Symposia Detail ● Wednesday ● July 10

Wednesday Morning 10:30am

10. Acceptance and Commitment Therapy for Psychosis: Recent evidence

Symposium (10:30am-Noon)

Components: Literature review, Original data

Categories: Clin. Interven. & Interests, Clin. Interven. & Interests, Other, Psychosis, Mindfulness, Schizophrenia

Target Audience: Interm., Adv.

Location: Mathews 107 (level 1)

Chair: Joseph Oliver, Ph.D., South London & Maudsley NHS Foundation Trust

Discussant: Steven Hayes, Ph.D., Department of Psychology University of Nevada

·The Lifengage RCT of ACT for people experiencing persisting positive symptoms of psychosis: Initial results

John Farhall, La Trobe University

Frances Shawyer, La Trobe University; Monash University

Neil Thomas, La Trobe University; Monash University

Steven Hayes, University of Nevada

David Castle, University of Melbourne

David Copolov, Monash University

The Lifengage trial aimed to address criticisms of earlier clinical trials of ACT for people with psychosis, by recruiting an adequate sample, randomising participants to ACT or an established comparison therapy, using published measures, and meeting CONSORT criteria for trial quality. Ninety-six participants with a diagnosis of schizophrenia and medication-resistant persisting positive symptoms were randomised to 8 sessions of ACT or Befriending therapy. Independent assessments of symptoms, functioning and ACT-related mediators were completed at baseline, post-therapy and 6-months follow-up. The main results will be discussed in relation to the applicability and efficacy of ACT for this sub-group of people living with psychosis, and research directions prompted by the study.

·Group Acceptance and Commitment Therapy (ACT) for Psychosis: The ‘ACT for Life’ Study

Louise Johns, King's College London

Eric Morris, South London & Maudsley NHS Foundation Trust

Joseph Oliver, South London & Maudsley NHS Foundation Trust

Lucy Butler, King's College London

Background: Evidence from randomised controlled trials demonstrates the utility of ACT for psychosis in terms of reducing relapse rates and psychotic symptoms. Protocols for ACT have been developed for brief group therapy, but these have not been evaluated formally within routine clinical services.

Aims: This study aims to evaluate effectiveness of ACT delivered in group format in community treatment settings for people with psychosis.

Method: The study used a waiting list control design, with measurement points at follow up, 6 weeks and 12 weeks. Participants completed measures of life interference, anxiety, depression, process measures (mindfulness, cognitive fusion, valued living) and satisfaction. Service use post intervention was also measured.

Results and Conclusions: This paper will present the final outcome data from the study. Results showed improvements in overall anxiety, depression and reductions in life interference by client problems. The role of process variables and service use will also be discussed. The paper will also describe the practical aspects of delivering the ACT intervention in real world settings, and will illustrate the group content with the use of clinical case material.

·The Exploration of Depression in Schizophrenia (ExoDiS)

Ross White, University of Glasgow

Andrew Gumley, University of Glasgow

Rosemary Moore, NHS Greater Glasgow and Clyde

Jackie Smith, NHS Greater Glasgow and Clyde

Corinna Stewart, University of Glasgow

Background: Depression is a significant problem amongst individuals with a diagnosis of Schizophrenia and is associated with poor quality of life.

Aims: The Exploration of Depression in Schizophrenia (ExoDiS) study aimed to (a) establish the prevalence of depression in a geographical cohort of individuals with a diagnosis of Schizophrenia, (b) characterise this group in terms of key correlates of depressed mood.

Method: The study used a cross-sectional design. Participants completed the Calgary Depression Scale for Schizophrenia, The Hospital Anxiety and Depression Scale, the Acceptance and Action Questionnaire-II, the Significant Other Scale, the Warwick Edinburgh Mental well-being Scale, The Self-Compassion Scale, and the Beck Cognitive Insight Scale.

Results and Conclusions: The Acceptance and Action Questionnaire-II had significant correlations with the depression measures, and many of the other measures used in the study. The implications that these findings have for future clinical trials of ACT for post-psychotic depression will be discussed.

As an intervention, ACT is well suited to working with people with psychosis, offering a method to develop and enhance values based living in the presence of often highly distressing and unwanted experiences. Since the early studies investigating ACT for psychosis interventions, by Bach and Hayes (2002) and Gaudiano and Herbert (2004), interest in this area has continued grow, culminating in the recent volume, ‘ACT and Mindfulness for Psychosis’ (Wiley-Blackwell). Evidence in this area has also continued to develop with the publication of a number of research trials. This symposium will bring together recent evidence from several studies. The Lifengage paper will present outcome data from the large RCT for ACT for positive symptoms of schizophrenia. The ACT for Life paper will describe outcomes from an ACT group-based intervention for psychosis. The ExoDiS paper will report on data exploring the role of depression and ACT process variables in psychosis. Together, the results from these studies will be discussed in relation to future directions for the field.

Educational Objectives:

1. Describe the up-to-date evidence for ACT and mindfulness based interventions for psychosis.

2. Explain key ACT process variables in relation to psychosis and understand issues concerning measurement.

3. Outline current knowledge gaps and future directions for ACT psychosis research and interventions.

 

12. Contextual Medicine Special Interest Group Symposium 1: Strategy, purpose, issues, roadmap

Symposium (10:30am-Noon)

Components: Conceptual analysis, Original data, Experiential exercises, Didactic presentation, Role play

Categories: Functional contextual neuroscience and pharmacology, Theory & Philo., Related FC approaches, Seamlessly integrating medicine with behavioral/evolutionary science, Philosophy

Target Audience: Intro., Interm., Adv.

Location: Mathews 309 (level 3)

Chair: Rob Purssey, MBBS FRANZCP, Private Practice and University of Queensland

Discussant: Tony Biglan, Ph.D., Oregon Research Institute

·Contextual Medicine - strategy and purposes: Creating a unifying, empowering clinical dialogue, embracing whole person/societal care

Rob Purssey, MBBS FRANZCP, Private Practice and University of Queensland

The Contextual Medicine Special Interest Group of ACBS was founded in mid-2012 defining our Topics of Interest as; human physiology, neuroscience, medicine, and their relations within the broader field of evolutionary science; integrating CBS case conceptualization with models and language familiar to medical practitioners; the functional contextual study of the effect of drugs on human behavior; and public health, socio-cultural, and economic issues relevant to practices of medicine including prescribing practices, and local variation in such issues. This paper lays out the functional contextual philosophy of science foundations, showing how FC assumptions (aontology, monism, pragmatic truth, “cause” entirely functional and situation specific for a purpose) can integrate the “physical” and “psychological” seamlessly, while illuminating how scientist / clinician values and purpose, being an integral part of the whole, are fundamental to “truth” of our work and findings.

·We Have a Stone in Our Shoe: Saving the World with Contextual Science

Kelly G. Wilson, Ph.D., University of Mississippi

Chronic mental health problems have increased dramatically. From 1987 to 2007 children on disability for mental disorders in the US has gone from around 16,000 to 561,000. The National Institutes of Health seeks causes in genetics and neurological dysfunction. From an evolutionary perspective, the causes cannot possibly be “broken brains” or “broken genes.” Such a search is akin to the following: If a person had a stone in their shoe, we could scan, x-ray, and do tissue cultures, check for swelling and inflammation. We could administer opiate drugs to reduce pain. But we would never find the cause. Opiates might allow walking, but they would cause great disability. Decontextualized medicine allows people to tolerate damaging environments. This is not restricted to mental health. Blood pressure medications allow people to live in environments that dangerously raise blood pressure, and diabetes drugs allow toxic dietary environments. I will argue for an evolutionary approach to health that offers direct suggestions for minimal requirements for sustained wellbeing in the modern world.

·“Assume that…”: The Clinical Application of Functional-Contextualist Science-Making Processes

Julian McNally, Private Practice, The ACT of Living

Much of the scope and depth of the ACT-RFT research enterprise derives from the willingness of its leaders to examine and establish their own assumptions and contrast them with the assumptions underlying competing models. Doing so has allowed for the development of logical connections between philosophy, research methodology and clinical practice. If this assumption-establishing process makes for good science - i.e. increases the ability to predict and influence with greater precision, scope and depth - could it be helpful for pursuing value-directed living? This paper aims to demonstrate that:

• assumptions govern actions constantly and powerfully,

• they are largely invisible, but can be revealed,

• they can be created or chosen, and;

• these last two processes can be influenced in conversation.

If time permits, sample interventions will be demonstrated.

Contextual Medicine seeks to integrate functional contextual behavioral science with models & language familiar with medical practitioners to address human physiology, neuroscience & medicine. Evolutionary CM science could impact public health, socio-cultural & economic realms to improve human well being, integrating basic research from epigenetic to social with clinical interventions from medication to therapy to public policy. This inaugural CM SIG Symposium will lay out the foundations, map a seamless biological, behavioral & cultural strategy, and critically examine where mainstream mechanistic assumptions have led us. We will offer suggestions for the minimal requirements for sustained well being, and a vision for progress using clinical applications of functional contextual science making processes.

Educational Objectives:

1. Describe the contextual medicine strategy of science, purpose of discipline, and the implications of its assumptions.

2. Apply evolutionary principles to explain recent epidemiological evidence of rapidly increasing psychological health morbidity in developed countries.

3. Create questions to uncover disabling assumptions.

Wednesday Afternoon 2:45pm

23. Relational Frame Theory research in Australia: First steps

Symposium (2:45-4:15pm)

Components: Didactic presentation

Categories: RFT, RFT, IRAP, deictic framing

Target Audience: Intro., Interm., Adv.

Location: Mathews 123 (level 1)

Chair: James E. Duguid, University of Western Sydney

Discussant: Joseph Ciarrochi, Ph.D., University of Western Sydney

·The Implicit Relational Assessment Procedure: Measurement from a functional contextual point of view

James E. Duguid, University of Western Sydney

Joseph Ciarrochi, Ph.D., University of Western Sydney

Ian Stewart, Ph.D., National University of Ireland, Galway

The Implicit Relational Assessment Procedure (IRAP) provides RFT researchers with a functional contextual measure of implicit cognition. The IRAP provides an alternative to mechanistic methodologies that have been popular for many years in social psychology. The IRAP provides a measure of brief and immediate relational responding as participants respond quickly and accurately to stimuli on a computer screen. IRAP research highlights not only the importance of context on relational responding, but the potential to predict behaviour months in advance. This paper will provide an overview of the IRAP, discuss recent developments in IRAP research as well as the author’s recent research on attitudes to body-size, and consider the importance of functional contextual measures in Contextual Behavioural Science.

·A Qualitative Measure of Deictic Framing

Paul Atkins, Ph.D., Australian National University

A primary aim of ACT is to help create a more flexible and adaptive relationship to the self and identity. But self-report measures are inadequate for capturing the depth and richness of change in identity resulting from mindfulness interventions. We describe a qualitative coding scheme based upon a functional theory of self-referencing behaviour that can be applied to any text to measure complexity and flexibility of self-reference and perspective taking. The scheme distinguishes between more or less flexible conceptualizations of the self, self as experienced in the present moment and self as a perspective from which experience is observed. A validation study based upon interviews before and after a community-based Mindfulness Based Stress Reduction (MBSR) course demonstrated high inter-rater agreement (Cohen’s Kappa = .59) and significant changes in identity associated with less rigid self-categorizations (p < .002), more flexible self-references (p = .035) and more references to self as an observer of experience (p = .015). The qualitative data revealed reduced reliance upon rigid rule-governed behavior and an increase in more flexible, contingency-sensitive responding. The measure provides a precise but semantically rich approach to understanding self-reference that is widely applicable to researching mindfulness interventions in a variety of contexts.

·A Qualitative Measure of Self-Rules

Robert Styles, Australian National University

Building on the previous talk, I present a method of interviewing that probes critical incidents for contextual and verbal contingencies governing behaviour as well as a method for coding these interviews in terms of the construction of a sense of self and self-rules in use. I present results from a study correlating these measures of selfing and self-rules with other commonly used self-report measures of mindfulness, perspective taking, and wellbeing.

Relational Frame Theory is the focus of research in many centres around the world, however this is only a recent development in Australia. RFT provides a comprehensive account of human language and cognition that is relevant to both basic research and applied settings. The papers presented in this symposium will highlight the early developments of RFT research at two universities in Australia. Each paper will highlight developments in measurement, present results from ongoing research, and discuss the importance of this research in Contextual Behavioural Science.

Educational Objectives:

1. Explain a new qualitative measure of self-construal.

2. Explain a new qualitative measure of self-rules.

3. Discuss the importance of functional contextual measures in RFT research.

 

24. Contextual control and transformation of function during the expansion of relational networks: Experimental findings and clinical implications

Symposium (2:45-4:15pm)

Components: Original data

Categories: RFT, Clin. Interven. & Interests, Transformation of functions

Target Audience: Interm.

Location: Mathews 309 (level 3)

Chair: Roberta Kovac, Ms, Nucleo Paradigma of Behavior Analisys

Discussant: Kelly G. Wilson, Ph.D., University of Mississippi

·The transfer of social exclusion and inclusion through stimulus equivalence classes

Louise McHugh, University College Dublin

Anita Munnelly, University College Dublin

Charlotte Dack, University College London

Georgina Martin, University College Dublin

Previous studies have reported that ostracism (to be excluded or ignored) can have distressing effects on individuals. One method in which ostracism has been studied in the experimental context is through a virtual ball-toss game, known as Cyberball. In this game, participants may be excluded or included from the ball-toss game, and participants typically report lower feelings of self-esteem, control, belonging and meaningful existence following exclusion from the game. The present study sought to explore the transer of feelings of exclusion and inclusion through stimulus equivalence classes. Participants were first trained and tested on two three-member equivalence classes (e.g., A1-B1-C1; A2-B2-C2). Next, all participants were exposed to the Cyberball exclusion game.  In this game, one stimulus (C1) from one equivalence class was assigned as the Cyberball game name. During a subsequent transfer test, participants were asked to rate how they thought they would perform on other online games, corresponding to member of both equivalence classes. Participants reported that thet felt they would be excluded from online games if they were members of the same equivalence class as C1. In contrast, participants reported that they felt they would be included in online games if they were member of the other equivalence class. Results demonstrate that feeling of exclusion and inclusion can transfer through equivalence classes.

