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Employing Acceptance and Commitment Therapy as Individual Therapy for Couple Problems: A Case Study for Women with Marital Strife

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Background Time perspective (TP) influences how individuals perceive and classify their past, present, and future, impacting their cognition, behavior, and psychological outcomes. Deviation from the balanced time perspective (DBTP) is associated with mental health problems (e.g., depression and anxiety). Emotion regulation (ER) encompasses cognitive and behavioral processes to regulate emotions, with maladaptive strategies like rumination and withdrawal linked to depression and anxiety. Despite extensive research on TP and ER, their joint impact, particularly in the context of depression and anxiety, and cultural differences remain underexplored. Method Participants ( N = 513 Iranian, N = 470 Turkish) completed self-report questionnaires on time perspective, cognitive and behavioral ER, anxiety, and depression symptoms. A moderated mediation model was assessed, incorporating the exogenous variable of DBTP, with ER strategies as mediators, and endogenous variables of depressive and anxiety symptoms. The model accounted for cultural variations in the paths as a moderator. Results Significant associations were found between DBTP, ER strategies, depression, and anxiety symptoms. Mediation analyses revealed that both cognitive and behavioral ER strategies (except for adaptive behavioral ER strategies) significantly mediated the associations between DBTP and depression and anxiety. Additionally, multigroup analyses suggested that these mediating effects were consistent across Iranian and Turkish samples, with exceptions in adaptive cognitive ER strategies. Conclusion The study highlights the crucial role of TPs and ER strategies in predicting anxiety and depression symptoms, with notable cultural nuances. Specifically, maladaptive strategies exacerbate symptoms, while adaptive strategies mitigate them primarily in Iranian contexts. Cultural subtleties are discussed in detail.
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Background Studies have shown that psychological factors, notably interpersonal needs and emotion regulation, play a significant role in suicidal behavior. Interpersonal needs are significant contextual components that affect emotion regulation and contribute to a wide range of dysfunctional behaviors, such as suicidal behavior. It has been postulated that emotion regulation mediates the associations between proximal and distal risk factors of suicidal behavior. Method The sample consisted of 340 community-dwelling individuals (62.5% women; SD = 0.48) with an age range of 18 through 55 (M = 30.23; SD = 8.54) who completed the interpersonal needs questionnaire, the suicide behaviors questionnaire-revised, and the cognitive emotion regulation questionnaire. The Structural Equation Modeling (SEM) approach was utilized to evaluate a mediation model. Results The findings indicate that interpersonal needs (i.e., perceived burdensomeness r = .55, p <.01 and thwarted belongingness r = .25, p <.01) and putatively maladaptive cognitive emotion regulation strategies (i.e., self-blame; r = .38, p <.01, catastrophizing; r = .55, p <.01, rumination; r = .40, p <.01, and other blame; r = .44, p <.01) have strong associations with suicidal behavior, and these strategies have a mediating effect on the association between interpersonal needs and suicidal behavior. Conclusions Our findings show that contextual-interpersonal needs, which underpin suicidal behavior, are significantly influenced by maladaptive emotional processes. Thus, therapeutic outcomes might be enhanced by focusing on the content of the associated cognitions and trying to reduce maladaptive regulatory processes like rumination and catastrophization.
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Objectives Infertility is a prominent problem affecting millions of couples worldwide. Recently, there has been a hightened emphasis on elucidating the subtle linkages between infertility treatment leveraging assisted reproductive technology and the complex realm of psychological challenges, as well as efforts in implementation of psychological interventions.The Mindful Self-Compassion (MSC) program seeks to improve self-compassion, compassion for others, mindfulness, and life satisfaction while reducing depression, anxiety, and stress. In the current study, an MSC intervention was performed on infertile women (IW) undergoing in vitro fertilization (IVF) to assess the effectiveness of this intervention in reducing psychological distress and psychopathological symptoms and enhancing life expectancy. Methods Fifty-seven IW undergoing IVF were randomly allocated to two groups: MSC (n = 29) or treatment as usual (TAU; n = 28). Participants in MSC met once a week for two hours for eight weeks and attended a half-day meditation retreat. The Synder's Hope questionnaire and the Revised 90-Symptom Checklist (SCL-90-R) were used as the primary outcome measures. Data were obtained before the intervention, immediately after the intervention, and two months post-intervention. Repeated measures of ANCOVA and paired t-tests in all assessment points were used to compare the MSC and the TAU groups in outcomes. Results In the MSC group, hopelessness, anger-hostility, anxiety, interpersonal sensitivity difficulties, and depression were significantly reduced compared with the TAU group, and those improvements persisted at the two-month follow-up. Reliable change index revealed that the MSC group's gains were both clinically significant and durable. Conclusions MSC can facilitate higher life satisfaction and mental well-being for IW undergoing IVF by reducing psychological distress, psychopathological symptoms, and hopelessness. These encouraging findings call for more research into the effectiveness of mindfulness-based therapies in addressing psychological problems among IW undergoing IVF.
