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Acceptance versus distraction: Brief instructions, metaphors and exercises in increasing tolerance for self-delivered electric shocks

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Abstract

The current study compared the effects of an acceptance versus distraction rationale on coping with experimentally induced pain. Eighty participants were randomly assigned to one of five conditions: Full-Acceptance, Full-Distraction, Instruction-only-Acceptance, Instruction-only-Distraction and No-Instructions. Participants completed a simple matching task and were intermittently given the choice either to receive an electric shock and continue, or to avoid the shock and terminate the task. Only the Full-Acceptance strategy (that included experiential exercises and a metaphor) had a significant effect on task tolerance as measured by an increase in the number of shocks delivered post-intervention relative to baseline. In addition, the participants in both of the acceptance conditions showed lower levels of believability in that they were more likely to continue with the task even when reporting more pain. The results support the prediction that acceptance-based interventions work by undermining the behavioural-control functions of pain-related thoughts and feelings, and call for a systematic analysis of how metaphors and exercises work in analogue research.

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... Previous studies found that acceptance-based strategies modulate behavioral pain measures such as pain threshold (PT) and tolerance more profoundly than other ER strategiesdesigned along the process model of ER -such as suppression of pain-related responses (Masedo and Esteve, 2007;Braams et al., 2012), reappraisal of the pain stimulus (Kohl et al., 2013), and distraction from pain (McMullen et al., 2008;Jackson et al., 2012;Moore et al., 2015). Similarly, so called control-based protocols, which are conceptualized as the exact opposite of ACT (Keogh et al., 2005) by instructing participants to ignore the pain stimulation and stop thinking about it, were found to be less effective in pain tolerance tasks than acceptance-based protocols (Keogh et al., 2005). ...
... Similarly, so called control-based protocols, which are conceptualized as the exact opposite of ACT (Keogh et al., 2005) by instructing participants to ignore the pain stimulation and stop thinking about it, were found to be less effective in pain tolerance tasks than acceptance-based protocols (Keogh et al., 2005). A meta-analysis by Kohl et al. (2012) suggests that acceptance-based strategies compared to other regulation strategies are especially successful in increasing pain tolerance, while findings involving subjective pain measures such as pain intensity are less clear: acceptance-based strategies led to either decreased pain intensity compared to suppression (Masedo and Esteve, 2007) and control-based protocols (Gutierrez et al., 2004;Keogh et al., 2005), showed no difference when compared to distraction (McMullen et al., 2008;Moore et al., 2015), reappraisal (Kohl et al., 2013), or control-based protocols (Hayes et al., 1999;Paez-Blarrina et al., 2008a,b), or were even less effective than distraction (Kohl et al., 2013). ...
... Most importantly, previous studies often used pre-topost measurements or control conditions containing either spontaneous coping (Masedo and Esteve, 2007;Evans et al., 2014;Forsyth and Hayes, 2014) or no instructions at all (McMullen et al., 2008;Paez-Blarrina et al., 2008a;Braams et al., 2012). This might have led to an unsystematic use of ill-defined strategies and thus compromised the results. ...
Article
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Acceptance-based regulation of pain, which focuses on the allowing of pain and pain related thoughts and emotions, was found to modulate pain. However, results so far are inconsistent regarding different pain modalities and indices. Moreover, studies so far often lack a suitable control condition, focus on behavioral pain measures rather than physiological correlates, and often use between-subject designs, which potentially impede the evaluation of the effectiveness of the strategies. Therefore, we investigated whether acceptance-based strategies can reduce subjective and physiological markers of acute pain in comparison to a control condition in a within-subject design. To this end, participants (N=30) completed 24 trials comprising 10 seconds of heat pain stimulation. Each trial started with a cue instructing participants to welcome and experience pain (acceptance trials) or to react to the pain as it is without employing any regulation strategies (control trials). In addition to pain intensity and unpleasantness ratings, heart rate and skin conductance were recorded. Results showed significantly decreased pain intensity and unpleasantness ratings for acceptance compared to control trials. Additionally, heart rate was significantly lower during acceptance compared to control trials, whereas skin conductance revealed no significant differences. These results demonstrate the effectiveness of acceptance-based strategies in reducing subjective and physiological pain responses relative to a control condition, even after short training. Therefore, the systematic investigation of acceptance in different pain modalities in healthy and chronic pain patients is warranted.
... ex., anxiété, dépression, incapacité), alors que l'intensité de la douleur en expliquerait seulement 2,5 %. Une autre étude montre que la défusion peut augmenter la tolérance à la douleur (McMullen et al., 2008). ...
... Quelques conclusions ressortent de ces recherches. Premièrement, la majorité des études démontre la supériorité de la stratégie d'acceptation en comparaison de la distraction et de la suppression des pensées pour ce qui est de la tolérance à la douleur (Branstetter-Rost, Cushing et Douleh, 2009 ;Gutiérrez, Luciano, Rodriguez et Fink, 2004 ;Hayes et al., 1999 ;Masedo et Esteve, 2007 ;McMullen et al., 2008 ;Páez-Blarrina et al., 2008a). Deuxièmement, la suppression de pensée peut générer un effet rebond, c'est-à-dire une augmentation des pensées intrusives après l'induction de la douleur (Cioffi et Holloway, 1993) ou un retour plus lent au niveau de base, comparativement au fait de porter attention aux symptômes (méthode issue de l'acceptation) surtout lorsque les niveaux de dramatisation (Sullivan et al., 1997) ou d'évitement expérientiel (Feldner et al., 2006) sont élevés. ...
... Quatrièmement, le niveau de tolérance à la douleur est amélioré lorsque les stratégies d'acceptation sont mises en oeuvre en relation avec les valeurs (p. ex., Branstetter-Rost et al., 2009 ;Páez-Blarrina et al., 2008a ;Páez-Blarrina et 2008b) et via une métaphore ou un exercice expérientiel (McMullen et al., 2008). L'impact de l'emploi de méthodes axées sur l'acceptation comparativement à des méthodes de contrôle pour ce qui est de l'intensité de la douleur est quant à lui plus équivoque. ...
Article
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Cet article vise a presenter les particularites de la therapie d’acceptation et d’engagement (Acceptance and Commitment Therapy ou « ACT ») dans l’intervention aupres de patients souffrant de douleur chronique. Il decrit le contexte historique du developpement des therapies comportementales et cognitives dans ce domaine et presente les fondements theoriques de l’ACT. Il introduit les composantes d’une intervention basee sur l’acceptation et la pleine conscience en visitant plusieurs concepts du modele de la flexibilite psychologique. Enfin, il synthetise un certain nombre de donnees probantes provenant des etudes experimentales, correlationnelles et cliniques qui appuient l’utilisation de l’ACT dans le domaine de la douleur chronique.
... [21][22][23] Previous experimental studies have compared the effects of acceptance-based and control-based instructions for coping with cold pressor pain [19][20][21][22][23] and electrical stimulation. [24][25][26][27][28] Results of these studies demonstrated that participants in the acceptance conditions showed better tolerance of pain. ...
... Individuals who demonstrate high pain believability interpret high levels of pain experienced as a reason to stop an activity. Research supports the idea that ACT produces a decrease in pain believability, 25,28 that is, individuals engaged in acceptance strategies tolerated pain well despite reporting high levels of pain. In particular, research has found that an acceptance-based protocol was superior to a control-based protocol for increasing pain tolerance, but only for participants experiencing higher levels of pain. ...
... Previous experimental research has suggested that acceptance-based strategies may be more successful than control-based strategies (such as distraction) at facilitating an increase in pain tolerance. [25][26][27][28] This was not found in either experiment. However, there is evidence that those in the acceptance condition did not implement their assigned strategy as well as those in the distraction condition. ...
Article
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This study compared an acceptance-based strategy with a control-based strategy (distraction) in terms of the ability of participants to tolerate a painful stimulus, across two experiments. In addition, participants were either actively encouraged, or not, to link pain tolerance with pursuit of valued goals to examine the impact of pursuing a personally meaningful goal or value on the extent to which pain will be tolerated. Participants in experiment 1 (n=41) and experiment 2 (n=52) were equally assigned to acceptance or distraction protocols. Further, half the participants in each group generated examples from their own lives in which they had pursued a valued objective, while the other half did not. In experiment 2, the values focus was enhanced to examine the impact on pain tolerance. There were no significant differences overall between the acceptance and distraction groups on pain tolerance in either experiment. However, in experiment 2, individuals classified as accepting in terms of general coping style and who were assigned to the acceptance strategy showed significantly better pain tolerance than accepting individuals who were in the distraction condition. Across both experiments, those with strong goal-driven values in both protocols were more tolerant of pain. Participants appeared to have more difficulty adhering to acceptance than to distraction as a strategy. Acceptance may be associated with better tolerance of pain, but may also be more difficult to operationalize than distraction in experimental studies. Matching coping style and coping strategy may be most effective, and enhancement of goal-driven values may assist in pain coping.
... In the study by Ritzert et al., a relatively complex Acceptance and Commitment Therapy (ACT)-based protocol was used, which included an experiential exercise, and thus it was not possible to determine if all or just some elements of the protocol were necessary. A limited number of studies have attempted to isolate the specific properties of "analog" ACT-based interventions to determine the active ingredients (e.g., McMullen et al., 2008), but none have involved the IRAP as a measure. ...