· The transfer of sameness and opposition contextual-cue functions through equivalence classes

William F. Perez, Ph.D., Nucleo Paradigma of Behavior Analysis

Roberta Kovac, Ms, Nucleo Paradigma of Behavior Analysis

Daniel de Moraes Caro, Nucleo Paradigma of Behavior Analysis

Yara C. Nico, Nucleo Paradigma of Behavior Analysis

Adriana P. Fidalgo, Nucleo Paradigma of Behavior Analysis

According to the Relational Frame Theory, relational responding is always under control of contextual cues (e.g., CRel). The present study aimed to investigate whether the contextual control of relational responding in accordance with sameness and opposition would transfer through equivalence classes. First, participants were exposed to a nonarbitrary training in order to establish two nonsense figures as contextual cues for sameness and opposition. After that same and opposite relations were establish among arbitrary stimuli (Same/A1–B1; Same/A1–C1, Opposite/A1–B2; Opposite/A1–C2) and derived relations were tested. In the next phase, contextual cues for sameness and opposition were included in the equivalence class of horizontal and vertical lines, respectively. The transfer of contextual control was tested replacing the nonsense figures originally established as contextual cues by the vertical and horizontal lines on training and test trials without feedback. By the end of the procedure, an arbitrary meaning was established for one member of the relational network and transformation of meaning was tested for the other members. Five of 10 participants achieved positive results for the transfer of the contextual-cue functions and three of them also presented the transformation of function on the transformation of meaning test.

·Generalization of thought suppression functions via trained and derived 'same' and 'opposite' relations

Louise McHugh, University College Dublin

Ian Stewart, National University of Ireland Galway

Nic Hooper, University of Wales Newport

This paper reports on a study that investigated generalization of thought suppression functions via trained and derived 'same' and 'opposite' relations. In Experiment 1, participants were first exposed to matching-to-sample procedures to establish contextually controlled 'same' and 'opposite' relational responding. They were then trained and tested for formation of two five-member relational networks composed of 'same' and 'opposite' relations. In the final stage they were instructed to suppress all thoughts of a particular word, which had previously appeared in one of the two relational networks, while a number of words appeared on the computer screen in front of them in a quasi-random cycle including the to-be-suppressed word, and words either in the same (experimental) relational network as the latter or in a different (control) relational network. During this final phase, participants could remove any word from the screen by pressing the spacebar. Findings showed that they removed the target word more frequently and faster than other words; removed words in trained relations with the target more frequently and faster than words in derived relations with it; removed words in 'same' relations with the target more frequently and faster than words in 'opposite' relations with it; and removed words in the experimental relational network more frequently and faster than words in the control relational network. These patterns were seen both at an individual as well as at a group level. In Experiment 2, which involved training and testing a network involving more 'opposite' than 'same' relations, a somewhat similar but weaker pattern was observed. Implication and research directions are discussed.

Educational Objectives:

1. Relate original data on the area of language and cognition to its applications in everyday life, mainly to clinical implications.

2. Understand how transformation of functions can be produced in an experimental setting.

3. Demonstrate the importance of basic research to clinical work.

 

Wednesday Afternoon 4:30pm

28. ACT with Parents

Symposium (4:30-5:45pm)

Components: Conceptual analysis, Literature review, Original data

Categories: Clin. Interven. & Interests, Prevention & Comm.-Based, Beh. med., Parenting

Target Audience: Intro., Interm.

Location: Mathews 123 (level 1)

Chair: Meredith Rayner, Ph.D., Parenting Research Centre

Discussant: Giovanni Miselli, Ph.D., AUSL Reggio Emilia

·Mindful pregnancy and childbirth: Effects of a mindfulness based intervention on women’s psychological distress and well-being in the perinatal period

Cassandra Dunn, University of Adelaide

Emma Hanieh, University of Adelaide

This pilot study explored the effects of an 8-week mindfulness-based cognitive therapy group on pregnant women. Participants reported a decline in measures of depression, stress and anxiety; with these improvements continuing into the postnatal period. Increases in mindfulness and self-compassion scores were also observed over time. Themes identified from interviews describing the experience of participants were: ‘stop and think’, ‘prior experience or expectations’, ‘embracing the present’, ‘acceptance’ and ‘shared experience’. Childbirth preparation classes might benefit from incorporating training in mindfulness.

·Psychological Flexibility, ACT and Parent Training: Different models for integrating ACT into services for families with a children diagnosed with Autism or PDD

Giovanni Miselli, Ph.D., AUSL Reggio Emilia

In Italy, behavioral parent training format has been enhanced with ACT elements, used as a way to reduce the barriers that may restrict new skill acquisition and employment for parents of children diagnosed with Autism and PDD. Recent evidence and theorization underline the role of some of the core processes in the impairment of parents’ ability to develop and employ new effective parenting skills and namely: experiential avoidance (feeling incompetent and ineffective) and Fusion (with thoughts and stories about their child’s disorder and misbehaviors or their own inability as parents). The program has been used in Private and Public Health Care Services as a part of comprehensive Early Intensive Behavioral Interventions reaching more than 300 families. Traditional Psychological Flexibility in Parenting has also been introduced and evaluated. Advantages, difficulties and data from different models that have been field tested in group, couple and individual formats will be presented, explored and discussed.

·Take a Breath: Pilot of a group intervention for parents of children with life-threatening illness delivered using online technology

Meredith Rayner, Ph.D., Parenting Research Centre

Frank Muscara, Murdoch Children's Research Institute

Parents with children diagnosed with a life threatening illness have been found to be at high risk of Acute Stress Disorder and Post Traumatic Stress symptoms. The Take A Breath program utilises an ACT approach to assist parents to develop effective mechanisms for coping with their child’s diagnosis, treatment and recovery by assisting parents to develop greater psychological flexibility. The aim is to help parens better manage the impact of distressing thoughts and emotions on daily functioning, reduce post traumatic symptoms in parents and ultimately improve family functioning and child psychological functioning and quality of life. Preliminary data from the pilot of the online group program delivered to parents of patients from the oncology, neurology, cardio and paediatric intensive care units at Melbourne’s Royal Children’s Hospital will be presented. The program is being piloted in an online interactive group format to increase accessibility for parents outside the Melbourne metropolitan area.

This symposium will present pilot data and discuss a variety of novel ways in which Acceptance and Commitment Therapy has been incorporated into three parent interventions. Traditional ABA, CBT and psycho education are commonly used in parent programs. This symposium presents pilot data on three parent interventions incorporating ACT components. The first paper discusses the results of a pilot study that explored the effects of an 8-week mindfulness-based cognitive therapy group on pregnant women. The second paper presents advantages, difficulties and data from parent interventions field tested in group, couple and individual formats parents of children diagnosed with Autism and PDD. The third paper presents preliminary pilot data for an ACT online group intervention for parents of children diagnosed with a life threatening illness.

Educational Objectives:

1. Describe the differences between acceptance and mindfulness techniques and traditional behavioural parenting training.

2. Utilize outcomes/implications of current pilot studies to design and implement similar programs in one's institution/facility.

3. Identify some techniques to incorporate the use of acceptance and mindfulness with traditional behavioural parenting training.

 

29. Living from Inside the Skin: Psychological Flexibility and Physical Self Care

Symposium (4:30-5:45pm)

Components: Conceptual analysis, Literature review, Original data, Experiential exercises, Didactic presentation, Case presentation

Categories: Beh. med., Clin. Interven. & Interests, Prevention & Comm.-Based, Performance-enhancing interventions, Beh. med., Theory & Philo., RFT, ACT, Depression, Anxiety, Chronic Pain, Health, Obesity, Health Anxiety

Target Audience: Intro., Interm., Adv.

Location: Mathews 309 (level 3)

Chair: Caroline Horwath, University of Otago

Discussant: Jennifer Gregg, San Jose State University

·Psychological flexibility, eating habits and 3-year weight gain: Results from a nationwide prospective study of mid-age women

Sara Gdovin, MSc, University of Otago

Sookling Leong, MSc, University of Otago

Andrew Gray, Biostatistican, University of Otago

Caroline Horwath, Ph.D., University of Otago

Psychological flexibility may be associated with differing abilities to pursue healthy food habits in the presence of uncomfortable thoughts/emotions. We hypothesized that greater psychological flexibility would be associated with healthier eating habits and prevention of weight gain over 3 years.

In 2009, 1601 participants were recruited from the NZ Electoral Roll (response 66%). The 3-year retention was 78%. Participants provided self-report data on height, weight, food patterns, and (baseline only) psychological flexibility (AAQ-II). There was evidence of a plateau in baseline BMI over a range of AAQ-II values with quadratic increases for lower levels of flexibility. Lower psychological flexibility was associated with increased odds of binge eating one or more times per week (OR 1.65/10 units, 95% CI: 1.47, 1.84, p < 0.001) and weight control (trying to maintain or lose weight, OR 1.25/10 units, 95% CI: 1.08-1.45, p=0.003). Psychological flexibility was not associated with change in BMI (p=0.168) but was with BMI stability (remaining within 3% of baseline, OR 0.88/10 units, 95% CI: 0.77-1.00, p=0.050) over three years.

·Acceptance, awareness, belief, and authentic goals: Identifying the distinctive psychological profiles of underweight, overweight, and obese people in a large American sample

Joseph Ciarrochi, University of Western Sydney

Baljinder Sahdra, University of Western Sydney

Sarah Marshall, University of Western Sydney

Philip Parker, University of Western Sydney

ACT has been shown to be beneficial for weight management, but little is known about how the ACT “ingredients” or process measures relate to potential differences in people who are underweight, overweight or obese. We utilized a planned missing data design to administer a large survey to a sample of Americans (n = 7884; 3748 males; 4136 females; Mean age =47.9, SD=16). We assessed the core process targeted in ACT, including psychological flexibility, dimensions of experiential acceptance, mindfulness, defusion, authentic valuing, and committed action. Profile analyses revealed that being moderately overweight (BMI from 25 to 30) was not associated with inflexibility or its components. Relative to normal weight people, both underweight and obese people were psychologically inflexible, but the underlying makeup of that inflexibility differed. Underweight people (BMI < 18.5) showed a profile of low social worth (self-esteem), high behavioural avoidance, distress intolerance, and controlled goals (e.g., ones done out of guilt or due to external pressure.). However, they also expressed moderate to high efficacy in being able to achieve their goals (hope) and moderate progress in actually achieving them. In contrast, obese individuals tended to score moderate to low on all indices of flexibility, expressed little hope, and felt they were making little progress on their goals. We discuss the implications of these different profiles for ACT interventions.

·ACT for Health Anxiety

Lisbeth Frostholm, Ph.D., Research Clinic for Functional Disorders, Aarhus University, Denmark

Ditte Hoffmann Jensen, Research Clinic for Functional Disorders, Aarhus University, Denmark

Trine Eilenberg, M.A., Research Clinic for Functional Disorders, Aarhus University, Denmark

Louise Kronstrand Nielsen, M.A., Research Clinic for Functional Disorders, Aarhus University, Denmark

Eva Oernboel, M.A., Research Clinic for Functional Disorders, Aarhus University, Denmark

Per Fink, MD, Ph.D., Research Clinic for Functional Disorders, Aarhus University, Denmark

Health anxiety (HA) or hypochondriasis is a disabling and persistent disorder with a high prevalence in primary care, and insufficient treatment opportunities and knowledge of treatment processes. Cognitive Behavioral Therapy (CBT) has shown positive effect for HA in a number of trials, but no clinical trials has yet examined the possible effect of ACT for HA. In this paper we will provide 1) an introduction to the diagnosis health anxiety, 2) an overview of the manual, we have developed for ACT group treatment for HA, 3) present results on patient satisfaction with the treatment, symptom reduction (Illness worry, using the Whiteley-7), and possible mechanisms of change (’psychological flexibility’ (AAQ-II) and ’mindfulness-skills’ (FFMQ) from an uncontrolled pilot study including 34 patients for a 6 months’ follow-up period. 4) Finally, we will present preliminary results from a randomized controlled trial of ACT group therapy for severe HA including 128 patients and outline the next steps in the development of evidence-based treatments for HA.

·The ACT of Self Forgiveness: A gateway to psychological flexibility?

Grant Dewar, The University of Adelaide

The ACT of self forgiveness contains within it the possibility and opportunity to enter into a new approach to life. This presentation will review current approaches to the treatment of psychological distress and the link between self forgiveness and restoration of psychological health. This will include: conceptualisation of the links between a lack of self forgiveness and psychological distress; the use of measures of forgiveness; and, a proposed framework for the use of concepts of self forgiveness in treatments that utilise ACT to provide a full range of benefits (including mental health, family and social well-being).

In particular this presentation will outline an approach to treatment of a 46 year old female experiencing chronic pain and who is a recovering alcoholic. The treatment utilises self forgiveness within a framework of Therapy with a primary focus on Acceptance and Commitment Therapy. The approach described utilises self forgiveness as a means to facilitate openness to new perspectives on both past transgressions and present moment action. Multiple factors have been proposed as contributors to alcohol dependence including heritable traits, cognitive constructs, familial, social and environmental influences. However the catastrophic consequences of inappropriate behaviour associated with alcohol can form major barriers to recovery and treatment. In the approach described it is the flexible use of ACT in the therapeutic alliance and the focus on self forgiveness which a pathway for recovery and provides tools for relapse prevention.

Implications of this approach for therapists and those seeking assistance with overcoming the burden of past events are considered. The important role of processes of stuck thinking, story telling and worry are examined and the innovative integration of self forgiveness into current therapeutic processes utilising ACT are underscored.

Research from the CBS perspective is converging to suggest that caring for the body in a way that allows for valued living demands psychological flexibility. Whether coping with physical health problems, struggling with body-related distress, or struggling with life in a way that has significant body costs, engagement, openness and purpose in the way we inhabit our bodies seems to have a significant impact on our well-being. The papers in this session will explore the ways that psychological inflexibility interferes with physical self-care while psychological flexibility promotes it. The first paper includes data from a large questionnaire study revealing the divergent psychological profiles of underweight and obese Americans in terms of awareness, acceptance, self-efficacy and chosen goals. The second paper will present data from a large longitudinal study considering the role of psychological flexibility in predicting healthier eating habits and BMI. The third paper will consider health anxiety (i.e., hypochondriasis) from a flexibility perspective, reviewing health anxiety and the role of psychological inflexibility in its development and maintenance, along with preliminary effectiveness data from a pilot and an RCT on ACT-based treatment for health anxiety. Finally, the fourth paper will explore the integration of forgiveness as an important part of flexibility-based treatments through a case study of a woman struggling with chronic pain and alcoholism.