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Substance use disorders (SUDs) are chronic conditions influenced by various societal, psychological, and physiological factors that considerably impact their course, maintenance, and recovery. Drug craving, as a proximal risk factor, can precipitate relapse and perpetuate substance use. Psychological distress (PD) and difficulties in emotion regulation (DER) are significant distal risk factors that may facilitate craving and subsequent relapse. This study aimed to examine the relationship between DER and craving in patients with SUDs and the extent to which psychological distress mediates this relationship. The Difficulty in Emotion Regulation Scale (DERS-16), the Temptations to Use Drugs Scale (TUD), and the Depression, Anxiety, and Stress Scale (DASS-21) were used. According to the findings, the total DASS-21 scores acted as a mediator between DER and craving. This association was also mediated by the DASS-21 stress and depression subscales. However, anxiety had no significant role in mediating this relationship. Since DER increases the likelihood of craving in patients with SUD, our results underline the significance of providing them with constructive emotion regulation skills. Furthermore, findings suggest that patients with SUD crave drugs to decrease DER-related depression and stress; hence, tailoring therapeutic approaches to address their psychological triggers of craving is critical.
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The study of Time has a long history, dating back to the earliest days of psychological science in the late 1800s. However, the conceptualization of time perspective has led to a better understanding of individuals' healthy and pathological attitudes toward time dimensions. Similarly, articulated psychological inflexibility components (i.e., Experiential Avoidance (EA) and Cognitive Fusion (CF)) have been found to have solid links with psychopathology, specifically psychological distress. The purpose of this study was to examine the serial mediating functions of EA and CF in the association between Deviation from Balanced Time Perspective (DBTP) and Depression and Anxiety symptoms. Also, a reversed model of serial mediation was tested. A total of 203 participants (155 female) aged between 17–73 (M = 28.45, SD = 11.43) completed measures of time perspective, CF, EA, anxiety, and depression. CF and EA functioned as mediators between DBTP and depression/anxiety in the first mediation model. However, in the reversed model, only the mediation effect for depression was observed. These results emphasize the need for tailoring treatments to the requirements of patients struggling with anxiety and depression symptoms, who may be more susceptible to imbalanced time perspectives and time-entrapped cognitive processes.
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Experiential avoidance and cognitive fusion are two transdiagnostic constructs underpinning psychological distress. This study aimed to explore the moderating role of experiential avoidance on the association between cognitive fusion and psychological distress. The sample consisted of 297 college students who were randomly selected by cluster sampling method. Participants completed the Cognitive Fusion Questionnaire, Acceptance and Action Questionnaire, and the Inventory of Depression and Anxiety Symptoms. It was found that experiential avoidance and cognitive fusion accounted for a significant amount of variance in depression (R² = .51). Furthermore, experiential avoidance moderated the relationship between cognitive fusion and depression; follow-up analysis showed that experiential avoidance had a buffering effect of cognitive fusion on depression. With regard to anxiety, findings showed experiential avoidance and cognitive fusion accounted for a significant amount of variance in anxiety symptoms (R² = .42), but the interaction between experiential avoidance and cognitive fusion was not significant. The findings suggest that experiential avoidance may play a moderating role with regard to the relation of cognitive fusion and depression, but not anxiety.
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The ability to engage flexibly with thoughts and behavior in line with the demands of a situation-termed psychological flexibility-has been linked to individual well-being. This registered report presents two studies that investigate the links between psychological flexibility, individual well-being, and relationship quality. Using structural equation modeling, Study 1 found that people who were more psychologically flexible reported higher levels of positive affect and lower levels of negative affect, which in turn were associated with higher relationship quality. Using dyadic mediation analysis, Study 2 repli-cated and extended these findings in a sample of 200 romantic couples, revealing both actor and partner effects. This research offers insight into the implications of psychological flexibility for relationship functioning. K E Y W O R D S Actor-Partner Interdependence Model, affect, psychological flexibility, relationship quality, structural equation modeling Study
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The efficacy of Acceptance and Commitment Therapy (ACT) has been evaluated in many randomized controlled trials investigating a broad range of target conditions. This paper reviews the meta-analytic evidence on ACT. The 20 included meta-analyses reported 100 controlled effect sizes across n = 12,477 participants. Controlled effect sizes were grouped by target conditions and comparison group. Results showed that ACT is efficacious for all conditions examined, including anxiety, depression, substance use, pain, and transdiagnostic groups. Results also showed that ACT was generally superior to inactive controls (e.g. waitlist, placebo), treatment as usual, and most active intervention conditions (excluding CBT). Weaknesses and areas for future development are discussed.