... It will be important, however, for future research to determine to what extent our simple verbal rehearsal task would need to be developed or enhanced to produce the types of effects reported by Ritzert et al. For example, is the inclusion of an experiential exercise a critical variable, or is some other feature more or less active in shifting IRAP and BAT performances specific to fear-related stimuli (see Kehoe et al., 2014;McMullen et al., 2008)? ...
... In the study by Ritzert et al., a relatively complex ACT-based protocol was used, which included an experiential exercise, and thus it was not possible to determine if all or just some elements of the protocol were necessary. A limited number of studies have attempted to isolate the specific properties of "analog" ACTbased interventions to determine the active ingredients (e.g.,McMullen et al., 2008), but none have involved the IRAP as a measure. ...
... In contrast, compared with other strategies (e.g., distraction, suppression, spontaneous coping, placebo, and reappraisal), the acceptance strategy can significantly increase people's tolerance of pain (Keogh et al. 2005;Kohl et al. 2012Kohl et al. , 2013Masedo and Esteve 2007;McMullen et al. 2008). For example, McMullen et al. (2008) found that subjects applying the acceptance strategy could increase tolerance for electric pain more than subjects using the distraction strategy. ...
... In contrast, compared with other strategies (e.g., distraction, suppression, spontaneous coping, placebo, and reappraisal), the acceptance strategy can significantly increase people's tolerance of pain (Keogh et al. 2005;Kohl et al. 2012Kohl et al. , 2013Masedo and Esteve 2007;McMullen et al. 2008). For example, McMullen et al. (2008) found that subjects applying the acceptance strategy could increase tolerance for electric pain more than subjects using the distraction strategy. Kohl et al. (2013) reported that acceptance was superior to reappraisal at increasing tolerance for experimentally induced pain. ...
... Participants in the pain-acceptance group were instructed to accept their thoughts and feelings without being controlled by them, in line with the acceptance intervention by McMullen et al. (2008). During the training, the participants were asked to recall three thoughts related to the desire to take their hands out of the ice water during the pre-test (e.g., BI can't stand this pain^). ...
Article
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Objectives Previous studies have shown that brief mindfulness trainings can have significant analgesic effects. However, the effects of the various components of mindfulness on pain analgesia are not well understood. The objective of this study was to examine the effects of two components of mindfulness interventions—attention and acceptance—on pain analgesia. Methods One hundred and nineteen healthy college students without prior mindfulness experience underwent a cold-pressor test to measure pain tolerance before and after the training. Pain intensity, tolerance, distress, threshold, and endurance time were also tested. The participants were randomly assigned to one of the following four conditions: (1) acceptance of pain, (2) attention to pain, (3) acceptance of and attention to pain, or (4) control. Results The results showed that both the acceptance strategy and the combined acceptance and attention group increased pain endurance and tolerance after training. Furthermore, the acceptance group had longer pain endurance and tolerance times than the attention and control groups. Conclusions These results suggest that acceptance of pain is more important than attention to pain. Study limitations and future research directions are discussed.
... n = 38; university students − Participants were randomly assigned to one of four conditions: (1) ACT protocol with coherent acceptance task followed by experiential avoidance protocol with a coherent suppression task, (2) protocols in reversed order, (3) and (4) serve as control conditions with tasks but no protocol − Computerized (acceptance and suppression) tasks with intermittently presented aversive noise through headphones − Assessment of level of discomfort at different points during the procedure − Participants receiving the ACT protocol and ACT-consistent task in the fi rst place before experiencing to control discomfort (Avoidance protocol and task) reported signi fi cantly lower levels of discomfort in response to aversive noise relative to the four other conditions Masedo & Esteve, 2007 n = 219 undergraduate students − All participants were assigned to three conditions: acceptance, suppression, and spontaneous coping − All individuals were exposed to a cold pressor − Assessment of subjective pain; assessment of subjective distress; ratings of pain recovery and distress recovery − Signi fi cant group differences in tolerance of pain: tolerance time of acceptance group was signi fi cant longer in comparison to other two groups − Signi fi cant group differences in pain ratings: in acceptance group signi fi cant lower pain ratings − Signi fi cant group differences in subjective distress: acceptance group rated distress signi fi cant lower − Pain recovery ratings in acceptance group are signi fi cant lower − Distress recovery ratings were signi fi cant lower in the acceptance group McMullen et al., 2008 n = 80, university students and ex-students − Participants were randomized to fi ve coping conditions (full-acceptance vs. full-distraction vs. instruction-basedacceptance vs. instruction-based distraction vs. ...
... Results showed that participants in the acceptance condition were less avoidant and more willing to repeat the CO 2 session and reported fewer and less-intense cognitive and fear symptoms during inhalations . Acceptance strategies have also been examined with stimuli of emotional and sensory pain (e.g., Gutiérrez, Luciano, Rodríguez, & Fink, 2004 ; Hayes, Bisset et al., 1999 ; Keogh et al., 2005 ; Masedo & Esteve, 2007 , McMullen et al., 2008 ; Roche, Forsyth, & Maher, 2007 ; Vowles et al., 2007 ) . For example, McMullen et al. ( 2008 ) compared the impact of acceptance versus distraction strategies on the tolerance of pain and examined additionally how the way in which the two coping strategies were delivered (instruction only versus instruction combined with an exercise and metaphor) effects tolerance of pain. ...
... Acceptance strategies have also been examined with stimuli of emotional and sensory pain (e.g., Gutiérrez, Luciano, Rodríguez, & Fink, 2004 ; Hayes, Bisset et al., 1999 ; Keogh et al., 2005 ; Masedo & Esteve, 2007 , McMullen et al., 2008 ; Roche, Forsyth, & Maher, 2007 ; Vowles et al., 2007 ) . For example, McMullen et al. ( 2008 ) compared the impact of acceptance versus distraction strategies on the tolerance of pain and examined additionally how the way in which the two coping strategies were delivered (instruction only versus instruction combined with an exercise and metaphor) effects tolerance of pain. Participants in the acceptance condition involving experiential exercises and metaphors showed the highest behavioral willingness (i.e., the highest willingness to experience the most pain, but no differences in subjective reports of pain) compared to participants who received coping instructions only or no instruction at all. ...
Chapter
Various aspects of exposure procedures can be found within Acceptance and Commitment Therapy (ACT), in which patients contact previously avoided stimuli with the goal of increasing psychological flexibility and moving towards chosen values. As such, exposure-like procedures within ACT share some characteristics with traditional exposure, yet place a different emphasis on stated goals and theory. This chapter examines the theoretical basis for this different emphasis and reviews the current empirical tests of various components of the theory. The chapter concludes by examining procedural considerations and discusses research needs.
... Results showed that participants in the acceptance condition were less avoidant and more willing to repeat the CO 2 session and reported fewer and less-intense cognitive and fear symptoms during inhalations. Acceptance strategies have also been examined with stimuli of emotional and sensory pain (e.g., Gutiérrez, Luciano, Rodríguez, & Fink, 2004 ;Hayes, Bisset et al., 1999 ;Keogh et al., 2005 ;Masedo & Esteve, 2007, McMullen et al., 2008Roche, Forsyth, & Maher, 2007 ;Vowles et al., 2007 ) . For example, McMullen et al. ( 2008 ) compared the impact of acceptance versus distraction strategies on the tolerance of pain and examined additionally how the way in which the two coping strategies were delivered (instruction only versus instruction combined with an exercise and metaphor) effects tolerance of pain. ...
... Acceptance strategies have also been examined with stimuli of emotional and sensory pain (e.g., Gutiérrez, Luciano, Rodríguez, & Fink, 2004 ;Hayes, Bisset et al., 1999 ;Keogh et al., 2005 ;Masedo & Esteve, 2007, McMullen et al., 2008Roche, Forsyth, & Maher, 2007 ;Vowles et al., 2007 ) . For example, McMullen et al. ( 2008 ) compared the impact of acceptance versus distraction strategies on the tolerance of pain and examined additionally how the way in which the two coping strategies were delivered (instruction only versus instruction combined with an exercise and metaphor) effects tolerance of pain. Participants in the acceptance condition involving experiential exercises and metaphors showed the highest behavioral willingness (i.e., the highest willingness to experience the most pain, but no differences in subjective reports of pain) compared to participants who received coping instructions only or no instruction at all. ...
... We conclude that, although there are studies with positive results (Campbell-Sills et al., 2006;Liverant et al., 2008, Masuda et al., 2004, 2010a, 2010bMcMullen et al., 2008), in the present study defusion effects have not been produced due to methodological characteristics. It is possible that the effects could be in the use of images as referents of participant emotions, when the usual methodology uses one or more self-applied phrases (Healy et al., 2008), or phrases that are verbalised by the individual (Marasigan, 2019), or fi gures and shapes that are associated via classical conditioning to other stimuli by way of equivalence (Luciano et al., 2014). ...
