Acceptance And Commitment Training Research Articles

Performance-based acceptance and commitment training in a collegiate flight program

Students in flight training programs experience high levels of stress and anxiety that may impede their performance on practical exams. The restrictive nature of Federal Aviation Administration (FAA) regulations and perceived negative consequences of seeking mental health treatment further exacerbates these challenges. This study examined the efficacy of performance-based acceptance and commitment training (ACT) in enhancing psychological flexibility, resilience, and mental well-being as well as improving FAA practical examination outcomes among collegiate flight training students. A randomized controlled trial was used to compare outcomes between students receiving a six-week ACT intervention (n = 23) and a control group (n = 27). The planned sample size of 100 was not achieved, thus, the analyses were underpowered and should be cautiously interpreted. Results indicate significant improvements among intervention participants in anxiety sensitivity (g = 0.43) and psychological flexibility (g = 0.58) compared to those in the control group. However, no significant differences in examination pass rates or time to completion were found between groups. To examine idiographic differences, individual change scores were plotted, demonstrating the heterogeneity of effects between participants. Potential explanations for the intervention's lack of effect on practical exam performance are discussed and suggestions are given to improve future performance-based interventions in this unique context.

The experiences of family caregiver and clinician facilitators implementing a co-delivered acceptance and commitment training (ACT) intervention

Family caregivers of people with neurodevelopmental disabilities (NDDs) experience high levels of stress, anxiety, and depression, yet few interventions target their wellbeing. Moreover, most evidence-based interventions fail to include caregivers in their design and delivery despite evidence that caregivers can play a vital role in enhancing the success of interventions to other caregivers. The present study explored the experiences of caregivers and clinicians who worked in partnership to co-deliver an Acceptance and Commitment Training (ACT) intervention to caregivers of people with NDDs in the community.Caregiver and clinician facilitators completed an open-ended survey asking about their experiences co-facilitating an evidence-based, group ACT intervention. Thematic analysis was used to analyze the data. Elements of successful partnerships, the benefits and challenges co-leading the intervention, and considerations for future implementation efforts were explored. Findings revealed the complementary contributions of facilitators’ diverse perspectives, experiences and skills, as well as how regular communication, trust, and flexibility supported successful partnerships. Benefits of co-facilitating included connection with others and personal growth, while challenges included emotional costs, capacity and compensation. Taken together, results highlight ways to support the successful implementation of an ACT intervention co-led by caregivers and clinicians, as well as other partnered interventions.

Comparison of the Effectiveness of Cognitive Behavioral Training and Acceptance and Commitment Training on High-Risk Behaviors in Self-Injurious Adolescents

Objective: Many adolescents face challenges with family, community, and relatives, which may push them towards high-risk behaviors during decision-making stages due to the pressure of these problems. This study compared the effectiveness of cognitive behavioral training (CBT) and acceptance and commitment training (ACT) on high-risk behaviors in self-injurious high school students. Methods and Materials: This quasi-experimental research used a pre-test, post-test, and follow-up design with a control group. The statistical population included self-injurious male adolescents (high school students in District 1 schools) in Sari during the 2021-2022 academic year. From this population, 45 students were selected using purposive sampling and randomly assigned to two experimental groups and one control group (15 students per group). The first experimental group underwent 8 weekly 90-minute sessions based on the CBT training package (Beck, 1976), and the second experimental group underwent 8 weekly 90-minute sessions based on the ACT training package (Hayes et al., 2013). Data collection tools included the High-Risk Behaviors Questionnaire (Zadeh-Mohammadi & Ahmadabadi, 2008) and the Self-Injury Questionnaire (Klonsky & Glenn, 2011). Data were analyzed using SPSS-21 software and statistical tests, including repeated measures ANOVA and two-way ANOVA. Findings: The results showed that both CBT and ACT had significant effects on high-risk behaviors in self-injurious students (F=42.00, P<0.001), with the effectiveness of CBT and ACT being similar on the studied variables. Conclusion: It can be concluded that both CBT and ACT significantly impacted high-risk behaviors in self-injurious students and can be used to address issues in adolescents with self-injury problems.

