Acceptance-based Interventions Research Articles

Effectiveness of a mindfulness and acceptance-based intervention for improving the mental health of adolescents with HIV in Uganda: An open-label trial.

Adolescents with HIV (AWH) face the double burden of dealing with challenges presented by their developmental phase while coping with stigma related to HIV, affecting their mental health. Poor mental health complicates adherence to daily treatment regimens, requiring innovative psychosocial support strategies for use with adolescents. We assessed the effectiveness of a mindfulness and acceptance-based intervention on the mental health of AWH in Uganda. One hundred and twenty-two AWH, mean age 17 ±1.59 (range 15 to 19 years), 57% female, receiving care at a public health facility in Kampala were enrolled in an open-label randomized trial (ClinicalTrials.gov: NCT05010317) with assessments at pre-and post-intervention. The mindfulness and acceptance-based intervention involved weekly 90-minute group sessions for four consecutive weeks facilitated by two experienced trainers. Sessions involved clarifying values, skillfully relating to thoughts, allowing and becoming aware of experiences non-judgmentally, and exploring life through trial and error. The control group received the current standard of care. Three mental health domains (depression, anxiety, and internalized stigma) were compared between the intervention and control groups. A linear mixed effects regression was used to analyze the effect of the intervention across the two time points. Results showed that the intervention was associated with a statistically significant reduction in symptoms of depression (β = -10.72, 95%CI: 6.25, -15.20; p < .0001), anxiety (β = -7.55, 95%CI: 2.66, -12.43; p = .0003) and stigma (β = -1.40, 95%CI: 0.66 to -2.15; p = .0004) over time. Results suggest that mindfulness and acceptance-based interventions have the potential to improve the mental health of AWH.

A Social Media-Delivered Melanoma Prevention Program for Young Women Engaged in Frequent UV Tanning: Protocol for a Randomized Controlled Trial.

Rates of melanoma have increased dramatically in the United States over the past 25 years, and it has become among the most prevalent cancers for young adult women. Intentional skin tanning leads to a pattern of intense and intermittent UV radiation exposure that is associated with increased risk of melanoma. Frequent tanning is most common among young women and is linked to a variety of sociocultural pressures that negatively impact body image and drive appearance control behaviors. Unfortunately, there are no established interventions designed for frequent tanners. This intervention addresses this gap with unique content informed by body image and acceptance-based interventions. The intervention is delivered using Facebook secret groups, an approach designed to support behavior change and ensure scalability. This study aims to describe the rationale and methodology of a randomized controlled trial of a melanoma prevention program targeting young women engaged in frequent indoor or outdoor UV tanning. Participants are women aged 18-25 years who report high-risk tanning (ie, at least 10 indoor tanning sessions in the past 12 months or 10 outdoor sessions in the previous summer). After recruitment and screening, participants completed a baseline survey and were randomly assigned to receive the intervention or an attention-matched control condition. Both conditions were 8-week-long Facebook groups (approximately 25 members each) with daily posting of content. Follow-up surveys are administered at 3, 8, and 18 months after baseline. The primary trial outcome is the combined number of indoor and outdoor tanning sessions reported at the 8-month follow-up. Hypothesized intervention mediators are assessed at the 3-month follow-up. This project was funded by a National Cancer Institute award (R01 CA218068), and the trial procedures were approved by the University of Kentucky Institutional Review Board in February 2020. Trial recruitment and enrollment occurred in 6 waves of data collection, which started in February 2022 and closed in May 2023. The study is closed to enrollment but remains open for follow-ups, and this protocol report was prepared before data analyses. As of February 2024, all participants have completed the 8-month follow-up assessment, and data collection is scheduled to close by the end of 2024 after the collection of the 18-month follow-up. This trial will contribute unique knowledge to the field of skin cancer prevention, as no fully powered trials have examined the efficacy of an intervention designed for frequent indoor or outdoor tanning. The trial may also contribute evidence of the value in translating principles of body image and acceptance-based interventions into the field of skin cancer prevention and beyond. If successful, the use of the Facebook platform is intended to aid in dissemination as it provides a way to embed the intervention into individuals' everyday routines. ClinicalTrials.gov NCT03441321; https://clinicaltrials.gov/study/NCT03441321. DERR1-10.2196/56562.