Educational Objectives:

1. Describe the link between underweight/overweight and acceptance, defusion, valued action.

2. Discuss the effect and possible mechanisms of change in ACT treatment for HA.

3. Explain the use of the concept of Self Forgiveness as a perspective for the application of Acceptance and Committment Therapy.

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Symposium Detail ● Thursday ● July 11

 Thursday Morning 10:30am

35. Compassion in Context: Viewing Compassion Focused Therapy From an CBS-Consistent Perspective

Symposium (10:30am-Noon)

Components: Conceptual analysis, Original data, Experiential exercises

Categories: Clin. Interven. & Interests, Theory & Philo., Compassion, Self-Compassion, Training, Depression, Anxiety

Target Audience: Intro., Interm., Adv.

Location: Mathews Theatre C

Chair: Paul Gilbert, Ph.D., FBPsS, OBE, Mental Health Research Unit, Kingsway Hospital

Discussant: Jason Luoma, Ph.D., Portland Psychotherapy Clinic, Research, and Training Center

·Learning ACT with Compassion

Martin Brock, University of Derby

Consistent with contemporary forms of cognitive behavioural psychotherapy, developing skills in compassion focused therapy or ACT effectively involves experiential learning which can be tricky. Clinician training literature shows that experiential teaching can improve educational outcomes in comparison to didactic methods alone and self-practise and self-reflection can facilitate understanding of techniques, with particular regard to their contextual use, and a deeper awareness of the self and CBT as a tool for personal change. Experiential components of CBT training are often described as being useful but workshop participants can report feeling hesitant to engage, doubts about what has actually been ‘learned’ or a sense of disconnection between the ‘workshop experience’ and clinical application. These dilemmas can be useful to explore as they might well mirror the ‘client experience’.' This presentation will consider how compassion and psychological flexibility can influence engagement in experiential learning and the functional value of the experiential component of ACT training. Opportunities to share experience of learning experientially and suggestions for refining experiential components will be offered.

·An ACT consistent Compassion Focused Therapy intervention for chronic Dysthymia and Generalized Anxiety Disorder: Single case study and conceptual analysis

Dennis Tirch, Ph.D., The Center for Mindfulness and Compassion Focused Therapy

Recent advances in psychotherapy theory and practice have suggested that compassion may be a significant, active process in psychotherapy effectiveness (Gilbert, 2010; Baer, 2010; Hofman et. al., 2011; Goetz et. al., 2010; Neff et. al.; 2007). As a result, cognitive and behavioral technologies are emerging, which aim to directly train clients to develop mindful compassion as an element of the treatment of anxiety and depression (Gilbert, 2010; Tirch, 2012; Neff & Germer, 2011). This presentation will introduce participants to the theory and interventions used in Compassion Focused Therapy (CFT) (Gilbert, 2009). CFT is based upon empirically supported psychological processes, affective neuroscience, evolutionary science, and meditation disciplines. CFT employs a conceptual and technical approach that is consistent with ACT and other contextual CBT tools. During this presentation, participants will learn, in detail, how CFT practices may be used to help clients with anxiety disorders. A single-case, clinical research example will be provided that demonstrates the effectiveness and change processes involved in an ACT consistent CFT intervention for chronic, generalized anxiety disorder and dysthymia. Participants will learn the CFT evolutionary model, including the nature of our three basic emotion regulation systems, and how to apply this theory in practical ways to a case formulation and intervention that is consistent with the psychological flexibility model.

·Gender and compassion: The development, experience and function of compassion in women and men

Laura Silberstein, Ph.D., The Center for Mindfulness and Compassion Focused Therapy

Although considered to be an evolved universal human capacity, there are important individual differences and processes in how people learn and respond to various forms of compassion. More specifically, researchers have observed certain gender differences in the motivation, experience and cultivation of compassion. These gender-based tendencies or patterns may have the potential to impact an individual’s experience of compassion. This presentation proposes and begins to explore questions, such as: “What do we know about possible behavioural differences between men and women that would influence the experience of compassion for themselves and others? Are gender differences more or less significant than other individual differences in CFT? When it comes to CFT, how are learning histories, social mentalities, and psychological flexibility processes considered in terms of gender sensitive treatment? What would gender sensitive CFT involve? What are the possible risks or concerns of gender sensitive treatment approaches to CFT?” These questions will be explored by reviewing the state of the research and exploring related evolutionary, genetic, cultural, social learning and associated behavioural patterns and processes.

This symposium examines fundamental definitions of compassion, and highlights how commitment and acceptance lie at the heart of compassion. Dr. Paul Gilbert will discuss how the acceptance that emerges from a compassionate mind does not mean non-action, but rather involves a courage that may be the fundamental attribute involved in the development of both commitment and acceptance. As blocks to compassionate commitment and acceptance may arise from the function of fear of compassion, Dr. Gilbert will address the major fears of compassion that present in a clinical context and how they can be addressed. Martin Brock, MSc, will discuss ways to enhance sensitivity to, and engagement with, compassion in the process of ACT training through experiential learning. Dr. Dennis Tirch will present a case example of an ACT consistent intervention that focuses on compassion in the treatment of depression and chronic anxiety. Dr. Laura Silberstein will discuss the conceptual and research bases for gender differences in compassion. Discussant, Dr. Jason Luoma, will consider the role of context in compassion and shame from a functional contextualist perspective. As such the historical, personal, genetic, and cultural context in which emotions are situated will be a part of the conversation. Data that relate to this topic will be reviewed.

Educational Objectives:

1. Explain the fundamentals of CFT’s underlying evolutionary theory of emotion regulation, attachment, behavior and cognition.

2. Assess functional dimensions of compassion in a range of contexts such as psychotherapy training, the treatment of depression, and gender differences.

3. Analyze the dynamics of a functional contextualist perspective on compassion.

 

38. ACTing with technology: Intervention trials incorporating the use of mobile and internet technology

Symposium (10:30am-Noon)

Components: Conceptual analysis, Original data

Categories: Clin. Interven. & Interests, Performance-enhancing interventions, Modern technology in ACT-interventions

Target Audience: Intro.

Location: CLB Theatre 2

Chair: Joseph Ciarrochi, Ph.D., University of Western Sydney

Discussant: Chris Horan, D.Psych. Candidate, Australian National University

·How mobile text-messages and the Internet can be of service in delivering an ACT-intervention for achieving smoking cessation

Stella Nicoleta Savvides, Ph.D. Candidate, University of Cyprus

Maria Karekla, Ph.D., University of Cyprus

Modern technology has begun to influence research in psychological fields and more specifically in the field of ACT. Traditional interventions (e.g. psychoeducation, CBT) for smoking cessation have limited success for adolescent groups who are not particularly motivated to quit. ACT for smoking cessation in youth presents with promising results, however more research is still needed. An ACT-based group intervention with the aid of ACT-text messages, involving adolescents (ages 15-18), was compared to a no-messages ACT group. The results show an advantage for the ACT-based messages intervention in increasing psychological flexibility and decreasing smoking (reflected in CO measurements). An ACT-based pilot intervention over the Internet is also investigated with college students, and compared to a psychoeducational internet intervention to determine the usefulness of adapting an established ACT manual for smoking cessation over the internet. It is expected that the ACT-based internet intervention will be more effective for smoking cessation than the psychoeducational internet intervention. Results of these studies will be discussed and implications for future research will be presented.

·Mobile technology fostering ACT-practice in daily life

Tim Batink, Ph.D. Candidate, Maastricht University

Dina Collip, Ph.D., Maastricht University

Marieke Wichers, Ph.D., Maastricht University

ACT teaches us to deal with our experiences in the present moment, in such a way that we can behave according to our values. However, clients do have to get out of their lives and into our therapy-office to learn to work with ACT. Mobile technology can help clients to train with ACT in their natural environment and learn to integrate ACT into their daily lives. In this exploratory study, we are examining the feasibility and effectiveness of a supplementary mobile ACT-intervention combined with experience sampling (a structured diary method) in a small clinical-sample from a broad-spectrum mental health centre. The mobile intervention, delivered by the PsyMate (PDA), will be described, the hurdles we had to overcome will be discussed and preliminary results will be presented. We will conclude with future plans and applications.

·Developing an ACT smartphone intervention with potential high impact

Jonathan Bricker, Ph.D., Fred Hutchinson Cancer Research Center & University of Washington

Julie A. Kientz, Ph.D., University of Washington

Katrina Akioka, B.S., Fred Hutchinson Cancer Research Center

Smartphone behavior change apps are growing exponentially due to their ability to provide low cost interventions directly to users whenever needed and wherever they are located. As an experiential and context-based intervention, ACT has the potential to be a highly impactful stand-alone smartphone-based intervention. Yet a critical challenge is distilling ACT's core processes, metaphors, and exercises into an intuitive, engaging, and accessible smartphone intervention. Responding to this challenge, we recently developed a video and audio-based ACT smartphone intervention for quitting smoking called Smart Quit. This talk describes the process of designing the Smart Quit intervention. The focus will be on the core development principles, intervention goals, storyboarding, selection and recording of exercises and metaphors, and usability testing. Lessons learned and implications for the design of ACT smartphone interventions will be discussed.

In the last decade, technological advancements in mobile connectivity, social networking and computing power have enabled the development of applications that make it easy for clients to apply ACT outside the therapy room, in their natural environment. In order to maximize the potential of these applications and to manage any associated risks, it is important that these interventions are studied carefully. This symposium will look at ACT-interventions incorporating these technologies (texting, internet, pda & smartphone app’s). Experiences on the development of these technology-based ACT-interventions will be shared and preliminary findings will be presented.

Educational Objectives:

1. Apply mobile technology in Acceptance and Commitment Therapy, describing feasibility and effectiveness.

2. Review and evaluate new technologies (text messages and the internet) as a useful and effective modality for ACT delivery.

3. Design a stand-alone ACT smartphone app.

 

39. As Easy as ABC: Using Derived Relational Responding and Psychological Flexibility to Promote Success and Psychological Health in University Students

Symposium (10:30am-Noon)

Components: Original data

Categories: Edu. settings, Performance-enhancing interventions, RFT, Values, Statistics, GRE

Target Audience: Intro.

Location: CLB Theatre 3

Chair: Danielle Moyer, University of Louisiana Lafayette

Discussant: Kelly Wilson, Ph.D., University of Mississippi

·Goals Worth Reaching: Investigating the Impact of a S.M.A.R.T. Goals Intervention with and without a Valued Living Component on Students in an Introductory Psychology Class

Danielle Moyer, University of Louisiana at Lafayette

Emmie Hebert, University of Louisiana Lafayette

Emily Sandoz, Ph.D., University of Louisiana Lafayette

Academic adjustment in college involves both academic success and a sense of belonging in the college environment. The earlier academic adjustment occurs, the stronger its impact on long-term achievement and performance in high stakes, high threat situations. Students' academic adjustment benefits both from opportunities to contact their values and support in setting appropriate goals. The current study will evaluate the impact of goal-setting, values affirmations, and the combination of the two in students in an introductory psychology course. Participants will be exposed to a short intervention involving either writing about a deeply held value, establishing appropriate goals, or both. Their adjustment will then be examined in terms of academic performance, academic belongingness, and psychological wellbeing.

·Raising the Confidence Coefficient: Derived Relational Responding, Statistics Anxiety, and Core Statistics Skills

Emmy Lebleu, University of Louisiana Lafayette

Emmie Hebert, University of Louisiana Lafayette

Mike Bordieri, M.S., University of Mississippi

Emily Sandoz, Ph.D., University of Louisiana Lafayette

Statistics courses are often a major challenge for students in behavioral science degree programs. Many students must take the class multiple times before they can make the passing grade, and the coursework often leads to increased stress and anxiety. Moreover, this increased anxiety is often correlated with poor performance in these courses. The current study offers a method of helping students to better understand statistics based on derived relational responding that may also indirectly target statistics anxiety. Participants engaged in a computer task that trained relational responding to statistics stimuli after completing self-report measures of psychological flexibility and statistics anxiety. The results of this study are intended to illuminate the learning processes involved in learning statistics and what roles statistics anxiety and psychological flexibility play in those processes.

·Don’t Forget to Breathe! The Impact of Flexibility versus Suppression Induction on Preparation for the Graduate Record Examination

Skylar Fusilier, University of Louisiana Lafayette

Shiloh Eastin, University of Louisiana Lafayette

Emmie Hebert, University of Louisiana Lafayette

Emily Sandoz, Ph.D., University of Louisiana Lafayette

The Graduate Record Examination (GRE) presents a significant challenge for many students wishing to attend graduate school in psychology. Most students report marked anxiety associated with the GRE, the avoidance of which can make adequate preparation nearly impossible. Thus, GRE scores are likely to reflect not only a student's skill on the tasks assessed, but also his or her psychological flexibility with GRE-related anxiety. Emerging research suggests that brief interventions can impact psychological flexibility in a way that decreases avoidance and increases engagement. The current study examined the impact of flexibility or suppression-based inductions on GRE practice engagement and performance. Participants were undergraduate and graduate student volunteers with substantial goals for GRE improvement. Preliminary data suggest increased engagement in GRE practice following flexibility-based training and provide support for the dissemination of brief, effective interventions to address GRE-related anxiety.

University students are faced with a number of obstacles and decisions throughout their experience that are both important and sometimes very stressful. The papers in this symposium will examine how Contextual Behavioral Science can be used to facilitate wellbeing and growth in university students as they transition through school and reach important milestones for their academic goals. The first paper will look at the effects of a values-based goal setting intervention on performance in an introduction to psychology class. The second paper will examine an intervention based on derived relational responding designed to aid students in understanding, and possibly lowering their anxiety in, their undergraduate statistics class. Finally, the third paper tackles one of the last big challenges for any student planning to continue their education: the GRE. The role of avoidance in research participation will also be discussed throughout.

Educational Objectives:

1. Apply functional contextual based research to improvement of academic program development.

2. Integrate derived relational responding techniques into programs designed to build student skill repertoires.

3. Discuss methodological challenges related to recruitment and assessment in studies that stimulate avoidant behavior.

 

40. ACT in Developing Nations

Symposium (10:30am-Noon)

Components: Original data

Categories: Clin. Interven. & Interests, Prevention & Comm.-Based, Global Mental Health

Target Audience: Intro., Interm., Adv.

