Joanna J Arch

University of Colorado Boulder | CUB · Department of Psychology and Neuroscience

Background Self-affirmation theory (SAT) and acceptance and commitment therapy (ACT) embody competing approaches to leveraging personal values to motivate behavior change but are rarely compared in the domain of health behavior. This study compares these theory-driven values-based interventions for promoting medication adherence. Purpose To compar...

Objectives Social anxiety has been linked with low trait self-compassion and high levels of self-criticism. Thus, there is growing interest in enhancing self-compassion to reduce social anxiety. However, a gap exists in reviewing the strength of the association between self-compassion and social anxiety and the efficacy of self-compassion-based int...

Anxiety and related disorders are a significant public-health burden with rising prevalence in the wake of the COVID-19 pandemic. As demand for effective anxiety treatment increases, so too does the need for strategies to bolster treatment outcomes. Research on the mechanisms of exposure therapy, the frontline behavioral treatment, will be critical...

Background: Adults with advanced cancer experience profound future uncertainty, reflected in elevated fear of cancer progression (FoP) and cancer-related trauma symptoms. These symptoms are associated with physical symptom burden and poorer quality of life, and few interventions exist to manage them. Objective: To develop and pilot a written exposu...

The Exposure Therapy Consortium (ETC) was established to advance the science and practice of exposure therapy. To encourage participation from researchers and clinicians, we describe the organizational structure and activities of the ETC. Initial research working group experiences and a proof-of-principle study underscore the potential of team scie...

PURPOSE Providers treating adults with advanced cancer increasingly seek to engage patients and surrogates in advance care planning (ACP) and end-of-life (EOL) decision making; however, anxiety and depression may interfere with engagement. The intersection of these two key phenomena is examined among patients with metastatic cancer and their surrog...

Social anxiety disorder (SAD) is characterized by an excessive fear of social evaluation and a persistently negative view of the self. Here we test the hypothesis that negative biases in brain responses and in social learning of self-related information contribute to the negative self-image and low self-esteem characteristic of SAD. Adult participa...

Purpose Following curative-intent therapy of lung cancer, many survivors experience dyspnea and physical inactivity. We investigated the feasibility, acceptability, safety, and potential efficacy of inspiratory muscle training (IMT) and walking promotion to disrupt a postulated “dyspnea-inactivity” spiral. Methods Between January and December 2022...

Purpose: Adjuvant endocrine therapy (AET) adherence among breast cancer survivors is often suboptimal, leading to higher cancer recurrence and mortality. Intervention studies to promote AET adherence have burgeoned, more than doubling in number since this literature was last reviewed. The current aim is to provide an up-to-date systematic review a...

e24122 Background: Poly(ADP-ribose) polymerase inhibitors (PARPi) have dramatically changed the treatment of advanced ovarian cancer and are increasingly used in other cancers. However, PARPi cause significant fatigue in nearly half of patients. Psychosocial interventions have shown promise for treating cancer-related fatigue, but there is limited...

This study audited publications in the Journal of Contextual Behavioral Science (JCBS) to characterize the extent to which articles published by the journal 2020 - 2021 used commonly accepted open science practices that enhance transparency & reproducibility.

Objectives: Caregivers of adult phase 1 oncology trial patients experience high levels of distress and face barriers to in-person supportive care. The Phase 1 Caregiver LifeLine (P1CaLL) pilot study assessed the feasibility, acceptability, and general impact of an individual telephone-based cognitive behavioral stress-management (CBSM) interventio...

This chapter reviews the literature on self-compassion and peripheral immune and stress response-related physiology. Specifically, we review the evidence related to self-compassion and relevant immune and stress response system (autonomic, hypothalamic–pituitary–adrenal axis, peripheral inflammatory) biomarkers, as well as evidence that self-compas...

Objective: Psychotherapies like Acceptance and Commitment Therapy (ACT) are thought to target multiple clinical outcomes by intervening on multiple mechanistic process variables. However, the standard mediation approach does not readily model the potentially complex associations among multiple processes and outcomes. The current study is one of th...

Purpose: To describe trajectories of general and bodily vigilance anxiety among cancer survivors during COVID-19 and examine associated factors. Design: Longitudinal survey study (May-December 2020). Sample: Colorado-based cancer survivors (N = 147). Methods: Latent class growth analyses were used to examine trajectories for two types of anx...

