BookLiterature Review

Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change

Authors:

Abstract

An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT Case Formulation. Steven C. Hayes, Kirk D. Strosahl, Jayson Luoma, Alethea A. Smith, and Kelly G. Wilson ACT with Behavior Problems Chapter 4. ACT with Affective Disorders. Robert D. Zettle Chapter 5. ACT with Anxiety Disorders. Susan M. Orsillo, Lizabeth Roemer, Jennifer Block-Lerner, Chad LeJeune, and James D. Herbert Chapter 6. ACT with Posttraumatic Stress Disorder. Alethea A. Smith and Victoria M. Follette Chapter 7. ACT for Substance Abuse and Dependence. Kelly G. Wilson and Michelle R. Byrd Chapter 8. ACT with the Seriously Mentally Ill. Patricia Bach Chapter 9. ACT with the Multi-Problem Patient. Kirk D. Strosahl ACT with Special Populations, Settings, and Methods Chapter 10. ACT with Children, Adolescents, and their Parents. Amy R. Murrell, Lisa W. Coyne, & Kelly G. Wilson Chapter 11. ACT for Stress. Frank Bond. Chapter 12. ACT in Medical Settings. Patricia Robinson, Jennifer Gregg, JoAnne Dahl, & Tobias Lundgren Chapter 13. ACT with Chronic Pain Patients. Patricia Robinson, Rikard K. Wicksell, Gunnar L. Olsson Chapter 14. ACT in Group Format. Robyn D. Walser and Jacqueline Pistorello

Chapters (14)

Human beings use language to shape their world: to structure it and give it meaning. Language builds our skyscrapers, imparts the strength to our steel, creates the elegance of our mathematics, and forms our art’s depiction of beauty. Language has been the source of so much human achievement that it is only natural that we look to it first to identify a problem and craft a solution. But it is precisely because language can be so useful that it can also be problematic. Language not only enables human achievements, but also our ability to project fearsome futures, to compare ourselves to unrealistic ideals and find ourselves wanting, or to torment our souls with the finitude of life itself. Language is at the core of the remarkable human tendency to suffer in the midst of plenty.
The purpose of this chapter is to present a consolidated overview of ACT treatment interventions and therapy processes. In Chapter 1 we described the philosophy, basic theory, applied theory and the theoretical processes that collectively define ACT as a clinical system. In this chapter we will examine the concrete clinical steps used in implementing this model.
Because ACT is a contextual treatment, your attempts to conceptualize a presenting problem might be different from traditional case conceptualization models. The most important principle in contextual analysis is that you are not just assessing a particular symptom with a particular topography; you are also attempting to understand the functional impact of the presenting complaint. The same clinical complaint can function in dramatically different ways for clients. Thus, your case conceptualization and associated treatment plan may differ for clients with seemingly similar problems. For example, many patients are diagnosed with major depression, single episode (a categorical formulation) based on the number and severity of symptoms described by the patient (a topographical assessment). In clinical practice however, it is fair to say that no two depressed patients are alike. Each is unique in how their life space is organized, how depression affects their functioning (and vice versa) and how depressive beliefs and behaviors define the individual’s sense of self and external world.
The human, social, and financial costs associated with affective disorders in general, and major depression in particular, are well-documented. Lifetime prevalence rates for major depression in the United States range up to 17.1% (Welshman et al., 1996), while those for bipolar disorder are significantly lower at approximately 1% (Myers et al., 1984). Major depression is expected to become the second leading cause of disability worldwide by 2020 and, by itself, is estimated to cost businesses in this country $70 billion annually in health care, lost productivity, and other expenses (Tanouye, 2001). Tragically, such “other costs” can include the permanent loss of employees. About 15% of individuals who have been diagnosed with major depression will commit suicide at some point during the life span (Maris, Berman, Maltsberger, & Yufit, 1992).
Anxiety disorders are the most commonly experienced mental health problems in the United States. Narrow, Rae, Robins, and Regier (2002), combining data from the National Institute of Mental Health Epidemiologic Catchment Area Program (ECA) and the National Comorbidity Survey (NCS), conservatively estimated the one-year prevalence for any anxiety disorder to be 13.1% for adults aged 18–54. These conditions tend to be chronic. Three year remission rates range from 16 to 23% for social phobia, generalized anxiety disorder, agoraphobia, and panic disorder with agoraphobia (Keller, 2000, in Barlow, 2002). In one longitudinal study, within the first 22 months following the onset of an episode, only 18% of individuals diagnosed with panic disorder and agoraphobia and about 43% of those with panic disorder without agoraphobia had recovered in comparison to approximately 80% of those with major depressive disorder (Hirschfeld, 1996). Functional status of patients with anxiety disorders is diminished as evidenced by higher rates of financial dependence, unemployment (e.g., Leon, Portera and Weissman, 1995), poorer quality of life (Massion, Warshaw, & Keller, 1993), and increased risk for completed suicide (Allgulander, 1994).
Epidemiological studies conducted in the United States indicate that prevalence rates for exposure to traumatic stressors may be as high as 70% of the adult population (Norris, 1992; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993). Trauma related experiences come in many forms: criminal victimization (rape, assault, armed robbery), domestic assault, childhood sexual abuse, natural catastrophes (tornado, fire) and combat related dangers, to name a few. Normal human responses to trauma (numbing, derealization, depersonalization) probably have significant adaptive value and over time tend to phase out of existence as the person integrates the impact of trauma in functional ways. However, for some trauma survivors, this adaptive integration does not occur. Instead, the impact of the trauma enlarges in their lives to the point that serious impairment in psychological, social and behavioral functioning occurs. Studies suggest that about 8% of the general population ultimately develops Posttraumatic Stress Disorder (PTSD; Breslau, Davis, Andreski, & Peterson, 1991; Kessler, Sonnega, Bronet, Hughs, & Nelson, 1995). Many trauma survivors seek therapy not only to address their private struggles with the aftermath of trauma, but also to help repair elements of their lives that are not working.
Drug dependence and abuse have reached epidemic proportions. The 2002 National Survey on Drug Use and Health (NSDUH) estimated that 22 million or 9.4% of Americans over age 12 meet diagnostic criterion for substance dependence or abuse. The individual and social costs of drug and alcohol addiction are staggering. The total indirect costs of alcohol and drug abuse paid by the government, persons using, and their families, is conservatively estimated to be $245.7 billion per year (National Institute on Drug Abuse/National Institute on Alcohol Abuse and Alcoholism, 1992). These costs include addiction treatment, healthcare expenditures, lost work productivity and lost earnings due to work disability.
Psychotic disorders in general and schizophrenia in particular have generally been regarded as disorders that are relatively difficult to treat. While psychopharmacological treatments are widely available and effective compared to placebo controls (Davis, Schaffer, Killian, Kinard, & Chan, 1980), many patients with serious mental illness (SMI) are unresponsive to medications. Relapse rates are 20% per year among patients who receive psychosocial treatment and antipsychotic medication and twice that among persons receiving medication only (Gorman, 1996). SMI patients also tend to be treatment non–compliant with high service utilization and service costs, and to have significant family, financial, and social problems, even with available treatment (Miner, Rosenthal, Hellerstein, & Muenz, 1997).
Of the many types of presenting problems seen by mental health, chemical dependency and general health care providers, none is more challenging than the patient experiencing chronic mood disturbance, marginal social adaptation, high levels of interpersonal isolation, conflict and/or daily stress and, frequently, recurrent self-destructive behavior. These patients often receive a clinical diagnosis of “personality disorder,” but it is probably more appropriate to describe them as “multi-problem” patients because of wide spread deficiencies in their cognitive, emotional, behavioral and social functioning. Such patients typically experience chronic negative emotional states such as depression, anxiety, apathy, boredom, loneliness, guilt and anger. This affect is a major driver of a plethora of maladaptive coping responses: chief among them are repetitious suicidal behavior, and addictive behaviors such as alcohol/drug abuse, eating disorders and/or chronic self-mutilation. Multi-problem patients also experience significant difficulties in social and interpersonal functioning. They have trouble forming and maintaining interpersonal relationships and often inject the therapy process with a conflict-laden set of issues around forming and maintaining both casual and intimate adult relationships. The number and magnitude of these behavioral, cognitive and emotional problems is a source of frustration for therapists. It is hard to conceptualize a plan of action in therapy when, at any given point in time, the patient exhibits generalized failure in so many areas of functioning. Further, the disruptive presence of chronic suicidal ideation, suicide attempting and various other forms of self-destructive behavior disrupts the continuity of treatment and can severely challenge the therapeutic relationship.
In contrast to the growing empirical support for ACT interventions with adult problems and populations, ACT applications with children, adolescents, and their parents are in relatively early stages of development. Our preliminary data, and data from other sites, suggest that ACT and its components can be successfully adapted for children in developmentally appropriate, therapeutically beneficial ways. Evidence suggests that ACT can be useful to parents dealing with the challenges children present. As with any new intervention, conceptualizing and using this approach is a trial-and-error process. Keeping this in mind, clinicians using the adaptations suggested in this chapter should be committed to measuring progress through the use of ongoing assessments.
The purpose of this chapter is to show how Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) can be used to reduce stress. Stress has generally been conceptualized as a relational context in which people believe that a particular event threatens their well being, because they evaluate it as taxing, or exceeding, their coping resources (e.g., Lazarus & Folkman, 1984). Based on this view, stress interventions have either targeted the stressor (the event itself) or the evaluation of the stressor as a threat to well-being and one’s ability to cope with it. While primarily focused on the latter target, ACT can be used to address them both.
ACT consistent interventions can be used by medical and behavioral health providers to help patients who are struggling to manage a chronic health condition or improve their general health status. The Acceptance and Commitment—Health Care Model (ACT-HC; Robinson & Hayes, 1997) is an approach to combining medical and psychological interventions within an ACT consistent framework. The goal of the ACT—HC model is to help medical patients successfully implement behaviors that are consistent with their values in the presence of difficult private experiences triggered by medical discomfort, chronic medical conditions or elevated health risk.
Pain that persists for months and years has a profound impact on the sufferer’s life. Many chronic pain patients develop co-morbid depression; they utilize medical care excessively and feel wronged by the care they receive; many leave their jobs; obtain disability and settle into a lifestyle that, at best, bears faint resemblance to that they once imagined was possible. Chronic pain is influenced by numerous psychosocial factors, including biological factors as well as the patient’s socio-cultural background, beliefs, expectations, and emotions (Turk & Okifuji, 2002). Medical treatment success rates are high for patients with acute pain, but are disappointing for patients with chronic nonmalignant pain. The most common sources of non-cancer-related pain include (in decreasing frequency) back, head, joints, extremity, chest, abdomen and other areas. Since most chronic pain patients experience pain in multiple areas, most medical providers struggle to assess and treat all sources of pain and remain within the time constraints of busy primary care practices. Many patients are referred to specialists and undergo expensive, unsuccessful, invasive procedures—often repeatedly. The problem is not restricted to adults: children and adolescents also develop pain symptoms that are refractory to treatment and that lead to severe disability (Kashikar-Zuck, Graham, Huenefeld, & Powers, 2000). Research is more extensive with adult populations (Morley, Eccleston, & Williams, 1999) than with pediatric pain.
