Dear Contextual Science Community,

We are happy to be putting out our full 2011 ACT/RFT Reader’s Update. In this Update we review assessment, chronic pain, experiential avoidance, pilot studies, RCT’s, relational frame theory and several research reviews. We hope you find the information helpful. Please take a look at the attached and find what interests you.

It has been interesting times at the Update, with change in editorial/writer staff (a big welcome to Katherine Young, Jeannette Tappe, Tam Nguyen and Aimee Zhang) and other unanticipated delays with this issue, we have been pressed to finish up and post.

We are also looking forward to including and perhaps featuring articles found in the Journal of Contextual Behavioral Science. We hope everyone is enjoying the journal and finding it useful. What a great contribution to ACBS! http://contextualscience.org/JCBS

Lastly and importantly, we are looking forward to ACBS World Conference in Sydney, Australia, July 8-12. The World Conference is always exciting, engaging and fun! Many great ideas for projects, studies and papers are generated at the conference and it will be sure to provide ACT/RFT Reader’s Update staff with plenty more to review! http://contextualscience.org/wc11

Warm Regards,

Maggie Chartier, Psy.D., MPH
Barbara Mazina, B.A.
Tam Nguyen, Ph.D.
Katie Sears, Ph.D.
Ian Stewart, Ph.D.
Jeannette Tappe, M.A.
Thuy Tran, B.A.
Robyn Walser, Ph.D.
Katherine Young, M.S.
Aimee Zhang, B.S.

Dear ACT Community,

We are excited….and relieved to put out two Reader’s Updates this round. Please log in to download the attachments from this webpage.

It is really great to see all of the work and writing that is being done in the areas of ACT, RFT and mindfulness. It is keeping us busy and energized as reviewers. Find in the Update, summaries designed to provide you with a quick overview of topics and issues, with links in the document to more detailed information.

In Update “10finalb” you will find summaries, references and abstracts on acceptance, addiction, assessment, case studies, children/adolescents, chronic pain, experiential avoidance and RFT.

In Update “10finalcd,” in addition to some of the same topics above, you will find summaries, references and abstracts on anxiety and depression, RCT’s and research reviews. In this issue we also wanted to feature RFT. It is the first summary presented in the Update. Ian Stewart has done an excellent job. He has thoughtfully put together information in a effort to keep us abreast of research this area. A big thanks to Ian!

We are diligently working on the next issue: Coming soon to a list-serve near you!

Finally, if you know of any articles, studies or other information that we should include in our next issue and may not be easily findable by regular search engines, please let us know. Also, be sure to let us know if we missed something.

Enjoy!

Reviewers and Editors

Maggie Chartier

Barbara Mazina

Katie Sears

Ian Stewart

Thuy Tran

Robyn Walser 

Dear Colleagues,

Welcome to this edition of the ACT/RFT Reader’s Update.

In this issue, as in all issues, we provide a summary of the literature published related to acceptance and commitment therapy, mindfulness and relational frame theory. We link summaries to particular topics and provide a review of the articles. Feel free to read the summaries and find the links to the references and abstracts related to the summaries right in the document. For a taste of what is in the Update, we summarize 3 articles on acceptance approaches to treatment, 3 on addiction that compare CBT to ACT, 1 on assessment by Wilson – the VLQ is alive and well -, 2 case study designs looking at the treatment of GAD and cancer, 3 articles on mindfulness based approaches with children and parents, 4 articles on experiential avoidance, 5 on mindfulness including how mindfulness works with managing emotions, intrusive thoughts, stress reduction and substance use. Finally, we have 3 on RFT reviewed by Ian – Thanks Ian!

We have sorted and distributed articles to our reviewers for the first half of 2011. We are looking forward to the next round.

Please let us know if we missed anything that we should include or inform us of dissertations, etc.

Thanks and Enjoy!

Kind Regards,

Robyn D. Walser, Ph.D.

Science and Practice: ACT /RFT Reader’s Update:  Final 2009 Review

Welcome to the ACT/RFT Reader’s update. This is the last issue reviewing the literature on ACT and RFT from 2009. We will be publishing updates for 2010 in late summer, fall and winter.

To kick off the issue, we want to extend a thank you to Dr. Chad Drake who has been with the Update since its inception. We thank Chad as he closes the “Update chapter of his life” and wish him much success in his new and fun endeavors. Thanks Chad!

In this issue, we summarize articles on assessment, ACT and diagnostic populations, experiential avoidance, behavioral health, RFT, mindfulness and “The Great Debate”.

The attached PDF includes a Table of Contents that allows you to “click” directly to the summary of multiple articles covering a topic and/or references and abstracts that you may be interested in. In addition, citations for the latest books, book chapters, editorials, and unpublished dissertations are listed.

Our aim with this update is to provide information that is clinically relevant, scientifically sound, and of interest in the ACT/RFT community. We have worked to keep the “busy” reader in mind and hope that you find the Update useful.

** If you are a graduate student working on an ACT/RFT study and would like to have us include your dissertation or thesis citation in this update,please send us an email backchannel.

**If you have published an editorial you would like us to include that citation, please send us an email back channel.

We hope you will find our e-mail updates of interest and value.  

