Showing papers on "Acceptance and commitment therapy published in 2013"

Mobile Mental Wellness Training for Stress Management: Feasibility and Design Implications Based on a One-Month Field Study

Abstract: Background: Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens. Objective: The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management. Methods: Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week’s and one month’s use. In-depth user experience interviews were conducted after one month’s use to study the acceptance and user experiences of Oiva. Results: Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P =.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P =.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems. Conclusions: A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection. [JMIR Mhealth Uhealth 2013;1(2):e11]

Pilot Randomized Controlled Trial of Web-Based Acceptance and Commitment Therapy for Smoking Cessation

Abstract: OBJECTIVE Web-based smoking cessation interventions have high reach, but low effectiveness. To address this problem, we conducted a pilot randomized controlled trial of the first web-based acceptance and commitment therapy (ACT) intervention for smoking cessation. The aims were to determine design feasibility, user receptivity, effect on 30-day point prevalence quit rate at 3 months post-randomization, and mediation by ACT theory-based processes of acceptance. METHODS Adult participants were recruited nationally into the double-blind randomized controlled pilot trial (N = 222), which compared web-based ACT for smoking cessation (WebQuit.org) with the National Cancer Institute's Smokefree.gov-the U.S. national standard for web-based smoking cessation interventions. RESULTS We recruited 222 participants in 10 weeks. Participants spent significantly longer on the ACT WebQuit.org site per login (18.98 vs. 10.72 min; p = .001) and were more satisfied with the site (74% vs. 42%; p =.002). Using available follow-up data, more than double the fraction of participants in the ACT WebQuit.org arm had quit smoking at the 3-month follow-up (23% vs. 10%; OR = 3.05; 95% CI = 1.01-9.32; p = .050). Eighty percent of this effect was mediated by ACT theory-based increases in total acceptance of physical, cognitive, and emotional cues to smoke (p < .001). CONCLUSIONS The trial design was feasible. Compared with Smokefree.gov, ACT had higher user receptivity and short-term cessation, and strong evidence of theory-based mechanisms of change. While results were promising, they were limited by the pilot design (e.g., limited follow-up), and thus a full-scale efficacy trial is now being conducted.

Measuring experiential avoidance and psychological inflexibility: The Spanish version of the Acceptance and Action Questionnaire - II.

Abstract: Background: Experiential avoidance and psychological inflexibility have been recently found to be important constructs related to a wide range of psychological disorders and quality of life. The current study presents psychometric and factor structure data concerning the Spanish translation of a general measure of both constructs: the Acceptance and Action Questionnaire - II (AAQ-II). Method: Six samples, with a total of 712 participants, from several independent studies were analyzed. Results: Data were very similar to the ones obtained in the original AAQ-II version. The internal consistency across the different samples was good (between a= .75 and a= .93). The differences between clinical and nonclinical samples were statistically significant and the overall factor analysis yielded to a one-factor solution. The AAQ-II scores were significantly related to general psychopathology and quality of life measures. Conclusions: This Spanish translation of the AAQ-II emerges as a reliable and valid measure of experiential avoidance and psychological inflexibility.

Measuring values and committed action with the Engaged Living Scale (ELS): Psychometric evaluation in a nonclinical sample and a chronic pain sample

Abstract: This article describes the development and evaluation of the Engaged Living Scale (ELS) as a new self-report, process-specific measure to assess an engaged response style as conceptualized in acceptance and commitment therapy (ACT). The psychometric properties of the ELS test scores were evaluated in both a nonclinical sample (N = 439) and a clinical sample consisting of chronic pain patients who participated in a study on the effects of an online ACT intervention (N = 238). Item analysis and exploratory factor analysis in the nonclinical sample suggested a 16-item version of the ELS with 2 subscales, Valued Living (10 items) and Life Fulfillment (6 items). A bifactor model with 2 specific factors and 1 general underlying factor showed the best fit in confirmatory factor analyses in the chronic pain sample. In both samples, the scores on the ELS and its subscales showed good internal consistency and construct validity by consistent patterns of relationships with theoretically related process and outcome variables, such as psychological well-being, anxiety/depression, acceptance, mindfulness, and pain interference in daily life. Furthermore, in the chronic pain sample, the ELS showed incremental validity in explaining anxiety and depression, positive mental health, and pain interference beyond both acceptance and mindfulness. This study suggests the ELS shows promise as a useful tool for the measurement of an engaged response style, enabling more comprehensive evaluation of working mechanisms of ACT.

