Michael P. Twohig's research while affiliated with Utah State University and other places

Publications (232)

Article
While the efficacy of internet-based acceptance and commitment therapy (ACT) has been examined for different mental health concerns in high-income countries, evidence for the potential efficacy of culturally-adapted ACT in non-Western, low- and middle-income countries is scarce. The present study is a randomized, waitlist-controlled trial of cultur...
Article
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Purpose This study sought to explore the associations between Intuitive Eating (IE), eating disorder (ED) symptom severity, and body image-related cognitive fusion within a clinical sample. IE was also examined as a possible mediator in the relationship between body image-related fusion and ED symptoms. Methods This study includes cross-sectional...
Article
Objective: To determine whether an acceptance and commitment training (ACT) program targeting reactions to difficult client interactions would reduce burden transfer, stress, and burnout among veterinary healthcare teams. Sample: Small animal veterinary hospital employees randomly assigned to participate in an ACT program (intervention group; n...
Preprint
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Process-based therapy (PBT) is model of psychotherapy designed to improve people’s ability to use a variety of skills from evidence-based treatments to match environmental needs and personal goals in the moment. This randomized trial tested the effect of an online self-help intervention modeled after PBT principles for participants with perfectioni...
Article
Process-based therapy (PBT) is model of psychotherapy designed to improve people's ability to use a variety of skills from evidence-based treatments to match environmental needs and personal goals in the moment. This randomized trial tested the effect of an online self-help intervention modeled after PBT principles for participants with perfectioni...
Article
Previous research indicates that a combination of Acceptance and Commitment Therapy (ACT) and Exposure and Response Prevention (ERP) is an effective treatment for obsessive-compulsive disorder (OCD). However, there are no studies to date of ACT for OCD in Latin American populations. Because socio-cultural context influences OCD symptomatology, it i...
Article
Trichotillomania is a chronic and impairing disorder typically beginning in youth. There is growing research on the use of acceptance-enhanced behavior therapy (AEBT) for trichotillomania in youth. However, few studies explore long-term outcomes for youth who receive treatment for trichotillomania, particularly AEBT. The current study presents long...
Article
Anxiety disorders are one of the most prevalent diagnoses in youth, often resulting in impaired social and school functioning. Research on treatments for youth anxiety is primarily based in traditional clinical settings. However, integrating youth psychotherapies into the school environment improves access to evidence-based care. The present study...
Article
Objective: Consistent hearing aid use is essential for spoken language development of children who are hard of hearing. A recent randomised controlled trial of an eHealth hearing aid management education program found the intervention increased knowledge, perceptions, confidence, and device monitoring among parents of young children. Yet, it is not...
Article
Exposure and response prevention (ERP) is the most empirically supported treatment for obsessive-compulsive disorder (OCD). However, details on how to effectively conduct ERP are lacking. The current study aimed to identify exposure parameters associated with better subsequent outcomes in ERP for OCD. We analyzed data from 271 therapy sessions acro...
Article
Purpose The purpose of this study was to investigate parent goals, questions, and challenges that emerged during coaching phone calls in an eHealth program designed to provide education and support for hearing aid management. Method Coaching phone calls were audio-recorded, transcribed, and qualitatively analyzed for emergent themes within the cat...
Article
Intensive outpatient treatment settings for adults with obsessive-compulsive disorder (OCD) are common, but data on their effectiveness are limited. The effectiveness of IOP treatment for adults with OCD using combined acceptance and commitment therapy (ACT) and exposure and response prevention (ERP) was studied with eight adults. The intervention...
Article
Intensive treatments for youth obsessive-compulsive disorder (OCD) are important and underresearched. This study used three adolescent cases to assess the preliminary efficacy of an intensive treatment combining acceptance and commitment therapy (ACT) with exposure and response prevention (ERP) for OCD. Participants received intensive treatment for...
Article
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The global burden of mental illness and limited resources make increasing the efficiency of available mental healthcare resources especially crucial. One way this can be done is a stepped care approach to treatment. To test the viability of using internet-based self-help in a stepped care model, we examined the feasibility, acceptability, and effec...