Our editors and reviewers include:
       Robyn Walser, PhD
       Maggie Chartier, PhD, MPH
       Katie Sears, PhD
       Thuy Tran, BS
       Chad Drake, PhD
       Elizabeth Gifford, PhD
       Ian Stewart, PhD
       Christi Ulmer, PhD
       Miguel Rodríguez Valverde, PhD
       Darrah Westrup, PhD

Science and Practice: ACT/RFT Reader’s Update December, 2009

___________________

Acceptance and Values-Based Action in Chronic Pain: A Study of Treatment Effectiveness and Process Cognitive-behavioral approaches to pain management have an established record of empirical support. However, as true with other behavioral problems, the mechanism by which improvement occurred is inconsistent with the theoretical underpinnings of CBT. In a recent paper, Vowles and McCracken add to their ongoing line of research in acceptance-based approaches to the treatment of chronic pain. In their paper, they present their findings of an inter-disciplinary treatment program based in Acceptance and Commitment Therapy, with a focus on acceptance and values-based action. One-hundred seventy-one participants completed the program which consisted of 3 to 4 weeks of inpatient treatment for about 30 hours per week. Participants improved across almost all domains, including pain, depression, pain-related anxiety, disability, medical visits, work status, and physical performance, and effect sizes for these improvements were medium to large. Analysis of reliable change revealed that 75.4% of participants improved in at least one key domain assessed. In contrast with CBT-based approaches to pain management, improvements across these domains were associated with ACT's proposed mechanisms of action, namely, acceptance of pain and values-based action. The authors conclude that these findings provide support for the ACT model of treatment for chronic pain, and the processes associated with improvement – acceptance and values-based action.

Vowles, K., & McCracken, L. (2008). Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process. Journal of consulting and clinical psychology, 76(3), 397-407.

___________________

Rule-Governed Behavior and Psychological Problems Humans, uniquely among animals, can come to understand and respond to linguistic rules, both effective ones and not so effective ones. The effective ones help us to learn and adapt to our environment. The ineffective ones can cause maladaptive behavior and diminish our lives considerably. This paper presents a functional analysis of patterns of rule-governed behavior (RGB) and shows how rules can contribute to psychopathology. Rules have been described as antecedent stimuli that alter the functions of stimuli in our environment. They allow us to respond to that environment in complex and efficacious ways. But what are rules? Relational Frame theory suggests that we humans learn to respond in accordance with abstract relational patterns based on cues (e.g., SAME). Rules are essentially combinations of cues that specify particular relations between environmental stimuli and between environment and behavior and thus allow us to respond in new ways (‘transformation of function’). The paper describes three functional patterns of RGB. These are pliance, tracking and augmental rule following. Pliance is RGB under the control of a history of socially mediated reinforcement for coordination between behavior and antecedent verbal stimuli (rules). A typical example might be a child obeying the rule ‘Don’t touch my laptop’ because their parent has given them this rule and because their parent has previously provided consequences for following or not following rules. Tracking is RGB under the control of a history of coordination between the rule and the way the environment is arranged independently of the rule. An example might be a child obeying the parental rule ‘Eat your breakfast because it will give you more energy’ because in the past the child has experienced the effect of other rules that have been accurate in their description of the environment. If this rule also shows coordination (i.e., the child finds an increase in energy when they eat breakfast), then this will further strengthen tracking behavior. Augmenting is RGB due to relational networks that alter the degree to which events function as consequences. The example given is ‘Eat your vegetables to be a big strong boy’. If this rule makes vegetable eating more reinforcing then it might be described as augmenting. Each of these patterns has its advantages and its disadvantages, including maladaptive behavior. It’s useful for children to learn pliance since this allows them to acquire useful adaptive habits, but doing things just because one is told to can make one insensitive to one’s environment. Tracking allows independence from social whim, but tracking can also lead to ineffective behavior; for example, tracking short term reinforcement can mean one misses longer term reinforcement. Augmenting is the most advanced form of rule governed behavior and as such it can interact with and reinforce either of the other two functional patterns resulting in strongly adaptive or maladaptive patterns. Experiential avoidance can be a product of the latter while valuing, an important part of the antidote to EA, is an example of the former. Törneke, Luciano and Valdivia (2008) have provided an excellent description of RGB and its relationship to psychopathology.

Törneke, N. Luciano, C. & Valdivia Salas, S. (2008). Rule-Governed Behavior and Psychological Problems. International Journal of Psychology and Psychological Therapy, 8 (2), 141-156.

___________________

Brief Review: A Parametric Study of Cognitive Defusion and Believability The effects of the “Milk, milk, milk” exercise are dependent upon the length of the intervention: Reducing distress in respect to private events has been a major emphasis of traditional behavioral and cognitive behavioral therapies. The inclusion of mindfulness interventions in some contemporary therapies like ACT has shifted this focus from distress reduction to changing the behavior regulatory functions of distressing private events. One means of examining this change is by asking clients about the believability of their thoughts. Defusion interventions represent efforts to disrupt this behavior regulation, and the “milk, milk, milk” exercise is the intervention examined in this article. Two studies examined the effect of this exercise on the emotional discomfort and believability of a negative, self-relevant word identified by the participant as sufficiently problematic. Each study varied the amount of time spent repeating the word – 0, 3, or 20 seconds in study 1 and 1, 10, or 30 seconds in study 2. A rationale for the procedure and training with the word “milk” was provided before each intervention. Results showed that emotional distress reduced significantly within 3-10 seconds, while believability reduced significantly only after 20-30 seconds. The difference in timing for these reductions suggests that discomfort and believability are functionally distinct behaviors. The authors suggest extending defusion exercises until the believability of thoughts, rather than just emotional distress, diminishes.

Masuda, A., Hayes, S. C., Twohig, M. P., Drossel, C., Lillis, J., & Washio, Y. (2009). A parametric study of cognitive defusion and the believability and discomfort of negative self-relevant thoughts. Behavior Modification, 33, 250-262.

