Program Committee Chairs

David Gillanders, D.Clin.Psychol.

David Gillanders is a Chartered Clinical Psychologist, member of the British Psychological Society, Health & Care Professions Council, Association of Clinical Psychologists (UK), British Association of Behavioural & Cognitive Psychotherapy and a founder member of the Association for Contextual Behavioural Science. He is Head of Clinical & Health Psychology at the University of Edinburgh. He leads a programme of research into the application of contextual behavioural science to living well with ill health, as well as research into training, supervision and basic measurement in behavioural science. He has published more than 35 peer reviewed articles and several book chapters, and is co-author of the self-help book, Better Living with IBS. He is a peer reviewed ACT trainer with ACBS. The peer review is the international association’s mark of high quality, high fidelity ACT training.

Louise McHugh, Ph.D.

Dr. Louise McHugh is an Associate Professor at University College Dublin, Ireland and a world leading researcher in the area of Acceptance and Commitment Therapy and Relational Frame Theory. She is a Fellow of the Association for Contextual Behavioral Science (ACBS) and has published over 80 papers in the area of CBS. She was an editor for the New Harbinger text The Self and Perspective Taking and author of the amazon best seller A Contextual Behavioral Guide to the Self. She is a Recognized Peer Reviewed ACT Trainer and an Action Editor for the Journal of Contextual Behavioral Science.

 

If you have questions about your submission(s), please contact David and Louise. 

RFT Track Chair: Lynn Farrell

Reviewers:

Friday, 28 June
15:10-16:40
Location: Q119

Session 83

• DNA-V as an integrated framework for quality of life, psychological wellbeing and physical health outcomes for children and young people with heath conditions  

James Lemon, DClinPsy, NHS Dumfries And Galloway (UK)

This talk is written by both young patients and staff and presents an overview of how DNA-V and we, a medical paediatric healthcare service have been co- evolving over several years. We have ‘co-learnt’ DNA-V with patients and then ‘co-developed’ a training package to share with other patients, and parents. We now asses levels of DNA-V skills periodically, such as at the Cystic Fibrosis (CF) annual medical reviews, which occur every six months, at screening sessions, and when patients with particular health conditions are beginning to transition to secondary school. If appropriate we can then offer a range of DNA-V approaches. We are now co-developing a group programme. We have taught multi-disciplinary staff DNA-V, which they can use within the context of their own speciality. The data we have collected shows that our scores for overall psychological wellbeing are above what would be expected, our treatment adherence levels are higher than expected and our complaints levels have reduced. Objective physical outcomes for particular patient groups have improved significantly.

• "I'd Rather Feel the Thorn than to Never See the Rose!" An Anthology of ACT Congruent Music.  

Victoria Samuel, South Wales Doctorate in Clinical Psychology, Wales, UK.
Dale Thomas, Trainee Clinical Psychologist, S.Wales Doctorate in Clinical Psychology, Wales, UK

Background ACT terms and processes can be ambiguous and hard to conceptualise for clients or students unfamiliar with the approach. Music can be emotive and memorable and can be powerful in influencing our affective state; music can soothe, inspire, empower, motivate, validate and affirm our experiences. Methods Over a period of 3 years the first author collated songs depicting key ACT processes and concepts. An exercise used during her teaching on local doctoral programmes in clinical psychology, in which students were encouraged to identify ACT congruent songs, provided a wealth of extra additions for the ACT playlist. The first author worked with the second author, a doctoral student, to shortlist the diverse songs into an ACT anthology of 5 minutes in duration. Results In this engaging, emotive, fun and high-energy ACT presentation, the music will ‘speak for itself’ taking us through a varied journey of ACT processes through ACT congruent lyrics. Conclusion Music can be a powerful resource; facilitating and solidifying awareness and use of ACT concepts and processes for professionals, clients and students alike.

• Health values: Exactly what they say on the tin (Except not always and quite rarely)  

Alison Stapleton, University College Dublin
Martin O'Connor, University College Dublin
Emmet Feerick, University College Dublin
John Kerr, University College Dublin
Louise McHugh, Ph.D., University College Dublin

Empirical research has shown that participants’ levels of health values directedness are not related to their reported engagement in certain important health behaviors (such as physical activity, dietary quality, and alcohol consumption). Suggesting that, although topographically congruent with health values, the aforementioned health-related behaviors are not functionally congruent with participants’ health values. Based on this research, the proposed Ignite presentation will elaborate on the apparent disconnect between health values and health behaviors. Attendees will be introduced to different health values frequently endorsed by participants and asked to pair these values with seemingly congruent behaviors. The proposed Ignite presentation seeks to highlight that functional congruence tops topographical congruence, or rather that health values are exactly what they say on the tin (except not always and quite rarely).

• A Beginners Guide to ACT Process Measures: Quantitative and Case-Study Insights into Picking an Effective Assessment System to Track Progress in Treatment  

Ronald Rogge, Ph.D., University of Rochester
Jennifer Daks, M.A., University of Rochester
Brooke Dubler, Ph.D., University of Rochester
Katherine Saint, M.A., The Chicago School of Professional Psychology

With the recent proliferation of process measures in the Acceptance and Commitment Therapy literature, we sought to examine the various strengths and weaknesses of the AAQ-II, CompACT, OESQ, and MPFI scales: (1) in a sample of 2,385 online respondents and (2) in a case study of a client receiving ACT for a depressive disorder. Quantitative results revealed that all of the flexibility scales were strongly linked to both psychological distress and individual wellbeing. However, the results further highlighted that newer multidimensional scales (the 3-dimension CompACT, the 12-dimension MPFI) offered greater insights into current functioning, often doubling the amount of variance explained by the AAQ-II alone. Both the quantitative analyses and the clinical case study vividly demonstrate the more nuanced and clinically meaningful patterns that emerge when multiple dimensions of flexibility and inflexibility are tracked. In particular, the results suggested the MPFI (and the MindFlex Assessment System that makes the MPFI easily usable online) offers researchers and clinicians the most conceptually comprehensive scale to represent the Hexaflex model. Concrete guidelines for selecting scales will be provided.

• Investigating the Psychometric Properties of the Values Wheel with a Clinical Cohort  

Kate Barrett, University College Dublin
Martin O'Connor, University College Dublin
Louise McHugh, University College Dublin

Background: Previous research demonstrated the psychometric properties of a novel, idiographic values-measure: the Values Wheel (VW). This study reports on the psychometric properties of the VW with a clinical cohort. Method: Fifty-one adult clients who were engaged with the mental health services attended an assessment session comprising a battery of questionnaires measuring mental health, well-being, life satisfaction, ACT processes, as well as a values card sort task and the VW. Results: The VW demonstrated partial evidence of structural validity, such that scores were positively related to well-being and life satisfaction outcomes, and negatively related to depression. Significant positive correlations were observed with alternative values-measures, suggesting the VW demonstrates good convergent validity. The discriminant validity of the VW was partially supported, as no significant correlations with two unrelated constructs were found. Evidence for the incremental validity of the VW was also indicated, as scores accounted for unique proportions of variance in well-being and life satisfaction outcomes, beyond psychological flexibility alone. Conclusions: Outcomes provide preliminary support for the psychometric properties of the VW with a clinical population.

• Should I give this talk?  

Kori Schagunn, University College Dublin

The aim of the proposed ignite presentation will be to examine the speaker’s new research idea: how improv comedy could be used in teaching psychological flexibility through improvisation. Psychological flexibility is an imperative skill that affects an individual’s quality of life. It is the ability to persist in values based actions whilst experiencing unwanted internal events such as thoughts and emotions which in turn enable behavioural adaptability. Improv comedy is an unscripted performance that is made up “on the spot” and is usually performed by a group or team. There are exercises within improv comedy that the speaker argues may teach and/or increase psychological flexibility. The exercise ‘new choice’ will be examined as an example of how improv could potentially assist in the learning of psychological flexibility. All of this will be examined while the speaker grapples with their “unwanted, away-moving” thought process that began with one sticky question: ”should I give this talk?”.

• Comfort Zone Challenges - a "fun" way to practice ACT skills  

Michael Herold, The Art of Charm

Comfort Zone Challenges are exercises that are designed to push participants out of their comfort zone in social settings. They are provoking anxiety, particularly in regards to embarrassment and rejection. They are most commonly exercised in group settings, to facilitate mutual support and motivation. Common Exercises: Lie down in a public area as if you were taking a sunbath. Walk down a busy street and high-five as many people as you can. Tell a joke to a stranger (preferably a joke that isn't even funny). And many more. As participants become intimately aware of unhelpful private experiences leading up to their "challenge", they are then able to practice psychological flexibility. The ACT processes are something that we cover in the theoretical part of our workshops - before and after the practical exercises. The biggest impact happens the moment a participant realizes that these exact same skills he or she practiced to perform one of those challenges can be used in anxiety-provoking real-life situations: in their social life, professional life or anywhere else.

• !The Young Ones! #Transdiagnostical #grouptherapy #youngsters #buildingbridges #humor #changetheculture #mentalhealth  

Kim Helmus, Amsterdam UMC

In this inspiring Ignite talk you will hear about and experience how, a practice based initiative for Young people with different kinds of symptoms and struggles WORKS. Initiative-taker and researcher Kim Helmus shares how she and her colleagues implemented this initiative five years ago within the biggest mental health organization in Amsterdam, the Netherlands. The Young Ones is an initiative that helps to change the organization from within towards more flexibility, defusion around ‘mental health diagnoses’, spreads humor, increases the joy within the departments and helps young people to cope with life differently. We hope to inspire you to take initiative! #cooperation with INTERACT Belgium/Netherlands #Phd_research #Act

• How to Arrive: engaging your psychological flexibility before the consultation begins  

Ray Owen, DClinPsy, Wye Valley NHS, Herefordshire, UK

Any health or social-care professional finds some consultations more anxiety-provoking than others. This is true for the counsellor about to see a client after a therapeutic rupture, the oncologist about to break unexpectedly bad news or the social worker having to explain to angry parents why safeguarding measures have been started. According to CBS approaches, dealing with complex situations will be helped by the professional responding in a psychologically flexible manner to the external and internal events of the consultation, even if the content of the interaction is not explicitly ACT-related (e.g. the doctor breaking bad news above). Unfortunately, anticipatory anxiety can prompt psychological inflexibility in professionals as well as anyone else, potentially leading to difficult consultations being handled less well right from the start. This IGNITE presentation will demonstrate a brief (maximum 20 seconds), easily-taught ACT-based procedure, which was originally developed for hospice nurses and doctors to help them enter a difficult consultation in an Aware, Engaged, Open stance. It can also be applied in psychotherapy, or other human interactions (formal or informal).

Saturday, 29 June 
15:10-16:40
Location: Q122

Session 133

• CBS Writ Large: Committed Actions and Opportunities  

Tiffany Rochester, Charles Street Clinic

ACBS has at its core a tenet to create and use Contextual Behavioural research to reduce human suffering and improve well-being. We do this in CBS labs, therapy rooms and other settings across the world, but in the current political, social and environmental climate we live in, is this enough? How do we do more, and should we? We are small, but we could be mighty! In this Ignite, I will share with you dreams and plans for how we can use the strength of our community to infuse CBS into the areas that matter to us most - from actions that take less than two minutes, through to incredible opportunities for growth as a whole organisation. We have the science - are we willing to take it to the world?

• Growing up in war- the impact on children and how CBS can help  

Felicity L. Brown, Ph.D., War Child Holland

Globally, 1 in 10 children live in an area affected by armed-conflict, and we are currently experiencing unprecedented numbers of refugees and internally displaced people, of which the majority are youth. Most armed-conflicts occur in low and middle-income countries (LMICs), and these LMICs also host almost 90% of the world’s refugees. Unfortunately, we know that tremendous care gaps exist in access to mental health and other services- particularly in LMICs. This can be further exacerbated by the destruction of essential infrastructure during armed-conflict. Thus the damaging effects of war and displacement frequently lead to dramatically increased youth risk factors at all ecological levels, and high mental health needs, in the very contexts where health and support systems are least equipped to cope with the burden. How can we take evidence-based practices from CBS and develop innovative solutions to tackle this immense need, and cruel disparity?

• Where is the service user voice in our research?  

Christine E. Ramsey-Wade, University of the West of England

Health intervention research has been criticised for a lack of focus on investigating acceptability, before examining efficacy and effectiveness. There are clear moral and ethical arguments for giving voice to service users’ experiences of helpful and unhelpful factors in health interventions, thereby ensuring that our research is relevant to their needs. While such work is now usually a requirement of funding bodies, it may still be viewed as simply a hurdle to be mounted before the real research begins. A lack of investment in this stage of the research process can weaken later quantitative evaluations, and is arguably symptomatic of a wider under-valuing of qualitative research in psychology. Qualitative research is vital to understand mechanisms of change, identify target populations, and inform intervention development. This presentation will seek to provoke debate around the place of accessibility research. It will review different ways in which this work can be undertaken, by for example contrasting patient participation with patient involvement. It will then describe a recent study exploring the accessibility of an 8-week mindful eating programme.

• From outside in to inside out: getting loose and letting yourSELF in the therapy room: Brazil Chapter Sponsored  

Raul Vaz Manzione, Centro Paradigma; Private Practice

Beginner ACT therapists can often get attached to rules on how to "behave appropriately" as an ACT therapist. Sometimes this might entail the message: "Being who I am it's not okay" which can lead to patterns of experiential avoidance in session. This IGNITE session aims to talk about on how by bringing your own self to the room can be helpful to the therapist and clients itself and empower your therapeutic work.

• How media helps to shape society toward psychological inflexibility  

Lori Eickleberry, Ph.D., ABPP, Institute for Life Renovation, LLC
Christina Doro, Psy.D., Institute for Life Renovation, LLC

Using humor and absurdity, this Ignite session will highlight how media portrays events and research in ways that shape society's belief toward "healthy normality." Authors will depict how this increases not only intolerance, but also associated difficulties with experiential avoidance and the conceptualized self. As society evolves, increase in distorted beliefs can shape values and interfere with acts of workability, further challenging the implementation of Acceptance and Commitment Therapy with patients. Authors will discuss the utility of openly discussing media and societal belief trends with patients as a way of increasing theoretical credibility and getting "unstuck" with patients.

• Acceptance and Commitment Therapy: A model for therapist self-care in the workplace  

Lori Eickleberry, Ph.D., ABPP, Institute for Life Renovation, LLC
Courtney Purdy, Psy.D., Institute for Life Renovaton, LLC

This Ignite session will apply the Hexaflex to illustrate how clinicians can apply our own ACT principles to not only reconcile, but also evolve from our work with patients. The presentation will highlight the unique—and often bizarre, funny, and frightening—situations that we encounter as clinicians, and how we can use our therapeutic skills to normalize and make sense of our interesting work with patients, and be better at what we do by behaviorally modeling the process we are teaching.

• Enough! An ACT Clinician’s Journey to Find Lagom: Women in ACBS SIG Sponsored  

Leslie A. Veach, M.S., NCC, LPCS, East Carolina University - Center for Counseling and Student Development

Early in my career, a client told me about the Swedish concept of “Lagom,” loosely translated as “enough.” Not having an exact word for this in English, we spent several sessions discussing what this meant to her. The concept spoke to me, and over the years I found myself coming back to it again and again as a way to clarify my own values and reassess how I define “enough.” For me, it has meant living in harmony with myself and others. In this brief presentation, I will humbly share my experience as a daughter, mother, wife, friend, counselor, and human how through study, reflection and committed action I have embraced diverse cultural concepts to defuse from the unworkable and embrace balance. I hope to ignite ideas for attendees on how they can do the same.

• Live better: An online ACT based self-help course in Icelandic.  

Orri Smarason, Lifdu betur
Sigurður Ólafsson, M.A., Lifdu betur
Guðný Einarsdóttir, M.Sc., Lifdu betur

Until recently no publicly available literature or information existed on Acceptance and Commitment Therapy in the Icelandic language. Lifdu betur (Live better), an online self help course, has now published the first publicly available ACT materials in Icelandic. The course consists of short video lectures, a small booklet, a workbook and a number of guided present moment awareness exercises. The talk will cover how the idea came about, the landscape of psychotherapy in Iceland, how the course was developed and how it has been received.

• ACT for Psychosis in Community-Based Mental Health Institutions  

Hüseyin Şehit Burhan, Karaman State Hospital, Turkey
Merve Terzioğlu, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery
Furkan Bahadır Alptekin, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery

The last 10 years rapidly developing community-based mental health institutions in Turkey serves particularly patients who were diagnosed with psychotic disorders. However, the application of evidence-based therapy methods is limited in these institutions. In a small city, we applied ACT-based group therapy for psychosis with the clients of the mental health institution. The results were very satisfactory. ACT-based interventions for psychosis can be implemented as an effective method in community-based mental health institutions serving thousands of customers across the country.

• Acceptance and Commitment Therapy (ACT) in the End of life: from resignation to acceptance.  

Alessia Medioli, Ph.D., ASCCO, ACT ITALIA
Giuseppina Majani, Ph.D., ASCCO, ACT ITALIA

This study aims to show the usefulness of Acceptance and Commitment Therapy (ACT) in a Geriatric Acute Care Unit by analyzing a case report which shows the approach to end of life from patient’s, caregiver’s and physician’s perspectives. The advanced stage of the disease asks to patient, family and clinicians to change their perspective, since death is no longer an antagonist to fight but becomes an event to be accepted and managed. The intervention moves from to cure to caring. Renato is an 82 years old patient whose weight loss initially considered by family and doctors as a consequence of depression was actually due to a total dysphagia. This fact required an attention shift from the possibility to manage the patient’s problems to the need to accept the situation limits from the different points of view. ACT made possible to calibrate the psychological intervention according to value priorities change connected to end of life.

Please note: You must be logged in as an ACBS member in order to view the content below.

WC17 Posters

Last updated 22 June, 2019

 

Tuesday, 25 June

Room Change

Prosocial: Using CBS to improve relations within and between groups will now be held in room Q158 (on the 1st floor of the Business School)

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Wednesday, 26 June

Room Change

Prosocial: Using CBS to improve relations within and between groups will now be held in room Q158 (on the 1st floor of the Business School)

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Thursday, June 27

Room Change 

All sessions that were scheduled for Q220, will instead be held in QG22 (on the ground floor of the Business School)

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Friday, June 28

Room Change

All sessions that were scheduled for Q220, will instead be held in QG22 (on the ground floor of the Business School)

Session Change

59. Measuring mindfulness
Invited (10:35-12:05)
Ruth Baer, Ph.D., University of Kentucky and University of Oxford

This presentation has been cancelled, and the following session will be replacing it:

59. Addressing Problematic Perfectionism from a Contextual Behavioural Approach: Forging links between research, practice, and lived experience
Panel (10:35-12:05)

Components: Conceptual analysis
Categories: Clinical Interventions and Interests, Theoretical and philosophical foundations,Perfectionism
Target Audience: Beginner

Location: Q122
Chair: Susannah C. Johnston, Ph.D., University of Edinburgh
Jennifer Kemp, M.Psych.(Clinical), Precious Minds
Lanaya L. Ethington, Ph.D., University of Iowa
David Gillanders, DClinPsy, University of Edinburgh
Lisa W. Coyne, Ph.D., Harvard Medical School

Perfectionists strive towards high standards and may experience concern over whether these standards will be achieved. In some cases, the standards and concerns become excessive, leading to poor life outcomes. For example, perfectionism is considered a transdiagnostic risk and maintenance factor for numerous psychological disorders and can also act as a barrier to successful recovery from clinical illness. Given the evidenced rise of perfectionism in recent decades, it is important for clinicians and researchers to forge collaborative relationships in the bid to address the more problematic features of perfectionism. Difficulties arise, however, in aligning conceptual, clinical, and lived experience perspectives of perfectionism. Disagreement remains about common and unique features of perfectionism in different populations, how these may influence life outcomes, and how best to address problematic features in a therapeutic setting. Might a contextual behavioural science approach aid our understanding and treatment of problematic perfectionism? This panel brings together clinicians and researchers from across the globe with interest and experience in this topic to discuss these issues and more.

Educational Objectives:

1. Describe key differences and commonalities between researcher, practitioner, and lived experience perspectives of perfectionism.
2. Evaluate the use of a CBS approach to understanding problematic perfectionism.
3. Contribute to an emerging dialogue between research and practice in an important transdiagnostic area.

 

Session Change
65. An ACT Approach to Emotional Dysregulation: Nuts and Bolts of Flexible Exposure
Workshop (13:20-16:40) 
Patricia E. Zurita Ona, Psy.D., East Bay Behavior Therapy Center
Russ Harris, Private Practice

This presentation has been cancelled, and the following session will be replacing it:

65. Self-as-context Made Simple
Workshop (13:20-16:40)
Russ Harris, Private Practice
Location: The Theatre (Helix-Ground Floor)

Components: Experiential exercises, Didactic presentation, Role play
Categories: Clinical Interventions and Interests
Target Audience: Intermediate, Advanced 

A highly experiential workshop which demonstrates in simple, clear, non-technical language many different ways to talk about and facilitate the experience of self-as-context – from lengthy interventions such as the classic ‘observer Exercise’ to extremely brief ones. It brings together metaphors and experiential exercises from ACT pioneers Steve Hayes, Kirk Strosahl and Kelly Wilson, as well as my own innovations. By the end of this workshop, attendees will have repeatedly experienced the psychological space of self-as-context, and will have a variety of tools to facilitate this process in therapy. They will also get an opportunity to practice some of these techniques on each other.

Educational Objectives

1. Communicate to the ‘average person’ about self-as-context – in a jargon-free manner
2. Explain the ‘psychological space’ of self-as-context
3. Utilize a variety of techniques for rapidly facilitating this experience in therapy

 

Busing Schedule Update 
Busing will now return from Nassau Street at 21:15, 21:30, 21:45 and 22:00.

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Saturday, June 29

Room Change

All sessions that were scheduled for Q220, will instead be held in QG22 (on the ground floor of the Business School).

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Sunday, June 30

Room Change

All sessions that were scheduled for Q220, will instead be held in QG22 (on the ground floor of the Business School).

Thursday, 27 June
Friday, 28 June
Saturday, 29 June
Sunday, 30 June

Thursday, 27 June

14. Encountering More Mystery than is Comfortable: Spirituality, Religion, Mysticism, and Mental Health Through a CBS Lens
Symposium (10:35-12:05)
Components: Conceptual analysis, Literature review, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Theoretical and philosophical foundations, spirituality, religion, psychedelics
Target Audience: Beginner, Intermediate
Location: Q122

Chair: Jason Luoma, Ph.D., Portland Psychotherapy Clinic, Research, & Training Center, Oregon Health Sciences University
Discussant: Kelly G. Wilson, Ph.D., University of Mississippi

Spirituality and religion are important aspects of human experience. Furthermore, research shows that religious attendance and spiritual beliefs can contribute to positive mental health. However, these topics have received relatively little theoretical and empirical attention from a CBS perspective. This symposium seeks to advance a CBS understanding of religious, spiritual, and mystical experience through three methods. The first paper presents a case study of the treatment of moral injury using Acceptance and Commitment Therapy, in which spiritual concerns played a central part. A second paper reviews data from clinical trials on psychedelic therapy showing that mystical states predict positive outcomes and attempts to understand these findings through the lens of CBS. A third paper presents data from a sample of US veterans, showing that religious and spiritual variables were related to positive outcomes, as well as examining relationships with variables related to psychological flexibility. In each paper, CBS theory will be utilized to understand the findings, with an eye to advancing understanding and research in this area of inquiry.

• Reengaging in Spirituality with Acceptance and Commitment Therapy for Moral Injury (ACT-MI): A Case Study
Lauren M. Borges, Ph.D., Rocky Mountain MIRECC, University of Colorado School of Medicine

Acceptance and Commitment Therapy has promising implications for breaking free from moral injury-related suffering (Farnsworth et al., 2017; Nieuwsma et al., 2015). A case study will be presented about ACT-MI in a telehealth format for a Service Member struggling to reengage with spirituality after violating his moral values. Through treatment he redefined his spirituality via “sharing myself with others.” In addition to demonstrating a marked increase in values-consistent behavior (Valued Living Questionnaire composite score from 17.9 to 57-points) following ACT-MI, social functioning, experiential avoidance, and cognitive fusion improved. Qualitative data also support the acceptability of ACT-MI in a telehealth format. On the Narrative Evaluation of Intervention Interview, he shared, “this has really helped me to reconnect with a sense of purpose and meaning and spirituality within my life.” Whereas at the beginning of treatment he identified spirituality as unimportant, at the end of treatment he expressed, “I want my life to have purpose and meaning. I want to connect to my values of family and spirituality. To be there for them and for me.”

• How the Experience of Mystical States in Psychedelic Assisted Therapy Can Inform Research into Processes of Change: A CBS and Affective Science Perspective
Jason Luoma, Ph.D., Portland Psychotherapy Clinic, Research, & Training Center, Oregon Health Sciences University

Modern clinical trials examining the psychedelics in the treatment of mental health problems has demonstrated surprisingly robust effects. Central to these outcomes is the inducement of mystical states through the moderate-to-high doses typically administered. In these studies, the occurrence of a mystical state during psychedelic dosing sessions strongly predicts positive outcomes. In other words, those patients who experience a mystical state usually have very positive outcomes whereas those who do not experience a mystical state typically show little benefit. In contrast to most of the theorizing on mechanisms of action of psychedelics, which emphasizes decontextualized brain states, this paper will take a contextual view on how a profound single experience can result in transformational changes in behavior. The paper begins with a review of modern trials on the effects of psychedelics on mental health, specifically with a focus on studies showing that the inducement of mystical states strongly predicts mental health outcomes. It then proceeds to outline how contextual behavioral and affective science can account for the observed effects and inform future treatment development.

• Differential Examination of Religious and Spiritual Self-Identification in Relation to Resilience and Mental Health Outcomes: Implications for ACT
Jason A. Nieuwsma, Ph.D., Duke University, VA Mid Atlantic MIRECC

Amid the decline of traditional religiosity in Western, industrialized nations, spirituality has emerged as a more subjective, individualized construct with which many people increasingly identify (Chaves, 2017; Saucier & Skrzypińska, 2006). Using a sample of 315 post-9/11 veterans, we examined how self-identification as religious and/or spiritual interacted with outcomes on measures of resilience (CD-RISC; identified in prior research as a proxy for psychological flexibility; Elliott et al., 2017), depression (BDI-II), alcohol abuse (AUDIT), PTSD (DTS), and moral injury (MIQ-M). Compared to those who identified as neither spiritual nor religious, those who identified as both had higher resilience scores (p<.001) and lower scores on measures of depression (p<.05), alcohol abuse (p<.01), and moral injury (p<.01). Those identifying as spiritual but not religious generally scored between these two groups, with patterns on measures of resilience and moral injury suggestive of a potential adaptive function for spirituality in the absence of religiosity for this group. This presentation will conclude with implications for using ACT to target psychological flexibility processes as interpreted through the lens of religion and/or spirituality.

Educational Objectives:
1. Demonstrate how ACT can be used in relation to issues of religion or spirituality. 2. Describe how psychological flexibility is related to psychedelic experience. 3. Describe how spirituality is linked to valuing as a behavior.

 

15. ACT and serious mental illness: Theory and Intervention
Symposium (10:35-12:05)
Components: Original data
Categories: Clinical Interventions and Interests, Psychosis and Bipolar Affective Disorder
Target Audience: Beginner
Location: Q158

Chair: Eric Morris, Ph.D., La Trobe University
Discussant: Joseph Oliver, Ph.D., University College London, Contextual Consulting

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 considers the theoretical and practical implementation of ACT to symptoms that are characteristic of individuals with serious and enduring mental illness. Paper 1 considers the role of psychological flexibility in understanding schizotypy—a continuum of psychotic-like experiences which extends from nonclinical presentations to schizophrenia and related disorders. Paper 2 focuses specifically on paranoia-a common, distressing, and persistent experience characterised by the belief that another will cause one harm. Here, we examine the application of values-based interventions for reducing non-clinical paranoia. Finally, Paper 3 presents innovative data on the application of group ACT for individuals with Bipolar Affective Disorder who experience psychotic symptoms. This presentation will provide insight into developing and implementing the group-based intervention, as well as presenting data from a randomised control trial.

• The Relationship Between Schizotypy and Well-being: The Mediating Role of Psychological Flexibility
Emily Tuckey, La Trobe University
Eric Morris, La Trobe University
John Farhall, La Trobe University

Psychological flexibility refers to a unified model of interrelated mindfulness, acceptance, values-based and behaviour change processes which are considered to enhance human functioning and well-being. Inversely, processes of psychological inflexibility have been linked to psychopathology and poor quality of life, including a link to the well-being outcomes associated with psychosis. The current study sought to extend these findings to investigate whether psychological flexibility and inflexibility may predict the well-being of individuals with features of schizotypy—a continuum of psychotic-like experiences which extends from nonclinical presentations to schizophrenia and related disorders. The study employed a mediation design to explore whether psychological inflexibility mediated the relationship between schizotypy and well-being. Participants from a nonclinical Australian sample (N = 143) completed a series of online questionnaires related to schizotypal traits, psychological flexibility and inflexibility and mental well-being. Overall, the results found support that the relationship between schizotypy and well-being was mediated through psychological inflexibility. These findings have implications for clinical treatment options for individuals with schizotypal traits who present with distress.

• Immediate and short term effects of values-based interventions on paranoia
Jessica Kingston, Royal Holloway
Nicole Evans, Royal Holloway
Rebecca Carpenter, Royal Holloway
Lyn Ellett, Royal Holloway

Paranoia is a common, distressing, and persistent experience that can negatively impact on health, wellbeing, and functioning. This study examined the immediate and short term (2-weeks) effects of two values-based interventions, versus a non-values control, on paranoia, as well as the moderating effect of self-esteem. 171 non-clinical adults were randomised to a value and goals task (VAG: clarifying and reflecting on core values and setting value-based goals), a values task (VA: clarifying and reflecting on core values without setting value-based goals), or a non-affirmation control task (NAC). VAG was uniquely associated with significant reductions in paranoia both immediately following the intervention (d=.27) and again at a two-week follow-up (d=.26). This effect was moderated by trait self-esteem. The findings suggest that focusing on a deeply held value and setting goals in line with that value reduced paranoia. This intervention may be most beneficial for individuals with low self-esteem.

• ACT for Bipolar Affective Disorder: The Balancing ACT project
Emma O’Donoghue, DClinPsy, South London and Maudsley NHS Foundation Trust

Bipolar disorder is a chronic and disabling psychiatric condition that places a heavy burden on sufferers, families and society. Many service users with bipolar also experience prominent psychotic symptoms and relapses characterised by repeated manic psychotic episodes and grandiosity. Such presentations require specific adaptations to standard bipolar disorder interventions in order to address their psychosis, alongside mood regulation, with a particular emphasis on impulsivity, irritability, disinhibition and elation. The Balancing ACT study aimed to evaluate an innovative group intervention combining Acceptance and Commitment Therapy and psychoeducation approaches with individuals experiencing bipolar disorder and/or symptoms within community psychosis services. This presentation will introduce the Balancing ACT project, and discuss the practical application and findings from the study Balancing ACT RCT.

Educational Objectives:
1. To compare the theoretical interface between ACT and symptoms of psychosis and bipolar affective disorder. 2. To dicuss the practical implementation of ACT-based interventions for individuals experiencing Bipolar Affective Disorder and/or paranoia. 3. To demonstrate knowledge of evidence-base for ACT and serious mental illness.

 

16. RFT analyses of rule-governed behavior and interventions to promote psychological flexibility
Symposium (10:35-12:05)
Components: Conceptual analysis, Original data
Categories: Relational Frame Theory, Clinical Interventions and Interests, Rule-governed behavior, learning difficulties, gifted children
Target Audience: Beginner, Intermediate, Advanced
Location: Q217

Chair: Iduar Dereix-Calonge, Fundación Universitaria Konrad Lorenz
Discussant: Carmen Luciano, Ph.D., Universidad de Almería

Experimental analyses of functional classes of rule-governed behavior (RGB) have experienced some difficulties and there is scarce empirical evidence on this topic. A recent research avenue has been opened by designing self-report measures of RGB such as the Generalized Pliance Questionnaire (GPQ; Ruiz, Suárez-Falcón, Barbero-Rubio, & Flórez, in press). The current symposium presents two studies that try to empirically link the literature on RGB with that of executive functions. This link was established by analyzing the correlations between self-reports of functional classes of RGB and executive function tests. The third study presented in this symposium shows a more clinically oriented study with gifted children with school maladjustment. Participants in this study were applied a brief, ACT protocol focused on reducing repetitive negative thinking with regard to school tasks and to promote generalized tracking.

• Generalized pliance and learning difficulties: An empirical investigation
Daniela M. Salazar, Fundación Universitaria Konrad Lorenz
María B. García-Martín, Fundación Universitaria Konrad Lorenz
Francisco Ruiz, Ph.D., Fundación Universitaria Konrad Lorenz

Previous research has found that a measure of generalized pliance, the Generalized Pliance Questionnaire (GPQ), shows strong positive correlations with tests of insensitivity to contingencies such as the Wisconsin Card Sorting Test (WCST) (O’Connor, Byrne, Ruiz, & McHugh, in press). Also, recent research has adapted the GPQ to be used in children (GPQ-C; Salazar, Ruiz, Flórez, & Suárez-Falcón, 2018). The current research analyzes the association of the GPQ-C with WCST and learning difficulties. A total of 38 children aged 7-10 years participated. Half of the participants were assessed as presenting a learning difficulty in language or mathematics. The other half of the participants were children with an average performance at school. All participants responded to the GPQ-C and the WCST. The results showed that participants with learning difficulties showed statistically significant higher scores in the GPQ-C (displaying greater generalized pliance) and insensitivity to contingencies. The scores on the GPQ-C and WCST showed a strong positive correlations. Results are discussed emphasizing the role of the transitions from pliance to tracking in school performance in children.

• Functional classes of rule-governed behavior and executive functions
María B. García-Martín, Fundación Universitaria Konrad Lorenz
Luna Bedoya-Valderrama, Fundación Universitaria Konrad Lorenz
Andrés Peña-Vargas, Fundación Universitaria Konrad Lorenz
Jorge E. Ávila, Fundación Universitaria Konrad Lorenz
Juan F. Gómez, Fundación Universitaria Konrad Lorenz
Vanessa Calle, Fundación Universitaria Konrad Lorenz
Francisco Ruiz, Ph.D., Fundación Universitaria Konrad Lorenz

Recent research has found that measures of functional classes of rule-governed behavior (RGB) significantly correlates with some executive function tests. For instance, O’Connor, Byrne, Ruiz, and McHugh (in press) found that scores on generalized pliance in adults showed strong positive correlation with measures of cognitive inflexibility such as Wisconsin Card Sorting Test (WCST). Also, Salazar, García-Martín, and Ruiz (in preparation) found that a measure of generalized pliance for children discriminated between children with learning difficulties and children with average performance at school. This study also obtained strong positive correlation between the measure of generalized pliance and the WCST. This study aimed to analyze in a more systematic way the relationships between executive function tests and self-reported measures of functional classes of RGB. One-hundred and four participants responded to a battery of executive functions and to measures of generalized pliance, generalized self-pliance, and generalized tracking. Preliminary analyses show significant positive correlations between measures of pliance and cognitive inflexibility, and significant positive correlations between tracking scores and performances in behavioral inhibition.

• Effect of a brief RNT-focused ACT protocol in improving school adjustment of exceptionally gifted children
Yury A. Larrea, Fundación Universitaria Konrad Lorenz
María B. García-Martín, Fundación Universitaria Konrad Lorenz
Francisco Ruiz, Ph.D., Fundación Universitaria Konrad Lorenz

An exceptionally gifted child stand out in general intelligence, easily learns contents of any domain, and demonstrate behavior more sophisticated than his/her reference group. However, a good number of exceptionally gifted children presents school maladjustment due to experiencing school tasks as low-demanding and boring. This usually leads to emotional difficulties and scholar failure. The current study describes the effect of a brief ACT intervention focused on disrupting rumination and procrastination, and increase valued actions in exceptionally gifted children. A multiple-baseline design across participants was used with 5 children experiencing significant levels of school maladjustment. All children were identified as exceptionally gifted by means of intelligence quotient and learning potential tests. The results showed significant reductions of children’s rumination and procrastination, and improvements of engagement in valued behaviors according to nonparametric tests for single-case experimental designs.

Educational Objectives:
1. Discuss the relationships between functional classes of rule-governed behavior and executive functions. 2. Identify the relevance of transitioning from a rule-governed behavior characterized by pliance to tracking. 3. List strategies to promote school adjustment in gifted children. 

 

17. Behavioral Measures of Experiential Avoidance: Context, Measurement, and Emotion Regulation Strategies as Predictors of Performance on Two Analogue Tasks
Symposium (10:35-12:05)
Components: Conceptual analysis, Original data
Categories: Theoretical and philosophical foundations, Functional contextual approaches in related disciplines, Experiential avoidance, behavior analogue research, emotion regulation
Target Audience: Intermediate
Location: Q218

Chair: Amy Naugle, Western Michigan University
Discussant: Robert Whelan, Ph.D., Trinity College Dublin

Experiential avoidance (EA), the unwillingness to experience aversive private events, is considered a core pathogenic process in the development and maintenance of human suffering. While acceptance and mindfulness-based psychotherapies appear to undermine EA, less is understood regarding contextual factors that evoke experientially avoidant responding. The present symposium will present data from a convenience sample (N = 160) of participants who completed the cold pressor task (see Zettle et al., 2012) and a modified version of the Trier Social Stress Task (TSST) to investigate behavioral, physiological, and emotional factors associated with EA. The first presentation will report findings on individual differences in contextual variables associated with self-reported EA across both tasks. The second presentation centers around the relationship between heart rate variability and socially desirable responding with avoidance strategies and context. The latter talk will focus on the unique contributions of interpersonal sensitivity to state emotion dysregulation and performance on these analogue tasks. Implications of these studies will be used to further understand and advance contextual behavioral science in each of these domains.

• An Investigation of the Role of Context in Predicting State and Trait Experiential Avoidance
Meaghan Lewis, Western Michigan University
Amy Naugle, Western Michigan University
Tabitha DiBacco, Western Michigan University
Kyra Bebus, Western Michigan University
Allie Mann, Western Michigan University

The purpose of the present study was to compare two seemingly disparate contexts in predicting experiential avoidance (EA) in the moment (state) and trait EA. Performance on the cold pressor task, which involved immersion of participants’ left hands in ice water, was measured along four operationalized dimensions of EA as originally described by Zettle and colleagues (2012). To compare EA related to physical discomfort with tasks that evoke social discomfort, these domains were further investigated using a modified version of the Trier Social Stress Task (TSST). While self-reported state and trait EA were associated with each task independently, EA as measured by the cold pressor task was not predictive of EA as measured by the TSST. This suggests that while EA may represent a functional response class across some contexts, certain strategies to manage emotion in the moment may be idiographic and sensitive to context. Individual differences in established measures of trait EA as predictors of state EA and emotion dysregulation will be discussed with implications for further conceptualization, measurement, and treatment of EA.

• Measurement Matters: Testing the Relationship between Experiential Avoidance and Physiological Variables in the Moment
Tabitha DiBacco, Western Michigan University
Meaghan Lewis, Western Michigan University
Amy Naugle, Western Michigan University
Kyra Bebus, Western Michigan University
Allie Mann, Western Michigan University

Experiential avoidance (EA) is one of several transdiagnostic variables that may have a role in the etiology and maintenance of various forms of psychopathology. As with many private events, EA is often quantified with self-report measures such as the Acceptance and Action Questionnaire (AAQ-II) and Multidimensional Experiential Avoidance Questionnaire (MEAQ). As self-report measures have limitations in validity, there is a need to further evaluate construct validity as well as behavioral and physiological measures (Lewis & Naugle, 2017; Rochefort, Baldwin, & Chmielewski, 2017). A small body of research has examined physiological measures along with EA with mixed findings and all studies utilized the AAQ (Sloan, 2004; Cochrane, Barnes-Holmes, Stewart, & Luciano, 2007; Salters-Pedneault, Gentes, & Roemer, 2007). The present study utilized heart rate data along with state and trait measures of EA to assist in mapping this physiological measure onto EA. Initial findings indicate increased heart rate variability is inversely associated with EA on the TSST. The role of state emotion regulation and socially desirable responding as moderators of these findings will be discussed.

• Interpersonal Sensitivity and Social Stress: The Role of State Experiential Avoidance
Kyra Bebus, Western Michigan University
Meaghan Lewis, Western Michigan University
Amy Naugle, Western Michigan University
Tabitha DiBacco, Western Michigan University
Allie Mann, Western Michigan University

From a functional contextual perspective, experiential avoidance (EA) can be conceptualized as a functional response class accounting for comorbidity across diverse forms of psychopathology (Thompson & Waltz, 2010; Cribb, Moulds, & Carter, 2006; Newman, & Llera, 2011; Kashdan et al., 2014; Zettle et al., 2012). While several research teams are beginning to evaluate behavioral and physiological measures associated with EA, more research is needed to understand the unique role of EA in socially uncomfortable tasks. Thus, the aims of the present study were to contrast analogue tasks in a laboratory setting with self-report measures of state and trait anxiety, negative affect intensity, and fear of negative evaluations. Participants who reported higher levels of trait interpersonal sensitivity demonstrated stronger negative affect intensity, state EA, and state emotion dysregulation following exposure to a social stress task. Interventions that target EA may be improved through more thorough assessment of interpersonal sensitivity. Clinical implications of these findings will be discussed in terms of the impact of treating symptoms using a dimensional approach to conceptualization.

Educational Objectives:
1. Describe the relationship between state/trait experiential avoidance and context. 2. Assess alternative methods to the measurement of experiential avoidance outside of self-report. 3. Critique the contributions of interpersonal variables and physiological contributions to psychological distress, emotion regulation, and experiential avoidance.

