Acceptance-based Behavioral Therapy Research Articles

Examining interrelations among trajectories of mindful awareness, acceptance, and values-consistent actions in acceptance-based behavioral therapy for generalized anxiety disorder

ABSTRACT The goal of this study was to understand how mindful awareness, acceptance, and values-consistent action change across acceptance-based behavioral therapy (ABBT) for generalized anxiety disorder (GAD) and determine their effect on symptoms. We examined weekly data from 31 individuals who received ABBT as part of a randomized control trial for individuals with GAD (Hayes-Skelton, Roemer, & Orsillo, 2013). Participants answered questions weekly about three components of ABBT, including the percentages of time they spent over their past week: 1) aware of the present moment, 2) accepting of their internal experiences, and 3) engaging in values. GAD symptoms were examined using two self-report measures (DASS-21 Stress subscale and PSWQ) and two clinician-rated interview measures (CSR and SIGH-A) at pre- and post-treatment. 1 Mindful awareness, acceptance, and values-consistent action increased linearly across ABBT. All three change trajectories were positively correlated (Z’s 2.99 to 8.74, p’s < .001). Mindful awareness, acceptance, and values-consistent action across treatment predicted decreases in GAD symptoms above and beyond baseline for most outcome measures (Z’s −1.95 to −3.03, p’s < .05), with the exception that mindfulness did not predict DASS-stress (Z = −1.39, p = .17). These findings are consistent with the structure and model of ABBT.

Do treatment responders maintain their gains following a randomized clinical trial comparing an acceptance-based behavior therapy to applied relaxation for generalized anxiety disorder?

ABSTRACT To examine the maintenance effects of acceptance-based behavior therapy (ABBT) and applied relaxation (AR) for generalized anxiety disorder (GAD) 46 adults (69.6% female, 82.6% White) with high end-state functioning following an RCT comparing ABBT to AR were re-assessed at 12- and 24-month follow-up. End-state functioning was based on post-treatment scores within one standard deviation of the mean on three of five outcome measures [Clinician Severity Rating (CSR), Hamilton Anxiety, Penn State Worry Questionnaire (PSWQ), Depression Anxiety Stress Scale stress subscale (DASS-Stress), and State-Trait Anxiety Inventory (STAI)]. At 12 months, 93.8% of high endstate responders in ABBT and 95.5% in AR had maintained gains. At 24 months, 71.4% of responders from ABBT and 83.3% from AR maintained gains. Mixed-effects regression models revealed a significant effect for Time and Condition for DASS-Stress but not for Condition X Time. There was also a significant time effect for PSWQ, indicating PSWQ and DASS-Stress scores increased across follow-up. The rate of increase did not differ across conditions. Non-significant, small effects were found for all other outcomes indicating that symptoms did not significantly change across follow-up regardless of condition. While the results are limited by dropout rates, clients receiving ABBT or AR appear to maintain gains over long-term follow-up.

Exploring the Effectiveness and Acceptability of a Self-Help Acceptance-Based Behavior Intervention for Anxiety in Black Adults: An Uncontrolled Pilot Study

An estimated one in five Black Americans meet criteria for an anxiety disorder in their lifetimes (Alvarez et al., 2019), but only about 20% of these receive mental health services. Self-help materials that have been shown to be effective in reducing anxiety and worry could be one method of increasing access to evidence-informed treatments for Black Americans. The current study explored the acceptability and effectiveness of the Worry Less Live More: The Mindful Way Through Anxiety Workbook (WLLM), a self-help workbook based on acceptance-based behavioral therapy, for reducing anxiety in a sample of Black individuals. Sixty-five Black individuals residing in the United States received the WLLM workbook and were asked to read it over 16 weeks at their own pace without intervention from researchers: 40 of those participants completed the follow-up survey. A majority of the participants agreed that the approach was a good match for them (70%) that it aligned with their personal and cultural views (60%), and that the strategies from the workbook were helpful for them when dealing with the stress related to encountering racial stressors (71%). There were significant improvements over time on self-reported general anxiety (d = .50, anxious arousal (d = .41), cognitive fusion (d = .45), and acceptance (d = .76), but no significant changes in engagement in values-based action over time. This study provided preliminary support for the acceptability of WLLM’s acceptance-based approach for Black adults.