___________________

Brief Review: Relational Frame Theory and Social Categorization The Matching-to-Sample procedure can transform the functions of arbitrary stimuli in the Implicit Associations Test: This study examined the acquisition of obesity stigma to arbitrary stimuli. More specifically, the matching-to-sample (MTS) procedure was used to provide relational conditioning sufficient to generate a transformation of stimulus functions for stigma to images of either horizontal or vertical lines. The Implicit Associations Test (IAT) was used to detect this transformation of functions. Fifty undergraduate psychology students engaged in a series of five computerized tasks: (1) an IAT containing evaluative words and images of horizontal and vertical lines, to confirm a lack of pre-existing bias, (2) an established IAT for detecting implicit evaluative bias toward obesity, to confirm the presence of pre-existing bias, (3) two MTS tasks providing relational conditioning sufficient to generate the transfer of positive and negative evaluative functions to images of horizontal and vertical lines, (4) the same IAT used in step 1, to assess for the acquisition of bias, and (5) the same IAT used in step 2. Results confirmed no pre-existing bias at time 1, a large and significant predicted bias at time 2, and a small and significant predicted bias at time 4. The results of this study are discussed in respect to an RFT account of the development of stigma and social categorization and contrasted with a more mainstream, cognitive account known as the Social Knowledge Structure.

Weinstein, J. H., Wilson, K. G., Drake, C. E., & Kellum, K. K. (2008). A relational frame theory contribution to social categorization. Behavior and Social Issues, 17, 39-64.

Revised/Reviewed by: Walser, R., Chartier, M., Sears, K., Drake, C., Valverde, M., Stewart, I., Ulmer, C., & Westrup, D. Read the ACT RFT Reader's Update: References & Abstracts, 2008 in an interactive PDF, attached below.

Science and Practice: ACT /RFT Reader's Update Fall, 2008

Welcome to ACT/RFT Reader's Update:

In our second issue we summarize 5 articles recently published in peer-reviewed journals. The references to full citations and whether they are available for download on the ACBS website is also included. Citations for the latest books, book chapters, and unpublished dissertations are listed at the end of the update. If you don't see your recently published article….hang on, we continue to work on future issues and have a fair number of articles that are being reviewed and summarized for our coming issues. However, if you are publishing or have recently published please make us aware by either sending us the reference or pdf. Thanks.

We hope you will find our e-mail updates of interest and value. 

Enjoy your read!

Our editors and reviewers/writers:

Editors:

Robyn D. Walser, Ph.D.
Maggie Chartier, MPH, MS

Reviewers/Writers:
Chad Drake, MA
Miguel Rodríguez Valverde, PhD
Ian Stewart, PhD
Christi Ulmer, PhD

This issue of Science and Practice: ACT/RFT Readers Update contains 5 summaries:

ACT ARTICLES AND RELATED TOPICS

Acceptance and commitment training reduces prejudice and promotes diversity-oriented behaviors in college students

Despite increased efforts at promoting diversity in recent years, prejudice continues to result in diminished quality of life for ethnic, racial and religious minorities across numerous life domains. Interventions designed to reduce prejudice have been moderately successful with short-term improvements, but do not seem to promote sustained equitable attitudes and behavior. In fact, in some instances, the interventions actually result in an increased bias. ACT may be particularly applicable to prejudice due to its focus on intransigent and difficult cognitions. Luoma and Hayes compared a brief ACT Training protocol to an education-based prejudice awareness training intervention for reducing racial and ethnic prejudice in college students. Material was presented to students using a counterbalanced within-group design such that the impact of each approach could be evaluated independently. The outcome measure, developed for this study, consisted of items assessing the following: awareness of bias; acceptance and flexibility; thought control and defusion; and positive actions. Student responses suggest that the ACT training produced greater reductions in prejudice across most dimensions, and that only ACT training promoted greater intention to engage in diversity-oriented behaviors. Changes in these positive intentions were partially mediated by acceptance and flexibility, and defusion processes explained more variance in positive intention outcomes than acknowledgement of bias. The authors suggest that the combined findings of this study and a previous ACT-based study on prejudice lend preliminary support to an ACT-RFT based model of understanding and reducing prejudice. The findings are also consistent with the theory underlying acceptance-based approaches stating that it is the relationship with thought rather than the content of thought that matters. Limitations of the study include the use of an unvalidated outcome measure, the potential self-selection bias of students who choose to enroll in a class on the psychology of racial differences, the potential for bias of the interventionist in favor of ACT, and a short follow-up interval. Future studies are proposed using a more intensive intervention and assessing longer-term outcomes. Given the need for empirically supported approaches to address prejudice, the findings of the current study are promising. In terms of clinical application, the authors propose that similar processes are likely in play with regard to mental health stigma, and that cognitive processes that promote prejudice are themselves psychologically damaging.