Acceptance and commitment training for reducing burnout in medical students during a clinical clerkship in psychiatry and palliative care: A pilot study

Physicians are likely to experience burnout early in their medical education, and it only accelerates as their clinical and academic responsibilities expand and they begin clinical practice. However, effective burnout interventions for clinical-year medical students are lacking. Avoidance of unpleasant internal experiences and decreased engagement in value-based behaviors are associated with burnout. This study, an open-label pilot research with a single-center, before-and-after comparative study design and without a control group, aimed to examine the feasibility and effectiveness of brief acceptance and commitment training (ACT) in reducing burnout during psychiatric clinical clerkships at a medical school. The feasibility proved to be good, with all the participants (n = 56) completing the training. There were no significant differences in the emotional exhaustion (EE) and depersonalization (DP) scores of burnout as measured by the Maslach Burnout Inventory (MBI) at the end of the ACT and two months following the intervention. A comparison was made with scores recorded before the intervention, and significant differences were observed. A subsample of medical students with moderate or greater burnout at T0 manifested significant burnout score reductions. The same subsample revealed a significant increase in psychological flexibility as indicated by the progress factor score on the Valuing Questionnaire (VQ) at T1 compared to T0 and a significant reduction in reaction latency to negative words as indicated by the DIRAP score of the Implicit Relational Assessment Procedure (IRAP) for anxiety. We argue that short-term ACT during clinical clerkships of medical students in psychiatry and palliative care is feasible and potentially effective, and a multi-site comparative study using more direct behavioral measures is warranted to further investigate its effectiveness.

Self-paced acceptance and commitment training reduces burden transfer, stress, and burnout in veterinary healthcare teams.

An acceptance and commitment training (ACT) educational program targeting reaction to difficult client interactions recently demonstrated efficacy in reducing burden transfer, stress, and burnout in veterinary healthcare teams. The current noninferiority trial compared effectiveness of the original program with a self-paced version. Employees of 2 corporate veterinary groups were randomized to live (n = 128) or self-paced (124) conditions. The workshop and assessments were completed by 137 (55 live and 82 self-paced). Asynchronous modules containing the same content as the original program were placed on in-house veterinary clinic learning systems. Participants of this parallel arms trial completed pretest measures of burden transfer, stress, and burnout. Following assessment, the 3-week ACT program was delivered via videoconferencing (live) or asynchronous modules (self-paced). At post-test and 1-month follow-up, measures were repeated, with added assessment of knowledge, helpfulness ratings, and usage of techniques. A subset (n = 33) of participants repeated measures 9 to 12 months as an extended follow-up. Program helpfulness was rated more highly by live versus self-paced participants. Self-paced showed better program retention. No differences in knowledge or use of program techniques (> 5 times daily) emerged. Relative to pretest, both conditions showed reduced burden transfer, stress, and burnout at post-test and follow-up; no differences by condition emerged. Participants completing extended follow-up maintained improvement from baseline. Findings suggest a learning system-based version of this program can improve occupational distress in veterinary healthcare teams, with gains maintained over time. The flexibility of this format promotes program completion and allows broader dissemination.

The effect of brief acceptance and commitment training on values-based behaviors of Japanese parents of children with autism

The purpose of this study was to examine the effects of brief acceptance and commitment training (ACT) on overt values-based behaviors, psychological flexibility, psychological well-being, and parental adherence of four Japanese mothers of children with autism. A non-concurrent multiple baseline design across participants with pre- and post-measures was used in this study. All four participants received five 45–60 min of online ACT sessions. The level of psychological flexibility and psychological well-being were assessed using a 6-PAQ and PWBS-42, respectively. In addition, a social validity questionnaire assessed the feasibility and acceptability of the ACT. To establish clinically significant change, between-case standardized mean differences and non-overlap of all pairs (NAP) were calculated for overt values-based behaviors. Reliable change index was calculated for the reported scores of 6-PAQ and PWBS-42. The NAP analysis demonstrated that three out of four participants showed moderate to strong improvement in overt values-based behaviors and some participants showed a reliable increase in reported scores on psychological well-being. The results suggest that ACT was effective and acceptable for the Japanese population. The paper highlights the importance of cultural variables in designing, implementing, and analyzing data and provides direction for future studies.

Effects of Acceptance and Commitment Training on Treatment Integrity Amongst Behavioral Technicians.

Behavioral technicians (BT) within the field of applied behavior analysis may be at greater risk for experiencing burnout and stress due to the nature of their clients, job demands, and work environments. Burnout and stress may negatively impact BT's work performances, more specifically, their treatment integrity. Acceptance and Commitment Training (ACT) may be a useful tool to address the private events as well as the covert and overt behaviors associated with burnout and stress. The purpose of this study was to investigate the effects of an ACT intervention on improving treatment integrity and reducing work-related burnout and stress amongst BTs. Four BTs participated in an ACT workshop, and their treatment integrity as well as their burnout and stress levels were measured prior to and following the ACT workshop. Treatment integrity increased for all participants, suggesting that ACT-based interventions may be an effective approach to improving work performance (i.e., treatment integrity) amongst BTs who may experience workplace burnout and stress.