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A growing body of research supports the importance of ACT's therapeutic targets (i.e., dimensions of psychological flexibility and inflexibility) for promoting individual wellbeing. The current systematic review and meta-analysis extended that work by examining how specific dimensions of psychological flexibility and inflexibility are linked to family and romantic relationship functioning. Drawing from the ACT, mindfulness, and emotion regulation literatures, 5006 records were initially identified via PsychInfo, Web of Science, and Google Scholar searches, resulting in a final set of 174 papers representing 203 distinct samples (95 romantic relationship samples, 101 family samples, and 7 samples evaluating both romantic relationship and family functioning), yielding a combined sample of 43,952 total subjects. Although the review was unable to identify sufficient numbers of studies to meta-analyze the relationship and family correlates of a subset of flexibility dimensions (contact with values, committed action, experiential avoidance, fusion, lack of contact with values, inaction), the review identified sufficient studies to meta-analyze the correlates of: acceptance, present moment awareness/mindfulness, cognitive defusion, self-as-context, global flexibility, lack of present moment awareness, self-as-content, and global inflexibility. Correspondingly, a total of 840 effects were extracted from the original studies, ultimately yielding 137 meta-analytic effects (using random effects models) that show a range of effect sizes (−0.51 to 0.61). Within families, higher levels of various forms of parental flexibility were linked to: (1) greater use of adaptive parenting strategies, (2) lower use of lax, (3) harsh, and (4) negative parenting strategies, (5) lower parenting stress/burden, (6) greater corresponding family cohesion, and (7) lower child internalizing and (8) externalizing symptoms. Within romantic relationships, higher levels of various forms of psychological inflexibility were linked to: (1) lower relationship satisfaction for themselves and (2) their partners, (3) lower sexual satisfaction and (4) emotional supportiveness, as well as (5) higher negative conflict, (6) physical aggression, (7) attachment anxiety, and (8) attachment avoidance. Taken as a set, these results suggest that psychological flexibility and inflexibility may play key roles both in couples and families to shape how individuals interact with the people closest to them.
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Abstract: Background and Objectives: Marriage is the start point in the family formation and it has been approved as the highest social practice to achieve emotional and security needs for adults. Although satisfactory marriage is an important factor in mental health but poor and unsatisfactory marriages can lead to unhappy couples which has negative and irreversible effects on both wives and husbands. The aim of this study was to evaluate the efficacy of the treatment based on Acceptance and Commitment (ACT) on marital satisfaction among couples who were married. Methods: A quasi-experimental pretest-posttest study design was used to conduct this study. The population consisted of all students of Islamic Azad University of Bandar Abbas who were married, during 2015 and 2016. Based on acceptance and commitment therapy protocol a 12-session intervention was conducted over a period of 3 months. Enrich marital satisfaction assessment questionnaire was used to collect data. The subjects responded to questionnaires before intervention and 1 month after intervention. Descriptive statistics and ANOVA using were used for data analysis in SPSS V.20. Results: The results of the analysis showed that the average post-test scores of between two groups in the components of marital satisfaction including sexual satisfaction (experimental, 24.45; control, 19.83), communications (experimental, 22.10; control, 19.81), solving conflict (experimental, 20.35; control, 17.15) and idealistic distortion (experimental, 16.65; control, 14.55) which the difference was statistically significant (p Conclusion: Based on the positive effect of acceptance and commitment therapy on marital satisfaction of the couples, this method is recommended to be used alongside other interventions for improving marital satisfaction of couples. Keywords: Acceptance , Commitment Therapy , Marital Satisfaction , Conflict Resolution , Communication , Ideal Distortion
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This work aims to integrate previous research perspectives on terminal well-being decline and partner bereavement by investigating the codevelopment of life satisfaction in the years preceding the death of one partner. We analyzed longitudinal data from the German Socio-Economic Panel Study (N = 1,450 couples) and applied dyadic multilevel models to estimate both partners' trajectories of life satisfaction and to reveal the pathways of well-being transmission in couple members approaching [partner] death. Findings were compared with a propensity-score-matched control sample of couples in which neither partner died during the study. We found that to-be-deceased and to-be-bereaved partners experienced increasing disparities in their trajectories of life satisfaction in the years before [partner] death: Although both partners exhibited significant and accelerated declines in life satisfaction, these declines were more pronounced in to-be-deceased individuals. In the control sample, we also identified significant and accelerated declines in life satisfaction but these declines were less intense and they did not differ between partners. Regarding