Location: Mathews 102 (level 1)

Chair: Ross White, Ph.D., University of Glasgow

Discussant: Ross White, Ph.D., University of Glasgow

·Commit and ACT in Sierra Leone

Beate Ebert, MSc, Private Practice

Ross White, Ph.D., University of Glasgow

Corinna Stewart, BSc, University of Glasgow

Representatives of commit + act visited Sierra Leone in 2012 to deliver workshops in Acceptance and Commitment Therapy to local social workers. Ninety-two people attended workshops in Freetown and Bo. A range of measures were used to evaluate the workshops including the Acceptance and Action Questionnaire-II, the Valuing Questionnaire, the Primary Care PTSD Screen, and the Satisfaction With Life Scale. Individuals completed measures before the workshop, immediately following the workshop, and at three-month follow-up. Data was collected from 46 individuals across all three time-points (50% follow-up rate). Results indicated that there were significant changes across the three time-points in: AAQ-II (p < 0.001), SWLS (p < 0.001) and VQ (p < 0.05) scores. The nature of change and internal consistency scores suggest that the AAQ-II has promise for use in Sierra Leone. Results also support the effectiveness of ACT training for boosting psychological flexibility in people attending workshops.

·ACT as a brief intervention: One versus seven ACT sessions to treat phobia of enclosed spaces

Karen Vogel, BSc, Institute of Psychiatry, Faculty of Medicine São Paulo (presented by Michaela Terena Saban

The phobia of enclosed spaces (and associated avoidance of restraint, confinement and asphyxiation situations) presents particular difficulties in urban centers, where there is a need to share small spaces (elevators, public transportation, airplanes, congested tunnels). This study compared the effectiveness of a brief (one session) Acceptance and Commitment Therapy (ACT) intervention with a seven session intervention to treat phobia of enclosed spaces.

A randomized trial with two parallel groups was performed. After initial evaluation, a sample of fifteen participants received one treatment session using a protocol developed by Páez-Blarrina et al. (2008), whilst another sample of fifteen participants received seven ACT sessions. Beck Depression Inventory (Beck et al, 2002), Clautrofobia Inventory (Gouveia et al, 2008) and IDATE (Spielberger,1979) were the measures used.

Results supported the effectiveness of the ACT brief intervention protocol to treat phobia of enclosed spaces and an increase in levels of psychological flexibility.

·A Study of ACT and Chronic Pain: Alternative Measures

Michaele Terena Saban, Pontifical Catholic University of São Paulo; Psychiatry Institute of Clinical Hospital of São Paulo Medical School

Francisco Lotufo Neto, Psychiatry Institute of Clinical Hospital of São Paulo Medical School

This is a pilot study of Acceptance and Commitment Therapy (ACT) applied to patients with chronic pain in a Brazilian hospital. Based on data of preview studies (Dahl, Wilson & Nilsson, 2004; McCracken, Vowles & Eccleston, 2005; Vowles et al., 2007; Vowles, McCracken & Eccleston, 2007; and Wicksell, Melin & Olsson, 2007) indicating that ACT improves quality of life of this population, it has used an adaptation of Vowles and Sorrell protocol “Live with Chronic Pain: An Acceptance-based Approach” (2007) with the total of eighth sessions intervention applied on three patients, to investigate if the results were similar to the literature. The methodology was a multiple baseline design. Assessments were completed at several timepoints (before, during, post-intervention and follow-up) using questionnaires, observation of the sessions and self-registration of pain episodes. The results indicate that the self-registration measure is effective for monitoring behavioral processes and variables that influence the pain and the quality of life.

The Association for Contextual Behavioral Science (ACBS) is a truly international society that draws members from many corners of the world. The ‘CBS Dissemination in Developing Nations Special Interest Group’ aims to promote the importance of contextual behavioral science for improving mental health in developing nations. This symposium will include presentations on ACT-related research that has been conducted in Sierra Leone and Brazil. Important themes that will be discussed include: the cross-cultural transferability of ACT-related processes, and adaptations that can be made to protocols and assessment tools to meet the needs of local populations.

Educational Objectives:

1. Explain research investigating the implementation of ACT interventions in developing nations.

2. Assess the cross-cultural transferability of ACT-related processes.

3. Discuss adaptations that can be made to ACT protocols and assessment tools to meet the needs of local populations.

 

42. The development and trial of an ACT framework for working with parents of children with disabilities

Symposium (10:30am-Noon)

Components: Original data, Didactic presentation

Categories: Clin. Interven. & Interests, Parenting

Target Audience: Interm.

Location: Mathews 123 (level 1)

Chair: Jeanie Sheffield, Ph.D., School of Psychology, The University of Queensland

Discussant: Jeanie Sheffield, Ph.D., School of Psychology, The University of Queensland

·Development and Trial of an ACT Approach with Parents of Children with an Autism Spectrum Disorder

Kate Sofronoff, Ph.D., School of Psychology, The University of Queensland, Brisbane

Jeanie Sheffield, School of Psychology, The University of Queensland, Brisbane

Koa Whittingham, PhD, Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Psychology, The University of Queensland, Brisbane

Objectives: To develop and trial a brief ACT intervention for parents of children with an autism spectrum disorder (ASD) and to develop a consistent measure of Experiential Avoidance.

Design: Pre- post- and follow-up pilot design plus qualitative data collected.

Participants: Ninety parents of children with ASD.

Method: Participants completed the ACT sessions within two different studies. The data have been combined for the purposes of this presentation.

Results: Qualitative data indicated that parents found the ACT sessions to be extremely useful. Significant increases were found in levels of parent reported adjustment indicators such that they reported lower depression, anxiety and stress after completing the ACT sessions. Parents also reported greater psychological flexibility on the measures of acceptance and mindfulness. It is, however, only by combining these two groups that outcomes can be demonstrated, the effect sizes are relatively small in this population.

Conclusions: ACT is useful for these parents but more work is still to be done on developing sensitive outcome measures.

·Acceptance and Commitment Therapy as an adjunct to an evidence-based parenting intervention for parents of children with acquired brain injury: A randomised controlled trial

Felicity L. Brown, BSc, School of Psychology, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane

Koa Whittingham, Ph.D., Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Psychology, The University of Queensland, Brisbane

Roslyn Boyd, Ph.D., Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane

Lynne McKinlay, MBBS, FRACP, FAFRM, Queensland Paediatric Rehabilitation Service, Royal Children's Hospital, Brisbane

Kate Sofronoff, Ph.D., School of Psychology, The University of Queensland, Brisbane

Objective: Parents of children with ABI experience high levels of psychological distress. This study aimed to determine the efficacy of a parenting intervention, Stepping Stones Triple P (SSTP), combined with an Acceptance and Commitment Therapy (ACT) workshop, in improving child and parent outcomes following pediatric ABI.

Participants: 59 parents of children with ABI.

Method: Participants were randomly assigned to a treatment group (ACT plus SSTP) or a waitlist control group.

Results: Relative to the waitlist group, parents in the treatment group showed significant improvements on measures of child behavioural and emotional functioning, parenting style, parent psychological flexibility, parent distress, and family and couple functioning. The role of experiential avoidance as a mediator of outcomes will be discussed.

Conclusions: ACT-based interventions may be helpful in enhancing experiential acceptance in this population, and when used in conjunction with parenting programs, may have important implications in improving capacity of parents to respond effectively to parenting challenges.

·Improving Outcomes for Families of Children with CP with a Parenting Intervention combined with Acceptance and Commitment Therapy

Koa Whittingham, Ph.D., Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Psychology, The University of Queensland, Brisbane

Matthew Sanders, Ph.D., Parenting and Family Support Centre, The University of Queensland

Lynne McKinlay, MBBS, FRACP, FAFRM, Queensland Paediatric Rehabilitation Service, Royal Children's Hospital, Brisbane

Roslyn Boyd, Ph.D., Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane

Objectives: To establish the efficacy of Stepping Stones Triple P (SSTP) combined with Acceptance and Commitment Therapy (ACT) for families of children with CP.

Design: RCT with three groups (SSTP, SSTP +ACT, waitlist control)

Participants: Sixty-seven parents (97.0% mothers; mean age 38.7 ± 7.1 years) of children (64.2% male; mean age 5.3 ± 3.0 years) with CP

Method: Participants were randomly assigned to; SSTP (10 hours group intervention + 1 hour phone consultations), SSTP +ACT (14 hours group intervention + 1 hour phone consultations) or waitlist control. Primary outcomes were child behavioural and emotional problems and parenting style. Analysis consisted of a series of ANCOVAs.

Results: At post-intervention, relative to the waitlist group parents in the SSTP + ACT group showed significant improvements on a range of measures of child behaviour and functioning and parenting style. In contrast, significant differences between the SSTP alone group and the waitlist group were found for two measured variables only.

Conclusions: Adding ACT to SSTP proved efficacious for families of children with CP.

Parents of children with disabilities experience higher levels of stress and distress than parents of typically developing children. High levels of distress and experiential avoidance impact on capacity to parent effectively. An ACT framework may be particularly useful as a first step in working with this population, in order to enhance psychological flexibility and resilience to meet the ongoing challenges of parenting a child with a disability. This symposium of 3 papers will describe the development of session content, measures, and pilot work of an ACT framework, with parents of children with an autism spectrum disorder, acquired brain injury, and cerebral palsy. The results of 2 randomised controlled trials will also be presented, and limitations and future research directions discussed.

Educational Objectives:

1. Explain how an ACT framework to increase psychological flexibility can be used with parents as a first step in undertaking specific parenting interventions.

2. Describe how a standard ACT measure can be modified and tailored for use with specific populations.

3. Analyze evaluation trials of an ACT intervention in the context of parenting stress and parenting practices.

 

Thursday Afternoon 2:45pm

53. Fundamental research and applications of Relational Frame Theory

Symposium (2:45-4:15pm)

Components: Original data, Conceptual analysis

Categories: RFT, Superv., Train. & Dissem., Prof. Dev., Theory & Philo., Children, Older adults, Cognition, RFT Dissemination

Target Audience: Intro., Interm.

Location: Mathews 107 (level 1)

Chair: Josh Pritchard, Florida Institute of Technology

Discussant: Darin Cairns, Charles Street Clinic, Perth

·A possible target for executive function intervention in older adults: Assessing mutual entailment of temporal relations

Denis O'Hora, National University of Ireland Galway

Catherine McGreal, National University of Ireland Galway

Michael Hogan, National University of Ireland Galway

John Hyland, Dublin Business School

When we report events or stimuli that we have experienced in reverse order, it seems to require mutual entailment of temporal relations. In the morning, we might hear an alarm, then see a person leave their bedroom and report that "she left the bedroom after the alarm". Such processes underlie executive function and this is known to degrade as we age. The current study compared performance of 23 younger (18-23 years) and 23 older (55-81 years) participants on a go/no-go order judgment task. In this task, two stimuli (A...B) were presented in sequence and, in probes, either a “Before” (A Before B) or an “After” (B After A) statement describing the order of the sequence stimuli was presented. Participants responded to confirm the statement (go) or did not respond to disconfirm it (no-go). Correct responses to “After” statements were slower than those for “Before” statements and younger adults responded more quickly and more accurately than older adults. When controlled for Before speed, older adults exhibited greater difficulty with mutual entailment than younger adults. These findings have implications for the understanding of memory and executive function deficits in older adults and suggest that interventions aimed at enhancing or preserving mutual entailment may be appropriate.

·Watering our Roots: Bringing RFT Back to ABA

Josh Pritchard, Florida Institute of Technology

Relational frame theory sprung from the behavioral traditions of BF Skinner as an extension of his interpretive account of language. Currently, it is a subject matter rarely touched upon in many behavior analytic degree programs. Despite its accumulating empirical support, RFT was again excluded from the 4th edition BACB™ task list. As such, it is unlikely to be added to many of the educational experiences of contemporary behavior analysts while obtaining their Master’s degree. In this paper, I will briefly outline the history/origins of applied behavior analysis and its interaction with relational frame theory before touching on the controversy which influences its continual exclusion from “ABA Proper” and an actionable plan to bridge the gap from those practicing in ABA (often in the DD/Autism world). In addition to providing this historical description This paper will be bolstered by my direct experience teaching RFT to graduate students in an ABA Master’s program as well as the inclusion of it in an online curriculum for the same.

·Reversing order and size judgements: Mutual entailment of non-arbitrary stimulus relations

Nicola Brassil, National University of Ireland Galway

Denis O'Hora, National University of Ireland Galway

Ian Stewart, National University of Ireland Galway

A number of studies have demonstrated that reversing order judgements takes time and effort. One suggested reason for this is that temporal order codes must be rewritten during reversal, a second is that the process requires mutual entailment. The current study analyzed reversed size and order judgments. Undergraduate participants (N=40) completed size and order judgement tasks in one of two counterbalanced orders. Acquisition, accuracy and response speed were compared. The size judgements task was learned in fewer trials than the temporal order task. However, once the tasks were learned, no significant difference was found between the two relations in accuracy. Reversal of both magnitude and temporal order relations significantly increased response times, but to a similar extent suggesting that both depended on similar processes, i.e. mutual entailment.

·Reading as derived responding: Exploratory studies in neurotypical, autistic and dyslectic kids

Giovambattista Presti, M.D., Ph.D., IULM University, Milan (Italy)

Melissa Scagnelli, IULM University, Milan (Italy)

Davide Carnevali, IULM University, Milan (Italy)

Melania Mazza, IESCUM, Italy

Federica Catelli, The RFT Lab at IULM University, Milan (Italy)

Relational Frame Theory (RFT) provides both a theoretical and an applied framework to understand language and other related cognitive skills including complex repertoires like reading. One mechanism that RFT enlightens is how symbolic behavior comes to bear and how sound, written word and “meaning” come to be equivalent. In addition it provides a framework to create programs to “teach reading” without directly targeting this behavior. On a theoretical level it challenges Skinner Verbal Behavior’s definition of the textual and taking dictation operant.

We trained neurotypical, autistic, dyslexic and dysgraphic kids who were able to tact (D stimulus) a picture in a conditional discrimination task to match a printed word in uppercase letters (A stimulus) with its picture (B stimulus) and the picture (B stimulus) with its printed word in lower case letters (C). Each stimulus class included three members. So, after testing for mutual and combinatorial entailment relations, we tested also other combinatorial relations namely A-D (reading printed words in uppercase letters), C-D (reading printed words in uppercase letters) and D-A and D-C (choosing uppercase and lowercase printed words conditionally to an auditory stimulus) relations. Correct responses ranged between 95 to 100% in three testing trials thus demonstrating the formation of a four-member class that included reading written words.

Following this first training, new triplets of words were progressively introduced until recombination of previously learned word formed new words. Carefully planning of this re-combinative strategy led to a progressive reduction of the number of trials for reaching master criterion in the A-B/B-C training and eventually to spontaneous reading of words never trained before.

