A Feasibility and Pilot Randomised Dismantling Trial of the Efficacy of Self-As-Context During Acceptance and Commitment Therapy

AbstractThe comparative clinical utility of the components of the psychological flexibility model of acceptance and commitment therapy (ACT) have not been equally evaluated. This study therefore conducted a feasibility and pilot two-arm dismantling trial by quarantining the self-as-context component. Sixteen participants were randomised to either 8 sessions of protocol-based ACT (Full-ACT) or 8 sessions of protocol-based ACT minus self-as-context (ACT-SAC). Process measures (flexibility and decentring) were taken at start of treatment, end of treatment, and at 6-week follow-up. Clinical outcome measures (functioning, anxiety, and depression) were collected on a session-by-session basis. Randomisation was well tolerated, all measures were completed, both interventions were competently delivered, and one adverse effect occurred in the full-ACT arm. Ten participants attended all 8 sessions creating a dropout rate of 37.50%. Clinical change appeared linear in both treatments and that treatment gains were maintained. Findings suggest that a full trial is possible and sample size calculations and methodological improvements are provided for this.

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A Randomised Controlled Trial of Acceptance and Commitment Therapy and Cognitive-Behaviour Therapy for Generalised Anxiety Disorder

Behaviour Change ◽

10.1017/bec.2014.5 ◽

2014 ◽

Vol 31 (2) ◽

pp. 110-130 ◽

Cited By ~ 23

Author(s):

Elbina Avdagic ◽

Shirley A. Morrissey ◽

Mark J. Boschen

Keyword(s):

Anxiety Disorder ◽

Acceptance And Commitment Therapy ◽

Treatment Completion ◽

Generalised Anxiety Disorder ◽

Reliable Change ◽

Commitment Therapy ◽

Acceptance And Commitment ◽

Treatment Gains ◽

Post Assessment

The study examined the relative efficacy of group acceptance and commitment therapy (ACT) for generalised anxiety disorder (GAD) compared to group cognitive-behavioural therapy (CBT). Fifty-one individuals with GAD were randomly allocated to a 6-week intervention, either ACT or CBT. Participants were assessed at pre-treatment, post-treatment, and 3-month follow-up on symptom measures, quality of life, and process measures. Data from 38 participants (19 in each group) were available at post-assessment, indicating significant improvements on all measures for both treatment conditions. Treatment gains were maintained at follow-up, with significant further improvements in anxiety, depression and stress symptoms for both groups. While no between-group differences were found at treatment completion, a significant interaction indicating steeper reduction in worrying symptoms (d = .79) from pre- to post-assessment was found for the ACT group compared to the CBT group. Furthermore, in relation to worrying, at treatment completion 78.9% of participants in the ACT group achieved reliable change compared to 47.4% of participants in the CBT group. However, both groups showed equivalent reliable change rates of 60% at the follow-up assessment. The results suggest that group ACT was as efficacious as group CBT. While participants in the ACT group maintained treatment gains at follow-up, participants in the CBT group continued to improve between post-assessment and follow-up.

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Acceptance and commitment therapy (ACT)-enhanced communication skills: development and evaluation of a novel training programme

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002786 ◽

2021 ◽

pp. bmjspcare-2020-002786

Author(s):

Nicholas J Hulbert-Williams ◽

Lee Hulbert-Williams ◽

Pandora Patterson ◽

Sahil Suleman ◽

Lesley Howells

Keyword(s):

Clinical Practice ◽

Acceptance And Commitment Therapy ◽

Cancer Care ◽

Psychological Flexibility ◽

Training Programme ◽

Free Text ◽

Evaluation Data ◽

Commitment Therapy ◽

Acceptance And Commitment

BackgroundPsychological suffering is ubiquitous with cancer and frequently presents as an unmet supportive care need. In clinical practice, distress-related needs are often addressed by nurses and non-psychologist allied healthcare professionals who may have limited training in psychological therapeutic frameworks, particularly more recently developed interventions such as Acceptance and Commitment Therapy (ACT).AimsWe developed a single-day training programme for professionals working in supportive and palliative cancer care settings to change the nature of clinical communication about psychological distress and suffering towards an ACT-consistent approach.MethodWe report on experiences of training delivery, and evaluation data about training satisfaction and intention to apply the training to clinical practice, from three training iterations in British and Australian, government-funded and charitable sectors. One hundred and sixteen cancer care professionals participated in the training. Evaluation data were collected from 53 participants (at either 2-week or 3-month follow-ups, or both) using self-report survey, including both quantitative and free-text questions.ResultsAt 2 week follow-up, 73% of trainees rating our course as having relevance to their work, and at 3 month follow-up, 46% agreed that they were better placed to provide improved clinical services. Qualitative feedback supported the inclusion of experiential learning and theoretical explanations underpinning ACT techniques. Undertaking this training did not significantly increase trainees’ stress levels, nor did implementation of this new way of working negatively affect staff well-being. Positive, ACT-consistent, changes in communication behaviours and attitudes were reported, however there was a lack of significant change in psychological flexibility.DiscussionAcceptability and applicability of this training to supportive and palliative healthcare is positive. The lack of change in psychological flexibility suggests a potential need for more experiential content in the training programme. Logistical challenges in one training group suggests the need for more robust train-the-trainer models moving forward.