The value of psychological flexibility: Examining psychological mechanisms underpinning a cognitive behavioural therapy intervention for burnout

Abstract: One hundred employees of a UK government department were randomly assigned to one of two conditions: (1) a worksite, group-based, CBT intervention called Acceptance and Commitment Therapy (ACT; n = 43), which aimed to increase participants’ psychological flexibility; and, (2) a waitlist control group (control; n = 57). The ACT group received three half-day sessions of training spread over two and a half months. Data were collected at baseline (T1), at the beginning of the second (T2) and third (T3) workshops, and at six months follow-up (T4). Consistent with ACT theory, analyses revealed that, in comparison to the control group, a significant increase in psychological flexibility from T2 to T3 in the ACT group mediated the subsequent T2 to T4 decrease in emotional exhaustion in the ACT group. Consistent with a theory of emotional burnout development, this significant decrease in emotional exhaustion from T2 to T4 in the ACT group prevented the significant T3 to T4 increase in depersonalization seen in the control group. Strain also decreased from T2 to T3 in the ACT group, only, but no mediator of that improvement was identified. Discussion focuses on implications for theory and practice in the fields of ACT and emotional burnout.

A randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder.

Abstract: Generalized anxiety disorder (GAD) is a chronic anxiety disorder associated with high comorbidity (Bruce, Machan, Dyck, & Keller, 2001), reduced quality of life (Hoffman, Dukes, & Wittchen, 2008) and significant health care utilization (Hoffman et al., 2008). Meta-analyses reveal that cognitive behavioral therapies are efficacious for GAD (Borkovec & Ruscio, 2001; Covin, Ouimet, Seeds, & Dozois, 2008). However, GAD remains one of the least successfully treated of the anxiety disorders (Waters & Craske, 2005), with most studies finding that fewer than 65% of clients meet criteria for high end-state functioning at post-treatment (e.g., Ladouceur et al., 2000; Newman et al., 2011) and few studies examining the impact of treatment on quality of life. Several researchers have aimed to refine and expand existing models of GAD in an effort to more clearly identify causal and maintaining factors to target in therapy (see Behar, DiMarco, Hekler, Mohlman, & Staples, 2009, for a review). Recent randomized controlled trials informed by these models indicate that targeting intolerance of uncertainty (Dugas et al., 2010), and the interpersonal and emotion focused aspects of GAD (Newman et al., 2011) yield effects comparable to existing CBTs for GAD. A small pilot study found that targeting meta-cognition in GAD (Wells et al., 2010) produced better outcomes than applied relaxation, however, the very low rates of response to applied relaxation, coupled with the small sample size, indicate a need for further research to confirm this finding. Roemer and Orsillo (2002) developed a model of GAD informed by research and theory highlighting the potential roles of experiential avoidance (e.g., Hayes, Wilson, Gifford, Follette & Strosahl, 1996) and ruminative, self-critical processing (e.g., Barnard & Teasdale, 1991) in the development and maintenance of psychopathology. Supported by research comparing individuals with and without GAD, this model suggests that those with GAD have a problematic relationship with their internalized experiences characterized by a narrowed attention toward threat (Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van IJzendoorn, 2007), and a critical, judgmental reactivity toward their emotional responses (e.g., Lee, Orsillo, Roemer, & Allen, 2010; Llera & Newman, 2010; Mennin, Heimberg, Turk, & Fresco, 2005) and thoughts (Wells & Carter, 1999). This reaction to internal experiences motivates individuals with GAD to engage in experiential avoidance (e.g., Lee et al., 2010) using a variety of strategies including worry, the central defining feature of GAD. Although worry decreases somatic arousal and helps to distract an individual from more emotional topics (see Borkovec, Alcaine, & Behar, 2004, for a review), rigid habitual efforts at experiential avoidance can paradoxically increase distress (e.g., Hayes et al., 1996), leading to a cycle of reactivity and avoidance that in turn affects behavior. Individuals with GAD are less likely to consistently engage in behaviors that are important to them (i.e., valued actions) and as a result experience a diminished quality of life (Michelson, Lee, Orsillo, & Roemer, 2011). This model led to the development of an acceptance based behavior therapy for GAD (ABBT; Roemer & Orsillo, 2009; Roemer & Orsillo, In press), a flexible treatment adapted from traditional CBT for GAD (e.g., Borkovec et al., 2004), as well as other acceptance-based behavioral therapies including Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), Mindfulness-based