The ACT materials and issues in this book have been discussed both in the context of individual therapy and group interventions, but no specific focus has been given to the special considerations that arise when ACT is delivered in a group format. There are many reasons to believe that delivering ACT in a group format may actually enhance its effectiveness in certain ways and there is a developing clinical literature to support this assumption. Nevertheless, adapting ACT for group work requires attention to a variety of issues. For several years, the authors have been involved in the development and application of ACT groups with a variety of clinical complaints and patient populations. The goals of this chapter are to: Summarize past and current efforts focused on adapting ACT to groups Identify advantages of delivering ACT in a group format Highlight issues to consider prior to starting an ACT group Discuss ACT-specific processes within the group format Address the issue of obtaining informed consent, and finally Describe how each of the core areas of ACT is adapted for group work.
... Psychological-models offer various potential mediating factors and therefore suggest possibilities for the focus of future research addressing this gap in the literature. Cognitive Behaviour Therapy (Beck, 1993), for example, suggests unhelpful cognitions to be of primary importance, while psychodynamic psychotherapy (Malan, 1999) suggests that we should be concerned with the unconscious content of individuals' psyches, Dialectical Behaviour Therapy (Linehan, 1993) suggests that we should consider individuals' skills, and Acceptance and Commitment Therapy (Hayes, Strosahl & Wilson, 1999) This study investigated the relationships between childhood attachment, experiential avoidance and alcohol dependence in the homeless population. It was hypothesized that experiential avoidance would mediate the relationship between childhood attachment and alcohol dependence. ...
... Providing further support for the conceptual overlap, it is also noted that recent literature regarding attachment theory and emotion regulation considers aspects such as thought suppression and ease of access to painful memories, which could be seen as closely mapping onto the phenomenon of experiential avoidance (Mikulincer & Shaver, 2007) The concept of experiential avoidance has been recognised, implicitly or explicitly, within most systems of therapy (Blackledge & Hayes, 2001). Hayes and colleagues (Hayes et al., 1996, Hayes, Strosahl & Wilson, 1999, however, introduce an extensive model viewing experiential avoidance from a contextual behavioural perspective, based on Relational Frame Theory, a theory regarding language and cognition (RFT; Hayes, Barnes-Holmes & Roche, 2001). Essentially, Hayes and his colleagues propose that, given its symbolic nature, the advent of human language has meant that internal experiences have come to represent external situations and that some are therefore appraised as aversive. ...
... Experiential avoidance is negatively reinforced by escape from aversive internal states but is damaging in the long term as attempts to avoid thoughts and feelings are frequently unsuccessful and harmful. Consequently, therapeutic approaches recognizing experiential avoidance, for example, Acceptance and Commitment Therapy (Hayes et al., 1999), Dialectical Behaviour Therapy (Linehan, 1993), and Mindfulnessbased Cognitive Therapy (Segal, Williams & Teasdale, 2001), focus on the acceptance of difficult thoughts and feelings (Roemer, Salters, Raffa & Orsillo, 2005). ...
Thesis
p>Homelessness continues to be a problem within society and over recent decades research into factors implicated in homelessness has featured in the literature. Within the literature a conceptual distinction is generally made between macro:level factors such as poverty and the limited availability of low-cost housing which explain the existence of homelessness within society, and micro-level factors, the focus of the current thesis, which influence individual vulnerability to becoming or remaining homeless. Initially, the literature regarding micro-level vulnerability factors for homelessness is reviewed, with five particular areas being selected for in-depth review. Models of the interrelationships between vulnerability factors are then described and discussed. Particularly strong evidence is found for childhood risk factors and substance use disorders constituting micro-level vulnerability factors for homelessness. It is also noted that empirical studies investigating the relationships between micro-level vulnerability factors for homelessness are limited in number and fail to consider the psychological processes which might mediate these relationships. On these grounds the present study sought to determine whether experiential avoidance mediates the relationship between poor childhood attachment and alcohol dependence in a sample of sixty homeless individuals. Somewhat surprisingly in the light of previous research linking childhood attachment and alcohol dependence, no significant association was found, suggesting that if these factors increase risk for homelessness, they do so independently. Significant predictive relationships were found, however, with regard to childhood attachment</p
... They also allocate attention during an interaction by detaching themselves from thoughts which may reinforce their own perspective and viewpoint, allowing them to be more in tune with their partner's needs (Bishop et al., 2004). This combination of high attention and high decentering enables increased understanding, empathy, careful listening, and asking and answering of questions in a curious and receptive way (Hayes et al., 1999;Safran & Segal, 1990). When interacting with a high mindful relating approach, partners pay attention and actively ensure that their ongoing attention remains focused on each other (Brown & Ryan, 2003). ...
... They exhibit low levels of collective judgment, such that neither individual needs to try to "one-up" the other, or prove anything (Kernis et al., 2000). Together, they focus on what their partner is expressing, rather than getting caught up in their own patterns of thinking Hayes et al., 1999;Teasdale, 1999). ...
... They are also likely to exhibit an "egocentric preoccupation with their own experiences" which limits their ability to socially connect as deeply with others (Fresco et al., 2007, p. 235), as they are unable to distance themselves from their own emotions and self-referential thoughts. This can lead them to relate with others in a careless or hurtful manner (Hayes et al., 1999), even if unintentional. This counteracts the high attention they give each other, because they can neither fully take in nor deeply process the information shared by their partner, because their own perspective is kept centered. ...
Article
Full-text available
Integrating theorizing on mindfulness and work relationships, we build a multilevel model of how mindfulness shapes interpersonal interactions and work relationship trajectories over time. Our framework of mindful relating yields three approaches an individual may utilize during an interpersonal interaction at work, based on the extent to which they incorporate the mindful qualities of attention and decentering. We theorize how the extent to which interaction partners are (in)congruent in their mindful relating approaches associates with interaction quality (positive, ambivalent, indifferent, and negative) – and how over time, this shapes the trajectory of a work relationship. We further posit that empathy, response flexibility, and emotional regulation transmit the effects of mindful relating and drive interaction quality. From a contextual perspective, we explore the roles of power dynamics and negative shock events as factors likely to impact how interactions over time collectively inform the trajectory of relationships. Finally, we explicate how our theory‐building can guide future work and make specific recommendations for theoretical and empirical advancement. This article is protected by copyright. All rights reserved
... They build on the firstand second-wave treatments, but seem to be carrying the behavior therapy tradition forward into new territory" (2004, p. 239). The group includes a number of approaches and schools of therapy which have been designed for a variety of different populations and disorders, including Dialectical Behavioural Therapy (DBT; Linehan 1993) and Acceptance and Commitment Therapy (ACT; Hayes, Strosahl & Wilson, 1999). Many of the third wave therapies, including the two just mentioned, include an element of mindfulness in their teaching. ...
... Acceptance and commitment therapy (ACT; Hayes, Strosahl & Wilson, 1999) is an individual therapeutic approach which can be used with a wide range of clinical problems and populations. It includes both behaviour change processes, as in cognitive therapy, and mindfulness and acceptance processes which are designed to facilitate the necessary behaviour changes. ...
... which have appeared in the last decade or so and which incorporate mindfulness into their programme.Acceptance and Commitment Therapy (ACT;Hayes, Strosahl & Wilson, 1999) was developed as an individual therapy to be used with a range of psychological problems. It incorporates aspects of mindfulness, but unlike MBSR and b1BCT it does not require formal meditation practice but instead teaches mindfulness through shorter tasks. ...
Thesis
p>The literature on mindfulness as a clinical intervention has rapidly expanded in recent years but questions about its use and effectiveness remain unanswered, one of which concerns the active agents of change. The current study aimed to investigate two specific techniques which currently form part of larger mindfulness training packages: mindful breathing and the body scan. 59 university undergraduates were recruited and were tested on a number of measures of stress tolerance, psychological symptoms and affect, as well as attention and mindfulness skills. A range of mixed design ANOVA statistics are calculated but no significant effect of training in either technique is reported. The study suggests that non-specific factors, such as membership of a group, might be important in the success of mindfulness training.</p
... Psychological inflexibility prevents humans from staying in the present moment and making changes according to their values (Hayes et al., 1999;Hayes et al., 2006). Through psychological inflexibility, individuals try to circumvent undesirable internal events like distressing emotions, negative thoughts and other private experiences. ...
... There are very limited studies that explore PI with other psychological variables, especially with PS and SC. PI has often been linked with distress across studies (Cheng et al., 2021;Hayes et al., 1999;Hayes et al., 2004;Hayes et al., 2006, Kashdan et al., 2009Orcutt et al., 2005;Sairanen, Lappalainen, & Hiltunen, 2018) consistent with current findings. High psychological flexibility has been shown to aid with countering risks and overcoming challenges (Jeffords et al., 2020). ...
... Further qualitative analysis could help understand these micro-processes better in mothers who are prone to experiencing stress and challenges during the early years of their parenting journeys. Psychological inflexibility can be investigated further in the context of mindfulness-based interventions and self-compassion (Hayes et al., 1999;Sharif Mohammadi, Chorami, Sharifi, & Ghazanfari, 2020). Longitudinal studies may be required to measure the protective power of self-compassion over time. ...
Article
Full-text available
Rationale. With social distancing and work from home the COVID-19 (WHO, 2020) pandemic has created a new reality for parents worldwide and brought along significant challenges in their lives. In particular, the process of mothering has been affected during the COVID-19 pandemic with higher physical and emotional labour and a greater responsibility for managing care of the children and household without the usual support system in place. Objective. The primary objective of the current study was to explore the mediating role of Psychological Inflexibility (PI) between the relationship of Parenting Stress (PS) and Self-Compassion (SC) among Indian mothers with children aged under 10 years during the COVID-19 pandemic. Design. Self-reported measures of PI, PS and SC through respective scales were used to collect data from N=552 Indian mothers. Results. The data analysis was indicative of a positive relationship between Self-compassion and Parental Stress and Self-compassion and Psychological Inflexibility. Psychological Inflexibility was found to positively mediate the relationship between Parental Stress and Self Compassion with the mediating effect being close to 31%. Conclusion. Increased parenting stress could have propelled mothers to be more self-compassionate in order to cope with the stress induced by the pandemic.
... Acceptance and Commitment Therapy (ACT; Hayes et al., 1999Hayes et al., , 2012) is a highly creative, flexible, and generative intervention model that has been evaluated in over 900 randomized trials to date (Hayes, 2022). These trials address an extremely broad range of psychological and behavioral problems and disorders, reflecting ACT's ability to leverage its core intervention strategies, perspectives, and skills to address diverse forms of human struggle and suffering. ...
... Given the centrality of process variables in ACT, researchers initiated efforts to develop and validate process measures relatively quickly following the publication of the foundational book on ACT (Hayes et al., 1999). The first widely used, validated, and published measure of ACT processes, the AAQ (Hayes et al., 2004), was designed to measure experiential avoidance. ...
... Empirically distinguishing the structure and relationships of ACT process variables 20 remains a foundational step in measuring them. ACT has been defined as having six core Hexaflex processes that are central to psychological flexibility (Hayes et al., 1999(Hayes et al., , 2012. This model is widely used in teaching (Harris, 2019) and studying ACT (Hayes et al., 2013), and ...
Article
Full-text available
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; 3) the earlier wide use of psychometrically weaker ACT process measures and the more limited use of stronger measures; 4) the inconsistency of evidence that ACT processes are sensitive or specific to ACT or mediate ACT outcomes specifically; 5) improving statistical power and transparency. Drawing on the existing literature, we characterize and provide evidence for each of these challenges. We then offer detailed recommendations for how to address each challenge in ongoing and future work. Given ACT’s core focus on theorized processes, improving the measurement and evaluation of these processes would significantly advance the field’s understanding of ACT.