Inflammatory markers changes following acceptance-based behavioral psychotherapy in generalized anxiety disorder patients: Evidence from a randomized controlled trial

IntroductionGeneralized anxiety disorder (GAD) has been associated with elevated levels of C-reactive protein (CRP) and proinflammatory cytokines. Despite robust evidence as an effective treatment for GAD, research on the effects of cognitive-behavioral therapies (CBT) in the inflammatory profile of patients with clinical anxiety has presented mixed results. ObjectiveThe present study aimed to investigate the effect of an acceptance-based behavior therapy (ABBT) on inflammatory biomarkers and their association with anxiety levels in GAD patients in comparison to supportive therapy as an active control. MethodsPeripheral inflammatory biomarkers (CRP, IL-1β, IL-4, IL-6, IL-10, TNF-α) were measured in 77 GAD patients who participated in a 14-week 10-session randomized clinical trial of group ABBT (experimental, n = 37) or supportive group therapy (ST: active control group, n = 40). ResultsThe concentrations of IL-1β decreased in the control group and the concentrations of IL-6 increased in the experimental group from baseline to post-treatment, whereas no difference was identified in IL-4, IL-10, TNF, or CRP. Although anxiety and depression levels decreased in both treatment conditions, no correlation with inflammation markers was found for most clinical and biological variables. A negative correlation between changes in IL-6 and IL-10 and anxiety symptom score changes was identified. ConclusionsThe present study results found that a short trial of acceptance-based behavior therapy did not change the proinflammatory profile which may be associated with GAD. Additional research is needed to evaluate the influence of other inflammation-related variables, longer periods of follow-up as well as the effect of supportive therapy on peripheral inflammatory biomarkers in GAD patients.

Noradrenergic control of neurobehavior in human binge-eating disorder and obesity (NOBEAD): A smartphone-supported behavioral emotion regulation intervention study protocol integrating molecular brain imaging.

The neurobehavioral underpinnings of binge-eating disorder (BED), co-occurring with obesity (OB), are largely unknown. This research project conceptualizes BED as a disorder with dysfunctional emotion regulation (ER) linked with changes in central noradrenaline (NA) transmission and NA-modulated neuronal networks. We expect abnormalities in NA activity in both BED and OB, but most pronounced in BED. We expect these abnormalities to be modifiable through state-of-the-art ER intervention, specifically in BED. To assess the role of NA transmission, we will quantify changes in NA transporter (NAT) availability using the highly NAT-specific [11 C]methylreboxetin (MRB) and positron emission tomography-magnetic resonance imaging (PET-MRI) that allows measuring molecular and neuronal changes before and after an ER intervention. Individual 12-session smartphone-supported acceptance-based behavioral therapy will be conducted to improve ER. Thirty individuals with OB and BED (OB + BED), 30 individuals with OB without BED (OB - BED), and 20 individuals with normal weight will undergo assessments of NAT availability and neuronal network activity under rest and stimulated conditions, clinical interviews, self-report questionnaires on eating behavior, ER, mental and physical health, and quality of life, and neuropsychological tests on executive function. Afterwards, in an experimental randomized-controlled design, individuals with OB + BED and OB - BED will be allocated to smartphone-supported ER intervention versus a waitlist and re-assessed after 10 weeks. By obtaining biological and behavioral markers, the proposed study will disentangle the involvement of NAT and the central NA system in the modulation of emotion-supporting neuronal networks that influence eating behavior. Neurobehavioral mechanisms of change during an ER intervention will be determined. German Clinical Trials Register (DRKS): DRKS00029367. This study investigates the central noradrenaline system by using hybrid brain imaging in conjunction with emotion regulation as a putative core biological mechanism in individuals with obesity with or without binge-eating disorder that is targeted by emotion regulation intervention. The results will provide a molecular signature beyond functional imaging biomarkers as a predictive biomarker toward precision medicine for tailoring treatments for individuals with binge-eating disorders and obesity.

A randomized trial of acceptance-based behavioral therapy to improve mental health outcomes for LGBTQ+ persons: Study protocol