Cognitive Therapy (MBCT; Segal, Williams, & Teasdale, 2002), and Dialectical Behavior Therapy (Linehan, 1993), that explicitly target these mechanisms1. Specifically, this ABBT aims to help clients to cultivate an expanded (as opposed to narrowed, threat-focused) awareness along with a compassionate (as opposed to judgmental) and decentered (as opposed to seeing thoughts and feelings as all-encompassing indicators of truth) stance towards internal experiences. These new skills reduce rigid experiential avoidance, as does the explicit promotion of an accepting and willing stance towards internal experiences. Behavioral avoidance and constriction are targeted by encouraging clients to identify and mindfully engage in personally meaningful actions. ABBT uses empathic validation, self-monitoring, formal and informal mindfulness exercises, encouragement of acceptance through psychoeducation and experiential exercises, and writing and behavioral exercises that apply these skills to personally meaningful activities (see Roemer & Orsillo, 2009; in press, for a more detailed presentation of the treatment). Data from an open trial (Roemer & Orsillo, 2007) and waitlist RCT (Roemer, Orsillo, & Salters-Pedneault, 2008) indicate significant effects on clinician-rated and self-report symptom measures of anxiety and depression, as well as self-reported quality of life and high rates of end-state functioning. Clients receiving ABBT report significant decreases in experiential avoidance (Roemer et al., 2008), distress about emotional responses, and intolerance of uncertainty (Treanor, Erisman, Salters-Pedneault, Orsillo, & Roemer, 2011) and significant increases in values-consistent behavior (Michelson et al., 2011). Moreover, both the time spent accepting internal experiences and engaging in valued activities significantly predict outcome (Hayes, Orsillo, & Roemer, 2010) providing support for the proposed mechanisms of action. However, studies are needed that compare this treatment to a credible, efficacious alternative therapy. Other acceptance- and mindfulness-based treatments have also been tested for GAD. A recent study comparing ACT to CBT (with behavioral exposures in both conditions) showed comparable effects of the two treatments, with the 14 individuals with GAD who received ACT demonstrating medium to large effects on outcome measures (Arch et al., 2012). Similarly, in a study of older adults with GAD, the seven individuals receiving ACT demonstrated large effect sizes on outcome measures, which were comparable to the nine individuals receiving CBT in this study (Wetherell et al., 2011). A recent meta-analysis demonstrated the promise of mindfulness-based interventions in reducing anxiety generally (Hofmann, Sawyer, Witt, & Oh, 2010), and two preliminary trials of MBCT suggest an effect of treatment on self-reported GAD symptoms (Craigie, Rees, Marsh, & Nathan, 2008; Evans et al., 2008), although outcomes fell short relative to other GAD treatment trials. Unlike ACT and ABBT, MBCT did not incorporate behavioral strategies, which may partly explain the more modest effects. While findings for ABBT are promising, previous studies were limited by absence of an active control condition and modest sample sizes. To more rigorously test ABBT, this study compared ABBT to an established and efficacious treatment, Applied Relaxation (AR). AR is an empirically supported treatment for GAD (Chambless & Ollendick, 2001) and is recommended in the NICE clinical guideline 113 (National Collaborating Centre for Mental Health and the National Collaborating Centre for Primary Care, 2011). This status comes from several methodologically rigorous studies that have examined the efficacy of AR. For example, randomized controlled trials demonstrated that AR was more efficacious than a nondirective, reflective listening therapy (Borkovec & Costello, 1993) and roughly as efficacious as cognitive therapy (Arntz, 2003; Ost & Breitholtz, 2000), cognitive behavioral therapy (Borkovec & Costello, 1993; Dugas et al., 2010), and worry exposure (Hoyer et al., 2009) in treating GAD. Further supporting the efficacy of AR, a meta-analysis by Siev and Chambless (2007) found that cognitive therapy and relaxation therapy were equivalent treatments for GAD. AR is also straightforward and relatively easy to learn, which increases the probability that therapists can deliver it with good adherence and competence. In the spirit of a comparative efficacy trial, we hypothesized that both ABBT and AR would lead to statistically and clinically significant change but that ABBT would be more efficacious than AR on measures of anxiety and quality of life. Additionally, because the processes targeted in ABBT are presumed to underlie many forms of psychopathology, we hypothesized that ABBT would be associated with greater decreases in depression and comorbidity than AR. Finally, we hypothesized that the treatments would be comparably credible and acceptable to participants.

