There is an Applying ACT to Addictions Special Interest Group (SIG) that ACBS members can join.

For an up-to-date list of ACT RCTs for addiction, ACBS members can go to the Applying ACT to Addictions SIG Resources.

Below is summarized existing ACT empirical articles and references related to substance abuse, gambling, and recovery. Please contribute by adding to it if you see that references are missing.

Gambling related references:

Dymond, S. & Whelan, R. (2007). Verbal relations and the behavior analysis of gambling. Analysis of Gambling Behavior, 1, 19-20

Nastally, B. L. & Dixon, M. R. (2012). The Effect of a Brief Acceptance and Commitment Therapy Intervention on the Near-Miss Effect in Problem Gamblers. Psychological Record, 62 (4), 677-690.

Non empirical publications on substance abuse

Batten, S. V., DeViva, J. C., Santanello, A. P., Morris, L. J., Benson, P. R., & Mann, M. A. (2009). Acceptance and Commitment Therapy for comorbid PTSD and substance use disorders. In J. Blackledge, J. Ciarrochi, & F. Dean (Eds.), Acceptance and Commitment Therapy: Current Directions (pp. 311-328). Queensland, Australia: Australian Academic Press.

Buckner, J. D., Zvolensky, M. J.,  Farris, S. G., & Hogan, J. (in press). Social Anxiety and Coping Motives for Cannabis Use: The Impact of Experiential Avoidance.
Psychology of Addictive Behaviors.

Heffner, M. & Eifert, G. (2003). Valued directions: Acceptance & Commitment Therapy in the treatment of alcohol dependence. Cognitive and Behavioral Practice, 10, 378-383.

Luoma, J.B. & Kohlenberg, B. S. (2012). Self-Stigma and Shame in Addictions. In S. C. Hayes & M. Levin (Eds). Acceptance, Mindfulness, Values, and Addictive Behaviors: Counseling with Contemporary Cognitive Behavioral Therapies. Oakland: New Harbinger.

Smout, M. (2008). Psychotherapy for Methamphetamine Dependence. Drug and Alcohol Services South Australia 2008: 429. https://www.sahealth.sa.gov.au

Turner, N., Welches, P., & Conti, S. (2013). Mindfulness-Based Sobriety. New Habringer, Oakland, CA. (book that integrates ACT with some other related approaches)

Wilson, K. G. & Byrd, M. R. (2004). Acceptance and Commitment Therapy for Substance Abuse and Dependence. In S. C. Hayes & K. Strosahl, (Eds.)A Practical Guide to Acceptance and Commitment Therapy (pp. 153-184). New York: Springer Press. (preprint available from 1st author -- click on his name above.)

Wilson, K. G. & Hayes, S. C. (2000). Why it is crucial to understand thinking and feeling: an analysis and application to drug abuse. The Behavior Analyst, 23, 25-43.

Wilson, K. G., Hayes, S. C., & Byrd, M. (2000). Exploring compatibilities between Acceptance and Commitment Therapy and 12-Step treatment for substance abuse. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 18, 209-234.

Substance abuse research

Batten, S. V., & Hayes, S. C. (2005). Acceptance and Commitment Therapy in the Treatment of Comorbid Substance Abuse and Post-Traumatic Stress Disorder: A Case Study. Clinical Case Studies, 4(3), 246-262.

Bricker, J. B., Mann, S. L., Marek, P. M., Liu, J. M., Peterson, A. V. (2010). Telephone-delivered acceptance and commitment therapy for adult smoking cessation: A feasibility study. Nicotine & Tobacco Research, 12,454-458.

Bricker, J., Wyszynski, C., Comstock, B., & Heffner, J. L. (2013). Pilot randomized controlled trial of web-based acceptance and commitment therapy for smoking cessation. Nicotine & Tobacco Research, 15(10), 1756-1764.  

Brown, R. A., Palm, K. M., Strong, D. R., Lejuez, C. W., Kahler, C. W. Zvolensky, M. J., Hayes, S. C., Wilson, K. G., Gifford, E. V. (2008). Development of an exposure- and ACT-based distress tolerance treatment for early lapse smokers: Rationale, program description, and preliminary findings. Behavior Modification, 32, 302-332.

Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M.., Rasmussen-Hall, M. L., & Palm, K. M. (2004). Acceptance theory-based treatment for smoking cessation: An initial trial of Acceptance and Commitment Therapy. Behavior Therapy, 35, 689-705.