When the subjects’ own writing samples were introduced to form a 6-member stimulus class (sound – printed uppercase word - printed lowercase word – handwritten uppercase word - handwritten lower case word - picture) with an additional training dyslexic and dysgraphic kids were able to read and write under dictation too. Stimulus control strategies were used to overcome problems with particular sign-sound relations that are considered critical for Italian speakers and a sign of dyslexia.

The results replicate and extend the generality of prior analyses of a reading programs based on stimulus equivalence and recombination of units. Differences with previously published researches will be addressed.

Relational frame theory is a pragmatic contextualist account of human language and cognition. This symposium reports recent studies in temporal, deictic and comparison relations. These studies address basic concerns but they also suggest avenues for intervention.

Educational Objectives:

1. Describe recent findings in RFT.

2. Identify novel applications of RFT.

3. Apply RFT findings to novel issues.

 

54. How well does ACT work? Results from recent reviews and meta analysis

Symposium (2:45-4:15pm)

Components: Literature review

Categories: Clin. Interven. & Interests, Reviews and meta analysis

Target Audience: Intro.

Location: Mathews 123 (level 1)

Chair: Maria Karekla, Ph.D., University of Cyprus

Discussant: Jonathan Bricker, Ph.D., University of Washington and Fred Hutchinson Cancer Research Center

·ACT as a “weapon of choice” for health-related problems

Maria Karekla, Ph.D., University of Cyprus

Eleni Karayianni, Psy.D., University of Cyprus

Recent years have seen a rise in clinical trials examining the effectiveness of ACT for a variety of problems. In an effort to examine the efficacy of ACT, several meta-analyses were conducted broadly comparing ACT to CBT. Simultaneously, we have seen the recognition of ACT as an evidence-based treatment for specific conditions such as chronic pain. However, there has not been an examination of the efficacy of ACT as applied to health problems. The present meta-analysis aims to systematically analyze the application of ACT for health-related conditions, emphasizing the identification of mediators of change. A thorough literature search identified all published ACT clinical trials involving health problems (e.g., chronic pain, cancer). Effect sizes were computed quantifying the effectiveness of ACT compared to control conditions (e.g., TAU). Discussion will relate the current evidence supporting ACT as the treatment of choice for health problems, highlighting caveats and areas for future growth.

·The expanding efficacy of ACT: Results from a meta analysis on clinical applications

Jacqueline A-Tjak, MSc, PsyQ and A-Tjak Cursussen

Several meta-analysis have been published on the efficacy of ACT (Hayes et al, 2006; Öst, 2008; Powers et al, 2009). Meanwhile a lot of studies have been published. A meta-analysis limited to the domain of clinical treatment of psychiatric disorders and diagnosable somatic illnesses with accompanying psychological problems is now warranted. In our meta-analysis we analyse around 40 RCT's and rate their methodological quality as measured against the criteria from Öst (2008).

·ACT outcome studies in context: A benchmarking perspective

Matthew Smout, Ph.D., Centre for Treatment of Anxiety and Depression, University of Adelaide, University of South A

While considerable attention in the literature has been given to whether ACT studies are sufficiently methodologically rigorous and demonstrate efficacy over a comparison condition, relatively little attention has been given to the end-state functioning achieved by clients in ACT studies, particularly in comparison to other leading approaches. Here, data from ACT outcome trials will be compared with benchmark studies for different psychological problems. Implications for treatment and further developing ACT protocols will be discussed.

How well is ACT holding up to the measures of good research according to its own criteria and those of the larger scientific community? Now that more and more data become available from well executed controlled trials, meta-analysis and reviews give us an important perspective on what these results mean in a bigger context. Results from two meta-analysis and a review will be presented. The presentations will cover the following:

1) A meta-analysis on the application of ACT for health-related conditions, emphasizing the identification of mediators of change.

2) A meta-analysis of ACT as a clinical treatment of psychiatric disorders and diagnosable somatic illnesses with accompanying psychological problems, with an assessment of methodological rigor.

3) A review on the end-state functioning achieved by clients in ACT studies, in which data from ACT outcome trials will be compared with benchmark studies for different psychological problems.

Educational Objectives:

1. Explain the efficacy of ACT resulting from a meta-analysis investigation for a variety of health related problems.

2. Explain the efficacy of ACT compared to waiting list, placebo therapies and established treatments on four areas of clinical treatments.

3. List for which problems ACT has shown comparable or superior end-state functioning to other leading psychotherapies and for which problems it has yet to achieve this.

 

Thursday Afternoon 4:30pm

59. Functional Contextual Global Health: One Size does not Fit All

Symposium (4:30-5:45pm)

Components: Conceptual analysis, Literature review, Experiential exercises, Didactic presentation

Categories: Theory & Philo., Clin. Interven. & Interests, Clin. Interven. & Interests, Prevention & Comm.-Based, Global Mental Health, Australian Aboriginal population, Functional contextualism

Target Audience: Intro., Interm., Adv.

Location: Mathews 107 (level 1)

Chair: Emma Hanieh, D.Psych., The ACT Centre

Discussant: Matthew Smout, Centre for Treatment of Anxiety and Depression

·Promoting Global Mental Health: The role of contextual science

Ross White, Ph.D., DclinPsy, University of Glasgow

The World Health Organization (WHO) estimates that four out of five individuals living in low and middle-income countries (LMIC) who require treatment for mental, neurological and/or substance use disorders do not receive it. Global Mental Health is an area of study concerned with addressing inequities and inequalities in mental health provision across the globe. WHO policies support the scaling-up of psychiatric services in LMIC despite widespread concerns about the cross-cultural validity of diagnoses and a paucity of evidence to support biomedical theories of mental health disorders. Concerns have been raised that an over-reliance on scaling up psychiatric services has led to insufficient emphasis being placed on social and cultural determinants of human distress. The possibility that consortia of international experts may have served to undermine local experience and expertise is highlighted. The paper will highlight the important role that contextual science can play in promoting mental health in a way that is truly global.

·ACT with the Australian Aboriginal Population

Emma Hanieh, D.Psych., The ACT Centre

This presentation will look at the very important issue of whether or not Acceptance and Commitment Therapy is applicable to Aboriginal people living in remote locations. It will include an exploration of the model as it applies to Aboriginal women and their children facing difficult life circumstances within families and communities. It is designed to raise questions around whether ACT is broadly applicable to all client groups. This presentation is designed for not only professionals working within Aboriginal health, but also those who have a genuine interest in Australia’s remote population.

·Functional-contextualistic view of mental health: General approach

Stanislaw Malicki, Innlandet Hospital Trust, Norway; University of Social Sciences and Humanities, Warszawa, Poland

Modern medicine delivers the message that psychological problems are similar to medical illnesses. Physical health is seen as the absence of disease and, similarly, mental health is seen as the absence of abnormal processes. Current approach to mental health may result in stigma, rejection, devaluation and labeling of patients. The author’s aim is to outline functional-contextualistic approach to mental health. An approach that not only situates psychological problems within the context of personal history and current life circumstances, but also views symptoms as apparently unsuccessful strategies of coping with life problems. The fundamentals of functional-contextualism will be presented, followed by a discussion of their implications for understanding of mental health problems. The practical applications of functional-contextualistic philosophy of health to the relationship between clinicians, clients and their families will also be discussed.

This collection of presentations serves to inform how an approach firmly embedded in functional contextualism may provide a potential and viable alternative to mainstream symptom-focused health provision. The importance of social and cultural factors at both a global level and within populations that are less well researched, such as the Australian Aboriginal population, is explored. Are functional contextualism and Acceptance and Commitment Therapy (ACT) applicable at this level? And if so, what factors need to be taken into account in order to optimally meet the global needs of people in the 21st century? This session serves to be a thought provoking one that encourages us to think outside the box and at an intensely global and adaptive level.

Educational Objectives:

1. Understand the important role that cultural beliefs and practices play in how mental health is conceptualized in different parts of the world.

2. Describe the potential health and mental health issues affecting Australia's Aboriginal population.

3. Discuss the applicability of ACT to a remote Aboriginal population.

 

60. Addressing Complex Clinical Presentations: Processes of Effective Change

Symposium (4:30-5:45pm)

Components: Conceptual analysis, Literature review, Original data, Didactic presentation

Categories: Clin. Interven. & Interests, Performance-enhancing interventions, Superv., Train. & Dissem., Theory & Philo., Panic Disorder & Agoraphobia, Psychotherapy Integration, Motivational Interviewing and ACT, Emotion Regulation

Target Audience: Intro., Interm., Adv.

Location: Mathews 123 (level 1)

Chair: Robert Brockman, M.A. (clinical Psychology), University of Western Sydney, Private Practice - Sydney

Discussant: Jacqueline A-Tjak, PsyQ

·Treating the Treatment-Resistant: A Randomized Controlled Trial of ACT for Treatment-Resistant Panic Disorder and Agoraphobia - Preliminary Results

Andrew Gloster, Ph.D., University of Basel

Rainer Sonntag, MD, Private Practice

Simone Heinze, Dipl.Psych, Technische Universität Dresden

Jürgen Hoyer, Ph.D., Technische Universität Dresden

Georg Eifert, Ph.D., Chapman University

Hans-Ulrich Wittchen, Ph.D., Technische Universität Dresden

Objective: Non-responsiveness to treatment is generally acknowledged, yet seldom systematically addressed. This study examined the malleability of treatment refractory patients using Acceptance and Commitment Therapy (ACT).

Method: A randomized controlled trial; n = 51 cases of patients diagnosed with primary panic disorder and/or agoraphobia with prior state-of-the-art treatment (mean number of previous sessions = 42.2) were treated with an ACT manual administered by novice therapists and followed up for six months. Patients were randomized to either immediate treatment (n = 33) or a four-week wait-list (n = 10) with delayed treatment (n = 8). The brief treatment consisted of only 8 sessions, implemented twice weekly over four weeks. Primary outcome measures were the Mobility Inventory (MI), Clinical Global Impression (CGI), Panic and Agoraphobia Scale (PAS), and the Acceptance and Action Questionnaire (AAQ-II). Numerous secondary assessments were administered that were both consistent with and divergent from ACT theory.

Results: At post-treatment, patients who received ACT reported significantly more improvement than the wait-list on the CGI and PAS (partial eta square: .25 & .14), nearly significant (p < .08) on the MI (partial eta square = .05), and non-significant on the AAQ (partial eta square = .03). Secondary measures were largely consistent with ACT theory, with significant differences between the ACT and WL cases on ACT consistent measures, but not on inconsistent measures. Follow up assessments were obtained from 84% of the sample. Both follow-up and process of change will be analyzed and presented.

Conclusions: Despite a clinically difficult sample, small sample size, and very brief treatment administered by novice therapists, patients reported significantly greater changes in functioning and symptomatology than the wait-list. These data suggest that ACT is a viable treatment option for treatment-resistant patients. This study was one of the first to examine a psychological treatment option for non-response to traditional state-of-the-art psychological treatments; further work in this area is clearly needed. 

·The Relationship between Schema Modes and Psychological Flexibility: Initial data, and exploration of the usefulness of the construct of schema modes as a therapeutic metaphor for use with multi-problem and personality disordered patients

Robert Brockman, University of Western Sydney, Private Practice, Sydney

Schema Therapy sits alongside ACT as a newer form of cognitive and behavioral therapy which is steadily acquiring empirical evidence of efficacy. However, whilst ACT has been acquiring empirical support for use with a very broad range of disorders and problems, the empirical support for schema therapy is generally confined to personality disordered populations, particularly borderline personality disorder, and with impressive early results (Gieson-boo et al 2006, etc.). Meanwhile, there has been increasing interest within ACBS over the past 12 months in the utility of schema therapy constructs and techniques within an ACT/RFT framework (e.g. McKay, Lev, Skeen, & Hayes, 2012). This paper will give a brief overview of the schema mode model of personality disorder before presenting some initial cross-sectional data on the relationship between schema modes and psychological flexibility which demonstrates that psychological flexibility is intertwined throughout the schema mode model. The implications for possible improvements to schema therapy using ACT techniques will be briefly discussed before a more in depth discussion and demonstration of the utility of the use of the mode construct as a clinical metaphor to aid in improving psychological flexibility in multi-problem patients and patients with severe within-session therapy interfering behaviors.

·ACT and MI: Lessons from a Combined Group Intervention

Onna Van Orden, M.A., VA Maryland Health Care System

James Finkelstein, Psy.D., VA Maryland Health Care System

ACT and Motivational Interviewing (MI) have potential as complementary interventions (Wagner, Ingersoll, & Rollnick, 2012; Bricker & Tollison 2011). This paper discusses similarities among ACT and MI as styles that emphasize language, values, and compassion as well as key differences in theory, mechanisms of action, and goals. It will include preliminary data from a novel, combined ACT and MI group intervention within an ACT-based Intensive Outpatient Substance Abuse Treatment Program. Group participants are veterans from diverse backgrounds demonstrating difficulty with abstinence from drugs and alcohol. Pre- and post-intervention assessment includes the Acceptance and Action Questionnaire II and measures of Stages and Processes of Change as described in the Transtheoretical Model of Intentional Behavior Change (Prochaska, DiClemente, & Norcross, 1992). This presentation will include discussion of clinical techniques, lessons learned about the potential “added value” of integrating ACT and MI, and future directions for interventions and research.

·ACT core processes from an emotion, affect, and mood regulation perspective

Michel André Reyes Ortega, Ph.D., México-ACBS & Universidad Iberoamericana Cd. de México

Emotion Regulation is a cognitive, behavioral, contextual and interpersonal process. When ineffective, it can be destructive and diminish life quality. Emotion Regulation has transdiagnostic value and clinical models who targets it can help to develop effective interventions for a wide variety of affective disorders with or without comorbidity. In this paper, an ACT based clinical model is described. The model acceptance and commitment strategies are analized from diferent models of emotion perspectives: Discrete, dimensional, associative, and goal based models are considered.

ACT is known as a treatment that has specific effectiveness for complex presentations and comorbidities. In fact, one of the strengths of ACT is that it can be used to address multiple problems simultaneously using a consistent conceptual model. The next phase of ACT treatment development and research thus will benefit from a clearer conceptualization of how ACT for multi-problem clients may or may not benefit from other models which may be complementary, such as motivational interviewing, emotion regulation, and schema therapy approaches. This symposium will focus not only on clinical applications and outcomes, but more importantly on processes of change that may make work with complex clinical presentations more effective.

