Does ACT work for minorities or the poor?

Printer-friendly version

The ACT literature is just now getting large enough to consider whether its impact is differential based on SES, ethnicity, gender, nationality, and the like. So far the news is good.

There are now several randomized trials with minority populations. Some examples are Gregg, Callaghan, Hayes, & Glenn-Lawson (2007), Lundgren and Dahl (2006), and Gaudiano and Herbert (2006)

Gregg, Callaghan, Hayes, and Glenn-Lawson is an RCT showing that a six hour ACT workshop with patient education works significantly better than a six hour patient education workshop alone in producing changes in diabetes self-management and blood glucose (at 3 month follow-up). The study was done at a public health clinic in a poor and largely Latino and Asian section of East Palo Alto. The percentage of minority participants was 76.5%.

Lundgren and Dahl is an RCT done in South Africa showing that a 9 hour ACT protocol reduced seizures in epileptics 96% (90& were seizure free at a one yar follow up), while an attention placebo had no effect. The participants were all poor South African blacks living in a residential center.

Guadiano and Herbert replicates the Bach and Hayes study on psychosis with better measures and a better control condition that controlled for experimental contact and attention. It had good results especially on measures of overt psychotic behavior (the Brief Psychiatric Rating Scale) and mediational analyses fit the ACT model. 80% of the population in this was African-American, mostly very poor since this was done in a public mental hospital.

Other such studies are coming, both international studies in countries like Japan, India, Brazil, and elsewhere -- in addition to the many studies in Europe -- and studies in the United States and elsewhere done with poor and minority populations. The overall effect size (Cohen's d) for these three studies are 1.26 at post and .74 as follow up (average length of follow up 22.3 weeks). Both of these values are above the average values overall in the ACT literature, which you can examine in the Hayes, Luoma, Bond, Masuda, & Lillis, 2006 meta-analysis. You can download this from the publication section too (if you are an ACBS member ... and if not you should join by clicking here!).

As for gender, in all of the studies so far ACT works as well for women as men, except for one analogue pain study in which it worked better for women. Byt the way, there is some indication that ACT helps with racial prejudice directly.

In Lillis & Hayes (2007) undergraduates enrolled in two separate classes on racial differences were exposed Acceptance and Commitment Therapy and an educational lecture drawn from a textbook on the psychology of racial differences in a counterbalanced order. Results indicate that only the ACT intervention was effective in increasing positive behavioral intentions at post and a 1-week follow-up. These changes were associated with other self-reported changes that fit with the ACT model.

Overall, so far as we can tell so far, ACT works well in different ethnical, cultural, national, and socio-economic groups; and works for both men and women. We shall learn more as the data come in, but it is pretty cool that ACT researchers are already refusing to limit their work for middle class majority populations. A similar thing can be said for cognitively disabled populations, as the psychosis data are showing.

Here are the references for the studies mentioned:

Gaudiano, B.A., & Herbert, J.D. (2006). Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy. Behaviour Research and Therapy, 44, 415-437.

Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(2), 336-343.

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

Lundgren, A. T., Dahl, J., Melin, L. & Kees, B. (2006). Evaluation of Acceptance and Commitment Therapy for drug refractory epilepsy: A randomized controlled trial in South Africa. Epilepsia, 47, 2173-2179. Mediational analyses for this study are reported in Lundgren, T., Dahl, J., & Hayes, S. C. (in press). Evaluation of mediators of change in the treatment of epilepsy with Acceptance and Commitment Therapy. Journal of Behavioral Medicine.

You can find a discussion of some of these issues in this paper:

Woidneck, M. R., Pratt, K. M., Gundy, J. M., Nelson, C., & Twohig, M. P. (in press). Exploring cultural competence in acceptance and commitment therapy outcome research. Professional Psychology: Research and Practice.

It did a comprehensive review of published ACT outcome research. ACT is being implemented and researched across a number of countries around the world, with a presumably diverse population. However, a notable percent of the outcome studies (especially those outside of the US) do not provide adequate descriptions of the demographic make-up of their samples, particularly related to ethnic/racial information. Studies that do report ethnic/racial information provide preliminary evidence that suggests ACT may be effective with diverse groups but more evidence is needed. 

There is also a discussion in this paper:

Hayes, S. C., Muto, T., & Masuda, A. (2011). Seeking cultural competence from the ground up. Clinical Psychology: Science and Practice, 18, 232-237.

For evidence that the model applies to Asian minorities see also Cook, D., & Hayes, S. C. (2010). Acceptance-based coping and the psychological adjustment of Asian and Caucasian Americans. International Journal of Behavioral Consultation and Therapy, 6, 186-197.