Gifford, E. V., Kohlenberg, B., Hayes, S. C., Pierson, H., Piasecki, M., Antonuccio, D., & Palm, K. (2011). Does acceptance and relationship focused behavior therapy contribute to bupropion outcomes? A randomized controlled trial of FAP and ACT for smoking cessation. Behavior Therapy, 42, 700-715. L

Hayes, S. C., & Levin, M. (Eds.). (2012). Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions. New Harbinger Publications.

Hayes, S. C., Wilson, K.G., Gifford, E.V., Bissett, R., Piasecki, M., Batten, S.V., Byrd, M., & Gregg, J. (2004). A preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance-abusing methadone-maintained opiate addicts. Behavior Therapy, 35, 667-688.

Luoma, J. B., Drake, C., Hayes, S. C., Kohlenberg, B. (2011). Substance Abuse and Psychological Flexibility: The Development of a New Measure. Addiction Research and Theory, 19(1), 3-13.

Luoma, J.B., Nobles, R. H., Drake, C., E., Hayes, S. C., O-Hair, A., Fletcher, L., & Kohlenberg, B. S. (2013). A New Measure of Self-Stigma in Addiction: Measure Development and Psychometrics. Journal of Psychopathology and Behavioral Assessment, 34, 1-12.

Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K. & Rye, A. K. (2008). Reducing the self stigma of substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes. Addiction Research & Therapy, 16, 149-165.

Luoma, J. B., & Kohlenberg, B.S., Hayes, S. C., & Fletcher, L. (2012). Slow and Steady Wins the Race: A Randomized Clinical Trial of Acceptance and Commitment Therapy Targeting Shame in Substance Use Disorders. Journal of Consulting and Clinical Psychology, 80, 43-51.

Smout, M. F., Longo, M., Harrison, S., Minniti, R., Wickes, W., & White, J. M. (2010). Psychosocial treatment for methamphetamine use disorders: A preliminary randomized controlled trial of cognitive behavior therapy and acceptance and commitment therapy. Substance Abuse, 31, 98–107.

Stotts, A., Masuda, A., & Wilson, K. (2009) Using Acceptance and Commitment Therapy During Methadone Dose Reduction: Rationale, Treatment Description, and a Case Report. Cognitive and Behavioral Practice, 16, 205-213.

Stotts, A. L., Green, C., Masuda, A., Grabowski, J., Wilson, K., Northrup, T. F., ... & Schmitz, J. M. (2012). A stage I pilot study of acceptance and commitment therapy for methadone detoxification. Drug and Alcohol Dependence, 125(3), 215-222.

Villagrá Lanza, P., & González Menéndez, A. (2013). Acceptance and Commitment Therapy for drug abuse in incarcerated women. Psicothema, 25(3).  This is part of a larger study so if it better to refewr to the full data set: Villagrá P, Fernández P, Rodríguez F, González A. (in press). Acceptance and commitment therapy vs. cognitive behavioural therapy in the treatment of substance use disorder with incarcerated women. Journal of Clinical Psychology. The long term (18 month) follow up data are reported in González-Menéndez, A., Fernández, P., Rodríguez, F., & Villagrá, P. (2014) Long-term outcomes of Acceptance and Commitment Therapy in drug-dependent female inmates: A randomized controlled trial. International Journal of Clinical Health Psychology, 14, 18-27.

Twohig, M. P., Shoenberger, D., & Hayes, S. C. (2007). A preliminary investigation of Acceptance and Commitment Therapy as a treatment for marijuana dependence in adults. Journal of Applied Behavior Analysis, 40,619-632.

Tull, M., Schulzinger, D., Schmidt, N.B., Zvolensky, M.J., Lejuez, C. W. (2007). Development and initial examination of a brief intervention for heightened anxiety sensitivity among heroin users. Behavior Modification, 31, 220-242.

Vilardaga, R., Luoma, J.B., Hayes, S.C., Pistorello, J., Levin, M., Hildebrandt, M.J., Kohlenberg, B., Roget, N. & Bond, F.W. (in press). Burnout among the addiction counseling workforce: The differential roles of mindfulness and values-based processes and worksite factors. Journal of Substance Abuse Treatment.

Here are just a few of the studies on ACT done in groups (some of these also have individual sessions, but all have groups as a substantial part of the intervention):

Bond, F. W. & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156-163.

Zettle, R. D., & Raines, J. C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45,438-445.

Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., Masuda, A., Pistorello, J., Rye, A. K., Berry, K. & Niccolls, R. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35, 821-835.

Hayes, S. C., Wilson, K. G., Gifford, E. V., Bissett, R., Piasecki, M., Batten, S. V., Byrd, M., & Gregg, J. (2004). A randomized controlled trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance abusing methadone maintained opiate addicts. Behavior Therapy, 35, 667-688.

Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M.., Rasmussen-Hall, M. L., & Palm, K. M. (2004). Acceptance theory-based treatment for smoking cessation: An initial trial of Acceptance and Commitment Therapy. Behavior Therapy, 35, 689-705.

McCracken, L. M, Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long-standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43, 1335-1346.

Gratz, K. L. & Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with Borderline Personality Disorder. Behavior Therapy, 37, 25-35.

Blackledge, J. T. & Hayes, S. C. (2006). Using Acceptance and Commitment Training in the support of parents of children diagnosed with autism. Child & Family Behavior Therapy, 28 (1), 1-18.

Lundgren, A. T., Dahl, J., Melin, L. & Kees, B. (2006). Evaluation of Acceptance and Commitment Therapy for drug refractory epilepsy: A randomized controlled trial in South Africa. Epilepsia, 47, 2173-2179.

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

Luoma, J. B., Hayes, S. C., Roget, N., Fisher, G., Padilla, M., Bissett, R., Kohlenberg, B. K. , Holt, C., & & Twohig, M. P. (2008). Augmenting continuing education with psychologically-focused group consultation: Effects on adoption of Group Drug Counseling. Psychotherapy Theory, Research, Practice, Training, 44, 463-469.

Varra, A. A., Hayes, S. C., Roget, N., & Fisher, G. (2008). A randomized control trial examining the effect of Acceptance and Commitment Training on clinician willingness to use evidence-based pharmacotherapy. Journal of Consulting and Clinical Psychology, 76, 449-458.

Lillis, J., Hayes, S. C., Bunting, K., Masuda, A. (2009). Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model. Annals of Behavioral Medicine, 37, 58-69.

Tapper, K., Shaw, C., Ilsley, J., Hill, A. J., Bond, F. W., & Moore, L. (2009). Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women. Appetite, 52, 396–404.

Flaxman, P. E. & Bond, F. W. (2010). A randomised worksite comparison of acceptance and commitment therapy and stress inoculation training. Behaviour Research and Therapy 43, 816-820.

Flaxman, P. E., & Bond, F. W. (2010). Worksite stress management training: Moderated effects and clinical significance. Journal of Occupational Health Psychology, 15, 347-358.

Fledderus, M., Bohlmeijer, E. T., Smit, F., & Westerhof, G. J. (2010). Mental health promotion as a new goal in public mental health care: A randomized controlled trial of an intervention enhancing psychological flexibility. American Journal of Public Health, 10, 2372-2378.

Bohlmeijer, E. T., Fledderus, M., Rokx, T. A., & Pieterse, M. E. (2011). Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: Evaluation in a randomized controlled trial. Behaviour Research and Therapy, 49, 62-67.

Brinkborg, H., Michanek, J., Hesser, H., & Berglund, G. (2011). Acceptance and commitment therapy for the treatment of stress among social workers: A randomized controlled trial. Behaviour Research and Therapy, 49, 389-398.

Pearson, A. N., Follette, V. M. & Hayes, S. C. (in press). A pilot study of Acceptance and Commitment Therapy (ACT) as a workshop intervention for body dissatisfaction and disordered eating attitudes. Cognitive and Behavioral Practice.

Luoma, J. B., Kohlenberg, B. S., Hayes, S. C. & Fletcher, L. (in press). Slow and steady wins the race: A randomized clinical trial of Acceptance and Commitment Therapy targeting shame in substance use disorders. Journal of Consulting and Clinical Psychology.

Morton, J., Snowdon, S., Gopold, M. & Guymer, E. (in press). Acceptance and Commitment Therapy group treatment for symptoms of Borderline Personality Disorder: A public sector pilot study. Cognitive and Behavioral Practice.

Folke, F., Parling, T., & Melin, L. (in press). Acceptance and Commitment Therapy for depression: A preliminary randomized clinical trial for unemployed on long-term sick leave. Cognitive and Behavioral Practice.

Biglan, A., Layton, G. L., Backen Jones, L., Hankins, M. & Rusby, J. C. (in press). The value of workshops on psychological flexibility for early childhood special education staff. Topics in Early Childhood Special Education.  

Most of these studies are in the publications area of the site (and if one is missing prompt the author to get it up there).

As healthcare delivery continues to move towards and integrated care model, the connections between biological, psychological, and social processes affecting health remain minimally understood. Researchers have been exploring the role of acceptance, mindfulness, and values in producing positive health outcomes, while examining the negative role of experiential avoidance in the development and maintenance of health problems. ACT studies have been conducted in the areas of chronic pain, smoking, stress, burnout, diabetes management, and epilepsy with more studies in progress. In this section you will find links to researchers, studies, and applications of ACT in the areas of Wellness, Behavioral Health, Health Psychology, and Behavioral Medicine.