Educational Objectives:

1. Discuss and critique viability of using ACT for non-responders to other treatments.

2. Describe the main emotion regulation transdiagnostic processes targeted by Acceptance and Commitment Therapy.

3. Apply the mode construct as a clinical metaphor to more effectively deal with problematic within session behavior.

Thursday Afternoon 4:45pm

63. Evaluating Mindfulness and Acceptance

Symposium (4:45-5:45pm)

Components: Conceptual analysis, Original data

Categories: Theory & Philo., Performance-enhancing interventions, Other, Performance-enhancing interventions, Other, Adolescent, Adult, Non-clinical, Questionnaire validation, Mindfulness

Target Audience: Intro., Interm., Adv.

Location: Mathews 102 (level 1)

Chair: Sue Jackson, Ph.D., Queensland University of Technology

Discussant: Maria Karekla, University of Cyprus, Nicosia, Cyprus

·Flow: A mindful edge in performance

Sue Jackson, Ph.D., Queensland University of Technology

Flow is an optimal psychological state because it involves being totally focused in the present moment. When in flow, nothing disturbs or detracts from this concentrated state. Flow occurs when we are engaged in activities we enjoy, which also extend our capabilities. A present-moment awareness and a focused mindset are key psychological factors for experiencing flow. Awareness and focus can be developed through the practice of mindfulness. The focus on present-moment awareness and taking committed action in the service of identified goals makes ACT a useful model to work from in performance-enhancing settings. Helping performers to identify what is important to them, and then to take action that will help them move towards these goals in a present-focused way is consistent with both ACT and flow-focused interventions. In this presentation, the idea that the flow state associated with high-level performance can be one outcome of being mindful in a challenging situation will be explored.

·Validation of a Chinese version of the Acceptance and Action Questionnaire II in four non-clinical student or employee samples

Yang Ji, Institute of Psychology, Chinese Academy of Sciences

Zhuohong Zhu, Institute of Psychology, Chinese Academy of Sciences

The Acceptance and Action Questionnaire II (AAQ-II) was translated (into Chinese), revised, and validated. Across four samples (college-students, employees, or crisis-influenced college-students), exploratory and confirmatory results were satisfactory, general response model illustrated sufficient individual item information, and item three and seven were age-specific in functioning. In most cases, the AAQ-II correlated well with constructs relevant/similar to psychological flexibility (fusion/mindfulness/meaning/rumination), psychological wellbeing (general-symptoms/depression/anxiety/life-satisfaction/post-traumatic stress), and medical condition; predicted psychological indicators with higher incremental variances to alternative measures. Yet, mixed correlation results were found in subscale measures of meaning (MLQ) between crisis-influenced and uninfluenced samples; and incremental validities fell short when AAQ-II was compared with fusion (CFQ) or meaning (MLQ) measure in predicting life satisfaction, depression, or anxiety in student or employee samples. Studies suggested good psychometric properties of the AAQ-II supporting the ACT pathological model, but the AAQ-II requires additional measures to fully capture the construct of psychological flexibility across groups.

This symposium explores focusing on the present moment, values and acceptance as processes central to Acceptance and Commitment Therapy. Two perspectives will be presented. The first analyzes the relation between the concept of flow and being engaged in the present moment. The second presentation presents preliminary data on the validation of the AAQ scale in a Chinese population.

Educational Objectives:

1. Explain the conceptual model of flow and the similarities between a mindful state and a flow state.

2. Design an experiment to test Mindfulness effects in the lab.

3. Compare the AAQ-II with alternative measures pertinent to ACT model or similar in psychological construct.

 

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Symposia Detail ● Friday ● July 12

 Friday Morning 9:00am

71. Do you have to be cognitively flexible in order to be psychologically flexible?: ACT for those with cognitive impairment

Symposium (9:00-10:15am)

Components: Conceptual analysis, Literature review, Original data, Case presentation

Categories: Clin. Interven. & Interests, Theory & Philo., Acquired Brain Injury, Cognitive Impairment

Target Audience: Interm.

Location: Mathews 102 (level 1)

Chair: Joseph Ciarrochi, Ph.D., School of Social Sciences and Psychology, University of Western Sydney, Australia

Discussant: Darin Cairns, The Cairns Psychology Group

·The utility of ACT in enhancing psychological flexibility for individuals with acquired brain injuries (ABIs)

Maria Kangas, Ph.D., Centre for Emotional Health, Department of Psychology, Macquarie University, NSW

To date, the efficacy of traditional Cognitive Behavioural Therapy (CBT) in treating emotional problems in cognitively impaired, ABI samples has demonstrated variable outcomes. In particular, cognitive restructuring, a meta-cognitive and core component of CBT is potentially challenging for persons with cognitive impairments. To this end, ACT may offer a compatible alternative in enhancing psychological flexibility in persons with ABIs experiencing psychosocial problems. In this presentation, a conceptual evaluation of the ACT model will be presented, specifically in terms of how each of the core components may be applied to persons with ABIs. A case presentation (based on a depressed and anxious adult diagnosed with a brain tumour), will be used to illustrate the potential utility of adapting each of the 6 core processes to enhance psychological flexibility and facilitate individuals to engage (or re-engage) in living a purposeful life following an ABI.

·The relationship between cognitive flexibility and psychological flexibility after acquired brain injury

Diane Whiting, School of Psychology, University of Wollongong; Liverpool Brain Injury Rehabilitation Unit

Frank Deane, Prof., School of Psychology, University of Wollongong, Australia

Joseph Ciarrochi, Prof., School of Social Sciences and Psychology, University of Western Sydney, Australia

Hamish McLeod, Ph.D., Institute of Health and Wellbeing, University of Glasgow, Scotland

Grahame Simpson, Ph.D., Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital; Rehabilitation Studies Unit, University of Sydney

Aim: This presentation will explore how the constructs of psychological and cognitive flexibility interact in individuals with an acquired brain injury.

Method: A total of 75 participants with an ABI were recruited from Liverpool Brain Injury Rehabilitation Unit and administered self report measures of mood, psychological flexibility (using measures of acceptance and action: AAQ-II & AAQ-ABI), avoidance and neuropsychological measures of cognitive flexibility on average 21 months after their injury.

Results: The measures of psychological flexibility correlated with measures of psychological distress in the predicted direction with higher levels of psychological flexibility significantly associated with lower levels of psychological distress. Functional measures of cognitive flexibility that assess the ’ability to shift’ were not related to psychological flexibility or distress. Broader measures of cognitive flexibility that capture additional cognitive processes were correlated with psychological flexibility but this relationship became nonsignificant when general intelligence was controlled.

Conclusions: Psychological flexibility does not appear to be related to cognitive flexibility, once general intelligence is considered.

·Using ACT with the cognitively inflexible: A case study

Dana Wong, Ph.D., School of Psychology and Psychiatry, Monash University, Victoria

This presentation will illustrate how ACT can be used in clinical practice with clients who have limited cognitive flexibility. The case of a 38 year old male who suffered a severe traumatic brain injury (TBI) in a pedestrian versus train accident will be discussed. “Simon” has a longstanding history of depression, and from a cognitive perspective demonstrates impairments in speed of processing, visuospatial abilities, visual memory, and executive functions including idea generation and cognitive flexibility. ACT was used in a one-year period of psychological treatment early after injury, and then again four years later. ACT strategies were adapted to compensate for his specific areas of cognitive difficulty. While his cognitive inflexibility presented several challenges for therapy, the application of ACT for depression in this case resulted in an increase in subjective mood ratings, and achievement of a range of occupational, recreational, and psychosocial goals in line with his values.

This symposium will explore Acceptance and Commitment Therapy (ACT) and the construct of psychological flexibility in the context of individuals with an acquired brain injury (ABI), who often display impairments in cognitive flexibility. Psychological flexibility is the desired outcome for treatment modalities such as ACT and is considered a fundamental component of psychological health. It is proposed that cognitive flexibility is a component of psychological flexibility, but there is limited evidence that aids our understanding of whether individuals with an ABI are able to improve their psychological flexibility. The symposium will incorporate three presentations: (1) A conceptual review of ACT and how it might be applied with people with ABI, (2) the presentation of empirical evidence exploring the relationship between psychological flexibility and cognitive flexibility and (3) a case presentation illustrating how ACT can be used in a person with traumatic brain injury.

Educational Objectives:

1. Understand and critique the components of ACT as they apply to individuals with cognitive impairment.

2. Analyze the extent to which cognitive flexibility impacts psychological flexibility.

3. Modify ACT for use with individuals with cognitive impairment.

 

72. Contextual Medicine Special Interest Group Symposium 2: Cutting edge data, current directions toward coherent clinical care

Symposium (9:00-10:15am)

Components: Conceptual analysis, Original data, Didactic presentation

Categories: Related FC approaches, Beh. med., 5HT, Pain

Target Audience: Intro., Interm., Adv.

Location: Mathews 107 (level 1)

Chair: Andrew T. Gloster, University of Basel

Discussant: Rob Purssey, MBBS FRANZCP, Private Practice and University of Queensland

·5HTT is Associated with Psychological Flexibility: Preliminary Results from a Randomized Clinical Trial

Andrew T. Gloster, University of Basel

Hans-Ulrich Wittchen, Technische Universität Dresden

Jürgen Deckert, University of Würzburg

Andreas Reif, University of Würzburg

Background: Research on flexibility may be instrumental in pinpointing evolutionary advantageous pathways To date, however, genetic and psychological theories of flexibility have existed largely separately. We therefore tested the importance of the interaction between psychological flexibility and the serotonin transporter (5HTT) that influences gene expression and has been associated with faster information processing.

Method: We tested whether the polymorphism (La/La vs. not La/La) impacted therapy response as a function of various endophenotypes (i.e., psychological flexibility, and other more established variables such as panic attacks, agoraphobic avoidance, general anxiety symptoms & anxiety sensitivity). Patients were recruited from a large multicenter randomized controlled clinical trial (n=160 treatment completers; n= 190 intent to treat). These patients were examined for pre-treatment to post-treatment changes across endophenotypes.

Results: 5HT polymorphism status (La/La vs. not La/La) differentiated pre-treatment to post-treatment changes in the endophenotype psychological flexibility (effect size difference d = 4.67, F = 8.9, p < .003), but none of the other tested endophenotypes (i.e., panic attacks, agoraphobic avoidance, general anxiety symptoms & anxiety sensitivity). This pattern was consistent for both completers and the intent to treat sample.

Conclusion: Based on the consistency with existing theory on behavioral flexibility, the specificity of the results across endophenotypes, and the consistency of results across analyses (i.e., completer and intent to treat) we cautiously conclude that 5HTT polymorphism and the endophenotype psychological flexibility represent an important explanatory variable involved in the treatment of PD/AG. If replicated and extended in other samples, the endophenotype psychological flexibility may help bridge genetic and psychological literatures.

·Chronic pain: From diagnosis to function, from management to multi-professional rehabilitation, a functional contextual medicine approach

Graciela Rovner, RPhT, MSc, BSc, Rehabilitation Medicine, Sahlgrenska Academy at Gothenburg University, Göteborg, SWEDEN

Graciela will present embryonal research in physical therapy and multi-professional pain rehab, exploring indicators, markers, and predictors building an algorithm to better assess and allocate patients in rehabilitation programs (in groups) and predict their outcomes. She will have preliminary data to explore from Swedish multi-professional ACT-based pain rehabilitation clinics (from a National registry) as well as from an ACT-based physical therapy trial conducted at a primary care setting in western Sweden.

·Individual differences influence quality of life in asthma patients: The role of anxiety, experiential avoidance, and gender

Maria Karekla, Ph.D., University of Cyprus, Nicosia, Cyprus

Maria Stavrinaki, MSc, University of Cyprus, Nicosia, Cyprus

Elena Hanna, B.S., University of Cyprus, Nicosia, Cyprus

Tonia Adamide, MD, Pneumonological Clinic, Nicosia General Hospital, Nicosia, Cyprus

Giorgos Georgiades, MD, Pneumonological Clinic, Nicosia General Hospital, Nicosia, Cyprus

Natalie Pilipenko, M.A., Ferkauf Graduate School of Psychology, Yeshiva University, New York, USA

Asthma is a chronic inflammatory disease of the airways, resulting in airflow obstruction. Research emphasizes the influence of individual differences on the quality of life (QOL) of asthma patients. The aim of our study was to explore how gender impacts upon QOL, whilst measuring the role of three levels of anxiety: non-clinical, sub-clinical, and clinical. The extent to which experiential avoidance moderates this association was also investigated.

 Two hundred and four asthma patients (136 women) from the Nicosia general hospital completed a packet of questionnaires including the AQLQ, the PHQ, and the AAQ-II.

Results showed that women with asthma report poorer asthma-specific QOL compared to asthmatic men. Women in all three anxiety levels reported lower QOL on three of the four subscales.

These results may aid in the design of personalized health care programs which take into account both the psychological factors associated with and gender of asthmatic patients.

Contextual Medicine seeks to integrate functional contextual behavioral science with models and language familiar to medical practitioners to address human physiology, neuroscience, and medicine generally. Further CM SIG aspires to connect the broader field of evolutionary science to impact public health, socio-cultural, and economic issues relevant to all human health and wellbeing including research, and all clinical practices, including those of prescribing and using medications. This inaugural CM SIG symposium hopes to lay the foundations, map out a seamless strategy integrating biological, behavioral, and cultural perspectives, critically examine from an evolutionary perspective where current mainstream mechanistic directions are leading us, and offer hope with evidence of recent applications of an integrated contextual physical/psychological approach within the clinical medical areas of asthma management and pain rehabilitation.

Educational Objectives:

1. Explain the importance of psychological flexibility in the treatment of PD/AG.

2. Design personalized health care programs which take into account both the psychological factors associated with and gender of asthmatic patients.

3. Analyze tools for diagnosing and predicting outcomes for physical therapy rehabilitation patients.

 

73. The effect of brief component ACT training on personally relevant issues

Symposium (9:00-10:15am)

Components: Original data

Categories: Prevention & Comm.-Based, Clin. Interven. & Interests, Prevention & Comm.-Based, Self-as-context, Defusion

Target Audience: Interm., Adv.