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MECHANISM OF ACTION: AGE DIFFERENCES IN RESPONSE TO ACCEPTANCE AND COMMITMENT THERAPY FOR CHRONIC PAIN

Innovation in Aging ◽

10.1093/geroni/igz038.2979 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S809-S809

Author(s):

Julie L Wetherell ◽

Matthew Herbert ◽

Niloofar Afari

Keyword(s):

Older Adults ◽

Chronic Pain ◽

Acceptance And Commitment Therapy ◽

Behavioral Therapy ◽

Pain Interference ◽

Younger Adults ◽

Pain Acceptance ◽

Commitment Therapy ◽

Acceptance And Commitment

Abstract A recent randomized comparison of Acceptance and Commitment Therapy (ACT) vs. Cognitive-Behavioral Therapy for chronic pain found a clear age interaction effect, such that older adults benefitted more from ACT. In a subsequent study comparing ACT delivered in person to ACT delivered via telehealth to a sample of veterans (N=128, mean age 51.9, SD 13.3, range 25-89), we found no significant age by modality interactions, suggesting that older veterans responded as well as younger people did to telehealth delivery. Consistent with our previous findings, we found a trend for older adults to experience greater reduction in pain interference (p = .051) and significantly greater reduction in pain severity (p = .001) than younger adults following ACT. In younger veterans, change in pain acceptance from baseline to posttreatment was related to change in pain interference from baseline to 6-month follow-up (r = -.38), but change in pain interference from baseline to posttreatment was not related to change in pain acceptance from baseline to follow-up (r = .14), suggesting that, consistent with the ACT model, increased pain acceptance at posttreatment was related to reduced pain interference at follow-up. By contrast, in older veterans, both correlations were significant and of comparable magnitude (rs = -.43 and -.46, respectively), providing no support for the idea that change in pain acceptance drove change in pain interference. Overall, our findings suggest that ACT may work better in older adults with chronic pain than in younger adults, but via a different mechanism.

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Behavioral Activation and Acceptance and Commitment Therapy in the Treatment of Anxiety and Depression in Cancer Survivors: A Randomized Clinical Trial

Behavior Modification ◽

10.1177/0145445520916441 ◽

2020 ◽

pp. 014544552091644

Author(s):

Concepción Fernández-Rodríguez ◽

Sonia González-Fernández ◽

Rocío Coto-Lesmes ◽

Ignacio Pedrosa

Keyword(s):

Cancer Survivors ◽

Acceptance And Commitment Therapy ◽

Experiential Avoidance ◽

Behavioral Activation ◽

Emotional Problems ◽

Post Treatment ◽

Behavioural Activation ◽

Commitment Therapy ◽

Acceptance And Commitment

Behavioural Activation (BA) and Acceptance and Commitment Therapy (ACT) aim to reduce the inflexible avoidance of painful thoughts, feelings and memories and to encourage involvement in relevant activities, objectives which are clearly relevant to the situation of cancer survivors with emotional problems. With a view to evaluating and comparing the efficacy of both therapies, applied on a group basis, a randomized controlled trial was developed. Cancer survivors (age 18–65 years) with anxiety and/or depression were assigned at random to two experimental groups (BA; ACT) and a waiting list control group (WL). Of the 66 cancer survivors randomized to trial (intention-to-treat sample), 46 participants ( M = 51.49; SD = 6.88) completed the intervention (BA, n = 17; ACT, n = 12; WL, n = 17) (per-protocol sample). The emotional state, experiential avoidance and behavioural activation of the participants was evaluated in the pre- and post-treatment and in a 3-month follow-up using standardized instruments. Both treatment groups showed statistically significant changes, indicating an improvement in all the result variables in the post-treatment and follow-up as compared to the pre-treatment. BA showed better results than ACT regarding impact on anxiety and activation. This greater efficacy may have been due to factors such as the emphasis placed in BA on behavioural activation and the central role played in it by functional analysis. The key role played by experiential avoidance and behavioral activation in the maintenance and treatment of emotional problems in cancer survivors is discussed. Raw data are available online ( http://dx.doi.org/10.17632/m7w688khs8.1 )

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A Preliminary Investigation of Acceptance and Commitment Therapy for Adolescent Obsessive-Compulsive Disorder

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.27.2.175 ◽

2013 ◽

Vol 27 (2) ◽

pp. 175-190 ◽

Cited By ~ 21

Author(s):

Andrew B. Armstrong ◽

Kate L. Morrison ◽

Michael P. Twohig

Keyword(s):