... Furthermore, when performing an experimental analogue in a therapeutic application, the infl uence of the researcher or therapist can be a fundamental variable (Follete et al., 1996;Hayes & Wilson, 1994;Pierson & Hayes, 2007;Vilardaga & Hayes, 2010). In contrast, using a computer programme or recording the instructions in an audio device improves control in clinical analogues (McMullen et al., 2008). In the present study, the procedure has been precisely carried out using a computer, following on-screen instructions, and with minimal intervention by the researcher. ...
Article
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Background: As one of the founding principles of Acceptance and Commitment Therapy (ACT), cognitive defusion is a contextual control of language, but it is not clear which behavioural process would allow such defusion. Two experiments are presented which analyse that process using a word repetition exercise. Method: Experiment 1 was performed with 30 randomised participants, using a factorial between-groups (4x2) with repeated measures design: Group 1 = milk-milk-milk exercise; 2 = emotional word repetition; 3 = milk-to-emotional word shaping; and 4 = control without intervention. Questionnaires were applied on thoughts, emotional regulation, and experiential avoidance, in addition to the evaluation of 20 images suggesting emotions. In Experiment 2, 78 participants were randomised using the same 4x2 design, and also 60 images with a proven emotional reactivity were used. Results: Experiment 1 did not show changes in any of the variables, nor a decrease in emotional assessment, which should occur according to the theory behind ACT. In Experiment 2, no significant changes between the groups and no pre-post changes appeared, except in latency time. Conclusions: The lack of replication of the defusion process is discussed, along with the mixed results of other studies.
... Here prospective and retrospective studies have demonstrated that acceptance is a reliable predictor of functioning in CPPs (1,16). Some experimental pain induction studies have also demonstrated that patients in the acceptance condition vs. patients in control-oriented conditions achieve greater pain tolerance (17)(18)(19)(20)(21)(22). To our knowledge, there are no studies comparing different pain groups such as acute pain patients (APPs) to CPPs for aspects of acceptance of pain. ...
Article
Many chronic pain patients (CPPs) cannot be cured of their pain, but can learn to manage it. This has led to research on pain "acceptance" which is defined as a behavior pattern with awareness of pain but not directed at changing pain. CPPs who have accepted their pain generally acknowledge that a cure is unlikely. Time with pain may be necessary to reach such an acknowledgment. It was therefore hypothesized that fewer acute pain patients (APPs) than CPPs should affirm that a cure is unlikely and that other described aspects of acceptance such as denial of disability status should be associated with cure is unlikely in both APPs and CPPs. APPs and CPPs were compared for frequency of endorsement of 2 items/questions with face validity for cure is unlikely: little hope of getting better from pain (LH) and physical problem (pain) can't be cured (CBC). Demographic variables and variables reported associated with acceptance were utilized in logistic prediction models for the above items in APPs and CPPs. Rehabilitation programs/offices. CPPs were statistically more likely than APPs to affirm both LH and CBC. In both APPs and CPPs, items reported associated with acceptance, e.g., denial of disability status, predicted LH and CBC. Information gathered from CPP self-reports. APPs versus CPPs differ on their affirmation on acknowledgement that a cure is unlikely. Acceptance, pain acceptance, chronic pain, acute pain, chronic pain patients, acute pain patients, Battery of Health Improvement (BHI 2), cure disability, illness uncertainty.
... Compared with various active control conditions, the WRT significantly reduced discomfort and believability ratings of negative self-referential thoughts (De Young, Lavender, Washington, Looby, & Anderson, 2010; Masuda, Twohig, et al., 2010; see also Masuda, Feinstein, Wendell, & Sheehan, 2010;Masuda, Hayes, Sackett, & Twohig, 2004) as well as obsessive-compulsive-disorder-related negative responses to contamination-related thoughts (Watson, Burley, & Purdon, 2010). Furthermore, several experimental studies have demonstrated superior outcomes of ACT defusion techniques, relative to other cognitive control strategies (e.g., distraction, expressive suppression), with respect to pain believability and coping with experimentally induced pain (Gutiérrez, Luciano, Rodríguez, & Fink, 2004;Hayes, Bissett, et al., 1999;Healy et al., 2008;McMullen et al., 2008 In total, this body of findings demonstrates the role of cognitive (de)fusion in mental health; in addition, this work suggests that defusion may, in part, mediate the effects of several types of interventions on these outcomes. In so far as the measurements and manipulations of cognitive defusion represent the metacognitive processes of meta-awareness and disidentification from internal experience (via the DDS), as well as reduced reactivity to thought content (via the CFQ and WRT), these studies provide additional evidence of the association between our metacognitive processes and mental health. ...
Article
The capacity to shift experiential perspective—from within one’s subjective experience onto that experience—is fundamental to being human. Scholars have long theorized that this metacognitive capacity—which we refer to as decentering—may play an important role in mental health. To help illuminate this mental phenomenon and its links to mental health, we critically examine decentering-related constructs and their respective literatures (e.g., self-distanced perspective, cognitive distancing, cognitive defusion). First, we introduce a novel metacognitive processes model of decentering. Specifically, we propose that, to varying degrees, decentering-related constructs reflect a common mental phenomenon subserved by three interrelated metacognitive processes: meta-awareness, disidentification from internal experience, and reduced reactivity to thought content. Second, we examine extant research linking decentering-related constructs and their underlying metacognitive processes to mental health. We conclude by proposing future directions for research that transcends decentering-related constructs in an effort to advance the field’s understanding of this facet of human experience and its role in (mal)adaptation.
... A series of laboratory-based studies investigated whether acceptance-based coping interventions decouple the relationship between increased levels of pain and decreased persistence in a pain-inducing task (Gutiérrez et al., 2004;McMullen et al., 2008;. All three studies included randomization to a brief acceptance-based intervention or a cognitive control-based intervention. ...
Article
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A growing body of research within the acceptance and mindfulness-based therapies suggests that these treatments may function in part by reducing or eliminating (i.e., decoupling) the normative relationships between internal experiences and other internal/overt behavior. Examples of decoupling effects found in this review include reduced relationships between urges to smoke and smoking behavior, between dysphoric mood and depressive cognitions, and between pain intensity and persistence in a painful task. A literature review identified 44 studies on acceptance and mindfulness that demonstrated decoupling effects. Overall, preliminary evidence for decoupling effects were found across a broad range of problem areas, including substance abuse, depression, eating disorders, overeating, chronic pain, anxiety, relationships, anger, avoidance behavior, and self-harm, with the strongest evidence currently available in the area of substance abuse. However, the review also notes a general lack of replication studies on decoupling effects and the need for more well-powered and controlled research testing specific decoupling hypotheses.
... This clarity about the purpose of treatment also applies to individual sessions, as evidenced by the rationales provided at the outset of each modular session. Some data suggest that the combination of rationale and experiential exercise produce superior outcomes compared with either component alone (McMullen et al., 2008). Although efforts were made to clearly describe the target behavior and the value of the behavior in these rationales, at times it may be challenging to translate the repertoires into accessible examples for the client. ...
Article
Clients who present to psychotherapy reporting diffuse and/or sub-clinical concerns may provide a puzzling treatment decision for providers of evidence-based practice. The current case study illustrates the implementation of an evidence-based treatment, Acceptance and Commitment Therapy (ACT), for a client diagnosed with adjustment disorder with mixed anxiety and depressive symptoms. ACT targets a dimensional, transdiagnostic construct known as psychological flexibility, currently conceptualized as involving six inter-related behavioral repertoires. The client was a Caucasian woman in her 30s who self-referred to therapy. She reported feeling anxious and depressed, especially in regard to interpersonal difficulties with her mother and her ex-husband. Fourteen sessions of an ACT protocol emphasizing a modular approach to the repertoires emphasized by the psychological flexibility model were provided. Each modular session consisted of psychoeducation, metaphors, experiential exercises, and daily practice assignments for one of the repertoires. The client completed pre-treatment, post-treatment, and 6-month follow-up outcome measures and weekly process measures to track change throughout treatment. One process measure assessed each of the six repertoires. The client's data revealed substantial increases in psychological flexibility and decreases in psychological distress from pre- to post-treatment, which remained stable at follow-up. This case report suggests that ACT may be a desirable treatment option for clients bearing ambiguous or sub-clinical presentations, including interpersonal conflicts. The report also provides a model for monitoring change with individual psychological flexibility repertoires with respect to a modular approach to teaching those repertoires.
... Participants who received the acceptance-based protocol showed signi cantly greater pain tolerance and lower pain believability (i.e., assessment of maximal discomfort while participants continued on task) than participants in the control condition. This study was replicated and extended in further studies (e.g., McMullen et al., 2008;Páez-Blarrina et al., 2008). ...
Article
Private events can have a dominant function in human behavior, especially with regard to the experience of self and selfing behavior. This article presents the building of selfing behavior throughout the early interactions of responding to others` behaviors and discusses the impact of learning to relate (i.e., learning human language). Special focus is on the significant impact of deictic and hierarchical framing in building self-contents, overaching abstract motivations, the abstraction of I, and the subsequent derivation of more self-contents. Also covered are the patterns of responding in coordination with one`s own behavior (psychological inflexibility) and responding hierarchically (psychological flexibility); and hierarchical responding as the final common pathway for the many faces of therapeutic processes towards building psychological flexibility. Finally, the experimental evidence that has been signaling this path for years is summarized.