Read the Article:

Lillis, J., & Hayes, S. C. (2007). Applying acceptance, mindfulness, and values to the reduction of prejudice: A pilot study. Behavior Modification, 31(4), 389-411.
________________

ACT and CT for anxiety and depression, a randomized controlled effectiveness trial

For some period of time there has been discussion and even argumentation between those who hold true to cognitive models of intervention (e.g. Beckian) and acceptance models of intervention (e.g. Hayesian). Forman and colleagues take a closer look. They explain that Cognitive Therapy (CT) has a mixed record of success in producing theoretically-consistent mediation of treatment outcomes while Acceptance and Commitment Therapy (ACT) has a relatively impressive, though preliminary record, of the same. Given that only a handful of studies have directly compared these treatments and that all contained methodological shortcomings the authors undertook that task of comparing each therapy's ability to produce mediation and positive outcomes among an outpatient sample of college students in a well-controlled trial. Services were provided by clinical psychology doctoral candidates working at a student counseling center. Outcome measures included self-reports of symptoms (BDI-II, BAI, OQ-45) and self-reports of quality of life (QOLI, SLS). Two mediational measures were administered (KIMS, AAQ). The study also included measures of treatment fidelity, therapist allegiance, and participant expectancies of treatment. Results showed that all measures were comparable between treatments, and that each treatment generated large effect sizes. Mediational analyses showed that the observing subscale of the KIMS more strongly (though nonsignificantly) predicted outcomes for CT, while the AAQ and the acting with awareness and acceptance subscales of the KIMS more strongly (and significantly) predicted outcomes for ACT. The authors reported that "changes in "observing" and "describing" one's experiences were more strongly associated with outcomes for those in the CT group relative to those in the ACT group, whereas experiential avoidance, acting with awareness, and acceptance were more strongly associated with outcomes for those in the ACT group" (p. 792). Although, the authors concluded that "these findings support the notion that CT and ACT are functionally distinct from one another" (p. 792), it was never explained why the capacity to observe and describe one's private experiences is a fundamental component of CT but not ACT.

Read the Article:

Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of Acceptance and Commitment Therapy and Cognitive Therapy for anxiety and depression. Behavior Modification, 31, 772-799.

RFT ARTICLES

How does multiple-exemplar training and naming establish derived equivalence in an infant?

Stimulus equivalence at its simplest can be described as follows. Imagine I train someone in the following two relations between physically different arbitrary stimuli: Pick stimulus B when you see stimulus A, and pick stimulus C when you see stimulus B. If given the opportunity, a verbally able human might subsequently go on to demonstrate further relations, without being trained to do so, including picking A when he sees B, and picking B when he sees C (i.e., reversing the trained relations, referred to as symmetry), picking C when he sees A (i.e., combining the trained relations, referred to as transitivity) and picking A when he sees C (a combination of symmetry and transitivity). This pattern of derived responses has been called stimulus equivalence, because it appears that, suddenly and unexpectedly and without being trained to do so, the person is treating a number of physically different stimuli as mutually substitutable for or equivalent to each other. There is growing interest in stimulus equivalence research as only verbally able subjects seem to be able to show this pattern readily, suggesting a link between equivalence and language. But what is the nature of this link? How are the two connected? The present paper discusses two theoretical approaches that claim to account for this link - Relational Frame Theory (e.g., Hayes et al., 2001) and Naming Theory (Horne & Lowe, 1996). More importantly, however, the paper reports a series of experiments involving training an infant in relational responding that provide important additional evidence pertaining to the debate between these approaches. More specifically, the results add to evidence in favour of the RFT account, while demonstrating a phenomenon that directly contradicts Naming Theory. This study is a significant empirical contribution for a number of reasons (i) It demonstrates the use of multiple exemplar training to establish generalized contextually controlled receptive mutual entailed relational responding; (ii) it provides the youngest empirical example of coordinate (sameness) combinatorial entailed relational responding (equivalence) ever recorded; and (iii) it provides extremely important evidence vis-a-vis the Naming Theory / RFT debate by providing empirical evidence that directly contradicts a core tenet of Naming Theory while being consistent with RFT.

Read the Article:

Luciano, C., Becerra, I. G., & Valverde, M. R. (2007). The role of multiple-exemplar training and naming in establishing derived equivalence in an infant. Journal of the Experimental Analysis of Behavior, 87(3), 349-365.
________________

Can the Implicit Relational Assessment Procedure be faked? First evidence says no.

The Implicit Relational Assessment Procedure (IRAP) is a computer-based task for the assessment of implicit cognitions recently devised within the theoretical framework of RFT. It is a latency-based response measure that intends to assess the participants' existing verbal-relational networks (i.e. beliefs). It works by requiring participants to respond as quickly and accurately as possible across trials when presented with particular relations (among sample and target stimuli) that may be consistent or inconsistent with their beliefs (i.e. relational networks). The idea is that participants will be faster when required to respond to stimulus relations that are consistent (e.g. categorizing words like love or peace as pleasant, and words like vomit or death as unpleasant) than to stimulus relations that are inconsistent with their verbal histories (e.g. categorizing vomit or death as pleasant, and love or peace as unpleasant). This idea is supported by empirical evidence from several recent studies. As with other implicit measures, like the Implicit Association Test (IAT), one of the strengths of the IRAP is that it may be less sensitive than questionnaires and other explicit measures to assess deliberate attempts to conceal information about one's own socially sensitive attitudes. This study attempted to see to which extent this is the case (i.e. whether the IRAP can be faked). Three groups of participants underwent two consecutive exposures of the IRAP task with the same stimuli (the words pleasant and unpleasant as samples, the words similar and opposite as response options, one set of six pleasant target words, and one set of six unpleasant target words). Between both exposures, one group was informed about how the IRAP works. Another group received the same information and was told to fake the IRAP, without a specific strategy to do so. The third group received the same information and were also provided with a strategy, namely slowing down on consistent trials and going fast on inconsistent trials. Results showed no evidence of faking in any condition. All groups showed an IRAP effect in the second exposure regardless of the instructions or strategies received. According to a post-task questionnaire, only two participants in the third group reported using the specific strategy they had received. All in all, participants found it difficult to fake the IRAP, even if provided with specific strategies. This contrasts with previous findings with the IAT, which can be successfully faked when explicitly told how to do so. This observed resistance to deliberate attempts to fake performance renders the IRAP a solid procedure for the assessment of implicit cognitions.

