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Abstract

Acceptance and commitment therapy (ACT) is a contextual–behavioral approach to psychotherapy and other behavioral health concerns that has progressively attracted attention from both researchers and clinicians. ACT’s psychological flexibility model relies on middle-level terms that, despite being less precise than behavioral principles, are seen as being valuable for teaching and practicing ACT. One such term is cognitive defusion, which refers to the reduction of stimulus function transformation that occurs through verbal relations. In other words, defusion aims to minimize the influence of verbal relations, such as thoughts, on behavior, when doing so leads to adaptive behavior and valued living. Recently, some authors have stressed the importance of functionally defining middle-level terms, establishing clear links between the concept and basic behavioral processes. This article begins this endeavor by analyzing these links with respect to cognitive defusion. First, we briefly contextualize ACT’s theoretical roots. Second, we present cognitive defusion as a therapeutic intervention, reviewing its objectives, procedures, outcomes, and hypothesized processes as stated in the relevant literature. Third, the outlined process of change is critically examined, leading to a new conceptualization of cognitive defusion. Finally, the conceptual, clinical, and research implications of this new conceptualization are considered.
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... Before proceeding with our suggested RFT treatment of fusion/defusion it seems useful to consider a recent attempt to deconstruct the concept (fusion/defusion) in terms of processes of change 2 . In doing so, we will draw on the work of Assaz et al. (2018), but fully recognize that this constitutes only one of many different interpretations that may be offered in the literature. ...
... There are many defusion techniques or exercises in the ACT literature, but Assaz et al. (2018) argued that four different basic processes of change are involved in ACT-based exercises that are used to target fusion/defusion. Specifically, the authors argued that it was possible to categorize different defusion interventions according to each intervention's key process of change. ...
... We will now provide a brief summary of these proposed processes of change along with an example of a defusion intervention that is suggested to operate through each process. Assaz et al. (2018) first argue that it may be useful to conceptualise ACT-based exposure interventions as working through respondent extinction. Specifically, interventions of this nature typically involve a stimulus being contacted repeatedly until the eliciting 1 Functional analyses may simply involve identifying functional relations between or among two or more variables. ...
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Relational frame theory (RFT) has historically been considered the basic explanatory science behind acceptance and commitment therapy (ACT). However, some have argued that there has been an increasing separation between the two in recent years. The primary aim of the current article is to explore the extent to which RFT concepts, particularly those that have been proposed recently in the context of “up-dating” the theory, may be used to build stronger links between basic and applied behaviour analyses in which there is a shared language of relatively precise technical terms. As an example of this strategy, we outline RFT process-based experimental and conceptual analyses of the impact of one of the most widely used sets of interventions employed in the ACT literature, defusion. In addition, we suggest a potential experimental methodology for analysing the basic behavioural processes involved. Overall, the current article should be seen as part of a broader research agenda that aims to explore how RFT may be used to provide a functional-analytic abstractive treatment of the behavioural processes involved in human psychological suffering.
... Another advantage of ACT is that it is readily disseminated and administered in different formats (Assaz et al., 2018;Dindo et al., 2017). Cost-effective delivery of psychological interventions is vital in the context of restricted healthcare funding (Luchinskaya et al., 2017). ...
... Its therapeutic techniques do not aim primarily to alleviate psychological distress (Guadiano, 2011) but rather to enhance psychological flexibility to change the relationship between a person, their distress and the behaviours the distress engenders. This promotes the transdiagnostic nature of ACT by requiring less specificity for interventions than psychological approaches based on cognitive processes and reinforcement contingencies (Assaz et al., 2018). ...
... The emphasis of ACT on experiential learning enables it to be used successfully with generalised cognitive impairments in learning disability settings (Brown and Hooper, 2009). For example, the ACT process of defusion (distinguishing between thoughts and reality) does not require cognitive reframing of psychologically distressing thoughts in order to reduce negative responses to thoughts (Assaz et al., 2018) and has been shown to produce more rapid change than cognitive restructuring (Deacon et al., 2011). Cognitive factors may also underpin ACT's success with complex presentations, i.e. treatment-resistant populations (Clarke et al., 2014). ...