... o surgimento de intervenção clínica de cunho cognitivista, que ficou conhecido como a segunda geração de terapias cognitivas e comportamentais e, posteriormente, durante a década de 80, o desenvolvimento de terapias contextuais, conhecido como terceira geração (Hayes & Pistorello, 2015), dentre as quais podem ser citadas: Terapia de Aceitação e Compromisso (ACT) (Hayes at al., 1999), Terapia Comportamental Dialética (DB) (Linehan, 1993(Linehan, /2010) e Psicoterapia Analítico-Funcional (FAP) (Kohlenberg & Tsai, 1991. ...
... Entender esse cenário é relevante pois alguns autores brasileiros discorrem sobre a compatibilidade e a incorporação de técnicas desses modelos por parte do terapeuta analítico-comportamental. Vandenberghe (2011, p. 39) afirma que a terapia brasileira "apresenta grande semelhança clínica e filosófica com as terapias da terceira geração", ambas compartilhando o recorte externalista, considerando a relevância da relação terapeuta-cliente na intervenção e valorizando processos e princípios em detrimento de técnicas, restando apenas dois pontos controversos: (1) a utilização do mindfulness, prática fundamentada nas tradições budistas orientais e tida como um aspecto central das terapias de terceira geração e (2) a linguagem pouco científica adotada em modelos como a ACT, quando propõe conceitos como "fusão cognitiva" e "eu como contexto" (Hayes at al., 1999); a FAP e termos como "espaço sagrado" (Kohlenberg & Tsai, 1991); e a DBT ao apresentar expressões como "mente sábia" e "bondade amorosa" (Linehan, 1993(Linehan, /2010. ...
... The theoretical and practical contribution of the study In this study, particular emphasis was placed on the strategies that can help individuals to modulate (i.e., increase or decrease) the association between perceived stress and PTSD symptoms, as well as to increase post-traumatic growth one year later. As regards the implications for clinical practice, our results suggest the usefulness of preferring therapeutic approaches related to the third-wave psychological interventions of Cognitive Behavioral Therapy (CBT; Beck, 1976), such as Acceptance Commitment Therapy (ACT; Hayes et al., 1999) and Mindfulness interventions (Halland et al., 2015;Kabat-Zinn, 1990).In particular, ACT places psychological inflexibility as the essential direct target of treatment (Hayes et al., 1999;Krafft et al., 2018): therefore, using ACT interventions to teach psychological flexibility techniques may help individuals to reduce the impacts of stress (Hayes et al., 2006;Tavakoli et al., 2019), even related to the COVID-19 Pandemic (Arslan et al., 2021;Dawson & Golijani-Moghaddam, 2020). There is certainly a link between psychological flexibility and coping strategies (e.g., orientation to the problem) (Dawson & Golijani-Moghaddam, 2020). ...
... The theoretical and practical contribution of the study In this study, particular emphasis was placed on the strategies that can help individuals to modulate (i.e., increase or decrease) the association between perceived stress and PTSD symptoms, as well as to increase post-traumatic growth one year later. As regards the implications for clinical practice, our results suggest the usefulness of preferring therapeutic approaches related to the third-wave psychological interventions of Cognitive Behavioral Therapy (CBT; Beck, 1976), such as Acceptance Commitment Therapy (ACT; Hayes et al., 1999) and Mindfulness interventions (Halland et al., 2015;Kabat-Zinn, 1990).In particular, ACT places psychological inflexibility as the essential direct target of treatment (Hayes et al., 1999;Krafft et al., 2018): therefore, using ACT interventions to teach psychological flexibility techniques may help individuals to reduce the impacts of stress (Hayes et al., 2006;Tavakoli et al., 2019), even related to the COVID-19 Pandemic (Arslan et al., 2021;Dawson & Golijani-Moghaddam, 2020). There is certainly a link between psychological flexibility and coping strategies (e.g., orientation to the problem) (Dawson & Golijani-Moghaddam, 2020). ...
Article
Full-text available
The present study investigates the mediating roles of psychological inflexibility and differential coping strategies on perceived stress and post-traumatic symptoms and growth in the context of COVID-19. Study one recruited 662 participants (54.8% women; Mage = 40.64 years, SD = 13.04) who completed a cross-sectional questionnaire. It was proposed that orientation to the problem, avoidance strategies, psychological inflexibility, and positive attitude were mediators for the positive association between perceived stress and PTSD symptoms. The fit indices for the path model were excellent: CFI = 0.977, TLI = 0.950, RMSEA = 0.057 [90%CI = 0.043–0.081], and SRMS = 0.042. Gender and stressful events encountered had indirect effects on the endogenous variables. In study two, 128 participants (57.8% women; Mage = 42.30, SD = 12.08) were assessed for post-traumatic growth one year later. Psychological inflexibility and orientation acted as mediators between perceived stress and PTSD symptoms. Furthermore, a novel path model was constructed in which psychological inflexibility and orientation to the problem as mediators for perceived stress and PTSD symptoms. The indices for the path model were excellent: CFI = 0.99, TLI = 0.97, RMSEA = 0.055 [90%CI = 0.001–0.144], and SRMS = 0.49. Furthermore, PTSD symptoms, psychological inflexibility, and orientation to the problem predicted post-traumatic growth. Specifically, both orientation to the problem (β = .06 [90%CI: .01;.13]) and psychological inflexibility (β = .14 [90%CI: .08;.26]) had an indirect effect on post-traumatic growth. Overall, these results significantly contribute to the literature as orientation to the problem positively predicted PTSD symptoms and post-traumatic growth one year later while psychological inflexibility predicted PTSD symptoms and less post-traumatic growth one year later. These results underline the importance of assessing both symptomology and psychological growth to determine adaptive coping strategies in specific contexts.
... Moreover, pain acceptance proved to have incremental validity over and above pre-existing predictors, such as coping strategies (21,22), to explain adjustment to pain (23)(24)(25). Pain acceptance-based interventions (i.e., Acceptance and Commitment Therapy, ACT) (26,27) demonstrated to significantly improve patients' functioning and to reduce the utilization of health-care services [e.g., (28)(29)(30)(31)(32)]. ...
... Findings from this study have also important implications on psychological interventions in the context of pain. There is increasing empirical support for acceptance-based interventions for chronic pain such as ACT (26,27). As mentioned above, ACT proved to be efficacious for enhancing functioning and decreasing psychological distress in patients with chronic pain [e.g., (28)(29)(30)]. ...
Article
Full-text available
Psychological acceptance has emerged as an important construct to explain low psychological distress in different clinical samples. However, the incremental validity of psychological acceptance to explain adjustment to medical conditions over other related and well-established constructs, such as coping, is relatively unclear. This study explored whether psychological acceptance significantly contributes to explain adjustment above and beyond coping in females with endometriosis. A total of 169 females ( M age = 34.95 years; SD age = 6.07 years) with endometriosis and pain symptoms completed the Acceptance and Action Questionnaire-II, the Brief-COPE, the Hospital Anxiety and Depression Scale, the Psychological Wellbeing Scale, and the Endometriosis Health Profile-5. We conducted Hierarchical Regression Analyses to determine the contribution of psychological acceptance to explaining adjustment. The results showed that the contribution of psychological acceptance ranged from 11 to 20% when controlling for coping, while coping explained from 1 to 8% when the model was reversed. The findings suggest that psychological acceptance is a more useful construct than coping for predicting PD and other psychological outcomes in females with endometriosis.
... These are specifically designed to reduce maladaptive behaviors and unhealthy attempts to avoid internal experiences by focusing on increasing behavioral and psychological resilience . They include helping clients to (1) learn to be more open to and accept their experiences rather than engaging in ineffective struggles; (2) make them more aware of their experiences and focus on the here and now rather than the past or worrying about the future; and (3) committing to doing things guided by what is truly important to them rather than what they want to avoid (Hayes et al., 1999). ...
... This narrow repertoire of behaviors toward inner experiences leads to a lifestyle based on negative reinforcement and weaker meaning rather than a lifestyle based on values (Yavuz, 2015). Conversely, committed action means committing to do what is really important; that is, to engage in personally meaningful activities that support what the person values (Hayes et al., 1999). In short, these are the behaviors people that exhibit according to their values. ...
Article
Full-text available
Citation: O. (2022). Building a bridge between spirituality/religion with acceptance and commitment therapy. Spiritual Psychology and Counseling, 7(2), 179-200. https://dx. Abstract This study provides a framework for acceptance and commitment therapy (ACT) and draws attention to the points that ACT shares with spiritual/religious traditions. The paper first presents the history of the theory, its view of human nature, its basic concepts, and the emergence of ACT while ACT's theoretical foundations, functional analysis of behavior theory, relational framework theory, and functional contextualism theory are presented as tables. The paper then explains the shared points between ACT and spiritual/religious approaches and dicusses how basic processes of the two can be combined. It then considers the spiritual/religious-oriented methods and techniques that can be used in ACT. The conclusion highlights the differences between ACT and other therapy approaches and the themes it shares with spiritual/religious approaches. Drawing on this study and ACT philosophy, new models could be developed that take into account the Islamic belief system specific to Turkish culture. Öz Bu çalışmanın amacı Kabul ve Karalılık Terapisi (Acceptance And Commitment Therapy-ACT) ile ilgili bir çerçeve sunmak ve ACT'ın manevi/dini gelenekler ile ortak olan noktalarına dikkat çekmektir. Çalışmada ilk olarak sırasıyla kuramın tarihçesine, insan doğasına bakışına, kullandığı temel kavramlara, ACT'ın ortaya çıkışına yer verilmiştir. Devamında ACT'ın kuramsal temellerini oluşturan; Davranışın İşlevsel Analizi, İlişkisel Çerçeve kuramı ve İşlevsel Bağlamsalcılık kuramları tablo halinde sunulmuştur. Ardından ACT'ın manevi/dini yaklaşımlarla ortak noktalarına değinilmiştir. ACT ile Manevi/dini geleneklerin ortak yönleri arasında ilişkiler kurulduktan sonra ACT temel süreçleriyle manevi/dini uygulamalar birleştirilip sunulmuştur. Devamında ACT'ta kullanılabilecek manevi/dini yönelimli yöntem ve tekniklerden bahsedilmiştir. Sonuç kısmında ACT'ın diğer terapi yaklaşımlarından farklılaşan noktalarına, manevi/dini yaklaşımlarla olan ortak temalarına değinilmiştir. Bu çalışmanın devamında ACT temel felsefesinden yola çıkılarak kültürümüze özgü İslam inanç sistemini dikkate alan yeni modellerin geliştirilebileceği düşünülmektedir.
... Acceptance is not an as yet fully explored area within the literature, however, there are a small number of studies that demonstrate a positive association between acceptance and successful adaptation to chronic pain (For example, Geiser, 1992;Jacob et al., 1993;Hayes et al 1994;Schmitz et al., 1996;McCracken, 1998McCracken, ,1999Hayes, Bissett, & Korn, 1999, Bach & Hayes, 2002. These studies have been demonstrative in highlighting the association between acceptance and the successful coping with chronic pain. ...
... Acceptance is not an as yet fully explored area within the literature, however, there are a small number of studies that demonstrate a positive association between acceptance and successful adaptation to chronic pain (For example, Geiser, 1992;Jacob et al., 1993;Hayes et al 1994;McCracken, 1998McCracken, ,1999Hayes, Bissett, Korn, & Zettle 1999, Bach & Hayes, 2002. These studies have been demonstrative in highlighting the association between acceptance and the successful coping with chronic pain. ...
