Acceptance-based Therapy Research Articles

Efficacy of an acceptance-based group behavioral therapy for generalized anxiety disorder.

Generalized anxiety disorder (GAD) shows the weakest treatment response among anxiety disorders. This study aimed at examining whether an acceptance-based group behavioral therapy (ABBT) for patients in a Brazilian anxiety disorders program, combining mindfulness and exposure strategies, can improve clinical outcome when compared with a standard nondirective supportive group therapy (NDST). Ninety-two individuals diagnosed with GAD were randomized to receive 10 sessions of either ABBT or NDST. Assessments at pretreatment, midtreatment, posttreatment, and 3-month follow-up comprised the following outcome measures: Hamilton Anxiety Rating Scale (HAM-A), Penn State Worry Questionnaire (PSWQ), Depression Anxiety and Stress Scale (DASS), and the Clinical Global Impressions (CGI). The World Health Organization Quality of Life (WHOQOL) was administered at pretreatment and posttreatment. The mixed-effects regression models for DASS-stress, Hamilton Anxiety Interview, and CGI showed a significant effect for Time and the Time × Treatment effect, but not for the Treatment main effect. Similarly, there was a significant Time × Treatment effect for the PSWQ, but not main effects of Time or Treatment. Altogether, these data indicate that symptoms decreased in both conditions across treatment and follow-up, and that the rate of change was more rapid for those participants in the ABBT condition. We found no differences between groups from pretreatment to posttreatment in DASS-anxiety or any secondary outcome measure, but for the physical health domain of WHOQOL, which was faster in ABBT. Both groups showed good clinical outcomes, but in general, participants of the ABBT group improved faster than those in the NDST group.

Brief acceptance-based therapy for women with high-risk pregnancies: Uncontrolled pilot of an intervention for inpatients

ObjectiveWomen hospitalized for high-risk pregnancies, including those with preterm premature rupture of membranes (PPROM), are at a greater risk for experiencing distress, as well as symptoms of anxiety and depression. An acceptance-based therapy would be particularly suitable for such women, as it encourages them to experience uncomfortable sensations and thoughts. The aim of this study was to pilot-test the feasibility and acceptability of a brief acceptance-based therapy for pregnant women on hospitalized bedrest, and to report preliminary symptom changes. MethodFive women admitted to the hospital for PPROM participated in a 7-day acceptance-based therapy. Treatment feasibility and tolerability along with psychological symptoms (positive and negative affect, depression, anxiety, stress, post-traumatic stress, pregnancy-related distress and psychological flexibility) were assessed at baseline, mid-intervention, post-intervention and at a 1-month postpartum follow-up (1MFU). ResultsTreatment feasibility, credibility, tolerability, and homework adherence were high. Participants reported clinical levels of positive and negative affect upon admission and indicated stress as a result of hospitalization. The intervention was associated with an increase in positive affect into a non-clinical range, which was maintained through the 1MFU. Psychological flexibility was high at admission and remained high post-partum. Depression, anxiety, prenatal distress, and PTSD symptoms were in a non-clinical range, and remained non-clinical following admission and at 1MFU. ConclusionsOverall, our brief acceptance-based therapy was feasible and an acceptable intervention to implement in a medical setting. Findings suggest preliminary evidence that our brief intervention was associated with symptom improvements or maintenance of non-clinical levels in women hospitalized for high-risk pregnancies.

Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study.

PurposeMethods for delivering aftercare to help chronic pain patients to continue practice self-management skills after rehabilitation are needed. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to partly fill this gap given its accessibility and emphasis on self-care. Methods for engaging and motivating patients to persist throughout the full length of treatment are needed. The aim of this study was to describe how chronic pain patients work in an ICBT program, through their descriptions of what is important when they initiate behavior change in aftercare and their descriptions of what is important for ongoing practice of self-management skills in aftercare.Patients and methodsFollowing a multimodal rehabilitation program, 29 chronic pain patients participated in a 20-week-long Internet-delivered aftercare program (ACP) based on acceptance-based cognitive behavioral therapy. Latent content analysis was made on 138 chapters of diary-like texts written by participants in aftercare.ResultsAttitudes regarding pain and body changed during ACP, as did attitudes toward self and the future for some participants. How participants practiced self-management skills was influenced by how they expressed motivation behind treatment goals. Whether they practiced acceptance strategies influenced their continuous self-management practice. Defusion techniques seemed to be helpful in the process of goal setting. Mindfulness strategies seemed to be helpful when setbacks occurred.ConclusionSelf-motivating goals are described as important both to initiate and in the ongoing practice of self-management skills. Experiencing a helpful effect of acceptance strategies seems to encourage participants to handle obstacles in new ways and to persist throughout treatment. Research on whether tailored therapist guidance might be helpful in stating self-motivating goals and contribute to ongoing practice of self-management skills is needed.