 

18. Using contextual behavioural science to predict and influence resilience in those with high negative affect
Symposium (10:35-12:05)
Components: Original data
Categories: Prevention and Community-Based Interventions, Clinical Interventions and Interests, Resilience, Depression, Suicide, ACT, Values, Ultra-brief
Target Audience: Beginner, Intermediate
Location: Q220

Chair: Nick Hulbert-Williams, University of Chester
Discussant: Lee Hulbert-Williams, University of Chester

Resilience enables people to adapt to adversities. Contextual Behavioral Science (CBS), particularly Acceptance and Commitment Therapy (ACT), offers a framework from which to develop and test interventions that encourage valued action, and build resilience to uncontrollable contextual factors and negative internal events; this symposium presents three papers testing these ideas. Paper one presents cross-sectional data from two studies, including the first time-point of a longitudinal study. These studies explore the relevance of CBS-based constructs (e.g., psychological flexibility) as protective and risk factors for suicidality (e.g., suicide ideation, self-harm, suicide attempts) in the general population. Paper two presents a double-blind randomised active-controlled study testing a novel values clarification exercise, “anti-values”. This makes use of negativity biases, commonly seen in clinical populations, to encourage valued action, goal-generation, and resilience against negative affect (including hopelessness) across time. The final paper presents a randomised-controlled study testing the use of an ultra-brief ACT/coaching intervention to boost resilience to aversive social interactions.

• Are Acceptance and Commitment Therapy-related processes protective against suicidality cross-sectionally?
Rosina Pendrous, University of Chester
Kevin D. Hochard, University of Chester
Lee Hulbert-Williams, University of Chester
Nick Hulbert-Williams, University of Chester

Suicide is a leading cause of death. Acceptance and Commitment Therapy (ACT) is potentially useful for those with suicidal thoughts to (re-)find meaning, however, few studies have explored whether ACT-related constructs are protective against suicidality cross-sectionally and over-time. In the first study, student participants (N=271) completed ACT process measures, defeat and entrapment, burdensomeness and belongingness, depression, anxiety and stress, and suicidal ideation, to assess cross-sectional relations. A second study using a cross-lagged design with three-time points is under-way to replicate and extend these findings longitudinally with members of the general population (target N=500). Cross-sectionally, suicidal ideation correlated with two measures of psychological flexibility (r=.50 and .63; p<.01), behavioral awareness (r=.38; p<.01), openness to experience (r=.47; p<.01), and valued action (r=.38; p<.01). Recruitment is ongoing for the longitudinal study. We aim to present preliminary cross-sectional data from both studies. The results from the first study tentatively suggest that ACT processes may be relevant to suicidality and contemporary theories of suicide yet need replicating. Overall, this research could inform treatment and preventative interventions.

• Integrating approach and avoidance to achieve valued living: developing and piloting anti-values clarification exercises across time
Kevin D. Hochard, University of Chester
Shane McLoughlin, University of Chester
Rosina Pendrous, University of Chester
Lee Hulbert-Williams, University of Chester
Francesca Todd, University of Chester
Nick Hulbert-Williams, University of Chester

Value clarification exercises (VCE) are common across third-wave behavioural therapies to aid goal generation and encourage valued action. Those with higher levels of negative emotion have difficulty problem-solving, future-thinking, and may be less able to specify and elaborate their values prior to setting achievable goals. These abilities are, however, crucial to success in conventional VCEs. We aimed to test a novel VCE (“anti-values”) suitable for those with negativity biases commonly seen in clinical populations. A double-blind randomized active-controlled experiment obtained baseline measures of personality, hopelessness, depression, anxiety (state and trait), stress, mood, and psychological flexibility. Participants completed either the anti-values VCE, a conventional VCE, or a goal-setting task. Post-intervention (and four-week follow-up), participants completed state measures of mood, anxiety, hopelessness, and valued action. Data collection is ongoing (currently N=30). Baseline and follow-up data will be presented (expected N=60). Preliminary analysis indicated that all conditions are equivalent to goal-generation. Our results tentatively indicate anti-values to be a useful alternative VCE for clinicians working with individuals who express high negative affect and hopelessness.

• Social Resilience: Ultra-brief Acceptance and Commitment Coaching
Kevin D. Hochard, University of Chester
Lee Hulbert-Williams, University of Chester
Sam Ashcroft, University of Chester

Social support and positive interactions are protective from psychopathologies, yet day-to-day interactions are seldom solely positive. The present study tests the efficacy of ultra-brief ACT coaching to increase resilience to negative social interactions. An RCT of ultra-brief (1hr) non-expert delivered ACT was compared to a CBT analogue, and placebo control (relaxation and information). Participants (n=60) were assessed on perceived burdensomeness, belonging, and 3 scenarios measuring anxiety, motivation and likelihood to engage in social situations. Participants then played Cyberball, an ostracising task, before recompleting aforementioned measures. Physiological measures indicate Cyberball to have been a stressful experience. Yet, a significant interaction (Group×Time) effect was observed (η2par=.147, p<.05) for likelihood to engage. Post-hoc tests indicated ACT increased motivation (d=.580, p<.05) and likelihood to engage (d=.757, p<.01) in the social scenarios. Ultra-brief ACT coaching interventions delivered by non-expert coaches appear promising in increasing participant’s likelihood to continue engaging in social interactions after a stressful social experience. Tentatively, gains in committed action are suggested to increase propensity in at-risk individuals’ to seek social support.

Educational Objectives:
1. Explain how ACT-based processes relate to contemporary predictors of suicidality. 2. Demonstrate the utility of a novel values clarification exercise that harnesses negativity biases to encourage valued behaviour. 3. Demonstrate the utility of an ultra-brief non-expert delivered intervention in fostering resilience.

 

23. Adapting and applying ACT to meet the needs of Older Adults: Aging in Context SIG Sponsored
Symposium (13:20-14:50)
Components: Literature review, Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Clinical Interventions and Interests, Supervision, Training and Dissemination, Professional Development, Ageing, older adults, group interventions, values, assessment
Target Audience: Intermediate
Location: The Studio

Chair: Clive Ferenbach, DClinPsy, National Health Service (NHS) Lanarkshire
Discussant: Susan McCurry, Ph.D., University of Washington

In the context of an ageing population, there is an escalating need to develop effective evidence based psychological treatments for older adults (OA). Various aspects of ACT, including its trandiagnostic applicability and evidence base in chronic health conditions, make it an intuitively appealing intervention for this population. Accordingly, the approach is gathering increasing interest from researchers and clinicians. This symposium will provide an overview of ACT’s applicability with OA and the current evidence base - and discuss how assessment, treatment, and formal measurement (particularly values) may be adapted to meet the needs of this population. Consideration will also be given to how ACT can be applied beyond individually delivered therapy, both by training the mental health workforce, and delivering group interventions.

• Aging Changes Things: Adapting ACT to Meet the Needs of an Aging Population
Pamela Steadman-Wood, Ph.D., ABPP, U.S. Department of Veterans Affairs, Providence VA Medical Center & Alpert Medical School of Brown University

The population of adults over the age of 65 is increasing around the world. Once an underserved population, older adult psychotherapy referrals are on the rise. As such, there is a need to strengthen the mental health workforce and training to serve this population. ACT is an effective intervention for older adults experiencing a range of psychological issues. The trans-diagnostic approach normalizes experiences common to aging and may be advantageous given the diversity of issues encountered. However, using ACT effectively with older adults can require making accommodations to compensate for aging related changes. Individuals treating older adults may benefit from learning the nuances of using ACT in this population. This paper will provide an overview of the rationale and research on ACT for older adults and discuss assessment and treatment adaptation considerations shown to be useful in adapting ACT for the unique of this population.

• A mixed methods feasibility study of group-based acceptance and commitment therapy with older people with mental health difficulties.
Clive Ferenbach, DClinPsy, National Health Service (NHS) Lanarkshire
Elizabeth Dewey, DClinPsy, National Health Service (NHS) Lanarkshire
Hamish McLeod, Ph.D., CPsychol, University of Glasgow

Traditional CBT has demonstrated mixed findings for older people with mental health difficulties. Due to the types of difficulties associated with old age, Acceptance and Commitment Therapy (ACT) could be a viable alternative treatment. This feasibility study used mixed methods to explore the acceptability and feasibility of delivering ACT groups to older people in an outpatient setting. 14 participants were recruited, nine of these completed the group and eight were interviewed. Results suggested that 12 weeks after the last session, completers’ anxiety and cognitive fusion scores significantly decreased. Interviews suggested that ACT was acceptable to participants. Conclusions: ACT is both a feasible and acceptable transdiagnostic intervention for older people in an outpatient setting. Preliminary quantitative analysis suggested the intervention reduced anxiety and cognitive fusion; however, this should be measured in future intervention studies with higher participant numbers (further data is currently being gathered by this research group). Qualitative analysis suggested older people appreciated the focus on visual materials (including metaphors), and the intervention seemed to increase their perspective taking and self-efficacy.

• Values Across the Lifespan Questionnaire (VALQUEST): Development of a New Values Assessment Tool for Use with Older Adults
Casey C. Catlin, Ph.D., Boston VA Research Institute, Inc.

Values are a core process of Acceptance and Commitment Therapy (ACT) and are especially important in work with older adults, who must adapt to inevitable changes and losses. The Values Across the Lifespan Questionnaire (VALQUEST) was developed to explore a more concrete yet flexible approach for values assessment to meet the needs of older adults. The VALQUEST covers three relevant life domains, allowing respondents to choose specific values from a provided list of exemplars, rate its importance, the motivation behind it (from an intrinsic or extrinsic perspective), and values-consistent behavior. The VALQUEST was administered to 488 adults (253 over age 55) along with other self-report measures. Factor analysis yielded a three-factor structure. The VALQUEST showed significant correlations with the Valued Living Questionnaire (VLQ: Wilson, Sandoz, Kitchens, & Roberts, 2010) and measures of psychological flexibility, committed action, depression, life satisfaction, ageism, and future time perspective, consistent with hypotheses. The VALQUEST also shows promise as a measure that could be modified to fit the needs of future research with specific populations or time series designs.

Educational Objectives:
1. Apply the research and clinical practice of ACT for older adults into existing practice. 2. To discuss how ACT can be adapted for delivery to older adults in group based interventions, and of qualitative and quantitative outcomes gathered from this approach. 3. Learners will administer and score a new values assessment tool for older adults.

 

29. Contacting values to produce change that matters
Symposium (13:20-14:50)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, values, Compassion, Careless Responding
Target Audience: Beginner, Intermediate, Advanced
Location: Q122

Chair: Ryan Moses, Metropolitan State University of Denver
Discussant: Steven C. Hayes, Ph.D., University of Nevada, Reno

Acceptance and Commitment Therapy (ACT) therapists teach clients to engage in values-based action despite the presence of difficult internal experiences. Although values is a core process in ACT, empirical literature demonstrating the isolated impact of values on behavior is limited. The purpose of the symposium is to discuss two values studies and a theoretical conceptualization of the intrinsic nature of values. In the first presentation, a study evaluating the impact of a values writing intervention on goal completion and mood will be discussed. The second presentation will discuss a study examining the efficacy of a values protocol on fear and avoidance responding. The symposium will close with a discussion about the contingencies of meaning.

• The efficacy of values writing and positive affirmations interventions on behavioral change in the context of relationships
Maureen Flynn, Ph.D., Metropolitan State University of Denver
Michael Bordieri, Ph.D., Murray State University

The aim of the study was to compare the efficacy of two brief interventions on mood and goal completion. Participants (n = 245) were randomly assigned to either the values writing or positive affirmations condition. As predicted, we found that participants in the values condition reported no difference in mood at post-intervention or 3-day follow-up and no difference in self-esteem at post-intervention or 3-day follow-up. Contrary to our predictions, participants in the values condition did not report higher challenge of self-selected goal at post or higher goal completion at 3-day follow up. Our hypothesized moderation models involving both trait self-esteem and psychological inflexibility were not supported; however, both trait self-esteem and psychological inflexibility displayed significant conditional effects on study outcomes. The implications of these findings on future research and clinical applications will be discussed, with particular attention given to our observed failure to replicate previous analogue studies involving positive affirmation (Wood. Perunovic, & Lee, 2009) and values writing (e.g., Crocker, Nijya, & Master, 2007).

• Analyzing the impact of a significant-valued-based protocol on experimentally induced fear and avoidance responding
L. Jorge Ruiz-Sánchez, M.A., University of Almería
Carmen Luciano, Ph.D., Universidad de Almería

Defusion and values-based protocols are built of interactions that involve responding from the hierarchical I-perspective by integrating rules-specifying aversive/appetitive consequences. Say another way, responding under the overarching motivative functions, as higher order establishing operations, while integrating rules driven emotive functions present at the moment. The aim of the present study was to isolate the impact of a non-significant valued task versus a significant-high order valued task on fear and avoidance responding. Firstly, 30 participants underwent an aversively conditioned task where non-avoidance was followed by shocks and noises, whereas a black screen followed avoidance responding. Next, participants randomly received one of three protocols: (a), deictic/hierarchical framing the aversive shock functions in hierarchy with the perspective of I while linking this perspective to a non-significant-higher valued task; (b), as (a) plus adding a significant-higher order valued task. And (c), a control protocol did not include any active component. Lastly, participants repeated the experimental task. Results show that framing the aversive shock functions from the hierarchical-I perspective and linking this perspective to high-order functions, alters avoidance responding.

• Contingencies of meaning: Values and the evolution of behavior theory
Kelly G. Wilson, Ph.D., University of Mississippi

Values are ways of speaking about human motivation. Victor Frankl describes a critical moment in a Nazi death camp. Though he could offer little hope of survival, he discovered a profound sense of liberation in remaining in the camp. Although Frankl had the opportunity to leave, he stayed and allowed being a doctor to be enough—likely forfeiting his life. How are we to understand reinforcers powerful enough, not only to keep Frankl in the camp, but to afford a sense of liberation, meaning, and purpose? In this talk, I will focus on the intrinsic nature of reinforcement within a CBS analysis of values. I will describe a technical analysis of “contingencies of meaning” that will clarify the source of reinforcement in valued action. A behavioral theory that cannot describe and investigate the contingencies surrounding the most profound human action falls short of the aims of ACBS. Because the analysis will explicate an extraordinarily source of reinforcement, it also lays a foundation for analysis of the opposite—an analysis of despair, moral injury, and hopelessness.

Educational Objectives:
1. Attendees will be able to describe the efficacy of values writing and positive affirmation interventions on goal completion and mood. 2. Attendees will be able to describe the efficacy of responding under the overarching motivative functions while integrating aversive functions and their implication for the treatment of anxiety disorders. 3. Attendees will be able to recite a definition of “contingencies of meaning.”

 

30. Advances in ACT for behavioral medicine and substance-related disorders
Symposium (13:20-14:50)
Components: Original data
Categories: Behavioral medicine, Clinical Interventions and Interests, Clinical Interventions and Interests, Prevention and Community-Based Interventions, Heart disease, Smoking, smoking cessation, schizophrenia, Health, Obesity, ACT and Addiction of Methamphetamine
Target Audience: Beginner, Intermediate, Advanced
Location: Q158

Chair: Martin O'Connor, M.Sc., University College Dublin

A growing body of evidence supports ACT as a promising treatment approach for health problems and addictive behaviors. This six-paper symposium focuses on recent advances in ACT for behavioral medicine and substance-related disorders. Paper 1 evaluates the efficacy of an ACT intervention in improving modifiable risk factors in people with coronary heart disease. Paper 2 investigates the contribution of an ACT-based smartphone app to ACT group treatment for smoking cessation. Paper 3 reports on the efficacy of an individual, face-to-face ACT intervention for smoking cessation in people with schizophrenia. Paper 4 focuses on fostering a healthy lifestyle with ACT and wearable technology. Paper 5 evaluates the efficacy of an ACT intervention in reducing substance use and impulsive behaviors in people with methamphetamine dependence. Paper 6 investigates the efficacy of a resilience group intervention based on ACT for people with multiple sclerosis.

• The ACTonHEART study: a two-arm RCT of a brief multi-discliplinary ACT programme for improving modifiable risk factors in people with Coronary Heart Disease.
Chiara A. M. Spatola, Catholic University of Sacred Heart, Milan
Emanuele A.M. Cappella, Catholic University of Sacred Heart, Milan
Roberto Cattivelli, Catholic University of Sacred Heart, Milan

The ACTonHEART study is the first RCT to evaluate the effectiveness of an ACT-based intervention protocol focused on promoting a change in lifestyle and reducing psychological stress of cardiac patients. 92 patients were enrolled and randomized, following an unbalanced randomization ratio of 2:1, to the ACTonHEART group (N= 59) and the control group (N= 33). The ACTonHEART protocol consists in 3 sessions, integrating educational topics on heart-healthy behaviours with acceptance and mindfulness skills. Participants were assessed at baseline (t0), at the end of the rehabilitation period (t1), and at a six-month follow-up (t2). A partially-nested design with three levels was used. Well-being significantly improved from t1 to t2 (β= 3.16, p< .001) regardless of the treatment condition (β= -0.01, p=0.996). The BMI levels decreased only in the ACTonHEART group. The time x treatment interaction showed a trend towards significance (β= 0.40, p= 0.08). Even for psychological inflexibility, a greater decrease over time in the ACTonHEART group was observed . The results of this first pilot study may inform the future implementations of the ACTonHEART program.

• Randomized controlled trial of a smartphone application as an adjunct to acceptance and commitment therapy for smoking cessation.
Martin O'Connor, M.Sc., University College Dublin
Robert Whelan, Ph.D., Trinity College Dublin
Jonathan Bricker, Ph.D., Fred Hutch Cancer Research Center & University of Washington
Louise McHugh, Ph.D., University College Dublin

Background: There is a major public health need for innovative and efficacious behavioral and cognitive interventions for smoking cessation. This randomized controlled trial evaluated the efficacy of an acceptance and commitment therapy (ACT) smartphone application in augmenting ACT group treatment for smoking cessation. Method: One hundred fifty adults smoking 10 or more cigarettes per day were randomly assigned to six weekly group sessions of behavioral support, ACT or ACT combined with the smartphone application. Measures of smoking status and ACT processes were obtained at baseline, post-treatment and six-month follow-up. Results: Biochemically verified quit rates in the combined, ACT and behavioral support groups were 36%, 20% and 24% at post-treatment, as compared with 24%, 24% and 20% at follow-up. The combined group reported significantly greater smoking reduction, acceptance and present-moment awareness than the behavioral support group at post-treatment, but not at follow-up. Conclusions: The combined intervention was found to be acceptable and efficacious in promoting smoking reduction, acceptance and present-moment awareness at post-treatment. Smoking cessation outcomes were comparable across the combined, ACT and behavioral support groups.

• Individual, Acceptance and Commitment Therapy (ACT) in smoking cessation for people with schizophrenia: a randomized controlled trial
Yim-wah Mak, Ph.D., The Hong Kong Polytechnic University
Alice Yuen Loke, Ph.D., The Hong Kong Polytechnic University
Doris YP LEUNG, The Hong Kong Polytechnic University

Background: Smoking remains the major health threats among people with schizophrenia. Effective non-pharmacological intervention for smoking cessation for this group is lacking. Objective and methods: We conducted a randomized controlled trial comparing a 10 weekly individual, face-to-face Acceptance and Commitment Therapy versus social support, as adjunct to printed self-help quitting materials as usual in enhancing smoking cessation for people with schizophrenia living in the community. Assessments were performed at baseline before the start of the intervention, at post-intervention (3-month), 6-month and 12-month after initial session of intervention. Results: One hundred and thirty adults with schizophrenia were recruited from 49 mental health rehabilitation settings in the community. No evidence of statistically significant differences between the ACT and social support groups were observed for the smoking cessation outcomes. Participants of the ACT group reported a significant in reduction of smoking related experiential avoidance and general experiential avoidance when compared with the social support control group. Participants of the ACT group were also more willing to experience negative thoughts and feelings related to quitting smoking.

• Merging ACT and wearable technology: the ACTonHEALTH feasibility study. Fostering healthful lifestyle with ACT and wearable technology to promote psychological flexibility and modular behavioral change
Rob Cattivelli, Ph.D., PsyD, Istituto Auxologico Italiano; Catholic University of the Sacred Heart, Milan
Giorgia Varallo, Istituto Auxologico Italiano; Catholic University of the Sacred Heart, Milan
Anna Guerrini Usubini, Catholic University of the Sacred Heart, Milan
Nicola Maffini, Casagioia Research Centre
Gianluca Castelnuovo, Istituto Auxologico Italiano; Catholic University of the Sacred Heart, Milan
Enrico Molinari, Istituto Auxologico Italiano; Catholic University of the Sacred Heart, Milan

Obesity is increasing steadily and becoming globally epidemic. Recent reports assess about 60% of the adult population as overweight in western countries with a increasing social and economic impacts, while most of the rehabilitation programs, do not produce long-lasting results. From a behavioral perspective can describe the phenomena with the lack of sources of reinforcement related to healthful habits in a daily life context. A feasibility first clinical study combining single-subject studies and group design will be conducted to compare the effect of the current standard in obesity treatment to Acceptance and Commitment Therapy (ACT) enhanced by wearable technology. The goal of this project, is to develop an effective intervention, efficient and sustainable, which even after the end of the intensive rehabilitation treatment can provide adequate contingencies of reinforcement in the natural environment, integrating systematic measurements, continuous feedback, and individualized, values-based objectives. Modular implementation of ACT with wearable technology are a promising field, enhancing deep understanding of psychological and behavioral processes implicated in health, and helping to create more efficient interventions. Preliminary results are discussed.

• Single-blinded, mixed methods, randomized controlled trial on a resilience training for people with MS
Ambra Mara Giovannetti, Fondazione IRCCS Istituto Neurologico C Besta, Milan, Italy; University of Queensland
Rui Quintas, Fondazione IRCCS Istituto Neurologico C Besta, Milan
Irene Tramacere, Ph.D., Fondazione IRCCS Istituto Neurologico C Besta, Milan
Andrea Giordano, Fondazione IRCCS Istituto Neurologico C Besta, Milan
Alessandra Solari, MD, Fondazione IRCCS Istituto Neurologico C Besta, Milan
Kenneth Pakenham, University of Queensland

Aim: To evaluate the efficacy of a resilience group intervention based on ACT (READY) in a sample of people with multiple sclerosis. Methods: Single-blind randomized controlled trial (RCT) and nested qualitative study. Measures of quality of life, mood, resilience, psychological flexibility and its protective factors were collected at baseline, after seven, 12, and 24 weeks. The interviews were run within 3 months of finishing the Italian READY for MS groups. Results: Four intervention groups were conducted (20 READY for MS; 19 relaxation). Thirty participants were interviewed. Repeated measures analyses revealed significant “time effect” (p < 0.02) for almost each variables assessed, but no “time X randomization effect” (p > 0,20). The thematic analysis delineated four main topics: attitudes towards the participation; participants’ opinion about READY; READY impact and determinants; differences and commonalities between READY and relaxation. Conclusion: READY for MS was not more efficacious than relaxation in terms of quantitative data, while qualitative data supported some trend differences detected at quantitative level. A multicentre RCT with a longer follow-up and wider sample size is needed.

• The efficacy of Acceptance and Commitment Therapy (ACT) on the severity of addiction and impulsivity in Methamphetamine users
Tahereh Seghatoleslam, Ph.D., University of Malaya, Centre of Addiction Sciences (UMCAS) Malaysia; Tehran University of Medical Sciences, PPRC Iran
Sajad Bahrami, Payame noor University Tehran
Hussain Habil, MD, University of Mahsa
Mohammad Reza Mohamadi, MD, Tehran University of Medical Sciences, Psychiatry and Psychology Research Center (PPRC)
Rusdi Rashid, MD, University of Malaya, Centre of Addiction Sciences

The present applied, an experimental, pretest-posttest, controlled study was conducted on the effectiveness of Acceptance and Commitment Therapy (ACT) in reducing substance use and impulsive behaviors in methamphetamine-dependent people. The statistical population consisted of individuals presenting substance abuse treatment centers in Tehran, Iran who used Methamphetamine. Thirty individuals were selected from this population and randomly assigned to the intervention and control groups. The intervention group received ACT training while the control group received no therapies. The Addiction Severity Index (ASI) and the Balloon Analogue Risk Task (BART) were used for data collection in this study. The data obtained from these questionnaires were analyzed using the ANOVA and ANCOVA. The results showed that the ACT-based intervention had a significant positive effect on impulsive behaviors and the severity of addiction and its components, Given the clinical outcomes of the theory of ACT and the results of the statistical analysis, it can be concluded that ACT is effective in reducing impulsive behaviors in substance abusers.

Educational Objectives:
1. Critically evaluate the efficacy of ACT interventions for health problems and addictive behaviors. 2. Discuss the role of psychological flexibility processes in alleviating a variety of problems. 3. Describe recent advances in ACT for behavioral medicine and substance-related disorders.

 

31. Application of Modern Technology in Ambulatory Assessments in Clinical and Basic Research: ACTing with Technology SIG Sponsored
Symposium (13:20-14:50)
Components: Original data
Categories: Clinical Interventions and Interests, Clinical Interventions and Interests, Laboratory Research, Technology and Digital Innovation
Target Audience: Beginner, Intermediate
Location: Q217

Chair: Andrew Gloster, Ph.D., University of Basel
Discussant: JoAnne Dahl, Uppsala University, Sweden

New Technologies empower researchers to gather data during participants’ lives. Two examples for such technologies are Smartphones and Wearables. Both can be given to a participant to carry/wear throughout the day. They allow the measurement of psychological and physiological variables in real-time in a natural environment, hereby increasing ecological validity and enabling an insight into processes that happen outside of the researcher’s presence. In this symposium three papers will be present how this technology can be used in clinical and laboratory research. The first two presentations use Experience Sampling Method (ESM), gathering baseline data from transdiagnostic in- and out-patients to assess psychological variables and ACT-specific processes. The first paper examines engagement and avoidance of social interactions as well as committed action. The second describes sleep, anticipatory stress, and psychological flexibility and examines how these variables interact. The third paper compares physiological variables assessed with a wearable and a stationary device in an experimental pain induction paradigm in order to establish the feasibility of wearables as a means to collect data in real-time.

• Committed action and the quality and avoidance of social interactions
Jeanette Villanueva, University of Basel
Andrea H. Meyer, University of Basel
Marcia T. B. Rinner, University of Basel
Victoria J. Firsching, University of Basel
Charles M. Benoy, University of Basel
Sandra Brogli, University of Basel
Klaus Bader, University of Basel
Andrew Gloster, Ph.D., University of Basel

Social functioning has been related to committed action (McCracken, 2013). However, how specific aspects of social interactions (SIs) are related to committed action remains an open question, especially in psychological disorders with problematic SIs as part of the clinical picture (e.g. in Major Depressive Disorder or Social Phobia, American Psychiatric Association, 2000; Baddeley, Pennebaker, & Beevers, 2013), suggesting a discrepancy between our values and our behavior. We investigated a sample of transdiagnostic in- and outpatients and examined how patients’ level of committed action was related to the quality and avoidance of SIs. Using Event Sampling Methodology, patients’ everyday social behavior was sampled six times per day during a one-week intensive longitudinal examination in their self-chosen environment. Preliminary results indicate an association between committed action and the quality and avoidance of SIs. Models will further examine how consistently patients act (in terms of what is important to them) from one time point to the next, and how this impacts the quality and avoidance of their SIs. Finally, we’ll investigate whether this differs for in- and outpatients.

• Interaction of Sleep Quality with Anticipatory Stress and Psychological Flexibility in a Clinical Sample - Preliminary Results
Victoria J. Firsching, University of Basel
Jeanette Villanueva, University of Basel
Marcia T. B. Rinner, University of Basel
Andrea H. Meyer, University of Basel
Charles M. Benoy, University of Basel
Sandra Brogli, University of Basel
Klaus Bader, University of Basel
Andrew Gloster, Ph.D., University of Basel

Low sleep quality affects patients both in in- and out-patient settings. Improving sleep may support the ability to handle anticipatory stress and can be thought of as a secondary goal of therapy. Experience Sampling Method (ESM) was collected from n=72 in-patients and n=37 out-patients in a transdiagnostic clinical trial with a wide range of diagnoses. Baseline data is analyzed to evaluate the sleep quality, anticipatory stress and psychological flexibility. Data was gathered with smartphones, six times a day over one week. Sleep, anticipatory stress, and psychological flexibility was assessed 1568 times (completion rate of 68.24%). 48.62% of participants were female and mean age was 34.61(13.24 SD). A multi-level model using sleep as dependent variable, and anticipatory stress, and psychological flexibility will be tested. It is hypothesized that the influence of anticipatory stress on sleep is moderated by the level of psychological flexibility. The results aim at improving the understanding of sleep disturbances of patients upon entering treatment. By using ESM data, this research shows the variance of sleep, stress, and psychological flexibility over one week.

• A comparison of wearable and stationary equipment in an experiment of pain induction
Pinelopi Konstantinou, University of Cyprus
Maria Karekla, Ph.D., University of Cyprus
Andria Trigeorgi, University of Cyprus
Chryssis Georgiou, University of Cyprus

There is a rise in the market with wearable devices that capture psychophysiological signals. However, the use of such devices has not yet infiltrated into experimental and clinical research. Reasons may include the lack of studies demonstrating the validity, reliability and sensitivity of these, in assessing psychophysiological indices. This study aimed to compare for the first time, psychophysiological data (SCR, HR, HRV) captured with a wearable device (Microsoft band) to those of a stationary device (Biopac MP150), in an experimental pain induction paradigm. The sample consisted of 43 students from the University of Cyprus (MeanAge=21.37), which participated in the Cold Pressor Task. Results showed that the indices of mean HR and HRV were very similar between stationary and wearable devices. However, no significant correlations were found for mean SCR. Implications include the establishment of a new way of collecting and analyzing psychophysiological data and in real-time. This in turn will help researchers to examine physiologically effective (e.g. acceptance) vs. ineffective (e.g. suppression) coping techniques of undesirable emotions continuously, in a less costly and time-saving way.

Educational Objectives:
1. Analyze how committed action impacts the quality and avoidance of social interaction. 2. Assess how sleep quality is linked to anticipatory stress and how psychological flexibility can impact it. 3. Utilize wearable devices to collect and analyze psychophysiological data in a laboratory setting and in real-time.

 

32. Contrasting perspectives on IRAP research: New applications, alternatives, and validity problems
Symposium (13:20-14:50)
Components: Conceptual analysis, Literature review, Original data, Experiential exercises
Categories: Relational Frame Theory, Clinical Interventions and Interests, Relational Frame Theory, IRAP, perspective-taking, empathy, Implicit measures (i.e., similar measures to the IRAP)
Target Audience: Beginner, Intermediate, Advanced
Location: Q218

Chair: Ian Hussey, Ph.D., Ghent University

The IRAP represents a significant investment of resources by the RFT community over the past 15 years. This symposium considers 1) new developments in IRAP research, 2) alternative measures that also attempt to capture relational responding, and 3) presents a critical examination of the IRAP literature to date. First, two talks discuss recent methodological evolutions in IRAP methodology to study perspective taking, including applications within the study of empathy and false-beliefs. Next, existing alternatives measures of relational responding are described, and suggestions are made for greater methodological variety in future research. Finally, across three talks, evidence is presented that suggests, worryingly, that the majority of published IRAP research has reached false conclusions, and why. Across talks, recommendations are made for whether and how the IRAP and its alternatives could, should, and should not be used in the future to achieve researchers’ goals.

• Preliminary use of the IRAP for the assessment of emotional perspective-taking
Álvaro Rodriguez, University of Jaén
Mónica Hernández-López, Ph.D., University of Jaén
Miguel Rodríguez Valverde, Ph.D., University of Jaén
Juan Carlos Lopez Lopez, Ph.D., University of Jaen

Abstract. In order to advance in the understanding of empathy from a functional-contextual perspective, the current study used an implicit relational assessment procedure (IRAP) for the assessment of emotional perspective-taking. Undergraduate students (N=30) completed a perspective-taking (PT) scale, a PT task (deictic relational task, DRT) and a spatial PT-IRAP (based on the study Barbero-Rubio, López-López, Luciano, & Eisenbeck, 2016). Subsequently, participants underwent a mood induction procedure. Half of the participants underwent the induction of a happy mood, and the other half underwent the induction of a sad mood before completing a second IRAP task. This IRAP was designed to evaluate verbal relations between one’s own (the participant’s name) or other’s perspective (a different participant’s name) and different emotional terms that were either consistent or inconsistent with the experimentally induced mood. Data collection is in progress. It is expected that participants will be faster in relating their own perspective as in coordination with emotional terms that are consistent with their experimentally induced mood.

• Exploring perspective-taking in a false-belief IRAP using pictures of self and other
Deirdre Kavanagh, Ph.D. candidate, Ghent University
Nele Matthyssen, Thomas More Hogeschool, Antwerp
Yvonne Barnes-Holmes, Ph.D., Ghent University
Dermot Barnes-Holmes, Ph.D., Ghent University
Ciara McEnteggart, Ph.D., Ghent University
Roberta Vastano, Ph.D., University of Miami

A growing body of IRAP research has focused on assessing verbal relations pertaining to the self and perspective-taking using various self-related stimuli. Experiment one sought to determine the feasibility of using matched pictures of self and of others across two IRAPs (N = 32). The results of the IRAPs were broadly consistent with common-sense expectations. Given these positive findings, experiment two sought to examine the impact of a brief vignette on performances on an IRAP containing self/other pictures and belief related statements (N= 60). Participants first completed a familiarisation IRAP, followed by one of two vignettes, one of which described a false-belief scenario and the other a control scenario. The results of the IRAPs were broadly consistent with the vignettes. That is, participants confirmed more readily than they denied that they had a true belief about the contents of a box and that the other had a false belief about the contents of a box. The specific limitations of the control condition and considerations for future research are discussed.

• New measures of verbal relational repertoires
Jamie Cummins, M.Sc., Ghent University
Jan De Houwer, Ph.D., Ghent University

Investigating the verbal histories of individuals is of critical importance to researchers within contextual behavioural science, in terms of both experimental investigation and clinical application. ‘Implicit measures’ are commonly employed for this purpose, both within cognitive and behavioural fields of research. By far the most frequently-used implicit measure of verbal histories within CBS is the IRAP, which has one key advantage over a number of its contemporaries: the ability to specify relations between experimental stimuli. From an RFT perspective, this relational component is critical if measures are to be successful in capturing verbal histories. Recently, the increased predominance of propositional theorising within cognitive psychology has led to the development of a variety of alternative implicit measures which can also capture relational information. These measures each possess unique features and advantages and may be better-suited to measuring verbal events than extant measurement approaches in certain contexts. This talk will discuss research findings from a number of these measures, which can broaden the scope of how CBS researchers investigate the verbal worlds of human beings.

• The IRAP is not sensitive to the domains it seeks to assess
Ian Hussey, Ph.D., Ghent University
Jamie Cummins, Ghent University
Chad Drake, Ph.D., University of Southern Illinois at Carbondale

The IRAP has been used in over 100 published studies by both applied and basic researchers. While researchers' goals can vary, for the IRAP to be useful, its results must be sensitive to the stimuli used within it. Put simply, differences in average performance should emerge between IRAPs designed to assess different domains (e.g., race, religion, body image, death). To test this, we conducted a (re)analysis of published and unpublished IRAP data across a large number of participants (N > 500) and a variety of domains (k = 7). Bayesian analysis demonstrated that equivalent effects were found across all domains. The domain being assessed accounted for a very small proportion of variance in IRAP effects (r2 < 0.05), whereas the majority of variance was instead attributable to a generic trial-type effect (r2 = 0.74). In short, variation in the IRAP effect seems to be driven predominantly by a generic response pattern that has little to do with the domain being tested, and which is even produced when nonsense words are used in the task.

• Common IRAP analytic strategies have a false positive rate approaching 100%
Ian Hussey, Ph.D., Ghent University
Jamie Cummins, Ghent University

This talk considers the implications of the generic trial type effect reported in the previous talk. First, we will discuss the most frequently used analytic strategies applied to IRAP data, as revealed by the systematic review in the third talk. We then outline why this generic response pattern within the IRAP invalidates the conclusions reached using many - but not all - of these common strategies. Second, results of a series of computational simulation studies will be discussed. These examine how the combination of (a) the generic trial-type effect and (b) the modal research practices for the analysis of IRAP data serve to inflate the false-positive rate. Results demonstrate that the false-positive rate due to the generic trial-type effect approaches 100%. Even when those problematic analyses are set aside, other commonly employed strategies highlighted by a systematic review serve to inflate the false positive rate to >40% - far above the 5% implied by an alpha value of 0.05. Results suggest that many commonly applied analytic strategies for IRAP data produce spurious conclusions.

• Most published IRAP research findings are false, and bias meta-analyses
Ian Hussey, Ph.D., Ghent University
Jamie Cummins, Ghent University
Chad Drake, Ph.D., University of Southern Illinois at Carbondale

Results from a systematic review demonstrate that the conclusions based on these problematic analytic strategies are ubiquitous in the IRAP literature (present in 82% of papers). Evidence of hidden researcher-degrees-of-freedom, low sample sizes, and a lack of sample size justifications was also observed (median n per cell = 16). These factors serve to inflate false-positive and false-negative rates, severely limiting the diagnostic value of any given p value in the literature. This has inevitable implications for meta-analyses: we updated one commonly cited meta-analysis of predictive validity (Vahey, Nicholson, & Barnes-Holmes, 2015) by excluding conclusions derived from problematic analytic strategies. This greatly reduced the meta-analytic effect size. In addition, whereas the original meta-analysis argued that there was no evidence of bias, we observed evidence of such bias in the original studies and the meta-analysis itself via the omission of a large number of results, further inflating the results. Together, results suggest that the majority of published IRAP research has reached false conclusions that the IRAP's predictive validity is greatly overestimated, and is based on biased studies.

Educational Objectives:
1. Describe two approaches to using the IRAP to assess perspective taking. 2. Describe two alternatives to the IRAP for the assessment of automatic relational responding. 3. Evaluate the evidence for the false positive rate in the published IRAP literature.

 

37. Health Behaviors in Context: Leveraging Technology for Contextually Sensitive Assessment and Intervention
Symposium (15:10-16:40)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, digital health, technology, functional contextual assessment
Target Audience: Beginner, Intermediate, Advanced
Location: QG15

Chair: Jennifer Villatte, Ph.D., University of Washington School of Medicine, Seattle, USA
Discussant: Megan Oser, Ph.D., Mahana Therapeutics

A contextual behavioral science (CBS) approach to health behaviors has the potential to revolutionize treatment and enhance the quality and longevity of people’s lives. In this symposium, we will discuss the use of mobile technologies to identify, predict, and influence contextual variables relevant to health behaviors. Studies presented use diverse mobile technologies including smartphone multimedia applications and biobehavioral sensors for assessment, intervention and tracking change. We will present findings from our studies, discuss issues related to collecting and analyzing these data, and discuss opportunities presented by new technologies as well as difficulties that may arise and possible ways to overcome them.

• Putting the Context into Our Assessments
Andrew Gloster, Ph.D., University of Basel

Most of the knowledge we have about therapy and theory stems from questionnaires. This type of information is important, but incomplete. Event Sampling Methods (ESM), which signal participants to record information close to the time it occurs in participants’ every-day lives, provide rich data that can augment current theories. One of the main advantages of ESM methods is that they increase ecological validity. ESM thus helps shed light on the interaction between a participants’ self-chosen natural context and their subjective and objective responses to these choices. With technological advances it is equally possible to collect parameters of participants' behaviour that are out of their awareness (e.g., passive assessment). In this talk, I will present information from ESM studies that highlight the potential of this methodology in both patients and the general population.

• Using Machine Learning to Classify and Predict Avoidance vs. Acceptance in Individuals with Health Risk Behaviors
Maria Karekla, Ph.D., University of Cyprus
Andria Trigiorgi, University of Cyprus
Chryssis Georgiou, University of Cyprus
Andrew Gloster, Ph.D., University of Basel

Avoidance is a basic evolutionarily important dimension of human behavior as seen by fight/flight response. Approach is another basic dimension involved in learning and survival and in nearly all positive reinforcing behavior. Avoidance and approach behaviors in addition to being observable, they are associated with distinct physiological/neurological response patterns and have been implicated in the development of psychopathologic conditions. To date, they tend to be assessed mostly via self-report, thus it remains an open question whether they can be detected and differentiated at a physiological level. We aimed to examine psychophysiological signals in individuals classified as high in experiential acceptance vs. avoidance, utilizing machine-learning algorithms to aid in the delineation and real-time prediction of these behaviors. Two different samples of participants (Total N=156; smokers and high-risk for eating disorders) and a total of 10 supervised algorithms were used to compare the predictive ability of physiological signals (skin conductance, heart rate, heart rate variability) in classifying acceptance vs. avoidance presentations. Results will help improve our understanding of pathology, well-being, and improve treatments.

• Maladaptive Eating and Weight Control: Identifying and Creating Contexts for Change
Rhonda M. Merwin, Duke University School of Medicine

Individuals with type 1 diabetes (T1D) are at greater risk for the development of maladaptive eating and weight control, including the life-threatening behavior of withholding insulin to lose weight. Conventional treatments for anorexia and bulimia nervosa have proved largely unhelpful for individuals with T1D, highlighting the importance of the context in which these behaviors are emerging and maintained, i.e., a chronic illness that influences the experience of the body and its signals, and the importance of maintaining control. Binge eating and withholding insulin are also behaviors that occur in a momentary situational context. I will present 2 studies that use a mobile app time-synced with continuous glucose monitoring (CGM) to identify relevant contextual variables for maladaptive eating and weight control among individuals with T1D and intervene in real time (R01DK089329, R21DK106603, Merwin et al., 2015; 2018; Moskovich et al., 2019). I will also present emerging data from studies using CGM and heart rate sensors to understand the context in which individuals report particular internal experiences (e.g., hunger, anxiety) and engage in emotional suppression vs. willingness.