... However, even under optimal experimental conditions (see Dymond, Roche & Bennett, 2013;and see Kazdin & Nock, 2003 for a broader discussion), analogue studies, almost by definition, must remain silent with regard to whether or not ACT's middle-level terms refer to functional processes. This is not to argue that analogue studies are without value, but simply to underscore that they do not, in our view, move the field forward in terms of identifying basic scientific (functional) processes (e.g., Gutiérrez-Martínez, LucianoSoriano, Rodríguez-Valverde & Fink, 2004;Kehoe, Barnes-Holmes, Barnes-Holmes, Cochrane & Stewart, 2007;Keogh, Barnes-Holmes & Barnes-Holmes, 2008;McMullen, Barnes-Holmes, Barnes-Holmes, Stewart, Luciano & Cochrane, 2008). To fully appreciate the foregoing point, consider the number of errors underlying the logic of analogue studies as the basis for identifying functional processes. ...
Chapter
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Most natural sciences aspire to a unified theory, such as Einstein's unified field theory that would specify how all space and time behave under changes in the parameters of the total field. This chapter presents a summary of the middle level terms that comprise the acceptance and commitment therapy (ACT) hexaflex, as well as mention of a number of additional middle-level terms commonly used by ACT practitioners and researchers. It discusses how the contextual behavioral science (CBS) community can harness each of its elements to progress the science toward a unified theory. The chapter considers whether the recently proposed reticulating model can facilitate this agenda. It addresses the question of how successfully one can close the gap between relational frame theory (RFT) and ACT. The chapter considers future directions for basic research in the service of a unified theory for CBS. It argues strongly for the advancement of basic science.
... Clinical researchers have generated an array of experimental contexts for the investigation of various aspects of mental distress, in the hope of improving our understanding and treatment of mental health issues (e.g., Hayes, Bisset, Korn, et al., 1999;Wegner, Schneider, Carter, & White, 1987). Existing methods of experimental stress induction employed as analogs of clinically relevant processes include: the CO2 challenge (e.g., Levitt, Brown, Orsillo, & Barlow, 2004); the cold-pressor task (e.g., Keogh, Bond, Hanmer, & Tilston, 2005); brief electric shock (e.g., McMullen, Barnes-Holmes, Barnes-Holmes, Stewart, Luciano, & Cochrane, 2008); and radiant heat induction (e.g., Kehoe, Barnes-Holmes, Barnes-Holmes, Cochrane, & Stewart, 2007). These procedures have been used to investigate psychological processes, such as thought suppression, panic, and pain tolerance, as well as treatment susceptibility, including the use of acceptance-based protocols. ...
Article
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The current study investigated the effects of a single- vs. multi-sentence stress induction paradigm on subjective ratings of discomfort, anxiety, and distress in a non-clinical sample. The Single-Sentence task required participants to write a sentence stating the hope that a loved one is involved in a car accident. The Multi-Sentence task required participants to write five sentences that added greater detail to the hypothetical accident. As predicted, both tasks were associated with an increase in the three dependent variables, suggesting that both served as stress induction procedures. Contrary to predictions, however, the Multi-Sentence Condition did not induce greater stress than the Single-Sentence Condition, although the former was associated with greater willingness to engage with thoughts of the accident and greater vividness of thoughts. In contrast, the Single-Sentence Condition was associated with stronger feelings of guilt and moral wrongness. The implications of the findings for existing stress induction procedures are discussed.
... Importantly, participants in the pain acceptance condition viewed pain and thoughts about pain as less influential than those in the pain control condition. This pattern of results has been replicated several times in studies with experimentally induced pain and healthy controls [23][24][25][26][27], as well as in adults with low back pain [28]. Furthermore, laboratory studies suggest that the inclusion of values in experimental pain settings is important. ...
Article
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Acceptance and Commitment Therapy (ACT) is a third wave behavior therapy approach which aims to increase engagement in activities that bring meaning, vitality, and value to the lives of individuals experiencing persistent pain, discomfort, or distress. This goal is particularly relevant when these aversive experiences cannot be effectively avoided or when avoidance efforts risk their exacerbation, all of which may be common experiences in children and adolescents with chronic pain conditions. The primary aim of the present paper is to review and summarize the extant literature on the application, utility, and evidence for using ACT with pediatric chronic pain populations by: (1) defining the theoretical assumptions of the ACT model; (2) summarizing research study findings and relevant measures from the published literature; and (3) critically discussing the strengths, limitations and areas in need of further development.
... Several studies have shown that acceptance-based interventions contribute to greater 'tolerance' for pain as compared to interventions utilizing distraction or suppression techniques [22,23]. Additionally, one experiment showed that ACT-based exercises delivered in an experiential and metaphorical manner contributed to greater pain tolerance than ACT exercises delivered didactically [24]. Experimental manipulations that place the experience of pain within the context of values have likewise been shown to increase pain tolerance [25][26][27]. ...
Article
Most clinicians and researchers with interest in cognitive behavioral therapy (CBT) will recognize a trend in current treatment developments, including in the area of chronic pain. These developments are loosely called mindfulness and acceptance-based treatments, although it is possible to be more precise about these developments, their theoretical models and treatment processes. One of the specific therapies here is acceptance and commitment therapy (ACT), based on the psychological flexibility model. ACT extends from previous developments of CBT and integrates many of the current CBT-related variables into a smaller number of core therapeutic processes. There are now 10 published RCTs that support the efficacy of ACT for chronic pain and many empirical studies of specific processes from the psychological flexibility model. There is a remarkable success story here that has played out over a rather short period. At the same time there are challenges for the future: establishing appropriate outcome measures for ACT trials, finding ways to more comprehensively assess therapy processes, meeting the challenge of wide access, and treatment fidelity. This article will provide a brief review of the evidence on ACT for chronic pain and will discuss current challenges and opportunities for progress.
... Compared with various active control conditions, the WRT significantly reduced discomfort and believability ratings of negative self-referential thoughts (De Young, Lavender, Washington, Looby, & Anderson, 2010; Masuda, Twohig, et al., 2010; see also Masuda, Feinstein, Wendell, & Sheehan, 2010;Masuda, Hayes, Sackett, & Twohig, 2004) as well as obsessive-compulsive-disorder-related negative responses to contamination-related thoughts (Watson, Burley, & Purdon, 2010). Furthermore, several experimental studies have demonstrated superior outcomes of ACT defusion techniques, relative to other cognitive control strategies (e.g., distraction, expressive suppression), with respect to pain believability and coping with experimentally induced pain (Gutiérrez, Luciano, Rodríguez, & Fink, 2004;Hayes, Bissett, et al., 1999;Healy et al., 2008;McMullen et al., 2008 In total, this body of findings demonstrates the role of cognitive (de)fusion in mental health; in addition, this work suggests that defusion may, in part, mediate the effects of several types of interventions on these outcomes. In so far as the measurements and manipulations of cognitive defusion represent the metacognitive processes of meta-awareness and disidentification from internal experience (via the DDS), as well as reduced reactivity to thought content (via the CFQ and WRT), these studies provide additional evidence of the association between our metacognitive processes and mental health. ...
Article
The capacity to shift experiential perspective – from within one’s subjective experience, onto that experience – is fundamental to being human. Scholars have long theorized that this metacognitive capacity – that we refer to as decentering – may play an important role in mental health. To help illuminate this mental phenomenon and its links to mental health, we critically examine decentering-related constructs and their respective literatures (e.g., self-distanced perspective, cognitive distancing, cognitive defusion). First, we introduce a novel meta-cognitive processes model of decentering. Specifically, we propose that, to varying degrees, decentering related constructs reflect a common mental phenomenon sub-served by three inter-related metacognitive processes: meta-awareness, disidentification from internal experience, and reduced reactivity to thought content. Second, we examine extant research linking decentering-related constructs and their underlying meta-cognitive processes to mental health. We conclude by proposing future directions for research that transcends decentering-related constructs in an effort to advance the field’s understanding of this facet of human experience and its role in (mal)adaptation.
... Finally, in regards to methodological rigor, there is a concern regarding the use of a face-to-face format in delivering active interventions. Previous analogue studies employed a computerized program or audiotaped intervention (e.g., McMullen et al., 2008) in order to standardize the contents of intervention conditions across participants. The current investigation employed a contact-based face-to-face format in order to maintain an applied atmosphere in an analogue setting, and this might have led to the variability in intervention delivery to participants assigned to the same condition. ...
Article
The purpose of the current analogue experiment was to investigate the impact of a cognitive defusion strategy, rapid vocal repetition, on self-identified negative body image thoughts. Undergraduate students (N=254) were randomized to one of five protocols: defusion condition with an experiential exercise for a self-identified negative body image thought, defusion without such an experiential exercise, distraction with an experiential exercise with the target thought, distraction without such an experiential exercise, and an experimental control task. At post-intervention, the defusion condition with an experiential exercise with the target negative body image thought showed significantly lower discomfort associated with that thought than distraction conditions and experimental control group, and this condition demonstrated greater decentering than the distraction condition without experiential exercise and the control group. The defusion condition with the experiential exercise with the target thought also demonstrated a greater reduction in believability than the other four conditions. Overall, our findings highlight the importance of including rapid vocation repetition of a target body image thought when trying to change the discomfort, believability, and decentering associated with that thought.