• Weight Maintenance Research (last updated 2017)
• Chronic Pain Research (last updated 2010)
• Epilepsy Research (last updated 2010)
• Smoking Research (last updated 2010)
• Stress and Burnout Research (last updated 2008)
• Cancer Research (last updated 2007)
• Other-Health Related Research (last updated 2007)

ACT has raised controversy in various wings of CBT, e.g.,

• Arch, J. J. & Craske, M. G. (2008). ACT and CBT for anxiety disorders.Clinical Psychology, Science and Practice, 5, 263-279.

• Hofmann, S. G. (2008). Acceptance and Commitment Therapy: New Wave or Morita Therapy? Clinical Psychology, Science and Practice, 5, 280-285.

• Hoffman, S. G., & Asmundson, G. J. G. (2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28, 1-16.

• Öst, L. G. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy, 46(3), 296-321

• The Three Waves of Behavior Therapy: Course Corrections or Navigation Errors? The Behavior Therapist

The relation of ACT to CBT was discussed in the earliest ACT writings. e.g.,

• Hayes, S. C. (1987). A contextual approach to therapeutic change. In Jacobson, N. (Ed.), Psychotherapists in clinical practice: Cognitive and behavioral perspectives (pp. 327 387). New York: Guilford.

And these more specific criticisms are gradually being answered, e.g.,

• Hayes, S. C. (2008). Climbing our hills: A beginning conversation on the comparison of ACT and traditional CBT. Clinical Psychology: Science and Practice, 5, 286-295.

• Hayes, S. C. (2008). Avoiding the mistakes of the past. The Behavior Therapist. 29, 150-153.

• Hayes, S. C., Levin, M., Plumb, J., Boulanger, J., & Pistorello, J. (2013). Acceptance and Commitment Therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44, 180–198. doi: 10.1016/j.beth.2009.08.002 PMCID: PMC3635495
• Atkins, P. W. B., Ciarrochi, J., Gaudiano, B. A., Bricker, J. B., Donald, J., Rovner, G., Smout, M., Livheim, F., Lundgren, T., Hayes, S. C. (2017). Departing from the essential features of a high quality systematic review of psychotherapy: A Response to Öst (2014) and recommendations for improvement. Behaviour Research and Therapy, 97, 259-272. Doi: 10.1016/j.brat.2017.05.016

In the 1980’s Steve Hayes and colleagues did a series of studies which found that cognitive and social learning methods did not work via processes described by these theories. e.g.,

• Harmon, T. M., Nelson, R. O., & Hayes, S. C. (1980). Self monitoring of mood versus activity by depressed clients. Journal of Consulting and Clinical Psychology, 48, 30 38.

• Hayes, S. C., Munt, E. D., Korn, Z., Wulfert, E., Rosenfarb, I., & Zettle, R. D. (1986). The effect of feedback and self reinforcement instructions on studying performance. The Psychological Record, 36, 27 37.

• Hayes, S. C., & Nelson, R. O. (1983). Similar reactivity produced by external cues and self monitoring. Behavior Modification, 7, 183 196.

• Hayes, S. C., Rincover, A., & Volosin, D. (1980). Variables influencing the acquisition and maintenance of aggressive behavior: Modeling versus sensory reinforcement. Journal of Abnormal Psychology, 89, 245 262.

• Hayes, S. C., Rosenfarb, I., Wulfert, E., Munt, E., Zettle, R. D., & Korn, Z. (1985). Self reinforcement effects: An artifact of social standard setting? Journal of Applied Behavior Analysis, 18, 201 214.

• Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.

• Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152-1168.

• Hayes, S. C., & Wolf, M. R. (1984). Cues, consequences, and therapeutic talk: Effect of social context and coping statements on pain. Behaviour Research and Therapy, 22, 385-392.

• Jarrett, R. B., & Nelson, R. O. (1987). Mechanisms of change in cognitive therapy of depression. Behavior Therapy, 18, 227-241.

• Nelson, R. O., Hayes, S. C., Spong, R. T., Jarrett, R. B., & McKnight, D. L. (1983). Self reinforcement: Appealing misnomer or effective mechanism? Behaviour Research and Therapy, 21, 557 566.

• Rosenfarb, I., & Hayes, S. C. (1984). Social standard setting: The Achilles' heel of informational accounts of therapeutic change. Behavior Therapy, 15, 515-528.