• Understanding Contingencies of Psychological Flexibility and Health
Jennifer Villatte, Ph.D., University of Washington
Michelle Hasan, University of Southern California, Los Angeles
Justin L'Hommedieu, University of Southern California, Los Angeles
Shrikanth Narayanan, University of Southern California, Los Angeles

Psychological flexibility is a primary determinant of health that can be operationalized both as a relatively stable trait and as a dynamic, context-dependent behavioral process. Yet most investigations of psychological flexibility use trait-like measures that are unable to capture behavioral variations and the contexts in which they occur. Innovations in behavioral signal processing and machine learning provide new methods for assessing the contingencies of psychological flexibility. This study sought to characterize how psychological flexibility varies across contexts and how these variations influence health. We conducted a 10-week multimodal assessment of 200 hospital workers, including baseline psychometric surveys, daily experience sampling, and continuous sensor-based monitoring of biobehavioral signals, smartphone usage, physical and social environment. We will present findings characterizing the dynamic relationships among psychological flexibility, health determinants (stress, pain, fatigue, emotional and social functioning), health behaviors (sleep, physical activity, tobacco and alcohol use), and the contexts which influence them (e.g., activities, pleasant/unpleasant psychological events, social interactions, time/day, location). We will also discuss challenges and opportunities in leveraging technologies for contextual behavioral assessment and adaptive intervention.

Educational Objectives:
1. Describe 2 methods for assessing health behavior in context. 2. Identify 1 challenge and 1 advantage in using technology to assess health behaviors. 3. Assess strengths and limitations of the research methods presented here.

 

38. ACT-based interventions in the cancer and palliative care setting
Symposium (15:10-16:40)
Components: Original data
Categories: Clinical Interventions and Interests, Behavioral medicine, Cancer and palliative care
Target Audience: Intermediate
Location: Q119

Chair: Nick Hulbert-Williams, Centre for Contextual Behavioural Science, University of Chester
Discussant: Lesley Howells, Maggie's Centres

Psychological distress and poor quality of life are commonly reported in people affected by cancer. This includes those who have received a diagnosis, their families and caregivers, and healthcare professionals working in this setting. Though there is a good deal of published data from questionnaire studies on the applicability of the ACT model in the oncology and palliative care setting, intervention-based research is sparse. In this symposium we present findings from four intervention studies that demonstrate the breadth of applicability of ACT in this setting. This includes two single-subject research designs: one delivering ACT to people with advanced cancer who are transitioning into specialist palliative care, and another to support effective stress management in cancer nurses. Though these both demonstrate acceptability of intervention content, outcome data is limited, raising both methodological and feasibility questions. The two remaining studies report the longitudinal benefits of an ACT-based residential programme for adolescents impacted by cancer, and a description of modifications made to TRUCE, a manualised intervention for adolescents and young adults who have a parent with cancer.

• The Place of Enablement, Empowerment, and Relationships (PEER) Program for Adolescents Impacted by Cancer
Fiona McDonald, CanTeen Australia, The University of Sydney
Pandora Patterson, CanTeen Australia, The University of Sydney
Helen Bibby, CanTeen Australia
Elizabeth Kelly-Dalgety, CanTeen Australia
Aileen Luo, CanTeen Australia

Personal and familial cancer impacts young people’s lives and few interventions exist to provide support and coping skills to this vulnerable group. Therapeutic residential programs are a promising approach in the delivery of effective interventions for this age group and so a 4-day residential program, the PEER Program, was developed based on ACT with the aims of enhancing the resilience and wellbeing. PEER was evaluated at 3-time-points (pre:T0, post:T1, 2 month follow-up:T2). Within one year across six programs, 191 adolescents (11-18 years; 68% female, Mage = 14.5 years, SD=1.6) attended PEER, 148 completed T0 and T1, and 102 completed T2. Participants’ quality of life improved significantly after participating in PEER (t=2.84, p=.005). Participants with high levels of distress (t=2.82, p=.006) high psychological inflexibility (t=2.39, p=.019) or low levels of mindfulness (t=-2.23, p=.028) at baseline experienced greater benefits from the program. Changes in self-kindness mediated changes in quality of life (β=0.19, 95% CI:0.04, 0.38) and distress (β=-0.41, 95% CI:-0.92, -0.03). These initial results demonstrate the benefits of an ACT based program for adolescents impacted by cancer.

• A single-subject research design to test the initial effectiveness and acceptability of ACTION: An Acceptance and Commitment Training Intervention for Oncology Nurses.
William Kent, Centre for Contextual Behavioural Science, University of Chester
Nicholas J. Hulbert-Williams, Centre for Contextual Behavioural Science, University of Chester
Kevin D. Hochard, Centre for Contextual Behavioural Science, University of Chester
Lee Hulbert-Williams, Centre for Contextual Behavioural Science, University of Chester

Oncology nurses are at high risk of experiencing chronic stress, including burnout and compassion fatigue. Evidence-based stress-management interventions are essential to promote coping, wellbeing, and optimal patient care. This study tested the initial effectiveness and acceptability of an ACT-based stress-management intervention for oncology nurses (ACTION). ACTION is group-delivered across three weekly 90-minute sessions, and was evaluated using a non-concurrent multiple-baseline single-case experimental design (n=8). Participants completed self-report assessments of daily perceived stress and psychological flexibility over a six-week period, including weekly assessment of other well-being outcomes. Follow-up qualitative interviews explored intervention acceptability. Participants displayed unstable baseline stress scores. Post-intervention, stress remained variable, though slightly less variable than at baseline. Tau-U calculations indicate no significant intervention effects on perceived stress (Tau-U=.01, p=.88). ANOVAs report no significant differences in any of our well-being outcomes from baseline to follow-up. Qualitative data indicated that participants perceived ACTION to be beneficial for promoting stress-management skills, and provided advice for further development (e.g. one-to-one coaching). This study offers insightful data on the effectiveness and acceptability of ACTION for oncology nurse stress-management.

• Modifying Truce - a program for young people with a parent with cancer - for online delivery
Pandora Patterson, CanTeen Australia, The University of Sydney
Fiona McDonald, CanTeen Australia, The University of Sydney
Joseph Ciarrochi, Institute for Positive Psychology and Education, Australian Catholic University
Louise Hayes, Ph.D., The University of Melbourne & Orygen Youth Mental Health
Tracey Danielle, Western Sydney University Penrith
Stephanie Konings, CanTeen Australia
Adam Wright, The Resilience Centre
Nicholas J. Hulbert-Williams, Centre for Contextual Behavioural Science, University of Chester

An ACT-based manualised 7-session in-person group program called Truce for adolescent and young adults (AYAs) who have a parent with cancer was developed and delivered to 80 AYAs. The program was well received by AYAs (mean session interest = 8.2/10). Truce was effective in reducing cancer related unmet needs compared with a control group (F = 5.2, p = .02) and there are promising preliminary outcome results focusing on core ACT processes such as psychological flexibility and mindfulness which are maintained at follow-up. To broaden the reach of this promising intervention, it was modified for online delivery. Examples of modification include: technical requirements, adapting practical exercises and materials (e.g. pre-recorded mindfulness activities), and also consideration of group size. AYAs were highly satisfied with the modified online version of the program, however attendance rates were slightly lower than the in-person program. Initial results suggest that Truce online is both feasible and acceptable, providing young people greater accessibility to this much needed program.

• Brief Engagement and Acceptance Coaching in Community and Hospice Settings (the BEACHeS Study): development and pilot-testing an evidence-based intervention to enhance wellbeing at transition into palliative care
Nicholas J. Hulbert-Williams, Centre for Contextual Behavioural Science, University of Chester
Sabrina Norwood, Centre for Contextual Behavioural Science, University of Chester
David Gillanders, Psy.D., University of Edinburgh
Anne Finucane, Marie Curie, UK
Juliet Spiller, Marie Curie, UK
Jenny Strachan, Marie Curie, UK
Josh Kreft, Centre for Contextual Behavioural Science
Brooke Swash, Centre for Contextual Behavioural Science, University of Chester
Sue Millington, Patient Representative

Terminal illness diagnosis and transition into palliative care can cause fear, and result in distress and decreased quality of life. ACT is a promising but under-researched intervention for supporting terminally-ill patients. We developed and are pilot-testing a brief ACT-based intervention to improve quality of life and psychological acceptance for this group. A multiple-baseline, single-case, non-controlled design is used. To date, seven participants have been recruited. Each receives five sessions with an ACT- trained facilitator. Quality of life, distress, and ACT-process changes are self-reported, weekly. Psychological flexibility and overall health are measured daily. Four participants have dropped out of the study. One participant who has completed the study demonstrated measurement floor and ceiling effects, but small increases in psychological acceptance. Two participants currently receiving the intervention are demonstrating tentative quality of life and psychological flexibility increases, in addition to some level of distress reduction. This study will complete by May 2019. Findings to date suggest that ACT may be beneficial for patients transitioning to palliative care, but high drop-out and measurement issues raise feasibility questions.

Educational Objectives:
1. Assess how and why ACT may need modifying for people affected by cancer in different ways (e.g. patients, family members, healthcare professionals). 2. Discuss the use of single-subject research designs in ‘Phase I’ health-service intervention development. 3. Compile some of the challenges of using ACT for populations who are traditionally more difficult to engage in research.

 

42. I-Measure. When a functional approach to language counts.
Symposium (15:10-16:40)
Components: Original data,
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, measures
Target Audience: Beginner, Intermediate, Advanced
Location: Q158

Chair: Giovambattista Presti, Ph.D., MD, Kore University, Enna, Italy
Discussant: David Gillanders, Psy.D., University of Edinburgh

Research on psychological self-report assessment instruments encompasses the adaptation of concepts and methods developed in one cultural setting to another language community. The adaptation of an instrument to a different language is not a mere literal translation from the original instrument to the target language. Moreover, original instruments should not be carelessly translated into other languages and assumed to have the same measurement properties across different languages and cultures. A central concern of any translation process is to yield a linguistic and cultural equivalent of the original. These methodological and theoretical challenges are amplified for ACT measures, which is grounded in a specific theory of language and cognition. The adaptation of a measures is a complex process that imply the inclusion of idiomatic expressions, the consideration of words that may have several valid translations. This symposium presents three papers whose shared rationale focuses not merely on obtaining a new translated instrument based on semantic equivalence, rather on the functional equivalence of these new instruments to its original versions.

• Intimacy-related behaviors and psychological flexibility. Psychometric properties of the Italian version of the Functional Analytic Psychotherapy Intimacy Scale .
Katia Manduchi, FAP Italia
Annalisa Oppo, Sigmund Freud University, Milano
Domenica Pannace, FAP Italia
Francesca Gini, FAP Italia
Giovambattista Presti, Ph.D., MD, Kore University, Enna, Italy

Literature suggests that intimacy-related behaviors show promising implications for the development of interpersonal repertoire that emerges during therapy; thus it is noteworthy targetting and assessing this repertoire throughout therapy with robust and well-constructed measures. The Functional Analytic Psychotherapy Intimacy Scale (Leonard et al., 2014 ) is a 14-item measure with three subscales (Hidden Thoughts and Feelings, Expression of Positive Feelings, and Honesty and Genuineness) developed to assess intimacy-related behaviors consistent with FAP. The aim of this study is to adapt the FAPIS to the Italian context. The FAPIS was administered to three different samples including students, psychologists and psychotherapists. Preliminary results, including factorial structure (subscales account for about 70% of the variance), and internal consistency (Cronbach’s alpha >= .80 for the three subscales) perfectly matched the original version of the instrument. Furthermore, consideration regarding intimacy-related behaviors, psychological flexibiliy and cognitive fusion will be analyzed and discussed. This study provide a preliminary support to the Italian version of FAPIS which seems to be a psychometrically and clinically useful measure to assess FAP processes.

• Exploratory validation study of the Italian Version of the 6-PAQ
Melina Di Blasi, Università Kore, Enna
Paola Dordoni, IRCSS Istituto dei Tumori Milano
Francesca Mongelli, Università Kore, Enna
Paolo Moderato, IULM, Milano
Giovambattista Presti, Ph.D., MD, Kore University, Enna

The purpose of this study was to validate the Parental Acceptance Questionnaire (6-PAQ), a scale developed by Green et al (2015) to measure ACT processes linked to psychological flexibility among parents. Items translation and fluency were rated by a team of senior ACT therapist and researchers and the resulting Italian version was back translated and rated. The scale was administered to 222 parents of children between 3 and 12 yrs along with the Parenting Stress Index and the Cognitive Fusion Questionnaire for divergent and convergent validity. The Italian version pf the instrument possessed an exceptional overall fit to the data RMSEA 0.049. EFA analysis showed that items load two factors that we can name psychological flexibility and psychological inflexibility.with items related to psychological flexibility saturating more on factor 2. These results provide preliminary support for the 6-PAQ is a reliable measure to assess parental psychological flexibility, and further studies and analysis are necessary to explore its psychometric properties.

• Adaptation and psychometric properties of the Italian version of the Self Exeperiences Questionnaire (SEQ-I)
Giovambattista Presti, Ph.D., MD, Kore University, Enna
Concetta Messina, KORE University, Enna
Annalisa Oppo, Sigmund Freud University, Milano

Acceptance and Commitment Therapy (ACT) includes “self” as one of the six processes at the core of Psychological Flexibility. It conceptualizes the sense of self as a result of three intertwining perspectives based on human language: self as content, self as process, and self as context. To our knowledge, the sole self-report measure developed to assess the multi-faceted features of the self from a Contextual Behavioral Science perspective was proposed by Lin Yu et al (2016) in the context of Chronic Pain. The Self Experiences Questionnaire (SEQ) is a 15-item instrument with two-dimensional scales (Self as distinction, Self as observer). The aim of the paper is twofold. Firstly, to provide initial psychometric properties of the Italian version of the SEQ; secondly, to extend this measure to other clinical and to the general populations. The 15-item original English version of the SEQ was translated into Italian and then back-translated into English in order to reach semantic equivalence and the SEQ was administered to a convenient sample with other self reported measures. Preliminary data will be presented.

• Mindfulness Skills and Psychological inflexibility: two useful tools for a clinical assessment for adolescents with internalizing disorders.
Annalisa Oppo, Sigmund Freud University, Milano
Arianna Ristallo, IESCUM, Milano
Marta Schweiger, IESCUM, Milano
Paolo Moderato, IESCUM, Milano
Giovambattista Presti, Ph.D., MD, Kore University, Enna

Child and Adolescent Mindfulness Measure (CAMM) and Avoidance and Fusion Questionnaire for Youth (AFQ-Y) are specifically developed for children and adolescents and their items are built to assess specific processes: Mindfulness Skills and Psychological Flexibility. This study aims to identify cut-offs that optimize sensitivity and specificity to detect adolescents with internalizing disorders. Furthermore, to identify homogeneous groups of adolecents with specific behavioral repertoires two Classification Tree Analyses (CTA) were performed. Participants (N=1336), aged between 11 and 18, were enrolled. The cut-offs identified are 24 for the CAMM, and 11 for the AFQ-Y. The CTA showed that low mindfulness skills and psychological inflexibility share a specific feature: namely the presence of depressive symptoms. However, social withdrawal seems to be associated only with low mindfulness skills, while somatic symptoms seems to be associated only with psychological inflexibility. The potential uses of the CAMM and AFQ-Y in research and clinical practice are drawn.

Educational Objectives:
1. Describe common obstacles in conducting validation study toreach functional and semantic equivalence. 2. Describe the features of intimacy, flexibility and self from a CBS perspective. 3. Plan an assessment with awareness.

 

43. Clinical Applications of RFT: Assessment and Formulation using Deictic Frames: A Case Series Analysis.
Symposium (15:10-16:40)
Components: Conceptual analysis, Didactic presentation, Case presentation,
Categories: Clinical Interventions and Interests, Relational Frame Theory, Case studies
Target Audience: Beginner, Intermediate
Location: Q217

Chair: Joseph Oliver, Ph.D., University College London, Contextual Consulting
Discussant: Yvonne Barnes-Holmes, Ph.D., Ghent University

The use of Relational Frame Theory (RFT) to inform interventions has steadily grown in recent years. This has been especially so in relation to deictic or self-related issues, whether in early child development or in adults with complex problems, such as low self-esteem, pervasive mood problems, psychosis and interpersonal problems. The lens of RFT helps with building precision in functional analysis, by identifying relevant relational responding across key networks. Doing this has the potential to develop interventions that have greater impact and are more efficient. However, this task is often complex and requires substantial familiarity with RFT. This symposium aims to help bridge the gap between theoretical understanding and clinical application by presenting two pieces of client work from different ends of the developmental spectrum. These two cases will be presented by experienced clinicians, who will give insight into how the functional analyses were arrived upon, and how the work was informed. The symposium will focus particularly on the practicalities of using RFT to inform clinical work, to give the audience practical suggestions.

• Using ACT and RFT with complex pain and identity issues
Richard Bennett, University of Birmingham, Think Psychology

Complex regional pain syndrome (CRPS) is a poorly understood condition in which a person experiences persistent severe and debilitating pain. The presentation is long-lasting, and in most cases, the affected person will experience pain for many years. There is no reliable remedy for CRPS, and a combination of educational, physical, medical and psychological interventions are generally offered in the service of helping to manage the symptoms (National Health Service, 2016). This paper describes the use of Acceptance & Commitment Therapy (ACT) with a woman diagnosed with CRPS relating to her foot. She turned to psychological therapy after many years in the unsuccessful pursuit of pain relief. In particular, the paper will focus on the clinical application of Relational Frame Theory (RFT) to the therapy, describing advantages in precision in assessment and intervention that RFT has brought in addition to ACT. There will be a particular focus on deictic relations and the notion of self-as-context.

• Autism, self harm and perspective taking in a 16 year old – an ACT intervention informed by RFT
Freddy Jackson Brown, Avon and Wiltshire NHS Trust

Young people with autism are at increased risk of experiencing mental health difficulties and engaging in self-harm. Key features of this population are language fusion, limited perspective taking abilities (deictics) and social anxiety and isolation. In the UK this population are also at higher risk of home or school breakdown leading to residential and hospital placements. This paper describes an intervention informed by Acceptance and Commitment Therapy and the clinical application of Relational Frame Theory with a 16 years young person with a diagnosis of autism. The person engaged in high levels of experiential avoidance and in intermittent episodes of severe self-harm that led to a 6 week hospital admission. The paper covers the period of his discharge and his rehabilitation into a college setting over a 12 month period. It will focus on concepts of values, willingness, relational network coherence, deictic functioning and hierarchical relations.

• Drawing together: using an RFT lens to identify functionally similar, clinically relevant themes
Yvonne Barnes-Holmes, Ph.D., Ghent University
Duncan Gillard, Ph.D., Bristol City Council

The third paper in this symposium seeks to draw out the main functional themes from the previous two case studies using an account based on RFT. Rather than focusing on the topographical differences between the cases, this part of the symposium will examine the functional overlaps in these distinct cases.

Educational Objectives:
1. Discuss how RFT can enhance ACT functional analyses and clinical interventions. 2. Describe core RFT principles and deictic relational frames as they apply developmentally. 3. Utilize knowledge of deictic framing in functional analyses.

 

44. Using Contextual Behavioural Science for Global Impact: Recent and Upcoming Innovations in Global Mental Health
Symposium (15:10-16:40)
Components: Conceptual analysis, Original data,
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Educational settings, Professional Development, global mental health, armed conflict, refugees, education, social emotional learning
Target Audience: Intermediate,
Location: Q218

Chair: Felicity Brown, Ph.D., War Child Holland
Discussant: Steven C. Hayes, Ph.D., University of Nevada, Reno

We are experiencing unprecedented levels of forced displacement globally- with over 65 million displaced people, including 22 million refugees. Exposure to armed conflict and displacement significantly increases the risk for a range of mental health difficulties, including depression, anxiety, traumatic stress, substance abuse, and behaviour problems. Yet, unfortunately, the majority of these individuals lack access to adequate care. It is estimated that 85% of the global refugee population are based in low- and middle-income countries (LMICs), where health systems are often under-resourced to cope with this extra burden. A major barrier to addressing this global treatment gap is the lack of availability of specialists in such settings, therefore recent innovations have focused on ‘task-shifting’, whereby non-specialists are trained to deliver treatments, while specialists provide training, supervision, and more intensive treatment for higher-needs cases. Innovative implementation strategies, such as via education settings, are also needed. This symposium will detail findings and next steps from three such innovations, implemented in Uganda, Rwanda, Colombia, and Europe, with World Health Organization, Peter C Alderman Foundation, and War Child Holland.

• The Effectiveness of an ACT-Based Guided Self-Help Intervention for South Sudanese Refugee Women in Uganda
Felicity L Brown, Ph.D., War Child Holland
Wietse A Tol, Ph.D., Johns Hopkins Bloomberg School of Public Health
Kenneth Carswell, DClinPsy, World Health Organization

Globally, emotional distress is common and a leading cause of health-related burden and lost productivity. Individuals in humanitarian crises are at greater risk for distress, yet tremendous care gaps exist. The research and implementation agenda of the WHO Mental Health and Psychosocial Support in Emergencies programme focuses on systematically developing, culturally-adapting, and evaluating low-intensity psychological interventions that can be delivered by non-specialists and require few resources to reach larger numbers of individuals. This presentation will report the findings of a cluster randomized controlled trial of an ACT-based guided self-help intervention conducted with South Sudanese refugee women in northern Uganda (SH+). The intervention is delivered in 5 workshops, using scripted audio recordings to deliver key content; ensuring fidelity and reducing training needs. Villages (n=14) were randomly assigned to receive either SH+ or enhanced usual care, and a total of 724 women participated. Results indicated significant improvements in the primary outcome of psychological distress from baseline to 3 month follow up, and significant improvements on a range of secondary outcomes. Implications and future directions will be discussed.

• Next steps with evaluating SH+ for refugees: Updates from clinical trials being conducted in Europe/Turkey and Uganda
Ross White, Ph.D., University of Liverpool
Wietse Tol, Ph.D., Johns Hopkins Bloomberg School of Public Health
Mark van Ommeren, Ph.D., World Health Organization
Corrado Barbui, Ph.D., University of Verona

Following on from initial positive research findings, this paper discusses additional activity being undertaken to further evaluate the ACT-based ‘Self-Help Plus’ (SH+). Work is currently underway in Uganda to determine the efficacy of SH+ for improving the mental health of male South Sudanese refugees in Uganda. Specifically, this project aims to adapt SH+ to maximize the engagement of male South Sudanese refugees, and assess the impact of SH+ on males’ psychological distress, various secondary outcomes (including alcohol misuse, anger, perpetration of violence against females), and economic outcomes. Activities include: a rapid ethnographic adaptation process, a pilot cluster randomized controlled trial (cRCT), process evaluation, and a definitive cRCT (target N = 1125). In addition, this paper reports on the progress of the RE-DEFINE project (http://re-defineproject.eu) which consists of two RCTs evaluating SH+ as an approach for preventing mental disorders in refugees and asylum seekers in the EU (target N = 600) and Turkey (target N = 600). The RE-DEFINE project has facilitated the adaptation of SH+ for speakers of the Arabic, Urdu and Dari languages.

• The theory and development process of a holistic teacher professional development intervention to improve teachers social emotional competencies, wellbeing and classroom management
April Coetzee, War Child Holland

The introduction of the Sustainable-Development Goals has seen a shift in focus from basic access to education globally, towards building quality education where children master not only academic skills, but also vital social and emotional skills. There are many factors that contribute to quality education, but a key element is having sufficient number of trained teachers who have the knowledge, skills and attitudes to create an enabling environment within the classroom. Personal Journeys is a new, innovative, scalable solution, building the necessary capacity in teachers through in-class coaching. The intervention focuses on three key areas for teachers; building skills in classroom management, developing personal social an emotional competencies and taking a mindfulness and acceptance approach to address the wellbeing of teachers. This presentation will outline the theory of change behind the intervention, the comprehensive development process, and plans for rigorous evaluation and well as exploring the place the study has in addressing dearth of scientific evidence for what works in the promotion of quality education and wellbeing in emergencies.

Educational Objectives:
1. Explain the need for task-shifting approaches in global mental health. 2. Describe the challenges and opportunities associated with large-scale evaluations of ACT-based guided self-help interventions. 3. Discuss the theory behind the assumption that social emotional learning, teacher wellbeing and classroom management can contribute to an enabling environment for child wellbeing.

Friday, 28 June

53. Compassion-based interventions to promote psychological and physical wellbeing/health: Examples in different settings and populations
Symposium (10:35-12:05)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Educational settings, Compassion-based interventions
Target Audience: Beginner, Intermediate, Advanced
Location: The Studio

Chair: Marcela Matos, University of Coimbra - CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Interventions), Portugal
Discussant: Laura Silberstein-Tirch, Psy.D., The Center for CFT, NYC

There is an increasing interest in compassion in the realm of contextual-behavioral science. Compassion involves the motivation to care, capacity for sympathy, tolerate unpleasant emotions, empathic understanding and non-judging; and can be directed at the self, at others, or received from them. Growing research suggests that compassion is positively associated with a range of wellbeing and mental health indicators, and compassion-based interventions have been found to be effective in reducing psychopathology and improving emotional and behavioral regulation. This symposium sets out to explore the healing and protective impact of compassion-based interventions on psychological and physical wellbeing/health in different settings and populations. This symposium explores: i) the psychological and physiological impact of a compassion focused intervention on teachers’ wellbeing in an educational setting; ii) the efficacy of a compassion-based intervention to reduce binge eating; iii) the pilot study of acceptability and efficacy of the MIND programme for cancer patients; iv) the efficacy of an ACT group intervention for chronic pain that integrates explicit self-compassion exercises (COMP.ACT).

• Nurturing Compassionate Schools: The psychological and physiological impact of a compassion focused intervention to promote teachers’ wellbeing
Marcela Matos, Ph.D., University of Coimbra - CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Interventions), Portugal
Isabel Albuquerque, Ph.D., University of Coimbra - CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Interventions), Portugal
Marina Cunha, Ph.D., University of Coimbra - CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Interventions), Portugal
Margarida Pedroso Lima, Ph.D., University of Coimbra - CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Interventions), Portugal
Ana Galhardo, Ph.D., University of Coimbra - CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Interventions), Portugal
Lara Palmeira, Ph.D., University of Coimbra - CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Interventions), Portugal
Frances Maratos, Ph.D., University of Derby, College of Health and Social Care Research Centre, UK
Paul Gilbert, Ph.D., OBE, Centre for Compassion Research and Training, University of Derby, College of Health and Social Care Research Centre

Compassion-based interventions have been found effective in developing adaptive emotional regulation skills and promoting mental health. Teachers present a high risk of professional stress, which negatively impacts their wellbeing and professional performance. Mental health problems are highly prevalent in the school context, affecting both teachers and students. Therefore it is crucial to promote psychological flexibility and emotional regulation that support teachers in coping with the challenges of the school context and promote their wellbeing. This study aims at testing the efficacy of the Compassionate Schools Program (CSP), a six-module compassionate mind training group intervention for teachers, and examining mediator processes of change. A randomized controlled study was conducted in a sample of 150 portuguese teachers. At pre and post intervention, participants completed measures of psychological (e.g.,burnout,psychopathology,positive affect) and physiological (i.e.,heart-rate variability) outcomes, and processes of change (e.g.,compassion,psychological flexibility,mindfulness). Results regarding the impact of the CSP on indicators of psychological and physiological wellbeing and the mediator processes of change will be presented. Implications for community-based interventions in educational settings will be discussed.

• Compassion in weight management interventions: Examples from a compassion-based intervention in a commercial weight management intervention and the NoHoW trial
Cristiana Duarte, Ph.D., University of Leeds
James Stubbs, Ph.D., University of Leeds
Carol Stalker, Ph.D., College of Life and Natural Sciences, University of Derby
Francisca Catarino, PsyD, College of Life and Natural Sciences, University of Derby
Sarah Scott, Ph.D., University of Leeds
Graham Horgan, Ph.D., Rowett Institute of Nutrition and Health at The University of Aberdeen
Paul Gilbert, Ph.D. OBE, College of Life and Natural Sciences, University of Derby
Berit Heitmann, Ph.D., Frederiksberg Hospital, The Parker Institute

This presentation will report data from two studies where components of compassion-based interventions were included in weight management interventions. A study with a two-arm, non-randomized parallel design examined whether adding compassion-focused online video exercises into a commercial weight-management programme helped individuals control their eating behaviours compared to the regular programme. The intervention significantly reduced binge eating symptomatology between 3-12 months. At 3-months the intervention had effects on psychological adjustment and self-evaluation. There were no intervention effects on weight. Mediation analyses in the intervention group indicated that changes in body image and weight-related shame, self-criticism, and self-compassion, mediated the effects of the intervention in decreases in binge eating symptomatology; reductions in binge eating were associated with weight loss over time. This presentation will also explore preliminary data of the NoHoW weight loss maintenance trial, which uses a 2x2RCT design to test the effects of a digital intervention that targets:(i)self-regulation and motivation, and (ii)contextual-behavioural science-based emotion regulation. Findings may elucidate the refinement of digital approaches and tools for longer term control of eating behavior and weight management.

• The MIND programme for cancer patients: A acceptance, mindfulness, and compassion-based intervention to promote well-being
Inês A. Trindade, Ph.D., CINEICC, University of Coimbra
Cláudia Ferreira, Ph.D., CINEICC, University of Coimbra
José Pinto-Gouveia, MD, Ph.D., CINEICC, University of Coimbra

Given the complementarity of mindfulness, compassion, and ACT-based approaches, and the considerable need to develop and test psychotherapeutic interventions for cancer patients, the MIND Programme for cancer patients was developed and manualized. The programme combines empirically-based mindfulness practices, and CFT and ACT components in one integrative intervention specifically adapted to cancer patients that overall aims to increase quality of life and prevent subsequent distress. The intervention intends to develop emotion regulation abilities based on acceptance, committed action, mindfulness, and self-compassion. Self-care and forgiveness modules were also included in the programme. An outline of the eight weekly group sessions of this intervention will be presented, as well as the individual assessment of each session by participants. The preliminary test of efficacy of the intervention in a sample of women with breast cancer, with a matched waitlist control group, will also be presented. Findings suggested that the MIND programme improves mental health, social functioning and adjustment to the disease, and support the integration of mindfulness, acceptance, and compassion-based therapies. Further implications and conclusions will be discussed.

• Accepting with compassion in chronic pain: testing the effect of explicit self-compassion exercises on the efficacy of an ACT group intervention (COMP.ACT)
Sérgio A. Carvalho, MSc, CINEICC, University of Coimbra
José Pinto-Gouveia, MD, Ph.D., CINEICC, University of Coimbra
David Gillanders, Psy.D., University of Edinburgh
Paula Castilho, Ph.D., CINEICC, University of Coimbra

The current study aims to test, in a pilot study, the efficacy of an ACT group intervention for CP that integrates explicit self-compassion exercises (COMP.ACT–8 sessions), and compare it with an ACT intervention (8 sessions) and with a control (TAU). We expect that adding explicit self-compassion exercises will increase the efficacy of an ACT intervention, and expect both conditions (COMP.ACT and ACT) to be significantly more effective than TAU. This will be tested in a sample of N = 30 CP patients recruited in a pain clinic, who will be randomly assigned into the three conditions. The efficacy will be tested by comparing results from pre- to post-intervention of the three groups in several self-report measures (pain intensity, disability, quality of life, patient global impression of change, depressive and anxiety symptoms, mindfulness, acceptance, and self-compassion). Results will be discussed accordingly. This study will shed new light on an ongoing discussion regarding the benefits of adding self-compassion exercises to an acceptance-based intervention, contributing to a better understanding of the role of potentially overlapping psychological processes.

Educational Objectives:
1. Describe novel compassion-based interventions with different formats (group and digital-based) targeting both clinical and non-clinical populations (teachers, women with binge eating disorder, patients with cancer, and chronic pain). 2. Discuss the impact of these interventions on well-being psychological and/or physiological outcomes. 3. Discuss the implications in clinical and educational settings of cultivating compassion in the targeted populations to promote adaptive psychological functioning and well-being.

 

55. Delivering acceptance and mindfulness online for university student mental health: New findings on efficacy and implementation strategies
Symposium (10:35-12:05)
Components: Literature review, Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Educational settings, Online interventions (websites, mobile apps), University students
Target Audience: Beginner, Intermediate, Advanced
Location: QG15

Chair: Michael Levin, Ph.D., Utah State University
Discussant: Jonathan Bricker, Ph.D., Fred Hutch Cancer Research Center & University of Washington

Online acceptance and mindfulness-based interventions offer significant promise in improving university students’ access to mental health services, reducing barriers such as provider availability, stigma, and time. Recent trials indicate online ACT and related mindfulness-based approaches are effective at improving university student mental health. However, implementation challenges have also been identified related to user engagement, reaching students, and resource costs. In this symposium, Dr. Crissa Levin will present results from a multi-site RCT evaluating an adjunctive online ACT website for college counselors to use with their clients, including lessons learned implementing adjunctive ACT programs within counseling centers. Panajiota Räsänen will describe findings from novel analytic methods used to evaluate text interactions between university students and coaches in the context of a RCT comparing coaching methods in a blended in-person and online ACT program. Elizabeth Hicks will present findings from a pilot RCT evaluating the Stop, Breathe, and Think mobile app for university students on the waitlist to start therapy. Dr. Jonathan Bricker will then discuss these studies and associated broader topics that they raise.

• Implementing online ACT guided self-help in college counseling centers: Results from a multi-site randomized control trial
Crissa Levin, Ph.D., Utah State University & Contextual Change LLC
Michael Levin, Ph.D., Utah State University & Contextual Change LLC
Jacqueline Pistorello, Ph.D., University of Nevada, Reno
Steven C. Hayes, Ph.D., University of Nevada, Reno
John Seeley, Ph.D., University of Oregon
Elizabeth Hicks, Utah State University

Mental health problems are prevalent among university students and college counseling centers are struggling to meet demands for services (Gallagher, 2014). Integrating online self-help into counseling services could increase the number of students receiving treatment and opportunities for additional services, while reducing resource costs on in-person providers. In a pilot trial, we found a prototype online ACT program (called ACT on College Life; ACT-CL) used in four college counseling centers was feasible to implement and improved student psychological inflexibility and mental health (Levin et al., 2015). This talk will present results from a recently completed multi-site RCT across 7 college counseling centers with the final ACT-CL program. A sample of 38 counselors were randomized to use ACT-CL or a psychoeducation control website (PCW) with eligible student clients (n = 185). Results on mental health and psychological inflexibility between students using ACT-CL versus PCW will be reported. We will also review findings on program usage and satisfaction by both counselors and students as well as lessons learned with regards to implementing ACT-CL in college counseling centers.

• Evaluation of a Mindfulness App for College Student Mental Health
Elizabeth Tish Hicks, B.A., Utah State University
Jennifer Krafft, M.S., Utah State University
Michael Levin, Ph.D., Utah State University

As the demand for college counseling services has steadily increased, so have college counseling center (CCC) waiting lists. Mobile mental health apps have the potential to offer support for students’ mental health while they are waiting to receive CCC services. The current study specifically evaluated the feasibility and clinical utility of offering a popular mindfulness app, Stop, Breathe & Think, as an interim intervention for students on a CCC waitlist. 22 students were randomly assigned to the active or waitlist condition for four weeks and completed baseline, mid, and post assessments. While a larger sample is needed for between group comparisons, among the students in the app condition, usability ratings were high, all students reported using the app, and students generally reported being satisfied with the app and that it was helpful while on the waitlist, though it would not replace the need for therapy. Implications of the study will be discussed in relation to implementation, feasibility, and clinical utility of utilizing mobile apps for clients on waiting lists.

• Coaches’ written online feedback to reduce psychological distress in an ACT-based program for university students: results from an RCT study that employed A.I. text analysis
Panajiota Räsänen, University of Jyvaskyla
Asko Tolvanen, University of Jyvaskyla
Riku Nyrhinen, University of Jyvaskyla
Raimo Lappalainen, Ph.D., University of Jyväskylä

There is limited research examining the active components contributing to the effectiveness of Internet interventions. One substantial component in guided interventions is the feedback given to the clients. We explored the role of online written feedback on clients’ outcomes. ACT trained psychology students, offered support as coaches (N=48) to university students, randomly assigned to two groups that both participated in 3 face-to-face sessions and an online 5-module ACT-based program. Group A (iACTA, N=62) received personalized, individually-tailored written feedback and group B (iACTB, N=61) received semi-structured written feedback with minimal personalization options. Participants’ texts as well coaches’ feedback were analyzed with artificial intelligence tools. Participants in both groups had significant gains in psychological well-being, psychological flexibility and mindfulness skills. Perceived stress and symptoms of depression were significantly reduced. The length of the coaches’ feedback did not have an effect on treatment outcomes. In both groups, feedback that was rich, diverse, directly targeting the participant’s reflections was associated in significant reduction of stress and depression. Differences were larger for the semi-structured group (iACTB) for stress outcomes.

Educational Objectives:
1. Discuss challenges and opportunities with incorporating online ACT into treatment settings. 2. Describe the feasibility and clinical utility of recommending mobile mental health apps to clients on waiting lists for therapy services. 3. Be able to identify and discuss important active components in designing and implementing blended online ACT-interventions.

 

60. Investigating fear and avoidance behavior: the merging of Contextual Behavioural Psychology and Cognitive Neuroscience.
Symposium (10:35-12:05)
Components: Original data
Categories: Functional contextual neuroscience and pharmacology, Relational Frame Theory, IRAP, EEG, fear, approach/ avoidance, ADHD
Target Audience: Beginner, Intermediate, Advanced
Location: Q158

Chair: Deirdre Kavanagh, Ghent University
Discussant: Michel Quak, Ghent University - department of experimental clinical and health psychology

This symposium will discuss findings from both contextual behavioral psychology and cognitive neuroscience on fear and approach/avoidance behavior. The goal is to explore how concepts and methods from cognitive neuroscience can be used to further the depth of clinically relevant research in Relational Frame Theory (RFT) and behavior analysis. The first talk will focus on research aimed to establish fear and avoidance functions for arbitrary stimuli through combinatorial entailment using a training version of the Implicit Relational Assessment Procedure (IRAP). The second talk will discuss the neurophysiological mechanisms of approach and avoidance behavior involved in implicit relational responding using a modified IRAP. The final talk will give an overview of the neurophysiological mechanisms underlying fear. Together, these talks hope to shed light on the potential of combining traditional functional analyses of behavior with concepts and methods from cognitive neuroscience in order to advance RFT.

• Training and Testing for the Transformation of Fear and Avoidance Functions via combinatorial entailment using the Implicit Relational Assessment Procedure (IRAP).
Aileen Leech, Ghent University - Department of experimental clinical and health psychology
Dermot Barnes-Holmes, Ph.D., Ghent University

Experiment 1 of the current research aimed to establish “fearful” and “pleasant” functions for arbitrary stimuli through combinatorial entailment using a training version of the Implicit Relational Assessment Procedure (IRAP). The critical tests for the transformation of functions involved exposure to two separate Test-IRAPs (one for fear and one for avoidance/approach), but both failed to yield any evidence for the transformation of functions. The findings of Experiment 1 contrast with the clear evidence of a transformation of functions via mutually entailed relations that was reported by Leech et al., (2018). Experiment 2, attempted to replicate and extend the findings of Leech et al, (2018) through combinatorial entailment by manipulating one or more of the dimensions within the MDML (i.e., levels of derivation). Results indicate that levels of derivation and an opportunity to respond to the derived relations play an important role in the transformation of fear and avoidance functions via combinatorial entailment within the IRAP context.

• Modifying the Implicit Relational Assessment Procedure (IRAP) for use with psychophysiological measures: an EEG test case.
Michel Quak, Ghent University
Aileen Leech, Ghent University
Dermot Barnes-Holmes, Ph.D., Ghent University

The Implicit Relational Assessment Procedure (IRAP) has been widely used to test the strength of ‘implicit’ relational responses in individuals. Previous studies that used electroencephalography (EEG) to examine the neurological mechanisms supporting relational responding have been inconclusive. We devised the sequential IRAP (S-IRAP) to use with EEG recording. Behavioural pilot studies indicated that the S-IRAP and traditional IRAP yield comparable outcomes. For the EEG study we tested 30 participants with the S-IRAP. Besides reducing the number of artefacts found in EEG data, the S-IRAP also allows us to investigate the neural activity at the moment of label and target presentation in isolation. Preliminary results indicate posterior neural activity show higher amplitudes for positive stimuli compared to negative. Some posterior electrode sites show an interesting interaction where amplitudes are higher for negative stimuli when participants are required to respond positively towards negative pictures. During target presentation we also find differential activity dependent on the type of label, target, and context presented. The S-IRAP will prove useful in examining underlying neural mechanisms of relational responding.

• Neural mechanisms and the role of inattention and memory in the relationship between ADHD and anxiety.
Robert Whelan, Ph.D., Trinity College Dublin
Dervla Gallen, Trinity College Dublin
Marc Patrick Bennet, Medical Research Council- Cognition and Brain Science Unit, University of Cambridge

Attention-deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder that has been consistently associated with an over-representation of comorbid anxiety disorders. Anxiety disorders can be further understood through maladaptive fear learning processes, such as fear generalisation. The current study aimed to determine if inattention and memory (i) mediated the relationship between ADHD and anxiety, and thus, (ii) lead to an over-generalisation of fear in individuals with ADHD. Participants with ADHD (n=33) and neuro-typical controls (n=44) were recruited for the study. Inattention and memory deficits and anxiety ratings were measured by the CAARS and STAI-T, respectively. Preliminary analyses indicated higher levels of anxiety, inattention and memory deficits in the ADHD group. Results revealed that inattention and memory partially mediated the relationship between ADHD and anxiety. Neither group differed with respect to fear acquisition. Supplementary EEG analyses indicated increased generalisation in the ADHD group. However, inattention and memory deficits did not appear to mediate this relationship. Heightened generalisation suggests there are clinical implications of inattention and memory deficits, resulting in the pathogenesis of anxiety disorders in ADHD.