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Background: Psychological distress is common after stroke, and affects recovery. However, there are few evidence-based psychological treatments. This study evaluates a bibliotherapy-based approach to its amelioration. Aims: To investigate a stroke-specific self-management book, based on acceptance and commitment therapy (ACT), as a therapist-supported intervention for psychological distress after stroke. Method: The design was a single case, randomised non-concurrent multiple-baseline design (MBD). Sixteen stroke survivors, eight males and eight females (mean age 60.6 years), participated in an MBD with three phases: A (randomised-duration baseline); B (intervention); and follow-up (at 3 weeks). During the baseline, participants received therapist contact only. In the bibliotherapy intervention, participants received bi-weekly therapist support. The primary measures of psychological distress (General Health Questionaire-12; GHQ-12) and quality of life (Satisfaction with Life Scale; SWLS) were completed weekly. Secondary measures of mood, wellbeing and illness impact were completed pre- and post-intervention. Results: Omnibus whole-group TAU-U analysis was statistically significant for each primary measure with a moderate effect size on both (0.6 and 0.3 for GHQ-12 and SWLS, respectively). Individual TAU-U analyses demonstrated that the majority of individuals exhibited positive change. All the secondary measures showed significant pre-post improvements. Eighty-one per cent of participants reported the book was helpful and 81% also found the ACT-based sections helpful. Relative risk calculations showed finding the book helpful was associated with improvement in GHQ-12 and SWLS scores. Conclusions: ACT-based bibliotherapy, with therapist support, is a promising intervention for psychological difficulties after stroke.
... Porém, recentemente esses termos têm sido criticados, uma vez que são utilizados na literatura para se referir a fenômenos distintos, como estados, procedimentos e processos (McEnteggart et al., 2015). A fim de evitar confusões conceituais, esses termos serão utilizados para se referir a estados disposicionais (Assaz et al., 2018). Ou seja, padrões de interação entre o indivíduo e seu ambiente no qual, diante de certas condições ambientais, o indivíduo tende a reagir de determinado modo (cf. ...
... Em contrapartida ao Modelo de Inflexibilidade Psicológica, é proposto o Modelo de Flexibilidade Psicológica, composto por outros seis conceitos correspondentes: aceitação, desfusão cognitiva, atenção flexível ao momento presente, senso de self-como-contexto, valores e ação comprometida (Luoma et al., 2017 (Assaz et al., 2018). O elemento norteador de uma terapia ACT são os valores do cliente. ...
... Nesse sentido, para além das respostas de auto-observação e autodescrição, mencionadas acima, é favorecida a autovalidação. Estas são verbalizações que normalizam a própria experiência ao dar sentido e coerência a ela enquanto uma reação condizente com as contingências atuais, contingências históricas ou até princípios do comportamento humano de modo geral (Linehan, 1997 Do outro lado, busca-se reduzir a influência rígida de certos pensamentos sobre outras respostas do indivíduo, expandindo o controle de estímulos sobre o comportamento (Assaz et al., 2018). Isso não significa modificar o conteúdo pensado, pensar positivo ou algo similar, mas sim desenvolver a consciência de que obedecer a seus pensamentos (i. ...
... However, relying on middle-level terms uncritically may present significant challenges for the clinician who develops and implements treatment plans designed to target each of the six components of the Psychological Flexibility Model (McEnteggart et al., 2015;Muñoz-Martínez & Follette, 2019). More specifically, if the relationship between middle-level terms and basic behavioral principles which supposedly underpin them is not well-described, these concepts may lose utility or even efficacy in the therapeutic setting (Assaz et al., 2018;McEnteggart et al., 2015). First, the term could stray from the philosophical and theoretical foundation of behavior science, approaching the conceptual status of folk psychology. ...