Online ACT Matrix Parent Training for Japanese-Speaking Mothers with Distress in the United States.

Cultural stigma, shame, self-concealment, and language and socio-economic barriers often keep Asian immigrant parents and children away from mental and behavioral services in the United States. Research shows that increased levels of parent distress suggest a negative impact on parenting practices and correlate child-maltreatment. Therefore, this study aimed to test one functionally contextual strategy to address such issues. The current study evaluated the effects of an online Acceptance and Commitment Training (ACT) Matrix for Japanese-speaking mothers living the United States. A nonconcurrent multiple baseline single-subject design across four mothers was used to assess the effect of ACT Matrix on value-driven behaviors, parental engagement (session attendance and daily assignment completion), parental distress, and psychological flexibility. The study consisted of a baseline, treatment (three ACT Matrix treatment sessions adapted from the six-step protocol), maintenance, and follow-up phases. A visual analysis reporting level, trend, variability, immediacy of change and overlap was used to identify a functional relation between the treatment and observable overt behaviors of value-driven behaviors and daily assignment completion. In addition, a non-overlap of all pairs was used to measure effect sizes for these behaviors. For psychological flexibility and parental distress, we used the reliable change index to assess whether clinically significant improvement occurred or not. The results revealed that the online ACT Matrix parent training program was effective in improving all four dependent variables. Mothers reported that the training was culturally sensitive, effective, and acceptable. The details of findings and the implications for future research as preventive science are discussed.

An Acceptance and Commitment Training (ACT) Framework for Teaching Cultural Humility: A Guide for Translating ACT from a Therapeutic Context into a Medical Education Curriculum.

The objective of this project was to train future physicians to work effectively and thoughtfully with diverse populations by teaching them to employ Acceptance and Commitment Training (ACT) skills to increase cultural humility, with the goal of improving attitudes, knowledge, and beliefs about working with diverse patients. We developed ACT for cultural humility online interactive modules as part of an elective course to teach Medical Spanish to 4th-year medical students. Pre- and post-pilot data pertaining to the cultural humility training modules on the Work-Related Acceptance and Action questionnaire, Multidimensional Cultural Humility Scale, knowledge, attitudes, and beliefs were analyzed using paired samples t-tests and Wilcoxon signed-rank tests. We also included descriptive data pertaining to overall satisfaction with the cultural humility modules and intent to apply the material learned to patient care. Our data showed a significant increase in the cultural humility of our participants as well as an increase in psychological flexibility, a higher favorability rating toward various ethnicities, improvements in attitude, and positive changes in beliefs and knowledge following completion of the modules. The modules were well received by the medical students, with high social validity ratings. The ACT for cultural humility curriculum has great potential to enhance medical education in diversity, equity, and inclusion by increasing both the understanding and the cultural humility of medical students and future professionals to work with diverse populations. The current paper provides a framework that can be used by other programs to shape the education of the future medical workforce to help promote culturally humble care.

An acceptance and commitment training program reduces burden transfer, stress, and burnout among veterinary healthcare teams

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. Small animal veterinary hospital employees randomly assigned to participate in an ACT program (intervention group; n = 72) or to not undergo the training program (control group; 71). The study was designed as a randomized, controlled, parallel-arms trial. All participants completed prestudy assessments of burden transfer, stress, and burnout. The ACT program consisted of 3 small-group-format educational sessions tailored to reducing reactivity to difficult veterinary client interactions; sessions were delivered via video teleconference. At the end of the educational sessions (posttest) and 1 month later (1-month follow-up), assessments of burden transfer, stress, and burnout were repeated, and participants in the intervention group provided ratings of program helpfulness and frequency of use for techniques taught in the program. Participants receiving the program rated it as helpful and reported frequent use of program techniques. Relative to the control group, the intervention group showed significantly reduced burden transfer, stress, work-related burnout, and client-related burnout after completing the educational sessions. These improvements were maintained at the 1-month follow-up. Findings support the usefulness of this program in reducing occupational distress in veterinary medicine. Future work is needed to examine whether it is similarly effective in formats that could be more broadly disseminated (eg, asynchronous, self-paced, independent learning).