Educational Objectives:
1. Describe the role of levels of derivation in the transformation of derived fear and avoidance functions on the IRAP. 2. Implement the modified IRAP for neurophysiological measurements and consider cognitive process in clinical research. 3. Utilize neurophysiological data to support findings in implicit relational responding.

 

61. Flexibility in the Workplace: Innovations in Research
Symposium (10:35-12:05)
Components: Literature review, Original data
Categories: Organizational behavior management, Wellbeing of healthcare workers; workplace coaching; organisational effectiveness and wellbeing
Target Audience: Beginner
Location: Q217

Chair: Frank W. Bond, Ph.D., Goldsmiths, University of London
Discussant: Sonja V. Batten, Ph.D., Booz Allen Hamilton

This symposium presents four new studies examining flexibility in the workplace. First, Dr Lamb will present the results of a systematic review that looked at associations between individual psychological constructs (e.g. personality, psychological flexibility, self-esteem, emotional intelligence) and wellbeing (e.g. burnout, stress, engagement, satisfaction) in mental health workers. Then, Dr Villatte will present a multimodal, longitudinal study that aimed to understand factors that influence psychological flexibility in healthcare workforce, using a combination of psychometrics, experience sampling, and biobehavioural and environmental sensors. Thirdly, Dr Skews will present data comparing two alternative theories of change in workplace coaching, looking at the relationship between psychological flexibility and coaching outcomes, and the quality of relationship in achieving coaching outcomes. Fourthly, Dr Gascoyne will present research that developed and validated a measure of organisational flexibility, a functional equivalent of psychological flexibility, for predicting and influencing both individual and organisational effectiveness and wellbeing (e.g. mental health, job satisfaction, organisational performance). Finally, Dr Sonja Batten will summarise the studies and explore how they relate to the wider CBS literature.

• Individual psychological characteristics associated with wellbeing at work in mental health staff: a systematic review
Danielle Lamb, Ph.D., University College, London

Background: The wellbeing of mental health workers is linked to absenteeism, staff turnover, productivity, and service-user outcomes. Individual workers are often exposed to similar organisational and job-related stressors, but experience different wellbeing outcomes. This indicates that individual-level factors may protect against, or exacerbate, occupational stress. This systematic review aimed to explore associations between individual psychological characteristics and wellbeing outcomes in mental health staff, in order to improve job design and support for these important workers. Method: A systematic search was conducted using eight databases. Methods adhered to PRISMA guidelines. Due to the heterogeneity of the studies returned, a narrative synthesis was planned. Results: 8,891 records were returned, and 44 studies included. Higher levels of mindfulness and psychological flexibility showed the most consistent associations with better wellbeing (r=-0.42 to r=-0.55). Implications: Research implications: 1) improve conceptual clarity around the constructs used in individual differences research; 2) improve understanding of mechanisms driving the relationships between individual characteristics and wellbeing outcomes. Practical implications: provision of contextual behavioural interventions/training such as ACT, in a preventative or remedial capacity. research.

• Intensive Longitudinal Assessment of Psychological Flexibility in Healthcare Workers
Jennifer Villatte, Ph.D., University of Washington
Justin L'Hommedieu, M.A., University of Southern California
Michelle Hasan, Ph.D., University of Southern California
Shrikanth Narayanan, Ph.D., University of Southern California

Previous research has established key relationships among psychological flexibility, workplace behaviors, and work-related individual differences, but little is known about momentary variations in psychological flexibility and its influence on healthcare workers. The purpose of this study was to better understand the dynamic relationships among psychological flexibility, work-relevant individual characteristics, and job performance in the healthcare workforce. We observed 200 hospital clinicians for 10 weeks using intensive, multimodal, longitudinal assessment. Assessments included baseline psychometric surveys of individual differences (psychological flexibility, intelligence, personality, affect, anxiety, stress, health, wellness) and work-related variables (work engagement, job performance, organizational citizenship behavior, counterproductive work behavior). We also used daily experience sampling to assess these constructs over time and across contexts. We will present results of multilevel modeling of between- and within-subject variability in psychological flexibility and its direct and indirect effects on work behavior, relative to individual differences. Implications for workplace interventions and future research will be discussed.

• Evaluating alternative processes of change in ACT-informed workplace coaching
Rachael Skews, Ph.D., Goldsmiths, University of London
Jo Lloyd, Ph.D., Goldsmiths, University of London

Background: Processes of change in workplace coaching interventions can be hypothesised using different theories of change; however little empirical evidence exists testing and comparing these different explanations. This study aims to test the indirect effects of two theoretically derived processes through which change has been hypothesised to occur in workplace coaching. Method: Using data from the intervention arm of an RCT study of ACT-informed coaching, a within-subjects repeated-measures analysis compared the indirect effects of psychological flexibility (derived from the ACT Model) and working alliance (derived from the Contextual Model) on coaching outcomes. Study participants are senior managers in the UK Civil Service, who received three sessions of ACT coaching (N = 65). Results: Intervention analyses show increases in general mental health, generalised self-efficacy, goal-directed thinking, goal attainment, psychological flexibility, and working alliance. Mediation analyses indicate increases in psychological flexibility mediated increases in generalised self-efficacy goal-directed thinking, and goal attainment. No significant mediation effects of working alliance are shown. Discussion: The implications of these results will be discussed, as well as directions for future research.

• A Scale to Measure Organisational Flexibility
Anneli Gascoyne, Ph.D., Goldsmiths, University of London
Jo Lloyd, Ph.D., Goldsmiths, University of London
Frank W. Bond, Ph.D., Goldsmiths, University of London

Background: Ph.D. research to develop and validate an organisational flexibility scale (OFS), reflecting Bond’s (2015) model of organisational flexibility, as a functional equivalent to psychological flexibility, for predicting and influencing individual and organisational effectiveness and wellbeing. Method: An individual-level sample (n = 303) was used for exploratory factor analysis (EFA). An organisational-level sample (n = 331, organisations = 31) was used for multilevel confirmatory factor analysis (MCFA), correlations and regressions to test factor structure, reliability and validity. Results: EFA indicated a reliable, multilevel, single-factor, seven-item scale. MCFA supported the structure, at both individual and organisational levels. Validity was supported by the OFS’s: 1) relationships with psychological flexibility and organisational learning; 2) ability to predict mental health, work motivation, job satisfaction and organisational performance; and 3) ability to do so over and above psychological flexibility and organisational learning. Implications: The OFS aims to fill the gap in organisational-level measures of flexibility, providing a reliable and valid measure, with potential utility in organisational and research settings.

Educational Objectives:
1. Plan research studies investigating the use of ACT interventions in the workplace. 2. Describe processes of change in ACT-based workplace interventions, and evaluate them based on empirical evidence. 3. Use measures of psychological and organisational flexibility in future research protocols.

 

62. An in-depth look at psychological flexibility using the CompACT
Symposium (10:35-12:05)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Clinical Interventions and Interests, Clinical Assessment, Psychometrics, Psychological Flexibility
Target Audience: Intermediate
Location: Q218

Co-Chairs: Kaylie Green, B.A. & Andi M. Schmidt, M.Sc., Pacific University
Discussant: Jason Luoma, Ph.D., Portland Psychotherapy Clinic, Research, & Training Center, Oregon Health Sciences University

Psychological flexibility involves mindfully engaging in behaviors that are in alignment with one’s chosen values. It is a key element of third-wave psychotherapies, and can enhance resilience and present-moment awareness. Higher levels of psychological flexibility may increase adaptability to demanding situations, improve perspective-taking, and decrease experiential avoidance. Using quantitative and qualitative methods, research presented in this symposium examines psychological flexibility as measured by the Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT) and Acceptance and Action Questionnaire (AAQ-II). Presentations in this symposium will (1) show support for a three-factor CompACT structure using a confirmatory factor analysis, (2) assess the unique variance accounted for by the CompACT relative to the Five Facet Mindfulness Questionnaire in predicting stress, anxiety, and depression outcomes, (3) examine the fidelity of the CompACT and AAQ-II in the measurement of ACT targets using cognitive interviewing, and (4) present the development and validation of an abbreviated, eight-item short form of the CompACT. Reaching a greater empirical understanding of psychological flexibility psychometrics will be critical to the measurement of contextual and behavioral processes.

• A confirmatory factor analysis and validation of the Comprehensive assessment of Acceptance and Commitment Therapy process (CompACT)
Joshua Kaplan, M.S., Pacific University
Ashley Eddy, B.A., Pacific University
Candice Hoke Kennedy, Pacific University
Jenna Flowers, M.S., Pacific University
Michael S. Christopher, Ph.D., Pacific University

Research shows psychological flexibility mitigates negative outcomes, and interest in its measurement has emerged. The Comprehensive assessment of Acceptance and Commitment Therapy (CompACT; Francis, Dawson, & Golijani-Moghaddam, 2016) was developed to address shortcomings of existing measures. In the initial validation study, the authors found acceptable psychometric properties. The goals of this study were to re-evaluate the CompACT factor structure using confirmatory factor analysis and to assess its psychometric properties in a sample of adults (n=601) representative of the U.S. population. Results suggest a modified three-factor solution provides an adequate fit to the data, SBχ²(167) = 227.58, p < .01, GFI = .90, CFI = .95, RMSEA = .07. The CompACT also demonstrated good internal consistency (α = .86) and expected correlations with constructs such as thought suppression (r = -.58) and psychological resilience (r = .59). Despite these positive outcomes, two of the three factors were not significantly correlated, and one factor had poor internal consistency. Implications for clinical and research use of the CompACT will be discussed.

• The incremental validity of psychological flexibility in the prediction of psychopathology symptoms
Andi M. Schmidt, MSc, Pacific University
Joshua Kaplan, M.S., Pacific University
Kaylie Green, B.A., Pacific University
Jenna Flowers, M.S., Pacific University
Eli Dapolonia, M.A., M.S., Pacific University
Michael S. Christopher, Ph.D., Pacific University

Dispositional mindfulness has substantial empirical support as a mitigating factor against the development of psychopathology. Psychological flexibility, a distinct, though related, construct also has strong support as a protective factor against psychopathology. The present study examined the incremental validity of psychological flexibility (Comprehensive assessment of Acceptance and Commitment Therapy [CompACT]) relative to mindfulness (Five Facet Mindfulness Questionnaire short-form [FFMQ-SF]) in predicting symptoms of anxiety, depression, and stress among a nonclinical sample of U.S. adults (N = 601). Main effects indicated higher levels of psychological flexibility and mindfulness were independently negatively predictive of symptom severity. Hierarchical regression analyses demonstrated that the CompACT significantly predicted depression (β = -.40, p < .001), anxiety (β = -.39, p < .001), and stress (β = -.48, p < .001) beyond the variance accounted for by the FFMQ-SF. When both CompACT and FFMQ-SF were entered in the same hierarchical regression block, both constructs significantly predicted outcomes, supporting previous findings that psychological flexibility and mindfulness function independently in the prediction of psychological outcomes. Clinical applications and research implications will be discussed.

• Examining ACT process measures with cognitive interviewing
Jessica Wright, MSc., University of Nottingham
David Dawson, DClinPsy, University of Lincoln
Nima Moghaddam, Ph.D., DClinPsy, University of Lincoln

Cognitive interviewing is an established applied qualitative method for examining and improving the face and content validity of psychological measures. Utilizing concurrent or retrospective interview techniques, the method examines how individuals interpret, understand and respond to psychometric items, to determine whether they target expected domains and processes. We aimed to examine respondents’ verbal responses to items within the CompACT and AAQ-II (given their use in clinical research and practice) in order to determine whether/how these responses correspond with ACT targets. Twenty-six ACT-naïve individuals completed both measures and cognitive interviews. Responses to 22 CompACT items corresponded with its putative three-factor conceptualization of psychological flexibility; mapping for one item was unclear. Responses to six AAQ-II items corresponded with concepts of experiential avoidance and committed action; mapping for one item was unclear. Low frequency problems (e.g., unclear wording) were found with items on both measures, and both appeared to target intended (but varied) ACT constructs. Findings seemingly support the CompACT as a conceptually broader measure of psychological flexibility, while the AAQ-II appears more targeted on experiential avoidance-related domains.

• Developing and testing a brief measure of psychological flexibility: The CompACT-8
Lucy Morris, M.Sc., University of Nottingham
Nima Moghaddam, Ph.D., DClinPsy, University of Lincoln
David Dawson, DClinPsy, University of Lincoln

The Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT) was developed to overcome some of the limitations of existing ACT process measures and to provide a fuller assessment of psychological flexibility. However, at 23 items, the CompACT is relatively lengthy and is therefore not ideally suited to all potential use-cases. In this presentation, we describe the development of a short-form version of the CompACT that is more apt for use when low-burden, frequent, and/or repeated measurement of psychological flexibility is required. We will outline the process of deriving the short-form, including the psychometric, theoretical, and qualitative steps taken, and present new validation data (N= 579) for this abbreviated, 8-item version of the CompACT (the CompACT-8). These data indicate that the CompACT-8 is psychometrically robust, with good internal reliability, concurrent and convergent validity, and good model fit with the previously-defined three-factor structure of the original CompACT. The additional use-cases of the new abbreviated measure will be discussed.

Educational Objectives:
1. Assess and select contextually-valid measures of psychological flexibility. 2. Analyze the CompACT to identify distinct construct factors of psychological flexibility. 3. Discuss revisions to traditional measures of psychological flexibility to enhance utility in clinical assessment.

 

63. Can You Help Me Do This Myself? Problem Solving, Autism, Insomnia, and Competitive Rock-Climbing Using ABA, RFT, and ACT Interventions
Symposium (10:35-12:05)
Components: Conceptual analysis, Literature review, Original data
Categories: Clinical Interventions and Interests, Theoretical and philosophical foundations, Autism, Problem Solving, RFT, ACT, ABA, Insomnia, Rock Climbing
Target Audience: Beginner, Intermediate, Advanced
Location: Q220

Chair: Thomas Szabo, Ph.D., BCBA-D, Florida Institute of Technology

This symposium includes philosophy, conceptual analysis, and applied empirical findings using single case design methods. We bring together Radical Behaviorist and Functional Contextualist philosophy, Skinnerian and RFT conceptualizations of problem-solving, and ACT and RFT interventions for individuals with autism having difficulties with sleep and competitive athletic performance. First, Lilly Flores-Fiumara presents an analysis of problem solving from a radical behaviorist and RFT perspective. Next, Tom Szabo presents findings from a study using an RFT approach to teaching problem-solving to young children in a rock climb gym and examining generalization of problem-solving repertoires to different contexts. Subsequently, Tom Szabo presents research comparing a novel iteration of ACT called Watch Me Try to direct contingency management to improve athletic performance of young adults with autism. Finally, Eric Morris discusses insomnia treatment for adults with autism using ACT.

• Problem Solving from a Radical Behaviorist and Relational Frame Theory Perspective
Lilly Alejandra Flores-Fiumara, University of West Florida
Heidi Eilers, The Chicago School of Professional Psychology
Eric Carlson, The Chicago School of Professional Psychology

In order to set the occasion for a coherent and consistent examination of problem solving, underlying assumptions rooted in radical behaviorism and functional contextualism will be discussed. This foundation set the boundaries for developing a unit of analysis, i.e., defining a “problem," revealing the context, pinpointing the behavior of interest, and exploring mediating responses and sources of control. The activity of solving a problem will be further reviewed from a Relational Frame Theory perspective. An understanding of how relations are derived among events, objects, and their features to generate novel stimulus functions welcomes a pragmatic verbal analysis. Lastly, the utility of a verbal pragmatic analysis for approaching effective solutions for problems and implications for future researchers and practitioners will be discussed.

• Generalized problem solving: From vocal to sub-vocal self-prompting in trained and novel contexts
Thomas Szabo, Ph.D., BCBA-D, Florida Institute of Technology

Skinner’s analysis of problem-solving and RFT provide robust predictions to test. We investigated whether young children with poor eye-hand coordination could be taught to use self-prompting strategies to solve movement problems on a 3 m tall climbing wall using directional, numerical, and oppositional framing. Two boys (6 and 7 years of age) were taught to vocalize problem-solving strategies related to movement and, when the context shifted from learning to competition, to diminish the magnitude of their responses so that others would not benefit from the supplemental stimuli they used to probe and prompt themselves. Consistent with Skinner’s analysis of problem solving, participants in this study responded in the context of an establishing operation by manipulating variables until a response resulted in reducing the aversive condition. Training resulted not only in improved physical skills but also in the acquisition of a verbal repertoire with respect to directional, numerical, and oppositional relational cues that generalized to novel contexts and novel behaviors. Results are discussed in terms of verbal behavior and relational framing approaches to problem-solving instruction.

• Watch me try: An acceptance and commitment training approach to improving athletic performance of young adults with ASD
Thomas Szabo, Ph.D., BCBA-D, Florida Institute of Technology

Few studies have examined the effects of contextual behavior science interventions for adult athletes with Autism Spectrum Disorder (ASD). Those few, reviewed herein, show preliminary empirical support for treating behavioral deficits exhibited by young adults with ASD engaged in competitive sports. In the current study, we evaluated a novel iteration of Acceptance and Commitment Training called Watch Me Try and compared it to direct contingency management to facilitate athletic performance of young adults with ASD using a concurrent multiple baseline across participants design. The title and language used in establishing the intervention were geared specifically to the social development of the participants. All three athletes improved their attendance and performance during these interventions. One improved with direct contingency management alone; the other two required the Watch Me Try approach to bolster their performance.

• An evaluation of an Acceptance and Commitment Therapy group program for people on the autism spectrum with insomnia
Eric Morris, Ph.D., La Trobe University
Kathleen Denny, La Trobe University
Lauren Lawson, La Trobe University
Amanda Richdale, La Trobe University

Insomnia is a common problem for autistic adults, and is associated with comorbid anxiety, depression, and challenges in occupational functioning. This paper will describe the results of a pilot investigation of an ACT group program designed to help adults on the autism spectrum experiencing insomnia. While there is a small body of evidence supporting parent training and CBT for anxiety in autistic children and adolescents, empirically-supported psychological interventions are lacking for adults. Anecdotal evidence suggests that autistic adults do not like CBT techniques such as cognitive restructuring (which may be difficult due to intrinsic social-cognitive difficulties). However, a small number of studies show that mindfulness/ACT can effectively address mental health difficulties for autistic adults. In this paper we will describe a multiple baseline single-case design evaluation of an ACT for insomnia group program for autistic adults. We will outline the components & adaptations of a group program that combines sleep hygiene principles with Acceptance and Commitment Therapy, and present participant-reported (insomnia and mental health) and objective outcomes (actigraphy), along with the feedback on program acceptability.

Educational Objectives:
1. Discuss the unit of analysis in defining and solving a problem and discuss the roles of self-prompting and self-probing within specified relational repertoires to solve problems involving spatial orientation. 2. Compare the relative strengths of direct contingency management and ACT strategies for improving athletic performance in young adults with autism. 3. Discuss sleep hygiene principles taught alongside ACT to promote healthy bedtime habits in adults with autism.

 

71. Defusion, Distraction, Cognitive Restructuring, Formal or Informal Mindfulness? A Data-Based Path Through the Jungle
Symposium (13:20-14:50)
Components: Conceptual analysis, Literature review, Original data
Categories: Clinical Interventions and Interests, Relational Frame Theory, ACT component analyses
Target Audience: Beginner, Intermediate, Advanced
Location: Q119

Chair: Thomas Szabo, Ph.D., BCBA-D, Florida Institute of Technology
Discussant: Nic Hooper, University of the West of England

As contextual behavior science (CBS) matures, integration of methods developed in other disciplines becomes possible. Deciding which among several competing or overlapping methods to use with a client can be daunting. Gordon Paul's question,“What treatment, by whom, is most effective for this individual, with that specific problem, under which set of circumstances, and how does it come about?” informs the CBS research papers included in this symposium. In the first paper, Lavelle, Dunne, Mulcahy, & McHugh will present research comparing chatbox-delivered defusion and cognitive restructuring interventions for negative self-referential thoughts. Next, Szabo, Tinnerman, and Haskins will present research comparing defusion and distraction as preventative measures to inoculate against human depression. Finally, Hope-Bell, Hooper, and Thompson will share findings related to a metaphor-based intervention to improve mindfulness without formal contemplative practices. Following the presentations, Dr. Nic Hooper will offer comments and generate discussion topics.

• Chatbot-delivered cognitive defusion verses cognitive restructuring for negative self-referential thoughts
Joseph Lavelle, University College Dublin
Neil Dunne, University College Dublin
Louise McHugh, University College Dublin
Hugh Edward Mulcahy, MD, FRCPI, University College Dublin

Negative self-referential thoughts are posited to be involved in a range of psychological disorders ranging from depression and anxiety to psychosis. Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) are approaches that target negative thoughts via processes of restructuring and defusion respectively. Research has lent support to computerized CBT and ACT while chatbot-delivered CBT has shown preliminary effectiveness in reducing depression and anxiety. The present research aims to compare two brief chatbot interventions which delivered cognitive restructuring and defusion interventions respectively. It was hypothesized that a defusion chatbot would lead to reduced cognitive fusion and thought believability relative to cognitive restructuring and a non-active control. Participants were randomized into one of three conditions (defusion, restructuring, control), engaged for five days and completed thought and mood measures pre- and post-intervention. Differences between groups on measures of: cognitive fusion; thought believability, negativity, discomfort, willingness; psychological flexibility; and mood will be discussed. Despite brevity of interventions, the present study lends support to the use of brief defusion-based chatbot interventions (and chatbots generally) as mental health interventions.

• A Comparison of Pre-teaching Methods in a Learned Helplessness Analogue of Human Depression
Thomas Szabo, Ph.D., BCBA-D, Florida Institute of Technology
Natalie Tinnerman, BCBA, Florida Institute of Technology
Miranda Haskins, Florida Institute of Technology

Thought distraction is a common approach for avoiding unwanted psychological events. Recent research suggests that such strategies may be counterproductive due to the resurgence of suppressed content in similar contexts. An alternative behavior analytic tactic is defusion, in which the literal functions of self-defeating thoughts are undermined and transformed. We pre-taught five participants to use either distraction or defusion strategies when thinking themselves incapable of a task. We then exposed them to repeated trials of unsolvable anagram problems that switched to being solvable without signal. In four out of five participants, defusion led to successful outcomes and distraction to giving up. Results suggest that pre-training in defusion techniques can help individuals to distance themselves from self-defeating thoughts long enough to contact delayed reinforcement.

• Increasing Mindfulness without Formal Mindfulness Practice
Josh Hope-Bell, University of the West of England
Nic Hooper, University of the West of England

Given poor adherence to formal mindfulness practice, this research study sought to determine if it is possible to increase levels of mindfulness without formal mindfulness practice. Specifically, it was hypothesized that metaphors stemming from Acceptance and Commitment Therapy (ACT) may be helpful in this regard. 115 participants, over a six-day period, were randomly allocated to receive brief metaphor-based interventions, brief mindfulness-based interventions or no intervention. Prior to, immediately following and one-week post-intervention, all participants were required to complete a measure of mindfulness. Results indicated significant increases in mindfulness for the metaphor and mindfulness conditions at post-intervention and at one-week follow-up, relative to the no-intervention control condition. This suggests that there are ways to increase mindfulness which do not involve formal mindfulness practice. The wider implications of these findings are discussed.

Educational Objectives:
1. Participants will describe the uses of chatbox-delivered defusion and cognitive restructuring interventions. 2. Participants will critique the relative strengths and weaknesses of defusion versus distraction as prevention against depression. 3. Participants will describe situations in which to use informal versus formal mindfulness practices.

 

75. When Life is Lame: Navigating Adolescent Mental Health
Symposium (13:20-14:50)
Components: Literature review, Original data, Case presentation
Categories: Clinical Interventions and Interests, adolescents, self-harm, protocol
Target Audience: Beginner, Intermediate, Advanced
Location: Q158

Chair: Ashley Braezeale, Munroe-Meyer Institute, University of Nebraska Medical Center
Discussant: Louise Hayes, Ph.D., The University of Melbourne & Orygen Youth Mental Health

Adolescent mental health has become a rising concern. In fact, 10-20% of adolescents are affected by mental health concerns and suicide is the third leading cause of death among children aged 15-19 years (World Health Organization, 2018). The primary aim of this symposium is to educate attendees on the prevalent presenting problems in adolescents and a novel approach to behavioral treatment. The presenter will discuss the relationship between components of psychological flexibility, family accommodation, and self-harm behaviors in adolescents with severe OCD. The second presenter will discuss a new measure of gender role conflict and its relationship with suicide ideation, self-esteem, and depression. The final presentation will introduce a multi-session Acceptance and Commitment Therapy (ACT) protocol that utilizes a singular metaphoric theme (Life is a Show) to guide the adolescent client through all ACT processes in treatment. The symposium will conclude with remarks on the shared concepts in all presentations and the importance of continued work in adolescent mental health.

• Self-Harm and Depression in Adolescents with Severe OCD: Relationships with Family Accommodation and Psychological Inflexibility
Lisa Coyne, Ph.D., Harvard Medical School/McLean Hospital
Rebecca Michel, Harvard Medical School/McLean Hospital
John L. McKenna, The New England Center for OCD and Anxiety
Evelyn Gould, Ph.D., McLean Hospital, Harvard University

Recent work has suggested that adolescents with OCD and anxiety are six times more likely to experience depression than younger children, and that 1 in 2 met criteria for a co-occurring mood disorder (Peris, Rozenman, Bergman, Chang, O’Neill & Piacentini, 2017). Our study examined the relationship between depression, suicidal ideation and self-harm behaviors, family accommodation, and contextual behavioral variables; namely, experiential avoidance, cognitive fusion, and valuing behavior, in adolescents with severe obsessive compulsive disorder. Our sample comprised 128 adolescents (Age M = 15.24; SD = 1.76) with severe OCD (M = 29.7; SD = 4.61). We expected to find a positive correlation between depression, self-harm, and obsessive-compulsive symptoms. We also expected that engagement in self-harm behaviors would be associated with higher psychological inflexibility and family accommodation. Strengths and limitations of the current study are discussed, as well as directions for future research.

• Adolescent Suicide Ideation, Depression and Self-Esteem: Relationships to a New Measure of Gender Role Conflict
Cormac Ó Beaglaoich, Ph.D., National Institution for Science and Education (NISE) and University of Limerick
Jessica McCutcheon, Ph.D., University of Saskatchewan
Paul Conway, Ph.D., National Institution for Science and Education (NISE) and University of Limerick
Joan Hanafin, Ph.D., National Institution for Science and Education (NISE) and University of Limerick
Todd G. Morrison, Ph.D., University of Saskatchewan

Among 15-24 year olds in Ireland, completed suicide was responsible for 4.1 times more male deaths than female deaths in 2014 (WHO, 2017). Few international research studies have investigated the relationship between masculinity (as measured by the Gender Role Conflict [GRC]) and suicide ideation, and none within an adolescent Irish context. Therefore, the purpose of the current study was to investigate the relationships between a new measure of GRC developed specifically for use with Irish adolescents (I-GRCS-A; O’Beaglaoich, Kiss, Ní Bheaglaoich & Morrison, 2016), and depression, self-esteem, and negative/protective suicide ideation. A sample of 176 secondary school boys (M = 16.9, SD = 0.94) took part in the study. Regression analyses and tests of mediation revealed that depression significantly mediated the relationship between GRC and negative suicide ideation, whilst self-esteem and depression significantly mediated the relationship between GRC and positive suicide ideation. Limitations of the current study are outlined and directions for future research are discussed.

• 3...2...1...ACTion!: A Unified Metaphor Approach to Treatment with Adolescents
Mindy Chadwell, Ph.D., Munroe-Meyer Institute, University of Nebraska Medical Center
Ashley Breazeale, Munroe-Meyer Institute, University of Nebraska Medical Center
Emmie Hebert, Munroe-Meyer Institute, University of Nebraska Medical Center

The prevalence of anxiety and depression among the US adolescent population has increased in recent years (Mojtabai & Olson, 2016). Adolescents experiencing symptoms of anxiety or depression often have difficulties with low mood, psychological inflexibility, withdrawal from valued activities, and/or heightened autonomic arousal, among many other symptoms that impair functioning. Acceptance and Commitment Therapy (ACT) is a treatment approach aimed at increasing psychological flexibility, increasing contact with the present moment, and increasing engagement in valued activities (Hayes, Strosahl, & Wilson, 2012). While adaptations to ACT have been made to respond to the unique developmental needs of adolescents, there are currently no adolescent-focused ACT approaches that operate from the use of a single metaphor; nor are there protocols that incorporate caregiver involvement. The purpose of this paper is to introduce the 3…2…1 ACTion! protocol, a unified metaphor for use with adolescents presenting in clinic with symptoms of anxiety and depression; as well as to present case study data describing the therapeutic impact of the protocol in relation to increasing psychological flexibility and engagement with valued activities.

• “My Schema is Shouting”: A Contextual Approach to Integrating Schema Therapy and PTSD Treatment
Peter Grau, M.S., Marquette University; Rogers Memorial Hospital
Chad Wetterneck, Ph.D., Rogers Memorial Hospital

Early childhood trauma results in increased risk of PTSD and poorer treatment outcomes from time-limited, evidence-based treatments (Harding, Burns, & Jackson, 2012; Price, 2007). One way these experiences can be understood is through the self-as-context congruent lens of the early maladaptive schema model, which has recently been explored within a CBS framework. In schema theory, early unmet core needs lead to the development of maladaptive schemas (e.g., abandonment, shame/defectiveness), which have been linked to high levels of PTSD symptom severity (Dutra et al., 2008), self-criticism (Thimm, 2017), and interpersonal struggles (Karatzias, 2016). Data from an ACT-informed exposure-based partial hospitalization program (n = 277) was examined for relationships between early maladaptive schemas, PTSD symptom severity, self-compassion, interpersonal functioning, and valued living with moderate to strong correlations between schema severity and the other variables. Longitudinal analyses will be conducted on relationships between schema change scores, symptom reduction, and quality of life. We will discuss ways to increase awareness of schemas and use self-as-context and defusion to disentangle patients from schema-based language systems and movement towards current values.

Educational Objectives:
1. Participants will be able to describe the relationship between self-harm, depression, family accommodation, and psychological flexibility in adolescents with severe OCD. 2. Participants will be able to describe a psychometric measure of gender role conflict and discuss how gender role conflict is related to depression and anxiety. 3. Participants will be able to discuss the unified metaphor for the 3…2…1 ACTion protocol and visually analyze case study data of the therapeutic effects of treatment.

 

76. How to Cry in Contextualism: Exploring Different Contextual Factors of and Interventions for Emotion Regulation
Symposium (13:20-14:50)
Components: Original data
Categories: Prevention and Community-Based Interventions, Performance-enhancing interventions, Emotion Regulation, Exercise, Substance Use Disorder, Video Games
Target Audience: Beginner
Location: Q217

Chair: Rebecca Copell, University of Louisiana at Lafayette
Discussant: Rhonda Merwin, Ph.D., Duke University School of Medicine

Emotions are an essential part of what it means to be human. While emotions are internal events, the regulating of emotional responses often takes the form of overt behavior that can have maladaptive effects and even pathological implications. It is suggested the difficulties in regulating emotions are central to most if not all psychological disorders. Research in this area needs to then consider not only contextual factors that affect emotion regulation but also interventions to improve emotion regulation, in both clinical and non-clinical settings. This symposium includes three presentations exploring these areas of research. The first presentation will look at how acute emotion regulation is affected by mindfulness and video game interventions as compared to a control game. The second presentation will focus how exercise affects emotion regulation. The final presentation will explore the unique struggles people with substance use disorders have with regulating emotions, especially in terms of depression. A general discussion will follow.

• Relation of Experiential Avoidance, Depression Symptoms, and Emotional Reactivity to a Distressing Laboratory Task in the Context of Inpatient Substance Use Patients
Emily A. Kalantar, University of South Dakota
Rachel C. Bock, University of South Dakota
Lucas D. Baker, University of South Dakota
Christopher R. Berghoff, University of South Dakota
Kim L. Gratz, University of Toledo
Matthew T. Tull, University of Toledo

Individuals with substance use or mood disorders experience emotion regulation difficulties (e.g., Chen et al., 2018; McFarland & Klein, 2009), which may be a source of mutual maintenance for these diagnostic categories. Yet, little extant research has identified individual-level variables that influence such relations in short-term contexts. Experiential avoidance (EA) may be one such factor. The present study aimed to clarify the relations of EA, emotional reactivity, and depression symptoms with a sample of inpatient SUD patients (N=221; Male=141; Mage=35.71; Range=18-61). Participants completed a multi-part distressing laboratory task and ratings of negative emotional responses (anxiety, frustration, and irritation; Lejuez et al., 2002). Multilevel modeling (Preacher, Curran, & Bauer, 2006) indicated significant within-person depression symptom by EA interactions on mean emotion, t=2.87, p=.005, and linear reactivity, t=-2.80, p=.006, across all trials. High EA was associated with elevated mean negative emotion only for individuals who reported elevated depression symptoms. Alternatively, high EA was related to elevated emotional reactivity only for individuals who reported low depression. Theoretical and clinical implications will be discussed.

• Examining the Effect of Acute Aerobic Exercise on Emotion Regulation and Attempts to Control Negative Affect
Madison K. Knox, B.S., University of Louisiana at Lafayette
Caitlin T. Daigle, B.S., University of Louisiana at Lafayette
Christopher R. Berghoff, Ph.D, University of South Dakota
Randy L. Aldret, Ed.D., University of Louisiana at Lafayette
Greggory R. Davis, Ph.D., University of Louisiana at Lafayette
David M. Bellar, Ph.D., University of Louisiana at Lafayette
Michael J. McDermott, Ph.D., University of Louisiana at Lafayette

Although physical exercise is associated with reductions in negative mood states, the precise mechanisms of this relation remain unclear. Recent studies indicate that exercise may improve psychological well-being through alterations in emotion regulation yet findings remain preliminary with limitations in the assessment of emotional and physiological responding. Thus, this study utilized a randomized cross-over design in which participants completed a 30-minute aerobic exercise intervention (Exercise) or a 30-minute rest control activity (Rest) followed by a computerized behavioral measurement of emotion regulation (PASAT-C). Results of a 2 (Exercise vs. Rest) × 3 (T1 vs. T2 vs. T3) repeated measures ANOVA controlling for relevant covariates demonstrated a significant condition × time interaction, F(2, 12) = 5.57, p = .004, ηp2 = 0.40, demonstrating that acute aerobic exercise may affect psychological well-being by protecting against declines in ER associated with stress. Results from behavioral distress tolerance task (PASAT-C) and measures of attempts to control negative affect will also be reported.

• Playing with Emotions: The Effects of Video Games and Mindfulness on Acute Emotion Regulation
Jonah McManus, University of Louisiana at Lafayette
Emily K. Sandoz, Ph.D., University of Louisiana at Lafayette
Patrick Rappold, University of Louisiana at Lafayette
Madison Gamble, University of Louisiana at Lafayette

Emotion regulation involves any attempt at changing, starting, or stopping covert verbal behavior, and associated emotions. Some experts suggest that difficulties in regulating emotions is central to most, if not all, psychological disorders. For this reason, increasing adaptive emotion regulation is a common therapeutic goal. However, therapeutic goals extend past the therapy context. For example, video game play and mindful breathing are commonly reported as simple approaches anyone can do to manage intense emotions and responses thereto. The current study examined the impact of two brief interventions, video games and mindful breathing, on acute emotion regulation measured via a distress tolerance task and self-reported emotional states as compared to a waiting control. Results showed differing effects of each intervention on emotion regulation and divergent results as measured by the self-report measures versus the distress tolerance task. Steps for future research and limitations as well as implications for assessment will be discussed.

Educational Objectives:
1. Describe how different interventions affect emotion regulation. 2. Discuss different models of emotion regulation. 3. Design future studies to further explore emotion regulation.

 

77. Randomized controlled trials of RNT-focused ACT protocols: Emotional disorders, clinical psychology trainees, and adolescents with interpersonal skills deficits.
Symposium (13:20-14:50)
Components: Original data
Categories: Clinical Interventions and Interests, Educational settings, Supervision, Training and Dissemination, Relational Frame Theory, Emotional disorders, interpersonal problem solving skills, clinical psychology trainees
Target Audience: Beginner, Intermediate, Advanced
Location: Q218

Chair: Daniela M. Salazar, Fundación Universitaria Konrad Lorenz
Discussant: Carmen Luciano, Ph.D., Universidad de Almería

Recent research on clinical RFT has identified repetitive negative thinking (RNT) as an especially counterproductive form of experiential avoidance because of its pervasiveness. RNT is usually the first response to aversive private events and some recent empirical analyses are showing that triggers of RNT are hierarchically related. This analysis has some clinical implications: (a) focusing the intervention on disrupting counterproductive patterns of RNT might be especially powerful and might produce rapid therapeutic gains; and (b) focusing therapeutic work on the triggers at the top of the hierarchy might promote greater generalization of the therapeutic outcomes due to how transformation of functions through hierarchical relations works. Some studies have been developed RNT-focused ACT protocols that have shown very promising outcomes. The current symposium will present new randomized controlled trials that have analyzed the effect of RNT-focused ACT protocols for emotional disorders, the difficulties found by clinical psychology trainess, and for adolescents with interpersonal skills deficits.

• Efficacy of a 2-session RNT-focused ACT protocol in emotional disorders: A randomized waitlist control trial
Francisco Ruiz, Ph.D., Fundación Universitaria Konrad Lorenz
Andrés Peña-Vargas, Fundación Universitaria Konrad Lorenz
Eduar S. Ramírez, Fundación Universitaria Konrad Lorenz
Juan C. Suárez-Falcón, Fundación Universitaria Konrad Lorenz
María B. García-Martín, Fundación Universitaria Konrad Lorenz
Diana M. García-Martín, Fundación Universitaria Konrad Lorenz
Andrea Monroy-Cifuentes, Fundación Universitaria Konrad Lorenz
Ángela Henao, Fundación Universitaria Konrad Lorenz

This parallel randomized controlled trial evaluated the effect acceptance and commitment therapy (ACT) focused on disrupting repetitive negative thinking (RNT) versus a waitlist control (WLC) in the treatment of adult emotional disorders. Forty-eight participants were allocated by means of simple randomization to a 2-session RNT-focused ACT intervention or the WLC. The primary outcomes were emotional symptoms as measured by the DASS-21. Process outcomes included ACT and RNT-related measures: general RNT, experiential avoidance, cognitive fusion, values, and generalized pliance. No blinding procedures were implemented. At the 1-month follow-up, linear mixed effects models showed that the intervention was efficacious in reducing emotional symptoms (d = 2.42, 95% CI [1.64, 3.19]), with 94.12% of participants in the RNT-focused ACT condition showing clinically significant change in the DASS-Total scores versus 9.09% in the WLC condition. The intervention effects were maintained at the 3-month follow-up. No adverse events were found. A very brief RNT-focused ACT intervention was highly effective in the treatment of emotional disorders.

• Acceptance and commitment training focused on repetitive negative thinking for clinical psychology trainees: A randomized controlled trial
Iduar Dereix-Calonge, Fundación Universitaria Konrad Lorenz
Francisco Ruiz, Ph.D., Fundación Universitaria Konrad Lorenz
Marco A. Sierra, Fundación Universitaria Konrad Lorenz
Andrés Peña-Vargas, Fundación Universitaria Konrad Lorenz
Eduar S. Ramírez, Fundación Universitaria Konrad Lorenz

This parallel randomized controlled trial evaluated the effect of Acceptance and Commitment Training (ACT) focused on disrupting repetitive negative thinking (RNT) versus a waitlist control (WLC) in clinical psychology trainees. Eighty-five trainees agreed to participate and were allocated by means of simple randomization to a group, 6-session RNT-focused ACT intervention or the WLC. The ACT training was based on an online program for emotional disorders. At posttreatment, repeated measures ANOVA showed that the training was efficacious in reducing emotional symptoms (d = 0.75), depression (d = 0.79), the frequency of behaviors obstructing valued living (d = 0.51), RNT focused on clinical practice (d = 0.89), and general RNT (d = 0.62). Larger effect sizes were obtained by participants showing high levels of emotional symptoms (d = 0.75 to 2.52), with 73.33% of participants obtaining a reliable change in emotional symptoms, and 66.67% a clinically significant change versus 7.14% for both indicators in the WLC condition. An easy-to-implement RNT-focused ACT training is effective in reducing emotional symptoms and promoting valued living in clinical psychology trainees.

• Improving interpersonal skills in adolescents with acceptance and commitment training: A randomized waitlist control trial
Koryn Bernal, Fundación Universitaria Konrad Lorenz
María B. García-Martín, Fundación Universitaria Konrad Lorenz
Francisco Ruiz, Ph.D., Fundación Universitaria Konrad Lorenz

This parallel randomized controlled trial evaluated the effect acceptance and commitment therapy (ACT) versus a waitlist control (WLC) in improving interpersonal skills in adolescents and reducing emotional symptoms. Participants with a low level of emotional intelligence were invited to participate in the study. Forty-two adolescents (11-17 years) agreed to participate. At pretreatment, the sample showed low levels of interpersonal skills, behavioral adaptation, and valued living; and high levels of repetitive negative thinking, psychological inflexibility, and emotional symptoms. Participants were allocated by means of simple randomization to the intervention condition or the waitlist control condition. The intervention was a 3-session, group-based adaptation of acceptance and commitment therapy (ACT) focused on repetitive negative thinking (RNT). At posttreatment, repeated measures ANOVA showed that the intervention was efficacious in increasing overall interpersonal skills (d = 2.92), values progress (d = 1.38), and reducing emotional symptoms (d = 1.08). No adverse events were found. A brief RNT-focused ACT intervention was highly efficacious in improving interpersonal skills and reducing emotional symptoms in adolescents.

Educational Objectives:
1. List three clinical applications of an RFT analysis of repetitive negative thinking. 2. Discuss the potential of RNT-focused ACT protocols. 3. Describe the efficacy of RNT-focused ACT protocols in different settings.