Background Up to half of adults with advanced cancer report anxiety or depression symptoms, which can cause avoidance of future planning. We present a study protocol for an innovative, remotely-delivered, acceptance-based, multi-modal palliative care intervention that addresses advance care planning (ACP) and unmet psychological needs commonly expe...

Objective: Though it is well-documented that cancer survivors experienced healthcare delays during the COVID-19 pandemic, who initiated those delays has not been examined. This longitudinal study distinguishes rates of patient- from provider-cancelled healthcare appointments at three timepoints during the pandemic, and examines psychosocial factor...

The question of whether some interventions lead to more consistent (i.e., similar) degrees of change across treated individuals than others remains a critical overlooked question in psychology, education, and related fields. Questions of consistency are becoming increasingly important as researchers develop adaptations, such as digital or peer-led...

Exposure therapy is a widely utilized and researched psychological intervention for the treatment of anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorders (OCD). Chap. 1 sets the stage for the chapters that follow by providing a brief overview of the history and the evidence base underlying exposure therapy’s u...

Purpose Oral anti-cancer medications are increasingly common and endocrine therapies represent the most common oral anti-cancer medications in breast cancer. Adjuvant endocrine therapies reduce the likelihood of recurrence and mortality in the approximately 80% of women diagnosed with hormone-receptor-positive breast cancer, thus rendering adherenc...

Background Improving medication adherence represents one of the greatest behavioral challenges in medicine. Personal values are an under-examined source of motivation for adhering to medication. This secondary analysis leverages a mixed-method approach to understanding a novel, online, values-based intervention (‘REACH’) for promoting endocrine the...

Acceptance and Commitment Therapy (ACT) emphasizes a focus on theory-driven processes and mediating variables, a laudable approach. The implementation of this approach would be advanced by addressing five challenges, including: 1) distinguishing ACT processes in measurement contexts; 2) developing and rigorously validating measures of ACT processes...

Objective Acceptance and Commitment Therapy (ACT) is a promising psycho-oncological intervention, but its mechanisms in real-world settings are not fully understood. This study examined core theorized ACT and broader ACT-consistent target processes as mediators of ACT versus minimally-enhanced usual care within a randomized trial for anxious cancer...

Objective: Psychotherapies like Acceptance and Commitment Therapy (ACT) are thought to target multiple clinical outcomes by intervening on multiple mechanistic process variables. However, the standard mediation approach does not readily model the potentially complex associations among multiple processes and outcomes. The current study is one of the...

Background Oral anti-cancer treatments such as adjuvant endocrine therapies (AET) for breast cancer survivors are commonly used but adherence is a challenge. Few low-touch, scalable interventions exist to increase ET adherence. Purpose To evaluate the acceptability, feasibility, and initial efficacy of a low-touch, remotely-delivered values plus A...

Introduction The COVID-19 pandemic has presented population-wide novel stressors. Acceptance and Commitment Therapy (ACT) may be potent for coping with novel, unpredictable stressors, but it is unknown whether pre-pandemic ACT treatment conferred protective benefit during the COVID-19 pandemic. Methods Participants (N = 73) from a previous randomi...

Objectives: Psychological flexibility/inflexibility (PF/PI) is a core component of the acceptance and commitment therapy (ACT) model, which is gaining more attention in the geropsychological literature. This scoping review examines the size and scope of the research on PF/PI in older adulthood related to age differences between older adult and you...

Despite some evidence of the benefits of self-compassion training among socially anxious individuals, little is known about whether enhancing self-compassion prior to exposure therapy increases initial exposure engagement. Additionally, manipulations have relied on broad definitions of self-compassion, rendering it difficult to distinguish the impa...

Purpose: Oral anti-cancer medications are increasingly common and endocrine therapies represent the most common oral anti-cancer medications in breast cancer. Adjuvant endocrine therapies reduce the likelihood of recurrence and mortality in the approximately 80% of women diagnosed with hormone-receptor positive breast cancer, thus rendering adheren...

Background: Improving medication adherence represents one of the greatest behavioral challenges in medicine. Personal values are an under-examined source of motivation for adhering to medication. This secondary analysis leverages a mixed-method approach to understanding a novel, online, values-based intervention (‘REACH’) for promoting endocrine th...

Chronic health conditions are the leading cause of disability, reduced quality of life, and death. For 20 percent of these patients, clinical anxiety and depression exacerbate existing disease. Despite the high prevalence of comorbidity, existing treatments and service delivery approaches largely reflect fragmented, disease-specific care. Tradition...