Preliminary feasibility, acceptability, and effectiveness of a pilot telehealth-based intensive outpatient program incorporating acceptance and commitment therapy for adolescents with obsessive compulsive disorder

Pediatric obsessive compulsive disorder (OCD) is a significantly impairing disorder. Given the impact of pediatric OCD, it is important to consider how to best adapt treatments for OCD, particularly for more severe youth that may not respond to traditional outpatient formats. Understanding how to implement such treatments via telehealth can improve access to care and reduce treatment burden on families. The current study therefore evaluates preliminary feasibility, acceptability, and effectiveness of delivering a pilot intensive, group-based telehealth treatment combining acceptance-based skills with exposure and response prevention (ERP) for pediatric OCD. Participants (N = 25) received two to 3 h of individual, family, and/or group treatment per day, four days per week, for a total of 10 h of treatment per week. Following the intensive outpatient program (IOP), adolescents reported large decreases in OCD symptoms, and small to large decreases in anxiety and depression. Parents reported similar outcomes, with small to large improvements in the impact of OCD on their child, anxiety, and familial accommodation. This pilot study thereby presents promising results and adds to the growing evidence base of acceptance-based interventions for adolescents with OCD, anxiety, and other mental health concerns.

The roles of readiness and dosage in predicting outcomes of a mindful sport performance enhancement intervention with U.S. college student-athletes

Research suggests that Mindfulness- and Acceptance-Based Interventions (MABIs) can impact sport performance and performance-relevant factors, though questions remain regarding when and for whom MABIs are effective. Specifically, inquiries into intervention engagement (i.e., dosage), potentially impacted by participant readiness, are needed. The present study utilized a non-randomized control group design with U.S. collegiate athletes to investigate MABI effects. Four teams from two universities in the Appalachian region (N = 57) engaged in Mindful Sport Performance Enhancement (MSPE) interventions during their offseason or pre-season training period. Participants were assessed on flow, psychological distress, mindfulness, emotion regulation difficulties, life satisfaction, readiness to practice mindfulness, attitudes toward sport psychology, and sport performance and enjoyment. Mindfulness dosage was measured weekly via self-report. Compared to controls, initial MSPE participants reported reductions in depressive symptoms and emotion regulation difficulties, and improvements in self-rated sport performance; at 6-week follow-up, initial MSPE participants reported significant increases in mindfulness and sport enjoyment, in addition to sustained reductions in emotion regulation difficulties. Pre-intervention readiness was not associated with changes across the intervention, though higher post-intervention readiness was associated with improvements in mindfulness, life satisfaction, and sport enjoyment. Higher post-intervention readiness was also associated with significantly more engagement (i.e., dosage), though no evidence indicated that dosage moderated the relationship between readiness and outcomes. These data suggest that post-intervention readiness may impact long-term engagement in mindfulness practice, and that pre-intervention readiness may not be an accurate indicator of engagement in or outcomes of an MABI with athletes.

A meta-analytic review of acceptance-based interventions for migraine.

To determine the efficacy of acceptance and mindfulness-based interventions on migraine disability, medication use, and attack frequency. Acceptance-based approaches to headache management are those in which individuals learn to mitigate the influence of pain-related experiences on their general functioning without controlling pain itself. Treatment approaches include acceptance and commitment therapy (ACT) and mindfulness-based practices. Both have shown promise in improving broad functioning and disability among individuals with headache. Despite a growing body of research examining acceptance-based interventions for headache broadly and migraine specifically, no meta-analytic review of ACT interventions for headache exists, and two meta-analytic reviews of mindfulness-based practices yielded conflicting results. The present study aimed to systematically and quantitatively review the literature related to the efficacy of acceptance-based interventions among adults with migraine. A multi-database search (PubMed/MEDLINE, Scopus, PsycINFO, and the Cochrane Central Register of Controlled Trials) identified clinical trials among individuals with migraine that compared structured ACT or mindfulness-based interventions to control treatment. Random-effects meta-analyses were performed using RevMan 5.4 meta-analytic software, and standardized mean differences (SMD) with 95% confidence intervals (CIs) quantified effect sizes on outcomes of disability, medication use, and headache frequency. Heterogeneity was quantified via I2 index and explored via subgroup analyses. Acceptance-based interventions yielded significant improvements in disability (SMD = -0.38, 95% CI = -0.56 to -0.20; I2 = 25%, p = 0.20) but not in medication use (SMD = -0.25, 95% CI: -0.57 to 0.06; I2 = 0%, p = 0.82) or headache frequency (SMD = -0.16, 95% CI = -0.37 to 0.05; I2 = 0%, p = 0.73). Results suggest that acceptance-based interventions are effective in improving disability among adults with migraine and are a viable non-pharmacological treatment option, in addition to well-established behavioral migraine management approaches, for patients seeking functional improvement.

