Michael E Levin

Utah State University | USU · Department of Psychology

Online Acceptance and Commitment Therapy (ACT) interventions use websites and smartphone apps to deliver ACT exercises and skills. The present meta-analysis provides a comprehensive review of online ACT self-help interventions, characterizing the programs that have been studied (e.g. platform, length, content) and analyzing their efficacy. A transd...

Background: Depression is a significant concern among college students, who suffer at higher rates and with greater severity than the general population. Online self-help could reduce the burden currently placed on college counseling centers, and programs based in cognitive behavioral therapies (CBTs) have a strong evidence base. However, online C...

Acceptance and Commitment Therapy (ACT) is an established in-person therapy but can be provided self-guided online. Recently, online ACT has been adapted to support dementia family caregivers. A primary goal of ACT is to connect individuals with their self-identified values, with the assumption that increased progress towards values will lead to im...

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...

Harmful effects of weight self-stigma on quality of life and health behaviors have been well-established. However, the processes that lead to these negative outcomes are less understood. Psychological inflexibility is defined as a pattern of rigid psychological reactions dominating over values and meaningful actions. A lack in valued action is char...

Online self-help programs such as the Acceptance and Commitment Therapy (ACT) Guide address significant barriers to receiving therapy but suffer from low adherence rates. Peer-delivered coaching, using undergraduate students as coaches, is an innovative alternative to traditional coaching methods which may improve adherence in a more scalable forma...

Treatments for trichotillomania in adolescence have historically been under-researched. This paper presents secondary analyses of treatment moderators and processes of change from a pilot trial assessing the efficacy of teletherapy acceptance-enhanced behavior therapy (AEBT) in adolescents (N = 28). All participants received 10 sessions of AEBT and...

Research on acceptance and commitment therapy (ACT) and its application to various clinical issues have proliferated across the world. Despite very active clusters of ACT research occurring worldwide, the science that is disseminated through the literature does not fully reflect this scope and diversity, with Iran serving as a prime example of this...

Online self-help programs such as the Acceptance and Commitment Therapy (ACT) Guide address significant barriers to receiving therapy but suffer from low adherence rates. Peer-delivered coaching, using undergraduate students as coaches, is an innovative alternative to traditional coaching methods which may improve adherence in a more scalable forma...

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...

Process-based therapy (PBT) is model of psychotherapy designed to improve people’s ability to use a variety of skills from evidence-based treatments to match environmental needs and personal goals in the moment. This randomized trial tested the effect of an online self-help intervention modeled after PBT principles for participants with perfectioni...

Process-based therapy (PBT) is model of psychotherapy designed to improve people's ability to use a variety of skills from evidence-based treatments to match environmental needs and personal goals in the moment. This randomized trial tested the effect of an online self-help intervention modeled after PBT principles for participants with perfectioni...

Anxiety disorders are one of the most prevalent diagnoses in youth, often resulting in impaired social and school functioning. Research on treatments for youth anxiety is primarily based in traditional clinical settings. However, integrating youth psychotherapies into the school environment improves access to evidence-based care. The present study...

Trichotillomania is a chronic and impairing disorder typically beginning in youth. There is growing research on the use of acceptance-enhanced behavior therapy (AEBT) for trichotillomania in youth. However, few studies explore long-term outcomes for youth who receive treatment for trichotillomania, particularly AEBT. The current study presents long...

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...

Although numerous studies on experiential avoidance and its relationship to psychopathology have been conducted, systematic summaries of this research are lacking. The current systematic review and meta-analysis evaluated the transdiagnostic role of experiential avoidance across depression, anxiety and related disorders (obsessive-compulsive and re...

Background Understanding how cognitive processes are naturally used by untrained individuals in the moment to cope with difficult thoughts may help inform effective and efficient interventions.Methods This study investigated self-reported naturalistic use of two evidence-based processes, cognitive restructuring and cognitive defusion, in an untrain...

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...

Associations between behavioral and psychological symptoms of dementia (BPSD), caregiver burden, and depressive symptoms are well-established, and these constructs are often targeted in interventions. Increasingly, dementia caregiver interventions are informed by mindfulness- and acceptance-based approaches, such as Acceptance and Commitment Therap...