Thesis
p>Acceptance and Chronic Pain Thesis Abstract This thesis examines psychological approaches to the understanding of chronic pain. The first paper reviews traditional psychological models, as applied to the understanding of chronic pain. The paper then reviews a newly proposed model of chronic pain, which includes the concept of acceptance. The second paper replicates a study conducted by McCracken (1998), and examines the concept of acceptance of pain. McCracken conducted his study using participants who were awaiting treatment at a specialist pain clinic. The current study used participants who had exhausted all available treatment options and had been discharged from a specialist pain clinic. Correlational analysis revealed that greater acceptance of pain was associated with less pain severity, fewer depressive symptoms, less use of avoidance strategies, fewer fearful pain-related thoughts, less pain related anxiety, less physical disability, less psychosocial disability, and lower overall disability. Results are discussed both as stand alone, and in relation to those obtained by McCracken.</p
... By examining the association between baseline distress intolerance with other symptom aspects that are theorized to maintain the disorder (i.e., responding to high distress by immediately ritualizing, pursuit of experiential avoidance; cf. Hayes, Strosahl, & Wilson, 1999), clinicians may be able to target those associations more effectively. For example, during YBOCS administration and in the exposure hierarchy creation process, clinicians may wish to highlight patients' beliefs that they cannot function effectively (i.e., move forward to other tasks while resisting rituals) in the context of high distress. ...
... Although data do not suggest group level outcome differences between traditional ERP versus ERP with third wave approaches (Twohig et al., 2018), our study suggests that potential differences may exist within patients. Such mindfulness approaches include noticing one's thoughts as separate entities (e.g., defusion) and observing them come and go without efforts to speed or slow that process (e.g., Leaves on a Stream mindfulness exercise; Hayes et al., 1999). Relatedly, ACT approaches encourage patients to re-center around values-driven behavior regardless of the context of distress (i.e., attenuating the correlation between observed distress and behavior or interference, as evinced more strongly in our non-responder group). ...
Article
Exposure and response prevention is the gold-standard treatment for obsessive compulsive disorder (OCD), yet up to half of patients do not adequately respond. Thus, different approaches to identifying and intervening with non-responders are badly needed. One approach would be to better understand the functional connections among aspects of OCD symptoms and, ultimately, how to target those associations in treatment. In a large sample of patients who completed intensive treatment for OCD and related disorders (N = 1343), we examined whether differences in network structure of OCD symptom aspects existed at baseline between treatment responders versus non-responders. A network comparison test indicated a significant difference between OCD network structure for responders versus non-responders (M = 0.19, p = .02). Consistent differences emerged between responders and non-responders in how they responded to emotional distress. This pattern of associations suggests that non-responders may have been more reactive to their distress by performing compulsions, thereby worsening their functioning. By examining the association between baseline distress intolerance with other symptom aspects that presumably maintain the disorder (e.g., ritualizing), clinicians can more effectively target those associations in treatment.
... In the last few years, a version of Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) focused on disrupting unconstructive worry and rumination has been developed (Ruiz, Riaño-Hernández, Suárez-Falcón, & Luciano, 2016). This approach has been called repetitive negative thinking-focused ACT (RNT-focused ACT). ...
... ▪ Exercise of alternating RNT and defusing from thoughts in a conversation with the therapist. ▪ Pink elephant exercise (based on Hayes et al., 1999): The participant was invited to avoid thinking about a pink elephant. ...
Article
Full-text available
Romantic relationship breakups often cause important behavioral and emotional consequences that can lead to experiencing complicated grief. However, little empirical research has tested psychological interventions for this frequent problem. This preliminary study explored the efficacy of a three-session protocol of Acceptance and Commitment Therapy (ACT) focused on repetitive negative thinking (RNT) for the treatment of complicated breakup grief in three women. A nonconcurrent, across participant, randomized multiple-baseline design was conducted. The three participants showed very large decreases in breakup distress that surpassed the criteria for claiming clinically significant changes. Two participants showed clinically significant changes in emotional symptoms, and all of them attained significant changes in life satisfaction. All three participants showed clinically significant changes in repetitive negative thinking, experiential avoidance, cognitive fusion, and valued living. Effect sizes comparable across designs were very large and statistically significant for breakup distress (d = 7.11), emotional symptoms (d = 2.46), and life satisfaction (d = 1.25). In conclusion, RNT-focused ACT protocols might be efficacious in cases of complicated breakup grief.
... A previous study already found that exposure to nature increases the ability to reflect on a life problem (Mayer et al., 2009). A second strategy, or "family of strategies, " involves meaning-making processes such as acceptance and positive reappraisal, for which numerous psychological benefits have been found (Hayes et al., 1999;Gross and John, 2003). For example, reflection led some participants to be able to accept difficult situations or events, such as Arne accepting the possible "mistakes" he made, often in the context of his autism spectrum disorder (ASD). ...
Article
Full-text available
Coastal environments are increasingly shown to have a positive effect on our health and well-being. Various mechanisms have been suggested to explain this effect. However, so far little focus has been devoted to emotions that might be relevant in this context, especially for people who are directly or indirectly exposed to the coast on a daily basis. Our preregistered qualitative study explored how coastal residents experience the emotions they feel at the coast and how they interpret the effect these emotions have on them. We conducted semi-structured interviews with a purposive sample of eight Belgian coastal residents aged 21–25 years old. The interviews were analyzed with the approach of interpretative phenomenological analysis. Five superordinate themes were identified and indicate that, for our participants, the coast represents a safe haven (1) in which they can experience emotional restoration (2), awe (3), and nostalgia (4). These emotional states are accompanied with adaptive emotion regulating strategies (5), such as reflection and positive reappraisal, that may facilitate coping with difficult thoughts and feelings. Our study demonstrates the importance of investigating specific emotions and related processes triggered at the coast and how these could contribute to the therapeutic value of the coast.
... Clients seeking to increase levels of dispositional mindfulness may benefit from engaging in mindfulness training. State, or present moment, mindfulness is frequently addressed in individual or group work through MBSR (Kabat-Zinn, 2003), mindfulness-based cognitive therapy (Segal et al., 2002), and acceptance and commitment therapy (ACT; Hayes et al., 1999). Mindfulness-based interventions can be categorized as (1) mindfulness-integrated (e.g., mindfulness-integrated cognitive behavior therapy [Frances et al., 2020]), dialectical behavior therapy (Linehan, 1993), and ACT; (2) mindfulness-based (e.g., MBSR, MBCT); and (3) singular mindfulness meditation (see Lutz et al., 2008). ...
Article
The COVID‐19 pandemic has had an unprecedented psychological impact, revealing immense emotional disturbances among the general population. This study examined the extent to which social connectedness, dispositional mindfulness, and coping moderate symptoms of anxiety and depression in 1242 adults under the same government‐issued COVID‐19 stay‐at‐home mandate. Participants completed measures of anxiety, depression, dispositional mindfulness, social connectedness, and coping, and regression analyses were used to examine associations and interaction effects. Results indicated that social connectedness and dispositional mindfulness were associated with reduced symptoms. For individuals living with a partner, decreased mindfulness and avoidant coping were associated with anxious symptoms. In households with children, overutilization of approach coping served to increase symptoms of depression. Results indicate the importance of considering social connectedness, mindfulness, and coping in counseling to enhance factors serving to protect clients during a public health crisis. Implications for professional counselors and areas of future research are discussed.
... Isto é, a utilização da medicação se configura como parte de eventos ambientais que alteram a efetividade dos estímulos presentes no ambiente. Considerando que a vitalidade é um produto de contingências reforçadoras (Skinner, 1987) que, na espécie humana, estão diretamente ligadas à valores (Hayes, Strosahl & Wilson, 1999), é possível dizer que a Medicalização, quando potencializa a emergência de flexibilidade psicológica, está diretamente ligada à experiência de vitalidade: trata-se de uma Medicalização Virtuosa. ...
Article
Enquanto prática cultural, a Medicalização da Vida é um fenômeno amplo, sig-nificativo para as ciências da saúde e do comportamento, e pródigo em suscitar acirrados debates. A argumentação desenvolvida no presente artigo discute esta prática cultural no contexto da análise clínica do comportamento, tendo como norte a seguinte questão: é possível pensar em uma Medicalização da Vida virtuosa? Para tanto, este trabalho (1) faz um levantamento do desenvolvimento atual do conceito de Medicalização da Vida; (2) apresenta uma perspectiva analítico-comportamen-tal da Medicalização e (3) apresenta uma reflexão crítica sobre os motivos pelos quais o analista do comportamento pode, ou não, considerar a Medicalização da Vida como um problema a ser enfrentado. Argumenta-se que a discussão normativa acerca da prática cultural da Medicalização da Vida no âmbito da análise clínica do comportamento depende, necessariamente, de uma clarificação acerca dos objeti-vos da prática clínica em questão.
... Mindfulness is strongly related to another commonly studied emotion regulation strategy, namely acceptance. Acceptance, in this context, is the active action of allowing internal sensations and reactions without judgment and without attempts at reduction or control (Hayes et al., 1999). The results are consistent with findings from other domains (Sheppes et al., 2011(Sheppes et al., , 2014, suggesting that while disengaging strategies, such as distraction or mental suppression, may be effective in the short term, they may be inferior in the long term. ...
Article
Full-text available
In the current study, we provided participants with written information about emotional dimensions of a sound presented as a task-irrelevant sound in the context of a serial recall task. We were interested in whether this manipulation would influence sound perception and spontaneous use of emotion regulation strategies. Participants were informed that they would hear either an aversive and annoying sound, or a pleasant and calming sound. They subsequently performed three blocks of a serial recall task with the sound presented in the background and rated the sound after each block. Results showed that participants in the negative information group rated the sound as more negative, with effects diminishing over repeated trials. While not impacting emotion regulation strategy directly, the manipulation indirectly influenced the degree to which participants used mental suppression as a regulatory strategy via changing affective responses. In the negative information condition specifically, participants who experienced the sound as more negative were more inclined to use mental suppression to deal with the sound, whereas no such relationship was observed in the positive information condition. The study adds to our understanding of how sounds come to acquire emotional meaning and how individuals spontaneously cope with emotional, task-irrelevant sounds.
... ACT has been widely researched in clinical samples with strong evidence for a wide range of mental health problems (Ruiz, 2010), such as anxiety (Swain et al., 2013), depression (Bai et al., 2020), and chronic pain (Veehof et al., 2016). Since introducing ACT (Hayes et al., 1999), many interventions in sport psychology have drawn from the ACT model and its six core processes (i.e., values, contact with the present moment, committed action, acceptance, self as a context, and defusion). Sport psychology researchers have mostly adopted the parts about being present in the moment and accepting internal events (i.e., thoughts and emotions) to enhance performance (e.g., The Mindfulness-Acceptance-Commitment approach; Moore, 2009). ...
Article
Full-text available
In recent years, athletes’ mental health has gained interest among researchers, sport practitioners, and the media. However, the field of sport psychology lacks empirical evidence on the effectiveness of psychotherapeutic interventions for mental health problems and disorders in athletes. Thus far, intervention research in sport psychology has mainly focused on performance enhancement using between-subject designs and healthy athlete samples. In the current paper, we highlight three interrelated key issues in relation to treating mental health problems and disorders in athletes. (i) How are mental health and mental health problems and disorders defined in the sport psychology literature? (ii) How are prevalence rates of mental health problems and disorders in athletes determined? (iii) What is known about psychotherapeutic interventions for mental health problems and disorders in athletes? We conclude that the reliance on different definitions and assessments of mental health problems and disorders contributes to heterogeneous prevalence rates. In turn, this limits our understanding of the extent of mental health problems and disorders in athletes. Furthermore, knowledge of the effectiveness of psychotherapeutic interventions for athletes with mental health problems and disorders is scarce. Future research should include athletes with established mental health problems and disorders in intervention studies. We also propose an increased use of N-of-1 trials to enhance the knowledge of effective psychotherapeutic interventions in this population.
... Acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is a contextual behavioral therapy that can provide an answer to the three alternatives commented above. The primary goal of ACT is to foster psychological flexibility in reaction to inner experiences, including thoughts, feelings, and bodily sensations. ...
Article
Full-text available
Although cognitive-behavioral therapy (CBT) is efficacious for treating panic disorder, a segment of the population is not treated due to the treatment length and the acceptability of interoceptive exposure. This study explored the efficacy of a brief protocol based on acceptance and commitment therapy (ACT) focused on repetitive negative thinking (RNT) in adults suffering from panic disorder. We designed a 4-session RNT-focused ACT protocol because previous CBT studies considered this length “ultra-brief.” Additionally, although conducting exposure is consistent with the ACT model, we did not include explicit exposure exercises to increase the intervention acceptability. A randomized, multiple-baseline design across three participants was implemented with a 3-month follow-up. The effect of the intervention was evaluated through weekly scores on the Depression Anxiety and Stress Scale – 21 (DASS-21; S. H. Lovibond & P. F. Lovibond, 1995), Penn State Worry Questionnaire (PSWQ; Meyer et al., 1990), and the frequency of panic attacks. After the intervention, all participants ceased to experience panic attacks and showed clinically significant changes in the DASS-Total and PSWQ. The effect sizes comparable across designs were very large and statistically significant for the DASS-Total (d= 2.48), DASS-Depression (d= 1.45), DASS-Anxiety (d= 1.93), DASS-Stress (d= 1.63), and PSWQ (d= 2.36). All three participants also showed clinically significant changes and large effect sizes in experiential avoidance (d= 3.26), cognitive fusion (d= 3.58), and valued living (Progress: d= 0.72, Obstruction: d= 2.43). In conclusion, brief RNT-focused ACT interventions might be efficacious for treating panic disorder
... Haugmark, Hagen, Smedslund, and Zangi (2019) found that these therapies obtained small to moderate effect sizes in reducing pain, emotional symptoms and improving sleep quality. Among these intervention approaches, acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) showed the most promising results, although the number of studies included in this meta-analysis was small (Luciano et al., 2014;Simister et al., 2018). ...
Article
Full-text available
Repetitive negative thinking (RNT), in the form of worry and rumination, is a factor that can have a negative impact on the quality of life and symptomatology of patients with fibromyalgia (FM). The present study analyzes the efficacy of a brief Acceptance and Commitment Therapy (ACT) protocol focused on reducing RNT in four women diagnosed with FM. A randomized, multiple-baseline design across participants was conducted. Participants completed 4-6 weeks of baseline and subsequently received a 4-session individual intervention. The effect of the intervention was assessed by conducting follow-ups for up to 3 months. All four participants showed clinically significant changes in emotional symptoms as measured by the Depression Anxiety and Stress Scale – 21 (DASS-21¸ S. H. Lovibond y P. F. Lovibond, 1995) and the General Health Questionnaire – 12 (Ruiz et al., 2017a). Likewise, participants showed significant improvements in parameters related to sleep quality and improvements in health-related quality of life. As for process measures, all participants showed clinically significant changes in pathological worry, and three of them also in cognitive fusion. Changes in valued actions were more modest. Effect sizes comparable across designs were very large and statistically significant for DASS-Total (d = 1.51), DASS-Depression (d = 1.83), pathological worry (d = 1.79), and cognitive fusion (d = 1.99). These results suggest that brief RNT-focused ACT interventions hold promise for intervention in patients with FM.
... The application of acceptance processes, along with commitment and value-directed behaviour change processes, is aimed at increasing psychological flexibility (eg, being fully present in the present moment, without trying to avoid/fight unwanted thoughts/feelings). 13 The psychological flexibility afforded by ACT is associated with reduced psychological distress in debilitating chronic diseases. 14 15 ACT is derived from cognitive-behavioural therapy (CBT). ...
Article
Full-text available
Introduction: Inflammatory bowel disease (IBD) involves an abnormal immune response to healthy gut bacteria. When a person develops IBD, their susceptibility to anxiety and/or depression increases. The ACTforIBD programme, specifically designed for people with IBD and comorbid psychological distress, draws on acceptance and commitment therapy (ACT), which promotes acceptance of situations that cannot be solved such as persistent physical symptoms. There are no ACT trials for IBD using an active control group or a telemedicine approach, which is important to improve accessibility, particularly in the context of the ongoing COVID-19 pandemic. The ACTforIBD programme is administered online with a 4-hour therapist involvement per participant only; if successful it can be widely implemented to improve the well-being of many individuals with IBD. Methods and analysis: Our team have codesigned with consumers the ACTforIBD programme, an 8-week intervention of 1-hour sessions, with the first three sessions and the last session delivered one-to-one by a psychologist, and the other sessions self-directed online. This study aims to evaluate the feasibility and preliminary efficacy of ACTforIBD to reduce psychological distress in patients with IBD. Using a randomised controlled trial, 25 participants will be randomised to ACTforIBD, and 25 patients to an active control condition. Ethics and dissemination: This protocol has been approved by Deakin University Research Ethics Committee in September 2021 (Ref. 2021-263) and the New Zealand Central Health and Disability Ethics Committee in December 2021 (Ref. 2021 EXP 11384). The results of this research will be published in peer-reviewed journals and shared with various stakeholders, including community members, policy-makers and researchers, through local and international conferences. Trial registration number: ACTRN12621001316897.
... A different approach to how individuals perceive and react to their emotions has developed from the functional-contextual perspective of Acceptance and Commitment Therapy (ACT) [21,22]. ACT is arguably the most representative and empirically supported of the Third Wave of cognitive-behavioral therapies [23]. ...
Article
Full-text available
The prevalence of mental health problems during childhood and adolescence is on the rise. There is a growing interest in the examination of personal variables that may function as risk factors and that may be targeted for effective intervention. This study explores the relationships amongst different aspects of psychological inflexibility (one, typically studied, focusing on the individual’s responding to unwanted emotions and cognitions, and another, more recently explored, focusing on the individual’s responding to desired thoughts and affective states), emotional intelligence, and mental health symptoms. A total of 129 school-going children (mean age: 11.16 years old) completed a battery of instruments comprising the Avoidance and Fusion Questionnaire-Youth (AFQ-Y17), the Experiential Approach Scale (EAS), the Emotional Intelligence Quotient Inventory (EQi-YV), and the Revised Child Anxiety and Depression Scale (RCADS-30). Results showed that both the AFQ-Y17 score and an EAS subscale score (Anxious Clinging) were significant independent predictors of mental health symptoms in general. Emotional intelligence was predictive only for depression, and both the AFQ-Y17 and the Anxious Clinging EAS subscale significantly incremented the predictive power of a hierarchical linear regression model including all three variables. These results underscore the relevance of psychological inflexibility for child/adolescent mental health, and the need to further explore a specific aspect of inflexibility regarding positive emotions and other appetitive private events.
... The AAQ-II is an instrument developed to assess experiential avoidance and psychological inflexibility. Experiential avoidance refers to neglect or avoidance of unpleasant thoughts, bitter memories, or physical sensations leading to action against one's values [39]. Psychological inflexibility is conceptualized as rigid or firm psychological reactions against one's values to avoid distress, uncomfortable feelings, thoughts, and ignoring the present moment [40]. ...
Article
Full-text available
In 2020, the COVID-19 pandemic struck the globe and disrupted various aspects of psychological wellbeing, more so in frontline workers. Research on assessing the seroprevalence of COVID-19 has been scarce; in addition, there are limited studies assessing the association between the seroprevalence of COVID-19 and psychological distress. Therefore, this study aimed to determine the seroprevalence of COVID-19 and the prevalence of psychological distress and to determine whether sociodemographic variables, occupational information variables, coping styles, and psychological processes might contribute to the development of psychological distress. A cross-sectional study involving 168 Universiti Malaysia Sabah (UMS) front liners was carried out to assess these issues. The Depression, Anxiety and Stress Scale (DASS-21) was employed to assess psychological distress, together with the COVID-19 Rapid Test Kit Antibody (RTK Ab) and a series of questionnaires, including a sociodemographic and occupational information questionnaire, the Balanced Index of Psychological Mindedness (BIPM) questionnaire, the Mindfulness Attention and Awareness Scale (MAAS), the Acceptance and Action Questionnaire (AAQ-II), and the Brief COPE questionnaire. The results demonstrated a seroprevalence of COVID-19 at 8.3% (95% CI = 5.0–14.0). Non-healthcare workers (HCWs) had a higher COVID-19 prevalence. Meanwhile, the prevalence of depression, anxiety, and stress among front liners was low (3.0%, 3.6%, and 1.2%, respectively). Younger people (aged 30 years old or less) and HCWs had a higher prevalence of psychological distress; being a HCW was significantly associated with a higher level of anxiety. Dysfunctional coping and psychological inflexibility were consistently found to be predictors for higher levels of the three psychological distress variables. This study suggested some alternatives that could be explored by mental health providers to address mental health issues among front liners at universities.
... Our analysis will focuse notacceptance behavior, more exactly actions against nuclear power. As 'acceptance' is a term applied to a person's recognition of information, it requires commitment, which indicates that behavior is maintained or modified in pursuit of personal beliefs and objectives [43]. Thus, articulated attitudes contribute to changing specific behaviors, especially in the event of an accident. ...
Article
Full-text available
This study aims to analyze the forward/reverse causal relationships between belief (risk perception), attitude (judgment), and behavior (acceptance). A traditional view stresses forward causal relationships between the three variables. However, recently, several studies have reported the possibility of reverse causal relationships between them. Based on survey data collected from 1027 Korean/Japanese participants, here we test not only the forward or reverse relationships between these three variables, but also how such causal relationships depend on the trust and country contexts (Korea and Japan in this study). The results showed that, first, not only a general forward causal relationship but also reverse causal relationship exists between belief, attitude, and behavior. Second, there exist the moderated mediation and mediated moderation effect of trust in government and media across two countries. Third, the effects of trust in government and media work significantly overall. However, the patterns of interaction effects differ between two countries. The level of trust in the government influenced the belief and attitude of citizens in Japan more than in Korea. However, the level of trust in the media showed opposite results.
... Cognitive dampening responses can be readily addressed in standard cognitive therapy (Beck et al., 1979) and integrated into existing therapies that aim to increase positive affect, such as Positive Affect Treatment (PAT; Craske et al., 2016). Furthermore, mindfulness-based interventions that promote acceptance of, and nonjudgmental attention toward, positive emotional experiences, such as Acceptance and Commitment Therapy (ACT; Hayes et al., 1999), may prove especially effective in reducing tendencies to engage in dampening. ...