Read the Article:

McKenna, I., Barnes-Holmes, D., Barnes-Holmes, Y., & Stewart, I. (2007). Testing the Fake-ability of the Implicit Relational Assessment Procedure (IRAP): The First Study. International Journal of Psychology and Psychological Therapy, 7, 253-268. (in English)
______________________

What can RFT add to the study of pain?

The current study focuses on an RFT interpretation of the way that pain takes part in complex behavioural episodes for humans. It is a theoretical/conceptual study that reviews functional-contextual approaches to the study of private events specifically related to pain and with a special emphasis in recent research in verbal behaviour, behaviour-behaviour relations, and transformation of psychological functions. The review is divided into four parts. The first summarizes the philosophical assumptions of functional-contextualism and its implications for the study of pain (e.g. the extent to which explanations of pain allow for effective action as the criterion against which these explanations should be tested). The second focuses on the classical behaviour-analytic point of view, where pain experiences have been conceptualized as private events that exert discriminative control over subsequent behaviours (e.g. abuse of pain-killers, inactivity, social isolation, etc.). This discriminative function (behaviour-behaviour relation) is the product of specific histories of reinforcement along the individual's development, in direct-contingency terms. This view is illustrated with the presentation of the contributions of Schoenfeld and, more specifically, of Fordyce. RFT is proposed as a more comprehensive framework for the behaviour ral study of pain, a framework where verbal (derived) histories can be included as part of the explanation. In line with this, pain-related clinical problems are conceptualized as a form of experiential avoidance disorder, where it is the verbal functions of pain, rather than pain itself, that limit the individual's life (i.e. the consideration of pain as a literal barrier for engaging in valued actions). This is described in the third part of the article. Finally, the last part of the article presents a general overview of ACT and describes its implications for the treatment of pain-related problems.

For more information, read the original article in Spanish:

Gutiérrez Martínez, O., & Luciano Soriano, C. (2006). Un studio del dolor en el marco de la conducta verbal. International Journal of Clinical and Health Psychology, 6, 169-188. [A study of pain in the framework of verbal behavior: from the contributions of W. E. Fordyce to Relational Frame Theory (RFT)]

(for correspondence and reprints): olgaguti@ugr.es

BOOKS

Ciarrochi, J. V., & Bailey, A. (2008). A CBT practitioner's guide to ACT. Oakland, CA: New Harbinger.

BOOK CHAPTERS

DISSERTATIONS

Barthold, C., & Hoffner, C. (2007). Factors affecting the generalization of 'wh-' question answering by children with autism. Dissertation Abstracts International Section A: Humanities and Social Sciences, Vol 68(4-A): 1403.

EDITORIALS AND COMMENTARIES

Hayes, S. (2007). Hello Darkness. Psychotherapy Networker, Sept/Oct. 46-52.

Hummelen, J. W., & Rokx, T. A. J. J. (2007). Individual-context interaction as a guide in the treatment of personality disorders. Bulletin of the Menninger Clinic, 71(1): 42-55.

Muran, J. C. (2007) Commentary: Language, Self, and Diversity. In S. C. Hayes (Ed.), Dialogues on difference: Studies of diversity in the therapeutic relationship ) pp. 275-279. Washington, DC, US: American Psychological Association.