Acceptability of an adapted mindfulness and acceptance-based intervention to support adolescents with HIV: A qualitative study with Ugandan health care providers

While the adaptation of evidence-based psychosocial support tailors the intervention components to the targeted context, minimizing the associated costs of developing new interventions for low-income contexts, the acceptability of such adapted interventions is important for augmenting successful implementation and sustainability. Given that psychosocial support to persons living with HIV is mostly rendered by healthcare providers, their acceptance of adapted interventions before implementation is crucial. This study explored healthcare providers' acceptance of an adapted mindfulness and acceptance-based intervention supporting adolescents with HIV. Ten healthcare providers at two urban clinics in Kampala, Uganda attended a three-day training on using the adapted intervention and gave feedback on its appropriateness during in-depth interviews conducted thereafter. Semi-structured interviews were based on the Theoretical Framework of Acceptability and findings were analyzed abductively within the seven components of the framework. Overall, the adapted intervention was perceived to be acceptable and appropriate for use with adolescents. Benefits included the intervention offering support beyond a focus on adherence to drugs, refocusing adolescents on aspects in their lives that matter most, and being easy to integrate into providers’ work processes. Providers however expressed concern about the time the intervention requires and the possibility of increasing their workload. These findings will support further adaptation and implementation.

Monitoring change in heart rate variability following acceptance and commitment therapy for chronic pain: Results of a randomized controlled trial for individuals with neurofibromatosis type 1

Acceptance and Commitment Therapy (ACT) is a well-evidenced therapeutic model for the treatment of chronic pain. While there is substantial data that indicates improvement in the cognitive and behavioral aspects of pain (e.g., pain acceptance, pain inflexibility, pain interference), significantly less research has explored changes in physiological variables following acceptance-based interventions. In particular, heart rate variability (HRV) is a physiological marker of pain and reflects the time elapsed between heart beats. The current study examined whether HRV changed following a randomized-controlled trial of ACT for individuals with neurofibromatosis type 1 and chronic pain (N = 62). Repeated measures analyses of covariance assessed change following ACT. In addition, hierarchical linear regression models examined pain-related predictors of HRV at follow-up. The results suggest that HRV improves following ACT, although given the small sample and limited analytical model, the findings should be considered preliminary. Further, improvements in HRV over the course of the intervention predicted improvements in pain intensity at follow-up suggesting a relationship between these two variables. Taken together, these data provide modest evidence of the relationships between ACT and HRV within a chronic pain population. Additional implications and future directions are discussed.

ID: 207542 Durable Chronic Low Back Pain Relief by RelieVRx, an at-Home Virtual Reality Program, 18 months Post-Treatment

Chronic low back pain (CLBP)1,2 prevalence is rising despite medical interventions. Access to cognitive behavioral therapy (CBT)3 4,5,6 is limited.7 On-demand immersive therapeutics provide home-based pain self-management. We tested the durability of CLBP reduction to 18-months post-treatment with RelieVRx, AppliedVR’s FDA-authorized solution for CLBP. RelieVRx is an 8-week, self-administered at-home virtual reality (VR) program designed to incorporate immersive therapeutics to build habits and behavioral skills for reducing pain and pain interference. It includes VR modules that incorporate principles and elements drawn from CBT, mindfulness and acceptance-based treatments for chronic pain.

A Mindfulness- and Acceptance-Based Intervention for Injured Athletes

The aim of this article is to describe a mindfulness- and acceptance-based intervention as it can be applied to athletes recovering from an acute injury. The intervention consists of two parts: (a) a web-based program where athletes are asked to engage in regular formal mindfulness practices, and (b) four sessions with a practitioner. The content of the intervention is described thoroughly, and I provide recommendations for practitioners who want to intervene with this group of athletes. A central point is to adapt the content of the intervention specifically to the rehabilitation context.