BackgroundDuring the COVID-19 pandemic, public health measures limited social interactions as an effective and protective intervention for all. For many, however, this social isolation exacerbated mental health symptoms. People who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ+) were already at elevated risk of anxiety and depression, relative to cisgender and heterosexual populations, and pandemic-related social isolation likely heightened these disparities. In our prior work with sexual and gender minorities, we developed and established feasibility and acceptability of a novel acceptance-based behavioral therapy (ABBT) intervention for HIV treatment. ABBT showed promise in improving social support and reducing mental health symptoms. In the current study, we investigate the efficacy of ABBT, compared to a treatment-as-usual control condition, in a full-scale randomized controlled trial to improve social support for LGBTQ+ persons living with anxiety and depression. MethodsTwo hundred forty LGBTQ+ adults with anxiety and/or depressive symptoms will be recruited and equally randomized to receive: (a) the ABBT intervention, consisting of two 30–40 min sessions plus treatment-as-usual (TAU), or (b) TAU only. Primary outcomes are interviewer-assessed anxiety and depressive symptoms. Secondary outcomes are self-reported anxiety and depressive symptoms. Experiential avoidance and social support are hypothesized mediators and presence of an anxiety and/or depressive disorder is a hypothesized moderator. ConclusionsABBT represents a novel, identify-affirming real-world approach to promoting social support as a means of improving mental health among individuals who identify as LGBTQ+. This study will contribute actionable data establishing the impact, mediational mechanisms, and effect modifiers of ABBT.Clinicaltrials.govregistration: NCT05540067

The Comparison of Metacognitive Group Intervention and Group Acceptance-Based Behavioral Therapy on Competitive Aggression of Anxious Professional Soccer Athletes in Tehran

The aim of present study was comparison of metacognitive group intervention and group acceptance based behavioral therapy on competitive aggression of anxious professional soccer players in U-19 league in Tehran. Participants in this study were 60 professional soccer players who were occupied in professional soccer leagues in Tehran. These participants were entered into the assessment stage and after obtaining informed consent, they randomly assigned in one of the three experiment groups MCT MAC, WL. The participants completed the Sport Aggression Styles Inventory in pre-test, post-test and 3 months follow-up stages. The results of present study demonstrate that MCT and MAC can make some changes in aggression styles of anxious soccer players. MCT have been affecting on passive-aggressive and somatic aggression styles. In addition, MAC have been affecting on sadistic and masochistic aggression styles. According to these findings, it would ensure that soccer players affected by anxiety and aggression-related problems get the opportunity to gain advantages from such third wave’s interventions.

Internet-delivered acceptance-based behavior therapy for trichotillomania and skin-picking disorder in a psychiatric setting: A feasibility trial

Trichotillomania (TTM) and skin-picking disorder (SPD) are two clinically related conditions that can be successfully treated with behavior therapy (BT). There is some research indicating that BT for TTM and SPD can be efficacious also when delivered online instead of face-to-face, however, previous studies have mainly used self-recruited samples in a university context and it is unclear if the effects of online BT also extend to regular psychiatric patients. The current study set out to investigate if internet-delivered BT (I-BT) is a feasible, acceptable and preliminarily efficacious treatment for patients in a routine psychiatric setting. Twenty-five adult clinician-referred patients with TTM (n = 7) and/or SPD (n = 18) received 10 weeks of therapist-guided I-BT. The I-BT program incorporated both traditional interventions (e.g. habit reversal) as well as more recent acceptance-based techniques (e.g. embracing the urges and mindfulness). Clinician- and self-rated outcomes were assessed at pretreatment, posttreatment and at the delivery of 4 additional booster modules. Results showed that the majority of the participants were satisfied with the treatment and found it credible. The average number of completed internet modules was 7.2/10; five participants ended treatment prematurely. Significant decreases in hair pulling and skin picking severity were demonstrated from pretreatment to posttreatment with within-group effect sizes ranging from d = 0.89 to 1.75. The results remained significant up to the 12-month follow-up on most outcome measures. Altogether, the results provide initial evidence suggesting that I-BT could be a feasible, acceptable and potentially effective treatment for TTM and SPD for patients in a regular psychiatric setting.

Acceptance-Based Behavioral Therapy: Treating Anxiety and Related Challenges. Lizabeth Roemer and Susan M. Orsillo. The Guilford Press, 2020, 318 pages.

Acceptance-Based Behavioral Therapy: Treating Anxiety and Related Challenges. Lizabeth Roemer and Susan M. Orsillo. The Guilford Press, 2020, 318 pages.

