference either by circling or by darkening a sizable box (cf. feature-positive effect). Experiment 1 revealed that the effort to darken substantially increased predecisional distortion. Experiment 2 ruled out elaboration as an explanation for the effect of darkening. Experiment 3 showed that, among participants who attributed the darkening effort to an external source, predecisional distortion decreased when the source was believed to summon effort. These findings suggest that the developing commitment to a tentatively preferred alternative is one driver of predecisional distortion.     

SOME FINAL,GULP, “WORDS” ON REBT,ACT &; RFT

After reviewing the target articles of this issue, Hayes and Ellis respectively see less and more possibilities for integration. This concluding article attempts to better elucidate possibilities for integration between second and third wave CBT’s, as exemplified by Rational-Emotive & Cognitive-Behavior Therapy (REBT) and Acceptance and Commitment Therapy (ACT). We suggest that if ACT is going to err, it will be in the direction of being too afraid of talk. If REBT is going to err, it will be in the direction of not being afraid enough. Address correspondence to Hank Robb, 4550 SW Kruse Way, Suite 225 Lake Oswego, OR 97035, USA.     

Affective and normative commitment to organization, supervisor, and coworkers: Do collectivist values matter?

Employees’ commitment to their organization is increasingly recognized as comprising of different bases (affect-, obligation-, or cost-based) and different foci (e.g., supervisor, coworkers). Two studies investigated affective and normative commitment to the organization, supervisor and coworkers in the Turkish context. The results of Study 1 confirmed that employees differentiate between affect versus obligation-based commitment towards the organization, supervisor and coworkers. Study 2 tested the “cultural hypothesis” which argues for the moderating influence of collectivistic values on the relationship between person (local) commitments and organizational-level (global) outcomes. The results failed to support the cultural hypothesis and showed that commitment to organization was predictive of organizational-level outcomes (e.g., turnover intentions), and commitment to supervisor was predictive of supervisor-related outcomes (e.g., citizenship towards supervisor). These findings suggest that the influence of culture may be less straightforward and may require a more sophisticated measurement of the nature of relationships and organizational characteristics in general.     

Commitment First,Communication Later: Dealing with Barriers to Effective Couples Therapy

Teaching communication techniques to couples is a common way for therapists to begin treatment. In many cases, couples then use these newly acquired skills to express negative or even hostile information to each other, sometimes doing more harm than good to the relationship. Based upon years of clinical experience with hundreds of couples in treatment, this article presents the idea that having the couple see themselves as an entity first, not as two individuals, may be necessary before clear communication can be maximally therapeutic. The article outlines the Couple Power model of treatment, suggesting that four basic tasks—commitment, cooperation, communication and community—need to be accomplished in that order, postponing the teaching of communication skills until later in therapy. Theory behind the tasks and suggestions for effective techniques to achieve the “Four C’s” of Couple Power are presented and discussed.     

Truthmakers and ontological commitment: or how to deal with complex objects and mathematical ontology without getting into trouble

What are the ontological commitments of a sentence? In this paper I offer an answer from the perspective of the truthmaker theorist that contrasts with the familiar Quinean criterion. I detail some of the benefits of thinking of things this way: they include making the composition debate tractable without appealing to a neo-Carnapian metaontology, making sense of neo-Fregeanism, and dispensing with some otherwise recalcitrant necessary connections.     

The role of dorsolateral prefrontal function in relationship commitment

Commitment is an important determinant of relationship stability. Previous studies demonstrated that relationship stability is influenced by several personality variables, one of which is conscientiousness. To account for the influence of conscientiousness on relationship stability, we propose a neurological model of commitment. The model assumes that conscientiousness and commitment are influenced by individual differences in anterior and mid-dorsolateral prefrontal (amDLPFC) functioning, and that conscientiousness is a partial mediator of the association between amDLPFC functioning and commitment. Results from two studies with dating couples are consistent with this model. Study 2 suggests that, relative to other conscientiousness facets, self-efficacy is a more likely mediator of the effect of amDLPFC functioning on commitment.     

Capturing ruminative exploration: Extending the four-dimensional model of identity formation in late adolescence

Identity exploration has been associated with openness and curiosity but also with anxiety and depression. To explain these mixed findings, the four-dimensional identity formation model [Luyckx, K., Goossens, L., Soenens, B., & Beyers, W. (2006b). Unpacking commitment and exploration: Validation of an integrative model of adolescent identity formation. Journal of Adolescence, 29, 361–378.] was extended using data from two late adolescent samples (total N = 703). A fifth dimension, labeled ruminative (or maladaptive) exploration, was added as a complement to two forms of reflective (or adaptive) exploration already included in the model (i.e., exploration in breadth and exploration in depth). Results indicated that ruminative exploration was positively related to distress and to self-rumination. The two forms of reflective exploration, by contrast, were unrelated to well-being and positively to self-reflection. Ruminative and reflective exploration also helped to distinguish between two types of less adaptive identities (i.e., Ruminative Moratorium and Diffused Diffusion) in a six-cluster solution that also contained adaptive types of identity. Implications for current research on identity formation are discussed.     

Living up to one's commitments: Agency, strategies and trust

In human social interaction, the notions of commitment and trust are strongly interrelated. A formal model for this interrelation will enable artificial agents to benefit from the associated reduction of complexity and improved possibilities for cooperation. We argue that the notion of living up to one's commitments, rather than actual fulfillment, plays the key role in the trust–commitment interrelation, and we propose a formal analysis of that notion in the framework of agents and strategies in branching time. The main technical innovation is a stringency ordering on an agent's strategies that allows one to classify what an agent does as more or less appropriate with respect to a given commitment, leading to a fine-grained assessment of trustworthiness.