Impact of Acceptance and Commitment Training on psychological flexibility and burnout in medical education

Medical students are at a disproportionate risk for experiencing burnout, making management of burnout a critical skill to teach in medical education. If left unmanaged, students may develop maladaptive coping strategies as well as substance misuse, suicidal ideation, and poorer quality patient care. This study examined the impact of Acceptance and Commitment Training (ACT) as a burnout management curriculum with medical students at a western U.S. medical school. Participants (n = 281) completed measures pertaining to psychological flexibility (i.e., the Acceptance and Action Questionnaire-II; AAQ-II) and burnout (i.e., the Implicit Relational Assessment Procedure; IRAP). Assessments were collected at three time points over the first two years of medical school. ACT was provided between Time 1 and 2, and not between Time 2 and 3. Results demonstrated statistically significant improvements, specifically for students starting medical school with clinically relevant levels of distress on the AAQ-II (n = 53). Positivity bias and negativity bias were measured with a burnout themed Modified-IRAP (MD-IRAP). Positivity bias maintained across all three time points, despite an increase in negativity bias. Implications for teaching psychological flexibility as a burnout management tool in higher education and healthcare systems will be discussed.

Effects of Acceptance and Commitment Training Plus Behavior Parent Training on Parental Implementation of Autism Treatment.

The objective of this study was to examine the effects of acceptance and commitment training (ACT) plus behavior parent training (BPT), when delivered via telehealth, on parental implementation of behavioral strategies, experiential avoidance (EA), and stress. The study also examined the subsequent effects on the parents’ autistic children’s behaviors. A multiple baseline design was implemented across four parent-child dyads who participated in the online training. The findings showed that ACT+BPT resulted in parental implementation reaching and maintaining high levels. The training also decreased EA and stress in three parents. Moreover, the parents’ ratings of their children’s challenging behaviors decreased. However, such a trend was not as clearly depicted by direct measures of the children’s behaviors. A social validity interview revealed parents found ACT beneficial in assisting them to learn and use the BPT strategies. Implications and suggestions for future research are discussed.

A Telecommunication Model to Teach Facilitators to Deliver Acceptance and Commitment Training.

Providing mediator training using a telecommunication format increases access to training by reducing geographical and financial barriers, while maintaining or increasing efficiency. Limited research has implemented this format to train facilitators in acceptance and commitment training (ACT), an empirically supported intervention. The aim of this research was to examine the efficacy of behavioural skills training via telecommunication for training novice facilitators to provide ACT to caregivers of individuals with neurodevelopmental disabilities. This two-part study involved concurrent multiple-baseline designs, each across 4 participants. Quantitative data on fidelity and confidence were collected at baseline, post-training, and at 1-month follow-up. The results from this study provide preliminary support for the use of behavioural skills training via telecommunication to train ACT facilitators. Increasing the number of competently trained facilitators will help build capacity to increase access to ACT across geographical regions.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40617-021-00628-x.

Using Relational Training to Improve Performance During Acceptance and Commitment Training Sessions.

The current study investigated the effect of relational training on improving engagement during acceptance and commitment training (ACT) sessions that aimed to reduce maladaptive behavior. Three female children diagnosed with autism participated in the current research. The relational training protocol involved eight programs designed to improve participants' ability to engage in relational responding. A concurrent multiple-baseline across-participants design was used, and participants' maladaptive behavior during ACT sessions was recorded. Results indicated a decrease in maladaptive behavior for one of the three participants, with a medium to large treatment effect. A secondary measure also showed improvement in all three participants' performance during ACT sessions. The percentage of nonoverlapping data and Cohen's d suggest a small to moderate treatment effect. Implications for implementing ACT with individuals diagnosed with autism are discussed.

Acceptance and Commitment Training in Applied Behavior Analysis: Where Have You Been All My Life?

Examining behavior within the context of applied behavior analysis (ABA) from the perspective of acceptance and commitment training (ACTr), while understanding the role of relational framing and the transformation of stimulus function, can better equip behavior analysts to effectively address complex behavior that may be influenced by covert verbal behavior. This approach may lead to a more comprehensive analysis of behavior and result in more effective interventions for socially significant change. The aim of this article is to provide behavior analysts with information and guidance on using relational frame theory (RFT) and ACTr in behavior-analytic services. The article first provides a rationale for considering thoughts as behavior and outlines important components of RFT. Subsequently, the benefits of employing ACTr in ABA are highlighted, including brief descriptions and examples of the use of ACTr within ABA practice. The article highlights the importance of expanding the consideration of maintaining variables when attempting to address maladaptive covert verbal behavior and ultimately aims to encourage a greater number of behavior analysts to adopt RFT and ACTr practices in applied settings.

