Processes in acceptance and commitment therapy and the rehabilitation of chronic fatigue

Acceptance and commitment therapy (ACT) has never been tested for patients with chronic fatigue. We aimed to test if a 3.5‐week ACT rehabilitation program for patients with chronic fatigue improved quality of life (QoL), fatigue, and psychological flexibility. Further, to test if improvements in QoL and fatigue were associated with improvement in psychological flexibility, and if psychological flexibility explained variance above and beyond maladaptive cognitions typically targeted in CBT for fatigue. Patients (n = 140) who had been on sick leave > 8 weeks due to chronic fatigue received a 3.5‐week non‐controlled inpatient rehabilitation program based on ACT. A physician and a psychologist examined the patients, assessing medication use and SCID‐I diagnoses. Patients completed questionnaires about somatic complaints, psychological complaints, and maladaptive cognitions before and after treatment. At post‐treatment, patients reported improved QoL (p < 0.001; g = 1.07) and less fatigue (p < 0.001; g = 1.08), but not increased psychological flexibility (p = 0.6). Changes in psychological flexibility was associated with improved QoL, but not fatigue, in hierarchical regression analyses. When adjusting for other cognitions, changes in fear‐avoidance cognitions and all‐or‐nothing thoughts, but not psychological flexibility, were associated with improved QoL and fatigue. The ACT‐based treatment improved QoL and reduced fatigue for patients with chronic fatigue with large effect sizes. Improvement was associated with a reduction in fear‐avoidance cognitions and all‐or‐nothing thoughts, but not psychological flexibility.     

Teaching mindfulness to psychotherapists in clinical practice: The Mindful Therapy Programme

Introduction: Initially proposed as a treatment modality for psychological disorders, mindfulness is now being promoted as a means of enhancing both therapist self care and therapeutic efficacy. The degree to which mindfulness can be learned by therapists to manage their own and clients' processes in therapy is as yet unknown. This study examines training outcomes of a standardised introductory mindfulness programme for mental health professionals. Methods: Forty-seven mental health professionals completed an eight-week mindful therapy (MT) training programme and associated measures. Results: Compared with baseline scores, participants demonstrated knowledge acquisition on all measures, including increased mindfulness in clinical work, increased capacity to intentionally invoke mindful states of consciousness, and higher participant ratings of well-being over the course of training sessions. Discussion: This research provides preliminary evidence that a brief, standardised mindfulness training programme can achieve acceptable knowledge and skills outcomes for therapists that can aid their therapeutic practice. Of note, increased ‘therapeutic mindfulness’ in this study resulted from changed mindfulness ‘attitudes’ (i.e. a more accepting and equanimous orientation within therapeutic work) as opposed to a clear demonstration of increased attention-regulation skills. The implications of these and other results for programme development and wider research are discussed.     

All quiet on the postmodern front?

This paper explores the question of the purpose of education within the context of Lyotardȁ9s framing of the postmodern condition. It points to some of the continuities and discontinuities in the framing of the current condition as postmodern and the recurrent problematics of truth-telling which is the mark of this condition. It suggests that educationally the postmodern condition is marked by lifelong learning, a constant apprenticeship rather than mastery, where in language stutters.     

Lyotard, nihilism and education

This paper argues the Lyotard's The Postmodern Condition is to be interpreted as a response to nihilism, especially in relation to the question of the legitimation of knowledge and the so-called crisis of narratives, and that, therefore, it provides an appropriate response to the question of nihilism in educational philosophy. The paper begins with a discussion of Nietzsche's and Heidegger's views of nihilism as a prolegomenon to Lyotard's views concerning European nihilism and the end of grand narratives. These are important sources for a philosophical reception of the problem and the context in which Lyotard formulates his response and the immediate sources against that conditions Lyotard's response. The problem of nihilism raises its head in education in a double way: in relation to both the foundation of knowledge and the problem of its legitimation (The Postmodern Condition) and the problem of values (The Differend).     

The relationship between acceptance,fatigue, and subjective cognitive impairment in hematologic cancer survivors

Background/Objective: Cancer and its treatment can have a detrimental impact on psychological well-being. Acceptance as the basis of acceptance and commitment therapy (ACT) has shown beneficial effects on depression and anxiety. However, its relationship to fatigue and cognitive impairment has not been investigated. A protective effect of acceptance may open up a new target for psychological intervention.Method: A cross-sectional postal survey was undertaken. 922 hematological cancer survivors (≥ 2.5 years post diagnosis) were recruited through two regional cancer registries in Germany. Acceptance (AAQ-II), fatigue (BFI) and subjective cognitive impairment (AFI) were assessed.Results: Higher levels of acceptance were negatively associated with fatigue and subjective cognitive impairment (R²= .34 and R²= .26, respectively). The relationship between fatigue and fatigue-related impairment of daily life was weaker for survivors with high acceptance.Conclusions: Acceptance is strongly associated with fatigue and subjective cognitive impairment. ACT may be useful to reduce symptoms of fatigue and subjective cognitive impairment in cancer survivors.     