 

78. Application and treatment efficacy of Compassion Focused Therapy: research findings among different populations
Symposium (13:20-14:50)
Components: Literature review, Original data,
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Behavioral medicine, Compassion Focused Therapy
Target Audience: Intermediate
Location: Q220

Chair: Chia-Ying Chou, Ph.D., Private Practice
Discussant: Dennis Tirch, Ph.D., The Center for CFT, NYC

Compassion Focused Therapy (CFT) is an evidence-based psychotherapy that draws upon our evolved capacity for compassion to facilitate the alleviation of human suffering, including but not limited to that associated with mental health challenges. Growing evidence has supported effectiveness of the therapy in treating symptoms of complex mental health disorders, e.g., Posttraumatic Stress Disorder, Major Depressive Disorder, and Eating Disorders, and improving a range of important psychological capacities, such as distress tolerance and openness to receiving compassion. This symposium will present two studies that applied CFT to underserved and less well-studied populations, i.e., individuals with Hoarding Disorder and sex offenders. The presenters will share how CFT was applied to treating the clinical challenges faced by the two populations, and the efficacy of the therapy. Finally, the third study of the symposium will illuminate mechanisms that are important to better treatment outcome of CFT based on self-report and biological evidence gathered from a healthy adult sample. The discussion will focus on the clinical implications of these research findings.

• Treating Hoarding Disorder with Compassion Focused Therapy
Chia-Ying Chou, Ph.D., Reservoir Psychotherapy, Research, and Training
Janice Tsoh, Ph.D., University of California, San Francisco
Martha Shumway, Ph.D., University of California, San Francisco
Lauren Smith, MSc., University of California, San Francisco
Joanne Chan, Psy.D., Private practice
Kevin Delucchi, Ph.D., University of California, San Francisco
Dennis Tirch, Ph.D., The Center for CFT, NYC
Paul Gilbert, Ph.D., OBE, Centre for Compassion Research and Training; University of Derby

Hoarding disorder (HD) was recognized as a psychiatric disorder in 2013. The study aimed to provide an initial evaluation on the potential of Compassion Focused Therapy (CFT) as an intervention for HD. Both CFT and another round of the current standard of treatment, Cognitive Behavioral Therapy (CBT) were investigated as follow-up treatment options for individuals who had completed CBT but still significantly symptomatic. Forty eligible individuals (20 in each treatment) were enrolled in either group. Treatment feasibility and acceptability were assessed. To explore treatment effectiveness, HD symptom severity, HD-related dysfunctions and their underlying mechanisms were assessed pre- and post-treatment for both treatments. Results showed that CFT yielded 72% retention rate and excellent satisfaction ratings. After receiving CFT, 77% of the treatment completers had HD symptom severity dropped below the cutoff point for clinically significant HD, and 62% achieved clinically significant reduction in symptom severity. These findings were discussed in comparison to those regarding receiving CBT again as a follow-up treatment option. Overall, the findings suggest promising potential of CFT as a treatment for HD.

• The Impact of Compassion Training and Compassion Practice on Psychological Symptoms and Spirituality for Individuals on Public Sex Offender Registries
Theresa M. Robertson, Ph.D., LCPC, Loyola University Maryland

The aim of this research was to examine the efficacy of an 8-week compassion-focused therapy (CFT) group intervention for increasing levels of compassion and spirituality, and decreasing levels of shame, stress, depression, anxiety, and hopelessness among 30 adult men on a public sex offender registry in a major metropolitan area. This research also sought to determine if the amount of between-session compassion practice would predict greater improvements in treatment outcome measures. Participants self-selected and were randomly assigned to one of six 8-week CFT groups. Repeated measures MANOVA revealed significant improvements for participants in self-compassion, spirituality, shame and stress. After controlling for personality, the results of multiple regression analyses indicated that greater levels of self-compassion significantly predicted lower levels of shame, depression, and hopelessness. Finally, greater engagement in between-session compassion practice was found to predict higher levels of self-compassion and lower levels of shame, stress, and depression. The results suggest that CFT may have the potential to positively impact criminogenic factors, including prosocial behavior of those convicted of sexually offending.

• The psychological and physiological effects of a brief compassion focused intervention and the importance of embodying the compassionate self
Marcela Matos, Ph.D., University of Coimbra - CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Interventions), Portugal
Cristiana Duarte, Ph.D., University of Coimbra - CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Interventions), Portugal
Joana Duarte, Ph.D., Royal Holloway University of London
José Pinto-Gouveia, Ph.D., MD, University of Coimbra - CINEICC (Center for Research in Neuropsychology and Cognitive and Behavioral Interventions), Portugal
Nicola Petrocchi, Ph.D., John Cabot University
Paul Gilbert, Ph.D., OBE, Centre for Compassion Research and Training; University of Derby

This paper examines the impact of a two-week Compassionate Mind Training (CMT) intervention on emotional, self-evaluative and psychopathology measures and on heart-rate variability (HRV), and explores how participants experienced the compassion practices, and the impact of the quality of practice on the effectiveness of the intervention. Participants (general population and college students) were randomly assigned to one of two conditions: CMT (n=56) and Wait-List Control (n=37). At post-intervention the experimental group significantly increased compassion for the self and openness to the compassion from others, safe and relaxed positive affect, and HRV; and showed reductions in shame, self-criticism and fears of compassion. Results also show that more than how often participants practiced the exercises, it is their perception of helpfulness of the compassion practices and their ability to embody of the compassionate self in everyday life and in moments of difficulty that are associated with increases in compassion for the self, for others and from others, positive affect and compassionate goals, and decreases in self-criticism, fears of compassion and stress, at post-intervention.

Educational Objectives:
1. Attendees will be able to identify compassion-based techniques that are effective in treating individuals with Hoarding Disorder and describe how to apply them. 2. Attendees will select a minimum of two empirically-based rationales for considering the benefits of compassion-based therapeutic approaches for treating individuals convicted of sexual offenses. 3. Attendees will describe which practice qualities in a compassion-focused intervention should be strengthened to improve its effectiveness.

 

88. Expanding our understanding: A Relational Frame Theory Perspective of Implicit Responding and its Measurement
Symposium (15:10-16:40)
Components: Original data,
Categories: Relational Frame Theory, Clinical Interventions and Interests, Educational settings, Bias Intervention, Implicit testing, IRAP, Children, Function Acquisition Speed Test (FAST), Sexual Orientation
Target Audience: Beginner, Intermediate, Advanced
Location: Q217

Chair: Lynn Farrell, Ph.D., Queen’s University, Belfast

Research examining implicit responding using RFT-based measures continues to enhance our understanding of this process and offer new questions. This collection of papers presents an interesting snapshot of the variety of work being carried out in the domain of implicit relational responding as these measures and our understanding of them continues to be refined. The included papers utilize the IRAP (Papers 1-4) and the FAST (Papers 4 & 5). Paper 1 examines the malleability of implicit gender-STEM bias and has implications for the measurement of implicit responding across time and contexts. Paper 2 extends findings in the domain of fear and avoidance using a verbal rehearsal task, with results having implications for the concept of defusion. Paper 3 assesses psychological flexibility among children while comparing two IRAP presentation formats. Paper 4 extends previous research in the area of implicit sexual responses with a focus on examining both relative and individual implicit biases. Paper 5 closes by discussing the assessment of attitudes towards abortion using the FAST which may offer advantages over other measures of implicit responding.

• Examining the malleability of implicit gender-STEM bias among adults using the Implicit Relational Assessment Procedure
Lynn Farrell, Ph.D., Queen’s University, Belfast
Niki Nearchou, Ph.D., University College Dublin
Louise McHugh, Ph.D., University College Dublin

Implicit gender bias is a barrier to women’s progression in Science, Technology, Engineering and Maths (STEM) fields. The current study assessed whether implicit gender-STEM bias was influenced by a brief bias intervention. Gender-STEM bias was assessed at two time points post-intervention, both at the explicit level (via rating scales) and the implicit level (via the Implicit Relational Assessment Procedure; IRAP). Participants (N = 210; 58.1% women) completed one of four conditions: (i) perspective-taking; (ii) exposure to counter-stereotypical exemplars; (iii) psychoeducation; or (iv) control. The IRAP offered greater detail regarding which relations were influenced by the interventions (e.g. Men- and/or Women-STEM relations). Results indicated that implicit gender-STEM bias is malleable, at least in the short term. The interventions strengthened a positive implicit relation between women and STEM. Psychoeducation appeared most effective. Results from session 2 presented a more complex picture of implicit bias change, as the control group exhibited an unexpected pattern of results. The implications of these findings are discussed in relation to gender-STEM bias and measuring the malleability of implicit bias.

• The Impact of an ACT Based Fear-Related Verbal Rehearsal Task on a Behavior-Behavior Relation and its Implications for the Experimental Analysis of Defusion.
Aileen Leech, Ghent University
Dermot Barnes-Holmes, Ph.D., Ghent University

The current research sought to replicate and extend the findings reported by Leech and Barnes-Holmes (2017) by examining the impact of a Fear-Related verbal rehearsal task on performance on two Implicit Relational Assessment Procedures (IRAPs), approach behaviour towards a spider (a BAT), and the relationship between the two measures. Participants were assigned to one of three conditions; control, accept-fear or reduce-fear. Participants were exposed to two IRAPs one targeting fear (Fear-IRAP) and the other targeting avoidance (Avoidance-IRAP), self-report measures, and a BAT. Consistent with Leech and Barnes-Holmes (2017), there were no significant differences between the three conditions for performances on the IRAPs and BAT. However, correlations between performances on the IRAPs and the BAT were concentrated almost exclusively in the control condition. When considered in the context of the results reported previously, the differential pattern of correlations observed here suggest that the verbal rehearsal task impacted upon a behavior-behavior relation that may be directly relevant to the concept of defusion in the ACT literature.

• Using the IRAP to measure psychological flexibility with children. Comparing natural language statements with a typical sample-target presentation format.
Gloria Torres-Fernandez, M.Sc., University of Jaen
Monica Hernandez-Lopez, Ph.D., University of Jaen
Miguel Rodríguez Valverde, Ph.D., University of Jaén

Few studies have used the IRAP with children (Rabelo et al., 2014; Scanlon et al., 2014). This study is part of a series exploring the use of the IRAP for the assessment of psychological flexibility with children. Specifically, it compares two IRAP presentation formats (typical sample-target vs. natural language statements) as Kavanagh et al. (2016) explored with adults. Seventy-two primary school students (9-10 years old) underwent the IRAP individually. The task assessed the strength of verbal relations among each of two samples (“I have to get rid of” and “I am willing to have”) and different emotional targets (joy, calmness, happiness, sadness, anxiety, and anger). Half of the participants were presented with the labels and targets composing a natural language statement (e.g. I have to get rid of anxiety), while the other half were presented with the samples and targets separate, without lexical links (e.g. get rid – anxiety). There were no significant differences between both experimental conditions. More detailed analyses found that only younger participants completed the IRAP faster in the typical sample-target condition.

• Measuring Implicit Sexual Response Biases to Nude Male and Female Pictures in Androphilic and Gynephilic Women using the IRAP and the FAST
Claudio Silva, M.Sc., Federal University of Minas Gerais
Renato Bortoloti, Ph.D., Federal Universtity of Minas Gerais

Timmins, Barnes-Holmes & Cullen (2016) demonstrated that an Implicit Association Test predicted the sexual orientation of gynephilic and androphilic men in terms of their attraction biases towards pictures of nude males and females. Relative bias scores were obtained, with no information on the separate response biases to each target gender. The present study sought to extend this research by assessing both relative and individual implicit biases using the IRAP.and the FAST (Function Acquisition Speed Test). An explicit measure screened for men with androphilic (n=33) or gynephilic (n=25) orientations on the dimensions of sexual attraction, sexual behaviour, sexual fantasies, hetero/gay lifestyle, and self-identification. The IRAP revealed a non-orthogonal pattern of biases across the two groups and had an excellent ability to predict sexual orientation with areas under the curves of 0,8313 for the relative bias score and 0,7532 and 0,8557 for the bias scores for the male and female pictures, respectively.

• Developing an “implicit” Function Acquisition Speed Test (FAST) for indexing strength of attitudes towards abortion.
Isabella Lalor, BSc, Maynooth University
Bryan Roche, Ph.D., National University of Ireland Maynooth
Andrew Crabbe, Maynooth University
Jamie Cummins, Ghent University

The current research was designed to validate a newly developed Function Acquisition Speed Test (FAST; O’Reilly et al., 2012) designed to measure attitudes to abortion among the general population and to retrospectively predict real world behavior in relation to voting for or against the availability of abortion services, in a national referendum. A sample of participants from the general population were exposed to an Implicit Association Test, a FAST procedure, an explicit attitudes to abortion questionnaire and a demographic survey. This procedure allowed for a comparison of FAST and IAT outcomes, inter-correlations between the explicit and implicit measures, as well as the predictive validity of the implicit measures of referendum voting behaviour. Results showed that the FAST performed favorably compared to the IAT in predicting self-reported attitudes and referendum voting behavior. This paper will involve an outline of the basic processes underlying the newly developed FAST method and illustrate how it may offer advantages over existing implicit test methods.

Educational Objectives:
1. Describe the use of the IRAP and the FAST for the examination of implicit relational responding. 2. Discuss the malleability and measurement of implicit responding across contexts. 3. Compare and contrast measures of implicit responding from an RFT perspective.

 

89. ACT Interventions for Eating and Weight-Related Concerns
Symposium (15:10-16:40)
Components: Original data
Categories: Clinical Interventions and Interests, Behavioral medicine, Weight Management, Disordered Eating, Obesity, Type 1 Diabetes
Target Audience: Beginner, Intermediate
Location: Q218

Chair: Jennifer L. Barney, M.S., Utah State University
Discussant: David Gillanders, Psy.D., University of Edinburgh

Problematic eating behaviors and weight concerns are notoriously difficult to treat. Further, those who experience initial behavioral change or weight loss gains during treatment often struggle to maintain these gains long-term. This symposium presents recent data from clinical trials examining the efficacy of ACT-based interventions to address these difficulties within multiple clinical populations. Each intervention utilizes novel interventions and differential treatment modalities (e.g. skills workshop; self-help; phone coaching; mobile health). Theory, intervention and modality efficacy, lessons learned, and recommendations for future research and applied work based on the outcomes of these studies will be discussed.

• Increasing access to obesity management services: Results from a pilot study of a telephone coaching program using Acceptance and Commitment Therapy for post-bariatric surgery patients
Dayna Lee-Baggley, Ph.D., Nova Scotia Health Authority, Dalhousie University
Tiffany Shepherd Ph.D.
Nicole Vincent, Ph.D.
Sulaye Thakrar, Ph.D.

Obesity is a well-established risk factor for multiple serious health problems and decreased quality of life. Access to services remains a key barrier in addressing obesity throughout Canada. Bariatric surgery is a well-established intervention for obesity, however studies show that a substantial proportion of patients will regain weight after surgery. Patients can minimize this weight gain by continuing to engage in weight-related health behaviors (e.g., portion monitoring, regular physical activity) in the long term. The current pilot study examines an 8-week ACT-based, telephone coaching intervention aimed at improving weight-related health behaviors for post-bariatric surgery patients. The authors will present techniques, clinical examples, and research data from the study. Pre- and post-data on psychological indicators (e.g., mindfulness), behavioral indicators (e.g., physical activity), and health indicators (e.g., weight, quality of life) will be presented. In addition, weekly changes in key psychological processes (e.g., self-compassion) will be examined. Implications for access to obesity management services and long term behavior change will be discussed.

• Evaluating an Acceptance and Commitment Therapy self-help book for weight self-stigma: Results from a randomized trial
Michael E. Levin, Ph.D., Utah State University
Sarah Potts, Ph.D., Utah State University
Jennifer Krafft, M.S., Utah State University

Overweight individuals experience chronic stigma, which is particularly harmful when internalized (i.e., weight self-stigma). ACT has been found to reduce weight self-stigma and improve diet, physical activity, and weight outcomes, but primarily through in-person interventions. The Diet Trap (Lillis, Dahl & Weineland, 2014) is an ACT self-help book targeting weight self-stigma, which can increase access for those who would benefit. The current randomized controlled trial sought to evaluate The Diet Trap and determine whether supplemental phone coaching is needed to be effective. 55 overweight/obese adults reporting high weight self-stigma were randomized to ACT guided self-help with phone coaching, ACT without coaching, or a waitlist. Preliminary results indicate both ACT conditions improved weight self-stigma and psychological inflexibility relative to waitlist. Only the ACT phone coaching condition improved dietary and physical activity behaviors relative to waitlist. No differences were found between the two ACT conditions. Final results will be presented and challenges and opportunities for delivering ACT self-help for weight self-stigma will be discussed.

• iACT: A Mobile Health Intervention to Address Maladaptive Eating and Weight Control among Adults with Type 1 Diabetes
Rhonda M. Merwin, Ph.D., Duke University Medical Center
Ashley A. Moskovich, Ph.D., Duke University Medical Center

Maladaptive eating and weight control are common among young women with type 1 diabetes (T1D) and increases the risk of early and severe diabetes-related medical complications and premature death. Conventional treatments for eating disorders are far less effective for individuals with T1D, highlighting the need for innovative treatments. We developed a novel ACT-based intervention combining individual sessions and a tailored mobile app for individuals with T1D (iACT), based on momentary assessment of target behaviors in T1D patients’ natural environment and qualitative research. Results from our pilot study indicate significant improvements in diabetes self-management and glycemic control. HbA1c levels also decreased with a significant decrease for participants with HbA1c>8. Participants reported greater acceptance of distressing thoughts/feelings about diabetes, and acceptance correlated with end-of-treatment HbA1c. Although not directly targeted, diabetes distress also significantly decreased pre-to-post treatment. This paper will provide an overview of this novel treatment, findings, and implications.

• Using novel behavioral interventions to improve long-term weight loss: A randomized trial comparing acceptance and commitment therapy and self-regulation for weight loss treatment seeking adults with overweight and obesity
Jason Lillis, Ph.D., Brown University Medical School
Rena R. Wing, Ph.D., Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Medical School

This randomized controlled trial compared an ACT workshop (ACT), a Self-Regulation workshop (SR), and a no-workshop control (Control) for weight loss treatment seeking adults who lost ≥5% of their body weight after completing a 3-month weight loss intervention (N=102). All three groups utilized a self-monitoring system that enabled participants to report key behaviors each week and receive weekly email messages for the 3 months following the workshop intervention. Retention at study end (24 months) was 80% for both the ACT and SR conditions, and 58% for Control. Participant acceptability ratings were generally positive, with slightly higher ratings on ACT as compared to SR. At 24 months, participants in the ACT condition lost significantly more weight when compared to the no-workshop control (-7.18% vs -1.15%; F=4.92; p=.033 ; d=.73). Additionally at 24 months, a greater percentage of ACT participants achieved ≥10% weight loss when compared to both the SR and Control groups (χ2=9.99, p=.007). Limitations, implications, and future directions will be discussed.

Educational Objectives:
1. Describe the theory and development of ACT interventions for addressing eating- and weight-concerns. 2. Assess outcomes data from multiple trials implementing novel ACT-based interventions for treating eating- and weight-concerns within various populations. 3. Discuss challenges and future directions for research and implementation of ACT interventions for eating- and weight-related concerns.

 

90. Parental Burnout - Guided Web-based ACT as a Solution
Symposium (15:10-16:40)
Components: Literature review, Original data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Performance-enhancing interventions, Parents
Target Audience: Beginner, Intermediate
Location: Q220

Chair: Päivi Lappalainen, Ph.D., University of Jyväskylä
Discussant: Juho Strömmer, Ph.D., University of Jyväskylä

Parents whose children have chronic conditions face an increased risk of worries and stress in everyday life, which can lead to burnout (Anclair et al., 2009; Miodrag & Hodapp, 2010). Web-based interventions can provide one solution for delivering psychological support for parents, who often have challenges in finding time to access face-to-face services. This symposium presents and compares the results of two randomized studies conducted in Sweden and Finland, and discusses the mechanisms of change and factors influencing engagement in the interventions. The three talks also explore implications for delivering guided web-based support for parents.

• Web-based Acceptance and Commitment Therapy intervention on wellbeing of parents whose children have chronic conditions: Effectiveness and mechanisms of change
Essi Sairanen, Ph.D., Karlstad University
Raimo Lappalainen, Ph.D., University of Jyväskylä
Päivi Lappalainen, Ph.D., University of Jyväskylä
Kirsikka Kaipainen, Tampere University
Fredrik Carlstedt, M.D., The County Council of Värmland, Research Unit in Primary Health Care
Malin Anclair, Ph.D., Karlstad University
Arto Hiltunen, Ph.D., Karlstad University

Web-based interventions offer a solution for delivering psychological support for parents of children with a chronic condition. We investigated the outcomes of a web-based acceptance and commitment therapy (ACT)-based intervention for parents of children with a chronic disease or functional disability. Psychological flexibility processes were investigated as mechanisms of change in the intervention. Participants (N=74) with burnout symptoms were randomly assigned to a web-based ACT intervention or a waiting list control condition. Symptoms of burnout (SMBQ), depression, anxiety and stress (DASS) as well as ACT-related processes of psychological flexibility (AAQ), cognitive fusion (CFQ) and mindfulness (FFMQ) were measured before and after the intervention period and at the four months follow-up measurement. The ACT web-intervention lasted 10 weeks and was guided by students of psychology. The ACT web-intervention produced significant improvements in burnout and depressive symptoms. Improvements were also observed in mindfulness skills of observing, describing, acting with awareness and non-reactivity as well as in cognitive defusion. Improvements in cognitive defusion and mindfulness skills mediated changes in psychological symptoms.

• Guided web-based ACT for parental burnout: An effectiveness study
Päivi Lappalainen, Ph.D., University of Jyväskylä
Inka Pakkala, Ph.D., GeroCenter Foundation for Aging Research & Development
Juho Strömmer, Ph.D., University of Jyväskylä
Kirsikka Kaipainen, Ph.D., Tampere University
Raimo Lappalainen, Ph.D., University of Jyväskylä

Internet-delivered interventions are one way to reach out to exhausted parents of children with chronic conditions or functional disability. Based on the experiences and results of a study conducted in Sweden, we developed a similar web-based ACT intervention for Finnish parents of children with chronic conditions or functional disabilities. Results and experiences from the Swedish and Finnish studies will be compared. Participants (N=40) were recruited on parent associations’ Facebook groups and randomly assigned to guided web-based ACT condition and a control condition receiving psychoeducation. The web-based ACT condition received a 10-week web intervention including three remote meetings with a psychologist through the telemedicine application Doxy.me. Symptoms of burnout (SMBQ), depression (PHQ), health-related quality of life (RAND-36), parent experience of child illness (PECI), parent psychological flexibility (PPF), and mindfulness (FFMQ) were measured before and after the intervention and at 4-month follow-up. In this paper we will discuss the results and experiences of the Finnish study.

• Understanding engagement in web-based Acceptance and Commitment Therapy interventions for parental burnout: Usage, dose-response and user experiences
Kirsikka Kaipainen, Ph.D., Tampere University
Essi Sairanen, Ph.D., Karlstad University
Päivi Lappalainen, Ph.D., University of Jyväskylä

Web-based acceptance and commitment therapy (ACT) interventions have shown their capacity to improve mental health and well-being (Brown et al., 2016). Engagement in technology-aided interventions is considered to be linked to intervention outcomes (Mattila et al., 2016; Short et al., 2018). Engagement can be defined as a composite of various measures such as usage time, task completion, interaction activity and user experience. We investigated how engagement influences outcomes in guided web-based acceptance and commitment therapy interventions for parents whose children have chronic conditions. We present findings from two studies: the first study was conducted in Sweden in 2017 (10-week intervention; N=36; median usage time 2:37 hours), and the second in Finland in spring 2019. Results related to the dose-response relationship between usage and the changes in psychological measures will be discussed. User experience findings of the two interventions will be compared to illustrate design choices that may have an influence on the engagement.

Educational Objectives:
1. Explain the mechanisms of change in a web-based ACT for parental burnout. 2. Discuss similarities and differences in guided web-based interventions for parental burnout in different countries. 3. Describe how user engagement in web-based interventions is connected to intervention effects, and apply this knowledge in intervention design.

Saturday, 29 June

100. Education and rehabilitative applications of SMART training
Symposium (10:35-12:05)
Components: Original data
Categories: Relational Frame Theory, Performance-enhancing interventions, Educational settings, SMART training, Children, Educational settings, Alzheimer's disease, Cognitive rehabilitation
Target Audience: Beginner, Intermediate
Location: QG13

Chair: Bryan Roche, Ph.D., National University of Ireland Maynooth
Discussant: Ian Stewart, Ph.D., National University of Ireland, Galway

SMART (Strengthening Mental Abilities with Relational Training) is an RFT web-based multiple exemplar training that has been demonstrated effective in raising cognitive skills and improve educational outcomes. The symposium offers the opportunity to know about the latest researches in the field. The first paper will present two of the largest stratified (by ability) active-controlled studies to date in which the utility of SMART training for improving matrix reasoning and examination performance was tested. The second presentation will present data on the effects of a SMART intervention on intellectual ability and measures of everyday attention in children aged attending school in the UAE. A newly-developed SMART:Remedial program, which aims to target more basic relational responding skills in individuals with developmental or intellectual difficulties, will be presented in the third paper. In the last one data of SMART as an add-on, non-pharmacological intervention to cholinesterase inhibitors (ChEIs) to increase cognitive skills in Alzheimer’s patients will be presented and seem to suggest that the training might slow down cognitive decline and improve general cognitive functioning in AD subjects.

• Two active-controlled trials to test the utility of relational operant training for enhancing children’s non-verbal IQ and subsequent educational outcomes.
Shane McLoughlin, University of Chester
Ian Tyndall, University of Chichester
Antonina Pereira, University of Chichester
Teresa Mulhern, University of Chester

Meta-analyses of randomized controlled trials suggest that cognitive training does not work. Behavior-analytic interventions are typically excluded from these meta-analyses due to their small samples. SMART is one form of gamified behavior-analytic training that has shown promise as a way to raise cognitive ability and improve educational outcomes. We will present two of the largest stratified (by ability) active-controlled studies to date in which we test the utility of SMART training for improving matrix reasoning and examination performance. The first study (N = 70; ages 12-14; active control = computer coding) was conducted in an Irish secondary school. The second (N = 39; ages 7-9; active control = online chess) was conducted in an Irish primary school. In each study, SMART successfully raised matrix reasoning ability. Analyzed together (N = 119; 1-β = .998), we found an overall increase in matrix reasoning of 7.18 non-verbal IQ points (ƞp2 = .17) with a low training dosage. Our results suggest that SMART may be used to raise cognitive ability and improve educational outcomes on a larger scale.

• A Relational Frame Skills Training Intervention to Increase IQ and Selective Attentional Abilities in 11-12 Year Old Children
Bryan Roche, Ph.D., National University of Ireland Maynooth
Ian Grey, Zayed University
Anna Dillion, Zayed University
Justin Thomas, Zayed University
Sarah Cassidy, Ph.D., Maynooth University, Ireland and Smithsfield Clinic (private practice)
Dylan Colbert, Maynooth University

The current study investigated the effects of a SMART (Strengthening Mental Abilities through Relational Training) intervention on intellectual ability and measures of everyday attention. Sixteen children aged between 11 and 12 years attending school in the UAE received approximately 1-5 hours of training per week in derived relational responding skills via a computerized on-line programme (SMART) over 13 weeks. Attentional abilities and intelligence were tested at baseline and follow-up using the Test of Everyday Attention-2 and the Wechsler Abbreviated Scale of Intelligence, respectively. Ten further children matched for age and baseline intellectual ability served as waiting controls. Results showed significant gains on IQ for the experimental participants only, whereas all participants showed significant gains on attentional skills, which was not related to the condition. Implications for future work and applications are discussed.

• The SMART:R system: A pilot analysis of a remedial relational skills training programme designed to increase intellectual performance
Dylan Colbert, Maynooth University
Sarah Cassidy, Ph.D., Maynooth University, Ireland and Smithsfield Clinic
Bryan Roche, Ph.D., National University of Ireland Maynooth

The SMART system (Strengthening Mental Abilities with Relational Training) has shown considerable efficacy in increasing intellectual performance. However, individuals with developmental or intellectual difficulties may not be able to access the benefits provided by this program, due to a high prerequisite relational skill fluency level. The current paper represents the first analysis of a newly-developed SMART:Remedial program, which aims to target more basic relational responding skills. A sample of Irish primary school children currently attending additional educational support (n = 22) was divided into two ability-matched groups, with experimental participants receiving bi-weekly SMART:R training sessions over a 16-week period while control participants received no additional intervention. Results indicated that SMART:R exerted a significant impact on WASI Full-Scale, Verbal and Performance IQ, as well as on a measure of relational skill. The current findings provide further support for the effectiveness of relational skills training in increasing intellectual performance, as well as providing preliminary validation of a first-build SMART:R intervention program.

• SMART aging: Improving cognitive skills in Alzheimer’s patient undergoing AChI treatment
Giovambattista Presti, Ph.D., MD, Kore University, Enna
Salvatore Torregrossa, Alzheimer and Dementia Unit – Neurodegenerative Disorders O.U., A.S.P. 2
Edoardo Cumbo, Alzheimer and Dementia Unit – Neurodegenerative Disorders O.U., A.S.P. 2
Daniela Stornaiuolo, Kore University, Enna
Annalisa Oppo, Sigmund Freud University, Milan
Bryan Roche, Ph.D., National University of Ireland Maynooth

Twenty-six patients with a diagnosis of mild-to-moderate Alzheimer’s disease (AD) were enrolled in a prospective, randomized, parallel-group trial to evaluate the efficacy of SMART training (RFT) as an add-on non-pharmacological intervention to cholinesterase inhibitors (ChEIs) to increase cognitive skills. Participants in the AChI+RFT group (n=13; 5 male and 8 female, mean age 78yrs) were exposed to a mean of 35-38 out of the 70 training sessions of SMART. Control group (n=13; 6 male and 7 female, mean age 77.38yrs) received only drug treatment. MODA (Milan Overall Dementia Assessment), Coloured Progressive (CPM) and attentive matrices assessed cognitive functioning. Patients treated with RFT (n=13) scored significantly better (p>0.05 vs baseline; p>0.05 vs ChEIs) on MODA, CPM and attentive matrices at the end of training. After 9 months FU a decay of the RFT group on MODA was present. These data seem to suggest that an RFT-based training might slow down cognitive decline in AD subjects treated with ChEI, and that number of training sessions and duration of the training could be critical factors for future studies.

Educational Objectives:
1. Describe latest applications of SMART training in educational and rehabilitative contexts. 2. Discuss its utility with a number of populations such as non-English speakers, individuals with developmental difficulties and Alzheimer’s patients. 3. Assess the effectiveness of SMART training on a larger scale.

 

106. Increases in quality of life using novel third-wave treatment for cancer for sufferers and informal carers
Symposium (10:35-12:05)
Components: Original data,
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Cancer patients, caregivers
Target Audience: Beginner, Intermediate,
Location: Q158

Chair: Silvia Golita, Babes-Bolyai University
Discussant: Andreas Larsson, Ph.D., Stockholm University

The number of new cancer incidents are on the increase globally and cancer is still the leading cause of morbidity and mortality worldwide (WHO, 2019). With advancement in cancer screening and treatment people are living longer with 50% now surviving 10 years or more (Cancer Research UK, 2019). Due to the threat of mortality, significant treatment burden and morbidity people diagnosed with cancer and their carers live with physical and psychosocial problems that may compromise their quality of life (Torre et al, 2016). Third-wave therapies or contextual approaches such as ACT, CFT and Mindfulness-based therapy may be of particular pertinence by offering an intervention model that may be better suited to the individualistic nature of cancer adjustment than second wave therapies (Hulbert-Williams & Storey, 2014). The current symposium brings together existing knowledge of third-wave treatment and people affected by cancer in under researched areas including young people with cancer, informal carers and web-based interventions.

• ACT with Mindfulness and Compassion course: A pilot for young adults diagnosed with cancer
Sari Harenwall, The Maggie Keswick Jencks Cancer Caring Centres Trust; Bradford District Care NHS Foundation Trust
Danielle Wilson, Newcastle Hospitals NHS Foundation Trust
Alice Bentley, Northumberland Tyne and Wear NHS Trust
Karen Verrill, The Maggie Keswick Jencks Cancer Caring Centres Trust
Lesley Howells, The Maggie Keswick Jencks Cancer Caring Centres Trust

Young adults (YA) diagnosed with cancer experience elevated risk of Distress, Depression and Anxiety (DDA: Lang et al., 2015). The combined trend of increased incidents of cancer in 15-24 year olds and increased survival rates (Cancer Research UK, 2019) calls for effective and accessible treatment to be available. The study piloted an 8-week ACT with Mindfulness and Compassion (ACTMC) group intervention for YA (18-31, m= 22.6) with cancer (n=9). The primary aim was to explore acceptability and feasibility with the secondary aim of measuring effectiveness in reducing distress and increase quality of life (QoL). Session ratings (mean ranging from 7.04-8.33 on 4 0-10 point likert-scales) and high attendance (m = 6 Std=0) indicated acceptability and feasibility. Secondary outcomes showed reduction in anxiety, depression and distress and an increase in psychological flexibility and QoL immediately after the course and maintained at 3 months follow-up. The pilot shows promise for ACTMC group interventions with valuable lessons learned to inform the design of randomized controlled trials as the necessary next stage.

• Compassionate Mind Training for informal caregivers of cancer patients: A pilot study
Elsa Olterman, M.S., Stockholm Health Care Services
Andreas Larsson, Ph.D., Stockholm University

Informal caregivers of cancer patients often experience increased anxiety and depressive symptoms and decreased QOL (Stenberg, et al. 2014). Existing interventions designed to alleviate these symptoms for informal caregivers show inconsistent and generally small to moderate effects which leaves room for extending research (Frambes et al, 2018). Compassionate Mind Training (CMT) is promising in decreasing depressive symptoms, self-criticism and shame (Matos et al., 2017). This pilot study aims to investigate the feasibility and acceptability of a four-week CMT course for young informal caregivers of cancer patients. Six Swedish individuals aged 25-33 (x̅ = 29, sd = 2.7) participated. On a group level the depressive symptoms decreased (r = -0.58) and QOL increased (r = -0.64) with better effect than what has been shown with existing interventions. The majority of the participants also arrived at a reliable clinical significant change and comments from participants reflected the study`s feasibility and acceptability. Even when considering the limited number of participants and the pilot study-format, the results indicate CMT as a promising intervention for informal caregivers of cancer patients.

• A Guided Internet-based Acceptance and Commitment Therapy Intervention for Romanian Women Diagnosed with non-metastatic breast cancer: Study protocol for a randomized controlled trial
Silvia Golita. Ph.D Cand, Babes-Bolyai University
Adriana Baban, Ph.D., Babes-Bolyai University

The first two years post-diagnosis are most negatively impacted by psychosocial and physical problems for non-metastatic breast cancer patients. The ACT model is proven beneficial for this population, further research needing to test a web-based version, which is more (cost)-effective and easily accessible. This intervention aims to improve quality of life and enhance involvement in meaningful activities. Acceptability, effectiveness, and mechanism of change will be assessed. 160 women recruited online and offline will be randomized to the intervention or to expressive writing as control condition. The intervention is delivered in 8-10 weeks via a counsellor guided online platform containing eight ACT-consistent modules. Data collection will occur at baseline, week 3 and 5, post-intervention along with qualitative and usage data and at 10 weeks follow-up. Primary outcomes: quality of life, life satisfaction. Secondary outcomes: emotional functioning, self-efficacy. Process outcomes: psychological flexibility, thought suppression, values based-living. Mediation and growth curve analysis and an ITT approach will be applied. This RCT will assess the first web-based ACT intervention for breast cancer patients against an active control group.

Educational Objectives:
1. Describe and discuss challenges in setting up group based interventions for young adults living with persistent health problems. 2. Describe the potential benefits of Compassionate Mind Training for the psychological difficulties informal caregivers of cancer patients can experience. 3. Develop design and decision-making skill necessary in the process of building a web-based ACT intervention for a specific population.

 

107. From human to robot therapists: How the functions of ‘therapists’ have evolved in the context of ACT for cigarette smoking cessation: Washington State, USA Chapter Sponsored
Symposium (10:35-12:05)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Therapist Process
Target Audience: Beginner, Intermediate, Advanced
Location: Q217

Chair: Jonathan Bricker, Ph.D., Fred Hutch Cancer Research Center & University of Washington
Discussant: Michael Levin, Ph.D., Utah State University

Consumer technologies can serve functions similar to human therapists. Smartphone apps, conversational agents ("chatbots"), and avatars with human-like nonverbal behaviors are providing people support, empathy, goal setting, and skill building right in the palm of their hands. Are we being replaced by robots? If not, what is our function as therapists? Can brain imaging studies give us answers? We will present original data on a full spectrum of “therapists” providing ACT interventions for health behavior change: human delivered intervention (Dr. Megan Kelly), smartphone app delivered intervention (Dr. Robert Whelan), chatbot conversational agent delivered intervention (Dr. Jonathan Bricker), and an avatar delivered intervention (Dr. Noreen Watson). We will focus on: How these different notions of “therapist” activate ACT processes, stimulate regions of the brain, and impact treatment outcome; How patients experience these different notions of therapist, in terms of receptivity, engagement, and satisfaction. Our broader goal is to develop a more flexible relationship to the concept of therapist, appreciating that flexibility as it applies to the world’s most preventable cause of premature death: cigarette smoking.

• Acceptability and Preliminary Efficacy of an In-Person Acceptance and Commitment Therapy for Post-traumatic Stress Disorder and Tobacco Addiction
Megan M. Kelly, Ph.D, Edith Nourse Rogers Memorial Veterans Hospital; University of Massachusetts Medical School
Kendra Pugh, M.A., Edith Nourse Rogers Memorial Veterans Hospital; University of Massachusetts Medical School
Steven D. Shirk, Ph.D., Edith Nourse Rogers Memorial Veterans Hospital; University of Massachusetts Medical School

Veterans with PTSD smoke at rates 2-3 times higher than the general population. However, few treatments specifically target emotional obstacles to smoking cessation for veterans with PTSD. The present study evaluated the acceptability and preliminary efficacy of Acceptance and Commitment Therapy for PTSD and Tobacco Addiction (ACT-PT), which helps veterans with PTSD overcome emotional challenges to quitting smoking. U.S. Veterans with PTSD were randomized to either nine face-to-face individual counseling sessions of ACT-PT (n=16) or the American Lung Association’s Freedom from Smoking Program (FFS; n=20). For veterans in the ACT-PT condition, 26% quit smoking at the end of treatment vs. 0% in FFS. For treatment completers, 50% in ACT-PT vs. 0% in FFS quit smoking at the end of treatment. Veterans were significantly more likely to reduce their smoking in ACT-PT vs. FFS. Veterans reported high satisfaction scores for ACT-PT and liking the one-on-one format. Veterans reported that the mindfulness exercises of ACT-PT were the most helpful treatment component. Overall, ACT-PT appears to be a promising and well-received smoking cessation treatment for veterans with PTSD.

• A longitudinal analysis of neural changes associated with SmartQuit App usage
Nigel Vahey, Ph.D., Trinity College Dublin
Louise McHugh, Ph.D., School of Psychology, University College Dublin
Robert Whelan, Ph.D., Trinity College Dublin

One of the most popular contemporary reformulations of the smoker-therapist relationship is in terms of smartphone applications, which coach smokers in various techniques related to successfully managing tobacco cravings. SmartQuit was designed to automate techniques from Acceptance and Commitment Therapy (ACT) that have already proven successful at promoting smoking-cessation. Forty participants were recruited into a longitudinal study. Brain activity during assays of response inhibition and reward processing, measured using electroencephalography, were recorded immediately prior to smoking cessation. Contingent on bio-verified abstinence, participants repeated the assessment at one week and one month. Machine learning was used to identify the neural, behavioral, clinical and demographic variables associated with SmartQuit usage and smoking cessation. These data provide a first test of how brain activity associate with SmartQuit usage relates to bio-verified duration of smoking-cessation.

• "Hi, its Ellen. Are you free to chat?": First randomized trial of a conversational agent chatbot for cigarette smoking cessation
Jonathan Bricker, Ph.D., Fred Hutch Cancer Research Center & University of Washington
Kristin E. Mull, M.S., Fred Hutch Cancer Research Center
Brie Sullivan, Fred Hutch Cancer Research Center

Computer-driven text messaging interventions are a prominent therapeutic technology. However, text messaging has modest treatment outcomes, driven largely by low user engagement. Fortunately, a new technology provides a potentially game-changing solution. Machine learning, natural language processing, and cloud computing are together creating conversational agents (CAs), which are digital coaches designed to form social-emotional connections with users. CAs are supportive, empathic, reflectively listen, personalize responses, and offer skills training appropriately timed to user needs. To date, there are only 5 trials of CAs for any behavior change--and none for smoking cessation. Through an iterative user-centered design process and a 14-day diary study of 8 users, we developed a CA for smoking cessation, called “QuitBot,” and then tested it in a randomized controlled trial (N = 300), comparing it to the US National Cancer Institute's SmokefreeTXT text messaging intervention with 3-month follow-up (93% data retention). We will present comparative results on participants’ (1) engagement and satisfaction, (2) therapeutic alliance, and (3) quit smoking rates. We will discuss implications for the contextual behavior science of therapeutic relationships.