Acceptance and Commitment Training for Ice Hockey Players: A Randomized Controlled Trial.

Recent systematic reviews on the topic of mindfulness- and acceptance-based approaches in sport psychology conclude that there is a need for further trials using a more robust research methodology with direct performance as outcome. Acceptance and Commitment Training (ACT) is a contextual behavioral change method that focuses on facilitating psychological processes such as values, committed action, acceptance and mindfulness. In the present study designed as a randomized controlled trial, 34 junior elite ice hockey players were allocated into either an ACT group intervention or a wait list control group. Results showed significant effects on both objective performance outcomes (goals, assists, and taken shots) and blinded coach ratings of players’ performance, focus and commitment to their development in favor of the ACT group. Effects lasted at 3-month follow-up for the coach ratings, but not for the objective performance measures. All ACT trained players recommended ACT to other players and considered the training as important for their development as ice hockey players. The results add to the growing body of evidence on ACT interventions for athletes and its effect on performance. Future studies should investigate the maintenance of effects from the psychological training over time, using robust research methodology and investigate theoretical coherent potential mediating variables.

Working With Values: An Overview of Approaches and Considerations in Implementation.

Acceptance and commitment training (ACT) has received support for addressing a number of difficulties within clinical behavior analysis, organizational settings, caregiver support, and other behavior change efforts. ACT is distinguished from many other approaches in its emphasis on values: aspects of life that clients find meaningful and important. Working with values lets behavior analysts draw on the functional properties of language to influence behavior. These techniques can help organize behavior to be influenced by long-term reinforcers, even in the face of short-term aversives, which may arise in the course of behavior change. Many exercises have been developed within the values arena with various strengths and limitations. This article provides an overview of commonly used approaches and aspects relevant to implementation. Considerations related to scope of practice, social desirability in responding, and aversive private events are also discussed.

Why We Are Not Acting to Save Ourselves: ACT, Health, and Culture.

Chronic health conditions are increasing at an alarming rate worldwide, and many could be prevented if people were to engage in specific lifestyle behaviors. Intervening on lifestyle behaviors is challenging due to the fact that the consequences associated with unhealthy behaviors are temporally distant and probabilistic, and the aversive functions of covert stimuli may interfere with people’s engagement in healthy, preventative behaviors. This article explores the role of relational framing in the promotion of healthy lifestyle behaviors and summarizes research supporting the use of acceptance and commitment training (ACT) as a framework for prevention and intervention. We explore how ACT alters the context in which rigid patterns of rule following occur. ACT loosens the literal functions of stimuli so that experiential-avoidance behaviors are weakened, and healthy, values-consistent behaviors are strengthened. We propose culture-wide interventions inspired by contextual behavior science so that healthier societies can be cultivated.

Constructs, Events, and Acceptance and Commitment Training.

The present article considers acceptance and commitment training (ACT) from the perspective of interbehavioral psychology. Specifically, J. R. Kantor's(1957) explicit distinction between constructs and events is reviewed, with particular attention given to the use of ACT in the practice settings of applied behavior analysis. It is recommended that practitioners be especially sensitive to the distinction between constructs and events as they consider employing ACT interventions. The interbehavioral field construct of interbehavioral psychology is briefly described as a context for conceptualizing both practice and research related to ACT in behavior analysis. Related conceptual issues, especially issues pertaining to the subject matter of behavior analysis and the Skinnerian concept of private events, are considered. The potential value of further integrating interbehavioral thinking into ACT practice and research is described.

The effect of acceptance and commitment training on improving physical activity during the COVID-19 pandemic

This study aimed to assess whether applied behavior analysis (ABA) procedures such as feedback, goal setting and stimulus control, combined with acceptance and commitment training (ACTr) interventions implemented digitally improve levels of physical activity, consistency with self-care values and psychological flexibility during the COVID-19 pandemic. A nonconcurrent multiple baseline design across five participants was used in this study. Participants included five women with BMI's in the overweight or obese range. All participants were exposed to two intervention phases. In the first phase, feedback, goal setting and stimulus control procedures were implemented to improve physical activity. In the next phase, these procedures were combined with mindful walking exercises and values clarification exercises. In addition, psychological flexibility related to physical activity and values consistency were measured throughout the study. Results indicated that step count improved with the implementation of ABA + ACTr across all participants. Furthermore, psychological flexibility and self-care value scores improved after the intervention and maintained at 1-week follow-up. Lastly, the impact of physical activity during COVID-19, effectiveness and efficiency of ABA + ACT interventions are discussed.