... We would go further and suggest that it might be reasonable to question Villatte's assertion that clinicians or therapists know why using ACT-based interventions makes sense from an RFT perspective given that they rarely, if ever, refer to RFT principles or processes in practice. Furthermore, some authors have argued that the link between middle-level terms and basic behavioral process or RFT principles seems to be poorly elaborated in ACT, including the central component of cognitive defusion (Assaz et al., 2018;McEnteggart et al., 2015). ...
... In a corollary conceptual development, ACT also provided a therapeutic strategy known as cognitive defusion, which is intended to disrupt verbal processes that support the transformation of stimulus functions (Assaz et al., 2018;Blackledge, 2007). ...
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Cognitive defusion is among the main components of Acceptance and Commitment Therapy (ACT), a contextual behavioral approach to psychotherapy. Defusion serves as a middle-level term, and, as such, may be useful for applying and disseminating behavior science, despite its lower precision. However, some authors argue that for middle-level terms in psychotherapy to be useful to clinicians, they need to be clearly linked to basic behavioral concepts, with higher precision; and that this is not currently the case with defusion. Our objective is to increase the pragmatic utility of the concept of “cognitive defusion” by providing a more nuanced, multi-faceted and process-based definition of the term. In order to do this, we surveyed the ACT literature regarding defusion and critically examined it through the lens of conceptual analysis. This culminated in a revised and updated conceptualization of defusion in terms of its relationship to basic behavioral concepts, in which defusion is an outcome that may be achieved through different processes.
... On the meanwhile, it teaches people to create mental distance from unwanted experiences without getting trapped in them [19]. In response to the tendency of over-identifying with one's thoughts, amplifying them in the mind almost to the extent that it becomes 'the truth', ACT encourages people to 'defuse' themselves from maladaptive patterns of thinking through a process of learning to observe one's thoughts and feelings in a detached manner ( [20]; also see [9]). Defusion involves looking at thoughts and noticing them rather than identifying with-and becoming caught up with these thoughts. ...
... Cognitive defusion refers to the attempts to change the way one interacts with-or relates to thoughts by creating contexts in which their unhelpful functions are diminished [19,33,34]. 'Decentering" based cognitive defusion involves the ability to observe one's thoughts and feelings in a detached manner, as temporary events in the mind [9,10,20]. Moreover, it reflects the realization that thoughts, feelings, and reactions are transitory patterns of mental activity; they are not necessarily true representations of the self and events, and they are not actually happening [18,35]. ...
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The current study investigated experiential emotion regulation. Rooted in an experien-tial- and client-centered psychotherapeutic approach, experiential emotion regulation involves an active, non-intervening, accepting, open and welcoming approach towards the bodily felt affec-tive experience in a welcoming, compassionate way, expressed in ‘experiential awareness’ in a first phase, and its verbalization or ‘experiential expression’ in a second phase . Defusion refers to the ability to observe one's thoughts and feelings in a detached manner . Nineteen healthy par-ticipants completed an emotion regulation task during fMRI scanning by processing highly arousing negative events by images. Both experiential emotion regulation and cognitive de-fusion resulted in higher negative emotion compared to a ‘watch’ control condition. On the neurophysiological level, experiential emotion regulation recruited brain areas that regulate attention towards affective- and somatosensorial experience such as the anterior cingulate cortex, the paracingulate gyrus, the inferior frontal gyrus, and the prefrontal pole, areas underlying multisensory information integration (e.g., angular gyrus), and linking body states to emotion recognition and awareness (e.g., postcentral gyrus). Experiential emotion regulation, relative to the control condition, also resulted in a higher interaction between the anterior insular cortex and left amygdala while participants experienced less negative emotion. Cognitive defusion decreased activation in the subcortical areas such as the brainstem, the thalamus, the amygdala, and the hippocampus. In contrast to cognitive defusion, xperiential emotion regulation relative to demonstrated greater activation in the left angular gyrus, indicating more multisensory infor-mation integration. These findings provide insight into different and specific neural networks underlying psychotherapy-based experiential emotion regulation and cognitive defusion.