Obsessive Compulsive Disorder ◽

Acceptance And Commitment Therapy ◽

Preliminary Investigation ◽

Obsessive Compulsive ◽

Self Monitoring ◽

Compulsive Disorder ◽

Commitment Therapy ◽

Acceptance And Commitment ◽

Treatment Procedures

There is growing support for the use of acceptance and commitment therapy (ACT) as a treatment for adults with obsessive-compulsive disorder (OCD), but no research has been published on the use of ACT for adolescent OCD. This preliminary study investigated ACT for youth with OCD using a multiple baseline across participants design. Three adolescents, ages 12 or 13 years, were treated with 8–10 sessions of ACT (without in-session exposure exercises). The primary dependent variable was daily self-monitoring of compulsions. Results showed a 40% mean reduction in self-reported compulsions from pretreatment to posttreatment, with results maintained at 3-month follow-up, for a reduction of 43.8%. Pretreatment to posttreament reductions in Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) ratings of OCD severity were 50.0%, 12.5%, and 22.0%; pretreatment to follow-up reductions were 54.0%, 12.5%, and 61.0%. Treatment procedures were rated by participants and parents as highly acceptable. Implications and future directions are discussed.

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A Four-Session Acceptance and Commitment Therapy Based Intervention for Depressive Symptoms Delivered by Masters Degree Level Psychology Students: A Preliminary Study

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465813000969 ◽

2013 ◽

Vol 43 (3) ◽

pp. 360-373 ◽

Cited By ~ 12

Author(s):

Aino Kohtala ◽

Raimo Lappalainen ◽

Laura Savonen ◽

Elina Timo ◽

Asko Tolvanen

Keyword(s):

Depressive Symptoms ◽

Acceptance And Commitment Therapy ◽

Well Being ◽

Psychology Students ◽

Waiting List ◽

Long Term Effects ◽

Average Decrease ◽

Commitment Therapy ◽

Acceptance And Commitment

Background:Depressive symptoms are one of the main reasons for seeking psychological help. Shorter interventions using briefly trained therapists could offer a solution to the ever-rising need for early and easily applicable psychological treatments.Aims:The current study examines the effectiveness of a four-session Acceptance and Commitment Therapy (ACT) based treatment for self-reported depressive symptoms administered by Masters level psychology students.Method:This paper reports the effectiveness of a brief intervention compared to a waiting list control (WLC) group. Participants were randomized into two groups: ACT (n= 28) and waiting list (n= 29). Long-term effects were examined using a 6-month follow-up.Results:The treatment group's level of depressive symptoms (Beck Depression Inventory) decreased by an average of 47%, compared to an average decrease of 4% in the WLC group. Changes in psychological well-being in the ACT group were better throughout, and treatment outcomes were maintained after 6 months. The posttreatment “between-group” and follow-up “with-in group” effect sizes (Cohen'sd) were large to medium for depressive symptoms and psychological flexibility.Conclusions:The results support the brief ACT-based intervention for sub-clinical depressive symptoms when treatment was conducted by briefly trained psychology students. It also contributes to the growing body of evidence on brief ACT-based treatments and inexperienced therapists.

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Short Report: Evaluation of Acceptance and Commitment Therapy Training for Psychologists Working with People with Multiple Sclerosis

International Journal of MS Care ◽

10.7224/1537-2073.2016-080 ◽

2018 ◽

Vol 20 (1) ◽

pp. 44-48 ◽

Cited By ~ 1

Author(s):

Kenneth I. Pakenham ◽

Theresa Scott ◽

Michele Messmer Uccelli

Keyword(s):

Multiple Sclerosis ◽

Acceptance And Commitment Therapy ◽

Behavioral Therapy ◽

Well Being ◽

Short Report ◽

Beneficial Effects ◽

Commitment Therapy ◽

Acceptance And Commitment ◽

Almost All

Abstract Background: Acceptance and commitment therapy (ACT) is the most widely used and researched recent variant of cognitive behavioral therapy and has been shown to increase quality of life in people with chronic illnesses, including multiple sclerosis (MS). However, few MS health practitioners are trained in ACT. This study evaluated a 2-day ACT training workshop for Italian psychologists working with people with MS. Methods: Data were collected via online questionnaires from 34 psychologists before the workshop, after the workshop, and at 6-month follow-up. Two sets of variables were measured at each assessment: primary outcomes (well-being, negative affect, positive affect, and job satisfaction) and ACT processes (values, mindfulness, psychological flexibility, and cognitive defusion). A separate online workshop evaluation questionnaire and an ACT knowledge examination were administered after the workshop. Results: Most participants (94%) acknowledged the potential beneficial effects of the workshop on their work. Almost all participants reported their intention to apply ACT clinically. More than 90% of participants indicated that the workshop was efficacious. All participants scored higher than 75% on the examination. Mindfulness increased from after the workshop to follow-up; however, there were no statistically significant changes in other variables. Correlations suggested beneficial associations between the ACT processes and the primary outcomes. Conclusions: Results suggest that ACT training is personally and professionally helpful for psychologists in the MS field.

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