Culturally adapting a mindfulness and acceptance-based intervention to support the mental health of adolescents on antiretroviral therapy in Uganda.

The dual burden of living with HIV and negotiating life stage changes has been identified as a contributing factor to lapsed adherence among adolescents with HIV in sub-Saharan Africa. While psychosocial support can promote medication adherence, most interventions in use with adolescents were originally developed for the general population creating a gap in appropriate support. Life-stage-appropriate, evidence-based psychosocial support interventions have been used with young people in high-income contexts, prompting interest in their use in low-income contexts. However, many interventions are less effective when implemented outside of their original settings, hence the need for modifications before implementation. We aimed to culturally adapt an evidence-based psychosocial support intervention designed to improve the mental health of young people for use among adolescents with HIV in a sub-Saharan African context and to explore the acceptability of the adapted intervention among adolescents. We engaged thirty stakeholders (n = 30) in Kampala, Uganda including psychologists, psychiatrists, social workers, HIV counselors, religious leaders and adolescent peers from December 2021 to April 2022 to modify an evidence-based intervention for adolescents. Key adaptations included simplifying the language, adding local practices, integrating locally relevant slang and stories into therapy, introducing racially-congruent visuals and cards representing emotions, and adjusting therapy materials for use in resource-constrained settings. We then tested the acceptability of the intervention in a small sample of service users using a qualitative approach. We recruited nine adolescents with HIV from a participating clinic in Kampala, delivered six 90-minute sessions of the adapted intervention across three weeks and conducted in-depth interviews to assess the acceptability of the intervention. We used thematic analysis to analyze the qualitative data. The adapted intervention was perceived as acceptable among adolescents with HIV, with many stating that it helped them overcome fears, increased their self-acceptance, and gave them the confidence to make careful health-enhancing decisions.

Relations of perceived injustice to psycho-spiritual outcomes in advanced lung and prostate cancer: Examining the role of acceptance and meaning making.

Many advanced cancer patients struggle with anxiety, depressive symptoms, and anger toward God and illness-related stressors. Patients may perceive their illness as an injustice (i.e., appraise their illness as unfair, severe, and irreparable or blame others for their illness), which may be a risk factor for poor psychological and spiritual outcomes. This study examined relations between cancer-related perceived injustice and psycho-spiritual outcomes as well as potential mediators of these relationships. Advanced lung (n=102) and prostate (n=99) cancer patients completed a one-time survey. Using path analyses, we examined a parallel mediation model including the direct effects of perceived injustice on psycho-spiritual outcomes (i.e., anxiety, depressive symptoms, anger about cancer, anger towards God) and the indirect effects of perceived injustice on psycho-spiritual outcomes through two parallel mediators: meaning making and acceptance of cancer. We then explored whether these relations differed by cancer type. Path analyses indicated that perceived injustice was directly and indirectly-through acceptance of cancer but not meaning making-associated with psycho-spiritual outcomes. Results did not differ between lung and prostate cancer patients. Advanced cancer patients with greater perceived injustice are at higher risk for poor psycho-spiritual outcomes. Acceptance of cancer, but not meaning making, explained relationships between cancer-related perceived injustice and psycho-spiritual outcomes. Findings support testing acceptance-based interventions to address perceived injustice in advanced cancer patients.

Exploring the contribution of psychological flexibility processes and self-compassion to depression, anxiety and adjustment in parents of preterm infants

BackgroundThe preterm birth and subsequent hospitalisation of an infant is a challenging time for parents, leaving many parents vulnerable to depression, anxiety and difficulties with adjustment. Psychological flexibility and self-compassion have been theorised to enable effective functioning in such challenging contexts, which may help us understand variation in parental experiences and adjustment. PurposeTo investigate the extent to which psychological flexibility sub-processes (valued action, behavioural awareness, and openness to experience) and self-compassion explain variation in depression and anxiety and individual and relational adjustment among parents of preterm infants. MethodsA sample of 215 parents of preterm infants were recruited via a charity for children born preterm. Data was collected via online survey and analysed using multiple hierarchical regressions. ResultsPsychological flexibility and self-compassion were significant predictors of depression and anxiety in parents of preterm infants. Components of psychological flexibility were significant predictors of individual and relational adjustment while self-compassion was predictive of relational but not individual adjustment. However, the portion of variance accounted for by self-compassion after controlling for psychological flexibility was modest. Components of psychological flexibility but not self-compassion retained their predictive value for individual and relational adjustment when controlling for depression and anxiety. ConclusionsThis study provides preliminary evidence that psychological flexibility and self-compassion are helpful for understanding depression, anxiety and adjustment difficulties in parents of preterm infants and provides support for future development of acceptance-based interventions for this population.