Pain Acceptance as a Predictor of Medical Utilization and School Absenteeism in Adolescents With Chronic Pain.

Identifying factors contributing to high medical utilization and productivity loss is important, given the high cost of pediatric chronic pain. The current study examined chronic pain acceptance as a predictor of medical utilization and school absenteeism in adolescents with chronic pain. In all, 122 adolescents (aged 12-21 years) with chronic pain and their parents/guardians completed questionnaires assessing medical visits (past 6 months), medication usage, and number of school absences (past month). Homebound school status was also reported. Adolescents completed the Chronic Pain Acceptance Questionnaire and pain intensity ratings, and underwent a diagnostic psychological evaluation. Multivariate generalized linear model analyses indicated lower pain acceptance predicted increased inpatient hospitalizations and higher number of opioid and nonopioid prescription medications, controlling for pain intensity, age, and sex. Pain acceptance was not associated with outpatient consultations or number of nonprescription medications. Exploratory moderation analyses indicated lower pain acceptance significantly predicted increased emergency department visits and inpatient hospitalizations for patients diagnosed with an internalizing psychological disorder. Patients in homebound schooling reported low pain acceptance and for those in school full-time, linear regression indicated lower pain acceptance significantly predicted higher number of school absences. Findings suggest that lower pain acceptance contributes to the use of higher-level medical care (especially for adolescents with internalizing disorders) and increased productivity loss owing to school absences or homebound school status. Clinical implications exist for recommending acceptance-based interventions for pain acceptance promotion and continued development of cost-effective, easily disseminated acceptance-based therapy modules to curb the economic burden of chronic pain.

The Effect of Acceptance and Commitment Therapy (ACT) on Body Image in Women between the Ages of Thirty and Forty after Beauty Surgeries

Abstract Background: In the 20th century, especially over the last decades, there have been new interpretations of beauty; and beauty is defined to include a set of components such as fitness, using cosmetics, clothing, attractiveness, and physical perfection. Objectives: The present study was aimed to examine the effect of acceptance-based and commitment-based therapy on body image in women between the ages of thirty and forty after beauty surgeries. Methods: This research was semi-experimental, using a pre-test post-test design, with a control group. The statistical population consisted of all individuals who visited Sepita Skin and Health Care Clinic, from whom 15 women were considered for a control group and 15 women were considered for an experiment group. Data collection tools included a body image questionnaire. Data were analyzed using a single-variable covariance analysis method. Results: The results of body image covariance analysis (ANCOVA) show that there is a significant difference between body image mean values in control and experiment groups, in terms of post-test scores. The women of the experiment group had a better condition than the women of the control group in terms of body image. Conclusions: Based on findings, it can be stated that commitment-based and acceptance-based therapy affects body image in women between the ages of thirty and forty after beauty surgeries.

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Ibobbly mobile health intervention for suicide prevention in Australian Indigenous youth: a pilot randomised controlled trial

ObjectivesRates of youth suicide in Australian Indigenous communities are 4 times the national youth average and demand innovative interventions. Historical and persistent disadvantage is coupled with multiple barriers to help...