... In an attempt to isolate the key, active elements within the acceptance approach to pain, recent research has examined the effect of removing metaphors and exercises from acceptance and distraction protocols (McMullen et al. 2008). The current series of experiments was designed along similar lines to further explore the critical elements of acceptance and distraction, and their impact on pain tolerance and distress. ...
Article
Full-text available
Numerous studies have demonstrated the utility of acceptance-based strategies for coping with pain. The current research comprised three studies (N = 186) that compared the effects of acceptance, distraction, and placebo protocols on the distress and tolerance of experimentally induced radiant heat pain. In Experiment 1, an acceptance intervention was associated with a significant increase in tolerance relative to baseline, distraction was not, and placebo was associated with a significant decrease. Experiment 1A comprised a revised Distraction 2 intervention that was compared with the original acceptance and placebo groups from Experiment 1. This explored the potential impact of defusion on the previous outcome for distraction. Indeed, the results indicated that Distraction 2 was not associated with increased tolerance. In Experiment 2, the Swamp Metaphor was removed from each intervention, but this had no direct impact on outcomes. Again, acceptance showed a significant increase in pain tolerance; distraction did not. The current research offers the first componential analysis of acceptance and distraction in the context of radiant heat pain.
... For example, ACT emphasizes experiential learning over direct instruction, in part because such interventions seek to undermine overly rigid rule-governed behavior (Hayes, Strosahl, & Wilson, 2012). To explore this, a study using a self-administered shock paradigm compared brief instruction-only versions of an acceptance and a dis traction intervention to versions that included experiential exercises and metaphors as well as a no-instruction control condition (McMullen et al., 2008). Only the full acceptance-based intervention led to increases in tolerance (i.e., number of shocks), while the instruction-only acceptance condition was relatively inert. ...
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.
... Nella prospettiva ACT questa procedura ha come bersaglio principalmente i pensieri, mentre per quanto riguarda le emozioni e le sensazioni si utilizzano di solito esercizi di accettazione esperienziale. Essendo però le due tipologie di esperienze spesso associate, non è infrequente l'utilizzo congiunto di entrambe le tecniche (Gutiérrez et al. 2004, Páez-Blarrina et al. 2008, McMullen et al. 2008. ...
Article
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Cognitive defusion is a fundamental process in Acceptance and Commitment Therapy, whose effectiveness has been demonstrated by many outcome studies across a large number of psychiatric disorders. This procedure allows to achieve psychological distance from private experiences (e.g. thoughts and mental images). The aim of defusion is to modify how an individual relates to negative thoughts so as to promote psychological flexibility, and to broaden the repertoire of behavioural and emotional responses. Research data demonstrate its effectiveness in reducing the believability of dysfunctional thoughts, thus allowing patients to act in line with one’s values as opposed to being governed by their dysfunctional beliefs. The conceptual framework of cognitive defusion is briefly presented, along with two exemplifications of typical defusion interventions and some indications for its correct implementation in psychotherapy.
... The carrying cards exercise coupled with ACT's "swamp metaphor" (cf. Hayes et al., 2012b) has been shown to decrease escape or avoidance behavior due to aversive stimulation without significantly affecting emotional discomfort (Gutiérrez, Luciano, Rodríguez, & Fink, 2004;Kehoe et al., 2014;McMullen et al., 2008). The same has been found with the content on cards exercise combined with a variation of ACT's observer exercise . ...
Article
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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.
... The sample size in this study was similar to the sample sizes in previous studies. 7,10,19 Participants received a small payment in compensation after completing the experiment. ...
Article
Self-distancing has been shown to alleviate emotional pain and to have potential efficacy for treating chronic pain and imagined acute pain, relative to self-immersing. This study examined the efficacy of self-distancing in relieving acute physical pain caused by a cold pressor task (CPT) in healthy adults. A total of 65 undergraduates were assigned pseudorandomly to 1 of 3 groups: 1) a self-distancing group, in which participants were instructed to “take a step back” to simulate their current painful experience as an observer, 2) a self-immersed group, in which participants’ current painful experience was stimulated from the egocentric perspective, and 3) a control group, in which participants coped with pains in their spontaneous ways. Three key sessions were included in the present experiment: the pretest CPT, the perspective training (instead of rest in the control group), and the posttest CPT. The participants were to adopt the designated perspective only during the posttest CPT. The results showed that 1) maintaining a self-distanced perspective while experiencing pain decreased the sensation of pain, relative to the self-immersed group and the control group; and (2) compared with the control group, maintaining a self-immersed perspective neither alleviated nor aggravated the pain. This result supports that self-distancing could relieve the acute pain induced by CPT. Perspective: This study presents a brief effective psychological intervention to manage acute pain. This result could potentially have clinical and everyday importance.
... Cognitive defusion has shown to be more effective than inactive control and placebo conditions in increasing pain tolerance (Carrasquillo, Nakisha, & Zettle, 2014), distress (Hinton & Gaynor, 2010), and decreasing thought believability (Prudenzi et al., 2019). Cognitive defusion conditions are also considered more efficacious than experiential avoidance (Hooper, Dack, Karekla, Niyazi, & McHugh, 2018), thought control (Gutiérrez, Luciano, Rodríguez, & Fink, 2004;Masuda, Hayes, Sackett, & Twohig, 2004;McMullen et al., 2008), thought suppression (Hooper, Sandoz, Ashton, Clarke, & McHugh, 2012), distraction (Hooper & McHugh, 2013;Mandavia et al., 2015;Masuda, Hayes, Sackett, & Twohig, 2004;Masuda, Feinstein, Wendell, & Sheehan, 2010;Masuda, Twohig, et al., 2010;Ritzert, Forsyth, Berghoff, Barnes-Holmes, & Nicholson, 2015), self-affirmations (Brandrick, Hooper, Roche, Kanter, & Tyndall, 2020), and general motivational protocols (Luciano et al., 2014). Tiggemann (2017, 2018) found that cognitive defusion was more efficacious than guided imagery in resisting food cravings in a general sample of women, but equivalent in clinical samples of food cravers. ...
Preprint
This chapter reviews the conceptualization and empirical evidence of the midlevel process called cognitivedefusion. Firstly, we present examples of cognitive fusion and cognitive defusion definitions offered inacceptance and commitment therapy (ACT) manuals, discuss their relationships with other ACT midlevelprocesses, and offer a relational frame theory (RFT) conceptualization of these processes. Secondly, wedescribe the type of cognitive defusion exercises and discuss the basic processes involved in them. Thirdly,we review the measurement of cognitive (de)fusion in the form of self-report instruments, behavioralmeasures, and the assessment in the clinical session. Fourthly, we present a review of the research oncognitive (de)fusion separated in laboratory research, survey research, and the analysis of processes ofchange in clinical trials. Lastly, we discuss some challenges and future directions in conceptualizing andresearching cognitive (de)fusion.
... Cognitive defusion has shown to be more effective than inactive control and placebo conditions in increasing pain tolerance (Carrasquillo, Nakisha, & Zettle, 2014), distress (Hinton & Gaynor, 2010), and decreasing thought believability (Prudenzi et al., 2019). Cognitive defusion conditions are also considered more efficacious than experiential avoidance (Hooper, Dack, Karekla, Niyazi, & McHugh, 2018), thought control (Gutiérrez, Luciano, Rodríguez, & Fink, 2004;Masuda, Hayes, Sackett, & Twohig, 2004;McMullen et al., 2008), thought suppression (Hooper, Sandoz, Ashton, Clarke, & McHugh, 2012), distraction (Hooper & McHugh, 2013;Mandavia et al., 2015;Masuda, Hayes, Sackett, & Twohig, 2004;Masuda, Feinstein, Wendell, & Sheehan, 2010;Masuda, Twohig, et al., 2010;Ritzert, Forsyth, Berghoff, Barnes-Holmes, & Nicholson, 2015), self-affirmations (Brandrick, Hooper, Roche, Kanter, & Tyndall, 2020), and general motivational protocols (Luciano et al., 2014). Tiggemann (2017, 2018) found that cognitive defusion was more efficacious than guided imagery in resisting food cravings in a general sample of women, but equivalent in clinical samples of food cravers. ...
Chapter
Full-text available
This chapter reviews the conceptualization and empirical evidence of the midlevel process called cognitive defusion. Firstly, we present examples of cognitive fusion and cognitive defusion definitions offered in acceptance and commitment therapy (ACT) manuals, discuss their relationships with other ACT midlevel processes, and offer a relational frame theory (RFT) conceptualization of these processes. Secondly, we describe the type of cognitive defusion exercises and discuss the basic processes involved in them. Thirdly, we review the measurement of cognitive (de)fusion in the form of self-report instruments, behavioral measures, and the assessment in the clinical session. Fourthly, we present a review of the research on cognitive (de)fusion separated in laboratory research, survey research, and the analysis of processes of change in clinical trials. Lastly, we discuss some challenges and future directions in conceptualizing and researching cognitive (de)fusion.