Unequally into “Us”: Characteristics of Individuals in Asymmetrically Committed Relationships

This study examined characteristics of individuals that are associated with being in asymmetrically committed relationships (ACRs), defined as romantic relationships in which there was a substantial difference in the commitment levels of the partners. These ACRs were studied in a national sample of unmarried, opposite‐sex romantic relationships (N = 315 couples). Perceiving oneself as having more potential alternative partners was associated with increased odds of being the less committed partner in an ACR compared to not being in an ACR, as was being more attachment avoidant, having more prior relationship partners, and having a history of extradyadic sex during the present relationship. Additionally, having parents who never married was associated with being the less committed partner in an ACR but parental divorce was not. Although fewer characteristics were associated with being the more committed partner within an ACR, more attachment anxiety was associated with increased odds of being in such a position compared to not being in an ACR. We also address how some findings change when controlling for commitment levels. Overall, the findings advance understanding of commitment in romantic relationships, particularly when there are substantial asymmetries involved. Implications for both research on asymmetrical commitment as well as practice (e.g., therapy or relationship education) are discussed.     

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis

As evidence‐based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural‐strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off‐model, nonsystemic formulations/interventions). Of these, “failure to think in threes” appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.     

Treatment‐as‐Usual for Couples: Trajectories Before and After Beginning Couple Therapy

Couple therapy has been shown to be a meaningful way to improve couples’ relationships. However, less information is known about couples’ functioning prior to entering treatment in community settings, as well as how their relationship functioning changes from initiating therapy onward. This study examined 87 couples who began community‐based couple therapy during a longitudinal study of couples in the military. The couples were assessed six times over the course of 3 years, including time points before and after starting couple therapy. Using an interrupted‐time series design, we examined trajectories across the start of couple therapy in relationship satisfaction, divorce proneness, and negative communication. The results demonstrated that couples’ relationship satisfaction was declining and both divorce proneness and negative communication were increasing prior to entering couple therapy. After starting couple therapy, couples’ functioning on all three variables leveled off but did not show further change, but previous experience in relationship education moderated these effects. Specifically, those who were assigned to the relationship education program (vs. control) demonstrated greater reductions in divorce proneness and greater increases marital satisfaction after starting therapy; however, they also started more distressed.     

The Quarter-life Time Period: An Age of Indulgence,Crisis or Both?

A new developmental stage called the quarter-life is proposed, extending from approximately 18–29 years of age and sometimes later. The emergence of this period is believed to be the result of several social, historic and economic factors that occurred post WWII. This article explores these changes in terms of the experiences of affluent young people in today’s Western society. A typology of adaptational responses are presented and explored as the quarter-lifers attempt to navigate their way to adulthood within the context of this ‘new’ affluent society. Implications for family therapists are considered.     

Apophasis and the turn of philosophy to religion: From Neoplatonic negative theology to postmodern negation of theology

This essay represents part of an effort to rewrite the history metaphysics in terms of what philosophy never said, nor could say. It works from the Neoplatonic commentary tradition on Plato’s Parmenides as the matrix for a distinctively apophatic thinking that takes the truth of metaphysical doctrines as something other than anything that can be logically articulated. It focuses on Damascius in the 5–6th century AD as the culmination of this tradition in the ancient world and emphasizes that Neoplatonism represents the crisis of Greek metaphysics on account of the inability to give a rational account of foundations for knowing and of the ultimate principle of beings. Neoplatonism discovered how all such ultimate principles were necessarily beyond the reach of reason and speech. This apophatic insight is drawn out with the help of contemporary criticism of Neoplatonic philosophy, defining also some points of divergence. The essay then discusses the motives for thinking the unsayable in postmodern times on the basis of this parallel with Neoplatonic thought. Discourse’s becoming critical of itself to the point of self-subversion animates them both. However, the tendency in postmodern thought to totally reject theology, including negative theology, is a betrayal of its own deepest motivations. This tendency is debated through an examination of the thought of Jean-Luc Nancy. While any traditional discourse can be negated, the negating and self-negating capacity of discourse itself is infinite, and this is where a perennial negative theological philosophy of the unsayable is to be located. Language, eminently the language of philosophy, as infinitely open, points in a direction which becomes equally and ineluctably theological.