This article offers an up-to-date selective review of acceptance and commitment therapy (ACT) conducted in the group format. ACT in the group format differs from ACT in the individual format; its potential advantages and disadvantages are discussed in general and in terms of the six ACT hexaflex processes. Reviewed in this article are select large...

INTRODUCTION: The COVID-19 pandemic has presented population-wide novel stressors. Acceptance and Commitment Therapy (ACT) may be potent for coping with novel, unpredictable stressors, but it is unknown whether pre-pandemic ACT treatment conferred protective benefit during the COVID-19 pandemic.METHODS: Participants (N = 73) from a previous randomi...

Purpose: Oral anti-cancer medications are increasingly common and endocrine therapies represent the most common oral anti-cancer medications in breast cancer. Adjuvant endocrine therapies reduce the likelihood of recurrence and mortality in the approximately 80% of women diagnosed with hormone-receptor positive breast cancer, thus rendering adheren...

This study developed and evaluated a brief, single-session online intervention designed to facilitate treatment seeking among adults with clinically significant social anxiety (SA) symptoms, who generally seek treatment at exceptionally low rates. Adults ( N = 267) reporting significant SA symptoms were recruited online and randomized to a brief, s...

Study objectives: Given the uncertainty COVID-19 has caused for individuals with prior medical conditions, we examined the extent to which cancer survivors consider themselves at risk for the global COVID-19 pandemic (henceforth COVID), both in general and due to their cancer history. Additionally, we evaluated whether perceived vulnerability to C...

Objective: Acceptance and Commitment Therapy (ACT) is a promising intervention for cancer survivors, but its mechanisms in real-world settings are not fully understood. This study examined ACT-specific and broader target processes as mediators in the Valued Living randomized controlled trial, which compared ACT and usual care for anxious cancer sur...

Objective: Anxiety symptoms are common among cancer survivors. This study evaluated whether an acceptance-based group intervention delivered by social workers in community oncology clinics improved anxiety and related symptoms, and healthcare use, relative to enhanced usual care (EUC). Method: This multi-site trial included 135 survivors of vari...

Self-transcendence is thought to increase well-being and is implicitly promoted in contextual cognitive behavioral therapies (CCBTs). This study conceptualizes, develops, and validates the first comprehensive CCBT-informed self-transcendence questionnaire. Using a CCBT-informed theory, we propose four self-transcendence facets: distancing oneself f...

Introduction There is a clear bi-directional link between stressful events and depressive symptoms in adolescence, but the directionality of this link for anxiety symptoms remains underexamined. We critically evaluate the longitudinal relationship between stressors and anxiety among youth. Specifically, we examine whether stressors predict anxiety...

Objective Oral PARP inhibitors (PARPi) have dramatically changed the treatment landscape for patients with advanced ovarian cancer. However, a subset of patients discontinue PARPi due to treatment-related fatigue. The current study sought to explore patients' lived experiences with fatigue on PARPi. Methods We conducted individual semi-structured...

Although task-unrelated thinking (often conceptualised as “mind-wandering”) has been increasingly investigated in recent years, the content and correlates of everyday off-task thought in clinical disorders, particularly anxiety disorders, remain poorly understood. We aimed to address this gap by using ecological momentary assessment to assess off-t...

Purpose Despite cancer survivors’ frequent endorsement of anxiety symptoms, assessing the full range of anxiety disorders (AD), their timing of onset relative to cancer diagnosis, co-morbidity with mood disorder, and predictors of post-cancer onset, is rare or absent to date. This study provides a step toward addressing these gaps. Methods Cancer...

Multiple randomized clinical trials have demonstrated that palliative care improves the quality of life of individuals with serious medical illness. Research also suggests that in patients with advanced cancer, palliative care’s focus on symptom management, coping with illness, goals of care, and treatment decisions may be associated with improved...

Experiential avoidance, a trait-like construct referring to the tendency to rigidly avoid or change unpleasant internal experiences stemming from an unwillingness to experience them, is believed to contribute to the development and maintenance of various forms of psychopathology. Despite significant research on this construct, it remains unclear wh...

Objectives The purpose of the current study was to describe anxious pregnant women’s concerns about using pharmacotherapy to treat anxiety symptoms, and the relationship of such concerns to women’s willingness to use pharmacotherapy during pregnancy. Methods Between April 2011 and May 2012, 148 women who were pregnant and reported elevated anxiety...