... Participants who received the acceptance-based protocol showed significantly greater pain tolerance and lower pain believability (i.e., assessment of maximal discomfort while participants continued on task) than participants in the control condition. The latter study was replicated and extended in further studies (e.g., McMullen et al., 2008;Páez-Blarrina et al., 2008). ...
... Some studies have shown that acceptancebased coping leads to significantly greater pain tolerance (participants endured pain longer or more intense pain) and/or lesser pain intensity (participants reported less degree of pain on the same pain stimuli; Hayes et al., 1999;Masedo & Rosa Esteve, 2007;McMullen et al., 2008). Furthermore, several analog studies have researched the effect of values clarification on coping with pain. ...
Article
Acceptance and commitment therapy (ACT) has been utilized to help individuals deal with pain avoidance. We analyzed whether the values clarification procedure used in ACT increased pain tolerance and experiment‐related activity for undergraduates exposed to pain using a cold pressor procedure. Participants built houses with blocks while experiencing pain. In Experiment 1, participants were randomly assigned to a value group (described and declared values) or a control group (described and declared block colors). The value group showed significantly greater pain tolerance, more block houses, and more colors/forms than the control group. Experiment 2 investigated the effects of declaring values. Participants were randomly assigned to one of three groups: declaration group (described and declared values), no declaration group (described values), and control group (described block colors). The no declaration group showed significantly greater pain tolerance and more block houses than the control group; there was no difference between the declaration and control groups. The results imply that describing values is useful for behavioral activation, but the effect of declaring values might depend on the context.
... This indirect effect of psychological flexibility was so significant that neither pain severity nor pain interference significantly predicted risk of opioid misuse when psychological flexibility was included in the model. The finding that psychological flexibility plays an important role in the prediction of both risk for opioid misuse by both severity and interference builds upon previous research examining the association between acceptance and pain tolerance (Masedo & Esteve, 2007;McMullen et al., 2008;Páez-Blarrina et al., 2008;Richardson et al., 2010;Vowles et al., 2007). Patients' reports of pain severity or interference alone may be less informative when predicting risk of opioid misuse than their reports of psychological flexibility. ...
Article
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Chronic pain has an estimated annual prevalence rate between 10 and 35%. In the US, first-line treatment for chronic pain is often opioids. Objective: To our knowledge, this is the first study exploring psychological flexibility and its association with pain severity, pain interference and risk of opioid misuse in chronic pain patients. Methods: Data were collected at two outpatient pain clinics in the northeastern United States. Adults (N = 99) completed a cross-sectional survey with validated measures. Pain severity and pain interference were hypothesized to uniquely predict the risk of opioid misuse. Pain severity was hypothesized to predict pain interference. Finally, psychological flexibility was hypothesized as an indirect effect in these relationships. Results: Main findings suggest that pain severity predicts risk of opioid misuse, mediated by psychological flexibly. Pain interference also predicts risk of opioid misuse, mediated by psychological flexibility. Finally, results suggest pain severity predicts pain interference, mediated by psychological flexibility. Discussion: Implications of findings are discussed in terms of future psychological and medical assessments and interventions for chronic pain patients seeking prescription opioids.
... De especial relevância é o fato de que os estudos que utilizaram o exercício Repetição da palavra consistentemente obtiveram uma grande diminuição nas medidas de desconforto emocional (Barrera et al., 2016;Deacon et al., 2011;De Young et al., 2010;Keogh, 2008;Mandavia et al., 2015;Maisel et al., 2019;Masuda et al., 2004;2010a;2010b;Ritzert et al., 2015;Tyndall et al., 2017;Watson, Burley & Purdon, 2010). Enquanto, do outro lado, as pesquisas que adotaram intervenções como Pensamentos em cartas e Carregando cartas não obtiveram diferenças significativas nessa variável, mesmo quando houve mudanças expressivas em respostas de fuga e esquiva (Gutiérrez et al., 2004;Luciano et al., 2014;McMullen et al., 2008). Tal diferença de resultados é difícil de ser integrada em uma conceituação de desfusão cognitiva na qual há um único processo de mudança envolvido, responsável por resultados tão díspares. ...
Thesis
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A Terapia de Aceitação e Compromisso (ACT) tem progressivamente conquistado espaço entre pesquisadores e clínicos. Entretanto, a apresentação do tratamento terapêutico por meio do Modelo de Flexibilidade Psicológica, descrito por meio seis termos de nível intermediário (aceitação, desfusão cognitiva, contato com o momento presente, senso de self-como-contexto, valores e ação comprometida) traz consigo algumas dificuldades. De especial relevância é a falta de clareza do elo entre cada um desses conceitos e o processo de mudança clínica subjacente em termos de processos comportamentais básicos. Considerando que a existência desta relação é necessária para a utilidade pragmática de conceitos de nível intermediário, em termos de ensino e implementação em sessão, a clarificação do elo é essencial. O presente trabalho tem o objetivo de aumentar o valor pragmático do conceito de desfusão cognitiva ao (a) aumentar sua precisão por meio da clarificação do elo entre este termo intermediário e processos comportamentais básicos; e (b) facilitar sua implementação em sessão por meio de diretrizes de tomada de decisão clínica idiográfica, analítico-funcional momento-a-momento durante a interação terapeuta-cliente. Para isso, foram realizados quatro estudos. O primeiro consiste em uma pesquisa bibliográfica exploratória do conceito de “desfusão cognitiva” na literatura da ACT e uma análise conceitual crítica dos resultados obtidos com base no corpo de conhecimento da Análise do Comportamento, levando a uma nova proposta de conceituação do termo. A partir das implicações desta conceituação, foi realizado um estudo análogo experimental comparando diretamente os efeitos de dois exercícios para promover desfusão cognitiva sobre medidas de dor e fuga em uma tarefa de conflito aproximação-fuga (Estudo II). Também a partir das implicações do Estudo I, foi adotada a metodologia da Task analysis para descrever como terapeutas ACT promovem desfusão cognitiva em sessão. Para isso, foi inicialmente construído um modelo racional de como clínicos promovem desfusão cognitiva em sessão e um sistema de categorização das falas do terapeuta e do cliente em sessão para analisar quantitativamente o modelo (Estudo III). Na sequência, foi realizado um estudo clínico no qual sessões de terapia com o objetivo de promover desfusão cognitiva foram gravadas, transcritas, categorizadas e analisadas quantitativamente e qualitativamente, refinando o modelo teórico com base nos dados coletados (Estudo IV).
... The acceptance instructions have different lengths, level of detail and level of complexity. Some of them include examples, metaphors or additional exercises (Gutiérrez et al., 2004;Roche et al., 2007;McMullen et al., 2008), while others do not. Sometimes, benefits of using acceptance are described in the instruction itself (so the effectiveness of the strategy is effectively primed; Levitt et al., 2004). ...
... A wide range of behavioural manipulations have been shown to attenuate mood/stress induced effects on subjective mood or physiological reactivity. These include brief instructions about accepting emotions (Campbell-Sills, Barlow, Brown, & Hofmann, 2006;Keogh, Bond, Hanmer, & Tilston, 2005;Levitt, Brown, Orsillo, & Barlow, 2004;McMullen et al., 2008;Schartau, Dalgleish, & Dunn, 2009;Singer & Dobson, 2007;Singer & Dobson, 2009;Vieten, Astin, Buscemi, & Galloway, 2010), guided imagery of the stressor prior to testing (Yaremko & Butler, 1975;Yaremko, Glanville, & Leckart, 1972), guided positive mental imagery (Jacob et al., 2011), guided neutral mental imagery (Joormann & Siemer, 2004;Joormann, Siemer, & Gotlib, 2007), attentional capture by happy faces (Sanchez, Vazquez, Gomez, & Joormann, 2014), occupancy of working memory by secondary tasks (Erber & Tesser, 1992;Kron, Schul, Cohen, & Hassin, 2010;Trask & Sigmon, 1999;Van Dillen, Heslenfeld, & Koole, 2009;Van Dillen & Koole, 2007, 2009, distress tolerance training (Bornovalova, Gratz, Daughters, Hunt, & Lejuez, 2012), acute exercise (Bernstein & McNally, 2017a, 2017bMata, Hogan, Joormann, Waugh, & Gotlib, 2013;Rejeski, Thompson, Brubaker, & Miller, 1992), exposure to green environments (Jiang, Li, Larsen, & Sullivan, 2014) and drawing pleasant pictures (Dalebroux, Goldstein, & Winner, 2008;Drake, Coleman, & Winner, 2011;Drake & Winner, 2012;Smolarski, Leone, & Robbins, 2015). Although any of these processes could be responsible for the effects found in the present study, occupancy of working memory resources is perhaps the most plausible mechanism (Tapper, 2018). ...