Chapter
Acceptance and commitment therapy (ACT) is a cognitive-behavioral therapy that developed out of behavior analysis with the goal of addressing the impact of language and cognition on human behavior. Theoretical, experimental, cross-sectional, and intervention studies on ACT for obsessive-compulsive and related disorders (OCRDs), as well as the devel...
Article
Individuals with eating disorders (EDs) may be particularly susceptible to body image related cognitive fusion (i.e., excessive entanglement with one’s body image related thoughts such that they unduly influence on behavior). The Cognitive Fusion Questionnaire-Body Image (CFQ-BI) is the only existing measure of this construct, yet its psychometric...
Article
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Clinical perfectionism is the rigid pursuit of high standards, interfering with functioning. Little research has explored neural patterns in clinical perfectionism. The present study explores neural correlates of clinical perfectionism, before and after receiving ten 50-minute, weekly sessions of acceptance and commitment therapy (ACT), as compared...
Article
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Background Hoarding disorder (HD) affects approximately 2.5% of the general population, leads to significant distress and impairment, and is notoriously difficult to treat. The crux of developing effective treatments for HD is our ability to reliably and validly measure relevant constructs in HD to better understand its presentation and, subsequent...
Article
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Generalized anxiety disorder (GAD) is a common and debilitating condition. Effective treatments exist, but they are time- and resource-intensive. This study tested the initial efficacy and acceptability of a novel treatment protocol designed to increase efficiency: acceptance and commitment therapy (ACT) taught in groups and through an adjunctive m...
Article
Aims To determine whether an educational programme targeting the reaction of veterinary medicine personnel to difficult client interactions reduces burden transfer, stress and burnout in veterinary medicine staff. Methods Employees of three small animal veterinary hospitals in the south-western United States of America were recruited and randomise...
Article
Full-text available
Objective: Perfectionism is generally associated with worse mental health outcomes, though evidence suggests elements of it may be helpful. In light of these findings, we examined whether psychological skills like psychological flexibility and self-compassion moderated the relationship between perfectionism and wellbeing (i.e., quality of life, sy...
Article
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Treatment of adolescent trichotillomania is understudied, and treatment providers are difficult to find. In this pilot study, we compared ACT-enhanced behavior therapy to a waitlist, with treatment delivered over Zoom, to 28 adolescents who met criteria for trichotillomania. This study partially occurred during the COVID-19 pandemic. A detailed des...
Article
Objective: Parents frequently experience challenges implementing daily routines important for consistent hearing aid management. Education that supports parents in learning new information and gaining confi- dence is essential for intervention success. We conducted a pilot study to test an eHealth program to determine if we could implement the prog...
Article
Full-text available
Hoarding disorder (HD) is associated with distress and functional impairment not only for the individual but also for their family members and community. Acceptance and commitment therapy (ACT) already has broad empirical support and may be helpful for treating HD. In this nonconcurrent multiple baseline study (N = 6), we examined the effect of ACT...
Article
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A process-based therapy approach emphasizes examining how and for whom specific therapeutic components linked to specific processes of change function. This preliminary study explored the processes of change for cognitive defusion and restructuring with daily ratings of self-criticism from a larger component trial as well as self-compassion as a mo...
Article
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Previous research indicates mixed results for guided support with online interventions. The current secondary analysis evaluated the effects of phone coaching from a dismantling trial of online acceptance and commitment therapy (ACT) in a sample of 136 distressed college students randomized to one of three versions of an ACT website. Participants w...
Article
This study compared the effects of adding acceptance and commitment therapy (ACT) or exposure and response prevention (ERP) to adults diagnosed with obsessive compulsive disorder (OCD) already on an optimal and stable dose of selective serotonin reuptake inhibitors (SSRIs). Forty adults on SSRIs who were diagnosed with OCD participated in a randomi...
Article
Background Psychosocial well-being can interfere with engagement in activities of daily life. Consideration of psychosocial domains within hearing health care can expand audiologists' ability to understand treatment barriers and provide an opportunity to jointly address challenges. Purpose This study explored psychosocial well-being and predictors...