between-partner correlations, we observed that couples approaching [partner] death experienced weaker interdependencies in their declines of life satisfaction. Finally, and concerning the pathways of well-being transmission, we found that life satisfaction was significantly transmitted between partners and the strength of this effect did not differ between the samples. These findings suggest that the years before [partner] death are characterized by distinctive patterns of change and interdependence in life satisfaction. Future studies may explore the sources of increasing between-partner disparities in life satisfaction in an end-of-life relationship context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Background: The need for effective interventions to improve mental health and emotional well-being at a population level are gaining prominence both in the United Kingdom and globally. Advances in technology and widespread adoption of Internet capable devices have facilitated rapid development of Web-delivered psychological therapies. Interventions designed to manage a range of affective disorders by applying diverse therapeutic approaches are widely available. Objective: The main aim of this review was to evaluate the evidence base of acceptance and commitment therapy (ACT) in a Web-based delivery format. Method: A systematic review of the literature and meta-analysis was conducted. Two electronic databases were searched for Web-delivered interventions utilizing ACT for the management of affective disorders or well-being. Only Randomized Controlled Trials (RCTs) were included. Results: The search strategy identified 59 articles. Of these, 10 articles met the inclusion criteria specified. The range of conditions and outcome measures that were identified limited the ability to draw firm conclusions about the efficacy of Web-delivered ACT-based intervention for anxiety or well-being. Conclusions: ACT in a Web-based delivery format was found to be effective in the management of depression. Rates of adherence to study protocols and completion were high overall suggesting that this therapeutic approach is highly acceptable for patients and the general public.
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Introduction: Schizophrenia and psychotic disorders are chronic conditions. Although antipsychotic medicationsare the first line of treatment, many patients continued to have symptoms. Acceptance and Commitment Therapy(ACT) is a therapy that applies mindfulness to teach patients accepting the existence of symptoms rather than avoidthem. A meta-analysis was conducted to measure the efficacy of ACT in treatment of psychosis.Methods: A systematic review search was conducted using the following keywords: "acceptance andcommitment therapy", "randomized", "clinical trials", "psychosis"," schizophrenia", and "major depressive disorderAND psychosis". All studies were read by two authors and checked for eligibility. Studies were included if randomlyallocate to ACT or usual treatment (TAU), and psychosis as diagnosis. Mantel and Haenszel approach was used todetermine the heterogeneity in the study. For quantitative outcomes, standardized mean difference between ACTand TAU was used to summarize effect size, while relative risk was used for categorical outcomes along with 95%confidence interval.Results: 217 studies were identified. 92 studies were selected for review after removing the duplications. Atotal of 4 studies were included in quantitative-synthesis. The mean age for the participants was 38 years of age.Regarding treatment outcomes, there was a significant difference between the two arms in the degree of change ofnegative symptoms (p=0.008), but the difference was not significant for positive symptoms. There was a reduction ofre-hospitalization rate at 4 months in ACT compared to TAU in participants with psychosis.Conclusions: ACT is a promising adjunctive therapy for patient with psychosis.
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Purpose - This study examined the impact of educational differences between married women and men on marital quality at the intersections of gender, race, and class. Methodology/approach - Guided by an intersectional perspective we analyzed data for 4,835 black and white married couples from the National Survey of Families and Households (NSFH; 1987-1988). Dyadic multigroup models were estimated using structural equation modeling to examine how status differences affected four latent dimensions of marital quality: happiness, stability, perceived fairness, and disagreement. Findings - Our findings highlight how multiple dimensions of marital quality vary according to intersections of gender, race, and class, and reveal how these intersections moderate the impact of status on marital quality. Research limitations/implications - To our knowledge, the NSFH is the most up-to-date, nationally representative dataset available with couplelevel data; however, the data were collected in the late 1980s and are insufficient for extending our analysis to other race-ethnic groups. Our findings demonstrate a strong need for more comprehensive contemporary data collection that has adequate numbers of respondents/couples at the intersections of gender, race, and class to facilitate further quantitative studies using an intersectional perspective. Originality/value - Our study is innovative in using education, an arena where women are currently outpacing men, as an indicator of status, and in embracing an intersectional perspective. By doing so we advance literature on status discrepant marriages, and contribute to the fields of gender and family studies which seek to understand how the changing roles of women may be affecting marital quality.