Welcome.... to the first issue of the ACT /RFT Reader's Update, an electronic newsletter provided for your information and perusal. This online newsletter provides summaries of recent, ACT and RFT articles (or related articles) published in peer-reviewed journals. In addition, citations for the latest books, book chapters, and unpublished dissertations will be listed. This will be an ongoing project, and new article summaries will be distributed via email every 4 months. You can identify these email summaries by the subject title "ACT/RFT Readers Update". Our main aim with this update is to keep the ACT/RFT community informed. We hope to include information that is relevant, scientifically sound, and of interest in the ACT/RFT community. Our purpose is not to recreate the abstract of these articles, but to provide a broader summary of the article. However, are goal is to keep the "busy" reader in mind, and therefore, we will work to keep the summaries brief. Additionally, we had to start somewhere, so we are only including summaries of some of the most recent articles.....and our next issue will include more from 2007 (such as ACT and diabetes and social anxiety disorder). We will conduct regular searches, however, if we missed your publication (from mid-2007 until now), please let us know. ** If you are a graduate student working on an ACT/RFT study and would like to have us include your dissertation or thesis citation in this update, please send us an email backchannel. **If you have published an editorial and you would like us to include that citation, please send us an email back channel. We hope you will find our e-mail updates of interest and value. If you have questions, please contact Robyn Walser, Robyn.Walser@va.gov or Maggie Chartier, maggie_chartier@yahoo.com Our reviewers include: Robyn Walser, PhD Christi Ulmer, PhD Maggie Chartier, MPH, MS Ian Stewart, PhD Miguel Rodríguez Valverde, PhD This issue contains 8 summaries. Please find references at end of summary and references listing at end of document: ACT ARTICLES AND RELATED TOPICS Acceptance and pain in children.... The literature supporting the use of cognitive-behavioral interventions for chronic pain in adults is fairly extensive. Nevertheless, considerably less empirical support is available for psychological approaches to pain in children. Even more limited is the literature on psychological approaches to idiopathic (of unknown cause) chronic pain in youths. Acceptance-based approaches have been implemented into behavioral pain treatments in adults, and have been found to be associated with better outcomes. The authors of a recent study investigated the impact of an ACT intervention with an exposure component for increased functioning and school attendance in 14 adolescents experiencing idiopathic chronic pain. The intervention was administered in individual therapy sessions tailored to the individual patient, but generally followed a format that included education, ACT, and exposure. Parents were also seen in separate sessions to provide guidance on an intervention-consistent parental coaching role versus a caretaking role. The number of sessions varied across patients. Post-intervention data revealed large effect sizes for improvements in the primary outcomes (functioning and school attendance) in addition to the secondary outcomes (pain intensity, pain interference, and catastrophizing). Interestingly, pain intensity and interference decreased following this intervention despite the absence of intervention components targeting pain reduction. Limitations of the study included lack of a control group, variability in session number and therapeutic skills, and absence of a measure of the proposed mechanism of action (psychological flexibility). Despite the limitations, this pilot study contributes to a nascent area of research on the treatment of chronic pain in youths, and suggests a potential role for ACT-based interventions in this population. Read the Article: Wicksell, R. K., Melin, L., & Olsson, G. L. (2007). Exposure and acceptance in the rehabilitation of adolescents with idiopathic chronic pain - A pilot study. European Journal of Pain, 11(3), 267-274. __________ Hair pulling and experiential avoidance... Trichotillomania (TTM) is estimated to be present in up to 3.4% of the population and is associated with significant psychosocial difficulties. Previous research has identified several specific cognitions and affective states that are associated with the tendency to engage in hair pulling. A recent internet-based study investigated the potential relevance of the stance of the TTM sufferer towards aversive thoughts and emotions in hair pulling severity. More than 700 individuals reporting a diagnosis of TTM completed an anonymous online survey assessing: DSM-IV TTM criteria; hair pulling severity, urge, behavior and consequences; shame; self-perceived appearance; and fear of negative evaluation; and experiential avoidance. In spite of the waning criticism of internet-based research, the sample characteristics suggest that is was similar to those of studies completed in clinical settings, and the reported internal consistencies of the employed measures suggested that participants provided meaningful responses. As found in previous research, hair pulling behavior was associated with greater negative cognitions. However, in the current study, these associations were either significantly reduced or eliminated when experiential avoidance was introduced as a mediator. Under the premise that aversive cognitions are functionally related to hair pulling behavior, clinicians commonly target thought content using a cognitive restructuring approach to TTM. However, the findings of the current study suggest that targeting avoidance may result in a greater degree of behavior change. Replication of this study is needed in a clinical sample and should include longitudinal data to explore causal pathways plus a larger battery of private events should be investigated. Despite the need for additional study, the findings of the current study implicate experiential avoidance as a potentially critical factor in the understanding and treatment of TTM. Read the Article: Norberg, M. M., Wtterneck, C. T., Woods, D. W., & Conelea, C. A. (2007). Experiential avoidance as a mediator of relationships between cognitions and hair-pulling severity. Behavior Modification, 31, 367-381. __________ Preliminary findings suggest that ACT is useful for coping with psychological distress related to breast cancer. A recent article in the Spanish journal of psychooncology (Psicooncología) suggests that psychological problems resulting from diagnosis, treatment, and possible sequels of breast cancer, can be analysed as a form of an experiential avoidance disorder. The authors explored the application of an acceptance-based psychological intervention to these problems in a Spanish sample, comparing it with a more traditional intervention based on cognitive-control. Twelve women (ages 42 to 50) that had been diagnosed and treated for breast cancer took part. Half of them were randomly assigned to treatment with a brief adaptation of Acceptance and Commitment Therapy. This acceptance-based protocol focused on the clarification of personal values, the detection and acceptance of psychological barriers to acting towards those values, and on the continued practice of cognitive defusion through experiential exercises and metaphors. The other six women were treated with a brief adaptation of the official cognitive-behavioral program of the Spanish Association Against Cancer. This protocol focused on analysing the relationships among disease-related thoughts, feelings, and actions, and in the modification of those cognitions and emotions through several strategies (e.g. identification and management of automatic