Changes in proposed mechanisms of action during an acceptance-based behavior therapy for generalized anxiety disorder

University of Massachusetts Boston, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 11/2009; 48(3):238-45. DOI: 10.1016/j.brat.2009.11.006
Source: PubMed

ABSTRACT Based on the theory that generalized anxiety disorder (GAD) is maintained through a reactive and fused relationship with one's internal experiences and a tendency towards experiential avoidance and behavioral restriction, an acceptance-based behavior therapy (ABBT) was developed to specifically target these elements. Since ABBT has been shown to be an efficacious treatment in previous studies, the current study focuses on proposed mechanisms of change over the course of therapy. Specifically, the current study focuses on session-by-session changes in two proposed mechanisms of change: acceptance of internal experiences and engagement in meaningful activities. Overall, clients receiving ABBT reported an increase in the amount of time spent accepting internal experiences and engaging in valued activities. Change in both acceptance and engagement in meaningful activities was related to responder status at post-treatment and change in these two proposed mechanisms predicted outcome above and beyond change in worry. In addition, change in acceptance was related to reported quality of life at post-treatment.

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Available from: Lizabeth Roemer, Sep 29, 2015
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    • "Despite the preceding case that values are a potentially important and underutilized aspect of OCD treatment, the current study is crosssectional in nature, therefore limiting the strength of the conclusion. More studies similar to that of Hayes et al. (2010), who measured values, acceptance and anxiety symptoms across sessions could be useful in examining the relationships explored in this paper in the context of OCD treatment. Moreover, due to the cross-sectional nature of the current study, the directionality of the relationship between values and OCD severity is unknown. "
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    ABSTRACT: New interventions such as Acceptance and Commitment Therapy (ACT) have shown early promise in the treatment of OCD, focusing on aspects of psychological flexibility including valued living, mindfulness, and committed action. However, research is needed to explore the relationship between the various components of ACT and OCD. The present study sought to investigate the relationship between values (i.e., self-compassion, courage, and the Valued Living Questionnaire [VLQ; the extent to which one has values and is living out values in everyday life]) and OCD severity. Participants (N=115) who self-reported meeting criteria for OCD completed an online survey assessing levels of different values as well as ratings of importance and consistent living within these values. Analyses yielded significant relationships between OCD severity and self-compassion, courage, and the VLQ. A multiple regression analysis revealed the VLQ and courage to be significant predictors of OCD severity. Interpretation of the results and their implications is considered.
    Journal of Contextual Behavioral Science 10/2013; 2(3-4). DOI:10.1016/j.jcbs.2013.09.002
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    • "nce or tolerance of unwanted internal experiences , developing inhibitory responses , or whether these even represent distinct mechanisms ( Craske et al . , 2008 ) . Whereas preliminary evidence suggests that experiential avoidance and psychological inflexibility may be malleable mediators of response to psycho - therapy ( Berking et al . , 2009 ; Hayes et al . , 2010 ) , additional research is warranted to clarify the influence of experiential avoid - ance and psychological inflexibility on trajectories of response to trauma over time , including response to treatment for PTSD . Strengths of the current study include the use of a gold - standard diagnostic interview and the inclusion of multiple , r"
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    ABSTRACT: Although much is known regarding predictors of posttraumatic stress disorder (PTSD), little of this knowledge directly informs treatment. This study examined whether higher scores on the Acceptance and Action Questionnaire—II (AAQ–II), a self-report measure that purportedly assesses experiential avoidance and psychological inflexibility, accounted for unique variance in PTSD symptoms compared with personality factors and other established predictors of PTSD. In addition, this study examined whether the construct measured by the AAQ–II accounts for unique variance in PTSD severity over and above the avoidance symptoms of PTSD. A sample of 109 trauma-exposed veterans of the wars in Iraq and Afghanistan, approximately half of whom met current PTSD criteria on the Clinician-Administered PTSD Scale (CAPS), completed self-report measures of PTSD, combat exposure, perceived life threat, peritraumatic dissociation, recent life stress, perceived postdeployment social support, and personality. Higher AAQ–II scores, which indicate higher levels of psychological inflexibility and experiential avoidance, accounted for unique variance in PTSD symptom severity after controlling for all other predictors (small effect size [ES] on the CAPS; large ES on the self-report PTSD measure). Significant effects for AAQ–II scores remained after controlling for the avoidance symptoms of PTSD (small ES on the CAPS; medium ES on the self-report measure). Scores on the AAQ–II appears to be an important predictor of PTSD that warrants further investigation. Research should continue to examine the malleability of the constructs assessed by the AAQ–II, which may be useful targets in treatment.
    Psychological Trauma Theory Research Practice and Policy 09/2013; 5(6):521-528. DOI:10.1037/a0030178 · 2.31 Impact Factor
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    • "ACT studies have typically focused on evaluation of the core processes of the model, as described above, to examine the validity and impact of each [12]. These studies have found support for the roles of defusion [29] and acceptance [17,30], and some support for the role of values and/or committed action [17] in reducing psychopathology. Ultimately, this emerging research has led to the genesis of three ACT mediational hypotheses, that psychological inflexibility precedes suffering among clinical and non-clinical populations; ACT increases psychological flexibility; and psychological flexibility leads to enhanced well-being, decreased clinical symptoms and increased value-based activities [14]. "
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    ABSTRACT: Background Anxiety disorders affect approximately 10% to 20% of young people, can be enduring if left untreated, and have been associated with psychopathology in later life. Despite this, there is a paucity of empirical research to assist clinicians in determining appropriate treatment options. We describe a protocol for a randomized controlled trial in which we will examine the effectiveness of a group-based Acceptance and Commitment Therapy program for children and adolescents with a primary diagnosis of anxiety disorder. For the adolescent participants we will also evaluate the elements of the intervention that act as mechanisms for change. Methods/design We will recruit 150 young people (90 children and 60 adolescents) diagnosed with an anxiety disorder and their parent or caregiver. After completion of baseline assessment, participants will be randomized to one of three conditions (Acceptance and Commitment Therapy, Cognitive Behavior Therapy or waitlist control). Those in the Acceptance and Commitment Therapy and Cognitive Behavior Therapy groups will receive 10 × 1.5 hour weekly group-therapy sessions using a manualized treatment program, in accordance with the relevant therapy, to be delivered by psychologists. Controls will receive the Cognitive Behavior Therapy program after 10 weeks waitlisted. Repeated measures will be taken immediately post-therapy and at three months after therapy cessation. Discussion To the best of our knowledge, this study will be the largest trial of Acceptance and Commitment Therapy in the treatment of children and young people to date. It will provide comprehensive data on the use of Acceptance and Commitment Therapy for anxiety disorders and will offer evidence for mechanisms involved in the process of change. Furthermore, additional data will be obtained for the use of Cognitive Behavior Therapy in this population and this research will illustrate the comparative effectiveness of these two interventions, which are currently implemented widely in contemporary clinical practice. Anticipated difficulties for the trial are the recruitment and retention of participants, particularly adolescents. To avert these concerns and maximize recruitment, several strategies will be adopted to optimize referral rates as well as reduce participant drop-outs. Trial registration This trial is registered with the Australian and New Zealand Clinical Trials Registry, registration number: ACTRN12611001280998
    Trials 05/2013; 14(1):140. DOI:10.1186/1745-6215-14-140 · 1.73 Impact Factor
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