Background: Adults with metastatic cancer frequently report anxiety and depression symptoms, which may impact health behaviors such as advance care planning (ACP). Objective: The study leveraged acceptance and commitment therapy (ACT), an evidence-based approach for reducing distress and improving health behaviors, and adapted it into a multimodal...

Purpose Within psycho-oncology clinical trials, usual care (UC) represents a common and important control condition. Yet recent shifts in oncology, coupled with insufficient description of such conditions, threaten to render UC increasingly difficult to define and interpret. This paper offers evidence of these shifts and recommendations for address...

Background: Safety behaviours are ubiquitous across anxiety disorders and are associated with the aetiology, maintenance and exacerbation of anxiety. Cognitive behavioural models posit that beliefs about safety behaviours directly influence their use. Therefore, beliefs about safety behaviours may be an important component in decreasing safety beha...

Avoidance has long been viewed as an etiological mechanism of anxiety disorders. Of more recent focus within this literature is the distinction between avoidance that is trait-based (experiential avoidance) versus contextual (safety behaviors). Whereas both experiential avoidance and safety behaviors have been studied within anxiety research, no kn...

Background Anxiety is a common concern of cancer survivors during the transition from active cancer treatment to cancer survivorship (the re-entry phase). This paper presents the study protocol for a novel group-based behavioral intervention to improve mental health, well-being, and medical use outcomes among anxious cancer survivors at re-entry....

CBT is considered the first-line treatment for anxiety disorders, particularly when it involves gradual confrontation with feared stimuli (i.e., exposure); however, delivery of CBT for anxiety disorders in real-world community clinics is lacking. This study utilized surveys we developed with key stakeholder feedback (patient, provider, and administ...

Despite the effectiveness of exposure-based cognitive behavioral therapy (CBT) for anxiety disorders, few individuals in need receive this treatment, particularly in community mental health settings serving low-income adults. The present study took a preliminary step to understand these barriers by conducting a series of key informant interviews an...

Background and objectives: This study evaluates the process and consequence of inducing self-compassion during recovery from social performance stressors. Though interest in self-compassion as an intervention target is growing, extant findings suggest that initially cultivating self-compassion can be challenging for those with high self-criticism a...

Background: Cancer survivor preferences for formal interventions designed to provide psychological support remain relatively unknown. To address this gap, we evaluated cancer survivors' preferences for psychological intervention, whom they preferred to recommend such intervention, and how their preferences compared with what they currently receive...

Misophonia is an important, yet understudied, psychological condition characterized by feelings of extreme anger and disgust in response to specific human-generated sounds. Several promising case studies using cognitive behavioral therapy to treat misophonia have been published, but given the limited work to date, exploring additional treatment opt...

People learn about their self from social information, and recent work suggests that healthy adults show a positive bias for learning self-related information. In contrast, social anxiety disorder (SAD) is characterized by a negative view of the self, yet what causes and maintains this negative self-view is not well understood. Here we employ a nov...

Purpose: We assessed whether experiencing parental cancer during childhood was associated with anxiety levels during young adulthood—and whether parental survival status moderated anxiety or related psychosocial outcomes. Methods: Young adults who experienced parental cancer during their childhood (n = 68) and those who did not (n = 298) completed...

Psychological interventions have a long history of successful treatment of patients suffering from mental health and certain medical conditions. At the same time, psychotherapy research has revealed key areas of growth for optimizing patient care. These include identifying novel treatment delivery methods that increase treatment adherence, developi...

Background: No prior studies have examined moderators of dropout between distinct treatments for anxiety disorders. This study applied a novel statistical approach for examining moderators of dropout from traditional cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). Method: We combined data from two randomized contr...

In this review, we examine common usage of the term third wave in the scientific literature, systematically review published meta-analyses of identified third wave therapies, and consider the implications and options for the use of third wave as a metaphor to describe the nature of and relationships among cognitive and behavioral therapies. We demo...

Objective: The successful recruitment and study of cancer survivors within psycho-oncology research can be challenging, time-consuming, and expensive, particularly for key subgroups such as young adult cancer survivors. Online crowdsourcing platforms offer a potential solution that has not yet been investigated with regard to cancer populations. T...

Methods: Initial emotion non-awareness, nonacceptance, and difficulties with goal-directed behavior were assessed in a community sample (n = 312, age range = 8-16, mean age = 11.68, 59% female, 69% Caucasian). Social anxiety, separation anxiety, and physical anxiety symptoms were assessed every 3 months for 3 years. Hierarchical linear modeling wa...