Self-focused attention and safety behaviors across group therapies for social anxiety disorder

ABSTRACTBackground: Self-focused attention (SFA) and safety behaviors are two variables implicated in the maintenance of social anxiety disorder (SAD).Design: The present study examined SFA and safety behaviors across two therapies for SAD, cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT).Method: Participants with symptoms meeting criteria for SAD (N = 137) were randomly assigned to the 12-week-treatment groups (n = 53 for each condition) or a waitlist control (n = 31). Variables were assessed at baseline, midtreatment, posttreatment, and a 3-month follow-up.Results: Both treatment conditions reported significantly lower SFA and safety behaviors compared to control, but did not differ from one another at posttreatment. Mediation analyses supported the following models: (1) safety behaviors mediating the relationship between SFA and social anxiety, and (2) SFA mediating the relationship between safety behaviors and social anxiety. These models were supported for both treatment groups.Conclusions: Both treatments may have the potential to reduce the SFA and safety behaviors that serve to maintain SAD.

Differential effects of coping strategies on autogenous and reactive obsessions

IntroductionObsessive thoughts can be categorized into two subtypes, autogenous obsessions and reactive obsessions. Although it has been investigated that each subtype associates with different maladaptive coping strategies, no studies have yet empirically compared the effectiveness of adaptive coping strategies on autogenous and reactive obsessions.ObjectivesIt is hypothesized that acceptance, which is a core therapeutic principle of acceptance-based cognitive therapy (ACT), is more effective on autogenous obsessions, whereas response suppression as a principle of exposure and response prevention (ERP) has a stronger effect on reactive obsessions.AimsTo compare the effectiveness of two coping strategies (acceptance and response suppression) on autogenous and reactive obsessions.MethodsA total of 164 undergraduate students completed questionnaires for obsessional thoughts and coping strategies. According to the most distressing thought, sixty subjects (n = 30 with autogenous obsession, n = 30 with reactive obsession) were randomly assigned to two groups differing in treatment conditions. Individual psychoeducation and practice were performed for four different groups (2 obsessional subtypes × 2 coping strategies).ResultsRepeated measure ANOVA demonstrated that the autogenous obsessional group showed greater distress reduction after acceptance treatment than response suppression treatment, although its effect was not statistically significant. However, the reactive obsessional group did not show the interaction effect between distress reduction and the two coping strategies.ConclusionsThe results suggest that coping strategies have differential effects on distress reduction of obsessional subtypes. Different therapeutic approaches may need to be offered to individuals with autogenous and reactive obsessions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Модели коррекции и профилактики самоповреждающего поведения

We present a review of models of correction of self-injurious and suicidal behavior. Cognitive-behavioral approach includes cognitive-behavioral therapy, acceptance-based group therapy focused on enhancing emotional regulation and rising emotional aware- ness, dialectical behavioral therapy directed at rising emotional awareness, improving in- terpersonal relationships and teaching adaptive ways of coping with emotions, functional analysis and functional communication training. Psychodynamic approach includes mentalized-based treatment, transference-focused psychotherapy, psychoanalytic psychotherapy, and cognitive-analytic therapy. Model of family therapy based on theory of attachment and multilevel model of intervention are considered. We discuss general and specific aspects of prevention of self-injury in clinical and normal populations. Requirements for the development of self-injury prevention programs for schools are listed.

Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial

Generalized anxiety disorder (GAD) is a disabling condition which can be treated with cognitive behaviour therapy (CBT). The present study tested the effects of therapist-guided internet-delivered acceptance-based behaviour therapy on symptoms of GAD and quality of life. An audio CD with acceptance and mindfulness exercises and a separate workbook were also included in the treatment. Participants diagnosed with GAD (N = 103) were randomly allocated to immediate therapist-guided internet-delivered acceptance-based behaviour therapy or to a waiting-list control condition. A six month follow-up was also included. Results using hierarchical linear modelling showed moderate to large effects on symptoms of GAD (Cohen's d = 0.70 to 0.98), moderate effects on depressive symptoms (Cohen's d = 0.51 to 0.56), and no effect on quality of life. Follow-up data showed maintained effects. While there was a 20% dropout rate, sensitivity analyses showed that dropouts did not differ in their degree of change during treatment. To conclude, our study suggests that internet-delivered acceptance-based behaviour therapy can be effective in reducing the symptoms of GAD.