Article
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The therapeutic effect of mindfulness interventions on problematic drinking is thought to be driven by increased resilience to the impact of stress on negative mood and alcohol-seeking behaviour, but this claim needs empirical support. To address this hypothesis, the current study tested whether brief training of one component of mindfulness - breath counting - would reduce drinkers' sensitivity to the effect of noise stress on subjective mood and alcohol-seeking behaviour. Baseline alcohol-seeking was measured by choice to view alcohol versus food thumbnail pictures in 192 student drinkers. Participants then received a 6-minute audio file which either trained breath counting or recited a popular science extract, in separate groups. All participants were then stressed by a loud industrial noise and alcohol-seeking was measured again simultaneously to quantify the change from baseline. Subjective mood was measured after all three stages (baseline, post intervention, post stress test). The breath counting group were instructed to deploy this technique during the stress test. Results showed that the breath counting versus control intervention improved subjective mood relative to baseline, attenuated the worsening of subjective mood produced by stress induction, and accelerated recovery from a stress induced increase in alcohol-seeking behaviour. Exploratory moderation analysis showed that this accelerated recovery from stress induced alcohol-seeking by breath counting was weaker in more alcohol dependent participants. Mindfulness therapies may improve problematic drinking by increasing resilience to stress induced negative mood and alcohol-seeking, as observed in this study. The weaker therapeutic effect of breath counting in more dependent drinkers may reveal limitations to this intervention strategy.
... Analysis indicated a minimum of 95 participants needed to detect an effect size of 0.3, with α = 0.05 and power =0.80. The expected effect size of 0.3 was based on the previous studies that showed a medium effect (e.g.: Kohl, Rief, & Glombiewski, 2012;McMullen et al., 2008) for both outcomes. Participants were students recruited through announcements on social media. ...
Article
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Cognitive behaviour therapy through cognitive restructuring is often used to challenge the dysfunctional thoughts regarding pain. Adjacent, acceptance and commitment therapy (ACT) uses acceptance or cognitive diffusion techniques to change the function of negative pain thoughts rather than modify their content. Previous research has shown that acceptance increases the pain tolerance. This study sought to replicate and extend these findings by comparing the impact of acceptance with that of cognitive restructuring and distraction in a sample of participants with induced pain using cold water. Participants (N=95) received a detailed training how to successfully apply these strategies when experiencing pain and then practiced the assigned technique as homework for 1 week. Before the training, after the training and after 1-week practice participant’s measures of pain intensity and pain tolerance were taken. Results suggest that these strategies are equally effective in increasing pain tolerance and decrease pain intensity but work through distinct processes of change. Findings are discussed in the context of theoretical and practical implications and provide further directions.
... The ways in which people speak about depression, including through their use of specific idioms and metaphors, could be used in counselling and therapy, with clinicians exploring these expressions and using them as a communication bridge (Tay, 2012). Moreover, clinicians may create metaphors as a way for their clients to cope with distressing problems (McMullen et al., 2008). The common presentation with physical symptoms needs to be included in this context. ...
Article
People from different cultural settings may differ in their presentation with depression. Exploration of experiences was assessed through interviews with 20 Javanese adults aged from 18 to 55 years in Yogyakarta, Indonesia, who had mild to moderate depression. Five themes emerged from the interviews as characteristic of Javanese experiences of depression: internalised and externalised emotions, loss of interest in social and religious activities, disturbance in cognition, the presence of physical symptoms, and suicidal ideation. Javanese respondents used particular terms to explain their depression. Attending to how people’s expression and experiences of their depression might enhance the capacity of clinicians to understand cultural variation, in order to respond appropriately to their clients.
... Also, correlational studies have illustrated that greater acceptance of pain is associated with better functioning (McCracken and Eccleston, 2003;Wicksell et al., 2008bWicksell et al., , 2010a. Furthermore, several laboratory studies have reported on the usefulness of acceptance strategies as compared with control-oriented coping techniques such as relaxation or distraction (McMullen et al., 2008). In addition, findings from the present study correspond with the existing body of literature supporting the utility of a cognitive behavioural approach to FM (Bernardy et al., 2010;Glombiewski et al., 2010). ...
Article
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Background Recent developments within cognitive behavior therapy (CBT) have emphasized the utility of acceptance and mindfulness strategies, contrasting interventions focused on reduction or control of symptoms. A study of fMRI changes after CBT in females with fibromyalgia (FM) has been performed and results are presented elsewhere (under review). The aim of the present study was evaluate the effectiveness of Acceptance and Commitment Therapy (ACT)-based intervention for patient diagnosed with FM in comparison with a wait-list control Method Female patients aged 18-55 years, fulfilling the American College of Rheumatology classification criteria for FM, and with a weekly self-reported average pain intensity of >40 (VAS 0-100) were considered eligible for inclusion. Participants completed a set of questionnaires prior to treatment, immediately following the treatment and at follow 3-4 months post treatment. Primary outcome variable was pain disability (PDI). FIQ, SF36, SES, STAI, pain intensity, BDI, PIPS (psychological inflexibility in pain scale) were also used. The ACT-intervention consisted of twelve weekly group sessions, ten with psychologist and two with pain physician. Treatment was evaluated and mediation analyses were performed. Results Primary outcome measure (PDI): A significant improvement in pain disability for ACT in relation to the control condition, p < 0.001. Secondary outcome measures: ACT showed significant improvement in mental health quality of life, self-efficacy, depression, and anxiety. Consistent with hypotheses, ACT did not result in significant changes in either physical quality of life or pain intensity. Mediation analyses: A decrease in psychological inflexibility from pre to post assessments significantly mediated the improvement in pain disability. Conclusion The present study supports the utility of using a relatively brief ACT intervention in a group format for women diagnosed with fibromyalgia, and data suggests a mediating function on improvements in psychological flexibility.
Article
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The present study aimed to extend the existing literature of mindfulness as a stress protective factor by (1) exploring the role of mindfulness state, not only in response to but also in anticipation of acute pain and (2) investigating an explanatory pathway, decreased rumination, between anticipation of acute pain and cognitive performance, with mindfulness moderating this indirect effect. One-hundred-and-four undergraduates were assessed for state mindfulness and then underwent an acute pain induction using the cold pressor task (CPT). Pain measures included pain threshold, pain tolerance, pain intensity, short-form McGill Pain questionnaire, and pain catastrophizing. Next, half of the participants were told that they would be repeating the CPT after some intervening tasks; half were not told to expect a second CPT. Participants completed a Cognitive Estimation Task (CET) that involved problem-solving, followed by a measure of rumination during CET. Results showed no meaningful associations between mindfulness state and sensory measures of pain (e.g., pain tolerance, pain threshold), but higher mindfulness state was related to lower pain catastrophizing and lower McGill affective subscale scores. There was also evidence of a moderated indirect effect: the indirect effect of condition through rumination on CET performance was moderated by mindfulness. That is, those in the anticipation condition with higher mindfulness state later reported ruminating less during CET and performed better at CET. Mindfulness thus appeared to have a protective role in maladaptive emotional responses when one anticipates acute pain, shielding self-regulatory resources needed to think flexibly when expecting a stressor.
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Modern behavioral therapies have claimed that thought stopping is an ineffective technique. This study compares the effectiveness of thought stopping and cognitive defusion on self-reported discomfort and the ability to deal with negative thoughts. 60 participants were randomly assigned to three groups: thought stopping, cognitive defusion and control group. Results from our study indicate that both techniques significantly reduced self-reported discomfort compared to the control group and there were significant differences between techniques in self-perceived ability to deal with thoughts and in self-perceived usefulness, with better results for thought stopping. Our results support that thought stopping, if properly trained, is at least as efficient as cognitive defusion. The authors discuss the mechanisms underlying both techniques and highlight the relevance of functional analysis to select the techniques to be applied to deal with negative thoughts. © 2014, Fundacion para el Avance de la Psicologia Clinica Conductual. All rights reserved.
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This chapter provides an overview of the key issues, challenges, and concerns involving contextual approaches to psychotherapy and clinical assessment. Applied behavior analysis with its emphasis on operant principles, along with psychotherapeutic approaches, such as systematic desensitization, based on respondent principles dominated the first generation of behavior therapy. The chapter focuses on some of the challenges in evaluating in-session therapist and client behavioral interactions that still need to be resolved for matters of this sort to be addressed empirically. It discusses the promise that a contextualistic perspective toward clinical assessment may offer in bridging this science practice gap within a wide array of psychotherapeutic approaches that include, but are not limited to contextual behavioral science (CBs). The development of psychometrically sound process measures is necessary, but not sufficient, for practitioners to have the means of guiding and making adjustments to the services they offer.
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This systematic review aims to review and update the current state of research on the acceptance strategy for a healthy population in a laboratory setting. Using a previously defined search strategy, the PsycInfo, PubMed, and Web of Science databases were searched from 1961 to May 2020 for articles on this topic. Twenty-five high-quality articles, involving a total of 2265 participants, met inclusion criteria. According to these results, acceptance is a strategy with promising outcomes for handling pain in healthy populations, although its superiority over other strategies to reduce negative affect, anger, and other pain variables is unclear. The instructions and outcome variables vary widely between studies, and few studies compare acceptance with mindfulness. We discuss these findings and provide information to guide future researchers for designing fine-grained investigations that can address the gaps in this area.