Background Engagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy. Objective This study aimed to test a serial mediation model...

The global burden of mental illness and limited resources make increasing the efficiency of available mental healthcare resources especially crucial. One way this can be done is a stepped care approach to treatment. To test the viability of using internet-based self-help in a stepped care model, we examined the feasibility, acceptability, and effec...

Weight self-stigma, the internalization of negative societal stereotypes, is a problem among populations with high weight. Weight self-stigma is associated with psychological inflexibility and maladaptive health-related behaviors. In this study, the authors explore how weight-related psychological inflexibility may influence weight self-stigma and...

Cognitive fusion is a psychopathological process that appears to be relevant to a wide range of disorders. This process is frequently measured with the Cognitive Fusion Questionnaire (CFQ). However, the construct validity of similar measures has been criticized for substantial overlap with distress. It is possible the CFQ may excessively measure th...

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...

BACKGROUND Engagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy. OBJECTIVE This study aimed to test a serial mediation model...

Clinical perfectionism is the rigid pursuit of high standards, interfering with functioning. Little research has explored neural patterns in clinical perfectionism. The present study explores neural correlates of clinical perfectionism, before and after receiving ten 50-minute, weekly sessions of acceptance and commitment therapy (ACT), as compared...

Objectives Psychosocial and cognitive-behavioral dementia caregiver interventions are effective, yet accessing counselor/therapist-led programs can be costly and difficult. Face-to-face therapist-led Acceptance and Commitment Therapy (ACT) is highly effective in dementia caregivers, as established by two different randomized control trials. The cur...

Background Hoarding disorder (HD) affects approximately 2.5% of the general population, leads to significant distress and impairment, and is notoriously difficult to treat. The crux of developing effective treatments for HD is our ability to reliably and validly measure relevant constructs in HD to better understand its presentation and, subsequent...

Generalized anxiety disorder (GAD) is a common and debilitating condition. Effective treatments exist, but they are time- and resource-intensive. This study tested the initial efficacy and acceptability of a novel treatment protocol designed to increase efficiency: acceptance and commitment therapy (ACT) taught in groups and through an adjunctive m...

Racism and sexism are pervasive forms of discrimination that cause significant individual and societal burden. Understanding manipulable psychological processes that contribute to these modes of discrimination would aid in developing anti-prejudice interventions that target them. Psychological flexibility has been proposed as a potential tool in co...

Purpose of Review While the treatment of addictive disorders proves to be challenging, new treatment approaches that evolved around the concepts of mindfulness and acceptance have been utilized and investigated in recent years. Our goal is to summarize the efficacy and possible underlying mechanisms of mindfulness-based interventions (MBI) in addic...

Objective: Perfectionism is generally associated with worse mental health outcomes, though evidence suggests elements of it may be helpful. In light of these findings, we examined whether psychological skills like psychological flexibility and self-compassion moderated the relationship between perfectionism and wellbeing (i.e., quality of life, sy...

The practice of generating and interpreting stories can be examined through a behavioral lens and has many potential implications for clinical practice. However, storytelling has for the most part yet to be integrated into the field of contextual behavioral science (CBS). A bedrock of human culture, storytelling has influenced both individual behav...

Treatment of adolescent trichotillomania is understudied, and treatment providers are difficult to find. In this pilot study, we compared ACT-enhanced behavior therapy to a waitlist, with treatment delivered over Zoom, to 28 adolescents who met criteria for trichotillomania. This study partially occurred during the COVID-19 pandemic. A detailed des...

Hoarding disorder (HD) is associated with distress and functional impairment not only for the individual but also for their family members and community. Acceptance and commitment therapy (ACT) already has broad empirical support and may be helpful for treating HD. In this nonconcurrent multiple baseline study (N = 6), we examined the effect of ACT...

A process-based therapy approach emphasizes examining how and for whom specific therapeutic components linked to specific processes of change function. This preliminary study explored the processes of change for cognitive defusion and restructuring with daily ratings of self-criticism from a larger component trial as well as self-compassion as a mo...