Article
Objective This study qualitatively explored the factors that influence how parents of children who are Deaf or hard-of-hearing with Down syndrome prioritise hearing care and management and developed an associated theory to explain that priority. Design Grounded theory was used for the purposes of this qualitative study. Data were collected using i...
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The efficacy of Acceptance and Commitment Therapy (ACT) has been evaluated in many randomized controlled trials investigating a broad range of target conditions. This paper reviews the meta-analytic evidence on ACT. The 20 included meta-analyses reported 100 controlled effect sizes across n = 12,477 participants. Controlled effect sizes were groupe...
Article
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The authors investigated the effectiveness of acceptance and commitment therapy (ACT) for the treatment of death anxiety and obsessive-compulsive disorder (OCD) with eight adult women in Iran. The ACT protocol was conducted in weekly solo sessions with each participant for 8 weeks (45 minutes each). The results were analyzed by visual analysis meth...
Article
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Background Self-help resources such as books may help meet critical mental health needs in college students, but there is insufficient evidence on whether and how such books work. This randomized trial compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (tCBT) self-help books for social anxiety, a common conc...
Article
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Clinical perfectionism is associated with various cognitive processes including performance monitoring and emotion regulation. This exploratory study analyzed neurological data from a randomized controlled trial for clinical perfectionism that compared acceptance and commitment therapy (ACT) to a waitlist control. The objective was to assess the ef...
Article
Purpose The purpose of this study was to explore the role of psychological processes (i.e., internalized shame, self-efficacy, psychological inflexibility) regarding hearing loss in the well-being of adults who have hearing loss. Method This study used a cross-sectional survey design. Two hundred sixty-four surveys were submitted for analysis. Dat...
Chapter
This chapter outlines how a first session of acceptance and commitment therapy (ACT) might go. This first session typically includes two components: (1) orienting clients to what to expect from therapy generally and ACT specifically, and (2) beginning work on creative hopelessness. Key points emphasized in this chapter are learning about clients’ p...
Chapter
This chapter provides an overview of how to conduct a clinical assessment when doing acceptance and commitment therapy (ACT). It outlines the functional basis of ACT as a therapeutic model and its implication: ACT is focused on the effect or purpose of behaviors, rather than their form. The four main areas of assessment covered in this chapter are...
Chapter
This chapter provides a broad overview of acceptance and commitment therapy (ACT), including empirical evidence for its effectiveness, how it fits with other cognitive-behavioral therapies, and defining features of ACT. The chapter also explains the theory and scientific philosophy underlying ACT so that readers have a framework to which to refer a...
Chapter
This chapter covers content that would be helpful after clients have been practicing willingness in the service of living a more meaningful life. More explicit work on values begins here, to give clients context for practicing difficult skills, such as acceptance and defusion. The chapter also describes how to further build on acceptance and defusi...
Chapter
This chapter describes a session focused on values work within the context of acceptance and commitment therapy (ACT). Values work or talking about values can help increase engagement in therapy, but the ultimate goal of clarifying values is to increase clients’ awareness of what truly matters to them so they have a meaningful direction in which to...
Chapter
This chapter builds on work described in Chapter 4, on creative hopelessness. Specifically, the therapist will continue to focus clients’ attention on the effects and effectiveness of trying to control thoughts and feelings. Once clients are able to track the limited effectiveness of attempts to control thoughts and feelings, the therapist can segu...
Chapter
This chapter builds on previous chapters that covered acceptance, defusion, mindfulness, self-as-context, and values in acceptance and commitment therapy (ACT). The emphasis in therapy now turns to using values as a foundation for behavior change and skill maintenance. It is possible that clients did not fully grasp the function of values in the pr...
Chapter
This chapter provides session outlines for covering acceptance and defusion with clients. It also describes how to be experiential when doing acceptance and commitment therapy (ACT). At this point in therapy, we expect that clients may not be fully on board with the idea of acceptance. Thus, the chapter provides some guidance on how to practice acc...
Chapter
This chapter provides an introduction to the worldview underlying the therapeutic context in acceptance and commitment therapy (ACT) and how this worldview influences what ACT sessions typically look like. In ACT, the therapeutic relationship is seen as a context in which clients learn to become more psychologically flexible or to interact with the...