... These two variables could be considered analogous, as they differ only in the nuances of their conception and both constitute the result of a sequence of processes that are altered through mindfulness skills, whether these be dispositional or developed through therapeutic exercises. Assaz et al. (2018) propose that this type of mechanism could be analysed using a basic process approach in order explain the changes associated with the implementation of strategies that promote processes such as defusion. The changes are thought to occur because different mechanisms such as responsive extinction, counterconditioning, inhibitory learning, differential reinforcement, and the introduction of verbal cues work together to reduce the influence of verbal relations on other behaviours. ...
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Introduction: The scientific community is taking an increasing interest in mindfulness due to its positive association with physical and psychological health indicators. However, there is still ongoing debate as to whether there could be other explanations for these effects. Aim: This study explores the relationships between dispositional mindfulness, cognitive fusion, effortful control and repetitive negative thinking (RNT). RNT was chosen as a potential mediating variable due to its presence in multiple psychological disorders. Method: A mediation analysis was performed using the bootstrap method with 5000 replications on data collected from a non-clinical sample of 415 young adults who completed a battery of online questionnaires. Results: Dispositional mindfulness is negatively associated with measures of RNT, effortful control and cognitive fusion. The analyses indicate that the effect that dispositional mindfulness has on cognitive fusion in young people can be partially mediated with medium effect size by RNT. Conclusion: RNT may play a central role as an underlying process in the link between mindfulness and different psychological aspects.
Chapter
Support for acceptance and commitment therapy (ACT), mindfulness-based, and other third wave therapies to treat addiction is growing, with recent support for treating alcohol use disorders AUDs and additional data demonstrating efficacy for smoking cessation. Several third-wave interventions with AUDs or substance use disorders (SUDs) have also shown significant promise for treating comorbid psychiatric conditions (e.g., depression), and PTSD. However, more large-scale research with acceptance and mindfulness-based therapies is needed on substance use and relapse prevention outcomes, ideally with limited study attrition and treatment dropout, increased effect sizes, comparisons with first line treatments (including traditional CBT), and rigorous study designs (e.g., double blinded). Additionally, more research is needed on the cultural appropriateness of these therapies with diverse samples from substance use and other addictive behavior populations. The budding interest in and preliminary efficacy for acceptance and mindfulness therapies to treat a host of addictive disorders (e.g., internet and phone addictions) make them highly attractive to therapists, providing broad application and significant potential for improved outcomes.KeywordsThird wave therapiesThird wave behavior therapy for alcohol use and substance use disordersThird wave cognitive behavior therapyAcceptance and commitment therapyMindfulness-based interventionSubstance use disordersAlcohol use disordersAddictive disorders
Article
Objectives Acceptance and Commitment Therapy (ACT) targets psychological flexibility and the ability to identify behavioral function in context. Properly measuring these constructs is imperative to understanding whether these processes are mechanisms of change in treatment. The current study examined the factor structure of the Comprehensive Assessment of ACT processes (CompACT) and Tacting of Function scale (TOF) in community-dwelling older adults. Methods Factor structure was examined with CFA. Eighty community-dwelling older adults completed questionnaires prior to an intervention. Results While the original 23-item, 3-factor structure of the CompACT demonstrated inadequate fit, a modified 15-item, 3-factor structure demonstrated adequate fit. The original 1-factor structure of the TOF demonstrated inadequate fit. A modified 2-factor structure of the TOF fit significantly better than the original 1-factor structure; however, this model also demonstrated inadequate fit. Conclusions Examining the factor structure of the CompACT and TOF in an older adult sample contributes to the field’s understanding of the constructs of psychological flexibility and tacting ability and to the clinical utility of these measures in an understudied sample. Clinical Implications These findings provide preliminary support for the use of a short-form version of the CompACT to measure therapeutic processes of change in community-dwelling older adults.