Reactions to an Acceptance-Based Behavior Therapy for GAD: Giving Voice to the Experiences of Clients From Marginalized Backgrounds

There is emerging evidence supporting the acceptability of mindfulness and acceptance-based therapies with individuals from marginalized backgrounds. The current phenomenological study aimed to understand the extent to which clients from marginalized backgrounds who had completed an acceptance-based behavioral therapy (ABBT) for GAD felt that their identities affected their experience of the treatment and the therapist. Purposeful sampling methods were used to identify seven clients from a larger RCT who identified with one or more marginalized identities. Nine themes related to the treatment components, treatment focus and/or delivery, and the therapist emerged. Themes reflected aspects of treatment that clients were satisfied with and areas where they experienced some discord with treatment. Clinical implications for working with marginalized individuals include the importance of inviting conversations about barriers to valued actions, balancing the need to maintain treatment fidelity with the need to be responsive to clients’ concerns, the utility of assessing responses to mindfulness exercises as they are presented, and making client-centered adjustments to either the content or delivery of mindfulness practice to help make connections between exercises and clients’ lives.

Progress in research on acceptance strategy coping with chronic pain

Objective Chronic pain has brought great suffering to patients, as well as a heavy burden to the society. More attention has been paid on the efficiency of psychological intervention as supplementary means. Among the treatments, acceptance strategy shows its superiority and gradually enters people's field of vision. However, researches in this area are still very scarce. This study intends to review relevant research to provide reference to clinical work and research. Methods Theacceptanceandchronic painas the keywords were searched from the American Psychological Association (APA), China National Knowledge Infrastructure (CNKI), Wanfang data from 1994 to 2014 in English and Chinese articles, and the articles were chosen according to the criteria: ①chronic pain and its current situation; ②acceptance strategy or acceptance-based therapy; ③intervention to chronic pain based on acceptance strategy; ④to explore the intervention mechanism of aueptance strategy. Results Eventually, 7 Chinese articles and 42 English articles were adopted. Conclusion Acceptance strategy shows some advantages in clinical pain improvement: it can significantly improve the psychological and social function of patients, but it is not always efficient in reducing the pain intensity. There are still some limitations in the present study. It is necessary to develop an acceptance-based therapy with Chinese culture to treat the domestic patients. Key words: Acceptance strategy; Chronic pain; Intervention

Acceptance-Based Exposure Therapy for Body Dysmorphic Disorder: A Pilot Study

Body dysmorphic disorder (BDD) is an often severe, chronic, and disabling disorder, and although some controlled trials of cognitive behavior therapy (CBT) have shown efficacy, the body of evidence is still limited. The condition is generally considered difficult to treat, and further research to determine the effectiveness of psychological treatments for BDD is needed. The present study is the first to evaluate an acceptance-based therapy for BDD. In total, 21 patients received a 12-week group treatment consisting of weekly sessions of psychoeducation, acceptance and defusion practice, and exposure exercises to foster acceptance of internal discomfort and to strengthen the patients’ committed purposeful actions. The primary outcome was BDD symptomatology (measured on the BDD-YBOCS) assessed by a psychiatrist before and after treatment and at 6months follow-up. The secondary outcomes were self-rated BDD symptoms, psychological flexibility, depressive symptoms, quality of life, and disability. Reductions in BDD symptomatology from pre- to posttreatment were significant and showed a large effect size, d=1.93 (95% CI 0.82–3.04). At posttreatment, 68% of the participants showed clinically significant improvement in the primary outcome variable. Treatment gains were maintained at 6months follow-up. The treatment also resulted in significant improvements in all secondary outcomes. The dropout rate was low; 90.5% of the participants completed treatment. This study suggests that acceptance-based exposure therapy may be an efficacious and acceptable treatment for BDD that warrants further investigation in larger controlled trials.

Mindfulness and acceptance-based group therapy and traditional cognitive behavioral group therapy for social anxiety disorder: Mechanisms of change

The present study investigated mechanisms of change for two group treatments for social anxiety disorder (SAD): cognitive behavioral group therapy (CBGT) and mindfulness and acceptance-based group therapy (MAGT). Participants were treatment completers (n = 37 for MAGT, n = 32 for CBGT) from a randomized clinical trial. Cognitive reappraisal was the hypothesized mechanism of change for CBGT. Mindfulness and acceptance were hypothesized mechanisms of change for MAGT. Latent difference score (LDS) analysis results demonstrate that cognitive reappraisal coupling (in which cognitive reappraisal is negatively associated with the subsequent rate of change in social anxiety) had a greater impact on social anxiety for CBGT than MAGT. The LDS bidirectional mindfulness model (mindfulness predicts subsequent change in social anxiety; social anxiety predicts subsequent change in mindfulness) was supported for both treatments. Results for acceptance were less clear. Cognitive reappraisal may be a more important mechanism of change for CBGT than MAGT, whereas mindfulness may be an important mechanism of change for both treatments.