Background Weight regain is common following behavioral obesity treatment and attenuates many of the benefits of initial weight loss. This paper describes a randomized controlled trial that will evaluate the efficacy of two low-contact weight loss maintenance interventions based on Acceptance and Commitment Therapy (ACT) and self-regulation (SR). P...

Previous research indicates mixed results for guided support with online interventions. The current secondary analysis evaluated the effects of phone coaching from a dismantling trial of online acceptance and commitment therapy (ACT) in a sample of 136 distressed college students randomized to one of three versions of an ACT website. Participants w...

Acceptance and commitment therapy (ACT) has shown benefit for improving diet, physical activity, and weight among adults who are overweight and obese. However, research to-date in this area has primarily evaluated ACT delivered through in-person interventions, which has more limited access relative to online formats. The present study evaluated an...

Weight self-stigma, in which individuals internalize stigmatizing messages about weight, is a prevalent problem that contributes to poor quality of life and health. This pilot randomized controlled trial evaluated acceptance and commitment therapy (ACT) guided self-help using The Diet Trap for 55 overweight/obese adults high in weight self-stigma....

Background Self-help resources such as books may help meet critical mental health needs in college students, but there is insufficient evidence on whether and how such books work. This randomized trial compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (tCBT) self-help books for social anxiety, a common conc...

Clinical perfectionism is associated with various cognitive processes including performance monitoring and emotion regulation. This exploratory study analyzed neurological data from a randomized controlled trial for clinical perfectionism that compared acceptance and commitment therapy (ACT) to a waitlist control. The objective was to assess the ef...

This chapter outlines how a first session of acceptance and commitment therapy (ACT) might go. This first session typically includes two components: (1) orienting clients to what to expect from therapy generally and ACT specifically, and (2) beginning work on creative hopelessness. Key points emphasized in this chapter are learning about clients’ p...

This chapter describes a session focused on values work within the context of acceptance and commitment therapy (ACT). Values work or talking about values can help increase engagement in therapy, but the ultimate goal of clarifying values is to increase clients’ awareness of what truly matters to them so they have a meaningful direction in which to...

This book is a guide for new therapists on the use of acceptance and commitment therapy (ACT) for any psychological disorder that involves some level of struggle with inner experiences; it is not targeted to any particular diagnosis. The book is suitable for graduate students who are seeing their first client, for clinicians with years of experienc...

This chapter provides an outline for a typical last session of acceptance and commitment therapy (ACT). The chapter describes how to assess readiness for therapy termination and debrief the course of therapy. In addition, the chapter highlights a few points that may be worth covering in a last session: predicting barriers to behavior change, troubl...

This chapter provides a broad overview of acceptance and commitment therapy (ACT), including empirical evidence for its effectiveness, how it fits with other cognitive-behavioral therapies, and defining features of ACT. The chapter also explains the theory and scientific philosophy underlying ACT so that readers have a framework to which to refer a...

This chapter provides an overview of how to conduct a clinical assessment when doing acceptance and commitment therapy (ACT). It outlines the functional basis of ACT as a therapeutic model and its implication: ACT is focused on the effect or purpose of behaviors, rather than their form. The four main areas of assessment covered in this chapter are...

This chapter builds on work described in Chapter 4, on creative hopelessness. Specifically, the therapist will continue to focus clients’ attention on the effects and effectiveness of trying to control thoughts and feelings. Once clients are able to track the limited effectiveness of attempts to control thoughts and feelings, the therapist can segu...

This chapter covers content that would be helpful after clients have been practicing willingness in the service of living a more meaningful life. More explicit work on values begins here, to give clients context for practicing difficult skills, such as acceptance and defusion. The chapter also describes how to further build on acceptance and defusi...

This chapter provides session outlines for covering acceptance and defusion with clients. It also describes how to be experiential when doing acceptance and commitment therapy (ACT). At this point in therapy, we expect that clients may not be fully on board with the idea of acceptance. Thus, the chapter provides some guidance on how to practice acc...

This chapter opens with teaching therapists how to lead a brief mindfulness exercise at the start of therapy sessions to increase clients’ present-moment awareness. The chapter describes the NOTE acronym as a means to help clients remember the skills they have learned up to this point: to notice what is happening, observe thoughts and feelings for...