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The current study examined the impact of a brief “verbal rehearsal” task on performance on two Implicit Relational Assessment Procedures (IRAPs), actual approach behavior towards a live spider (a BAT), and the relationship between the IRAPs and the BAT. Participants first completed the Fear of Spiders Questionnaire (FSQ), followed by one of two verbal rehearsal tasks, one of which focused on fear-acceptance and the other on fear-reduction as ways of coping with fear. All participants then completed two IRAPs similar to those employed by Leech, Barnes-Holmes, and Madden (2016). Finally, participants completed the BAT using a live common house spider. Broadly similar findings were obtained for performance on the IRAPs as were reported by Leech et al. No significant differences between the two verbal-rehearsal conditions emerged on the self-report measures, the IRAPs, or the BAT. However, correlations between performances on the IRAPs and the BAT were concentrated in the reduce-fear condition. When considered in the context of the results previously reported by Leech et al., the differential pattern of correlations observed in the current study suggest that the verbal rehearsal task impacted upon a behavior-behavior relation that may be directly relevant to the concept of defusion in the Acceptance and Commitment Therapy literature.
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This chapter examines the degree of empirical support available for the theoretical model, treatment components, and clinical applications of acceptance and commitment therapy (ACT). It highlights the clinical implications of existing knowledge and theoretical model of ACT as well as key questions to be tested in future research. Psychological inflexibility is the core pathological process targeted by ACT. ACT is designed to be a transdiagnostic treatment targeting a common core pathological process and mechanism of change. Thus, quite naturally, ACT has been applied broadly across clinical populations. Behavior therapies share common components with ACT but may offer advantages because they are more efficiently targeted at the behavioral strategies to promote clinical change. Preliminary moderation research has highlighted some clues regarding for whom ACT or traditional cognitive behavioral therapy (CBT) may be more effective in the area of anxiety disorders.
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Acceptance approaches, which have been receiving increased attention within behavior therapy, seek to undermine the linkage between private events and overt behavior, rather than attempting to control the form or frequency of private events per se. Research comparing control versus acceptance strategies is limited. The present study examined the behavioral and subjective impact of a control-based versus acceptance rationale, using a cold pressor task. Subjects in the acceptance group demonstrated greater tolerance of pain compared to the control-based and placebo groups. Only the control-based rationale targeted the subjective experience of pain but it did not differ across rationales. Results confirmed that acceptance was effective in manipulating the believability of reason giving, a key process measure. By encouraging individuals to distance themselves from their private events, acceptance methods may help reduce the use of emotional reasons to explain behavior and hence shift concern from moderating thoughts and feelings to experiencing the consequences of one's action. Acceptance is a promising new technique. Its effect is all the more surprising given that it teaches principles (e.g., "thoughts do not cause behavior") that run counter both to the popular culture and to the dominant approaches within empirical clinical intervention.
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Full-text available
Acceptance approaches , which have been receiving increased attention within behavior therapy, seek to undermine the linkage between private events and overt behavior, rather than attempting to control the form or frequency of private events per se. Research comparing control versus acceptance strategies is limited. The present study examined the behavioral and subjective impact of a control-based versus acceptance rationale, using a cold pressor task. Subjects in the acceptance group demonstrated greater tolerance of pain compared to the control-based and placebo groups. Only the control-based rationale targeted the subjective experience of pain but it did not differ across rationales. Results confirmed that acceptance was effective in manipulating the believability of reason giving, a key process measure. By encouraging individuals to distance themselves from their private events, acceptance methods may help reduce the use of emotional reasons to explain behavior and hence shift concern from moderating thoughts and fee lings to experiencing the consequences of one's action. Acceptance is a promising new technique. Its effect is all the more surprising given that it teaches principles (e.g., "thoughts do not cause behavior") that run counter both to the popular culture and to the dominant approaches within empirical clinical intervention.
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This study compares specific acceptance-based strategies and cognitive-control-based strategies for coping with experimentally induced pain. Forty participants were randomly assigned to an acceptance-based protocol (ACT), the goal of which was to disconnect pain-related thoughts and feelings from literal actions, or to a control-based protocol (CONT) that focused on changing or controlling pain-related thoughts and feelings. Participants took part in a nonsense-syllables-matching task that involved successive exposures to increasingly painful shocks. In both conditions, the task involved an overall value-oriented context that encouraged the participants to continue with the task despite the exposure to pain. At times throughout the task, participants were asked to choose to continue with the task and be shocked or stop the task and avoid being shocked. Each choice had specific costs and benefits. Participants performed the task twice, both before and after receiving the assigned experimental protocol. Two measures were obtained at pre- and post-intervention: tolerance of the shocks and self-reports of pain. ACT participants showed significantly higher tolerance to pain and lower believability of experienced pain compared to the CONT condition. Conceptual and clinical implications are discussed.
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This study compares the effect of an acceptance-based protocol (ACT) and a cognitive control-based (CONT) protocol on three measures of pain coping: tolerance, self-report, and believability. Specific methodological controls were employed to further isolate the role of the value of participating in a pain task, compared to previous investigations on the alteration of the function of aversive stimulation. Twenty participants were randomly assigned to one of the conditions (ACT vs. CONT), and a pre-post design was used. In the ACT condition, the protocol established a relation of coordination between the pain-related thoughts and the actions in the valued direction. In the CONT condition, the protocol established a relation of opposition between the same aspects. Results show an increase in pain tolerance and a reduction of self-reported pain at posttest for both conditions. However, ACT participants showed significantly lower believability of pain than did CONT participants. Conceptual and clinical implications are discussed.
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Acceptance of chronic pain entails that an individual reduce unsuccessful attempts to avoid or control pain and focus instead on participation in valued activities and the pursuit of personally relevant goals. Recent research suggests that pain-related acceptance leads to enhanced emotional and physical functioning in chronic pain patients above and beyond the influence of depression, pain intensity, and coping. In these studies, acceptance was measured using the Chronic Pain Acceptance Questionnaire (CPAQ). Preliminary analyses of the CPAQ have supported its psychometric properties. The present study sought to further refine the CPAQ by examining its factor structure and evaluating the relations of these factors to other indices of pain-related distress and disability. Although a previously demonstrated factor structure of the CPAQ was generally supported, only factors assessing (a) the degree to which one engaged in life activities regardless of the pain and (b) willingness to experience pain had adequate reliability and validity and were significantly related to the other measures of patient functioning. A revised version of the CPAQ is suggested.
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The current study reflects recent developments in psychotherapy by examining the effect of acceptance-based coping instructions, when compared to the opposite, more control/distraction-based instructions, on cold-pressor pain. Since previous research indicates gender differences in how people cope with pain, we also sought to determine whether differences would be found between healthy men and women. As predicted, results indicated that women reported lower pain threshold and tolerance level than did men. Furthermore, the acceptance-based instruction resulted in lower sensory pain reports when compared to the opposite instructions. Finally, for affective pain, acceptance instructions only benefited women. These results suggest that acceptance-based coping may be particular useful in moderating the way in which individuals, especially women, cope with pain.
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Wegner's Theory of Ironic Processes has been applied to study the effects of cognitive strategies to control pain. Research suggests that suppression contributes to a more distressing pain experience. Recently, the acceptance-based approach has been proposed as an alternative to cognitive control. This study assessed the tolerance time, the distress and the perceived pain intensity in three groups (suppression, acceptance and spontaneous coping groups) when the participants were exposed to a cold pressor procedure. Two hundred and nineteen undergraduates volunteered to participate. The suppression group showed the shortest tolerance time and the acceptance group showed the longest tolerance time. The acceptance group showed pain and distress immersion ratings that were significantly lower than in the other two groups, between which the differences were not significant. In the first recovery period, the suppression group showed pain and distress ratings that were higher than in the other two groups. In the second recovery period, although the acceptance group showed pain and distress ratings that were significantly lower than in the other two groups, the suppression and the spontaneous coping groups did not differ. The presence of a 'rebound' of physical discomfort and the effects of suppression on behavioural avoidance are discussed. These results support the acceptance approach in the management of pain.
Doing what you do not want to do to achieve valued outcomes: Acceptance and valuing in the face of aversive stimulation
  • B Johnson
  • I Stewart
  • D Barnes-Holmes
  • Y Barnes-Holmes
  • C Luciano
  • K Wilson
Johnson, B., Stewart, I., Barnes-Holmes, D., Barnes-Holmes, Y., Luciano, C., Wilson, K. (2004). Doing what you do not want to do to achieve valued outcomes: Acceptance and valuing in the face of aversive stimulation. Paper presented at the symposium: Behavior therapy: Process oriented experimental analyses, held at the annual conference of the Psychological Society of Ireland, Cork Ireland, November 2004.
Coping with pain in the motivational context of values: Comparison between an acceptance-based and a cognitive-control-based protocol. Behavior Modifcation
  • M Paéz-Blarrina
  • C Luciano
  • O Gutie´gutie´rrez-Martı´martı´nez
  • S Valdivia
  • M Rodrı´rodrı´guez
  • J Ortega
Paéz-Blarrina, M., Luciano, C., Gutie´Gutie´rrez-Martı´Martı´nez, O., Valdivia, S., Rodrı´Rodrı´guez, M., Ortega, J. (in press). Coping with pain in the motivational context of values: Comparison between an acceptance-based and a cognitive-control-based protocol. Behavior Modifcation. ARTICLE IN PRESS