• Why unicorns don’t make good therapists: Design of an avatar-led, ACT-based digital smoking cessation intervention targeted for sexual and gender minority young adults
Noreen Watson, Ph.D., Fred Hutch Cancer Research Center
Maria Karelka, Ph.D., University of Cyprus
Megan Kelly, Ph.D., Edith Nourse Rogers Memorial Veterans Hospital
Melissa Gasser, B.A., University of Washington
Edit Serfozo, M.P.H., Fred Hutch Cancer Research Center
Jaimee Heffner, Ph.D., Fred Hutch Cancer Research Center

In the US, sexual and gender minority (SGM) young adults (YAs) have a smoking prevalence twice as high as non-SGM YAs and are a population that experiences tobacco-related health disparities. In 2018, we began adapting an existing, avatar-led, web-based program based on Acceptance and Commitment Therapy that previous research suggests is effective for YAs at all stages of readiness to quit smoking to meet the unique needs of SGM YAs. Employing a user-centered design framework of literature reviews, review of existing programs, and 2 rounds of user feedback (n=7), we identified what unique needs this intervention should address (e.g., mental health, e-cigarettes, stigma), prioritized changes to the original intervention (e.g., importance of an inspiring, relatable avatar to guide the program), and have finalized the program’s content in preparation for an upcoming single-arm pilot trial. In this presentation, we will detail the identified needs of this population and how we adapted the existing ACT exercises and engagement features of the program to address these needs, with particular focus on the program’s avatar guide.

Educational Objectives:
1. Develop a more flexible relationship to the concept of therapist. 2. Describe how different notions of “therapist” activate ACT processes, stimulate regions of the brain, and impact smoking cessation treatment outcome. 3. Explain how patients experience these different notions of therapist, in terms of receptivity, engagement, and satisfaction.

 

109. "Does it really work?" New approaches to guiding and evaluating interventions in organizations and groups
Symposium (10:35-12:05)
Components: Conceptual analysis, Original data, Case presentation,
Categories: Organizational behavior management, Prevention and Community-Based Interventions, Performance-enhancing interventions, measurement, prosocial, workgroups, organizations
Target Audience: Intermediate,
Location: Q220

Chair: Amanda Hagenbeek-Gels, M.S., AMHG Advies
Discussant: Andrew Gloster, Ph.D., University of Basel

During recent years, there's been an increased focus on ways to improve the efficacy and well-being of workgroups within organizations. Methods based on contextual behavior science, most notably the Prosocial initiative, are gaining momentum although further empirical support is needed to understand the impact. To support the development of evaluations it's important to create measures that allow systematic adaptation and assessment of the effectiveness of interventions. We will briefly present the components of the Prosocial initiative, and describe two approaches to measurement within this context. The third presentation features psychometric data and examples of practical application of a newly developed measure focused on social interactions in workgroups, based on the Nurturing Environments framework (Biglan, Flay, Embry, & Sandler, 2012).

• Overview of the Prosocial Core Design Principles for Groups and Suggestions for Operationalizing to Enhance and Further Develop Behavioral Measures.
Julia Fiebig, Ph.D., ABA Global Initiatives, LLC, Ball State University
Rebecca A. Watson, ABA Global Initiatives, LLC, RSU 13
Brittany T. Mazur, Private Consultant

Behavior science offers tools that can help groups identify values and pinpoint which behaviors are most critical to gain optimal team outcomes. Values are seen as conduits that inform an individual’s behavior (Ciarrochi, Fisher, & Lane, 2011) and are the result of an individual’s history of responding and reinforcement (Skinner, 1971). To connect values to behavior the Prosocial process involves using the Acceptance and Commitment Training Matrix (Polk, Schoendorff, Webster, & Olaz, 2016) and eight Core Design Principles (CDPs) for group interaction (Wilson, Ostrom, & Cox, 2013) to help groups clarify common purpose, build flexibility, and cultivate collaborative relationships for group wellbeing and improved performance of the team. In this talk, we will provide an overview of the CDPs and share data showing impact of the Prosocial process on team performance and engagement across multiple educational, public service organizations. Additionally, we will share practical suggestions for operationalizing each CDP, making these principles observable and measurable within and across groups to facilitate flexible and healthy group dynamics that aim to positively impact cooperation, performance, and well-being.

• Prosocial: Evolving a community approach to measurement & practice.
Ian MacDonald, Ph.D., University of Binghamton
Paul Atkins, Ph.D., Institute for Positive Psychology and Education, Australian Catholic University

The Prosocial process involves a set of tools and ideas for improving collaboration within and between groups. While the initiative is informed by modern evolutionary theory, and rests on evidence from Ostrom's Nobel Prize winning research and the field of CBS, many aspects of the process await empirical testing as a package. Consequently, this talk has two inter-related aims. First, we introduce some of the specific tools we’re developing to assist the growing community of Prosocial facilitators and trainers to measure the effectiveness of their work. Second, and looking to the future of Prosocial, we discuss potential opportunities and challenges associated with a community-directed, co-evolutionary process of measurement and research unfolding over our distributed network of researchers, practitioners, tools and methods.

• Measuring Nurturance in Work Environments - an instructive assessment for improving social work environments.
Magnus Johansson, M.S., Oslo Metropolitan University
Anthony Biglan, Ph.D., Oregon Research Institute

The Nurturing Environments Observation Form (NEOF) was created based on the Nurturing Environments framework (Biglan, Flay, Embry, & Sandler, 2012) as a free to use questionnaire meant to provide clear targets of change to improve the social work environment in a group or organization. The NEOF contains behavioral items connected to the four domains of Nurturing Environments - toxic social conditions, prosocial behavior, limiting problems, and psychological flexibility. By collecting data on both frequency of behaviors and desirability, group level analysis results in both prescriptive targets of change and targets derived from discrepancies between frequency and desirability. Psychometric data and strategies for analyzing and presenting NEOF data for group development will be presented.

Educational Objectives:
1. Participants will list and describe the 8 Core Design Principles of cooperative groups and discuss examples of response classes of behavior related to each principle and suggestions for measurement. 2. Participants will use data from the Nurturing Environments Observation Form to inform interventions to improve the social work environment of workgroups. 3. Participants will discuss the challenges and opportunities of creating a measurement system to be used by a community of researchers.

 

114. Strengthening the foundations: Advances in basic RFT research
Symposium (13:20-14:50)
Components: Conceptual analysis, Original data, Didactic presentation
Categories: Relational Frame Theory, Clinical Interventions and Interests, Educational settings, Functional contextual neuroscience and pharmacology, Functional contextual approaches in related disciplines, Relational Frame Theory, Artificial intelligence, Children, skill assessment, RFT, remedial education
Target Audience: Beginner, Intermediate, Advanced
Location: The Studio

Chair: Sabrina Norwood, M.S., Centre for Contextual Behavioural Science, University of Chester

The expansion of RFT into various applied domains has highlighted the importance of continuing to examine and increase our understanding of psychological phenomenon through basic RFT research. This symposium brings together a collection of papers which contribute to this endeavor, showcasing the variety to be found in terms of both topic and approach. Paper 1 examines repertoires of arbitrarily applicable relational responding (AARR) among typically-developing children and children with Autism Spectrum Disorder, with an additional focus on contextual conditions. Paper 2 combines AARR with Artificial Intelligence, demonstrating an Artificial General Intelligence system problem-solving using relational frames. Paper 3 expands research on the transfer of conditioned fear using a more current recommended psychophysiological measure – eye-blink startle. Paper 4 utilizes transformation of stimulus functions to understand the euphemism treadmill effect, with implications for stigma reduction. Paper 5 highlights the importance of Randomized-Control Trials in basic research, enhancing our understanding of metaphors and the impact of additional contextual cues. Paper 6 finishes by examining how pliance plays a mediatory role in the relationship between perfectionism cognitions and self-esteem.

• Assessing Derived Relations in Typically-developing Children and Children with Autism Spectrum Disorder: the role of assessment context and relational complexity across broad relational repertoire.
Krystyna Pomorska Ph.D., University of Social Sciences and Humanities
Paweł Ostaszewski, University of Social Sciences and Humanities
Yvonne Barnes-Holmes, Ph.D., Ghent University

The research aimed at exploring the core repertoires of arbitrarily applicable relational responding in typical and atypical development. Across two studies, we assessed repertoires of co-ordination, distinction, comparison, opposition, and deictic relations in typically-developing children aged 6-8 years and in children with ASD aged 6-10 years. The other aim was to systematically investigate the contextual conditions under which the two samples of children could or could not demonstrate the target relational responses (i.e., by testing the relations in more or less naturalistic contexts). Another aim was to investigate the functional distinctions between mutually entailed and combinatorially entailed relational responding, as this functional distinction has received limited empirical scrutiny, but may be important in terms of targeting relational responding skills for remedial purposes. The results of both studies suggest that relational repertoires do not develop uniformly from non-arbitrary to arbitrary or from simple to complex relations. Furthermore, the context in which these repertoires are assessed appears to be important but differently for typically and atypically developing children.

• Arbitrarily applicable relational responding in an artificial general intelligence framework
Robert Johansson, Ph.D., Stockholm University and Linköping University
Jonas Ramnerö, Stockholm University
Arne Jönsson, Linköping University

During the last few years we have seen an enormous progress in the field of artificial intelligence. However, not much work has been done in studying whether machines can do AARR. It is clear that AARR is a domain-independent process, potentially occuring at many levels, and seems to be involved in many cognitive functions. Hence, it seems like a promising approach to consider AI models that aim to build general-purpose intelligent systems that could perform in a wide range of domains. A subfield in AI, Artificial General Intelligence (AGI) is a small but active field of research where these questions are explored. One example of an AGI system is NARS (Non-Axiomatic Reasoning System; Wang, 2013). In NARS, its various cognitive functions are uniformly carried out by a central reasoning-learning process following a “non-axiomatic” logic (Wang, 2013). In the talk, we will provide examples of how forms of AARR can be specified in NARS. Using this, we will show how NARS solves various problems that require repeated applications of different relational frames.

• Experimental analysis of the transfer of conditioned fear with multiple physiological measures.
Miguel Rodríguez Valverde, Ph.D., University of Jaén
Sergio Jordan-del-Jesus, B.A., University of Jaen
Monica Hernandez-Lopez, Ph.D., University of Jaen

Although research on the transfer of aversively conditioned respondent functions is key to understanding human fear and anxiety, there is limited empirical evidence. The few published studies are based on skin conductance responses (SCRs) as the measure of fear. However, current recommendations in psychophysiology research point to fear-potentiated blink startle as a more adequate measure. Forty-one participants underwent an MTS procedure for the formation of two five-member equivalence classes. Two elements from each class were used in a differential aversive conditioning procedure (CS+1: B1; CS+2: C1; CS-1: B2; CS-2) with electric shock as the UCS. Transfer tests were presented with the remaining class elements. Acoustic eye-blink startle (EMG activity of orbicularis oculi) was the main dependent variable (SCRs and heart rate were recorded too). Results show a transfer effect at the group level with the startle measure, with a significant main effect for stimulus class [F(1,40)= 5.696; p= ; η2= .449], but no significant main effect for trial nor any significant interaction (both Fs< 1). Similar results were obtained with SCRs.

• Examining the euphemism treadmill effect using transformation of stimulus functions
Sabrina Norwood, M.S., Centre for Contextual Behavioural Science, University of Chester
Lee Hulbert-Williams, Ph.D., Centre for Contextual Behavioural Science, University of Chester
Nicholas J Hulbert-Williams, Ph.D., Centre for Contextual Behavioural Science, University of Chester
Michelle Mattison, Ph.D., University of Chester

A common approach to stigma reduction is the enforcing of politically correct language. Opponents of this argue that terms which were once deemed politically correct, over time, lose their correctness and have to be replaced by a new word. This concept is often referred to as the euphemism treadmill effect (Pinker, 1994). Such an effect would be in keeping with RFT, yet the existence of such an effect is largely ignored in stigma-reduction policies. This study aims to examine this effect experimentally using two different methods. Both experiments will involve participants learning coordination relations between gay people and an arbitrary group name. The first experiment attempts to achieve this using a match-to-sample procedure. The second experiment will use a vignette, in order to achieve a degree of ecological validity. A stigma questionnaire will be employed to demonstrate transformation of stimulus function. ANOVA will be applied to data on approximately 400 participants. The euphemism treadmill effect, if confirmed, would have strong implications for future approaches to stigma reduction.

• Appetitive augmental functions and common physical properties in metaphor effect: An extended replication
Rosina Pendrous, University of Chester
Lee Hulbert-Williams, University of Chester
Kevin D. Hochard, University of Chester
Nick Hulbert-Williams, University of Chester

Understanding metaphors, according to Relational Frame Theory (RFT), rests on our ability to derive relations based on relevant contextual cues. Experimental work has demonstrated that including additional cues within perseverance metaphors which specify common physical properties (CPPs; e.g. “very cold”) encourages verbal generalisation to the cold pressor task, increasing pain tolerance (Sierra et al., 2016). When the metaphor also specified appetitive augmental functions (AAFs), pain tolerance increased further. We aimed to directly replicate and extend these findings. A stratified double-blind randomized-controlled (RCT) experiment obtained baseline measures (including analogical reasoning) and demographics. Participants (N=89) were allocated to a prerecorded audio-delivered metaphor exercise containing either: (i) CPPs, (ii) AAFs, (iii) both CPPs and AAFs, or (iv) neither (control). Participants completed the cold pressor task before and after the metaphor exercise. There were no significant main effects of time on pain tolerance nor significant interactions between time and condition. The original findings were not replicated; pain tolerance did not increase in any condition. These results highlight the importance of using RCT designs in basic and applied RFT research.

• The Mediator Role of Pliance in the Relationship Between Perfectionism, Cognitions, and Self-esteem
Engin Büyüköksüz, Okan University
Işıl Tekin, Ph.D., İstanbul Medeniyet University
Asiye Büşra Şirin Ayva, School Counselor

The aim of this study is to search the mediator role of plıance in the relationship between perfectionism cognitions and self esteem. participants of this study are undergraduate students (n=200: 61 males; 139 females). Measuring instruments of this study are perfectionism cognitions inventory (Flett, Hewitt, Whelan, & Martin, 2007), Rosenberg self-esteem scale (RSE) (Rosenberg, 1965), and generalized pliance questionnaire (Ruiz, Suárez-Falcón, Barbero-Rubio, & Flórez). As a result of this study, it is seen that pliance plays a partial mediatory role between perfectionism cognitions and self esteem.

Educational Objectives:
1. Describe current advances in basic RFT research across domains. 2. Assess relational repertoires across populations and contexts. 3. Demonstrate the variety of empirical approaches currently being used and adapted by RFT researchers.

 

121. Using ACT to better understand and intervene in Gastrointestinal (GI) disorders: ACT for Health SIG Sponsored
Symposium (13:20-14:50)
Components: Original data
Categories: Behavioral medicine, Clinical Interventions and Interests, Gastrointestinal disorders
Target Audience: Beginner, Intermediate, Advanced
Location: Q158

Chair: Nuno Ferreira, University of Nicosia, Cyprus
Discussant: Maria Karekla, Ph.D., University of Cyprus

It has been well established that psychological factors and brain-gut dysregulation play a critical role in the development and maintenance of GI disorders, and there is a recognized need for psychologists to intervene in GI practice settings (ROME foundation, 2018). In this symposium, we present 3 papers that address the usefulness of the ACT model in describing, predicting and intervening in GI disorders. The first paper will address the influence of psychological flexibility in psychosocial processes in Irritable Bowel Syndrome; the second paper will highlight the longitudinal impact of cognitive fusion on the evolution of Inflammatory Bowel Disease outcomes (symptoms, physical and mental health); and the third paper will present preliminary results of a randomized control trial comparing an ACT based intervention with psycho education for Body Image Dissatisfaction in Inflammatory Bowel Disease. The theoretical and clinical implications of the results will be discussed.

• Moderating effect of Psychological flexibility in the relation between Symptom Severity and Quality of Life in Irritable Bowel Syndrome (IBS)
Nuno Ferreira, University of Nicosia, Cyprus
Hester Bowers, University of Edinburgh
David Gillanders, Psy.D., University of Edinburgh

Objective: The present study will present and test a theoretically driven model (Ferreira et al., 2011) of how visceral anxiety, behavioural response, symptom severity, quality of life and psychological flexibility interact to determine how people cope and respond in IBS. Methods: A model of moderated serial mediation was tested using a sample of 166 gastrointestinal outpatients attending a tertiary care Gastrointestinal Motility disorders clinic. Results: Visceral anxiety and behavioural response were found to serially mediate the relationship between symptom severity and quality of life (p<.001). A significant interaction was also found for psychological flexibility as a moderator at the level of the indirect effect (-.0091, 95%CI = .-.0163 to .0019). The strength of the mediatory effect appears to be linearly related psychological flexibility. Conclusions: The results suggest multiple psychosocial variables interact to shape IBS experience and outcomes. This study provides a clearer picture on the variability of Quality of Life across patients that present with similar Symptom Severity. The theoretical and clinical implications of these findings are discussed in the light of a biopsychosocial approach

• The longitudinal influence of cognitive fusion on the evolution of physical and psychological health in inflammatory bowel disease
Inês A. Trindade, Ph.D., CINEICC, University of Coimbra, Portugal
Cláudia Ferreira, CINEICC, University of Coimbra, Portugal
José Pinto-Gouveia, CINEICC, University of Coimbra, Portugal

Aims: To explore the longitudinal impact (18 months) of cognitive fusion on the evolution of IBD symptomatology, physical health, and psychological health in a sample of IBD patients. Method: 116 adult IBD patients completed self-report measures (IBD symptoms checklist, CFQ-7, WHOQOL-bref) in three different times equally spaced 9 months apart. Latent growth analyses were performed to examine the trajectory of the variables. Results: IBD symptomatology and cognitive fusion significantly influenced the baseline levels of psychological health (bsympt = -0.29; βcf = 0.62) and physical health (bsympt = -0.59; βcf = -0.28) but only cognitive fusion presented a significant effect on the evolution of these outcomes (all p<.001). Cognitive fusion influenced the growth trajectory of psychological health (β = 0.30, p = 0.007) and physical health (β = 0.26, p = 0.024), predicting change in these variables. Discussion: These findings inform that IBD care may benefit from comprising psychological interventions focusing on defusion and acceptance, such as those based on Acceptance and Commitment Therapy. Further implications for research and clinical practice are discussed.

• Acceptance and Commitment Therapy (ACT) compared with psychoeducation for Body Image dissatisfaction in adults with Inflammatory Bowel Disease: A Randomized Controlled Trial
Lisa Murphy, University College Dublin, Ireland
Louise McHugh, University College Dublin, Ireland
Barbara Dooley, University College Dublin, Ireland
Hugh Mulcahy, St. Vincents University Hospital

Background and Objective: Many adults with Inflammatory Bowel Disease (IBD) describe considerable psychosocial disability, including body image dissatisfaction (BID). (Jedel, Hood & Keshavarzian, 2015). Formal IBD patient education has been found to empower patients, improve quality of life, have a positive effect on coping, physical appearance and body image. In addition, findings from ACT interventions that target BID suggest that psycholological flexibility may facilitate a reduction in BID. Method: This study is a randomized controlled trial of a one day ACT workshop intervention (n=40) compared to a one day psychoeducational intervention (n=40) for adults with a diagnosis of an IBD. Participants will complete a series of baseline questionnaires assessing demographic, socioeconomic and clinical details. Psychological questionnaires including the Body Image Scale will also be completed at baseline and post treatment. Results: Baseline demographic questionnaires will be analysed. In addition, psychological questionnaires including the Body Image Scale will be analysed at baseline and post treatment. Conclusion: This study will demonstrate the potential benefits of an ACT workshop intervention compared to a psycho-educational intervention in targeting BID.

Educational Objectives:
1. Describe the state of current research regarding ACT in GI disorders. 2. Discuss the mechanisms of action of ACT in GI disorders. 3. Analyze the potential of ACT as an intervention for GI disorders.

 

122. Exciting new Contextual Behavioral Science measures and a cautionary note
Symposium (13:20-14:50)
Components: Conceptual analysis, Literature review, Original data,
Categories: Psychometrics, Methodology and statistics, Clinical Interventions and Interests, Prevention and Community-Based Interventions, Performance-enhancing interventions, Behavioral medicine, Supervision, Training and Dissemination, Professional Development, Theoretical and philosophical foundations, Relational Frame Theory, Psychometrics, Mechanisms in ACT, General clinical application of ACT, FAP, Process-Based Therapy, Scale development and validation, Emotions, Internal Experiences, Measurement, Psychometrics, Applied Practice, CBS
Target Audience: Beginner, Intermediate, Advanced
Location: Q217

Measuring behavior is of critical importance to behavioral scientists. The first five papers in the current symposium showcase exciting new measures of different processes in the area of Contextual Behavioral Science. Data will be presented on the brief item response theory analysis of the AAQ-II brief form, the MindFlex Assessment System, the ACT-Fidelity measure (ACT-FM), FAP assessment via the FIAT-Q-SF and the Felt Experiences from Everyday Living (FEEL) scale. The symposium will conclude with a cautionary note on the limitations of self-report measurement and the threat that can pose to research findings.

• An Item Response Theory analysis of the AAQ-II & validation of a brief form
Lee Hulbert-Williams, Ph.D., University of Chester
Kevin Hochard, Ph.D., University of Chester
Nick Hulbert-Williams, University of Chester

The Acceptance and Action Questionnaire (AAQ-II; Bond et al. 2011) is the most widely used measure of psychological flexibility. Whilst there is evidence of its reliability and validity, some psychometric questions remain. By combining Item Response Theory (IRT) and other approaches, we developed an ultra-brief version and further tested the scale’s psychometric properties. Combining data from seven heterogenous samples, including general population, cancer patients/survivors, and people recovering or suffering from anorexia or sleep paralysis to create a large dataset (N=2174, Nfemale=1734, ages 16 to 96), we ran IRT analysis, tests of unidimensionality, and a variety of item-reduction techniques. A

• Developing a More Nuanced Understanding of Mechanisms of Change in ACT: Clarifying Specific Dimensions of Psychological Flexibility Linked to ACT Treatment Effects with the MindFlex Assessment System
Ronald D. Rogge, Ph.D., University of Rochester
Jenna Macri, University of Rochester
Katherine J. Saint, M.A., The Chicago School of Professional Psychology
Brooke Dubler, Ph.D., University of Rochester
Jaci L Rolffs, M.A., University of Rochester

Studies have examined psychological flexibility as a potential mechanism to explain the robust and consistent improvements in functioning seen with ACT. Most of those studies have used scales like the AAQ-II in their mediation analyses, treating flexibility as a single dimension. This study sought to extend that work by examining 12 distinct dimensions of flexibility and inflexibility as possible mechanisms of change in ACT. We collected baseline and 2-month follow-up data using the MindFlex Assessment System from 37 clients receiving some form of ACT. The MindFlex Assessment System is an online assessment tool for therapists to establish baseline functioning and track meaningful change in treatment on seven outcome dimensions (depressive symptoms, generalized anxiety, life satisfaction, vitality, autonomy, competency, & relatedness) and on 12 dimensions of flexibility and inflexibility (using the MPFI). Specific dimensions of flexibility emerged as uniquely predictive of outcomes. For example, increases in acceptance and decreases in fusion were particularly strongly linked to drops in depressive symptoms. The talk will blend these quantitative findings with specific case-study examples to highlight their clinical relevance.

• The Acceptance and Commitment Therapy Fidelity Measure (ACT-FM): Results of an Online Delphi Study and Field Testing
Lucy O'Neill, University of Leeds
Gary Latchford, Ph.D., Institute of Health Sciences, University of Leeds and Leeds Teaching Hospitals NHS Trust
Lance McCracken, Uppsala University
Christopher D. Graham, Ph.D., Queen's University Belfast

We aimed to develop a new trans-diagnostic measure of therapist fidelity to Acceptance and Commitment Therapy (ACT). Study 1 used Delphi methodology to design the measure. We recruited 13 experienced ACT clinicians from across countries and specialities, approximately half of whom were ACBS peer reviewed trainers. There were three iterative rounds of online questionnaires. After considering a preliminary draft of the measure - in the first two rounds - participants rated the utility of items, the manual and structure of the measure, and generated new items for consideration. In the third round participants provided final suggestions on an emergent draft of The ACT Fidelity Measure (ACT-FM). Study 1 resulted in a measure with 24-items divided among ACT-consistent and inconsistent domains against the three-part model of psychological flexibility (“Tri-flex”).Study 2 comprised an investigation of the usability and preliminary psychometric properties of the ACT-FM. A group of ACT clinicians used the ACT-FM to rate a videoed ACT therapy session. The inter-rater reliability was moderate to excellent. Based on clinician feedback, the measure was expanded to 25 items.

• New data and new questions: Examining the FIAT-Q-SF and understanding FAP assessment in a process-based era
Cory Stanton, M.S., University of Nevada, Reno
Jonathan Singer, M.A., University of Nevada, Reno
Brandon Sanford, M.S., University of Nevada, Reno
William C. Follette, Ph.D., University of Nevada, Reno

One of the challenges of doing Functional Analytic Psychotherapy (FAP) is understanding the unit of analysis. As the “protocols for syndromes” era fades in clinical science, opportunities abound for process-oriented therapies such as FAP. How to best conceptualize processes in FAP remains an area of investigation and discussion. The FIAT-Q-SF (Darrow, Callaghan, Bonow, & Follette, 2014) is a measure of interpersonal difficulties that represents an extension of the broader FIAT system of assessment (Callaghan, 2006). As an example of how assessment issues can be framed, data will be presented from two time points (n = 636 baseline, 569 follow-up) with undergraduate students that include the FIAT-Q-SF as part of a wider assessment battery. Factor structure, reliability, and predictive validity will be reviewed. Preliminary analyses indicate that while the sum score is an effective predictor, the factor structure appears to differ from the original publication. Interpreting these findings will be discussed in an era of process-based therapy and idiographic assessment, while also considering how network analysis and experience sampling methods hold promise for future research.

• Hidden invalidity among self-report measures poses a threat to research findings
Ian Hussey, Ph.D., Ghent University
Sean Hughes, Ph.D., Ghent University

CBS goes beyond previous waves of behaviourism by paying particular consideration to language and cognition. This has required a greater reliance on self-report measures: 99% of papers published in JCBS employ self-reports (Newsome et al., 2018). Their use necessitates their validity, and thus the appropriate assessment of this. Elsewhere, Flake, Pek, and Hehman (2017) demonstrated that metrics of structural validity are severely underreported in social and personality psychology. We applied their recommendations for the comprehensive assessment of structural validity to a uniquely varied dataset (N > 150,000) to investigate the structural validity of widely used measures in social and personality psychology (k = 15). Comprehensive assessment of internal consistency, immediate and delayed test-retest reliability, factor structure, and measurement invariance for median age and gender revealed that only 60% demonstrated good validity. Furthermore, the less commonly a test is reported in the literature, the more likely it was to be failed. Results are equally relevant to measures in clinical psychology and CBS: widespread hidden invalidity in the measures we use poses a threat to research findings.

• Using felt experiences as guides for living a purpose-oriented life: Psychometric properties of the Felt Experiences from Everyday Living (FEEL) scale
Jonathan R. Dowling, Ph.D., Goldsmiths, University of London
Frank W. Bond, Ph.D., Goldsmiths, University of London

Recent theoretical and empirical developments in the contextual behavioural sciences have highlighted the functional role that emotions have in enabling individuals to live lives that matter to them. Based upon widely discussed, contextual-based conceptualisations of emotions over the past century, this paper presents a novel measure of emotions, Felt Experiences from Everyday Living (FEEL) (Bond, & Dowling, 2019), that conceptualises these felt experiences, in part, as indicators that reflect the extent to which a person is relating to their current circumstances, as the person they wish to be both now-and-in-the-future. We present results from a series of mixed-methods studies that provide robust findings for the factor structure of the FEEL scale. We also discuss findings from several large-scale studies that suggest its usefulness in predicting a wide-range of outcomes, from quality of life and feelings of hope, to performance-based pay and promotion decisions. Discussion focuses on how these findings relate to wider developments in RFT and CBS, more generally.

Educational Objectives:
1. Get to grips with the theoretical and practical challenges presented by applying standardised measures to ACT, FAP and Mindfulness. 2. Describe what is meant by hidden invalidity. 3. List methods and strategies to avoid or overcome the issues with standardized measurement as a behavioral scientist.

 

123. Maximizing the functional impact of defusion, mindfulness, and self-compassion processes: Implications for the timing, use, and delivery of ACT interventions
Symposium (13:20-14:50)
Components: Original data,
Categories: Clinical Interventions and Interests, Relational Frame Theory, Component studies
Target Audience: Beginner, Intermediate, Advanced
Location: Q218

Chair: Timothy R. Ritzert, Ph.D., Longwood University
Discussant: Dennis Tirch, Ph.D., The Center for CFT, NYC

Myriad laboratory-based studies have evaluated ACT components in isolation, generally indicating that individual interventions derived from the psychological flexibility model produce outcomes predicted by theory (Levin, Hildebrandt, Lillis, & Hayes, 2012). However, few studies have used overt behavioral outcomes and more work is needed to understand for whom and under what conditions individual therapy components work best. The papers in this symposium will present studies addressing these important issues, with the aim testing important theory-driven predictions about individual intervention components. The first paper presents a study investigating the impact of a defusion intervention on a laboratory analogue of valued behavior that involves approaching a feared stimulus in the service of a valued outcome. The second paper evaluates the conditions under which a mindfulness exercise works best by manipulating the rationale for the exercise and exploring how the rationale impacts behavior during a subsequent CO2-enriched air challenge task. The final paper uses an RFT framework to explore how language used during self-compassion exercises impacts an individual’s subjective response to these interventions.

• Defusion in Action: Results From a Study Evaluating the Impact of an ACT Defusion Intervention on Valued Living in the Context of Anxiety and Fear
Timothy R. Ritzert, Ph.D., Longwood University
Leonie Verstraete, Longwood University
Myonni Alexander, Longwood University
Kathryn Bates, Longwood University
Marcella Johnson Boone, Longwood University
Emily Randall, Longwood University

This study is evaluating the impact of a defusion intervention on a laboratory analogue of valued behavior in the context of anxiety. Undergraduates with elevated spider fear who endorse the value of helping others are being randomized to one of three conditions: defusion, distraction, or inactive control. Defusion and distraction protocols are targeting thoughts about spiders. Following intervention, participants complete a spider behavioral approach task (BAT) featuring several steps, each of which brings participants closer to a spider. Participants are informed that for each completed step, the researchers will donate money toward meals for people struggling with hunger. Participants are told that by approaching fear, they can live this value. Although data collection is ongoing, a preliminarily analysis using ordinal logistic regression indicates that participants (N = 18) the defusion condition (Wald = 8.01, p = .005) are more likely to complete a greater number of BAT steps, relative to control. Data suggest defusion might facilitate valued action in the presence of anxious distress.

• Context of Meditation: Manipulating the Rationale Given for Mindfulness Meditation
Eric D. Tifft, B.A., University at Albany, SUNY
Emily Padula, B.A., University at Albany, SUNY
Glenn Philips, B.A., University at Albany, SUNY
John P. Forsyth, Ph.D., University at Albany, SUNY

The psychological benefits of mindfulness are well documented (Eberth & Sedlmeier, 2012). Western society appears to be amid a mindfulness zeitgeist. Numerous publications, podcasts, and smartphone apps promote mindfulness meditation and its benefits. By focusing on psychological outcomes such as helping with anxiety-related problems, applications of mindfulness meditation run the risk of deviating from traditional intentions of increasing psychological acceptance. In some contexts, mindfulness meditation might be packaged as a method of controlling experience, rather than fostering an open, nonjudgmental posture. In a recent study, we found that among those who meditate, 59% reported using it to control unwanted thoughts and emotions and 41% reported practicing meditation with the traditional intention. The difference in intention raises a question: Does how one uses meditation impact important behavioral outcomes? This paper will present results from an experiment manipulating the rationale given for a mindfulness exercise, comparing a traditional acceptance-based rationale with a control-based rationale, testing the prediction that one’s intention during meditation affects subjective and psychophysiological experience during and after a subsequent anxiogenic CO2-enriched air challenge task.

• When Self-Compassion Interventions Backfires: The Role of Oppositional Frames
Shannon B. Underwood, B.S., University at Albany
John P. Forsyth, Ph.D., University at Albany

Professionals are increasingly utilizing loving-kindness and compassion meditations to cultivate self-compassion in their clients. However, the initial introduction of the loving-kindness meditation might be challenging with certain clients (Galante, Galante, Bekkers, & Gallacher, 2014). It has been suggested that future research should identify strategies to more effectively introduce loving-kindness meditation to clients (Boellinghaus, Jones, & Hutton, 2014). Relational frame theory could provide a framework to assess, understand, and address resistance to self-compassion prior to intervention. The phrases used in these meditations (e.g. may I be safe) could possibly evoke frames of opposition in clients (e.g. I am often in danger). In the present study, participant responses to a measure were coded to detect potential frames of opposition in response to widely used phrases in loving-kindness and compassion meditations. The present study aims to explore the role of language in self-compassion interventions and identify phrases that might be more difficult than others for clients to utilize during intervention. Results will be presented in the context of developing strategies to effectively deliver loving-kindness mediation.

Educational Objectives:
1. Use behavioral and physiological assessments to evaluate ACT components. 2. Describe strategies for introducing and delivering mindfulness and self-compassion interventions. 3. Evaluate defusion and mindfulness-based intervention components.

 

124. Can We Capture AARRing in non-English Speaking Participants (Japanese and Chinese)?- Modified IRAP, FAST and Developing a New Measure: the Kanji Maze Technique (KMT): Japan Chapter Sponsored
Symposium (13:20-14:50)
Components: Original data,
Categories: Relational Frame Theory, AARRing, IRAP, FAST
Target Audience: Intermediate,
Location: Q220

Chair: Shinji Tani, Ph.D., College of Comprephensive Psychology, Ritsumeikan University
Discussant: Ian Stewart, Ph.D., National University of Ireland, Galway

This symposium presents the results of measuring AARRing for non-English speaking participants by using the IRAP, FAST, and Kanji Maze Test (KMT). The KMT was developed to capture AARRs in Japanese’s participants. The symposium will comprise three papers. The first presenter (Zhang) will show the effect of mastering the clinical conversation on altruism IRAP responses in Japanese and Chinese. The findings from the altruism IRAP data show that mastering the clinical conversation is useful to promote altruistic cognition. The second presenter (Natsumi) presents on a study that investigates the effect of defusion on mental illness stigma with FAST and SC-IAT. To our knowledge, this is the first study using the FAST in Japan. The third presenter (Yuki) reports on a study looking at the effect of defusion on depressive rumination with the KMT. The data from the KMT suggest that defusion is an effective coping strategy for depressive rumination.

• The Effects of Improving Sensibility to Altruistic Behavior on Altruistic Relational Responding
Zhang Pin, Graduate school of Science for Human Service, Ritsumeikan University
Shinji Tani Ph.D., College of Comprephensive Psychology, Ritsumeikan University

The purpose of the study is to introduce the relational framework response related to altruistic behavior and changes in the AAQ by improving sensitivity towards altruistic behavior, and to verify the effectiveness of mastering the clinical conversation. A 2(Japanese or Chinese) x 2(clinical conversation group or control group) × 2(PRE or POST) design was used to show the impact of the interventions on the IRAP effect and AAQ. The results showed that the Chinese intervention group experienced no changes in bias against altruistic behavior unlike the Japanese intervention group. This study also recognized differences between the D-Score and the AAQ as observed in an ANCOVA. In the Japanese clinical conversation group, the D scores of "i" and "altruism", POST were significantly higher than PRE, whereas for the Chinese clinical conversation group, PRE are significantly higher than POST responses. The present study suggested that improving sensitivity can effectively promote the establishment of a new relational network, and improve psychological flexibility.

• Is It Possible to Use FAST in Non-English Countries?: An Example of Cultural Adaptation
Natsumi Tsuda, M.A., Doshisha University
Asako Okuyama, Doshisha University
Shoki Sonoda, Doshisha University
Kokoro Makino, Doshisha University
Ayaka Nishii, Doshisha University
Takashi Muto Ph.D., Doshisha University

In this presentation, the use of the Functional Acquisition Speed Test (FAST) to measure implicit stigma towards mental illness in Japan is discussed. The FAST is based on Relational Frame Theory, and is used to measure participants history of relational framing. This presentation covers three topics: 1) How to translate the FAST from English to Japanese and the selection of stimuli 2) Assessing the FAST data as a measurement of the intervention. The experiment followed a 3(Time: Pre, Post, FU)×3(Group: Defusion, Thought suppression, Control) design, and participants comprised ten undergraduate students in each group. There was no main effect of group and no influence of practice effect in FAST data either. 3) Comparison of FAST data and the Single Category-Implicit Association Test (SC-IAT) data. The findings suggested that the two implicit measures measured different stigma.

• The Effect of Defusion on Depressive Rumination in Japan: The Investigation of a New Measure; the Kanji Maze Technique (KMT)
Yuki Shigemoto Ph.D., Kyotobunkyo University
Takashi Muto Ph.D., Doshisha University

The purpose of this presentation is to show the effect of defusion on depressive rumination using the Kanji Maze Technique KMT. Törneke (2014) states that depressive rumination is the result of relational framing. Therefore, defusion may be an effective coping strategy for depressive rumination. However, to date this has not been examined. Shigemoto and Muto (2018) developed the KMT as a measure which determines depressive rumination and its relation to behavioral inflexibility. Therefore, this study investigated the effect of defusion by the KMT. Participants were assigned to a defusion (female 15 and male 9) or control group (female 19 and male 5). The effect of defusion was measured by the CFQ-28, Visual Analogue Scale (VAS), Ruminative Response Scale (RRS) and the KMT. All data were analyzed pre- and post- with two groups repeated measures ANOVA. Believability at post intervention was significantly decreased compared with pre intervention within the defusion group. Post intervention believability was significantly less for the defusion group than the control group. Depressive rumination measured by the KMT decreased from pre- to post. The conclusion is that defusion beneficially effects depressive rumination after intervention.

Educational Objectives:
1. Describe the modification of AARRing measures for non-native English speakers. 2. Design the measure of AARRing according to their language. 3. Discuss the effect of MCC on altruistic cognition, and defusion on mental illness stigma and depressive rumination.

 

128. Adapting Acceptance and Commitment Therapy (ACT) for people with intellectual/learning disabilities and their parents and carers
Symposium (15:10-16:40)
Components: Original data, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Clinical Interventions and Interests, Intellectual/learning disabilities
Target Audience: Beginner
Location: The Studio

Chair: Freddy Jackson Brown, AWP NHS Trust, Bristol, UK
Discussant: Giovanni Miselli, Ph.D., BCBA, Instituto Ospedaliero Fondazione Sospiro Onlus (CR) Italy

People with intellectual/learning disabilities are at increased risk of experiencing difficulties with psychological wellbeing and behaviour that challenges. This symposium examines how ACT can be adapted to continue to be effective in supporting the needs of people with intellectual/learning disabilities. The first paper, presented by Mark Oliver, presents data on the development and initial properties of a psychometric measure of psychometric flexibility for people with intellectual disabilities. The second paper, presented by Natalie Bailey, focuses on the development of deictic functioning in a young person with autism and the impact this had on his social functioning and levels of behaviours that challenge. The third paper, presented by Steve Noone, used participatory methods to develop a group based ACT intervention to support parental wellbeing. Data indicating improved wellbeing and reductions in behaviour that challenges are presented. The fourth paper, presented by Gina Skourti, presents the outcomes of an ACT based group intervention for carers of young people with an intellectual/learning disability. Psychological acceptance and goal-based outcome measures alongside a thematic analysis were employed.

• The development and initial psychometric properties of the Psychological Flexibility Questionnaire for People with Intellectual Disabilities (PFQ-ID)
Mark Oliver, Northumberland Tyne and Wear NHS Foundation Trust
Matthew Selman, Northumberland Tyne and Wear NHS Foundation Trust
Megan Thomson, Northumberland Tyne and Wear NHS Foundation Trust
Rebecca Long, Northumberland Tyne and Wear NHS Foundation Trust
Nikki Forshaw, Northumberland Tyne and Wear NHS Foundation Trust
Samuel Brice, Northumberland Tyne and Wear NHS Foundation Trust

Introduction The lack of accessible process measures may be a barrier to wider clinical and research interest in ACT for people with intellectual disabilities (aka mental retardation). This paper presents the initial development of the Psychological Flexibility Questionnaire for People with Intellectual Disabilities (PFQ-ID). Methods Initial questionnaire development and focus group work led to the PFQ-ID. It was piloted alongside two established measures (AAQ-II and the Cognitive Fusion Questionnaire) across some staff resilience workshops. More detailed analysis of the psychometric qualities of the measure took place with data from an online survey of typically developing adults (n=100). Results The focus group data revealed that people with ID preferred the PFQ-ID over the mainstream measures, which they found difficult to understand and aversive. Initial psychometric testing has revealed encouraging psychometric data when compared with the established measures. Implications The PFQ-ID represents the only known adapted and accessible measure for the processes targeted for change in ACT. If adapted by the field, clinicians and researchers could use this to evidence ACT interventions for people with intellectual disabilities.

• Case study: A deictics intervention to support development of perspective taking and empathy in a child with ASC
Natalie Bailey, Avon & Wiltshire Partnership NHS Trust, Bristol, UK
Freddy Jackson Brown, Avon & Wiltshire Partnership NHS Trust, Bristol, UK

Introduction Individuals with a diagnosis of Autism Spectrum Condition (ASC) typically have difficulties taking the perspective of others, which is a central skill in empathy development. This paper presents a deictics intervention delivered to a young person with ASC and the effects on their empathy skills, frequency of physical aggression and unprompted apologies. Methods Weekly multiple exemplar training of three sets of deictic stimuli I-YOU, HERE-THERE and NOW THEN was completed over 6 months. Results An increase in deictic perspective taking skills correlated with an increase in empathy scores and an increase in unprompted apologies following physical aggression. Data illustrated that the frequency of incidents of physical aggression significantly decreased over time, with a noticeable decrease following a period of increased unprompted apologies. Implications Deictic perspective taking skills can be learned and generalised to everyday situations to support the social communication and functioning of individuals with a diagnosis of ASC.