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In the past decade, multiple studies have examined the effectiveness of Acceptance and Commitment Therapy (ACT) for substance use disorders relative to other active treatments. The current meta-analysis examined the aggregate effect size when comparing ACT to other treatments (e.g., CBT, pharmacotherapy, 12-step, treatment as usual) specifically on substance use outcomes. A total of 10 randomized controlled trials were identified through systematic searches. A significant small to medium effect size was found favoring ACT relative to active treatment comparisons following treatment. Effect sizes were comparable across studies for smoking cessation (k=5) and for other drug use disorders (k=5). Based on these findings, ACT appears to be a promising intervention for substance use disorders. Limitations and future directions are discussed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Objective: Underutilization of needed mental health services continues to be the major mental health disparity affecting Asian Americans (Sue, Cheng, Saad, & Chu, 2012). The goal of this study was to apply a social psychological theoretical framework—the health belief model (Rosenstock, 1966)—to understand potential reasons why Asian Americans underutilize mental health services relative to White Americans. Method: Using a cross-sectional online questionnaire, this study examined how perceived severity of symptoms, perceived susceptibility to mental health problems, perceived benefits of treatment, and perceived barriers to treatment influenced intentions to seek help among a sample of 395 Asian American and 261 White American students experiencing elevated levels of psychological distress. Results: Analyses using structural equation modeling indicated that Asian Americans in distress had relatively lower intentions to seek help compared with White Americans. Perceived benefits partially accounted for differences in help-seeking intentions. Although Asian Americans perceived greater barriers to help seeking than did White Americans, this did not significantly explain racial/ethnic differences in help-seeking intentions. Perceived severity and barriers were related to help-seeking intentions in both groups. Conclusions: Outreach efforts that particularly emphasize the benefits of seeking mental health services may be a particularly promising approach to address underutilization. The findings have implications in help-seeking promotion and outreach.
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The aim of this article is to provide readers who have not yet undertaken n-of-1 or within-subject experimental studies with a general overview of the methodology from a health psychology perspective and to provide some tools to give readers the opportunity to give it a go themselves.
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Although there is substantial evidence linking marital quality to physical health, few studies have been longitudinal. This study examined data from the Marital Instability Over the Life Course Study; 1,681 married individuals followed for 20 years were included in these analyses. In order to control for life course effects, participants were divided into 2 cohorts: early life and midlife. On the basis of latent growth curve analysis, the results indicated that initial values of marital happiness and marital problems were significantly associated with the initial value of physical health among both cohorts. In addition, the slope of marital happiness was significantly associated with the slope of physical health among the younger cohort, and the slope of marital problems was significantly associated with the slope of physical health among the midlife cohort. These results provide evidence of the significant association between positive and negative dimensions of marital quality and physical health over the life course.
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Single-case design (SCD) research is an experimental approach for analysis of an effect between an independent variable and dependent variable. Traditionally, analysis of effect for SCD has relied on visual analysis, an approach whereby a trained observer analyzes a visual display of the data. Recent advances in statistical approaches have been forwarded for SCD research in the literature to assist in the interpretation of intervention effects. This review outlines the logic of SCD and describes the varied approaches for the analysis of effect in SCD research.
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Introduction: Available treatments for hot flashes in patients with breast cancer are not always tolerable or effective for all patients. Methods: Patients diagnosed to have primary breast cancer were randomly allocated to receive 10 mg of escitalopram, placebo, or progressive muscle relaxation therapy. Patients were asked to report the frequency and duration of hot flashes during day and night, at baseline and after ten weeks of treatment, and completed the menopause rating scale. Results: Eighty-two patients were randomly assigned to receive escitalopram (n = 26), PMRT (n = 28), and placebo (n = 28). PMRT and escitalopram could effectively decrease number and duration of diurnal and nocturnal HFs in patients with breast cancer, with a better effect observed from escitalopram. They could both decrease the total score of MRS. Conclusion: Both escitalopram ad PMRT can reveal nocturnal and diurnal HFs in terms of frequency and duration in patients with breast cancer.