Table of contents Introduction to the 3rd Biennial Conference of the Society for Implementation Research Collaboration: advancing efficient methodologies through team science and community partnerships Cara Lewis, Doyanne Darnell, Suzanne Kerns, Maria Monroe-DeVita, Sara J. Landes, Aaron R. Lyon, Cameo Stanick, Shannon Dorsey, Jill Locke, Brigid Ma...

Exposure-based therapy represents a first line treatment for anxiety disorders, but it is often underused. One target for improving client engagement is manipulating the theoretical perspective from which exposure is framed. Ninety-six adults with elevated social anxiety were enrolled in a two-session exposure therapy intervention. Participants wer...

Arch et al. (2014) demonstrated that brief self-compassion meditation training (SCT) dampened sympathetic (salivary alpha-amylase) and subjective anxiety responses to the Trier Social Stress Test (TSST), relative to attention and no-instruction control conditions. The present study examined baseline predictors and moderators of these SCT interventi...

Objective: Mindfulness-based interventions have been increasingly applied to treat eating-related problems ranging from obesity to eating disorders. Yet few studies have empirically examined the mechanisms of a mindful approach to eating. The current studies examine the potential of brief mindfulness instructions to enhance the psychological and b...

Background Pretreatment biases in attending toward threat have been shown to predict greater symptom reduction following cognitive behavioral therapy (CBT) for anxiety. Findings to date do not extend to clinical severity of diagnoses and they assess treatment response immediately posttreatment and not at follow-up. Research in this area has also no...

Cognitive behavioral therapy (CBT), particularly when it includes an exposure component, is an empirically supported psychosocial treatment for anxiety disorders that has been shown to be highly efficacious, desirable to patients, and cost-effective. However, access to and receipt of exposure-based treatment CBT anxiety remains lacking despite thes...

Background and Objectives Identifying for whom and under what conditions a treatment is most effective is an essential step toward personalized medicine. The current study examined pre-treatment physiological and behavioral variables as predictors and moderators of outcome in a randomized clinical trial comparing cognitive behavioral therapy (CBT)...

Objective: To examine the effects of a daily, 10-minute mindfulness meditation intervention administered online through Mechanical Turk over a two-week period on the intensity of anxiety, perceived stress, and reported sleep quality in participants pre-screened for general anxiety symptoms. Method: One hundred and forty-eight participants pre-scree...

Objective To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder. Method Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized me...

Objective: Cognitive behavioral therapy (CBT) is an empirically supported treatment for social phobia. However, not all individuals respond to treatment and many who show improvement do not maintain their gains over the long-term. Thus, alternative treatments are needed. Method: The current study (N = 87) was a 3-arm randomized clinical trial co...

A growing body of research has revealed that social evaluative stressors trigger biological and psychological responses that in chronic forms have been linked to aging and disease. Recent research suggests that self-compassion may protect the self from typical defensive responses to evaluation. We investigated whether brief training in self-compass...

Cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is often highly effective, yet some patients experience relapses following a seemingly successful course of treatment. In this article we describe the components of CBT for OCD and then present a patient who relapses after making significant gains during a course of CBT. Lik...

Relatively little is known about women's anxiety-related treatment preferences and no studies have examined potential differences between pregnant versus non-pregnant women. Treatment credibility and willingness are particularly important to understand regarding exposure-based cognitive behavioral therapy (CBT) and pharmacotherapy, the leading evid...

Objective: Identifying treatment moderators facilitates treatment matching and personalized medicine. No previous studies have investigated treatment moderators for a mindfulness-based versus traditional cognitive behavioral therapy (CBT) for anxiety disorders to determine for whom each is most effective. The current study examined three putative...

This study presents the perspectives of academic-VA partners who have recently completed a randomized clinical trial within a VA outpatient clinic. The authors reflect on the challenges and rewards of implementing academic-VA community clinical research partnerships with the aim of assisting new VA investigators and VA collaborators. Staff resistan...

It remains unclear if diminished high frequency heart rate variability (HF-HRV) can be found across anxiety disorders. HF-HRV and heart rate (HR) were examined in panic (PD), generalized anxiety (GAD), social anxiety (SAD), and obsessive-compulsive disorder (OCD) relative to healthy controls at baseline and during anxiety stressors. All disorders e...