Chapter
This chapter opens with teaching therapists how to lead a brief mindfulness exercise at the start of therapy sessions to increase clients’ present-moment awareness. The chapter describes the NOTE acronym as a means to help clients remember the skills they have learned up to this point: to notice what is happening, observe thoughts and feelings for...
Book
This book is a guide for new therapists on the use of acceptance and commitment therapy (ACT) for any psychological disorder that involves some level of struggle with inner experiences; it is not targeted to any particular diagnosis. The book is suitable for graduate students who are seeing their first client, for clinicians with years of experienc...
Chapter
This chapter provides an outline for a typical last session of acceptance and commitment therapy (ACT). The chapter describes how to assess readiness for therapy termination and debrief the course of therapy. In addition, the chapter highlights a few points that may be worth covering in a last session: predicting barriers to behavior change, troubl...
Article
Interventions for hoarding disorder need to target difficulty letting go of items to reduce clutter and improve functioning. The present studies were designed to test the efficacy of brief cognitive interventions for letting go of possessions and self-report outcomes. Participants ( N = 67 in Study 1; N = 110 in Study 2) received training on defusi...
Article
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Psychological inflexibility is a rigid behavioral pattern that interferes with engagement in personally meaningful activities; it is the hypothesized root of suffering in acceptance and commitment therapy (ACT). Thus, the quality of its measurement affects the research, theory, and practice of ACT. The current study aimed to evaluate the discrimina...
Article
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This secondary analysis examined the processes of change from a randomized dismantling trial evaluating the Open (i.e., cognitive defusion, acceptance) and Engaged (i.e., values, committed action) components of acceptance and commitment therapy (ACT). Analyses were conducted with 161 distressed college students randomly assigned to a full online AC...
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Objectives Self-help has the potential to improve access to mental health resources for college students. However, solutions are needed to improve sustainable delivery and cost-effectiveness, and to know which resources are most useful.MethodsA sample of 109 college students were randomly assigned to read either an acceptance and commitment therapy...
Article
Full-text available
Purpose: The purpose of this study was to explore factors influencing the well-being of parents who have children who are deaf or hard of hearing (DHH) and to compare their experiences to non-clinical samples. Method: A cross-sectional online survey was used to collect data (N = 296). Results: Data analyses revealed the majority of parents of child...
Article
Obsessive Compulsive Disorder (OCD) is among the most common psychiatric comorbidities with eating disorders (EDs) and most studies have only examined this relationship at a diagnostic level. More research is needed to determine whether specific symptom domains and cognitive patterns commonly observed in OCD are most salient among individuals with...
Article
Changes in psychological flexibility were tracked in a combined protocol of exposure and response prevention (ERP) and acceptance and commitment therapy (ACT) for adults with OCD to assess if changes in psychological flexibility processes were unique to ACT intervention (e.g., not impacted by ERP). Using a non-concurrent multiple baseline design, f...
Article
Full-text available
This dismantling trial compared the effects of a full online Acceptance and Commitment Therapy (ACT) intervention to the isolated effects of the Open (i.e., acceptance, cognitive defusion) and Engaged (i.e., values, committed action) components of ACT. A sample of 181 distressed college students were randomized to one of four conditions: a 12-sessi...
Article
Exposure and response prevention (ERP) is an effective treatment for obsessive compulsive disorder (OCD); yet, improvement rates vary and it is therefore important to examine potential predictors of outcome. The present study examined adherence with ERP homework as a predictor of (a) treatment response across OCD symptom dimensions and (b) reductio...
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This article describes process-based therapy (PBT) as a natural evolution toward more effective and efficient mental health care. Using acceptance and commitment therapy (ACT) as an example of an early prototype of PBT, the article explicates the broader features of PBT and the shift in mindset researchers and clinicians will need to take to fully...
Article
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Hoarding symptoms include difficulty letting go of possessions, excessive acquisition, and clutter that precludes use of active living spaces. The current study compared the effect of acceptance training to that of psychoeducation on hoarding severity in a sample of college students with elevated hoarding symptoms. Participants (N = 47) completed s...