Book
Originally published in 1992, the editors of this volume fulfill three main goals: to take stock of progress in the development of data-analysis procedures for single-subject research; to clearly explain errors of application and consider them within the context of new theoretical and empirical information of the time; and to closely examine new developments in the analysis of data from single-subject or small n experiments. To meet these goals, this book provides examples of applicable single-subject research data analysis. It presents a wide variety of topics and perspectives and hopes that readers will select the data-analysis strategies that best reflect their methodological approaches, statistical sophistication, and philosophical beliefs. These strategies include visual analysis, nonparametric tests, time-series experiments, applications of statistical procedures for multiple behaviors, applications of meta-analysis in single-subject research, and discussions of issues related to the application and misapplication of selected techniques.
Article
Third-wave behavioural interventions are increasingly popular for treating and preventing mental health conditions. Recently, researchers have begun testing whether these interventions can effectively targeting eating disorder risk factors (disordered eating, body image concerns). This meta-analysis examined whether third-wave behavioural interventions (acceptance and commitment therapy; dialectical behaviour therapy; mindfulness-based interventions; compassion-focused therapy) show potential for being effective eating disorder prevention programs, by testing their effects on eating disorder risk factors in samples without an eating disorder. Twenty-four studies (13 randomized trials) were included. Most studies delivered selective prevention programs (i.e. participants who reported elevated risk factor). Third-wave interventions led to significant pre–post (g = 0.59; 95% CI = 0.43, 0.75) and follow-up (g = 0.83; 95% CI = 0.38, 1.28) improvements in disordered eating, and significant pre–post improvements in body image (g = 0.35; 95% CI = 0.13, 0.56). DBT-based interventions were associated with the largest effects. Third-wave interventions were also significantly more efficacious than wait-lists (g = 0.39; 95% CI = 0.09, 0.69) in reducing disordered eating, but did not differ to other interventions (g = 0.25; 95% CI = –0.06, 0.57). Preliminary evidence suggests that third-wave interventions may have a beneficial effect in ameliorating eating disorder risk.
Article
Purpose Work-related stress amongst staff working in direct care roles in mental health and intellectual disability settings is associated with a range of problematic outcomes. There has been a proliferation of research into the use of acceptance and commitment therapy (ACT)-based interventions in this staff population. The purpose of this paper is to review the extant literature. Design/methodology/approach A systematic search of the literature was conducted, and seven studies identified which met the criteria for inclusion in the review, of which four were eligible for meta-analysis. Findings Results of the meta-analysis were most convincing for the effectiveness of ACT-interventions to reduce psychological distress within a subgroup of those with higher distress at baseline. There was no statistically significant effect for the amelioration of burnout, nor for an increase in psychological flexibility (a key ACT construct). Research limitations/implications Conceptual issues are considered including the purpose and treatment targets of ACT interventions, such as supporting valued living rather than diminishing stress per se . Methodological issues are discussed around the measurement of psychological flexibility. Originality/value This review makes recommendations for future research and for the implementation of ACT-interventions for work-related stress in these settings.
Chapter
Acceptance and commitment therapy (ACT) is one of several new cognitive and behaviour therapies that are now being referred to as the ?third wave? of behaviour therapy. It seeks to promote acceptance of unwanted private experiences through the application of various mindfulness strategies. This chapter tries to show the application of ACT treatment to the case of Gail, a 48-year-old woman with a long history of repeated episodes of depression. First, it introduces a case conceptualization framework that helps to ?describe? Gail's strengths and weaknesses from an ACT perspective. The chapter then demonstrates various ACT interventions suggested by the case conceptualization process. It also describes how an ACT therapist would adjust course on the basis of Gail's response (or lack of response) to an ACT clinical intervention. Finally, the chapter explains that there are obviously many nuances in the application of ACT that cannot be properly addressed.
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.
Article
Social role theory What causes sex differences and similarities in behavior? At the core of our account are societal stereotypes about gender. These stereotypes, or gender role beliefs, form as people observe male and female behavior and infer that the sexes possess corresponding dispositions. For example, in industrialized societies, women are more likely to fill caretaking roles in employment and at home. People make the correspondent inference that women are communal, caring individuals. The origins of men's and women's social roles lie primarily in humans' evolved physical sex differences, specifically men's size and strength and women's reproductive activities of gestating and nursing children, which interact with a society's circumstances and culture to make certain activities more efficiently performed by one sex or the other. People carry out gender roles as they enact specific social roles (e.g., parent, employee). Socialization facilitates these sex-typical role performances by enabling men and women to ...