HIV Engage—A randomized controlled efficacy trial of an acceptance-based behavioral therapy intervention to improve retention in care for HIV treatment naïve patients: Study protocol

IntroductionPeople with HIV (PWH) who are not consistently retained in medical care, particularly when they are first diagnosed, are at risk for: delayed antiretroviral therapy (ART) initiation, suboptimal ART adherence, unsuppressed viremia, and mortality. Suboptimal retention means effective ART cannot be leveraged to prevent onward HIV transmission. To address this, we developed and previously pilot tested the HIV Engage intervention—a novel behavioral approach to enhance retention in HIV care using acceptance-based behavioral therapy (ABBT)—and established feasibility and acceptability of this approach. In the current study, we investigate the efficacy of ABBT compared to an attention-matched control condition in a full-scale randomized controlled efficacy trial. MethodsTwo hundred seventy HIV care naïve patients from geographically diverse clinics will be recruited and equally randomized to receive (a) the HIV Engage intervention, consisting of two 20–30 min ABBT sessions delivered in-person or remotely, or (b) an attention-matched HIV education control condition. Primary outcomes are number of HIV care appointments kept and HIV viral load suppression. Secondary outcomes are higher self-reported ART adherence, HIV status disclosure, increased social support, and reductions in perceived HIV stigma. Hypothesized mediators include acceptance of one's HIV diagnosis and willingness to disclose serostatus. We will also assess for epidemiologically-linked moderators of the treatment effect. ConclusionsABBT represents a novel, potentially promising approach to enhance retention in ongoing HIV care among treatment naïve PWH. This study will contribute significant actionable data establishing the impact, mediational mechanisms, and effect modifiers of ABBT.

Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with generalized anxiety disorder.

The evidence base supporting the usefulness of traditional cognitive-behavioral therapy (CBT) and newer acceptance-based CBT treatments for generalized anxiety disorder (GAD) has grown over the past decades. GAD is prevalent among several Latino subgroups, particularly Puerto Ricans. However, there remains uncertainty regarding the appropriateness of these interventions for Spanish-speaking Latinos since they have been routinely excluded in both efficacy and effectiveness studies. As an initial step to bridge this gap, this pilot study examined the potential efficacy of two CBT interventions for GAD, traditional CBT and acceptance-based behavioral therapy (ABBT), in a sample of Spanish-speaking Latinos. Ninety primary care patients with GAD were randomly assigned to receive CBT (n=30), ABBT (n=30), or treatment as usual (TAU) (n=30). Excessive worry, the core feature of GAD, was assessed with the Penn State Worry Questionnaire (PSWQ), which is considered the gold standard measure of GAD-related worry. At follow-up, PSWQ scores for participants in the CBT and ABBT groups were statistically lower than those of the TAU group and statistically comparable to each other. CBT and ABBT reduced worry level to a greater degree than usual care by follow-up. Our findings provide preliminary, yet crucial data, which support the potential of both interventions targeting GAD symptoms among Spanish-speaking Latino primary care patients.

تاثیر رفتار درمانی مبتنی بر پذیرش بر شاخص توده بدنی در بیماران کرونری قلبی زودرس

Background and Objective: Obesity is a known risk factor for cardiovascular diseases; however, weight loss and decreasing body mass index (BMI) are difficult for many patients with coronary heart disease. The purpose of this study was to determine the effectiveness of acceptance-based behavior therapy on BMI among patients with premature coronary heart disease. Materials and Methods: This study was conducted in the summer of 2018 and was of quasi-experimental design with control group, pre-test, post-test, and a follow-up period after 3 months. The statistical population included all male patients with premature coronary heart disease who were younger than 50 years old and were referred to Shahid Rajaee hospital in Tonekabon, among whom 24 were selected via convenience sampling method and divided into two intervention and control groups. The intervention group received treatment-based behavioral therapy for eight weekly sessions while the control group did not receive any intervention. BMI was calculated in the pre-test, post-test and follow-up for each participant. Data were analyzed via SPSS software version 22. Results: In the experimental group, the mean (SD) BMI decreased from 32.2 (3.4) before the intervention to 31.5 (3.1) after the intervention (P<0.01). In the control group, the mean (SD) BMI decreased from 32.6 (3.5) before the intervention to 32.5 (3.4) after the intervention; however, the decrease was not statistically significant. In addition, in the follow-up phase of the experimental group, the mean (SD) BMI decreased from 31.5 (3.1) in post-test to 30.4 (2.8) in the follow-up (P<0.001). In the control group, the mean (SD) BMI decreased from 32.5 (3.4) in post-test to 32.4 (3.4) in the follow-up; however, this decrease was not statistically significant. Conclusion: It could be concluded that acceptance-based behavioral therapy lead to a decrease in BMI among premature coronary heart disease patients.