Article
Dampening responses to positive affect have been posited to confer vulnerability to depression, but longitudinal studies have not consistently shown dampening tendencies to predict follow-up depression. The cross-sectional, longitudinal, and cross-lagged relationships between dampening and depression were determined using meta-analytic methods. A systematic literature search of the PsycINFO and PubMed databases supplemented by Google Scholar yielded 60 samples suitable for inclusion in the cross-sectional analyses and 12 samples meeting criteria for the longitudinal analyses. In the first meta-analytic study to examine the relationship between dampening and depression, we found dampening to be associated with depression both cross-sectionally (r = .45) and prospectively (r = 0.34). Crucially, dampening at baseline remained a significant predictor of follow-up depression even after controlling for baseline levels of depression in cross-lagged analyses (β = .09). A bidirectional effect was also found, with baseline levels of depression predicting follow-up tendencies to engage in dampening (r = 0.36). This relationship was again diminished but remained significant after controlling for initial levels of dampening (β = .14). These results suggest that dampening responses to positive affect are a risk factor for the development of depression and highlight the importance of targeting dampening cognitions in treatment.
... Moreover, modern cognitive-behavioral therapies, such as dialectical behavioral therapy (DBT; Linehan, 1993) and acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999), are focused on accepting negative emotional experiences rather than controlling them. In DBT, painful emotions are seen as inevitable, while the non-acceptance of emotions is seen as contributing to suffering (Linehan, 1993;Linehan et al., 2001). ...
Thesis
Full-text available
The aim of this study was to develop and preliminarily validate a transdiagnostic model of how clients overcome Aversion to Emotion/ Self-Interruption (AESI) over the course of a session of emotion-focused therapy. The study employed task analytic methodology and consisted of two phases: a Discovery Phase and a Validation Phase. In the Discovery Phase of the study, a model of the resolution of AESI was developed through the intensive analysis of 5 cases (3 Resolved, 2 Unresolved). The model identified 7 component processes involved in this task: Marker of AESI, Awareness of How Interrupting, Awareness of Purpose of Interruption, Realization of Negative Impact of Interruption, Reduction of Fear of Emotion, Desire to Allow Emotion, and Resolution of AESI. Rating scales were developed to measure each component, so that they could be used to verify the model in the Validation Phase of the study. These rating scales consisted of the Marker of AESI Rating Scale (MARS), the Components of Resolution of AESI Rating Scale (CRARS), and the Resolution of AESI Rating Scale (RARS). In the Validation Phase of the study, segments of therapy sessions from a sample of 24 clients (13 Resolved, 11 Unresolved) were rated for the presence of model components, using the MARS, CRARS and RARS. Significant inter-rater reliability was obtained on each scale. Preliminary support for the validity of the model of resolution was established. The two early mid-model components (Awareness of How Interrupting and Awareness of Purpose of Interruption) were present among all clients, while the three late mid-model components (Realization of Negative Impact of Interruption, Reduction of Fear of Emotion, and Desire to Allow Emotion) occurred more frequently among Resolved clients, compared to Unresolved clients. Resolution of AESI had a perfect positive relationship with Reduction of Fear of Emotion, a fairly strong positive relationship with Desire to Allow Emotion, and a moderate positive relationship with Realization of Negative Impact of Interruption. Support for the structure of the model was mixed. Clinical and theoretical implications of these findings are discussed and contextualized within current psychotherapy research literature.
... Mindfulness acceptance commitment (MAC) (Gardner & Moore, 2004;2007), as one of the sportspecific mindfulness-based interventions is grounded on two established mindfulness-and acceptance-based therapies (i.e., Acceptance and Commitment Therapy (ACT; Hayes, Strosahl & Wilson, 1999) and Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams & Teasdale, 2002). MAC approach promotes an awareness and acceptance of the internal state of the athlete, suggesting that "internal states need not be disregarded, eliminated, altered, or controlled to enable positive behavioural outcomes. ...
... Experiential avoidance is an instance of psychological inflexibility; specifically, it occurs when an individual attempts to alter, escape from, or control difficult, uncomfortable, or undesirable internal states (thoughts, feelings, sensations, etc.), even when this leads to or would lead to actions that are incongruent with one's values and goals (Hayes et al. 2006). Thus, experiential avoidance is diametrically opposed to the notion of psychological flexibility, which is frequently described in the acceptance and commitment therapy model for mental illness (Hayes et al. 1999). Experiential avoidance has often been shown to only create or exacerbate problems or, ironically, increase interaction with the situation trying to be avoided (Gámez et al. 2011). ...
Article
Full-text available
The practice of prayer has been shown to predict various mental health outcomes, with different types of prayer accounting for different outcomes. Considering the numerous stressors facing seminary students, which have only intensified throughout the COVID-19 pandemic, prayer may be a common coping strategy for students who study theology, spiritual growth, and leadership. The present study investigates the role that different types of prayer may have in reducing anxiety, depression, and work burnout among seminary students. Experiential avoidance is proposed as a mediator such that specific types of prayer contribute to greater spiritual and characterological formation through staying engaged in the midst of struggle. Longitudinal data was collected from 564 graduate seminary students from 17 institutions accredited by the Association of Theological Schools. Based on previous research, we hypothesized that experiential avoidance would mediate the relationship between colloquial, liturgical, meditative, and petitionary prayer types and the negative mental health outcomes of anxiety, depression, and work burnout. Results confirmed significant negative relationships between colloquial, liturgical, and meditative prayer types and all three mental health indicators, fully mediated by experiential avoidance. Petitionary prayer was not significantly related to lower levels of mental health. These results indicate that engaging in certain prayer practices may be a protective factor by facilitating experiential engagement.
... The interest in the study of verbal interaction in clinical sessions from a functional perspective is present since the early 60 s (see Moore, 1991). This conceptual development helped to foster empirically-supported psychological treatments like the Functional Analytic Psychotherapy (Kohlenberg and Tsai, 1991) or the Acceptance and Commitment Therapy (ACT; Hayes et al., 1999;Hayes, 2004) 1 . Also, helped to develop coding systems for the observational study of the verbal interaction like the Functional Analytic Psychotherapy Rating Scale (FAPRS; Callaghan et al., 2008); the Multidimensional System for Coding Behaviors in Therapist-Client interaction (SiMCCIT; Zamignani, 2008) or the Verbal Interaction Categorization System in Therapy (Froxán-Parga et al., 2011;Alonso-Vega et al., 2022). ...
Article
Full-text available
Recent developments in pattern analysis research have made this methodology suitable for the study of the processes that are set in motion in psychological interventions. Outcome research, based on the comparison between clinical results from treatment and control groups, has leveraged our empirical knowledge about the efficacy of psychological interventions. However, these methods of research are not precise enough for the analysis of these processes. On the contrary, pattern analysis could be a powerful tool to study moment-to-moment interactions typical of psychological interventions. This is methodology is relevant because clinical psychology is experiencing a paradigm shift from a protocol for syndrome perspective to a principle-based and person-centered intervention. This evidence-based, theory-grounded, and process-oriented paradigm of clinical intervention needs new research methods to thrive (i.e., pattern analysis). The analysis of the therapeutic relationship built into the verbal interaction between the clinician and the client is one of the cornerstones of this new era of research. So, the purpose of this article is three-fold: (1) to discuss the role of the verbal interaction pattern analysis in the clinical context to the development of the principle-based clinical psychology, (2) to analyze the patterns of verbal interaction in a clinical case, and (3) to compare the results using two different methods. To reach these purposes, using the observational methodology, we have coded the verbal interaction of 16 clinical sessions with a person diagnosed with a borderline personality disorder. We have analyzed the data using sequential analysis (GSEQ) and pattern recognition algorithms (i.e., T-Pattern detection). We have been able to detect typical patterns during different phases of psychological intervention (i.e., evaluation, explanation, treatment, and consolidation). Finally, the conceptual, methodological, and empirical implications of this study will be discussed within the realms of pattern analysis research and principle-based clinical psychology.
... Yet, there are no empirical studies examining the moderating role of individual intrinsic attributes in the direct or indirect relationship between online loafing and sense of meaning in life. Psychological flexibility means that individuals consciously contact the present situation in a flexible and independent way, and act according to their own values in light of the conditions provided by the environment (32). Individuals with psychological flexibility pay attention to their current life experience and feelings with a receptive attitude, by observing those conceptualized self-experiences from the perspective of a third party, and actively dealing with negative emotional events. ...
Article
Full-text available
Background With the gradual penetration of network media into various fields of people's life, the relationship between network behavior and the sense of meaning of life is bound to be closer and closer. The purpose of this study is to explore the mediating role of state anxiety between cyber loafing and the sense of meaning of life, and the moderating role of psychological flexibility in this mediating relationship. Methodology With 964 undergraduates recruited as subjects three-wave-time-lagged quantitative research design was conducted in China. All participants were required to complete a self-reported electronic questionnaire. Then, the mediating mechanism and moderating effect were explored with utilization of SPSS25.0. Results The results showed that cyberloafing had significant negative correlation with the sense of meaning of life. Our analysis testing the mediating effect showed that state anxiety partially mediated the relationship between cyberloafing and the sense of meaning of life (indirect effect = −0.05, p < 0.01,), while the mediating effect was 31.25% of the total effect. Our analysis testing the moderating effect showed that psychological flexibility significantly moderated the relationship between cyberloafing and state anxiety (interaction effect = −0.26, p < 0.01). And our analysis testing the moderated mediating effect showed that psychological flexibility played a moderating role in the mediating effect of state anxiety. Conclusion Based on the findings of this study, college students' cyberloafing negatively affects their sense of meaning of life. Therefore, appropriate measures should be taken to supervise and restrict college students' Internet use and provide them with corresponding guidance; certain psychological adjustment measures should also be taken when necessary to help college students with low psychological flexibility in reducing their state anxiety and improving their sense of meaning of life.
... A number of nonpharmacological approaches are effectively utilized to treat anxiety in adult population without PD, and in individuals with a variety of other chronic medical and neurological conditions. The most common of these include; cognitive behavior therapy (CBT), which aims to examine and modify maladaptive thoughts and to change maladaptive behaviors and beliefs through a skills-based approach (Beck, 1979); acceptance and commitment therapy (ACT), which helps individuals to develop psychological flexibility and to take committed action based on a connection with personal values (Hayes, Strosahl, & Wilson, 1999); and mindfulness interventions, which focus on cultivating conscious awareness and an open, nonjudgmental attitude, with an emphasis on accepting things as they are (Kabat-Zinn, Lipworth, & Burney, 1985). However, many other approaches have also demonstrated efficacy or effectiveness for anxiety in adults without PD (Bandelow et al., 2015), including psychodynamic therapy (Steinert, Munder, Rabung, Hoyer, & Leichsenring, 2017), problem solving treatments (PST) (Beaudreau, Gould, Mashal, Huh, & Fairchild, 2019;Beaudreau et al., 2021;Zhang et al., 2019), interpersonal psychotherapy (Chen, Nehrig, Wash, & Wang, 2020;Markowitz, Lipsitz, & Milrod, 2014), and compassion focused therapy (CFT) (Birdsey, 2020;Frostadottir & Dorjee, 2019). ...
Article
Objectives: Anxiety is common in Parkinson's disease (PD), negatively impacting daily functioning and quality of life in PD patients and their families. This systematic review evaluates the effectiveness of different psychotherapeutic approaches for reducing anxiety in PD and provides recommendations for clinical practise. Methods: Following PRISMA guidelines, 36 studies were included and risk of bias was evaluated. Results: We identified cognitive behavioral therapy (CBT), mindfulness-based therapies, acceptance and commitment therapy, and psychodrama psychotherapies. There is good evidence-base for anxiety reduction using CBT approaches, but with mixed results for mindfulness-based therapies. Other therapeutic approaches were under researched. Most randomized control trials examined anxiety as a secondary measure. There was a paucity of interventions for anxiety subtypes. Secondarily, studies revealed the consistent exclusion of PD patients with cognitive concerns, an importance of care partner involvement, and a growing interest in remote delivery of psychotherapy interventions. Conclusions: Person-centered anxiety interventions tailored for PD patients, including those with cognitive concerns, and trials exploring modalities other than CBT, warrant future investigations. Clinical implications: Practitioners should consider PD-specific anxiety symptoms and cognitive concerns when treating anxiety. Key distinctions between therapeutic modalities, therapy settings and delivery methods should guide treatment planning.