Location: Mathews 123 (level 1)

Chair: Andreas Larsson, Swansea University

Discussant: Emily Sandoz, Ph.D., University of Louisiana Lafayette

·Self as Context increases recall of self threatening information

Louise McHugh, Ph.D., Swansea University

Kali Barawi, School of Psychology, University College Dublin

Ates Erdogan, School of Psychology, University College Dublin

Jo Saunders, School of Psychological Sciences and Health, Strathclyde University

Previous research has suggested that we tend to show impaired memory for self threatening information, an effect known as mnemic neglect. Mnemic neglect is believed to be due to shallow processing or inhibition of self threatening information. Mnemic neglect, however, could be an example of emotional avoidance which we attempted to reverse with self as context training. Participants either participated in a short self as context intervention or unfocused distraction before being asked to read behaviours that differed on how central to the self they were and on valence. Participants were then asked to recall those behaviours. We found that recall of self threatening information was increased following the self as context intervention but not unfocused distraction. We also found a more general memorial improvement with other information relevant to the self showing improved recall following self as context training particularly forperipheral information. We suggest that self as context overcomes the emotional avoidance normally associated with self threatening information as well as increasing memory performance more generally.

·Self as Context reduces halluncination like experiences in undergraduate students

Orla Moran, School of Psychology, University College Dublin

Andreas Larsson, Swansea University

Louise McHugh, School of Psychology, University College Dublin

The impact of self as context work with individuals with psychosis has received much interest over the last few years. However, the effects of such interventions on individuals experiencing psychotic-like symptoms who may be ‘at risk’ of developing psychosis has so far sparked little research. The current study aimed to look at the effects of self as context training on a group of individuals from a nonclinical population who report hallucination-like experiences. In particular, the aim was to look at the effects of the self as context training on the distress and anxiety caused by these hallucination-like experiences, along with the frequency and intrusiveness of the experiences. Participants were recruited for the study based on their scores on the Launay Slade Hallucination Scale-Revised (LSHS-R). Fifteen participants were randomly allocated to either the mindfulness intervention or the no intervention control group. Participants were required to fill out six pre and post experimental self-report measures. The results indicated a significant reduction in the distress and anxiety associated with the hallucination-like experiences for the self as context intervention group. There was also a significant decrease in the reported frequency and intrusiveness of the experiences. The results of the current study highlight the potential efficacy of providing self as context training to those who may be ‘at risk’ of developing psychosis.

·Negative thinking, bang for your buck?

Andreas Larsson, Swansea University

Nic Hooper, Ph.D., Middle-Eastern Technological University

Paul Bennett, Swansea University

Louise McHugh, School of Psychology, University College Dublin

A central part of psychotherapy involves providing patients with coping strategies for negative thoughts. Two contemporary techniques for coping with negative thoughts are cognitive restructuring and cognitive defusion. Across two studies we aimed to compare the relative effectiveness of these two strategies. Both studies were identical with the exception of delivery (i.e., one to one vs. online). In both studies participants were either provided with a cognitive restructuring, defusion or no instruction control technique to manage a personally relevant negative thought. Across a five-day period participants were reminded, via SMS messages, to use their assigned strategy in managing the thought. Participants were also required to complete a daily online questionnaire assessing the total amount of unwanted thought intrusions and their level of willingness to experience the unwanted thought. Before and after the five-day period, participants reported the (1) believability, (2) comfort, (3) negativity and (4) willingness to experience their unwanted thought. The results indicated that both restructuring and defusion were effective in decreasing the believability and negativity, and increasing comfort and willingness to have the negative thought. Further analyses suggested that defusion tended to be more helpful than restructuring across all four domains and both delivery methods. The findings are discussed in terms of the efficacy of using defusion as a strategy for managing unwanted thoughts.

The current symposium comprises of three empirical papers. The unifying concern of which is to demonstrate the effect of brief component ACT training on clinically relevant issues such as memory for threatening information or hallucination like experiences. Paper 1 investigates the impact of a self as context intervention on memory of self-threatening information. The findings suggest that memory is enhanced by brief self as context training. Paper 2 looks at the effect of brief self as context training on hallucination like experiences in undergraduate students. The results support the utility of self as context training in reducing believability but not the occurrence of hallucination like experiences. Finally, Paper 3 compared the use of cognitive defusion and cognitive restructuring in two studies and using different delivery methods: face-to-face or posted online. Results indicate that although both methods are better than control, defusion is the more efficient technique. Together the symposium demonstrates that the effectiveness of individual components of the ACT model are altering clinically relevant behaviors.

Educational Objectives:

1. Demonstrate the effect of brief component ACT training on clinically relevant issues such as memory for threatening information or hallucination like experiences.

2. Explain how different different delivery forms for ACT component training can result in different outcomes.

3. Describe differences in the effect of Self-as-Context training for self-threatening information or hallucinations.

 

Friday Morning 10:30am

79. Implementation of ACT with serious mental illness

Symposium (10:30am-Noon)

Components: Conceptual analysis, Original data, Didactic presentation, Case presentation

Categories: Clin. Interven. & Interests, Prevention & Comm.-Based, ACT and Serious Mental Illness (Psychosis and Bipolar Disorder)

Target Audience: Interm., Adv.

Location: Mathews 107 (level 1)

Chair: Neil Thomas, Brain and Psychological Sciences Research Center, Swinburne University, Melbourne, Australia

Discussant: Eric Morris, South London and Maudsley NHS Foundation Trust

·The role of service user co-facilitators in delivering ACT for Recovery group interventions

Emma O'Donoghue, South London and Maudsley NHS Foundation Trust/Kings Health Partnership

Lucy Butler, South London and Maudsley NHS Foundation Trust/Kings Health Partnership

The ACT for Recovery project will assess the feasibility of training service user co-facilitators to deliver ACT psychosis (ACTp) workshops for clients and caregivers. Study one will collect preliminary data on service use and the economic impact of the intervention, in order to establish its cost-effectiveness in a larger study. We will also conduct the first randomized controlled evaluations of ACTp workshops for both service users and caregivers. Study two will qualitatively explore both the experiences of service user co-facilitators of being trained to deliver ACTp workshops and the experience of client and caregiver participants attending the workshops. Preliminary data on the role of disclosure from service user co-facilitators on processes such as stigmatization, perspective taking and defusion will be explored.

·What's happening inside ACT for psychosis sessions?: Consumer reports and session ratings from the Lifengage RCT

Tory Bacon, La Trobe University

John Farhall, La Trobe University

We examined the theoretical underpinnings of ACT by exploring its active therapeutic processes in its application to psychosis. Study one investigated the active therapeutic role of ACT for psychosis (ACTp) from a client’s perspective and its congruence with the underlying theoretical processes. Mindfulness, defusion, acceptance and values work were described as the most useful therapy components and as contributing to positive changes. Self-rated frequency of symptoms did not change, however a reduction in the intensity and distress associated with symptoms was reported. Study two objectively measured ACT-related in-session verbal behavior, the uptake of the ACT processes by participants and associations with outcome. All ACT components were active in sessions. Greater uptake of ACT processes in-session was related to positive outcome. Together these findings are consistent with the underlying theoretically defined, active components of ACT for individuals experiencing persistent symptoms of psychosis. Both studies also provide rich clinical data for the application of ACT in psychosis.

·Pole to Pole: The development of an ACT-based resource for Bipolar Disorder

Gordon Mitchell, Department of Clinical Psychology, Stratheden Hospital, Fife, Scotland

Pole to Pole is an approach designed for people with a diagnosis of bipolar disorder; the people in their lives (i.e. family and friends); and professionals who work with people with bipolar disorder (e.g. healthcare workers). The approach is based upon the principals of ACT and has been developed in collaboration with a local bipolar support group. The name Pole to Pole simultaneously recognises the bipolar nature of emotional experience and the concept of exploring this experience. The approach consists of a resource pack, containing activities to explore experiences and values, which people are guided through in three group sessions. The sessions are designed to help people to reflect openly on their experiences of bipolar, whether directly or as a carer, and to communicate about the impact the condition has had in their lives. We also include experiential exercises in the sessions to deliver concepts such as acceptance and valued-living.

The role of psychological flexibility has been shown to be important in the development and maintenance of serious mental illness. Evidence is emerging of the effectiveness of ACT-based interventions for such problems. This symposium aims to present current implementations in ACT for serious mental illness, including bipolar and psychotic disorders. All three projects focus particularly on service user involvement and incorporating their experiences in the development of ACT for psychosis (ACTp) interventions. The first presentation will introduce the ACT for Recovery project, and discuss the practical benefits of training service user co-facilitators to deliver ACT workshops. The second will present the Lifengage project and discuss the active therapeutic role of ACTp from a clients’ perspective and its congruence with ACT theoretical processes. Keeping with the theme, the third presentation will discuss the practical application of ACT for people with a diagnosis of bipolar disorder and their caregivers in the Pole to Pole project.

Educational Objectives:

1. Implement ACT interventions for clients with serious mental illness and their caregivers.

2. Discuss emerging evidence of ACT interventions in serious mental illness.

3. Examine practical benefits of training and working with service user co-facilitators and consultants.

 

80. ACT for the next generation: A series of research papers with children and adolescents

Symposium (10:30am-Noon)

Components: Original data, Didactic presentation

Categories: Clin. Interven. & Interests, Edu. settings, Prevention & Comm.-Based, Adolescent Mental Health, Children

Target Audience: Intro., Interm.

Location: Mathews 123 (level 1)

Chair: Julian McNally, Private Practice

Discussant: Giovanni Miselli, AUSL Reggio Emilia

·The importance of mediational analysis for enhancing adolescent mental health in the classroom

Tamar Black, Monash University

Dr. Glenn Melvin, Centre for Developmental Psychiatry and Psychology, Monash University

Louise Hayes, Ph.D., Orygen Youth Research Centre, University of Melbourne

There have been few school based studies investigating the effectiveness of ACT with adolescents, and to date only two using ACT as part of a universal intervention. Research with adults has demonstrated that there are different mediators associated with changes for ACT and CBT. Participants in this study were Year 9 students in two Australian schools (N = 98) who were randomly allocated to either ACT or CBT as part of the regular school curriculum, and participated in an 8 week intervention during regular class time. The first objective of the current study was to investigate the relative efficacy of ACT compared to CBT. Initial results suggested that there were no significant effects of either intervention, at post or at the 6 and 12 month follow-up assessments. The second objective was to investigate the impact of psychological flexibility and describing one’s experience (a mindfulness sub-factor) on depression, psychological inflexibility, and self-efficacy as intervention outcomes for each intervention. Models of expected change were analysed using multiple regression analysis. Results suggested that there were different mediators associated with outcomes for the ACT and CBT interventions. Describing one’s experience was more strongly associated with general self-efficacy and academic self-efficacy for the ACT group than for the CBT group. For both groups, describing one’s experience was negatively associated with depression and psychological inflexibility. However, for the CBT group, describing one’s experience had a stronger negative association with depression, and for the ACT group, describing one’s experience had a stronger negative association with psychological inflexibility. The significance of these mediational findings will be discussed.

·Cool-Mind and Mind-Chill: ACT group based protocols using a CBT framework for children and young people with anxiety

Karen Hancock, Ph.D., The Children's Hospital at Westmead

Angela Dixon, Ph.D., The Children's Hospital at Westmead

Jessica Swain, University of Newcastle

Cassandra Hainsworth, The Children's Hospital at Westmead

Siew Koo, The Children's Hospital at Westmead

Karen Munro, The Children's Hospital at Westmead

While ACT treatment protocols are increasingly being developed for adults, those for children are lacking, with even fewer that have been empirically evaluated. This presentation describes an evidence-based ACT adaptation of the Cool Kids ® and Chilled ® programs, which are widely used scientifically evaluated CBT programs. Cool-Mind (for ages 7-11 years) and Mind-Chill (12-17 years) are 10 week ACT manualised programs that have recently been evaluated under a randomised clinical trial. They incorporate all six components of the ACT model. Examples of these concepts and activities for children are demonstrated in this presentation. Each session commences with a mindfulness exercise with children and parents before separating into parent and child groups. The concept and activities related to fighting fear in the CBT program are replaced with acceptance. Cognitive restructuring strategies are replaced with cognitive defusion strategies, with children learning “mindful thinking” as opposed to “detective thinking” or “realistic thinking”. The “mindful thinking worksheet” and other activities also encompass values. Committed action is addressed through the use of exposure via stepladders, with willingness being used as a guide for step progression. Not only was the program found to be a feasible treatment option for children with anxiety, it was positively evaluated by parents and children.

·Randomized Controlled Trial of Acceptance and Commitment Therapy (ACT) versus Cognitive Behavioural Therapy (CBT) and wait list control for children and adolescents with anxiety disorders

Karen Munro, The Children's Hospital at Westmead

Cassandra Hainsworth, The Children's Hospital at Westmead

Karen Hancock, Ph.D., The Children's Hospital at Westmead

Jessica Swain, The University of Newcastle

Angela Dixon, The Children's Hospital at Westmead

Siew Koo, The Children's Hospital at Westmead

There is a paucity of research investigating the effectiveness of ACT for children with anxiety disorders. To the researcher’s knowledge, this is the largest trial of ACT in the treatment of children and young people, and the first RCT in this group. The aim of the study was to compare the efficacy of ACT versus CBT in children and adolescents with anxiety disorders. This study block randomised 198 children with one or more DSM-IV anxiety disorders to one of three conditions (ACT, CBT or waitlist control) in a clinical environment at The Children’s Hospital at Westmead, Sydney, Australia. The ACT group underwent a 10 week group-based program that the researchers adapted from an evidence-based CBT program (Cool-Mind/ for children/Mind-Chill for adolescents, adapted from Cool Kids ®/Chilled®). The CBT group underwent the Cool Kids/Chilled program. Controls received the CBT program after a 10 week wait-list period. There were 158 completers (55 in ACT, 57 CBT, 46 controls) aged 7-17 years. Participants were assessed pre-treatment, post-treatment and three months post-treatment (except controls who were assessed 10 weeks apart pre-treatment) on the Anxiety Disorders Interview Schedule for Children (version 4), the Multidimensional Anxiety Scale for Children, The Child Depression Inventory, The Child Behaviour Checklist, The Children’s Anxiety Life Interference Scale – Child Form and The Avoidance Fusion Questionnaire for Youth. Adolescents were also assessed on the Child Acceptance and Mindfulness Measure, the Toronto Alexithymia Scale, and the Positive Affect Negative Affect Scale. Main outcomes and mechanisms of change will be presented, with implications for treatment discussed. These results provide empirical evidence for the efficacy of ACT as a viable alternative to CBT in children and young people with anxiety disorders.