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Parallels between the ancient Hellenistic philosophies of the Stoics and Epicureans, on the one hand, and modern cognitive psychotherapy, on the other, are well known and a topic of current discussion. The present article argues that there are also important parallels between Pyrrhonism, the third of the major Hellenistic philosophies, and the currently state-of-the-art "3rd wave" cognitive-behavioral therapies in general, and Acceptance and Commitment Therapy (act) in particular. This provides a crucial insight into Pyrrhonism: understanding Sextus' term adoxastos using the technical act term 'defusion' illuminates the psychological condition of the Pyrrhonist and explains why the apraxia objection against Pyrrhonism is misguided.
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Objective: The word repetition technique is used in acceptance and commitment therapy as a method of facilitating cognitive defusion from distressing thoughts. The present study conducted a randomised trial to manipulate the rate of word repetition and evaluate its impact on the efficacy of cognitive defusion. Method: Thirty-two participants repeated a self-chosen negative self-evaluative word for 30 seconds at the rates of one word per 0.5-, 1-, or 2-seconds. Visual analogue scales were used to measure the associated levels of believability and discomfort at pre- and immediately postrepetition, and 1 month later. Results: Both believability and discomfort were significantly reduced immediately after word repetition in the 0.5-seconds and 1-second conditions. There was a significantly greater reduction in Discomfort in the 1-second condition in comparison to the 2-second condition. The 1-second condition alone maintained significant reductions in both believability and discomfort at 1-month follow up. Conclusion: Differences in the cognitive defusion of distressing thoughts appear to be influenced by word repetition rate with repetition rates of one word per 0.5 and 1 seconds somewhat more effective for treating distressing private experiences associated with problem words.
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The current paper re-examines the concept of intelligence using Relational Frame Theory (RFT) and suggests a theoretical framework for the analysis of “intelligent” behaviors. We begin by introducing the practices of the standard measurement of intelligence, the intelligence quotient (IQ), and some key features of commonly used IQ tests. We outline a proposed framework, which we suggest provides a rationale for the construction of interventions to raise intelligence quotients as calculated by standardized IQ tests. Specifically, the current paper proposes that training skills in derived relational responding (DRR) by utilizing multiple exemplar training (MET) can accomplish this goal.
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A previous study by Roche and Barnes (1997) examined the transformation of conditioned sexual arousal in accordance with arbitrary relations. The current research replicated and extended that study by attempting to bring the derived transformation effect under contextual control. In Experiment 1, the functions of hand waving and clapping were first established for two nonsense syllables (called B1 and B2, respectively). Subjects were then exposed to relational pretraining, similar to that employed by Steele and Hayes (1991), in order to establish the contextual functions of Same and Opposite in two arbitrary stimuli. Subsequently, subjects were trained in the following relations; Same/A1-[B1-B2-N1], Same/A1-[C1-C2-N2] Opposite/A1-[B1-B2-N1], Opposite/A1-[C1-C2-N2] (underlined comparison stimuli indicate reinforced choices) from which the following relational responses emerged; Same/B1-C1; Same/B2-C2; Opposite/B1-C2; Opposite/B2-C1. During a testing phase, the stimulus functions established for B1 emerged for C1 in the presence of Same (i.e., the subjects waved) but those established for B2 emerged for C1 in the presence of Opposite (i.e., the subjects clapped). Similarly, the functions of B2 emerged for C2 in the presence of Same (i.e., the subjects clapped), but those established for B1 emerged for C2 in the presence of Opposite (i.e., the subjects waved). Experiment 2 established similar results using respondent eliciting functions in the place of hand clapping and waving.