dysfunctional emotional reactions, emotional ventilation techniques, breathing and relaxation techniques for anxiety control, etc.). The general aim was to promote a sense of personal control over problematic private events, and to encourage a positive coping style. Overt behavioral components (exposure and activity planning) were explicitly excluded from this protocol. Both interventions were administered in eight sessions (two initial individual sessions, five group sessions, and a final individual session), with pre- and post -treatment assessment, and up to 12-month follow-ups. Post-treatment effects were similar for both conditions, but after one year, ACT was significantly more effective, with improvements in anxiety and depression scores, quality of life scores, and affected valued life areas. Despite the key limitation in terms of generalizability due to the small sample size, the results are promising and these findings point to ACT as a potentially effective treatment for disease-related psychological distress in long-term medical conditions. Read the Original Article in Spanish: Páez, M. B., Luciano, C., & Gutiérrez, O. (2007). Tratamiento psicológico para el afrontamiento del cáncer de mama. Estudio comparativo entre estrategias de aceptación y de control cognitivo. Psicooncología, 4, 75-95. [Psychological treatment for coping with breast cancer. A comparative study of acceptance and cognitive-control strategies]. __________ Can brief training for new therapists in ACT and CBT be effective? Many psychotherapy effectiveness trials use experts in the therapies they are testing. In this Finnish study, the authors wanted to first reduce this professional bias common in many head-to-head trials, by using graduate-level therapists. They explored level of training, regardless of therapeutic intervention, required to achieve significant psychological effects in treated individuals. Therapists were taught both CBT and ACT, through a combination of lectures, reading, and case supervision. Each therapist delivered a CBT treatment and an ACT treatment. The only criteria for entry into the study was a desire for individual therapy, thus a range of diagnoses were represented in the study population of 28. The techniques used within each model were based on a functional analysis case formulation model, and as such there was some overlap in techniques. For example, both interventions set treatment goals, used behavioral activation and exposure; and the treatments were problem, not syndrome focused. Overall, ACT showed significantly larger effect sizes at post and follow-up for symptom improvement. Both groups showed improvements on symptom reduction, but the ACT group was "virtually indistinguishable" from community norms. CBT showed more rapid improvement in self-confidence than ACT, and ACT improved acceptance of private experience more than CBT. When controlling for self-confidence, acceptance remained a significant predictor of improved outcome on the SCL-90 at both post and follow-up assessment. There were no differences between the two on client satisfaction or client willingness to recommend the therapy. There were also no differences post treatment in the therapist comfort with therapy or how much they felt they had helped their clients, although therapists reported more discomfort and confusion about learning and delivering ACT. So the answer is, yes. Brief training in either ACT or CBT with novice therapists produced moderately good psychological effects. The authors emphasize in their discussion of the limitations that this was not an effectiveness trail comparing the two therapies, but rather an effectiveness trial focusing on the issues of brief training and competency. Read the Article: Lappalainen, R., Lehtonen, T., & Skarp, E. (2007). The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial. Behavior Modification, 31(4), 488-511. __________ Do we need to challenge thoughts in CBT? The title says it all. In this review of CBT component analyses, the authors investigate the 'three anomalies of CBT' put forth by Steve Hayes in a previous paper. These are that component analyses do not show added value of cognitive interventions; that there is often early rapid improvement in CBT prior to cognitive intervention; and that changes in cognitive mediators (thoughts/beliefs) don't seem to precede symptom changes. The authors found 13 component analysis for Cognitive Therapy (CT) in the treatment of depression and anxiety, published since 1980 in English. There were no significant differences between conditions that targeted cognitive process only or primarily and comparison groups that often included behavioral activation (BA). In many cases, BA was found to be as effective as CT and/or Automatic Thought (AT) interventions. To quote the authors, "the case at issue is not that CT performed poorly, but that BA performed so well." They discussed preliminary findings from a long-term large-scale project that has been presented at conferences (but not yet published) in which BA performed as well as antidepressant medication, and that both were superior to CT. For anxiety disorders, cognitive interventions have not been found to be more effective than disorder-specific exposure techniques. In addressing the second anomaly the authors concluded that that early responding has insufficient evidence to support CT. And as for the third, it appears that there is insufficient evidence to support cognitive mediation as a mechanism of change in therapy. The authors conclude that, almost without exception, among component analysis studies, there was no difference in effectiveness between the behavioral and cognitive components of CBT. The cognitive interventions appeared to add no additional value to behavioral interventions. The authors called CT theorists and researchers to task, requesting further investigation of the fundamental tenets of CT therapy. Read the Article: Longmore, R. J., & Worrell, M. (2007). Do we need to challenge thoughts in cognitive behavior therapy? Clinical Psychology Review, 27(2),173-187. RFT ARTICLES Training more-than/less-than relations can facilitate derived comparative relations in young children ... One critical assumption in RFT is that relating events is operant behavior. This is a challenge to demonstrate empirically, since relating is theorized to develop early in life. Examining relatively complex relations among older, more manageable subjects is one means of avoiding certain difficulties in this analysis. This study was conducted with four normally functioning females between four and five years old. The design of the study involved a multiple baseline across participants in groups of two. Stimuli were paper slips displaying arbitrary pictures. Sessions were conducted between 1 and 3 times weekly, each lasting between 40 and 60 minutes. Participants required between 2 and 6 months to complete the study. All participants displayed deficiencies in more-than/less-than relating before training and demonstrated derived performances after sufficient training. Two of the four participants required non-arbitrary training among differing stacks of pennies before demonstrating criterion responding in training with arbitrary stimuli. In summary, these results provide evidence supporting the contention that relating events is an operant class, and that a repertoire of relating among non-arbitrary events may be a prerequisite for arbitrarily applicable derived relational responding. Read the Article (available for download on the ACBS website): Berens, N. M., & Hayes, S. C. (2007). Arbitrarily applicable comparative relations: Experimental evidence for a relational operant. Journal of Applied Behavior Analysis, 40, 45-71. __________ Combinatorial entailment in young children is facilitated by multiple exemplar training... RFT