The work-related acceptance and action questionnaire: Initial psychometric findings and their implications for measuring psychological flexibility in specific contexts

Abstract: Over the past decade, experimental and longitudinal research has shown that psychological flexibility is an important determinant of mental health and behavioral effectiveness in the workplace. These findings have been established using a general measure of this psychological process, the Acceptance and Action Questionnaire—Revised (AAQ-II). Consistent with Acceptance and Commitment Therapy (ACT) theory, psychological flexibility may demonstrate even stronger associations with variables related to a work context (e.g., job satisfaction) if it were assessed using a measure of the construct that is tailored to the workplace. To test this hypothesis, we first developed such a measure, the Work-related AAQ (WAAQ). Findings from 745 participants across three studies reveal that the structure, validity and reliability of the WAAQ are satisfactory. As predicted, the WAAQ, in comparison to the AAQ-II, correlates significantly more strongly with work-specific variables. In contrast, the AAQ-II tends to correlate more strongly with outcomes that are likely to be more stable across different contexts (e.g., mental health and personality variables). These findings are discussed in relation to ACT theory.

Acceptance and commitment therapy as a novel treatment for eating disorders: an initial test of efficacy and mediation.

Abstract: Eating disorders are among the most challenging disorders to treat, with even state-of-the-art cognitive-behavioral treatments achieving only modest success. One possible reason for the high rate of treatment failure for eating disorders is that existing treatments do not attend sufficiently to critical aspects of the disorder such as high experiential avoidance, poor experiential awareness, and lack of motivation. These variables are explicit targets of Acceptance and Commitment Therapy (ACT). The current study examined the efficacy of an ACT-based group treatment for eating disorders by examining whether the addition of ACT groups to treatment-as-usual (TAU) at a residential treatment facility for eating disorders would improve treatment outcomes. TAU patients received an intensive residential treatment, while ACT patients received these services but additionally attended, depending on diagnosis, either ACT for anorexia nervosa groups or ACT for bulimia nervosa groups. Although individuals in both treatment conditions demonstrated large decreases in eating pathology, there were trends toward larger decreases among those receiving ACT. ACT patients also showed lower rates of rehospitalization during the 6 months after discharge. Overall, results suggest that ACT is a viable treatment option for individuals with eating pathology and further outcome research is warranted.

'Third wave' cognitive and behavioural therapies versus other psychological therapies for depression

Abstract: Background So-called 'third wave' cognitive and behavioural therapies represents a new generation of psychological therapies that are increasingly being used in the treatment of psychological problems. However, the effectiveness and acceptability of third wave cognitive and behavioural therapy (CBT) approaches as a treatment for depression compared with other psychological therapies remain unclear. Objectives 1. To examine the effects of all third wave CBT approaches compared with all other psychological therapy approaches for acute depression. 2. To examine the effects of different third wave CBT approaches (ACT, compassionate mind training, functional analytic psychotherapy, extended behavioural activation and metacognitive therapy) compared with all other psychological therapy approaches for acute depression. 3. To examine the effects of all third wave CBT approaches compared with different psychological therapy approaches (psychodynamic, behavioural, humanistic, integrative, cognitive-behavioural) for acute depression. Search methods We searched the Cochrane Depression, Anxiety and Neurosis Group Specialised Register (CCDANCTR to 01/01/12), which includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also searched CINAHL (May 2010) and PSYNDEX (June 2010) and reference lists of the included studies and relevant reviews for additional published and unpublished studies. An updated search of CCDANCTR restricted to search terms relevant to third wave CBT was conducted in March 2013 (CCDANCTR to 01/02/13). Selection criteria Randomised controlled trials that compared various third wave CBT with other psychological therapies for acute depression in adults. Data collection and analysis Two review authors independently identified studies, assessed trial quality and extracted data. Study authors were contacted for additional information where required. We rated the quality of evidence using GRADE methods. Main results A total of three studies involving 144 eligible participants were included in the review. Two of the studies (56 participants) compared an early version of acceptance and commitment therapy (ACT) with CBT, and one study (88 eligible participants) compared extended behavioural activation with CBT. No other studies of third wave CBT were identified. The two ACT studies were assessed as being at high risk of performance bias and researcher allegiance. Post-treatment results, which were based on dropout rates, showed no evidence of any difference between third wave CBT and other psychological therapies for the primary outcomes of efficacy (risk ratio (RR) of clinical response 1.14, 95% confidence interval (CI) 0.79 to 1.64; very low quality) and acceptability. Results at two-month follow-up showed no evidence of any difference between third wave CBT and other psychological therapies for clinical response (2 studies, 56 participants, RR 0.22, 95% CI 0.04 to 1.15). Moderate statistical heterogeneity was indicated in the acceptability analyses (I2 = 41%). Authors' conclusions Very low quality evidence suggests that third wave CBT and CBT approaches are equally effective and acceptable in the treatment of acute depression. Evidence is limited in quantity, quality and breadth of available studies, precluding us from drawing any conclusions as to their short- or longer-term equivalence. The increasing popularity of third wave CBT approaches in clinical practice underscores the importance of completing further studies to compare various third wave CBT approaches with other psychological therapy approaches to inform clinicians and policymakers on the most effective forms of psychological therapy in treating depression.

