Changes in proposed mechanisms of action in an acceptance-based behavior therapy for generalized anxiety disorder

University of Massachusetts Boston, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 11/2009; 48(3):238-45. DOI: 10.1016/j.brat.2009.11.006
Source: PubMed


Based on the theory that generalized anxiety disorder (GAD) is maintained through a reactive and fused relationship with one's internal experiences and a tendency towards experiential avoidance and behavioral restriction, an acceptance-based behavior therapy (ABBT) was developed to specifically target these elements. Since ABBT has been shown to be an efficacious treatment in previous studies, the current study focuses on proposed mechanisms of change over the course of therapy. Specifically, the current study focuses on session-by-session changes in two proposed mechanisms of change: acceptance of internal experiences and engagement in meaningful activities. Overall, clients receiving ABBT reported an increase in the amount of time spent accepting internal experiences and engaging in valued activities. Change in both acceptance and engagement in meaningful activities was related to responder status at post-treatment and change in these two proposed mechanisms predicted outcome above and beyond change in worry. In addition, change in acceptance was related to reported quality of life at post-treatment.

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    • "A number of studies suggest that changes in ACT processes are associated with and often precede change in outcomes for a variety of disorders treated with acceptance and mindfulness based CBT, including ACT (e.g., Hayes, Orsillo, & Roemer, 2010; Hesser, Westin, Hayes, & Andersson, 2009; Lundgren, Dahl, & Hayes, 2008; Masuda et al., 2009; Wolitzky-Taylor, Arch, Rosenfield, & Craske, 2012). For example, Hayes et al. (2010) found an increase in emotional acceptance and time spent on valued activities in those receiving acceptance-based behavior therapy for generalized anxiety disorder. Change in acceptance and values engagement was related to responder status at posttreatment above and beyond changes in worry. "
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    ABSTRACT: Acceptance and commitment therapy (ACT) has a small research base as a treatment for obsessive compulsive disorder (OCD) and related disorders. It is presumed that the process of change in ACT is an increase in psychological flexibility. This study focuses on session by session changes in psychological flexibility in 41 adults diagnosed with OCD who were treated with ACT compared with 38 individuals who received progressive relaxation training. In a randomized controlled design, participants received 8, one-hour weekly sessions with posttreatment assessment one week after treatment and follow up three months later. Results showed that treatment effects were gradual with significantly better outcomes for ACT occurring in the final two sessions. Multiple levels of analyses show that changes in psychological flexibility predict changes in OCD better than changes in OCD severity predicting changes in psychological flexibility. Similarly, multiple levels of mediational analyses showed that posttreatment levels of psychological flexibility mediate pretreatment to follow up reductions in OCD severity.
    No preview · Article · Jul 2015 · Journal of Contextual Behavioral Science
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    • "Despite the preceding case that values are a potentially important and underutilized aspect of OCD treatment, the current study is crosssectional in nature, therefore limiting the strength of the conclusion. More studies similar to that of Hayes et al. (2010), who measured values, acceptance and anxiety symptoms across sessions could be useful in examining the relationships explored in this paper in the context of OCD treatment. Moreover, due to the cross-sectional nature of the current study, the directionality of the relationship between values and OCD severity is unknown. "
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    ABSTRACT: New interventions such as Acceptance and Commitment Therapy (ACT) have shown early promise in the treatment of OCD, focusing on aspects of psychological flexibility including valued living, mindfulness, and committed action. However, research is needed to explore the relationship between the various components of ACT and OCD. The present study sought to investigate the relationship between values (i.e., self-compassion, courage, and the Valued Living Questionnaire [VLQ; the extent to which one has values and is living out values in everyday life]) and OCD severity. Participants (N=115) who self-reported meeting criteria for OCD completed an online survey assessing levels of different values as well as ratings of importance and consistent living within these values. Analyses yielded significant relationships between OCD severity and self-compassion, courage, and the VLQ. A multiple regression analysis revealed the VLQ and courage to be significant predictors of OCD severity. Interpretation of the results and their implications is considered.
    Full-text · Article · Oct 2013 · Journal of Contextual Behavioral Science
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    • "nce or tolerance of unwanted internal experiences , developing inhibitory responses , or whether these even represent distinct mechanisms ( Craske et al . , 2008 ) . Whereas preliminary evidence suggests that experiential avoidance and psychological inflexibility may be malleable mediators of response to psycho - therapy ( Berking et al . , 2009 ; Hayes et al . , 2010 ) , additional research is warranted to clarify the influence of experiential avoid - ance and psychological inflexibility on trajectories of response to trauma over time , including response to treatment for PTSD . Strengths of the current study include the use of a gold - standard diagnostic interview and the inclusion of multiple , r"
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    ABSTRACT: Although much is known regarding predictors of posttraumatic stress disorder (PTSD), little of this knowledge directly informs treatment. This study examined whether higher scores on the Acceptance and Action Questionnaire—II (AAQ–II), a self-report measure that purportedly assesses experiential avoidance and psychological inflexibility, accounted for unique variance in PTSD symptoms compared with personality factors and other established predictors of PTSD. In addition, this study examined whether the construct measured by the AAQ–II accounts for unique variance in PTSD severity over and above the avoidance symptoms of PTSD. A sample of 109 trauma-exposed veterans of the wars in Iraq and Afghanistan, approximately half of whom met current PTSD criteria on the Clinician-Administered PTSD Scale (CAPS), completed self-report measures of PTSD, combat exposure, perceived life threat, peritraumatic dissociation, recent life stress, perceived postdeployment social support, and personality. Higher AAQ–II scores, which indicate higher levels of psychological inflexibility and experiential avoidance, accounted for unique variance in PTSD symptom severity after controlling for all other predictors (small effect size [ES] on the CAPS; large ES on the self-report PTSD measure). Significant effects for AAQ–II scores remained after controlling for the avoidance symptoms of PTSD (small ES on the CAPS; medium ES on the self-report measure). Scores on the AAQ–II appears to be an important predictor of PTSD that warrants further investigation. Research should continue to examine the malleability of the constructs assessed by the AAQ–II, which may be useful targets in treatment.
    Full-text · Article · Sep 2013 · Psychological Trauma Theory Research Practice and Policy
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