This chapter builds on previous chapters that covered acceptance, defusion, mindfulness, self-as-context, and values in acceptance and commitment therapy (ACT). The emphasis in therapy now turns to using values as a foundation for behavior change and skill maintenance. It is possible that clients did not fully grasp the function of values in the pr...

This chapter provides an introduction to the worldview underlying the therapeutic context in acceptance and commitment therapy (ACT) and how this worldview influences what ACT sessions typically look like. In ACT, the therapeutic relationship is seen as a context in which clients learn to become more psychologically flexible or to interact with the...

This randomized controlled trial evaluated the acceptability and additive effects of self-monitoring avoidant and valued functions of behavior, in the context of self-monitoring physical activity and dietary behavior in a mobile app. The self-monitoring approach was based on the Acceptance and Commitment Therapy (ACT) Matrix. A sample of 102 adults...

Psychological inflexibility is a rigid behavioral pattern that interferes with engagement in personally meaningful activities; it is the hypothesized root of suffering in acceptance and commitment therapy (ACT). Thus, the quality of its measurement affects the research, theory, and practice of ACT. The current study aimed to evaluate the discrimina...

Objective Considering increasing demands for mental health services at college counseling centers (CCCs), there is a need for cost-effective solutions that avoid depleting stressed CCC resources. This study examined if ACT Daily, a mobile application based on acceptance and commitment therapy (ACT), could serve as an effective self-guided intervent...

Objectives Self-help has the potential to improve access to mental health resources for college students. However, solutions are needed to improve sustainable delivery and cost-effectiveness, and to know which resources are most useful.MethodsA sample of 109 college students were randomly assigned to read either an acceptance and commitment therapy...

This secondary analysis examined the processes of change from a randomized dismantling trial evaluating the Open (i.e., cognitive defusion, acceptance) and Engaged (i.e., values, committed action) components of acceptance and commitment therapy (ACT). Analyses were conducted with 161 distressed college students randomly assigned to a full online AC...

Cognitive defusion may enhance healthy coping with negative self-referential thoughts amongst college students. However, research is needed to examine how to effectively introduce and teach defusion to this population. The current pilot study tested the usability of and satisfaction with the d-FUSE program, a single-session, web-based program for a...

Objectives: College counseling centers face significant challenges meeting the mental health needs of their students and waitlists are common. Mobile apps offer a promising solution to increase access to resources while students wait for services. Methods: This pilot randomized controlled trial evaluated the feasibility and acceptability of a publi...

This dismantling trial compared the effects of a full online Acceptance and Commitment Therapy (ACT) intervention to the isolated effects of the Open (i.e., acceptance, cognitive defusion) and Engaged (i.e., values, committed action) components of ACT. A sample of 181 distressed college students were randomized to one of four conditions: a 12-sessi...

This article describes process-based therapy (PBT) as a natural evolution toward more effective and efficient mental health care. Using acceptance and commitment therapy (ACT) as an example of an early prototype of PBT, the article explicates the broader features of PBT and the shift in mindset researchers and clinicians will need to take to fully...

Hoarding symptoms include difficulty letting go of possessions, excessive acquisition, and clutter that precludes use of active living spaces. The current study compared the effect of acceptance training to that of psychoeducation on hoarding severity in a sample of college students with elevated hoarding symptoms. Participants (N = 47) completed s...

People who drink alcohol to cope with negative affect tend to drink more and experience more frequent negative alcohol-related consequences. Experiential avoidance-the tendency to avoid, suppress, or otherwise attempt to control unwanted inner experiences-is a largely pathological process that may help account for how negative affect is linked to i...

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...

This study examined the function of hoarding behaviors and the relations between hoarding and a series of cognitive and affective processes in the moment using ecological momentary assessment. A matched-groups design was used to compare college students with higher hoarding symptoms (n = 31) and matched controls (n = 29). The two groups did not dif...

Background: There is robust evidence that mindfulness trainings enhance mindfulness as operationalized in Western psychology, but evidence about their effect on aspects of heartfulness is sparse. The present study, therefore, sought to evaluate whether a brief mindfulness training enhances heart qualities, including self-compassion, gratitude, and...