Acceptance and Values-Based Treatment of Adolescents With Chronic Pain: Outcomes and Their Relationship to Acceptance

Abstract: Objective Psychological treatments for pediatric chronic pain are moderately effective. However, there have been few studies of the psychological processes associated with treatment response. This study examines the effects of Acceptance and Commitment Therapy (ACT) treatment on a severely disabled group of adolescents with chronic pain, examining relationships between outcome and acceptance. Methods 98 adolescents with pain, mean age 15.6 years, underwent an uncontrolled trial of 3-week residential ACT treatment. Results Adolescents improved in self-reported functioning and objective physical performance at 3-month follow-up. They were less anxious and catastrophic, attended school more regularly, and used health care facilities less often. Most positive treatment outcomes were associated with improvements in acceptance. Conclusions An intensive ACT-based pain rehabilitation course was an effective treatment for disabled adolescents with chronic pain. Its results were theoretically consistent—improvements were associated with changes in acceptance and were achieved without pain control or cognitive restructuring techniques.

A Systematic Review of Gender Differences in the Effectiveness of Mindfulness-Based Treatments for Substance Use Disorders

Abstract: Substance use disorder (SUD) onset, trajectory, comorbidity, and outcome can differ greatly according to sex and gender. Mindfulness-based interventions are promising treatments for SUD; however, as of yet, no systematic review has organized the results of studies examining these treatments according to gender. The purpose of this review was to determine whether gender influences the efficacy and effectiveness of mindfulness-based treatments (MBTs) for substance use. A systematic review was conducted on journal databases, and out of 36 papers that met the criteria for inclusion, 6 included participant gender as a variable. Two papers based on one randomized controlled trial study failed to find gender differences in the efficacy of MBTs for substance use, though a number of quasi-experimental studies and case series did find that women gravitated more towards MBTs or that women may have benefitted more from mindfulness interventions. Overall, MBTs hold promise as treatments for SUD. Additional research on mindfulness-based interventions for SUDs is needed that includes gender as a variable.

Couples coping with multiple sclerosis: a dyadic perspective on the roles of mindfulness and acceptance

Abstract: This study investigated the roles of mindfulness and acceptance on adjustment in couples coping with multiple sclerosis (MS) by examining the effects of an individual's mindfulness and acceptance on their own adjustment (actor effects) and the effects of their partner's mindfulness and acceptance on their adjustment (partner effects) using the Actor-Partner Interdependence Model. The study was a cross-sectional standard dyadic design that collected data from couples coping with MS. Sixty-nine couples completed measures of mindfulness, acceptance and adjustment (depression, anxiety, life satisfaction, positive affect and relationship satisfaction). As hypothesised there were actor effects of mindfulness and acceptance on better adjustment, however, the beneficial actor effects of mindfulness were only evident on depression and anxiety. The actor effects of both mindfulness and acceptance on relationship satisfaction were moderated by MS status. Regarding partner effects, there was support for the beneficial impact of acceptance on partner relationship satisfaction. In addition, the partner effect of acceptance moderated the actor effect of acceptance on depression, such that the actor effect on lower depression was weaker when the partner reported high acceptance. Findings support the roles of mindfulness and acceptance in shaping individual and dyadic adjustment in couples coping with chronic illness.