An integrated mindfulness and acceptance-based program for young elite female basketball players: Exploratory study of how it works and for whom it works best

In order to better understand how an integrated mindfulness and acceptance-based intervention works and for whom it works best, study objectives were to examine (i) the trajectories of mindfulness skills and performance-related outcomes during the intervention, and athletes’ perceptions of the impact of the intervention; and (ii) the potential moderating effects of personality characteristics on changes in targeted variables associated with the intervention. The sample consisted of 40 young elite female basketball players (M = 16.33, SD = 0.75 years) from three incoming groups at the French Federal Basketball Center over a 3-year period. All players participated in a 15-week Mindfulness BasketBall Integrated program. They completed online questionnaires measuring personality traits 10 months before the intervention, as well as pre-, mid- and post-intervention measurements of mindfulness skills, intensity and directional interpretation of stress, and performance satisfaction. They also participated in semi-structured social validation interviews conducted one month after the intervention. The results of the multilevel growth curve (MGCA) and thematic analyses revealed how the mindfulness skills and performance-related outcomes evolved over the course of the intervention and how these changes were perceived by the athletes. Specifically, the MGCA showed significant linear increases in acceptance, positive stress direction, and performance satisfaction. The complementary social validation data indicated perceived improvements in mindfulness skills and performance. The MGCA also showed that baseline personality traits moderated the effects of the program on acceptance and experience of stress. These findings may be used to inform the design of more effective integrated mindfulness and acceptance-based interventions.

Mindfulness and acceptance-based interventions with Black Americans: A meta-analysis of intervention efficacy for depressive symptoms.

A growing literature supports mindfulness and acceptance-based interventions (MABIs) for depression prevention and treatment with individuals from dominant cultural groups, and MABIs have been theorized to be well suited to resonate with individuals from nondominant groups. The aim of the current meta-analysis was to determine whether this promise is realized in practice by evaluating the efficacy of MABIs for depression symptoms in Black Americans. Thirty studies with an adequate proportion (>20%) of Black Americans were identified using previous reviews and electronic databases, yielding a total of 1,703 participants with an average proportion of 70% Black Americans. Data on moderators (i.e., geographic location, study design, and intervention protocol) and outcomes were extracted and analyzed using metaregression. Results indicated a moderate effect of MABIs on symptom outcomes in the full sample g = 0.48. Effect sizes were similar in study subsets comprising majority (>50%; k = 19) g = 0.39, and predominantly (>90%; k = 10) g = 0.35, Black participants, with no significant moderating effect of racial composition. Effects were moderated by both sample and intervention level characteristics. The current findings support the conclusion that MABIs are efficacious to varying degrees for Black Americans; with stronger support for use in adult samples than youth samples. These results are promising, and further support efforts to expand research on evidence-based treatments (EBTs) to meet the specific mental health needs of Black Americans. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Supplemental Material for Mindfulness and Acceptance-Based Interventions With Black Americans: A Meta-Analysis of Intervention Efficacy for Depressive Symptoms

Supplemental Material for Mindfulness and Acceptance-Based Interventions With Black Americans: A Meta-Analysis of Intervention Efficacy for Depressive Symptoms

Parental experiences of psychological interventions for recurrent abdominal pain in childhood.

Active components of psychological intervention for RAP remain unclear. This study involved completing interviews about parental experience of psychological intervention for RAP to ascertain how and why psychological intervention can be effective. Difficulty making sense of RAP and barriers to treatment were identified as struggles. Acceptance and containment were key overlapping mechanisms, which allowed families to develop a changed relationship with the pain and manage the impact of pain. To further develop interventions, the role of containment should be considered and acceptance-based interventions explored, given the growing evidence base in this area. Practical implications of this research are also discussed.