... The fact that we used CBT as the primary focal point for our message content could also be seen as a limitation, although we argue that most of the implications we elicited should extend beyond our particular questions and prompts. Future work could still explore messages built on other principles like acceptance and commitment therapy (ACT) [56], positive reinforcement [116], and reassurance [147]. Bhattacharjee et al. ...
Preprint
Full-text available
One-way text messaging services have the potential to support psychological wellbeing at scale without conversational partners. However, there is limited understanding of what challenges are faced in mapping interactions typically done face-to-face or via online interactive resources into a text messaging medium. To explore this design space, we developed seven text messages inspired by cognitive behavioral therapy. We then conducted an open-ended survey with 788 undergraduate students and follow-up interviews with students and clinical psychologists to understand how people perceived these messages and the factors they anticipated would drive their engagement. We leveraged those insights to revise our messages, after which we deployed our messages via a technology probe to 11 students for two weeks. Through our mixed-methods approach, we highlight challenges and opportunities for future text messaging services, such as the importance of concrete suggestions and flexible pre-scheduled message timing.
... Both IG and the WL participants were informed that the intervention involves some kind of support but did not know about differences in guidance to prevent potential bias. The intervention StudiCare Mindfulness integrated elements of acceptance and commitment therapy (ACT) (S. C. Hayes et al., 1999), mindfulness-based stress reduction (MBSR) (Kabat-Zinn, 1982), and general stress management techniques (Kaluza, 2015). The intervention was developed by the Department for Clinical Psychology and Psychotherapy of Ulm University in collaboration with psychology students ("by students, for students"). ...
Article
Full-text available
Objectives College is an exhilarating but stressful time often associated with mental distress. The StudiCare project offers Internet- and mobile-based interventions (IMI) for college student mental health promotion. Within this framework, we evaluated the IMI StudiCare Mindfulness , and examined potential moderators and mediators of effectiveness. Methods In this randomized controlled trial, 150 college students with low to moderate mindfulness were randomly assigned to StudiCare Mindfulness or a waitlist control group (WL). StudiCare Mindfulness comprises 5 weekly online modules based on Acceptance Commitment Therapy and stress management. Assessments took place before (t0) and 6 weeks after (t1) randomization. Primary outcome was mindfulness. Secondary outcomes were stress, depression, anxiety, quality of life, intervention satisfaction, and adherence. Sociodemographic variables, pre-intervention symptomatology, personality traits, and attitudes towards IMI were examined as potential moderators. Results Intention-to-treat analyses ( N = 149) showed a large effect of StudiCare Mindfulness on mindfulness ( d = 1.37; 95% CI: 1.01–1.73) compared to WL at t1 ( β = 1.18; 95% CI: 0.96–1.40). Effects on secondary outcomes were significant in favor of the intervention group except for physical quality of life. Mindfulness was found to mediate intervention effectiveness on depression, anxiety, and stress. Moderation analysis was non-significant except for baseline openness to experience, with lower openness associated with larger intervention effects on mindfulness. Conclusions This trial suggests that StudiCare Mindfulness may enhance mindfulness and reduce mental health problems. Its potential applicability as low-threshold prevention and treatment option on a population level should be subject to future trials. Trial Registration German Clinical Studies Trial Register TRN: DRKS00012559.
... As a clinical note, in societies that promote "positive minds" and throw the idea it is possible to "stay positive" through practicing emotional or experiential control techniques, our results suggests it might be beneficial teaching individuals to (1) notice those societal mandates (i.e., cognitive defusion), (2) discriminate whether adjusting their behavior to them brings joy and fulfillment to their lives; and (3) if not, actively search for alternative ways to naturally bring a sense of happiness that goes beyond the inmediate and purposeful experience of positive emotions (i.e., acceptance). On this regard, we point out to the literature on the protective role exerted by values-based pursuing of happiness (e.g., Plumb et al., 2009), as promoted in contextual therapies such as Acceptance and Commitment Therapy (Hayes et al., 1999). Values are intrinsically meaningful principles for living that contribute to wellbeing when they organize and direct current action (Wilson and Dufrene, 2009;Lundgren et al., 2012). ...
Article
Full-text available
Previous evidence has shown that excessive valuing happiness may relate to lower psychological wellbeing across cultures. Considering the lack of data with Spanish population, we examined the relation between tightly holding happiness emotion goals and subjective wellbeing in a sample of Spanish women, and explored the mediation role exerted by psychological inflexibility components (namely, cognitive fusion and experiential avoidance) in the relation between valuing happiness and subjective wellbeing. A female adult sample (n = 168) filled out measures of excessive valuing happiness, psychological inflexibility, positive affect, negative affect, and life satisfaction. Valuing happiness only showed positive total effects on negative affect and strong direct effects on both cognitive fusion and experiential avoidance. Analyses revealed the mediating roles exerted by psychological inflexibility components, with experiential avoidance leading to lower pleasure; and cognitive fusion leading to greater displeasure and lower life satisfaction. Psychological inflexibility components explained between 40 and 80% of the total effect of valuing happiness on our outcome variables. Our findings highlight the need for further research on the benefits of hedonic vs. values-based approaches to happiness.
Article
Full-text available
Discrimination as a crucial stressor damages the mental health of socioeconomically disadvantaged individuals through increased ruminative thinking. A “stress-is-enhancing” mindset may protect the mental health of socioeconomically disadvantaged individuals under the pressures of perceived discrimination and rumination. This study examined the mediating role of rumination and the moderating role of stress mindset in the relationship between perceived discrimination and psychological symptoms among socioeconomically disadvantaged college students. A total of 919 socioeconomically disadvantaged undergraduate students (48.4% female, ages 17–25) were recruited. The results indicated that perceived discrimination was positively associated with psychological symptoms among socioeconomically disadvantaged undergraduate students through rumination ( B = 0.11, boot SE = 0.01, boot 95% CIs = [0.08, 0.13]). Importantly, stress mindset moderated the indirect association between perceived discrimination and psychological distress through rumination ( B = −0.18, boot SE = 0.08, boot 95% CIs = [−0.32, −0.03]). Specifically, compared with individuals with low levels of the stress-is-enhancing mindset, the indirect effect of perceived discrimination on psychological distress through rumination was weaker among individuals with high levels of the stress-is-enhancing mindset. The findings provide support for future intervention practice to promote a stress-is-enhancing mindset to protect the mental health of socioeconomically disadvantaged college students under the pressures of perceived discrimination and rumination.
Article
Full-text available
Aims As refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe. Methods Refugees and asylum seekers with psychological distress (General Health Questionnaire-12 ⩾ 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes. Results Of 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389–1.819; p -value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180–1.544; p -value = 0.230). SH + was associated with improvements at 12 months in psychological distress ( p -value = 0.004), depressive symptoms ( p -value = 0.011) and wellbeing ( p -value = 0.001). Conclusions The present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.
Article
This case study outlines the use of acceptance and commitment therapy with a client struggling with uncomfortable thoughts and emotions concerning his injury, impacting adherence to his rehabilitation plan. The aims were to increase psychological flexibility and decrease cognitive fusion to allow for greater adherence to his rehabilitation plan and support well-being. The client engaged in a series of one-on-one sessions, discussing the triflex within acceptance and commitment therapy through the strategy of “recognize, release, refocus.” The intervention included practice engaging with the present moment, exploring defusion techniques, clarifying values, and committing to subsequent values-driven behaviors. The effectiveness of the intervention was assessed by monitoring psychological flexibility, cognitive fusion, and feedback from the client’s physiotherapists. The trainee sport and exercise psychologist then provided reflections on the case.
Article
Full-text available
La Terapia de Aceptación y Compromiso (ACT) se está convirtiendo en una vía de intervención prometedora en los problemas psicológicos en la infancia. En el presente estudio se aborda la intervención desde ACT en un caso de un niño de 9 años (J) que muestra numerosas conductas disruptivas en el contexto familiar, especialmente en situaciones que involucran a su hermano menor, y un patrón de rumia muy extendido. Se utilizó un diseño de caso único A-B con medidas de seguimiento. Los resultados muestran una reducción clínicamente significativa de las conductas disruptivas e incremento de flexibilidad psicológica tanto en el niño como en los padres. Se presentan los principales ejercicios y metáforas que se utilizaron para incrementar la flexibilidad psicológica de J, así como la intervención realizada con los padres, tanto de cara a la gestión de sus propias barreras psicológicas como las pautas para potenciar un comportamiento más flexible en su hijo.
Article
Full-text available
Veterans with PTSD often have substantial interpersonal difficulties and low levels of social support, which puts them at increased risk of mortality, but few treatments address global social impairment for veterans with PTSD. This study is a pilot randomized trial of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD (ACT-SS), a psychotherapy that targets social avoidance and eroded social relationships, compared to Person-Centered Therapy (PCT), a non-directive psychotherapy. Participants were randomized to twelve sessions of either ACT-SS (n = 21) or PCT (n = 19). The results showed that veterans with PTSD had high ratings of satisfaction for both treatments. Contrary to the PCT group, participants in the ACT-SS group showed a significant improvement in the quality of social relationships, engagement in social and leisure activities, and PTSD symptoms from the baseline assessment to the end of treatment and a three-month follow-up. Veterans in the ACT-SS group, but not the PCT group, also showed significant improvements in mindfulness and valued living and a reduction in experiential avoidance from baseline to the end of treatment, with sustained improvements in valued living at the three-month follow-up. Overall, the present study demonstrated the feasibility, acceptability, and positive preliminary outcomes of ACT-SS for veterans with PTSD.