Learning gains from a one-day training in acceptance-based behavior therapy

ABSTRACT The primary method of training for individual licensed mental health professionals is continuing education (CE). Despite the promise of CE as a vehicle for training clinicians in evidence-based practices, only a handful of studies have examined the efficacy of trainings delivered in the CE context. Moreover, these studies have focused on a few very specific therapeutic approaches. There is a growing body of evidence supporting Acceptance-based Behavior Therapy (ABBT) as a treatment for generalized anxiety disorder (GAD) and related disorders. Training workshops aimed at disseminating ABBT are regularly conducted across and outside the United States, yet the effectiveness of these trainings is unknown. The goal of this study was to examine learning outcomes among licensed mental health professionals following a six-hour CE training in ABBT. Data were collected at baseline, post-training, and at three-month follow-up. Participants demonstrated a statistically significant increase in learning on an ABBT Knowledge Questionnaire and in their coded responses to client scenarios from baseline to follow-up, although there was a significant decline in knowledge between post and follow-up. Beyond baseline ABBT knowledge, attitude towards evidence-based practice was the only predictor of change in knowledge over time.

A randomized controlled pilot study evaluating Worry Less, Live More: The Mindful Way Through Anxiety Workbook

ABSTRACT Effective interventions for generalized anxiety exist, but barriers to treatment prevent their broad dissemination. Commercially available self-help materials may help bridge this gap, but few have been empirically evaluated. This study compared self-reported change in generalized anxiety symptomology and associated problems between community members with excessive worry who were randomly assigned to receive the Worry Less, Live More: The Mindful Way through Anxiety Workbook (n = 35) and those in a delayed condition (n = 29). Participants in the workbook condition reported significantly greater reductions between baseline and 11-week follow-up in self-reported worry (η 2 =.15), general anxiety/tension (η 2 =.13), and anxiety (η 2 =.24) than those in the delayed condition, although no statistically significant differences across condition on changes in depression, functional impairment or acceptance were detected. This pilot study provides support for continued research examining the efficacy of acceptance-based behavioral therapy delivered in a self-help format.

The comparison impact of Metacognitive Therapy-Based Group Intervention and Group Acceptance-Based Behavioral Therapy on Psychophysiological Signs of Professional Soccer Players in the U-19 League in Tehran

: The present study aimed to compare the effect of metacognitive therapy-based group intervention and group acceptance-based behavioral therapy on psychophysiological signs of professional soccer players in the U-19 league in Tehran. Participants were professional soccer players occupied in professional soccer leagues in Tehran. The participants were entered into the assessment stage, and after obtaining informed consent, they were randomly assigned to one of the three experiment groups, namely MCT, MAC, and WL. The participants’ psychophysiological signs included EEG, EMG, HR, GSR, temperature, and RR, which were recorded using the ewave 8-channel neuro-biofeedback device. The data were analyzed using the eProbe7.8.3 software of Rubymind.us. The results demonstrated that MCT and MAC could make some changes in psychophysiological signs of anxious soccer players. MCT was shown to affect Fz Highbeta-Gama and RR, which had a correlation with anxiety. In addition, MAC was observed to affect the asymmetry of F3 alpha and F4 alpha as a remarkable EEG pattern of aggression. However, MCT and MAC did not show any effect on HR, EMG, temperature, and GSR. According to these findings, it can be inferred that those soccer players who are uncomfortable and suffer from anxiety and aggression-related problems may benefit from such interventions.

Efficacy of an Acceptance-based Group Behavioral Therapy for Generalized Anxiety Disorder.

Efficacy of an Acceptance-based Group Behavioral Therapy for Generalized Anxiety Disorder.

Internet-Delivered Acceptance and Commitment Therapy for Anxiety Treatment: Systematic Review.

BackgroundAnxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, acceptance-based behavioral therapy for anxiety. However, there are treatment barriers (eg, financial, geographical, and attitudinal), which prevent people from accessing it. To overcome these barriers, internet-delivered ACT (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill training exercises on the Web, either as pure self-help or with therapist guidance.ObjectiveThis systematic review aimed to examine the therapeutic impact of iACT on all anxiety conditions.MethodsThe EMBASE, MEDLINE, ProQuest Central, PsycINFO, Scopus, and Web of Science databases were searched up to September 2018. The titles and abstracts of remaining records after deduplication were screened by 2 authors with a total of 36 full-text articles being retained for closer inspection next to eligibility criteria. Empirical studies of all designs, population types, and comparator groups were included if they appraised the impact of iACT treatment on any standardized measure of anxiety. Included studies were appraised on methodological quality and had their data extracted into a standardized coding sheet. Findings were then tabulated, and a narrative synthesis was performed because of the heterogeneity found between studies.ResultsA total of 20 studies met inclusion criteria. There were 11 randomized controlled trials (RCTs) and 9 uncontrolled pilot studies. Participants across all studies were adults. The anxiety conditions treated were as follows: generalized anxiety disorder (GAD), social anxiety disorder (SAD), illness anxiety disorder (IAD), and general anxiety symptoms, with or without comorbid physical and mental health problems. A total of 18 studies reported significant anxiety reduction after iACT treatment. This was observed in studies that delivered iACT with (n=13) or without (n=5) therapist guidance. The average attrition rate across all included studies during the active iACT treatment phase was 19.19%. In the 13 studies that assessed treatment satisfaction, participants on average rated their iACT experience with above average to high treatment satisfaction.ConclusionsThese findings indicate that iACT can be an efficacious and acceptable treatment for adults with GAD and general anxiety symptoms. More RCT studies are needed to corroborate these early iACT findings using empirical treatments in active control groups (eg, internet-delivered cognitive behavioral therapy). This would potentially validate the promising results found for SAD and IAD as well as address the full spectrum of anxiety disorders.

Treatment for Anxiety and Depression via Clinical Videoconferencing: Evidence Base and Barriers to Expanded Access in Practice.

This review summarizes six decades of clinical outcome research relevant to evidence-based practices for depression and anxiety delivered via clinical videoconferencing. The authors conducted a literature search of previous systematic reviews and an updated search of publications specific to anxiety and depression. Overall, strong evidence supports the safety and clinical effectiveness of administering evidence-based psychotherapy for anxiety and depression via clinical videoconferencing among heterogeneous populations and age ranges, and in multiple care settings, with similar outcomes to in-person care. Despite the overall clinical effectiveness of the modality, the authors discuss common logistical and institutional barriers to long-term effective implementation. Future systems-level research is required to investigate replicable and sustainable models for implementing and expanding access to evidence-based psychotherapies via clinical videoconferencing.

Personality and Marital Relationships: Developing a Satisfactory Relationship with an Imperfect Partner

Two partners tying a marital knot cannot possibly fathom the complexity of the relationship that lies ahead. Once married, the success or failure of marriage is determined by a myriad of factors. Each partner is a unique agglomeration of stable personal dispositions that influence marital relationships. During courtship, partners typically idealize their relationship and maintain a positive illusion about their significant other, and behaviors and traits that may later threaten the developing relationship are mostly ignored. In the early marriage years, however, the process of marital disillusionment begins and the personal dispositions that were dismissed earlier become increasingly conspicuous and hard to ignore. Eventually, partners come to grips with reality and experience a decline in love. Acknowledging that personal dispositions are ingrained in the genetics and are reinforced by the early experiences and attachment bonds, this paper reviews the role of personal dispositions on marital outcomes and examines how negative outcomes can be curbed by therapeutic interventions. In this context, the acceptance and commitment therapy (ACT; an experiential acceptance-based behavior therapy) that targets experiential avoidance and increases psychological flexibility is discussed.

Using Acceptance and Commitment Therapy to Improve Outcomes in Functional Movement Disorders: A Case Study

Although there are many theories of functional movement disorders (FMD), the causes and prognosis remain unclear, and there are no treatments with high-quality empirical support. Acceptance and commitment therapy (ACT) is an acceptance-based behavior therapy which, via altering a process called psychological flexibility, aims to support behaviors that are consistent with a person’s overarching values—even in difficult, uncertain, or immutable contexts. It may, therefore, have pragmatic benefits in the context of FMD. We outline the theoretical basis for ACT and detail a case study of a brief (six session) intervention for increasing personally meaningful activity with FMD. The participant was in her early 20s and had been diagnosed with functional propriospinal myoclonus. ACT techniques including relational framing, defusion, and mindfulness exercises were used to increase psychological flexibility, with the goal of enabling effective functioning within the difficult context created by FMD. Following treatment, the participant showed a reliable change/clinical recovery in psychological flexibility (Acceptance and Action Questionnaire II [AAQ-II]), FMD symptom interference (Work and Social Adjustment Scale [WSAS]; primary outcome), and mood (Clinical Outcomes in Routine Evaluation 10-item scale [CORE-10]; secondary outcome). This case study demonstrates an approach that focuses first on improving functioning with FMD, as opposed to eliminating or controlling symptoms.