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This study examined the function of hoarding behaviors and the relations between hoarding and a series of cognitive and affective processes in the moment using ecological momentary assessment. A matched-groups design was used to compare college students with higher hoarding symptoms (n = 31) and matched controls (n = 29). The two groups did not dif...
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The present study evaluated moderators and processes of change in a randomized controlled trial comparing exposure and response prevention (ERP) delivered from a traditional framework versus ERP from an acceptance and commitment therapy framework (ACT + ERP) for obsessive-compulsive disorder (OCD). This paper presents baseline, weekly session, post...
Article
Purpose Clinical supervision for counseling skill development can be variable and can undermine student ability to learn patient-centered care communication. The current study aimed to evaluate the effectiveness of consultation and feedback sessions on counseling behavior, in actual clinical practice, among clinical audiology supervisors. We also c...
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Background: There is robust evidence that mindfulness trainings enhance mindfulness as operationalized in Western psychology, but evidence about their effect on aspects of heartfulness is sparse. The present study, therefore, sought to evaluate whether a brief mindfulness training enhances heart qualities, including self-compassion, gratitude, and...
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Objectives: Most research on mindfulness and meditation has focused on structured therapeutic interventions, such as mindfulness-based stress reduction, or meditation retreats. Such programs have received moderate empirical support for improving psychological outcomes in clinical and nonclinical populations, but there remains a paucity of research...
Article
Cognitive fusion (CF), involves the tendency to “buy in” to thoughts and feelings and consists of three empirically established domains: somatic concerns, emotion regulation, and negative evaluation. CF is hypothesized to play a role in obsessive‐compulsive disorder (OCD). The present study examined how well the CF domains, relative to traditional...
Article
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Online acceptance and commitment therapy (ACT) is promising for treating a range of psychological problems. Component research can further clarify which components are needed for optimal outcomes in what contexts. Online platforms provide a highly controlled format for such research. In this pilot trial, 55 adults were randomized to: ACT-Open (i.e....
Article
Trichotillomania (TTM) involves the chronic pulling out of hair to the point of hair loss or thinning, which continues despite repeated attempts to stop. Behavior therapy is a promising treatment for the condition, but studies have been limited by the lack of a credible control condition, small sample sizes, follow-up periods of short duration, and...
Article
Objective: Hearing loss is a chronic condition that impacts functioning among individuals with hearing loss and caregivers of children with hearing loss. Even though treatments for hearing loss can alleviate functional impairment, psychological factors like psychological inflexibility may interfere with treatment engagement and adherence, undermini...
Article
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The current study examined psychological inflexibility and self-compassion as theoretically relevant mediators and moderators of outcomes following acceptance and commitment therapy (ACT) for clinical perfectionism. Fifty-three participants with clinical perfectionism were randomized to either a 10-session ACT condition or a 14-week waitlist contro...
Article
Full-text available
Clinical perfectionism is characterized by imposing excessively high standards on oneself and experiencing severe distress when standards are not met. It has been found to contribute to the development and maintenance of various clinical presentations including anxiety, obsessive-compulsive, and eating disorders. The present study tested the effica...
Article
Purpose Counseling practices in audiology play a critical role in helping patients and families understand, accept, and adjust to the dynamic impacts ear-related disorders have on their lives. The purpose of this study was to identify what competencies (i.e., knowledge, skills, and attitudes) are important for audiologists to possess to provide eff...
Article
Symptom reduction over the course of cognitive-behavioral therapy is not always distributed evenly across sessions. Some individuals experience a sudden gain, defined as a large, rapid, and stable decrease in symptoms during treatment. Although research documents a link between sudden gains and treatment for depression and anxiety, findings in the...
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Conducted in Iran, participants included 69 adolescents with obsessive-compulsive disorder (OCD) who were on a stable selective serotonin reuptake inhibitor (SSRI) dose and were randomly assigned to one of three conditions: group acceptance and commitment therapy (ACT)+SSRI, group cognitive behavioral therapy (CBT)+SSRI, or continued SSRI treatment...