Article
Full-text available
心理接受是接受與承諾治療的重要概念。此療法的發展是建築在佛法的基礎上,其創始人Hayes曾說過佛法的智慧是前科學系統,接受與承諾治療的實徵研究結果都可以用來支持佛法的概念與修練是實際上有效的。但心理接受並沒有完整涵蓋與詳細說明修養心理接受過程中如何對治個人內在慾望、慣性與自我中心。因此本文先探討西方心理接受之內涵,再來探討心理接受在西方心理治療的應用與限制,接續探討以說明含攝佛法智慧的心理接受修養的涵義、內容與修練方法,最後提出修正的接受與承諾療法中心理接受與心理治療步驟。依據佛法智慧,心理接受的目的是要朝向自性覺醒,回到原來的面目,我們原來的面目是可以接受所有心理活動,但不會有任何的心理煩惱或情緒困擾。然而要達到沒有任何的心理煩惱或情緒困擾,需要長久的修養,因此實務修養可以採用減低或消除24個不善自我,來回到自我原來的面目,將心理煩惱或情緒困擾降到最低。心理接受應用在心理治療實務中的三個目標為:減輕症狀、鼓勵培養佛法智慧、建立實踐自性覺醒的修養習慣來回到原來面目。本文含攝佛法智慧來修正Hayes心理治療歷程的六步驟並加入兩個步驟,共提出八步驟分別是:(1)評估個案的善與不善自我(2)鼓勵個案培養與吸收佛法智慧(3)接受:接受善與不善自我(4)與此時此刻連結:連結善的自我來達到無我(5)視自我為情境的脈絡:視原來的我為情境的脈絡(6)脫離糾結:化解不善自我(7)價值觀:以佛法的智慧為價值觀(8)承諾行動:建立實踐自性覺醒的修養習慣。此佛法脈絡下的心理接受修養歷程可說明如何透過心理接受修養以達到真實與持久的快樂,並提供心理治療另一個選擇。 Psychological acceptance is an important concept of Acceptance and Commitment Therapy (ACT). The development of ACT was based on Buddhism. Hayes, the founder of ACT, said that Buddhist wisdom is a pre-scientific system, and the empirical research results of ACT can be used to support that Buddhism is effective for clinical applications. But the concept of psychological acceptance does not fully cover Buddhist wisdom and explain in detail how to deal with the desires, and self-centeredness of the individual in the self-cultivation manner. Therefore, this article first discusses the concept of psychological acceptance. We then discuss the application and limitation of psychological acceptance. Buddhist wisdom inclusive meaning, content, and training methods for psychological acceptance is provided. A revised ACT is offered. According to Buddhist wisdom, the purpose of psychological acceptance is towards the original self in a cultivating self-enlightenment way. Our original self is able to accept all psychological activities without mental distress or suffering. The original self means non-self that has no mental distress or suffering. Given that the self-nature is changeable and does not possess permanent and independent characteristics, and self is changeable. Accordingly, we have opportunities to change ourselves. The major cause of suffering is clinging to or obsession with the delusional selves. Eliminating clinging to or obsession with the delusional selves will lead to the original self via cultivating self-enlightenment from the self to the non-self state. There are 24 delusional selves as follows: Fury, Hatred, Angry, Concealment, Deceit, Hypocrisy or flattery, Haughty manner, Hostility or aggression, Jealousy, Avarice or miser, Shamelessness, Disregard, Unfaith, Laches, Blindness of the self-nature, Unmindfulness, Hedonic activities, Forgetfulness of Buddha’s wisdom, Wandering mind, Chaos or confusion, Sleep, Regret, Rough conation, and Refined conation. However, it takes a long time to achieve no mental distress or suffering. For this reason, the initial and practical goal aims to reduce or eliminate 24 clinging to or obsession with the delusional selves to approach to the original self, with a view to minimizing psychological disturbances. The three purposes of psychological acceptance in the practice of psychotherapy are: alleviating symptoms, encouraging to cultivate Buddhist wisdom, and establishing the habit of practicing the self-enlightenment process to approach to the original self. This article contains revised six steps derived from Hayes’ ACT and adds two steps based on Buddhist wisdom. A total of eight steps are proposed: (1) Assessing client’s 24 clinging to or obsession with the delusional selves (2) Encouraging to cultivate Buddhist wisdom (3) Acceptance: accepting good selves and the 24 kinds of clinging to or obsession with the delusional selves (4) Cognitive defusion: eliminating or distinguishing the 24 kinds of clinging to or obsession with the delusional selves (5)Contacting the present moment: contacting good selves towards non-self (6) Self-as-context: the original self as context (7) Values: absorbing values based on Buddhist wisdom (8) Committed action : establishing the habit of practicing the self-enlightenment process. These eight steps are indivisible process. To form a habit of practicing these eight stepwise steps reduce or eliminate 24 delusional selves to approach to the non-self state will attain the authentic happiness. The revised ACT based on Buddhist wisdom explains how to achieve authentic and durable happiness through psychological acceptance along with self-cultivation, and provides another avenue for psychotherapy.
Article
Acceptance and Commitment Therapy (ACT) is an empirically supported treatment for several psychological conditions, including anxiety, within a psycho-oncology setting. The ACT emphasis on psychological flexibility, values, and willingness to experience unwanted thoughts and emotions can be powerful for patients with cancer. However, practicing ACT within psycho-oncology can be difficult for providers who feel a desire to protect patients from distress or instill positivity in each session. We present a specific, though not uncommon, clinical presentation and provide a framework for clinicians to build awareness of the therapeutic challenges of using ACT within psycho-oncology. Key clinical considerations include intersectionality, the consequences of positivity in cancer culture, integrating practical problem-solving into the ACT framework, and the psychologist’s own fusion with thoughts and feelings about psychotherapy.
Article
Full-text available
Purpose of Review Compulsive sexual behavior disorder (CSBD) is a new diagnosis included in the International Classification of Diseases 11th Revision (ICD-11). Interventions have been developed to address CSBD-related issues. We sought to review findings from recently published behavioral interventions for CSBD. Recent Findings Nine clinical trials met criteria for inclusion in our review. Each intervention was associated with decreases in CSBD symptoms. Intervention formats differed considerably. Acceptance and commitment therapy and cognitive behavioral therapy were the most common overarching conceptual approaches. Most of the studies utilized small samples. Trials with larger samples had significant attrition problems. Of the reviewed studies, no follow-up measurements beyond 6-month post-treatment occurred. Almost all of the samples were comprised of men from Western countries. Four of the nine trials had control conditions (a waitlist in each case). Summary While behavioral interventions for CSBD will likely decrease symptoms, future research is needed to ascertain preferred approaches. To address current treatment gaps in the literature, we recommend additional clinical trials utilizing larger/diverse samples with stronger conceptual grounding.
Chapter
Children and adolescents are removed from their homes and placed within foster care due to various concerns. One entry point to foster care that presents various challenges to the mental, emotional, and behavioral stability and adult-sufficiency of youth are those with an incarcerated parent. Research indicated that 20-30% of foster care youth have an incarcerated parent. Yet, the children of incarcerated parents are often understudied when it comes addressing the issues and needs of foster care youth. This chapter will focus on the role out-of-home care plays on youth who are in foster care due to the incarceration of a parent. The barriers foster care youth with an incarcerated parent experience will be examined, and the intersection of parental criminal justice involvement and child welfare involvement will be explored. Protective factors, practice, and policy implications for human service professionals supporting youth in foster care who have an incarcerated parent will be shared.
Article
Dijitalleşme, modern yaşam ve gelişmelere olan yoğun bağımlılığın bir sonucu olarak insan hayatı, insanlıkla ve maneviyatla bağlarını kaybetme tehlikesiyle karşı karşıyadır. Bunun muhtemel bir çözümü, Büyük Kanyon’un enginliğine veya yüzlerce yıldızla dolu bir gökyüzüne tanık olmak veya mistik bir deneyim yaşamak gibi örneklerle açıklanabilecek, hayret ve hayranlığın duygusal bir algısı olan awe duygusunun beslenmesidir. Bu çalışmada öncelikle alan yazın titizlikle taranmış ve awe üzerine yapılan araştırmalar bu duygunun ne olduğu, formülasyonu, felsefesi çerçevesinde derlenmiştir. Daha sonra awenin Varoluşçu ve Transpersonel psikolojideki kullanım alanları verilmiş ve ayrıca hastalarda bu duyguyu güçlendirebilecek terapi önerileri de sunulmuştur. Sonuç olarak awenin halk sağlığının yükseltilmesi ve yaşam doyumunun yükseltilmesine yönelik tedavilerde daha fazla kullanılması gerektiğine inanıyoruz.
Chapter
The purpose of this chapter is to provide an overview of what you might expect to find in a CBT program for insomnia. That is, what would comprise the standard treatment protocol . I have taken the perspective that the published literature provides us with the greatest confidence in knowing what is effective, and so have included, as standard, those elements of CBT that have the strongest evidence base. That said, a feature of the insomnia trials literature is that CBT has typically been evaluated as a multicomponent therapy, so discrete elements have not necessarily been investigated as fully as one might wish, and the contribution of those elements to the overall treatment effect remains largely unknown. Consequently, where a given intervention has been a common component in trials demonstrating the effectiveness of CBT, I have taken the view that there are good grounds for thinking of that intervention as part of the standard protocol. In other words, it is at the very core of CBT for insomnia. Inevitably, I have had to make some choices and some judgements in proposing this standard protocol, and I recognise that others may take a different view. My intention is that the chapter is practical, in keeping with the purpose of this book, rather than heavily referenced to source materials, so I have relied mainly on clinical guidelines, practice parameters and systematic reviews when citing evidence. It is important to note, however, that clinical trials, of which there are many, are readily accessible through these overviews and I would recommend that you look at some of those to see just how varied CBT for insomnia can be, in content, content ordering, in treatment duration and in format of delivery. There are situations, however, where I have felt it helpful, and interesting perhaps, to provide more referencing; for example, to the scientific and historical roots of CBT. I often feel that these are overlooked. It is very important to appreciate the strength, depth and longevity of our field, even if the terminology we use (and sometimes re‐brand) appears as if it is novel! Our confidence that CBT works is also based on this provenance, and the diligent work of countless clinicians and researchers over many decades. Finally, this chapter is provided as a platform upon which other chapters may build. By presenting this standard protocol, focussed primarily in relation to adults with insomnia, applications of CBT to other populations, age groups and circumstances, protocol variations, and emerging approaches to therapeutics can compare, contrast and evolve through the course of the textbook. I have also tried to write as much as possible in plain language, and to share personal accounts of how I would deliver CBT, to make this chapter as clinically informative as possible. If you would like further insight into my approach to the actual delivery of CBT‐I, I would refer you to two recent books, one for patients (Espie, 2021) and the other for clinicians (Espie, 2022).
Chapter
As a growing body of literature suggests, insomnia and emotion regulation (ER) are closely linked, and there is a complex interplay between them, possibly bidirectional. Nevertheless, ER strategies have not yet been included or combined with the standard CBT‐I programmes, with only a few exceptions. The aim of the chapter is to outline a new therapeutic eight‐session protocol that may help the clinician to target sleep difficulties in conjunction with emotional problems. Specifically, the first four sessions target sleep difficulties through a standard CBT‐I training, including the manualized CBT‐I techniques, while the last four sessions provide an add‐on or adjunct to CBT‐I, focusing upon emotion regulation ability and strategies. The structure of the ER training is presented in detail. Both the CBT‐I training and the ER training were preliminary tested for efficacy, showing promising results. A clinical case study is presented of a 54‐year‐old woman with chronic insomnia of about 20 years duration who underwent the combined training. Future studies should evaluate the efficacy of this eight‐session combined training (CBT‐I + ER) in reducing insomnia symptoms and emotion regulation difficulties using randomized controlled trials. However, its brevity, structure and the topics presented allow clinicians and researchers to apply and adapt the proposed protocol to different conditions and populations with a degree of flexibility.
Article
Mindfulness-based interventions (MBIs) have entered mainstream Western culture in the past four decades. There are now dozens of MBIs with varying degrees of empirical support and a variety of mindfulness-specific psychological mechanisms have been proposed to account for the beneficial effects of MBIs. Although it has long been acknowledged that non-specific or common factors might contribute to MBI efficacy, relatively little empirical work has directly investigated these aspects. In this Perspective, I suggest that situating MBIs within the broader psychotherapy research literature and emphasizing the commonalities of rather than the differences between MBIs and other treatments might help to guide future MBI research. To that end, I summarize the evidence for MBI efficacy and several MBI-specific psychological mechanisms, contextualize MBI findings within the broader psychotherapy literature from a common factors perspective, and propose suggestions for future research based on innovations and challenges occurring within psychotherapy research. A variety of mindfulness-specific psychological mechanisms have been proposed to account for the beneficial effects of mindfulness-based interventions. In this Perspective, Goldberg argues that emphasizing the commonalities rather than differences between mindfulness-based interventions and other treatments might help to guide future research.
ResearchGate has not been able to resolve any references for this publication.