Book
Since the original publication of this seminal work, acceptance and commitment therapy (ACT) has come into its own as a widely practiced approach to helping people change. This book provides the definitive statement of ACT—from conceptual and empirical foundations to clinical techniques—written by its originators. ACT is based on the idea that psychological rigidity is a root cause of a wide range of clinical problems. The authors describe effective, innovative ways to cultivate psychological flexibility by detecting and targeting six key processes: defusion, acceptance, attention to the present moment, self-awareness, values, and committed action. Sample therapeutic exercises and patient–therapist dialogues are integrated throughout. New to This Edition *Reflects tremendous advances in ACT clinical applications, theory building, and research. *Psychological flexibility is now the central organizing focus. *Expanded coverage of mindfulness, the therapeutic relationship, relational learning, and case formulation. *Restructured to be more clinician friendly and accessible; focuses on the moment-by-moment process of therapy.
Chapter
Laboratory based studies have long been a core aspect of psychological research. This chapter focuses on how these methodologies may be best used from a contextual behavioral science (CBS) perspective to help bridge basic research, applied theory, and interventions. It specifically focuses on the domains directly relevant to psychopathology and therapeutic interventions. To illustrate how these methods can help bridge levels of analysis, the chapter discusses research conducted in the field of relational frame theory. Research is needed to elaborate on and test theoretical suppositions about how basic principles might contribute to psychopathology. The chapter describes some of the important ways laboratory-based intervention research adds to a program of research seeking to bridge treatment, middle-level theory, and basic principles. As there has been more research on laboratory-based intervention studies than research bridging basic and applied theory, the chapter also reviews its limitations.
Chapter
This chapter provides an overview of the approach to behavior science, contextual behavioral science (CBS). To adequately test the scope and depth of the theoretical model and basic principles it is important to examine whether they apply across a broad range of behaviors that are hypothesized to share similar functions, and across levels of analysis. Consistent with a functional contextual approach to science, environmental variables are considered central to any analysis of behavior. CBS puts theory at the forefront of research questions, rather than just testing the efficacy of intervention packages. It considers a scientific analysis correct only if it helps to meet scientific goals, and focuses on variables that can be manipulated. In these ways, CBS offers one potential answer for how to develop a progressive approach to behavioral science that might better meet the challenges faced by society and opportunities for further growth.
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This study investigated the role of generalization in the transfer of consequential functions through stimulus equivalence classes. In Phase 1, 12 subjects were trained in AB, AC conditional discriminations and tested for the emergence of three 3-member equivalence classes. In Phase 2, reinforcement and punishment functions were trained to B1 and B3, respectively. In Phase 3, the B functions were tested in a matching-to-sample task, and then the transfer of function from the Bs to the Cs was tested in a letter-choice task. Seven subjects showed generalization from matching-to-sample to the letter-choice task and transfer of function in Phase 3. A series of tests in Phase 4 assessed whether generalization was involved in the failure of transfer of function for the remaining five subjects. For 4 of these subjects, when generalization of the B functions was brought about, transfer of function also occurred. The remaining subject showed generalization but not transfer of function. These results suggest that transfer of function in stimulus equivalence is contextually controlled and interacts with basic processes such as generalization in predictable ways.
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This study is a step forward in the difficult task of analyzing the transformation of functions via hierarchical relations. Eight participants underwent a computer task with five phases. During Phase 1, four stimuli were trained to become the following relational cues: INCLUDES, BELONGS TO, SAME, and DIFFERENT. In Phase 2, three equivalence classes were trained and tested (A1-B1-C1-D1; A2-B2-C2-D2; A3-B3-C3-D3). During Phase 3, inclusion relations were first established, by using the INCLUDES and BELONGS TO relational cues, between the to-be lower levels of the hierarchy, namely A1/B1, A2/B2, and A3/B3; and stimuli X.1, X.2, and Y.1, respectively. Then, the INCLUDES relational cue was used to establish inclusion relations between X.1/X.2 and X, and between Y.1 and Y, so that X and Y would become the most inclusive levels of two separate hierarchical networks. In Phase 4, X.1 was established as cold, D2 as heavy, and C3 as sweet. Lastly, in Phase 5 (Critical Test), seven stimuli from both hierarchical networks were tested for the transformation of functions. Five of the six participants who made it to this test responded correctly. Implications, limitations, and further research are discussed.