is built on the basic tenet that relating events is a generalized operant. In other words, the ability to derive relations among arbitrary stimuli develops from explicit training with multiple exemplars in early life. Consistent with this assumption, a former study found that derived symmetrical relations among the majority of a sample of 4-5 year old children were contingent upon explicit training with multiple exemplars. The current work contains two studies, each incorporating a multiple baseline design. Participants were two female and two male children between the ages of 4:6 and 4:10 years/months. The first study examined the repertoire for symmetrical relations using the procedures of the former study. Participants received conditional discrimination training for an action (e.g., clapping, waving) given an object (e.g., doll, truck). Subsequently they were tested for symmetrical relations between the action and the object. All children successfully derived symmetrical relations without encountering exemplar training. The second study examined for equivalence relations, building upon the training provided in the first study. A new set of actions (e.g., touching forehead, touching shoulder) were trained in respect to the objects. Subsequently the children were tested for equivalence relations between the actions trained in the first study and the new actions. Three of the four children required exemplar training for equivalence before demonstrating derived equivalence. These results support the developmental trajectory hypothesized in RFT, and suggest a means of remediation for delayed or absent relational abilities. Read the Article: Gomez, S., Lopez, F., Martin, C. B., Barnes-Holmes, Y., & Barnes-Holmes, D. (2007). Exemplar training and a derived transformation of functions in accordance with symmetry and equivalence. Psychological Record, 57, 273-294. __________ RFT and Perspective-taking in children with high-functioning autistic spectrum disorder . The current research involves using a test of perspective taking based on the Relational Frame Theory to (i) compare normally developing children and autistic children and (ii) demonstrate how perspective taking skills may be trained when they are deficient. According to RFT, language essentially involves relating things in accordance with particular learned patterns referred to as relational frames. Perspective taking is one specific pattern of relating or 'relational framing' in which the relating depends on the perspective of the person who is doing the relating. According to RFT, there are three core relational patterns or frames involved in perspective taking: I-YOU, HERE-THERE and NOW-THEN. This article reports on two experiments focusing on perspective taking in normal and autistic subjects. In the first experiment they use an RFT-based test of perspective taking to compare two groups of 9 children each. One of these groups is composed of normally developing children while the other is composed of high functioning autistic children. Results from this first experiment were that (i) there was a significant difference between the means scores for the normal and autistic groups of children on both the clinical tests; (ii) across both groups, most errors in the perspective taking test were made on reversed relations and there was a significant difference between performance on the simple and reversed level tasks; (iii) the two groups - normally developing and autistic - differed significantly as regards to performance on the reversed relations tasks but not as regards to performance on either of other two task types; (iv) there was a correlation across all subjects between performance on the NOW-THEN reversed relations task and Daily Living Skills scores. The researchers suggest that despite a small sample size, the results provide support for the RFT account of perspective taking as deictic relational responding in that autistic children did perform more poorly than the normally developing children in the relational perspective-taking tasks provided. They performed significantly more poorly in the reversed relational tasks than in the simple tasks. They did not perform significantly more poorly in the double reversed relational tasks than in the simple tasks. However, as the researchers point out, this may be because these tasks may be answered correctly without necessarily responding appropriately in accordance with deictic relations. In the second experiment, the researchers used the RFT tasks employed in Experiment 1 combined with appropriate feedback (cartoon animations for correct responses) to train up perspective taking ability in two of the children from the normally developing group from the first experiment. The results showed that the relational pattern involved in perspective taking could indeed be trained up as RFT would predict. They suggest that this implies that the RFT account of perspective taking is a useful one, and that RFT-based perspective taking tasks such as those used in the current experiments may be used in future work to train up perspective taking in autistic children. Read the Article: Rehfeldt, R.A., Dillen, J.E., & Ziomek, M.M.(2007) Assessing Relational Learning Deficits in Perspective-Taking in Children with High-Functioning Autism Spectrum Disorder. Psychological Record, 57(10), 23-47. BOOKS Gregg, J. A., Callaghan, G. M., & Hayes, S. C. (2007). Diabetes lifestyle book. Oakland, CA: New Harbinger Press. Follette, V. M., & Pistorello, J. (2007). Finding life beyond trauma. Oakland, CA: New Harbinger Press. Hayes, S. C., Bond, F. W., Barnes-Holmes, D., & Austin, J. (2007). Acceptance and Mindfulness at Work: Applying Acceptance and Commitment Therapy And Relational Frame Theory to Organizational Behavior Management. Binghamton, NY: Haworth Press. Lejeune, C. (2007). The Worry Trap: How to Free Yourself from Worry & Anxiety using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger Press. Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An acceptance and commitment therapy skills-training manual for therapists. Oakland, CA: New Harbinger Press. Walser, R., & Westrup, D. (2007). Acceptance & Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder: A Practitioner's Guide to Using Mindfulness & Acceptance Strategies. Oakland, CA: New Harbinger Press. Zettle, R. D. (2007). ACT for depression: A clinician's guide to using acceptance and commitment therapy in treating depression. Oakland, CA: New Harbinger Press. Also: Check out the ACT in ACTion DVD set. Available at newharbinger.com BOOK CHAPTERS Pierson, H., & Hayes, S. C. (2007). Using acceptance and commitment therapy to empower the therapeutic relationship. In P. Gilbert & R. L. Leahy (Eds.), The therapeutic relationship in the cognitive behavioral psychotherapies (pp. 205-228). New York, NY: Routledge/Taylor & Francis Group. Twohig, M. P., Pierson, H. M., & Hayes, S. C. (2007). Acceptance and Commitment Therapy. In N. Kazantzis & L. L'Abate (Eds.), Handbook of homework assignments in psychotherapy: Research, practice, prevention (pp. 113-132).New York, NY: Springer Science + Business Media. DISSERTATIONS Pellowe, M. E. (2007). Acceptance and commitment therapy as a treatment for dysphoria. Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 67(9-B), 5418. Braekkan, K. C. (2007). An acceptance and commitment therapy intervention for combat veterans with posttraumatic stress disorder: Preliminary outcomes of a controlled group comparison. Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 67(12-B), 7365. EDITORIALS Curran, J., & Houghton, S. (2007). Moving beyond mechanism. Mental Health Practice, 10(8), 20-23. Blackledge, J. T. (2007). Disrupting verbal processes: Cognitive defusion in Acceptance and Commitment Therapy and other Mindfulness-based Psychotherapies. The Psychological Record, 57(4).