• Development of Group ACT Based Intervention for Parents using participatory research methodology
Steve Noone, Northumbria University
Tina Cooke, Hope University

Introduction Research shows parents of adult sons and daughters with intellectual disability face high levels of stress yet receive little support to promote well-being. Although parent training has been identified as effective, many families remain suspicious of being patronised. This study describes the development of a group based intervention (FabPos), in collaboration with families, to identify indicators of success. Methods Three consecutive groups of 8 parents, received five, two hour sessions. Each iteration was altered based on feedback from previous groups, obtained from personal and focus group interviews. Themes were identified through qualitative analysis. Results Parents contributed to content and process of workshops. Significant indicators of success were: identification of new value based activities, increased quality interaction with other family members and tangible improvements in health and well-being. Implications Collateral benefits were the reduction in aggressive behaviour of a number of adult children and reduction in psychiatric medication. Further research is under way to develop technology to aid continued connectivity of group participants and to train wider range of workshop facilitators.

• Using acceptance-based interventions to promote the well-being of caregivers of young people with intellectual and developmental disabilities
Gina Skourti, Central and North West London (CNWL) NHS Trust
Lisa Brosh, Central and North West London (CNWL) NHS Trust

Introduction Caregivers are known to experience stress and other emotional difficulties when supporting a child who displays challenging behaviour. Acceptance and Commitment Therapy (ACT) based workshops are run to support wellbeing. Methods Participants were carers of children with intellectual and developmental disabilities accessing specialist services in the UK. The workshops involved two 4-hour group sessions on consecutive weeks. One follow up individual appointment 4–6 weeks following the group took place, to evaluate progress and conduct a semi-structured interview. Results To assess the outcomes of our intervention, we used a general measure of psychological acceptance and a goal-based outcome. Thematic analysis was used as a means to gain insight of participants' experiences. The analysis suggests that carers found the workshops useful, and mindfulness interventions may positively affect their psychological flexibility. Implications This intervention appears to promote carers’ well-being and may also establish a flexible behavioural repertoire. Emotional support for caregivers might be considered within the Positive Behaviour Support (PBS) framework, and we are developing the integration of ACT based strategies with our work with families.

Educational Objectives:
1. Demonstrate how ACT can be adapted for people with intellectual/learning disabilities. Utilize examples of effective ACT based interventions with a case study with a child and groups for parents and carers of people with intellectual/learning disabilities. 2. Demonstrate Core ACT skills in a user friendly and clinically accessible way by describing clinical processes with child and prepare how to deliver ACT in groups with parents and carers. 3. Explain how to measure psychological flexibility with a new psychometric measure developed for people with intellectual/learning disabilities.

 

130. Who's on first? Choosing Your Target, Terminology, and Training in High Performance Applications
Symposium (15:10-16:40)
Components: Conceptual analysis, Original data, Case presentation
Categories: Performance-enhancing interventions, Clinical Interventions and Interests, Sport, Military, Mindfulness
Target Audience: Beginner, Intermediate
Location: Q119

Chair: Emily Leeming Ph.D., United States Army
Discussant: Fabián O. Olaz Ph.D., Universidad Nacional de Córdoba

Psychological flexibility based interventions continue to show support across the spectrum of human performance. Within high performing populations the growth of these interventions is occurring rapidly. In this symposium we discuss the effects of mindfulness and acceptance-based interventions as compared to psychological skills training (PST) in a randomized control trial for competitive athletes. Additionally, the following two papers will discuss clinical approaches to enhancing the effectiveness of interventions with athletic teams and within tactical athlete demographics.

• Mind the gap: common and unique effects of mindfulness / acceptance-based interventions and psychological skills training in competitive athletes
Daniel Birrer, Swiss Federal Institute of Sport Magglingen
Stephan Horvath, Swiss Federal Institute of Sport Magglingen
Philipp Röthlin, Swiss Federal Institute of Sport Magglingen

Recent evaluations of the application of mindfulness-based interventions in sport revealed that they might be remarkably impactful (Bühlmayer, Birrer, Röthlin, Faude, & Donath, 2017). Nevertheless, RCTs comparing mindfulness / acceptance-based interventions (MAI) with traditional psychological skills training (PST) are sparse. 95 competitive athletes (Mage = 24.4) were randomly assigned either to a PST (n=32), MAI (n=32) or waiting control group (n=31). Both intervention programs consisted of four 90 minutes group workshops, which took place over a period of one month (Röthlin & Birrer, 2019). As expected the MAI group increased significantly their meta-cognitive awareness and their acceptance and decreased their experiential avoidance / psychological inflexibility, whereas the PST group significantly increased the use of self-talk. Both intervention groups significantly increased their use of relaxation and activation techniques and emotional control in comparison to the waiting control group. Furthermore, athletes participating in the MAI increased significantly their subjective functional athletic behavior as measured by an ambulatory assessment during competition. We conclude that different mechanisms of action are involved in the programs.

• Play Smarter Not Harder: Targeting Systemic Elements of Athletic Environment for Broader Impact
Patrick Smith, University of Nevada, Reno
Emily Leeming Ph.D., United States Army

The majority of current research in applying ACT, RFT, and/or Mindfulness is done at the level of the individual athlete. These investigations are gathering evidence of significant improvement in sport performance and reduced prevalence of clinical outcomes. Moving beyond the level of the athlete can magnify those improvements. Behavior occurs in context. Targeting systematic interventions across the athletes' training environments may not only bolster outcomes for the athlete, but influence secondary and tertiary effects on those in the athlete’s sphere of influence. Theory stands to support that creating social environments supporting psychological flexibility will improve the psychological flexibility of those operating inside those environments. Such work may maximize and support sustained effects of individual intervention too. This symposium will review the state of research, present a network map of contact points influencing athletes that may be leveraged for improvement, and provide research implications of those different contact points and the network as a whole.

• Meeting in the Middle: Using Culturally Relevant Language to Implement Behavioral Principles with Tactical Athletes
Emily Leeming, Ph.D., United States Army
Patrick Smith, University of Nevada, Reno

Technical terms within science are intended to create a specific and objective way to communicate specialized concepts. Yet in applied arenas these technical terms may limit the effectiveness of clinicians serving their clients. As it relates to psychological flexibility many middle level terms have been developed and used to describe principles and processes in understandable ways to nonscientific audiences. Yet not all nonscientific audiences are the same, the necessary middle level terms used within the United States Military are no exception. This symposium will discuss how common place and technical military language can be used as bridging terms between soldiers and psychologists in a brief ACT and behavioral education-based intervention protocol for students preparing for Jumpmaster (Airborne Parachute Safety Operations) qualification training.

Educational Objectives:
1. Discuss the effects of mindfulness and acceptance-based interventions as compared to psychological skills training (PST) in a randomized control trial for competitive athletes. 2. Discuss clinical approaches to enhancing the effectiveness of interventions with athletic teams and within tactical athlete demographics. 3. Assess and compare possible mechanisms of action inherent in traditional psychological skills training and mindfulness /acceptance-based interventions within competitive athletes.

 

134. Cutting edge research on Acceptance and Commitment Therapy and Mindfulness with Children, Adolescents and Parents
Symposium (15:10-16:40)
Components: Conceptual analysis, Literature review, Original data, Case presentation,
Categories: Clinical Interventions and Interests, Educational settings, Clinical Interventions and Interests, Performance-enhancing interventions, Behavioral medicine, Educational settings, Supervision, Training and Dissemination, Autism and Anxiety, ACT; Psychological flexibility; Youth; Inpatient care; Adolescent depression; Adolescent anxiety; Mediation, Children and Family, Mindfulness, partial hospital program, mood disorders
Target Audience: Beginner, Intermediate, Advanced
Location: Q158

Chair: Kate J. Zelic, Ph.D., Mayo Clinic

Contextual Behavioral Science research with children and adolescents is growing. The current symposium comprises six papers presenting research data on different unique aspects of child and adolescent research. The first paper looks at the using ACT interventions to tact private events in youth diagnosed with autism and anxiety. The second paper looks at ACT for antisocial youth. The third paper looks at the effects of ACT on children and adolescents classroom behavior. The forth paper will report on the impact of mindfulness on sleep in youth with mood disorders. The fifth papers investigates the impact of mindfulness with children diagnosed with autism of different cognitive capacities and the session concludes with a paper on the effectiveness of mindfulness and ACT strategies to help support parents of children with medical/psychological diagnoses.

• Using Functional Contextual Interventions for Private Events When Private Events are Extra Hard to Name: A Pilot Study of ACT interventions in Youth with Autism and Anxiety
Rebecca Hambin, Ph.D., University of Texas Medical Branch
Barbara Calvert, Ph.D., University of Texas Medical Branch
Olga Berkout, Ph.D., Texas A& University Corpus Christi

Despite promising initial results and calls by experts for more research on ACT interventions for individuals with disabilities (Harper et al. 2013; Eilers and Hayes, 2015; Hoffman, Contreras, Clay, & Twohig, 2016), very little empirical evidence exists on the application of ACT interventions in youth with autism and developmental disabilities. Additionally, while both ACT and exposure therapy are know interventions for anxiety and obsessive-compulsive disorders (OCD) in general, traditional exposure therapies are less efficacious when delivered to children and adolescents with autism spectrum disorders (ASD) relative to typically developing children (Storch et al., 2016). Thus, although an estimated 90% of individuals with ASD struggle with impairing anxiety, existing treatments are insufficient for addressing the unique needs of this growing population. This presentation will describe a pilot study examining the application of an ACT in a small (N=7) group of youth diagnosed with ASD and impairing anxiety and their parents. Methods and rational for creating the treatment model for youth and parents, description of implementation, and initial data on outcomes will be presented.

• A Quasi-Experimental, Multicenter Study of Acceptance and Commitment Therapy for Antisocial Youth in Residential Care
Fredrik Livheim, M.S., Karolinska Institutet
Anders Tengström, Ph.D., Karolinska Institutet
Gerhard Andersson, Ph.D., Karolinska Institutet
JoAnne Dahl, Ph.D., University of Uppsala
Caroline Björck, Ph.D., Karolinska Institutet
Ingvar Rosendahl, Ph.D., Karolinska Institutet

Background: Treatment of youth in residential care is a challenging task for most providers because comorbid problems are common and general psychosocial functioning is low. Objective: The purpose of this study was to test a brief, transdiagnostic, ACT group intervention for youth in residential care. Method: With a quasi-experimental design, 69 youth received Treatment-as-Usual (TAU), and 91 youth received TAU with an additional 12 hours of ACT in a group setting (TAU+ACT). Both short- and long-term follow-up was conducted. We hypothesized that psychological flexibility (PF) would mediate outcome. Findings: ITT analyses showed statistically significant improvements in the primary outcome variables of anxiety and depression in TAU+ACT youth after the end of treatment. Regarding secondary outcomes, the TAU+ACT group showed several improvements. Psychological flexibility mediated the decrease in the primary outcome of decreased anxiety. Conclusions: ACT in group format may be of help in promoting various positive outcomes for youth in residential care. Increasing psychological flexibility is a promising process variable that can be targeted to increase the effectiveness of interventions for this population.

• Mindfulness and Sleep in Youth with Mood Disorders in an Integrated Family-Based Partial Hospitalization Program
Kate J. Zelic, Ph.D., Mayo Clinic
Jarrod M. Leffler, Ph.D., ABPP, Mayo Clinic

Background: Meta-analytic reviews of mindfulness-based interventions in youth have demonstrated small positive average treatment effects in studies involving controlled and pre-post designs (Zenner et al., 2014; Zoogman et al., 2015). The current study involved participants admitted to Mayo Clinic’s Child and Adolescent Integrated Mood Program (CAIMP), a two-week family-based partial hospitalization program for youth with mood disorders that integrates components of evidence-based treatments. We aimed to provide preliminary data on 1) implementing a mindfulness-based intervention in CAIMP and 2) examining the relationship between mindfulness and sleep indices. Method: Participants included 31 youth who were primarily Caucasian (80.60%), female (71.00%), adolescents (M=14.06, SD=2.21). Youth completed self-report measures of mindfulness and sleep. Results: Correlational data revealed positive associations between youth mindfulness and multiple sleep indices. Paired samples t-tests showed significant change in multiple sleep indices from pre-treatment to post-treatment. Discussion: Findings revealed that youth with mood disorders with a greater propensity towards mindfulness had higher ratings of sleep, and there were also significant improvements in sleep indices from pre-treatment to post-treatment.

• Exploring the Effects of Acceptance and Commitment Therapy on Children and Adolescents’ Classroom Behaviors
Emily Dzugan, M.S., BCBA, Saint Louis University
Victoria Hutchinson, M.S., BCBA, Saint Louis University
Alyssa N. Wilson, Ph.D., BCBA-D, Saint Louis University

The purpose of the current study was to examine the effectiveness of implementing tailored Acceptance and Commitment Therapy (ACT) interventions based off of Dixon’s (2014) curriuculum with three school aged students who displayed challenging behaviors in the classroom. A nonconcurrent multiple baseline with withdrawal design was used to compare the effects of ACT and control sessions during classroom observations. ACT sessions were tailored to the student’s interest and current need, while control sessions included unrelated therapeutic activities. Following all treatment sessions, students were observed by a secondary research team member, during 10-30min observations. All direct observation sessions were conducted using a 30-sec combined partial and whole interval recording schedule, tracking vocal disruption, physical aggression, classroom disruption, and on-task behavior. Following individualized ACT treatment, participants’ behaviors improved compared to baseline and control conditions. Standard Mean Difference (SDM) analyses indicated moderate to large effects across all conditions. Implications for school-based treatment programs and collaborative transdisciplinary intervention strategies will be discussed.

• Mindfulness and children with autism across different cognitive levels
Rachel Lam, M.S., BCBA, Aspiration & Discoveries
James C. K. Porter, C. Psych., BCBA, New Beginning Wellness

Attention, self-regulation and on-task behaviour are crucial skills to a child’s learning success and it has raised various concerns which led to numerous research in the past. Many mindfulness studies have demonstrated the effectiveness of mindfulness-based intervention in increasing students’ on-task behaviours. However, these studies mostly targeted special needs children with relatively higher cognitive ability (IQ score of 70-75 or above) and excluded children with Autism with IQ under 70-75. Therefore, we are examining through a 9 weeks modified mindfulness based on MYmind plus additional behaviour analytical strategies implemented with group of 7 children with ASD: (1) Whether there is a correlation between cognitive function and the child’s ability in implementing mindfulness strategies on two levels, a) early level (IQ score below 70) and b) advance level (IQ score above 70). (2) Whether there are significant differences on participates’ (a) executive function and self-regulation, (b) problem behaviours, (c) and attention prior to and after mindfulness training across cognitive levels. (3) Ability in following mindfulness program across cognitive levels.

Educational Objectives:
1. Describe the effects of ACT and mindfulness interventions with different child and adolescent populations. 2. Apply and combine behavior analytic based strategies with ACT and mindfulness interventions. 3. Describe youth and parent acceptability of ACT and mindfulness interventions in different settings.

 

136. Interbehaviorism, and the psychological event: implications for investigating complex patterns of relational responding.
Symposium (15:10-16:40)
Components: Conceptual analysis, Original data
Categories: Interbehaviorism, Interbehaviorism, RFT, IRAP
Target Audience: Beginner, Intermediate, Advanced
Location: Q218

Chair: Mitch Fryling, Ph.D., California State University, Los Angeles
Discussant: Dermot Barnes-Holmes, Ph.D., Ghent University

This symposium will provide an outline of the work of JR Kantor, and detail the application of this work to analyses of complex behaviors. The first paper provides an introduction to Kantor’s thinking, and to the tenets of interbehavioral psychology. The second paper will present a formulation of complex behavior from the interbehavioral perspective. The final paper will present analyses of individual patterns of behavior in the IRAP that draw on the Kantorian construction of the psychological event. This symposium seeks to highlight the benefit of interbehavioral thinking for those working under the umbrella of ACBS. Specifically, awareness of system building, assumptions, constructs and events can benefit researchers working on RFT as they grapple with complex behavioral interactions.

• Interbehaviorism and Contextual Behavioral Science
Mitch Fryling, Ph.D., California State University, Los Angeles

Kantor’s work has a number of implications for contextual behavioral science. In general, Kantor’s work calls attention to what science is and is not, and to the importance of developing an authentic philosophy of science. Other implications include the explicit articulation of philosophical assumptions at all levels, a careful appreciation of the distinction between constructs and events, the role of research in science, and the analysis of science as a cultural institution. Kantor’s system of psychology is also distinctive. For example, the subject-matter of psychology is constructed as a psychological event, and a system building procedure is proposed whereby sciences continuously evaluate their validity, significance, and comprehensiveness. Kantor also outlines a number of discipline specific assumptions in Interbehavioral Psychology, and describes the role of various subsystems within the larger system of psychology. The aim of this paper is to provide a broad overview of Kantor’s philosophy of science and system of psychology, and to highlight implications for work in contextual behavioral science throughout.

• Complex Behavior in Interbehavioral Perspective
Linda J. Parrott Hayes, University of Nevada, Reno

When a unit psychological event is construed as a coordination of responding and stimulating, understanding a complex response requires consideration of the complex stimulational circumstances participating in the event. Complexity is a matter of multiple conditions having to do with the response factor, the stimulus factor, or both. For example, responding may be subtle, stimulating may arise from verbally attributed properties, and both may be substitutional. Understanding psychological events, particularly when these sorts of complications are present, requires consideration of the settings in which they are occurring. In doing so, it becomes obvious that the setting is neither stable nor impotent. It is rather a continuously evolving field of many factors integrated with the continuously evolving relation of responding and stimulating constituting the event focus. In short, the setting is an aspect of a unit psychological event such that different setting factors constitute a different unit. The aim of this paper is to see how this perspective, namely that of interbehavioral psychology, may be of service in attempts to understand complex human behavior.

• Predicting-and-Influencing Patterns of Arbitrarily Applicable Relational Responding in Individual Performances in the Implicit Relational Assessment Procedure
Martin Finn, MSc, Ghent University
Dermot Barnes-Holmes, Ph.D., Ghent University

An emerging model of differential arbitrarily applicable relational responding effects (the DAARRE model, pronounced “Dare”; Finn, Barnes-Holmes, & McEnteggart, 2018) has focused on coherence among the Cfunc, Crel, and RCI properties of the stimuli presented in each block of trials within the IRAP. A sequence of IRAP studies tested the DAARRE model at the individual participant level. Patterns of D-IRAP effects were brought under experimental control by focusing on the Cfunc and Crel properties of the label and target stimuli. First, labels and targets with pre-experimentally established functions were employed. Next, the functions of the label and targets were established within the experiment by means of matching-to-sample, and Training IRAP procedures. The results from these studies suggest that the relative dominance of Cfunc and Crel control over patterns of relational responding can be manipulated. This relatively precise experimental manipulation of patterns of derived relational responding may have important implications for basic RFT research, and for its relationship to the analysis of natural language in more applied settings.

Educational Objectives:
1. Discuss how an understanding of the interbehavioral construct of the psychological event can contribute to RFT research. 2. Describe the DAARRE model. 3. Analyze and interpret patterns of IRAP effects.

 

137. Complex relationships: Courage in the Context of Trauma and Intimacy
Symposium (15:10-16:40)
Components: Conceptual analysis, Original data,
Categories: Clinical Interventions and Interests, Theoretical and philosophical foundations, Interpersonal functioning and trauma
Target Audience: Beginner,
Location: Q220

Chair: Victoria Follette, Florida Institute of Technology
Discussant: William C. Follette, Ph.D., University of Nevada, Reno

This symposium brings together three areas of research that are woven together by both theory and populations. While the field has focused on a range of psychological difficulties, there is often less focus on the range of interpersonal difficulties. The first paper addresses issues with sexual intimacy issues faced by women surviving sexual assault as a child or adult. Understanding the role that avoidance plays in impacting the ability to function sexually has not been addressed in the empirical literature. In a different but related vein, the second paper addresses interpersonal targets from FAP in explaining treatment outcomes for trauma survivors. The third paper examines issues with intimacy that are related to trauma and depression. Together these papers contextualize issues that go beyond basic symptomology and examine the impact of relationship variables on clinical problems. New empirical research presented will be discussed in terms of theoretical and clinical implications. Moving away from single target treatments and including clinically relevant behaviors in our treatment programs will help in the evolution of one-size-fits-all treatment packages.

• Sexual functioning: the role of experiential avoidance and trauma in predicting sexual satisfaction
Victoria Follette Ph.D., Florida Institute of Technology
Kerri Guadagni, Florida Institute of Technology

There is a large body of empirical literature demonstrating the negative impacts of sexual victimization on psychological functioning. Research has also shown the relationship of experiential avoidance in mediating negative outcomes. The clinical literature on victimization frequently discusses negative outcomes in the areas of intimate relationships and sexual functioning. However, the empirical literature in this area is extremely limited. Using the online Amazon Mechanical Turk platform, we recruited 280 women over the age of 18 to participate in the study. Several types of victimization were assessed including child sexual abuse, adolescent abuse, and adult assault. Findings indicate that victimization, particularly revictimazation, is associated with increased trauma symptoms, experiential avoidance, and lower sexual satisfaction and functioning, Clinical implications for working with women who are survivors of sexual trauma will be discussed. Specifically, when is a focus on PTSD not necessary or sufficient in trauma therapy?

• Awareness, courage, and responding in an Exposure-based PTSD Program: Integrating Interpersonal Flexibility into Trauma Treatment
Peter P. Grau, M.S., Marquette University

The impact of interpersonal functioning on PTSD treatment outcomes has been demonstrated consistently in the literature (De Jongh et al., 2016), especially for patients with a chronic trauma history (Cloitre, 2005). Recently, machine learning approaches have shown that change in interpersonal targets from FAP (i.e., Awareness, Courage, and Responding [ACR]) predict up to 20% of the variance in PTSD treatment outcomes (Wetterneck, Grau, & Singh, 2018). While these results are encouraging, additional research is needed to further examine the factor analytic structure of the ACR and relationship to relevant outcome variables (e.g., self-compassion, shame, and quality of life). This study explores both the psychometric properties and predictive power of the ACR in an ACT-informed, exposure-based partial hospitalization program (PHP). Initial results (n = 132) show change in awareness of self is a significant predictor of PTSD symptom severity and self-compassion, while change in interpersonal courage is the strongest scale predictor of discharge PTSD symptom severity, self-compassion, trauma-related shame, and quality of life. Factor analytic findings and implications for treatment will be discussed.

• The role of disruptions in the interpersonal model of intimacy in the development and maintenance of maladaptive behaviors
Daniel Maitland, Texas A&M University

Loneliness has long been implicated as a risk factor for issues of mental and physical health (Leigh-Hunt, 2017). However, there is evidence that the detrimental impact attributed to loneliness may be due to low levels of subjective feelings of social connection rather than objective social isolation (Ge et al., 2017). While the process of developing feelings of connection (social intimacy) is relatively well understood (Reis & Shaver, 1988) and the evidence of the therapeutic benefits of increasing intimacy via contextual behavioral interventions such as FAP are emerging (Maitland et al., 2016), the exact nature of deficits in intimacy in maladaptive behaviors are not well understood. The current study presents data from large data sets collected at a medium sized university assessing the role of deficits in intimacy on complex grieving, trauma related symptoms, and depression. Discussion will focus on where in the intimacy process disruptions occur, how these deficits function to develop and maintain maladaptive behavior, and on the ramifications of these findings on treatment.

Educational Objectives:
1. Describe the interpersonal model of intimacy and articulate how disruptions to that process maintains maladaptive behaviors. 2. Demonstrate the role of experiential avoidance in the sexual satisfaction of women with a history of sexual victimization. 3. Explain the prediction of the impact of awareness, courage, and responding in a trauma affected population outcomes.

Sunday, 30 June

145. Addressing common difficulties in ACT-based group treatment: Research and clinical innovations.
Symposium (9:00-10:15)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Educational settings, mindfulness; adults; ACT; group interventions
Target Audience: Intermediate, Advanced
Location: Q119

Chair: Elena Ballantyne, Psy.D., C.Psych., St. Joseph's Healthcare Hamilton/McMaster University

Despite demonstrated effectiveness for treating physical, psychological, and social issues, challenges remain in delivering ACT-based group protocols (e.g., differential responsiveness, skill generalization, unsystematic intake to group programs, uneven access to care, medium-low effect sizes). We identified common difficulties across diverse settings, populations, and countries and will present models and results regarding novel use of the underlying processes of CBS. The first presentation will describe results from an intervention emphasizing values and committed action to facilitate self-care among healthcare trainees struggling to cope with professional demands. The second will describe a triage algorithm for the assessment, intake, and modularization of pain rehabilitation programs based on CPAQ-8 and their way to accept (or not) their pain, the outcomes for the patient, the benefits for the clinic. The third will provide evidence supporting modified ACT interventions for psychiatric outpatients with cognitive impairment that facilitate their participation and improve outcomes. Finally, ways to overcome practical challenges in adapting ACT to a broad, group-based setting and satisfaction, utility, and understandability of the ACT-based group intervention will be presented.

• I Know I Should But…”: A Randomized Control Trial Using Values to Promote Health Care Trainee’s Self-Care Behavior
Jorden Cummings, Ph.D., R.D.Psych., University of Saskatchewan
Jessica Campoli, University of Saskatchewan

Trainees in professional health care programs report stress levels that exceed the general population. Despite an ethical responsibility to engage in self-care, professional knowledge of the importance of self-care, and awareness of what such practices often entail, trainees report barriers to engaging in self-care. They also report feeling ill-equipped to cope with the demands of their programs. We present results from a wait-list randomized control trial evaluating Value-Based Self-Care (VBSC), an ACT-informed intervention emphasizing values and committed action. Participants were from a variety of health disciplines (e.g., medicine, nursing, psychology) who completed a 6-week group intervention. We provide an overview of the intervention and present results from our pilot. Pre-to post-treatment results showed a significant impact on frequency of self-care utilization, stress, and anxiety. Participants reported being highly satisfied with the intervention. Given that self-care practices established early in one’s training can influence an entire career and the number of lives health care professionals touch over the course of their careers, our results have substantial implications for participants as well as their future patients.

• Process-based tailored group interventions: how to create groups with shared behavioral flexibility patterns and shared therapeutic needs
Graciela Rovner, Ph.D., Karolinska Institutet & ACT Institutet Sweden

ACT programs for chronic health conditions (such as pain) yield effect sizes medium to low showing the differential responsiveness among participants. Grouping patients by their pain acceptance (with 8 questions) offers a clear understanding of their behavioral flexibility, as well as their rehab-needs in terms of processes, in turn guiding the modularization of the rehab-program. Based in our research (Rovner, 2014; Rovner, Vowles, Gerdle, & Gillanders, 2015) we’ve developed ACTiveRehab, the clinical implementation that supports a novel logistic in the intake and allocation of patients in groups guiding decision making and how to tailor a stepped care for group settings. We will present comparisons between the before and after implementation of the ACTiveRehab model in terms of not only clinical outcomes, but also how other patients considered ‘difficult’ were no longer rejected from the programs and explain why.

• Evaluating the effectiveness for a modified intervention group for neuropsychiatric illness and cognitive impairment
Elena Ballantyne, Psy.D., C.Psych., St. Joseph's Healthcare Hamilton/McMaster University
Jorden Cummings, Ph.D, R.D.Psych., University of Saskatchewan
Megan English, Ph.D., R.Psych., Eastern Health, Health Sciences Centre

The purpose of this non-randomized pre-post study was to examine potential benefits of a modified ACT intervention for individuals (n=26) with psychiatric/neurological illness who, due to neurocognitive difficulties, could not otherwise benefit from traditional group-based psychotherapy. A prior pilot study examining feasibility informed the current study which assessed whether adaptations (e.g., memory aids, shorter exercises, between-session support) facilitated learning/use of strategies, skill generalization, emotional awareness, and reduction of executive dysfunction/inattention. Pre-group cognitive screens and pre-post questionnaires were completed to assess executive functioning and ACT-based skills. Process of change using weekly measures of acceptance and mood variables were administered. Groups met for 10 weeks with two booster sessions after group completion. The primary outcome was participants' level of self-reported mindfulness with respect to 5 dimensions: observing, describing, act with awareness, non-judgment, and non-reactivity. Emotional dysregulation, executive functioning, valued living, mood, and acceptance were examined. Results from qualitative analysis of between session telephone support and quantitative process measures will be presented. Discussion will include clinical issues and strategies for adapting ACT for this population.

• Patient Satisfaction and Understanding of Components of the Acceptance and Commitment Therapy (ACT) Model: Challenges in Adapting ACT to Group-Based Care
Theresa A. Morgan, Ph.D., Rhode Island Hospital, Department of Psychiatry
Brian Pilecki, Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University
Catherine D'Avanzato, Ph.D., Lifespan Physican Group
Sarah Zimage, M.A., Lifespan Physican Group
Rawya Aljabari, Ph.D., Lifespan Physican Group
Olga Obraztova, Ph.D., Lifespan Physican Group
Douglas Long, Ph.D., Lifespan Physican Group
Savannah McSheffrey, Rhode Island Hospital Partial Hospital Program

Existing ACT research emphasizes patient outcomes including symptom change, improved functioning, and process change in the short- and long-term. In contrast few studies report on patient experiences with the ACT model. Patient satisfaction is positively associated with improved outcomes (Shipley et al., 2000), correlates with quality of care (Trujols et al., 2014), and is integral to program evaluation and development (Glorimar, 2014). The current study reports over 17,000 patient-rated surveys on satisfaction, utility, and understandability of ACT-based treatment groups in a partial-hospital setting (Morgan et al., 2014). Group topics included: mindfulness, values, committed action, self-as-context, defusion, and acceptance. Results showed high correlations between patient-rated satisfaction, perceived utility, and understandability of the groups. Globally, satisfaction was most correlated with perceived utility of the group (all rs' > .92). Highest ratings were given for groups on mindfulness, and lowest ratings for self-as-context. Experiential groups were rated higher than groups with a didactic-basis. Discussion will include using data to identify and address growth areas for the program, and practical challenges in adapting ACT to a broad, group-based setting.

Educational Objectives:
1. Identify and list common challenges in the implementation and operationalization of group-based ACT interventions for clinical and non-clinical populations. 2. Discuss the effectiveness of adapting evidence-based ACT techniques to specific populations of interest in group treatment (e.g., individuals with neurological impairment, chronic pain, mental health conditions) based on the results of our collective studies. 3. Plan methods for how to overcome common challenges in implementing group-based ACT interventions (e.g., reactions to acceptance-based interventions, predict readiness for change, increase access to services, improve skill use).

 

148. Social anxiety: Bridging experimental and clinical research
Symposium (9:00-10:15)
Components: Original data, Didactic presentation,
Categories: Clinical Interventions and Interests, Clinical Interventions and Interests, Basic/Applied, Social Anxiety
Target Audience: Beginner, Intermediate, Advanced
Location: Q122

Chair: Helen Bolderston, Ph.D, Bournemouth University
Discussant: Michael Levin, Ph.D., Utah State University

Social anxiety (SA) is common and can significantly impact individuals’ mental health and functioning, but evidence-based interventions for SA are only effective for approximately half of treated individuals. There is a large body of SA clinical intervention research, but far fewer experimental explorations of processes, components and activities that might significantly impact the efficacy of those interventions. It is therefore important to conduct well-designed basic research that is relevant to clinical intervention. This symposium presents three innovative studies that bridge the gap between experimental research and clinical intervention. The first tests standalone ACT and CBT components for SA, and utilizes self-report and behavioural (eye-gaze) measures. The second study assesses the impact of engaging in helping behaviour on well-being in individuals with social anxiety and depression, and uses Event Sampling Methodology. The final, RFT-based study, tests the impact of hierarchical and distinction-based self interventions on public speaking anxiety. Implications for future research will be discussed, in terms of furthering understanding of SA, and the use of experimental research to guide the development of clinical interventions.

• The impact of ACT and CBT components on social anxiety and eye-gaze behaviour
Georgia Turner, MSc., Bournemouth University
Helen Bolderston, Ph.D., Bournemouth University
Nicola Gregory, Ph.D., Bournemouth University
Sarah Thomas, Ph.D., Bournemouth University

Current evidence-based psychotherapies for Social Anxiety Disorder (SAD) such as CBT and ACT significantly benefit approximately 50% of treated patients. It is therefore imperative to increase understanding of the active components of these psychotherapies as well as hypothesised maintenance processes, in order to increase efficacy of clinical interventions. The present lab-based experiment compared brief, standalone components of ACT (acceptance and defusion) with a key component of CBT (cognitive restructuring), and an active control condition. Participants were 120 students with SAD symptomology. Outcomes were assessed based on state self-report measures as well as socio-attentional eye-gaze behaviour. The impact of these components on symptomology, maintenance processes, and eye-gaze behaviour will be discussed, along with implications for adaptations of current psychological interventions for SAD.

• Is helping you helping me? The assessment of helping others in individuals with social anxiety and depression.
Marcia Rinner, MSc., University of Basel
Andrea H. Meyer, Ph.D., University of Basel
Jürgen Hoyer, Ph.D., Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
Thorsten Mikoteit, Ph.D., University of Basel, Psychiatric Hospital, Centre for Affective, Stress and Sleep Disorders
Christian Imboden, Ph.D., Psychiatric Services Solothurn and University of Basel, Switzerland
Martin Hatzinger, Ph.D., Psychiatric Services Solothurn and University of Basel, Switzerland
Marcel Miché, Ph.D., University of Basel
Roselind Lieb, Ph.D., University of Basel

The act of helping others can be an expression of ones values (i.e., value-oriented behavior) or be driven by avoidance such as in a rule-governed behavior (e.g. helping because of social pressure). Those different motivations may help explain contradicting findings on helping and well-being. Previous studies have reported beneficial effects of helping (higher well-being), and costs from helping (lower well-being). Especially, for patients with social phobia, for whom the social context can be anxiety provoking, it is crucial to assess whether helping other increases their well-being. It is further important to assess helping within other clinical and non-clinical populations, while using golden standard assessment methodologies, such as Event Sampling Methodology (ESM), instead of relying on questionnaires. The presented study assessed helping behavior using ESM within individual with a social phobia and major depression diagnosis and non-depressed, non-anxious individuals. Results showed that three group show similar helping frequencies and all profit from helping. Results give important contribution to the use of helping within therapy and public mental health programs.

• Development of self-based interventions for Public Speaking Anxiety.
Ana Gallego, MSc., University of Jyväskylä
Matthieu Villatte, Ph.D., Bastyr University
Louise McHugh, Ph.D., University Colleague Dublin
Raimo Lappalainen, Ph.D., University of Jyväskylä

Based on Relational Frame Theory (RFT), the present study aimed to analyze the effect of two self-based interventions. Using a between-subjects design, participants (n= 119) were randomly assigned to one of the three groups: Group 1 (Hierarchical Self), Group 2 (Distinction Self), Group 3 (Control group). The primary outcome was Public Speaking Anxiety. An additional dependent variable was Psychological Flexibility. There were no significant differences between the groups for PSA and PF. However, results from the mediational analysis (using M Plus) suggested that Cognitive Defusion skills mediated the changes in PSA only for the intervention groups, but not for the Control Group. In addition, results from the correlational analyses showed that PSA correlated significantly with Psychological Flexibility, Openness to one’s own Experiences, Self-Perspective Skills, and Cognitive Fusion. However, there was no significant correlation between the Physiological Activation and PSA, neither with PF. The implications of the findings for clinical practice are discussed.

Educational Objectives:
1. Discuss the impact of psychotherapy components on eye-gaze behaviour in social anxiety. 2. Explain the relationship between helping and well-being for common mental health conditions. 3. Discuss the use of RFT-based self interventions in relation to public speaking anxiety.

 

149. CBS research in the area of health and performance: Hungary Chapter Sponsored
Symposium (9:00-10:15)
Components: Conceptual analysis, Original data, Didactic presentation
Categories: Evolution, Interventions in occupational settings, Performance-enhancing interventions, Clinical Interventions and Interests, Prevention and Community-Based Interventions, Performance-enhancing interventions, Organizational behavior management, Theoretical and philosophical foundations, Children, parents, asthma, Acceptance and Commitment Therapy, body compassion; perimenopause, Health-care organization; neurodevelopmental disorders, Surgeons; resilience; burnout; ACT training, space psychology
Target Audience: Beginner, Intermediate, Advanced
Location: Q158

Chair: Jennifer K. Altman, Ph.D., University of Washington

The current symposiums unifying concern is the use of CBS principles to promote health and performance. The first paper investigates the predictive factors of adherence in a parent training program using ACT for childhood asthma management. The second paper reports data on the role of compassion in the well-being of women during menopause. Paper three looks at the price equation and professional behavior in care pathways for neurodevelopmental disorders. The four paper is a feasibility study on resilience, burnout, and distress in surgeons and the final paper looks at how to improve the performance and well-being of astronauts and flight controllers of the European Space Agency. Together these papers demonstrate the growing research base for CBS across different populations.

• Predictive factors of enrollment and adherence in a parent training program using Acceptance and Commitment Therapy (ACT) for childhood asthma management
Yuen-yu Chong, Ph.D., The Nethersole School of Nursing, The Chinese University of Hong Kong
Yim-wah Mak, Ph.D., The Hong Kong Polytechnic University
Alice Yuen Loke, Ph.D., The Hong Kong Polytechnic University

Identifying family and child characteristics associated with the enrollment and adherence in parent training programs may help to optimize treatment outcomes. This study assessed factors predicting enrollment and adherence of a parent training program using ACT for childhood asthma management. Data were based on a randomized controlled trial examining the efficacy of a 4-session, parental training program using group-based ACT plus asthma education for childhood asthma management in parent-child dyads. The baseline characteristics between participants and non-participants, and those who completed and did not complete all the ACT sessions were compared and analyzed. Half (55.6%) of the parents enrolled in the program. Of those parents in the ACT group (n=84), 74% attended all the sessions. Multilevel regression models showed that frequent emergency attendance due to childhood asthma attacks (adjusted OR =3.47, 95%CI [1.37, 8.83], p=.009) predicted enrolment. Socioeconomically disadvantaged families, in terms of poor monthly household income (p=.046) and single-parent status/divorced families (p=.034) predicted non-adherence to ACT. Future studies shall make ACT more feasible and acceptable to disadvantaged families of children with poor asthma control.

• Women facing THE change: What role does body compassion play?
Jennifer K. Altman, Ph.D., University of Washington

Body compassion is a construct based in mindfulness-and acceptance-based conceptual models with three subscales: defusion, common humanity, and acceptance. During perimenopause, key characteristics for which women seek health care include: vasomotor symptoms, sleep quality, depression, and quality of life. We examined the potential predictive validity of the Body Compassion Scale (BCS) in these characteristics in women in perimenopause (N=281) with the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS), BCS, Pittsburgh Sleep Quality Index, Self-Compassion Scale (SCS), Center for Epidemiological Studies Depression scale and Menopause Rating Scale. In backward regressions the defusion subscale of body compassion was retained in every final model predicting outcomes of perimenopause (Range β = -.30 to -.59, p< .001). Regarding frequency of vasomotor symptoms, the three BCS subscales were the sole predictor variables when included in backward regressions with the MBSRQ-AS and SCS subscales (R-squared = .07, p <.001). Body compassion presents an opportunity to directly measure and ultimately intervene with the experience of perimenopause. Further results regarding clinical utility of body compassion, women’s health and perimenopause will also be presented.

• The Price equation explains professional behavior in care pathways for neurodevelopmental disorders.
Gustaf Waxegård, MSc, Linnaeus University
Hans Thulesius, Ph.D., Lund University

Building on earlier conceptualizations of Scandinavian-type care pathways for neurodevelopmental disorders as Ostromian common pool resources (CPR:s), this presentation uses the Price equation from (cultural) evolution science to model the observed CPR dynamics quantitatively. The Price equation applies because professional fitness in an organization co-varies differently with different professional strategies. Along with in-group processes, the model parsimoniously explains spread or non-spread of professional behavior serving different functions. Importantly, how professional behavior co-varies with professional fitness depends both on organizational context and organizational level. To exemplify, budget-keeping behavior may be more associated with professional pay-off than doing high-quality work. Professionals interested in high-quality work rather than budget keeping may then discount future profits and exit the care pathway, further strengthening transmission and replication of budget-keeping behavior. When applied to inter-professional cooperative behavior, the Price equation also clarifies that care pathways of the type studied are sub-optimally structured to elicit appropriate professional cooperation. Seeing the relevance of evolutionary dynamics in everyday health care structures helps to influence and predict professional activity in these systems.

• ACT based Resilience Training for Surgeons.
Stephen Richer, Bournemouth University
Helen Bolderston, Ph.D., Bournemouth University
Kevin Turner, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
Sine McDougall, Bournemouth University
Kevin Thomas, Bournemouth University

Surgeons are no more psychologically resilient than the general population, but their work typically involves adverse surgical events that can negatively impact their psychological, personal and professional lives. This can lead to high levels of burnout and distress, as well as poorer work performance and attrition from the profession. Surprisingly, little empirical research has been conducted to identify means by which these negative experiences might be mitigated. This pilot intervention study (N = 10) assessed the feasibility and impact on resilience, burnout, and distress, of a brief Acceptance and Commitment Therapy (ACT) based training course among trainee surgeons in the UK. Participants received 3 x 2-hour 1-to-1 ACT training sessions across an 8-week period. Significant improvements in resilience, burnout, distress and a range of process variables will be discussed. Additionally, the on-going ACT for surgeons RCT based on this pilot study, will also be outlined.

• Contextual Behavioural Science to Improve the Performance and Well-being of Astronauts and Flight controllers of the European Space Agency
Károly Kornél Schlosser, Goldsmiths, University of London
Frank W. Bond, Ph.D., Goldsmiths, University of London

Applied psychology in space exploration is becoming vital (Vakoch, 2011) as humans are preparing to take the next leap to explore space and establish colonies on the Moon and Mars. The endeavours of becoming inter-planetary species will require significantly longer missions and so it is crucial for astronauts to perform outstandingly, whilst maintaining their psychological well-being and performance in situations that have not yet been fully examined. In order to successfully accomplish mission outcome in such extreme and isolated environments, astronauts and their team need to remain psychologically flexible in supporting each other and addressing unexpected issues. We believe that Acceptance and Commitment Therapy (ACT) and mindfulness meditation, underpinned by over two decades of empirical research, is well placed to improve the psychological and behavioural skills needed for such demanding missions. This presentation discusses our latest progress in developing a complex training based on contextual behaviour science for astronauts and the mission control team of the European Space Agency.