Article
Life satisfaction (LS) is closely linked to romantic relationships. However, we lack knowledge on the nature of the longitudinal associations between LS and relationship quality, as well as on the longitudinal associations between two partners’ LS—especially for persons in long-term relationships. Better understanding of such associations could possibly add to the existing knowledge on how to increase LS. The current study used data from 239 heterosexual couples to examine longitudinal associations between relationship quality and LS over a 3-year period. Associations between one partner’s baseline LS and change in the other partner’s LS from baseline to 3-year follow-up were also examined. Relationship quality predicted change in LS, and LS predicted change in relationship quality. The results also showed that one partner’s LS predicted change in the other partner’s LS over a 3-year period, even when controlling for both partners’ baseline evaluation of relationship quality. The results suggest that a partner’s general LS can increase both the couple’s relationship quality and the other partner’s LS over time. Further, the results also suggest that relationship quality can contribute to positive change of both partners’ LS.
Article
Structural Equation Modeling techniques were used to clarify the relationship between marital characteristics, marital processes, and the dependent variable—marital satisfaction—in a sample of 201 participants who were in 1st marriages. The Dyadic Adjustment Scale (DAS; G. B. Spanier, 1976) and the Enriching and Nurturing Relationship Issues, Communication and Happiness Inventory (ENRICH; D. H. Olson, D. G. Fournier, & J. M. Druckman, 1987) provided scales to measure marital interaction processes and marital satisfaction. A new instrument, the Characteristics of Marriage Inventory (CHARISMA; J. R. Rosen‐Grandon & J. E. Myers, 2001), was developed using factor analysis to determine which marital characteristics were statistically significant. Structural equation modeling identified a path model wherein 6 marital interaction processes had a statistically significant influence on marital satisfaction when mediated by 3 latent factors of marital characteristics (love, loyalty, and shared values) and 2 moderating variables (length of marriage and gender of participant).
Article
A fair amount of research exists on acceptance and commitment therapy (ACT) as a model and a treatment for anxiety disorders and OCD spectrum disorders; this paper offers a quantitative account of this research. A meta-analysis is presented examining the relationship between psychological flexibility, measured by versions of the Acceptance and Action Questionnaire (AAQ & AAQ-II) and measures of anxiety. Meta-analytic results showed positive and significant relationships between the AAQ and general measures of anxiety as well as disorder specific measures. Additionally, all outcome data to date on ACT for anxiety and OCD spectrum disorders is reviewed, as are data on mediation and moderation within ACT. Preliminary meta-analytic results show that ACT is equally effective as manualized treatments such as cognitive behavioral therapy. Future directions and limitations of the research are discussed.
Article
Despite the demonstrated efficacy of conjoint couple therapy, many clients seeking help for couple problems ultimately find themselves in individual therapy for these concerns. Individual therapy for couple problems (ITCP) may evolve from a partner's refusal of conjoint therapy or from the treatment format preferences of either the client or therapist. Having acknowledged the role of partner refusals, we offer some perspectives about the idiosyncratic personal factors and professional background factors that may lead therapists to provide ITCP and discuss the significant pitfalls in its practice. We emphasize five central areas of concern in the ongoing practice of ITCP: structural constraints on change; therapist side-taking and the therapeutic alliance; inaccurate assessments based on individual client reports; therapeutic focus; and ethical issues relevant to both attending and nonattending partners. We conclude by urging that this very important but largely neglected topic be paid greater attention in psychotherapy research, training and continuing education.
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Attention is called to disturbing developments in insurance reimbursement that threaten the practice of therapy involving more than one person. This can be seen as part of the movement to marginalize psychotherapy as first-line treatment and replace it with the inappropriate and excessive (and often exclusive) use of medication.
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The present article summarizes the assumptions, model, techniques, evidence, and diversity/social justice commitments of Acceptance and Commitment Therapy (ACT). ACT focused on six processes (acceptance, defusion, self, now, values, and action) that bear on a single overall target (psychological flexibility). The ACT model of behavior change has been shown to have positive outcomes across a broad range of applied problems and areas of growth. Process and outcome evidence suggest that the psychological flexibility model underlying ACT provides a unified model of behavior change and personal development that fits well with the core assumptions of counseling psychology.
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Longitudinal studies often conclude that marital happiness declines over time. The present study examined marital happiness trajectories over the first 16 years of marriage and implications of trajectories for divorce. Participants included 373 (174 White, 199 Black) couples who first participated in 1986 and were re-interviewed years 2, 3, 4, 7, and 16. Analyses revealed that husbands and wives fit into distinct marital happiness trajectory groups characterized with either high stable marital happiness over time or moderate to low happiness that declined over time. Trajectories significantly predicted divorce. Findings support the enduring dynamics and gradual disillusionment models of marital development.