Online acceptance and commitment therapy (ACT) is promising for treating a range of psychological problems. Component research can further clarify which components are needed for optimal outcomes in what contexts. Online platforms provide a highly controlled format for such research. In this pilot trial, 55 adults were randomized to: ACT-Open (i.e....

The current study examined psychological inflexibility and self-compassion as theoretically relevant mediators and moderators of outcomes following acceptance and commitment therapy (ACT) for clinical perfectionism. Fifty-three participants with clinical perfectionism were randomized to either a 10-session ACT condition or a 14-week waitlist contro...

Clinical perfectionism is characterized by imposing excessively high standards on oneself and experiencing severe distress when standards are not met. It has been found to contribute to the development and maintenance of various clinical presentations including anxiety, obsessive-compulsive, and eating disorders. The present study tested the effica...

There is growing evidence for the efficacy of acceptance and commitment therapy (ACT) interventions delivered through smartphones, but research has not yet focused on how to optimize such interventions. One benefit of mobile interventions is the ability to adapt content based on in-the-moment variables. The current randomized controlled trial evalu...

Acceptance and Commitment Therapy (ACT) takes a functional perspective on behavior and supports clients in responding in values consistent ways to their internal experiences. The capacity to notice and label the functions of one's ongoing behavior may be an important skill in functional interventions such as ACT, which may facilitate other facets o...

Web-based programs that focus on values, a core process within acceptance and commitment therapy (ACT), may be a promising approach to cultivate positive psychosocial adjustment among undergraduates. The current study tested the usability, acceptability, and receptivity of the Living Your Values (LYV) program, a single-session, web-delivered, self-...

Psychological flexibility is the act of being open to internal experiences while pursuing valued life directions and has been implicated in positive mental health. A lack of psychological flexibility has been implicated in a wide range of mental health problems. In most research, assessment of psychological (in) flexibility has been done with the A...

This article describes the initial phase of acceptance and commitment therapy (ACT). The article begins with a review of ACT's theoretical orientation. Basic empirical support for ACT and its model are covered. A case description follows that highlights the initial phases of ACT. The article concludes with practical recommendations for starting the...

Psychological flexibility refers to a way of interacting with internal experiences and the external environment that advances one toward chosen values whereas psychological inflexibility reflects rigid adherence to ineffective responses such that valued living is compromised. Psychological flexibility is a critical variable of interest in acceptanc...

There are ongoing questions regarding the similarities and differences in the clinical impact and processes of change for cognitive restructuring and cognitive defusion. This clinical component test compared 87 adults high in self-criticism randomized to a cognitive defusion mobile app, restructuring app, or waitlist condition for 2 weeks. Equivale...

Objective It is essential to identify modifiable risk factors that can be targeted to reduce suicidal ideation (SI) and behavior in college students. Psychological inflexibility, a pattern of responding to internal experiences in a literal and rigid way, and attempting to control those experiences even when it interferes with valued living, could t...

Motivative augmentals are rules or statements that temporarily change the effectiveness of a consequence, similar to establishing operations for nonverbal consequences (Hayes, Barnes-Holmes, & Roche, 2001). Many communications by an organization's leadership may function as such and alter the function of stimuli in the workplace, which in turn may...

Transdiagnostic cognitive behavioral interventions target different cognitive processes to promote mental health, including cognitive fusion and cognitive reappraisal. Determining the relative impact of cognitive fusion and reappraisal on a range of student mental health concerns could help interventions target psychopathological cognitive processe...

The purpose of this study was to examine acceptance and commitment therapy (ACT) as a standalone treatment for trichotillomania in a randomized controlled trial of adults and adolescents. Participants consisted of a community sample of treatment seeking adults and adolescents with trichotillomania. Of the eligible 39 participants randomized into tr...

Mobile apps are promising for teaching how to practice psychological skills in high-risk and in vivo momentary situations, but there has been minimal research on the immediate effects of app-based skill coaching on mental health in-the-moment. This study analyzed the mobile app data in a non-clinical sample of 39 adults participating in a larger ra...