Predictors of psychological adjustment, experienced parenting burden and chronic sorrow symptoms in parents of children with cerebral palsy

Abstract: Aim To investigate the role of child behaviour, parental coping and experiential avoidance in predicting the psychological outcomes of: (i) psychological symptoms; (ii) chronic sorrow symptoms; and (iii) experienced parenting burden in parents of children with cerebral palsy (CP). Method This study is a cross-sectional, correlational study. Ninety-four parents of children (aged 212 years) with CP (various levels of motor functioning GMFCS IV) participated. Results Together, the three predictors of child behaviour, parental coping and experiential avoidance explained 36.8% of the variance in psychological symptoms with child behavioural problems and experiential avoidance as significant unique predictors. In addition, 15.8% of the variance in chronic sorrow symptoms was explained by the three predictors with experiential avoidance alone as a significant unique predictor. Lastly, the predictors together explained 24.3% of the variance in experienced parenting burden with child behavioural problems and experiential avoidance as significant unique predictors. Conclusions This study demonstrates a relationship between child behavioural problems and parental psychological symptoms and experienced parenting burden as well as a relationship between experiential avoidance and parental psychological symptoms, experienced parenting burden and chronic sorrow symptoms.

Homework Compliance Counts in Cognitive-Behavioral Therapy

Abstract: Background: Prior research has demonstrated that there is some association between treatment engagement and treatment outcome in behavioral therapy for anxiety disorders However, many of these investigations have been limited by weak measurement of treatment engagement variables, failure to control for potentially important baseline variables, and failure to consider various treatment engagement variables simultaneously The purpose of the present study is to examine the relationship between two treatment engagement variables (treatment expectancy and homework compliance) and the extent to which they predict improvement from cognitive-behavioral therapy (CBT) for anxiety disorders Methods: 84 adults with a DSM-IV-defined principal anxiety disorder took part in up to 12 sessions of CBT or acceptance and commitment therapy Pre- and post-treatment disorder severity was assessed using clinical severity ratings from a semi-structured diagnostic interview Participants made ratings of treatment expectancy af

"Decentering" reflects psychological flexibility in people with chronic pain and correlates with their quality of functioning.

Abstract: Objective Acceptance and mindfulness-based treatments for chronic pain attempts to alter the impact of pain-related thoughts and feelings on behavior without necessarily changing the thoughts and feelings themselves. A process called "decentering" appears relevant to these treatments because it includes the capacity to observe thoughts and feelings from a detached perspective, as transient events in the mind, that do not necessarily reflect reality or the self. This study examines relations of decentering with other processes related to "psychological flexibility" and the daily functioning of people with chronic pain. Method Consecutive adults seeking treatment for chronic pain (N = 150) provided data for the study by completing a set of measures, including a measure of decentering, the Experiences Questionnaire (EQ). Results The EQ demonstrated adequate internal consistency reliability, and correlation results supported its validity. Decentering significantly correlated with anxiety, depression, and psychosocial disability. In multiple regression analyses it added a significant increment to explained variance in the prediction of depression and psychosocial disability. Across all measures of functioning, pain acceptance and decentering combined accounted for an average of 23.6% of variance while pain accounted for 2.5%. Conclusions People with chronic pain may benefit from the capacity to contact their thoughts and feelings from a perspective as a "separate observer," to see them as transient, and to experience them as cognitively "defused."

The Value of Workshops on Psychological Flexibility for Early Childhood Special Education Staff

Abstract: High stress and burnout are common for early childhood special educators, contributing to high rates of attrition, diminished educational effectiveness, and high turnover. Acceptance and Commitment Therapy (ACT) is a promising approach for the prevention and treatment of a wide variety of problems. Using a randomized wait-list control design, this pilot study evaluated whether ACT workshops delivered to preschool teachers who serve children with developmental disabilities would improve stress-related problems of teachers (i.e., stress, depression, and burnout) and increase collegial support. At pretest, measures of experiential avoidance (EA) and mindful awareness (MA) showed significant relationships to reports of depression, stress, and burnout. The intervention reduced staff members' EA, increased teachers' MA and valued living (VL), and improved teachers' sense of efficacy. This suggests that ACT workshops can help influence factors affecting depression, stress, and burnout in an early childhood special education setting.