Acceptance of chronic pain in depressed patients with HIV: correlations with activity, functioning, and emotional distress

ABSTRACT Chronic pain is highly prevalent among persons with HIV (PWH), as is depression. Both comorbidities might contribute to, as well as be maintained by, avoidance-based coping. A promising alternative to avoidance-based coping is acceptance. Acceptance of pain is associated with improved functioning and quality of life in chronic pain patients, but this relationship has not been substantially explored among PWH. Cross-sectional data from 187 adult outpatients enrolled in a randomized trial for depressed PWH with chronic pain were analyzed. Controlling for pain severity and demographics, the relationships among pain acceptance and indicators of activity, functioning, and emotional distress (i.e., anxiety and anger) were assessed in seven regression models. No significant relationships were found between self-reported physical activity or objective measurement of mean steps/day with pain acceptance. Results revealed an inverse relationship between chronic pain acceptance and pain-related functional interference (by.x = −.52, p < .01) and a positive relationship with self-reported functioning (by.x = 7.80, p < .01). A significant inverse relationship with anxiety symptoms (by.x = −1.79, p < .01) and pain acceptance was also found. Acceptance of chronic pain can facilitate decreased emotional distress, improved well-being, and better functioning and quality of life. Further investigation of chronic pain acceptance among PWH could inform the development of acceptance-based interventions.

Be ACTive! mindfulness and acceptance-based interventions for physical activity engagement in adolescents.

Be ACTive! mindfulness and acceptance-based interventions for physical activity engagement in adolescents.

Evaluating the efficacy of mindfulness and acceptance-based treatment components for weight loss: Protocol for a multiphase optimization strategy trial

Behavioral weight loss treatment (BT) for individuals with overweight and obesity is effective but leaves room for improvement. Mindfulness and acceptance-based treatments may bolster weight loss outcomes; yet, little is known about the efficacy of the individual components or the combinations of components that are most effective in producing weight loss above and beyond standard BT strategies for weight loss. This protocol manuscript describes the use of a multiphase optimization strategy to evaluate the independent and combinatory efficacy of three mindfulness and acceptance-based components (mindful awareness, willingness, values). Using a 2 × 2 × 2 factorial design, participants (N = 288) will be randomized to one of eight conditions, each representing a combination of core MABT strategies in addition to foundational BT strategies. Assessments occur at baseline, mid-treatment (week 24 through 26), post-treatment, and at 6, 12, and 24-month follow-up. The primary aim is to elucidate the independent efficacy of each MABT component on weight loss above gold-standard BT. The secondary aims are to evaluate the independent effect of these components on calorie intake, physical activity, and overall quality of life; evaluate target engagement (i.e., the degree to which each treatment component affects proposed mechanisms of action); and evaluate the potential moderating effect of susceptibility to internal and external food cues on outcomes. The exploratory aim is to quantify any component interaction effects (which may be synergistic, fully additive, or partially additive).

Effectiveness of a Mindfulness-Based Intervention Program for Women Family Caregivers of Older Adults.

Background: The objective of this study was to analyze the effectiveness of a mindfulness-based intervention program for the promotion of well-being and health in family caregivers. Methods: The participants were 111 family women caregivers aged between 33 and 75 years old. This was a double-blinded randomized controlled trial. The mindfulness intervention program lasted 12 weeks. The experimental group underwent mindfulness and acceptance-based interventions (MABIs). The control group performed physical activity training. Results: A cross-lagged panel analysis was computed with the two waves of health, well-being, burden and resilience and age in years and intervention as predictors. The cross-lagged path model fit well χ2 (8) = 7.179, p = 0.51, root mean square error of approximation (RMSEA) = 0.00, comparative fit index (CFI) = 1.00, standardized root mean square residual (SRMR) = 0.05. The mindfulness intervention program was a significant predictor accounting for decreasing health problems (β = −0.292, p < 0.01) and burden (β = −0.190, p < 0.01) and increasing well-being (β = 0.107, p < 0.05) at post-test. Conclusions: Mindfulness-based intervention programs are effective in coping with the burden of family caregivers and, in turn, in promoting resilience, well-being and health among caregivers. Our findings encourage clinical uses of mindfulness interventions to promote health.