Review of The mindfulness and acceptance workbook for social anxiety and shyness: Using acceptance and commitment therapy to free yourself from fear and reclaim your life.

The Mindfulness and Acceptance Workbook for Social Anxiety and Shyness: Using Acceptance and Commitment Therapy to Free Yourself From Fear and Reclaim Your Life by Jan E. Fleming and Nancy L. Kocovski, Oakland, CA: New Harbinger Publications, Inc., 2013, 168 Pages. (ISBN-10: 1608820807, US $19.95 Paperback) Reviewed by RANDI E. MCCABE DOI: http://dx.doi.org/10.1037/a0038090Individuals who are dispositionally shy may desperately wish to engage more socially but feel inhibited from doing so due to feelings of awkwardness and anxiety. This anxiety may be associated with a range of situations, including social interactions such as making conversation, and performance situations such as giving a speech. Feelings of social anxiety and fears of negative selfevaluation can directly interfere with life satisfaction and goal attainment as negative reinforcement leads individuals to alter their life path in ways that minimise the experience of social discomfort. For a subset of people, social anxiety leads to significant clinical distress and impairment warranting a diagnosis of social anxiety disorder. The evidence-based psychological treatment of choice for individuals suffering from social anxiety disorder is cognitive behaviour therapy (CBT), an approach that encompasses a variety of treatment packages, the majority of which include a central emphasis on exposure. CBT has been associated with moderate to large effect sizes; however, dropout rates are in the range of 10-20% and a portion of treatment completers achieve only a partial response (Rodebaugh, Holaway, & Heimberg, 2004). Thus, there is a need for new approaches that may meet the needs of those who do not respond to traditional CBT protocols. This book provides just that option.In The Mindfulness and Acceptance Workbook for Social Anxiety and Shyness, the authors present a comprehensive treatment approach for overcoming shyness and social anxiety using mindfulness and acceptance strategies. In developing their treatment program, Fleming and Kocovski drew from the work of Steve Hayes (Acceptance and Commitment Therapy; ACT), Jon Kabat- Zinn (Mindfulness-Based Stress Reduction; MBSR), and Zindel Segal (Mindfulness-Based Cognitive Therapy; MBCT), who contributed the foreword for the book. Integrating ACT, MBSR, and MCBT strategies, the authors have specifically tailored the program to individuals with social anxiety. The book naturally developed out of the authors' own research program investigating group mindfulness- and acceptance-based therapy for social anxiety (MAGT). A major strength of the book is that it is based on empirical evidence showing both in an open trial and in a randomized controlled trial (RCT) that MAGT is associated with a significant reduction in social anxiety that is equivalent to the efficacy associated with CBT. Thus, the workbook offers a viable treatment option for consumers with social anxiety and for therapists working with clients with social anxiety. The approach may be used as an initial treatment or as an alternate option if standard CBT was not a good fit or the gains realised were suboptimal. The authors do a thorough job of summarising the research literature on mindfulness- and acceptance-based strategies for social anxiety, including their own work in this area, in Appendix A of the workbook.Overall, the book is well-written and a quick read with short chapters and focused exercises. In the introduction, the authors orient the reader to the roots of the approach taken in the book (ACT, MBCT, and MBSR) as well as the authors' inspiration for the book. They provide an overview of the organisation of the book as well as how to use it. An attractive feature of this workbook is the companion resources provided on the publisher's website. Users of the workbook can download all the worksheets as well as listen to audio files of the seven main meditation exercises (mindful eating, observing the mountain, body scan, mindful stretching, awareness of thinking, imagining VITAL action, and loving kindness). …

Living with chronic neuropathic pain after spinal cord injury: an interpretative phenomenological analysis of community experience