Article
This article describes the need for systematic methods for summarizing single-participant research, describes various approaches for quantitative synthesis, and reviews conclusions of completed synthesis efforts. There is general, but not universal, agreement for the need for systematic literature-review procedures. Areas of disagreement center around the issue of whether outcomes of single-participant research studies can be represented by a single common metric and, if so, which metric is the most useful. Although several alternatives are reviewed, we recommend the use of the percentage of nonoverlapping data metric, and we describe several instances in which it has been employed effectively.
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Die Interpersonelle Psychotherapie (IPT) wurde von verschiedenen Autoren als frauenspezifisches Verfahren bezeichnet. Ob Frauen mehr von einer Behandlung mit IPT profitieren als Männer ist bislang unklar. 124 stationäre Patienten mit einer Major Depression wurden 5 Wochen lang entweder mit IPT oder mit Clinical Management jeweils in Kombination mit einer Pharmakotherapie behandelt. Zu Behandlungsbeginn waren bei Frauen Rollenwechsel innerhalb der Familie (z. B. durch Mutterschaft) signifikant häufiger als depressionsrelevanter Problemfokus vertreten, während es bei Männern überwiegend berufliche Veränderungen waren. Weiterhin gab es Unterschiede bezüglich des komorbiden Alkoholmissbrauchs und der interpersonellen Probleme zuungunsten von den Männern. Auf die stationäre Depressionsbehandlung sprachen Männer unabhängig von der Behandlungsform schneller an. Entgegen der verbreiteten Annahme, dass Frauen mehr von einer IPT profitieren, zeigten Männer bei Entlassung eine höhere Remissionsrate bei ansonsten vergleichbarer Wirksamkeit der Therapie.
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Change-oriented strategies such as problem-solving/communication training (PS/CT) and parental behavior management training (BMT) have been used to treat parent-adolescent conflict. Although several studies have documented the efficacy of these approaches relative to wait-list control conditions, clinically significant improvements have not been achieved for the majority of adolescents with significant behavioral problems such as comorbid ADHD/ODD. A similar pattern of findings was observed in earlier studies examining couple relationships. Extending the focus and scope of traditional couple therapy to an acceptance-based integrative approach has led to impressive treatment improvements in that area. In a similar vein, we propose an integrative family therapy and suggest enhancing more traditional change-oriented approaches such as PS/CT and BMT by integrating acceptance strategies into a values-centered family therapy. We discuss the role of experiential avoidance and values orientation within a family context and present examples of techniques adapted from traditionally adult- and couple-focused therapies. Finally, we discuss the balancing and sequencing of acceptance and change techniques and offer suggestions for future research and practice.
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This study reports on the development of the Dyadic Adjustment Scale, a new measure for assessing the quality of marriage and other similar dyads. The 32 item scale is designed for use with either married or unmarried cohabiting couples. Despite widespread criticisms of the concept of adjustment, the study proceeds from the pragmatic position that a new measure, which is theoretically grounded, relevant, valid, and highly reliable, is necessary since marital and dyadic adjustment continue to be researched. This factor analytic study tests a conceptual definition set forth in earlier work and suggests the existence of four empirically verified components of dyadic adjustment which can be used as subscales [dyadic satisfaction, dyadic cohesion, dyadic consensus and affectional expression]. Evidence is presented suggesting content, criterion related, and construct validity. High scale reliability is reported. The possibility of item weighting is considered and endorsed as a potential measurement technique, but it is not adopted for the present Dyadic Adjustment Scale. It is concluded that the Dyadic Adjustment Scale represents a significant improvement over other measures of marital adjustment, but a number of troublesome methodological issues remain for future research.
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The present study shows that long-term, low-quality marriages have significant negative effects on overall well-being. We utilize a nationally representative longitudinal study with a multi-item marital quality scale that allows us to track unhappy marriages over a 12-year period and to assess marital happiness along many dimensions. Remaining unhappily married is associated with significantly lower levels of overall happiness, life satisfaction, self-esteem and overall health along with elevated levels of psychological distress compared to remaining otherwise continuously married. There is also some evidence that staying unhappily married is more detrimental than divorcing, as people in low-quality marriages are less happy than individuals who divorce and remarry. They also have lower levels of life satisfaction, self-esteem and overall health than individuals who divorce and remain unmarried. Unhappily married people may have greater odds of improving their well-being by dissolving their low-quality unions as there is no evidence that they are better off in any aspect of overall well-being than those who divorce.