If ACBS is to have greater community influence, then an important step is to test outcomes for ACT with young people and parents. This series of papers will investigate progress with children and adolescents across a range of settings. The first paper presents outcome data from an RCT comparing the efficacy of ACT versus CBT in children and adolescents with anxiety disorders, while the following paper will present the development of this intervention. The remaining two papers are adolescent universal studies. First, one paper shows how ACT principles were used to strengthen a universal group-based parenting intervention for parents with 11-13 year old adolescents. Then the symposium concludes with a paper regarding meditational data looking at processes of change from a school based trial, also with adolescents.

Educational Objectives:

1. Discuss the benefits and limitations of universal interventions with adolescents in schools.

2. Implement ACT interventions for children and young people using a CBT framework.

3. Describe the applicability of ACT for children between ages 7 and 17 years.

 

81. Applications of Contextual Behavioural Science to the Workplace

Symposium (10:30am-Noon)

Components: Conceptual analysis, Experiential exercises, Didactic presentation

Categories: Org. Beh. Management, Performance-enhancing interventions, Leadership Development, Workplace Bullying, Workplace Safety

Target Audience: Interm.

Location: Mathews 309 (level 3)

Chair: Rachel Collis, Queensland University of Technology

Discussant: Paul Atkins, The Australian National University

·Workplace Bullying and ACT: Typical ‘Thoughts and Feelings’ of Targets

Mike Richards, Private Practice

At least 30% of workers have been or will experience workplace bullying, many of whom will seek counselling to alleviate the traumatic impact of their experiences. However, the lack of targeted knowledge and awareness in mental health professionals of the negative consequences of workplace bullying (Sespico, Faley, and Knapp, 2007; Namie and Namie, 2003) may limit their ability to respond effectively, further entrenching the client’s feeling of ‘stuckness’ and ability to make safe and committed change. Targets of workplace bullying will typically cognitively fuse with a range of specific ‘thoughts and feelings’ to make sense of their situation. This fusion may unconsciously limit their ability to take in new information, connect with others and act in ways to limit their suffering. This presentation will present a range of common thoughts and feelings which targets of workplace bullying experience. This increased awareness may facilitate the mental health professional’s ability to help their client ‘defuse’ from thoughts and feelings towards effective intervention and change in the client’s situation.

·Facilitating Front Line Manager Performance through ORBs (Organizationally Relevant Behaviors)

Sonja Batten, Ph.D., US Dept of Veterans Affairs

Daniel J. Moran, Ph.D., Pickslyde Consulting

Front-line managers hold a tremendous amount of day-to-day responsibility, but usually do not have much guidance on how to use their management styles and practices to directly improve performance of individual employees. What if, rather than focusing by default on supervisee behaviors, procedures, and policies, the manager was trained to focus more specifically on those behaviors for the individual supervisee that have the most organizational relevance? In vivo feedback and reinforcement in the workplace are essential, but many supervisors are lacking guiding principles to help them focus on reinforcing the behaviors that would be most useful to the team and to the organization. This presentation will describe a model that builds on the principles of Functional Analytic Psychotherapy, but shifts the focus from Clinically Relevant Behaviors (CRBs) to Organizationally Relevant Behaviors (ORBs). Examples of how ORBs can be harnessed will be provided from the public sector and the private sector.

·Building Safety Commitment

Daniel J. Moran, Ph.D., Pickslyde Consulting

Well-developed safety programs get optimal results when companies have the full commitment of leadership, managers, and front-line workers. A critical but often unanswered question for many safety processes is “How can we increase personal commitment to safety?” Commitment is defined as “acting in the direction of what you care about even in the presence of obstacles.” ACTraining aims to sharpen employees’ understanding of how they can be “acting” in order to improve safety in the organization, and also aims to help employees clarify “what you they about” (values) in order to accelerate safety motivation. In addition, ACTraining aims to increase skills of situational awareness and mindfulness to help employees deal with “the presence of obstacles” that often impede dedication to safety.

Workplaces are complex systems with complex challenges. Contextual behavioral science has much to offer a range of workplace problems. This session will explore three different applications of CBS to workplace situations. Workplace bullying has a significant impact on employees and organizations. How do employees respond to the experience of workplace bullying and how can counselors use ACT to improve client outcomes? Supervisors spend a lot of time and energy trying to influence the behaviour of their direct reports. Could CBS give them a set of guiding principles for what to pay attention to and how to reinforce desired behaviours? OHS staff spend a lot of time and energy trying to improve safety behaviours. How might the introduction of ACTraining impact on both commitment to workplace safety behaviours and situational awareness around safety obstacles?

Educational Objectives:

1. Describe specific ‘thoughts and feelings’ that targets of workplace will overtly or covertly bring to the counselling setting.

2. Give an example of how the concepts of Organizationally Relevant Behaviors (ORB1s and ORB2s) can be applied to enhancing the effectiveness of front-line managers.

3. Utilize mindfulness exercises in order to improve situational awareness in the workplace.

 

Friday Afternoon 2:45pm

86. Innovations in ACT for Smoking Cessation Research: Unipolar and Bipolar Depressed Smokers, a Website, and a Smartphone App

Symposium (2:45-4:15pm)

Components: Original data, Case presentation

Categories: Clin. Interven. & Interests, Prevention & Comm.-Based, Smartphone, Website, Bipolar, Depression, Smoking

Target Audience: Intro., Interm., Adv.

Location: CLB Theatre 1

Chair: Jonathan Bricker, Ph.D., University of Washington & Fred Hutchinson Cancer Research Center

Discussant: Steven Hayes, Ph.D., University of Nevada, Reno

·Secondary Analysis of the First Web-based Acceptance and Commitment Therapy for Smoking Cessation: Focus on Smokers with Depressive Symptoms

Helen Jones, University of Washington

Jonathan Bricker, Ph.D., Fred Hutchinson Cancer Research Center & University of Washington

Objective: Smokers with depressive symptoms have more difficulties quitting smoking than the general population of smokers. In order to help smokers with depressive symptoms to quit, the present study examines an original web-based treatment using Acceptance and Commitment Therapy (ACT). The study aimed to determine the users: (1) willingness to experience smoking cues, and (2) 3-months post randomization smoking status. Method: All baseline depressed smokers (n = 94) selected from the main double-blind randomized controlled pilot trial (N = 222) which compared web-based ACT for smoking cessation (webquit.org) with smokefree.gov—a current standard in web-based smoking cessation intervention. Results: While non-significant, participants in the ACT WebQuit.org had suggestively (1) higher willingness to experience smoking cues, and (2) higher quit rates (20% vs. 12%) than in the smokefree.gov control arm. Conclusion: Lack of power from this subanalysis prevents definitive conclusions. However, a fully powered trial of the ACT Webquit.org intervention tailored specifically to depressed smokers could be a promising strategy to help smokers with depressive symptoms to quit smoking.

·ACT for bipolar smokers: Protocol development, feasibility study, and a case presentation

Jaimee Heffner, Ph.D., Fred Hutchinson Cancer Research Center

Jonathan Bricker, Ph.D., Fred Hutchinson Cancer Research Center & University of Washington

Compared to the general population, people with bipolar disorder are two to three times more likely to smoke cigarettes, and those who do smoke are less likely to quit. We developed an ACT intervention that provides an integrative framework to address multiple barriers to smoking cessation among individuals with bipolar disorder, including postcessation negative affect and strong cravings to smoke. Our in-progress treatment development study of ACT for this high-risk population of smokers involves preparation of a treatment manual and pilot testing with a small sample of participants (n=15) to determine whether the intervention is feasible, acceptable to participants, and demonstrates potential for efficacy. This talk will focus on the study rationale and design of the bipolar intervention and provide a clinical case presentation from an actual participant in this 10-session treatment protocol.

·The "SmartQuit" ACT Iphone app for quitting smoking: Live demonstration and pilot randomized trial test

Jonathan Bricker, Ph.D., Fred Hutchinson Cancer Research Center

Julie Kientz, Ph.D., University of Washington

The combination of (1) ACT's potential to boost quit smoking rates over current standard interventions and the (2) delivery of ACT via a smartphone app has the promise to impact many thousands of smokers around the world at low cost. Responding to this potential, we recently completed the "SmartQuit" ACT Iphone app for quitting smoking. In this paper, we will first describe how we created a stand-alone ACT smartphone intervention that integrates innovative video and audio ACT metaphor and exercise content with the tracking, progress feedback, and social networking functions now standard in quit smoking apps. We will show the audience a live video demonstration of the SmartQuit app. Second, we will describe the design and implementation of an ongoing US nationwide pilot randomized trial (N = 160) comparing SmartQuit with a current standard US Government smartphone app called "QuitGuide."

ACT interventions for quitting smoking have recently focused on the high need populations of depressed smokers and the emerging delivery methods of websites and smartphone apps for the general population of smokers. Unipolar and bipolar depressed smokers smoke at about 2-3 higher rates and quit at about half the rate of smokers in the general population. Websites and smartphone apps have the potential to impact many thousands of smokers at low cost. Accordingly, Paper One will present a unipolar depressed smokers secondary analysis of the Webquit pilot trial comparing web-based ACT with a current standard quit smoking website (Smokefree.gov). Paper Two will describe a new in-person ACT intervention for bipolar smokers, present an ongoing feasibility study of the intervention, and provide a recent case presentation from the study. Regarding new methods of delivery, Paper Three will give a live video demonstration of a newly developed ACT Iphone smartphone app, designed for the general adult population of smokers, called "SmartQuit" and describe its testing in an ongoing randomized trial comparing it with a traditional current standard quit smoking app (QuitGuide). Steve Hayes will synthesize the three papers and discuss their implications for the broad base of ACT clinical interventions and research.

Educational Objectives:

1. Explain the testing of web-delivered ACT for quitting smoking among unipolar depressed smokers.

2. Describe the design and clinical application of ACT for quitting smoking among bipolar depressed smokers.

3. Explain how to use an ACT smartphone app for quitting smoking and describe its testing in a randomized trial.

 

90. Exploring adolescent development through the lens of contextual behavioural science: New directions in theory and research

Symposium (2:45-4:15pm)

Components: Conceptual analysis, Literature review

Categories: RFT, Clin. Interven. & Interests, Adolescents

Target Audience: Interm., Adv.

Location: Mathews 107 (level 1)

Chair: Louise Hayes, Ph.D., Orygen Youth Health Research Centre, University of Melbourne

Discussant: Joseph Ciarrochi, Ph.D., University of Western Sydney

·The adolescent self: A functional account of their developing self

Louise McHugh, Ph.D., University College Dublin (UCD)

Louise Hayes, Ph.D., Orygen Youth Health Research Centre, University of Melbourne

Adolescence represents a time of enormous change and testing of concepts of self. The adolescent self is a concept that is widespread in modern psychology and has played either a central or supporting explanatory role in several major theoretical approaches to their development. Despite the popularity of theories of self-development, the adolescent self has remained ill-defined. Recently, however, functional contextualistic (FC) behaviour analysis has provided an account of human language and cognition characterised by precision, scope and depth that allows new insight into the changes that adolescents experience, and how this shapes their sense of self. Functional contextualism and more specifically Relational Frame Theory explain language as relationally framing and the self as the product of framing the behaviour of oneself and others in accordance with perspective taking relations. This paper will introduce the FC / RFT conceptualisation of the self, with specific consideration of adolescent behaviours, changes they experience, and how this impacts on their relationships with parents, peers, and their ability to become psychologically flexible adults.

·Examining the relative influence of self-esteem and self-compassion as predictors of mental health among Australian adolescents

Sarah Marshall, University of Western Sydney

Joseph Ciarrochi, Ph.D., University of Western Sydney

Phillip Parker,

Patrick Heaven,

Despite their conceptual similarities, global self-esteem and self-compassion have been established as distinct constructs. Existing research demonstrates the importance of each for psychological health. Building on the existing literature this study sought to examine the relative influence of self-esteem and self-compassion as predictors of mental health over a one year period. Specifically we administered measures of self-esteem, self -compassion and general health to 2448 adolescents across two yearly time points (Grades 9 and 10). Structural equation modelling was utilised to test whether self-compassion and self -esteem predicted changes in mental health. Additionally we examined the potential interaction between self-compassion and self-esteem. Our findings suggest that both self-esteem and self-compassion predict improvements in mental health over time. Moreover a significant interaction effect was observed. For adolescents who are high in self-compassion, low self-esteem had little influence on mental health. However for adolescents who are relatively low in self-compassion, low self-esteem was strongly associated with poor mental health. We discuss the implications.

·Difficulties Regulating Emotion in Adolescents and the Development of Mental Ill-Health and Psychological Flourishing: A Longitudinal Study

Loch Forsyth, University of Western Sydney

Louise Hayes, Ph.D., Orygen Youth Health Research Centre, University of Melbourne

Phillip Parker,

Joseph Ciarrochi, University of Western Sydney

This study sought to assess what aspect of emotion regulating skill (ERS) was uniquely related to the development of mental health and wellbeing in adolescents. Emotion regulation skill (ERS), in this context, was defined not just as the modulation of emotional arousal, but also the awareness, understanding, and acceptance of emotions and the ability to act in a desired way regardless of emotional state (Gratz & Roemer, 2004). We measured ERS, mental ill-health, and psychological well-being in a two year longitudinal study consisting of 2070 adolescents (1019 males, 1051 females). Structural equation modelling was used to predict relationships between individual emotion regulation strategies and changes in mental illness and wellbeing (social, emotional, and psychological). We found that each of the six emotional regulation skills (awareness, clarity, non-acceptance, strategies, impulses, and goals) significantly predicted some aspect of well-being. However, the most reliable of the six strategies at predicting poor wellbeing and mental health was ‘difficulties engaging in goal directed behaviour.’ Adolescents who can keep working toward their goals even when upset were more likely to report better levels of mental health and wellbeing. Future research will help determine if this relationship changes at different developmental stages and how important early emotion regulation strategies are to later life. These findings will hold importance for all those interested in promoting and maintaining adolescent wellbeing.

This symposium will present theoretical and empirical investigations into adolescent development. Recent advances in RFT, CBS and evolution science have changed how we view adolescence. We are no longer bound by the theories of normative stage based development and instead can reposition adolescence as a time of adaption to context, where context and consequences contribute to flexibility, with much individual variation. These 3 papers present new theoretical discussions and empirical data on psychological flexibility in adolescence.

Educational Objectives:

1. Develop an understanding of the contextual behavioural approach to adolescent development.

2. Understand various components of RFT and adolescence.

3. Discuss factors that contribute to adolescent psychological flexibility.