Educational Objectives:
1. Describe current advances in CBS health and performance research. 2. Assess the effectiveness of CBS research across different populations. 3. List a variety of empirical approaches currently being used and adapted by CBS researchers.

 

150. New directions in the conceptual and empirical analyses of rule-governed behaviour
Symposium (9:00-10:15)
Components: Conceptual analysis, Literature review, Original data,
Categories: Relational Frame Theory, Rule-governed behaviour
Target Audience: Beginner, Intermediate, Advanced
Location: Q217

Chair: Colin Harte, Ghent University
Discussant: Ian Stewart, Ph.D., National University of Ireland, Galway

The concept of rule-governed behaviour has been widely recognized for many decades within the behaviour-analytic literature. It has also been argued that the human capacity to formulate and follow complex rules may undermine sensitivity to direct contingencies of reinforcement, and that excessive reliance upon rules may be an important variable in human psychological suffering. This symposium aims to explore recent conceptual and empirical advances in the analysis of rule-governed behaviour. The first paper will consider how the concept of derived stimulus relations could allow for a more precise experimental analysis of instructional control, and explore how recent conceptual developments in RFT could be used to advance research in the area. The second paper will examine a series of empirical studies that directly apply these conceptual advances in the lab, and explore the potential benefits of discussing behaviour traditionally referred to as rule-governed in terms of the dynamics of relational responding. The final paper will outline experimental work systematically evaluating how derived relational responding can account for rule-governed behaviour, which involves specifying a three-term contingency.

• Conceptual developments in the study of rule-governed behaviour as involving the dynamics of derived relational responding.
Colin Harte, Ghent University
Dermot Barnes-Holmes, Ph.D., Ghent University
Yvonne Barnes-Holmes, Ph.D., Ghent University
Ama Kissi, Ghent University

While the concept of rules would appear to have been relatively useful within behaviour analysis, it seems wise from time to time to reflect upon the utility of even well-established concepts within a scientific discipline. Doing so may be particularly important if it begins to emerge that the existing concept does not readily orient researchers toward potentially important variables associated with that very concept. The primary purpose of the current paper is to engage in this reflection. Specifically, we will focus on the link that has been made between rule-governed behaviour and derived relational responding, and consider the extent to which it might be useful to supplement talk of rules or instructions with terms that refer to the dynamics of derived relational responding.

• Exploring the behavioural dynamics involved in persistent rule-following: The differential impact of derivation and coherence
Colin Harte, Ghent University
Dermot Barnes-Holmes, Ph.D., Ghent University
Yvonne Barnes-Holmes, Ph.D., Ghent University
Ciara McEnteggart, Ph.D., Ghent University

Behaviour described as rule-governed, and the ability to engage in arbitrarily applicable derived relational responding, have both been identified as uniquely human abilities and have been highlighted as potentially important variables in psychological suffering. However, there is limited basic laboratory research that attempts to bridge the gap between these two areas. This paper will present a series of experiments that explore the impact of the dynamics of derived relational responding on persistent rule-following through the lens of recent conceptual developments in RFT (outlined in Paper 1 in this symposium). Specifically, Experiments 1 through 4 investigate the impact of levels of derivation on rule persistence at the level of mutual and combinatorial entailment, while Experiments 5 and 6 explore the impact of coherence. Finally, a seventh experiment assesses the dynamic impact of both of these variables together. Results demonstrate that both levels of derivation and coherence impact upon rule-persistence in subtle and unique ways. The benefits of investigating rule-persistence through the conceptual lens of RFT, and further implications for the study of rule-persistence will be discussed.

• Rule-governed behaviour: A relational account
Cainã Gomes, Instituto de Psicologia Baseada em Evidências (InPBE)
Dermot Barnes-Holmes, Ph.D., Ghent University
William F. Perez, Paradigma Centro de Ciências e Tecnologia do Comportamento

Since the term was coined by BF Skinner over fifty years ago, the definition and study of rule-governed behaviour has been the subject of much debate. Traditionally within the behaviour-analytic literature, rules were defined as “contingency-specifying stimuli”. Since its inception, RFT, has sought to provide a more functional account of “specifying” and proposed that derived relational responding could be at its core. However, no experimental study to date has systematically evaluated how relational responding could account for a rule that specifies a three-term contingency. Across three experiments, the impact of coordination and temporal framing in direct and derived rule-following was accessed using a go/no-go procedure. Temporal and coordination relations were used to specify antecedents, key-pressing response sequences and consequences. A fourth experiment then evaluated the impact of using natural language words as contextual cues in generating rule-following. Results showed that both temporal and coordination relations were necessary in establishing rule-following, which involved a three-term contingency specifying stimulus. Variations in results across experiments and their implications for future research are discussed.

Educational Objectives:
1. Define the basic concept of derived stimulus relations; 2. Describe the basic concept of rule-governed behaviour; 3. Discuss how recent conceptual developments and basic research have integrated these two areas

 

151. Psychological flexibility in cancer and palliative care populations
Symposium (9:00-10:15)
Components: Original data,
Categories: Clinical Interventions and Interests, Behavioral medicine, Organizational behavior management, Oncology, Palliative Care
Target Audience: Beginner,
Location: Q218

Chair: Pandora Patterson, Ph.D., CanTeen Australia / Sydney University
Discussant: Olivia Donnelly, Ph.D., North Bristol NHS Trust

The application of Contextual Behavioural Science in the area of oncology and palliative care is still relatively early in its journey, though is growing rapidly. Patients who receive a cancer diagnosis can experience understandable but distressing emotional reactions at a number of different points in their experience of cancer, from diagnosis, through treatment, survivorship, or progression and terminal illness. In addition, professional staff can also experience a range of emotional and behavioural reactions that can affect their wellbeing and the care they provide. In this symposium, data will be presented that shows the utility of Psychological Flexibility as an overarching concept for guiding investigations into treatment targets, moderating mechanisms and naturalistic longitudinal processes that influence outcomes, across a wide variety of concerns. Unusually, this symposium has five papers each just 15 minutes long. This shows the breadth of this work, reporting on international studies, gathered by clinicians and researchers in the UK, Australia, and Canada.

• ACT-based therapeutic process changes and their association with patient-report outcomes: results from an international cancer survivorship cohort study.
Nick Hulbert-Williams, Ph.D., University of Chester
Lee Hulbert-Williams, University of Chester, UK
Brooke Swash, University of Chester
Rosina Pendrous, University of Chester, UK
Fiona McDonald, CanTeen Australia & The University of Sydney, Australia
Lesley Storey, Queen’s University Belfast, UK
Melissa Pilkington, Manchester Metropolitan University, UK
Sylvie D Lambert, McGill University, Canada
David Gillanders, Psy.D., University of Edinburgh
Pandora Patterson, CanTeen Australia & The University of Sydney, Australia

Background: Previous literature demonstrates the effectiveness of ACT for cancer survivors. Cross-sectional studies highlight significant correlation between ACT therapeutic processes and patient-reported outcomes, but longitudinal data are lacking. Our study explored prediction of distress, quality of life, benefit finding and fear of recurrence from changes in ACT processes. Method: 200 participants were recruited using social media; our sample is demographically and clinical heterogenous. Participants complete online questionnaires assessing ACT processes and outcome measures every three months for two years. Results: Cross-sectional baseline analysis indicates high correlation between process and outcome variables. Effects remain statistically significant after controlling for demographic and clinical variables, using both baseline (R2 range = .168 to .560, p<.001) and three-month (R2 range = .205 to .435, p<.05) outcome data. Effects of change in ACT processes on outcomes are smaller and less statistically significant. Conclusions: Comprehensive theoretical modelling of longitudinal psychological adjustment is a necessary step in effective intervention development. Findings replicate and extend previous literature. Ground-up, data-driven approaches, will help us to develop more patient-led, clinically- and cost-effective interventions.

• Investigating the role of psychological flexibility, masculine self-esteem and stoicism as predictors of psychological distress and quality of life in men living with prostate cancer
Gareth McAteer, University of Edinburgh
David Gillanders, Psy.D., University of Edinburgh

Objective: This study examined the predictive power of psychological flexibility, masculine self-esteem and stoicism in influencing psychological distress and quality of life in men with prostate cancer Method: The study used a quantitative, cross sectional design. A heterogeneous sample of 286 men diagnosed with prostate cancer completed self-report questionnaires. Correlation, hierarchical multiple regression and conditional process analysis were used to explore relationships between variables. Results: Psychological flexibility and masculine self-esteem predicted significant variance in both distress and quality of life, beyond the impact of physical symptoms. Stoicism was not significantly correlated with any predictor or outcome variable. Conditional process analysis showed psychological flexibility significantly moderated the predictive effect of both prostate cancer physical symptoms and masculine self-esteem in predicting distress, but did not significantly moderate these predictors on quality of life. Conclusions: Interventions targeted at raising psychological flexibility, particularly those that encourage adaptive masculine values, may be effective in reducing psychological distress in prostate cancer patients.

• Does Psychological Flexibility buffer the impact of fear of recurrence or progression in men with Prostate Cancer?
Lindsay-Jo Sevier-Guy, University of Edinburgh, NHS Fife
David Gillanders, Psy.D., University of Edinburgh
Caroline Sommerville, NHS Fife
Nuno Ferreira, University of Nicosia

Background: Fear of recurrence or progression is common in men with prostate cancer and is associated with increased distress and reduced quality of life. Psychological Flexibility may moderate the impact of fears on outcomes. Methods: 144 men with Prostate Cancer responded to an online survey, measuring distress, quality of life, psychological flexibility, and fear of recurrence or progression. Conditional Process Analysis was used to test the hypothesis that Psychological Flexibility would moderate the relationship between fear of recurrence and distress or quality of life. Results: Psychological Flexibility was a significant predictor of distress and quality of life, and was a stronger predictor of distress than fear of recurrence. Fear of recurrence was also a significant predictor of both outcome variables and was a stronger predictor of quality of life than Psychological Flexibility. Psychological Flexibility moderated the relationship between fear of recurrence and psychological distress, but not quality of life. Conclusions: Psychological Flexibility may be a useful treatment target to improve psychosocial outcomes in men with prostate cancer.

• A Pilot Group-Based ACT Intervention to Address Fears of Cancer Recurrence Following Treatment for Primary Breast Cancer: Impact on Anxiety, Mood, Fear of Recurrence, Quality of Life and Psychological Flexibility.
Christopher Hewitt, Beatson West of Scotland Cancer Centre
Natalie Rooney, Greater Glasgow & Clyde NHS
Fiona Sinclair, Beatson West of Scotland Cancer Centre
Philip McCloone, Beatson West of Scotland Cancer Centre
David Gillanders, Psy.D., University of Edinburgh

Fear of cancer recurrence (FCR) is one of the most commonly reported for cancer survivors and their families (Simard et al., 2013). Estimates of prevalence of FCR are between 33% to 96% of patients (average 73%), depending on demographic variables, disease type and assessment methodology (Koch et al., 2013, Simard et al. 2010). Given that all cancers are associated with the possibility of recurrence, fears are a normal and rational response. However, some patients develop more severe, longer-term and debilitating levels of distress. This paper describes a six session, interdisciplinary group-based ACT intervention, for 73 women, post breast cancer-treatment. Results showed statistically and clinically significant improvements in fear of recurrence, depression and anxiety from pre to post treatment. Significant improvements in psychological flexibility and quality of life were also reported. Qualitative analysis of post intervention feedback also showed that the women had benefited by having clearer information, a new perspective on recurrence, learning different ways to handle emotions and appreciating the supportive peer group aspect of the intervention. Clinical and service implications will be highlighted.

• A Longitudinal Study of the Acceptance and Commitment Therapy (ACT) processes and the Mindful Healthcare Scale (MHS) in Healthcare Professionals
Shaun Fisher, University of Edinburgh
David Gillanders, Psy.D., University of Edinburgh
Nuno Ferreira, University of Nicosia
Paul Morris, University of Edinburgh

This study examined the psychometric properties of the MHS and explored ACT processes in relation to professional quality of life in healthcare professionals (including those working in palliative care and cancer settings) using a longitudinal design with two time points (T1 = initial survey; T2 = 6 month follow-up). Predictor variables were the MHS, the CompACT, self-compassion, self-as-context, and empathy. Outcome variables were compassion satisfaction (i.e. deriving pleasure from caring for others), burnout, secondary trauma, and general wellbeing. There were 163 healthcare professionals recruited at T1 and 83 were retained at T2. Analyses revealed that the MHS at T1 correlated with outcome variables at T2 in expected directions. Furthermore, the MHS was the strongest predictor of compassion satisfaction and burnout in regression analyses. Additionally, the MHS was found to have good test-retest reliability (ICC = .77, p<.001). Interestingly, the Defusion subscale of the MHS only significantly contributed to the MHS in predicting compassion satisfaction and was found to negatively predict this outcome (β = -.254). Theoretical and practical implications of these findings for psychological flexibility in healthcare professionals will be discussed.

Educational Objectives:
1. Discuss psychological factors influencing adjustment in cancer from a contextual behavioural science perspective. 2. Describe a range of CBS consistent treatment targets and how these integrate with other treatment modalities. 3. Apply CBS understandings to understanding common healthcare professional reactions to working in similar healthcare fields.

 

152. Use of ACT and mindfulness to develop courage, acceptance and flexibility in people with neurological conditions
Symposium (9:00-10:15)
Components: Original data, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Neurological conditions
Target Audience: Intermediate
Location: Q220

Chair: Richard Coates, Private Practice, UK
Discussant: Kenneth Pakenham, The University of Queensland, Brisbane, Australia

Neurological conditions (such as traumatic brain injury, stroke, multiple sclerosis, brain tumour) can significantly impact on an individual’s ability to undertake values-based living across all domains of life. Such conditions can bring either overnight, or gradual changes in functioning. There is an exciting opportunity for ACT to offer a radically different, compassionate and engaging approach to existing rehabilitation for people with a wide range of neurological conditions, helping them to embrace change and face it with courage and flexibility. ACT aims to increase psychological flexibility, by promoting mindfulness and acceptance towards unwanted private events (thoughts, feelings, sensations) and to help people engage in actions based on values. Together, the speakers will present data that explores this model, evaluating the impact that ACT and mindfulness has on key outcomes across a range of neurological conditions, formats, ages, settings and time-frames.

• A five-year evaluation of a brief community-based mindfulness intervention for people with multiple sclerosis
Kenneth Pakenham, The University of Queensland

Following a successful pilot study (Spitzer & Pakenham, 2018), Kenneth Pakenham will describe a five-year evaluation of a brief community-based mindfulness intervention for people with multiple sclerosis. The presentation will show that mindfulness group programs (19 groups, 186 attendees) delivered in community settings can be sustained over the long term with this population. Preliminary analyses revealed pre- to post-intervention improvements on mental health quality of life (p=.002, d=- .33), global distress (p=.022, d=.28), depression (p=.022, d=.26), stress (p=.004, d=.42), perceived stress (p=.006, d=.35), anxiety (p=.064, d=.37), mindfulness (p=.002, d=-.42), self-compassion (p=.002, d=-.35), and psychological flexibility (p=.024, d=.34). Intervention gains were maintained at follow-up on all outcomes except perceived stress. Self-compassion and mindfulness emerged as mediators of improvements on the primary outcomes.

• The living well with neurological illness program
Geoff Hill, James Cook University Hospital

Geoff Hill will describe the Living Well with Neurological Illness program (Hill et al., 2017a), a series of eight, weekly, three-hour ACT workshops. Initial analysis recorded significantly increased psychological flexibility (AAQ-II), reduced depression (HADS-D), and reduced distress (CORE-10) between pre- and post- self-rated intervals (N = 6, Hill et al., 2017b). Analysis of the data from five iterations of the workshops (N = 30, Hill et al., in preparation) demonstrated significantly increased mindfulness (Five Facet Mindfulness Questionnaire, d=0.63) and reduced distress (CORE-10, d = 0.60). 100% of attendees would recommend ACT to friends or family. The Living Well workshops will inform a post-doctoral fellowship and feasibility of a randomized controlled trial later this year.

• ACT for adolescents with postconcussive injuries
Drew Carr, Huntington Memorial Hospital, Southern California Neurology

Drew Carr will present work with athletes experiencing post-concussive injuries in the context of navigating changes associated with adolescence. ACT has shown promise in helping individuals adjust to pain and other bodily-related issues; however, many patients with brain injuries acquire executive dysfunction that may inhibit their ability to attend to longform metaphors, mindfulness interventions, or experiential exercises. This presentation will provide a framework, overview of several cases and methods in how using ACT interventions in a brief, focused manner, may improve outcomes for adolescents with post-concussive sequelae. Recommendations for future research and clinical work will be provided.

Educational Objectives:
1. Describe the benefits of ACT and mindfulness approaches for people with neurological conditions, across a range of contexts. 2. Evaluate the suitability of ACT and mindfulness approaches for people with neurological conditions. 3. Adapt and apply ACT and mindfulness approaches for people with neurological conditions within their own practice.

 

162. Recent Methodological Advances in Training and Testing Relational Framing in Children and Adults
Symposium (10:35-12:05)
Components: Original data
Categories: Relational Frame Theory, Performance-enhancing interventions, Educational settings, Experimental analysis of behavior, Cognitive training, Children, Relating relations, Analogy
Target Audience: Intermediate, Advanced
Location: Q158

Chair: Ian Stewart, Ph.D., National University of Ireland, Galway
Discussant: Bryan Roche, Ph.D., National University of Ireland Maynooth

This symposium presents a series of papers involving new methods for training and testing relational framing in children and adults. Paper 1 presents a series of studies evaluating the extent to which a non-reinforcement based correlation training procedure could combine with a Yes/No evaluation method to establish and test for derived equivalent and spatial relations. Paper 2 explores students’ cognitive ability and personality factors in engagement with, and benefits from computerized (SMART) relational operant training; qualitative data on what students liked and disliked about the training are also presented. Finally, Paper 3 presents the latest data from a series of studies using a novel protocol (ARA) for assessing and training analogical relations in young (5 year old) children.

• Examining the Effects of Using Correlation and Yes/No Evaluative Procedures on Establishing Derived Stimulus Relations
Tim Fuller, Ph.D., Fit Learning
Linda J. Hayes, Ph.D., University of Nevada, Reno

The purpose of this series of studies was to evaluate the extent to which a non-reinforcement based correlation training procedure could combine with a Yes/No evaluation method to establish and test for derived equivalent and spatial relations. In the first experiment, participants were trained stimulus pairs between A-B and B-C across three stimulus sets. Participants were subsequently tested using a Yes/No evaluative procedure of untrained B-A, C-B, A-C, and C-A relations. Experiment two utilized the same training structure as well as testing for the same derived relations, however used a complex semi-random trial structure. In both experiments 1 and 2 the majority of participants responded accurately to all of the possible tested derived relations. In experiment 3, the same training and testing procedure was employed to establish spatial relations. Tests for possible derived spatial relations were observed for the majority of participants. The three experiments demonstrated the effectiveness of a correlation training and Yes/No evaluation procedure that to date has not been reported in the derived relational responding literature.

• Characteristics of Children Who Engage With and Benefit From Computerized Relational Operant Training.
Shane McLoughlin, University of Chester
Sue Bentham, University of Chichester
Antonina Pereira, University of Chichester
Teresa Mulhern, Ph.D., University of Chester
Ian Tyndall, Ph.D., University of Chichester

Typically, applied behavior analytic educational interventions involve one-to-one or one-to-few delivery, and therefore may be too costly to implement on a large scale. One possible way to ameliorate this problem of scalability is to computerize, for example, precision teaching techniques for training operant repertoires. However, engagement with and subsequent benefit from interventions that are not directly supervised by a professional inevitably depend more on participants’ individual characteristics to begin with. We tested one such relational operant training system known as Strengthening Mental Abilities with Relational Training (SMART) in a sample of 7-9 year-olds in a school in Ireland over a period of several months. In this study, we report on the cognitive and personality factors associated with (i) completing more training, and (ii) benefitting more from the training in terms of cognitive ability and educational outcomes. Finally, we will present qualitative data on what children enjoyed and did not enjoy about taking part in this intervention.

• Developing Training Protocols to Test and Train Analogical Responding in Young Children
Elle Kirsten, National University of Ireland Galway
Ian Stewart, Ph.D., National University of Ireland, Galway

Analogical (A:B::C:D) relational responding is a key repertoire in the development of verbal and intellectual repertoires. This paper will 1) briefly review the Analogical Relations Assessment (the ARA); a Relational Frame Theory based assessment of analogical relations, and, 2) discuss RFT-based training procedures used to train arbitrary analogical relations in 5-year-old children. The ARA allows assessment of (i) non-arbitrary relations (ii) non-arbitrary analogy (relations between physical relations) (iii) arbitrary relations and (iv) arbitrary analogical relations (relations among relations). Study 1 correlated ARA performance with performance on other measures; the extent to which basic relational patterns are prerequisite repertoires needed for analogy, and the age of emergence of analogy will be discussed. Subsequent studies have focused on testing and training arbitrary analogical relations in 5-year-old children. Data from testing, training, and generalization trials will be presented and discussed.

Educational Objectives:
1. Describe the use of correlations procedures pursuant in establishing derived stimulus relations, and distinguish between the various methodological options appropriate for establishing derived relational responding. 2. Identify traits of those who 1) engage with, and, 2) benefit from SMART relational operant training. 3. Discuss RFT research on analogical responding in young children.

 

163. Toward a Contextual Psychedelic Assisted Therapy: Contextual Behavioral Science and the Third Wave of Psychedelic Research
Symposium (10:35-12:05)
Components: Conceptual analysis, Literature review, Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Functional contextual neuroscience and pharmacology, psychedelics, depression, RFT
Target Audience: Beginner, Intermediate
Location: Q217

Chair: Jason Luoma, Ph.D., Portland Psychotherapy Clinic, Research, & Training Center, Oregon Health Sciences University
Discussant: Steven C. Hayes, Ph.D., University of Nevada, Reno

Scientific research into psychedelic compounds is undergoing a renaissance. After regulatory changes halted research in the 1970s, research restarted in the early 1990s and has been increasing ever since. New clinical research is particular promising, having demonstrated preliminary efficacy and safety of psychedelic compounds across a range of clinical presentations, with research currently heading into Phase III trials that will conceivably result in the legal prescription of at least some psychedelic compounds for therapeutic purposes. This symposium is intended to provide an overview of what psychedelics are, the current research landscape, and contribute to an understanding of how contextual behavioral science can be used to understand psychedelics assisted therapy and further its application. The first paper provides a historical and empirical overview of therapeutic psychedelic use, the second a conceptual model for a CBS understanding of psychedelic experiences the third discusses how qualitative research into change processes informed the use of the hexaflex in psilocybin integration, and the fourth outlines how results using MDMA for PTSD can be understood through a CBS lens.

• The History of the Use of Psychedelics as Treatment for Mental Health Problems
Brian Pilecki, Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University

Throughout history, psychedelics have been an integral part of culture, religion, spirituality, and philosophy, traditionally viewed as “medicines” and agents for healing and personal growth. Modern scientific inquiry into their therapeutic benefits began with the “first wave” of psychedelic research (1890-1940), marked by the discovery of mescaline, and a second wave (1940-1970), marked by the discovery of lysergic acid diethylamide (LSD) and psilocybin. More recently, a third "wave" continues to build on earlier findings demonstrating that psychedelics can be beneficial in treating mental health problems, such as the use of MDMA (“ecstasy”) for PTSD, ketamine for treatment-resistant depression, or psilocybin (“magic mushrooms”) for alcohol abuse. This presentation will outline these three waves and summarize the current state of research. Potential risks and contraindications for such treatment will also be addressed. Finally, the role of functional contextualism in providing a framework for the study and use of psychedelics will be discussed, as much of the history of psychedelic research has lacked a unifying theoretical framework and relied on multiple orientations such as psychodynamic or Jungian.

• Recipes for Spirituality: Entheogenic Journeys and the Centrality of a Relational Operant Account of Human Consciousness
Stuart Law, University of Nevada, Reno
Steven C. Hayes, Ph.D., University of Nevada, Reno

After a long hiatus, therapeutic applications of entheogenic (psychedelic) experiences are once again the subject of scientific study. There appears to be wide agreement that psychosocial elements are needed to safely and progressively study the impact of these experiences on outcomes and behavior. In this paper we describe how current developments in—targeted relational operant instruction, evolutionary science models of intervention, Process-Based Therapy, and idiographic data analysis—can combine with data on the psychological flexibility model to help guide parts of entheogenic research. We will emphasize the analysis of spirituality and sense of self from a contextual behavioral viewpoint. Of interest to behavior scientists, these entheogenic practices may represent a tool for further building the bridge between basic verbal/relational units and higher-order ACT processes. With the thrust of these treatments seeming to be found in a deep, historically-rooted, verbally-extended, and often-noetic experiences, there seems to be an opportunity for reciprocal benefit to researchers and therapists in the areas of RFT/ACT and therapy involving these potentially network-expanding psychological journeys.

• The Use of a Psychological Flexibility Model to Guide Psilocybin Integration
Rosalind Watts DClinPsy, Imperial College Psychedelic Research Group

Integration of psychedelic experiences is important for maintaining benefits of psychedelic assisted therapy over time. However, how psychotherapy might enhance and prolong the changes initially catalysed by dosing sessions has not been studied empirically. The psychological flexibility model (PFM) appears to be a promising one to guide psychedelic integration in order to extend acute effects of psychedelic administration. This paper proposes a model for psychedelic integration based on the PFM that incorporates a modified hexaflex diagram. Previously published qualitative analyses of patient accounts of change processes in psilocybin assisted therapy identified themes of “acceptance” and “connection” as primarily responsible for positive outcomes. Based on these results, the six processes were rearranged into an acceptance triad (defusion, present moment focus, willingness) and a connection triad (self as context, values, committed action). This model is described as well as its use in trial of psilocybin assisted therapy for major depressive disorder. The paper also revisits the qualitative study of participant descriptions of psilocybin change processes and recategorizes participant reports in terms of the six flexibility processes.

• An Examination of Phase 2 Outcomes from the MAPS Sponsored MDMA-Assisted Psychotherapy for PTSD Trial Interpreted Through an ACT/CBS Frame
Gregory Wells, Ph.D., San Francisco Insight & Integration Center

Phase 3 clinical trials have begun in the U.S. as MDMA moves toward rescheduling by the DEA and accepted clinical use. Phase 2 data will be discussed and interpreted from a contextual behavior perspective. Results from the double-blind, placebo-controlled, Phase 2 pilot study of 28 participants found that 76% of participants no longer met diagnostic criteria for PTSD 12 months after their third active-dose MDMA session. MDMA lends itself to being perhaps the perfect partner for ACT-based therapy. The reduced fear state and increased feelings of empathy and self-compassion engendered by MDMA naturally create states of acceptance and cognitive defusion and the therapy is very much directed by the participant’s own inner healing intelligence (self as context). Natural outcomes of the therapy are often a reconnection to values and committed action in day-to-day life. Specific assessment measures used in the study will also be discussed as they relate to ACT principles and participant quotes will be used for further illustrate ACT principles as they naturally emerge in the treatment process.

Educational Objectives:
1. Discuss how contextual behavioral science applies to psychedelic experience. 2. Assess the research support for psychedelic assisted therapy. 3. Describe how psychological flexibility relates to psychedelic experience.

 

164. ACT as applied to treatment adherence and engagement behaviours in long-term health conditions: ACT for Health SIG Sponsored
Symposium (10:35-12:05)
Components: Original data,
Categories: Behavioral medicine, Clinical Interventions and Interests, Behavioral medicine, Adherence
Target Audience: Beginner, Intermediate, Advanced
Location: Q218

Chair: Anthony Mark Harrison, Ph.D., Institute of Health Sciences University of Leeds and Leeds Teaching Hospitals NHS Trust
Discussant: David Gillanders, Psy.D., University of Edinburgh

Many people with long-term physical health conditions (LTCs) are non-adherent to prescribed treatment recommendations and therefore have an increased risk of morbidity and mortality. Several psychological models have attempted to understand why people with LTCs do not adhere. However, there is a lack of research investigating the utility of psychological flexibility (PF) and Acceptance and Commitment Therapy (ACT) in this context. This symposium brings together a growing body of evidence from applied international clinicians and researchers in the field exploring the applicability of PF in predicting and influencing adherence outcomes in people with LTCs and outlines key challenges with addressing and evaluating this perennial issue. Specifically, this symposium will highlight research among individuals with a diverse range of LTCs, including breast cancer, chronic obstructive pulmonary disease and the human immunodeficiency virus.

• Exploring longitudinal relationships between established and novel ultra-brief measures of psychological flexibility, medication adherence and general functioning in people with long-term health conditions.
Anthony Mark Harrison, Ph.D., Institute of Health Sciences University of Leeds and Leeds Teaching Hospitals NHS Trust
Christopher D. Graham, Ph.D., Queen's University Belfast
Gary Latchford, Ph.D., Institute of Health Sciences University of Leeds and Leeds Teaching Hospitals NHS Trust

Many people with long-term physical health conditions (LTCs) are non-adherent to prescribed medications and therefore have an increased risk of morbidity and mortality. Several psychological models have attempted to understand why people with LTCs do not adhere but show limited explanatory power and treatments arising from these show modest effects. Currently, there is a lack of research investigating the utility of psychological flexibility (PF) and Acceptance and Commitment Therapy (ACT) in this context, but preliminary ACT trials show promising efficacy. Studies exploring relationships between PF and adherence have used cross-sectional and/or group-level designs, which do not account for within-individual variability across contexts over time, introducing retrospective self-report and aggregation biases. Currently, few momentary PF measures have been validated in LTCs. This longitudinal study examined relationships between validated measures of PF and self-reported adherence outcomes and general functioning in n=704 people with LTCs at 0- and 3-months. A secondary aim was to preliminary validate new momentary PF, adherence and mood scales for future ecological momentary assessment studies to assess within-individual and group-level variability. Results/conclusions: TBC.

• Testing psychological flexibility as a predictor of engagement in pulmonary rehabilitation programmes following hospital admission for an acute exacerbation of Chronic Obstructive Pulmonary Disease.
Caroline Fernandes-James, M.Clin., North Tees and Hartlepool NHS Foundation Trust
Christopher D. Graham, Ph.D., Queen's University Belfast
Alan Batterham, Ph.D., Teesside University Middleborough
Samantha L. Harrison, Ph.D., Teesside University Middleborough

Pulmonary rehabilitation (PR), an exercise and education programme, improves quality of life and reduces mortality. However, few patients complete PR. To inform future interventions, we investigated whether Psychological Flexibility predicts engagement in PR. Participants completed the Acceptance and Action Questionnaire-II (AAQ-II) and the Engaged Living Scale (ELS) on admission to hospital. To enhance our understanding of this context, cognitive interviewing was undertaken with participants as they completed the psychological flexibility questionnaires. A total of 20/43 patients accepted a referral to PR. Only the ELS total score was associated with acceptance (odds ratio for a 1-SD increase = 3.05, 95% CI 1.33 to 7.00). The probability of acceptance for an ELS score 1-SD below and above the mean was 22% and 73%, respectively. The ELS total score was strongly correlated with the breathlessness extended MRC Dyspnoea score, with greater disability linked to lower ELS scores (r= -0.57). Only 7/43 attended the first PR session. Emergent qualitative themes triangulated with the quantitative data suggesting an intricate relationship between values and disease severity in relation to PR engagement.

• A co-developed ACT intervention to support medication decisions and quality of life in women with breast cancer: The ACTION study
Louise H. Hall, Ph.D., University of Leeds
Rachael J. Thorneloe, Ph.D., University of Leeds
Jane Clark, DClinPsy, Leeds Teaching Hospitals NHS Trust
Sam G. Smith, Ph.D., University of Leeds
Christopher D. Graham, Ph.D., Queen's University Belfast

Most women with oestrogen-receptor positive breast cancer are prescribed hormone therapies to reduce their risk of recurrence. Non-adherence is common, often because of adverse side effects. Previous interventions to support adherence have been unsuccessful, potentially because they failed to consider patient preferences and the feasibility of delivery within a resource-limited healthcare service. Using a co-development approach, we aimed to design an acceptable and feasible intervention based on Acceptance and Commitment Therapy (ACT), to improve medication adherence and quality of life in women with breast cancer. Six patient focus groups (n=24) and ten clinician interviews were conducted to understand the acceptability of ACT in this context. A workshop with patients (n=12) and clinicians (n=9) was undertaken to co-design the intervention. These studies indicated consensus that the intervention should consist of an individual meeting and three group sessions with a clinical psychologist, in addition to online educational and ACT resources. The intervention needs to address side-effect management, returning to work, and psychological adjustment. It will be evaluated in a case study and pilot randomised controlled trial.

• Acceptability and Efficacy of Acceptance-Based Behavior Therapy to Promote HIV Acceptance, HIV Disclosure, and Retention in Medical Care
Ethan Moitra, Ph.D., Brown University
Philip A. Chan, M.D., Brown University & The Miriam Hospital
Andrea LaPlante, Psy.D., Crescent Care
Michael D. Stein, Ph.D., Boston University & Brown University

Drop-out rates from medical clinics in the months following initiation of HIV care can run as high as 50%. HIV patients who are not retained in care are at risk for myriad health consequences and are known to be a source of ongoing HIV transmission. In a randomized controlled trial, this study sought to improve HIV treatment retention by promoting patients' acceptance of the illness and facilitating informed disclosure to social supports as a by-product of acceptance. Thirty-four newly HIV-infected patients were recruited from two diverse clinics in the U.S. and randomized to receive treatment-as-usual (TAU) or a 2-session acceptance-based behavior therapy (ABBT). Over nine months, ABBT increased retention by 20% compared to TAU. At follow-ups, results showed that ABBT, relative to TAU had medium to large effects on experiential avoidance of HIV (d=-.35 to -.59), willingness to disclose HIV status (d=.18 to .53), and perceived social support (d=.29 to .43). These data strongly suggest that the use of ABBT with HIV patients will inform a new treatment approach for persons first entering HIV care.

Educational Objectives:
1. Discuss how the psychological flexibility model could potentially explain non-adherence behaviour in people with long-term health conditions based on new theoretical evidence. 2. Drawing on growing evidence for novel ACT interventions to improve adherence to treatment recommendations in people with long-term health conditions, implement and evaluate ACT-based interventions for adherence in their own clinical practice. 3. Describe and critique the challenges of operationalising, predicting and influencing non-adherence behaviour from a contextual behavioural science perspective.

 

165. Empirical and Methodological Innovations in Addressing and Understanding Shame and Stigma in Marginalised Populations
Symposium (10:35-12:05)
Components: Conceptual analysis, Literature review, Original data, Didactic presentation,
Categories: Functional contextual approaches in related disciplines, Clinical Interventions and Interests, Prevention and Community-Based Interventions, methodology and statistics, LGBT+, Minority groups, stigma, psychological flexibility, Anxiety, Depression, Self-criticism, social anxiety, external shame, Single Case Experimental Design (SCED), ACT for marginalised groups, Homelessness, Single Case Experimental Design
Target Audience: Beginner, Intermediate, Advanced
Location: Q220

In today's challenging cultural and political environment, it is increasingly important that CBS is actively engaged in understanding and generating evidence-based solutions that address distress experienced by stigmatised populations. The first paper looks to determine whether a values-based intervention can enhance the psychological well-being of gender and/or sexual minorities who have experienced enacted stigma based on their group identification. The second paper considers the psychological implications of the most recent U.S. presidential election for minority groups. The third paper explores if social anxiety and depression could be predicted by early memories of warmth and safeness with parents and peers, and if external shame and self-criticism mediates this relationship. The fourth paper will discuss the benefits and limitations of using single case experimental designs (SCED) and look at new technology to streamline analysis. The fifth paper will discuss the use of SCED in exploring effects of an ACT intervention to promote well-being and mitigate the deleterious effects of shame and self-stigma for individuals experiencing homelessness.

• Overcoming stigma: A values-based intervention for GSM individuals who have experienced stigma and discrimination.
Lauren E. Griffin, University of Louisiana at Lafayette
Emily K. Sandoz, Ph.D., University of Louisiana at Lafayette

Through an ACT lens, valued living is an integral part in fostering meaning and purpose (1). Put together, values and committed action help people understand what matters to them; it gives them directions that bring them closer to what they value (2). Having values in life has been associated with positive emotions and self-concept, higher levels of satisfaction, and more growth outcomes when dealing with stressful situations (3). Put simply, valuing in ACT is successful in decreasing psychological suffering and supporting better overall well-being (2). For gender and sexual minorities (GSM), searching for meaning in life may be more difficult in heterosexist environments (3). Recent research indicate that GSM individuals are less likely to remain fused with thoughts about past discriminations if they have a strong sense of what they value (3). The present study focuses on helping GSM individuals increase their valued living. The purpose of this study is to determine whether a values-based intervention enhances the psychological well-being of GSM individuals who have experienced enacted stigma based on their gender or sexual identity.

• Governing bodies’ effect on human behavior: Implications of the U.S. presidential election on minority groups
Rebecca Copell, University of Louisiana at Lafayette
Lauren Griffin, University of Louisiana at Lafayette
Emily K. Sandoz, Ph. D., University of Louisiana at Lafayette

In just three days after the most recent presidential election, over 200 incidents of election-related harassment were reported in the United States. Among the minority groups most affected (listed by number of incidents, in ascending order) were black people, immigrants, Muslims, and LGBT+ people (Southern Poverty Law Center, 2016). In the year following the U.S. election, hate crime rose over 12%. The current study considered the direct and indirect psychological implications of the U.S. presidential election for minority groups in the months immediately following the announcement of the election and inauguration. Members of minority groups in a southeastern university reported on various aspects of psychological distress, coping, social support, and quality of life. Relations amongst these variables will be discussed, particularly the buffering effects of certain coping strategies moderating relationships between distress and functioning. Implications for community-based intervention to support minority groups will be proposed.

• The impact of early memories of warmth and safeness on social anxiety and depression in a clinical sample: The meating role of selfcriticism and external shame
Brígida Caiado, University of Coimbra
Maria do Céu Salvador, Cognitive-Behavioral Center for Research and Intervention (CINEICC); University of Coimbra

This study explored if social anxiety (SA) and depression could be predicted by early memories of warmth and safeness (EMWS) with parents and peers, and if external shame and self-criticism would mediate this relationship, in a clinical sample of 53 adults with SA disorder (SAD) (34% females; Mage = 24,36; SD = 5,758). Both models presented very good fits, explaining 29% of SA and 28% of depression. Only EMWS with peers presented a significant impact on external shame, self-criticism, SA and depression. The effect of EMWS with peers on SA occurred through external shame, or through external shame and self-criticism. The effect of EMWS on depression only occurred through the combination of the two variables. The role of external shame on SA occurred directly and indirectly through self-criticism, whereas in the case of depression, it only occurred indirectly through self-criticism. In face of these results, interventions in depression and in SAD should focus on decreasing self-criticism and promoting self-compassion. In addition, in people with SAD, the intervention should also decrease of external shame.

• A web app to make Single Case Experimental Design research more accessible and robust
Ian Hussey, Ph.D., Ghent University

Single Case Experimental Designs are recognised alongside RCTs as a source of strong evidence for the efficacy of therapeutic interventions (Chambless & Hollon, 1998). Despite having the benefit of being feasible using far smaller sample sizes compared to RCTs, SCEDs are under used. This is possibly due to (a) the heterogeneity of statistical practices and recommendations, and (b) the relative difficulty of implementing SCED analyses compared to between groups analyses such as ANOVAs. This talk addresses both issues in order to encourage the use of SCED. A simulation study was used to assess the performance of multiple different pre-post SCED analysis methods across a wide range of plausible experimental designs. This provided concrete recommendations for useful, robust, and interpretable hypothesis testing methods. A web app and open-source R package was created and will be demonstrated. This implements these statistical methods along with both data visualizations and a between-subjects meta analysis method. Small research teams, or even individual clinicians, can use these to quantify and track the efficacy of their interventions and practice.

• Efficacy of a Single-Session Acceptance and Commitment Therapy Intervention to Promote Well-Being and Mitigate the Deleterious Effects of Shame and Self-Stigma in Adults Experiencing Homelessness: A Randomised Multiple Baseline Design
Varsha Eswara Murthy, University College Dublin
Ian Hussey, Ghent University
Louise McHugh, University College Dublin

The stigma associated with experiencing homelessness can lead to individuals being discriminated against, such as reduced employment opportunities and interpersonal rejection. This often results in individuals self-stigmatising and experiencing intense shame, which can result in negative psychological and behavioural consequences. A randomised multiple-baseline design was utilised to evaluate the efficacy of a single session, one-to-one ACT intervention to promote well-being and mitigate the deleterious effects of shame and self-stigma for individuals experiencing homelessness. Participants were 9 adults currently experiencing homelessness. Internalised shame, depression, anxiety, psychological, emotional and social well-being, cognitive fusion, psychological flexibility, valued action, and openness to experience were measured at baseline, post-intervention, and at a 6-week follow up. Daily measures of self-reported shame and experiential avoidance were collected via text. Results showed that the intervention improved outcomes on all measures, for all participants. Results highlight the efficacy of a brief ACT intervention in promoting well-being in a homeless population and the benefits of using single case methodology to examine intervention effects in populations that may be difficult to study at a group level.

Educational Objectives:
1. Describe the negative effects of shame, stigma and self-criticism and their clinical implications. 2. Analyse the efficacy of CBS interventions for different marginalised populations and stigmatised groups. 3. Discuss the relative benefits of single case experimental design and its utilisation for research with marginalised populations.