Purpose: This article presents an in-depth, idiographic study examining the lived experience of chronic pain following spinal cord injury (SCI). Neuropathic pain (NP) occurs in a large majority of the SCI population and is particularly intractable to treatment. It can be both psychologically and physically debilitating. This study examines how the experience of NP is mediated by its meaning to the sufferer. Methods: Semi-structured interviews were conducted with eight people with SCI and chronic NP, attending outpatient clinics at a specialist SCI Centre in the UK. Verbatim transcripts were subjected to interpretative phenomenological analysis to further understand the experience. Results: Analysis suggested that NP has powerful consequences upon the sufferer’s physical, psychological and social well-being, in line with a biopsychosocial understanding of pain. Three super-ordinate themes were identified: a perceived gap between treatments received and participants’ views of what they wanted and needed; a fight for life control and acceptance; and feeling understood by others with SCI, but isolated from the non-understanding able-bodied. Conclusions: The results are discussed in terms of the possible application of acceptance-based therapy to NP and the potential for the alleviation of the debilitating consequences of NP.Implications for RehabilitationChronic NP after SCI is often described as worse than the injury itself, often impacting upon the sufferers physical and psychological health.The experiences of persons with SCI-specific NP highlight the impact of pain on their physical, psychological and social health. This indicates that healthcare professionals should incorporate a biopsychosocial approach for managing pain post-SCI.Routine clinical follow-up of SCI patients with chronic NP, as well as comprehensive pain management treatment programmes, could address the three themes evidenced in the current study, by moving routine intervention with NP away from pain relief, towards pain management.Continued education for patients, friends, family members and healthcare professionals may be beneficial in promoting understanding and awareness of NP and its consequences following SCI.

Internet-Based Acceptance and Commitment Therapy for Psychological Distress Experienced by People With Hearing Problems: Study Protocol for a Randomized Controlled Trial.

Psychological distress and psychiatric symptoms are prevalent among people with hearing loss or other audiological conditions, but psychological interventions for these groups are rare. This article describes the study protocol for a randomized controlled trial for evaluating the effect of a psychological treatment delivered over the Internet for individuals with hearing problems and concurrent psychological distress. Participants who are significantly distressed will be randomized to either an 8-week Internet-delivered acceptance-based cognitive behavioral therapy (i.e., acceptance and commitment therapy [ACT]), or wa it-list control. We aim to include measures of distress associated with hearing difficulties, anxiety, and depression. In addition, we aim to measure acceptance associated with hearing difficulties as well as quality of life. The results of the trial may further our understanding of how to best treat people who present problems with both psychological distress and hearing in using the Internet.

Acceptance-Based Therapy, Mindfulness, and Modification of Environmental Risk Factors for Weight Control

lthough people are often successful in losing weight, sustaining weight loss and healthy eating over the long term is challenging for many. New behavioral strategies can be used to help patients use acceptance and mindfulness to improve decision making. Additionally, behavioral strategies can help to promote a healthy environment for children, reducing the risk of obesity and related medical complications.

Mindfulness and acceptance-based group therapy versus traditional cognitive behavioral group therapy for social anxiety disorder: A randomized controlled trial

Recent research has supported the use of mindfulness and acceptance-based interventions for Social Anxiety Disorder (SAD). ObjectiveThe purpose of the present study was to compare mindfulness and acceptance-based group therapy (MAGT) with cognitive behavioral group therapy (CBGT) with respect to outcome. It was hypothesized that MAGT and CBGT would both be superior to a control group but not significantly different from one another. MethodIndividuals (N = 137, mean age = 34 years, 54% female, 62% White, 20% Asian) diagnosed with SAD were randomly assigned to MAGT (n = 53), CBGT (n = 53) or a waitlist control group (n = 31). The primary outcome was social anxiety symptom severity assessed at baseline, treatment midpoint, treatment completion, and 3-month follow-up. Secondary outcomes were cognitive reappraisal, mindfulness, acceptance, and rumination. Depression, valued living, and group cohesion were also assessed. ResultsAs hypothesized, MAGT and CBGT were both more effective than the control group but not significantly different from one another on social anxiety reduction and most other variables assessed. ConclusionsThe present research provides additional support for the use of mindfulness and acceptance-based treatments for SAD, and future research should examine the processes by which these treatments lead to change.