• Rosenfarb, I. S., Hayes, S. C. & Linehan, M. M. (1989). Instructions and experiential feedback in the treatment of social skills deficits in adults.Psychotherapy: Theory, Research, and Practice, 26, 242-251.

• Zettle, R. D., & Hayes, S. C. (1982). Rule governed behavior: A potential theoretical framework for cognitive behavior therapy. In P. C. Kendall (Ed.), Advances in cognitive behavioral research and therapy (pp. 73 118). New York: Academic.

• Zettle, R. D., & Hayes, S. C. (1983). Effect of social context on the impact of coping self statements. Psychological Reports, 52, 391 401.
  

  ACT followed a whole set of studies that showed that cognitive methods worked because of contextual factors

There is a growing set of empirical articles comparing ACT with traditional BT and CBT methods. Virtually all have shown differences at the level of process, and some in outcome.

• Lappalainen, R., Lehtonen, T., Skarp, E., Taubert, E., Ojanen, M., & Hayes, S. C. (2007). The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial. Behavior Modification, 31, 488-511.

   

  Randomized controlled study in which 14 student therapists treat one client each from an ACT model or a traditional CBT model for 6-8 sessions following a 2 session functional analysis. Participants with any normal outpatient problem were included, mostly anxiety and depression. At post and at the 6 month follow up ACT clients are more improved on the SCL-90 and several other measures. Greater acceptance for ACT patients; great self-confidence for CBT patients. Both correlated with outcomes, but when partial correlations are calculated, only acceptance still relates to outcome.

   

• Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of Acceptance and Commitment Therapy and Cognitive Therapy for anxiety and depression. Behavior Modification, 31(6), 772-799.

   

  101 heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned either to traditional CT or to ACT. 23 junior therapists were used. Participants receiving CT and ACT evidenced large and equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction and clinician-rated functioning. “Observing” and “describing” one’s experiences mediated outcomes for those in the CT group relative to those in the ACT group, whereas “experiential avoidance,” “acting with awareness” and “acceptance” mediated outcomes for those in the ACT group.

• Zettle, R. D. & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: The context of reason giving. The Analysis of Verbal Behavior, 4, 30 38.

   

  Small controlled trial. Shows that ACT is more effective that cognitive therapy for depression when presented in an individual format, and that it works by a different process.

• Zettle, R. D., & Rains, J. C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45, 438 445.

   

  Small controlled trial. Shows that ACT is as effective as cognitive therapy for depression when presented in a group format, and that it works by a different process.

• Bond, F. W. & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156-163.

   

  Randomized controlled trial. Shows that ACT is more effective than a previously empirically supported behavioral approach to reducing worksite stress and anxiety, and that both are better than a wait list control. Process analyses fit the model.

• Zettle, R. D. (2003). Acceptance and commitment therapy (ACT) versus systematic desensitization in treatment of mathematics anxiety. The Psychological Record, 53, 197-215.

   

  Small randomized controlled trial shows that ACT is as good as systematic desensitization in reducing math anxiety, but works according to a different process. Systematic desensitization reduced trait anxiety more than did ACT. The study has been replicated with interesting results:

  Brown, L. A., Forman, E. M., Herbert, J. D., Hoffman, K. L., Yuen, E. K. and Goetter, E. M. (2011). A randomized controlled trial of acceptance-based behavior therapy and cognitive therapy for test anxiety: A pilot study. Behavior Modification, 35, 31-53. Very small RCT (N = 16) for test anxiety comparing ACT (with mindfulness elements) and Beck’s CT. Similar outcomes on self-reports but ACT participants did objectively better on test scores in school.

• Hayes, S.C., Bissett, R., Korn, Z., Zettle, R. D., Rosenfarb, I., Cooper, L., & Grundt, A. (1999). The impact of acceptance versus control rationales on pain tolerance. The Psychological Record, 49, 33-47.

   

  Analog study. Shows that a 90 minute acceptance intervention drawn from the ACT protocol produces more pain tolerance than a pain control intervention drawn from Turk’s CBT pain management package.

• Forman, E. M., Hoffman, K. L., McGrath, K. B., Herbert, J. D., Brandsma, L. L., & Lowe, M. R. (2007). A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study.Behaviour Research and Therapy, 45, 2372-2386.

   

  98 participants with chocolate cravings were exposed to a well known CBT-based protocol (Kelly Brownell’s LEARN program) and an ACT-based protocol or no instructions and required to carry chocolate with them of for two days. Those more impacted by food related cues ate less and had fewer cravings in the ACT condition.

• Masedo, A. I. & Esteve. M. R. (2006). Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress. Behaviour Research and Therapy, 45, 199-209.

   

  A large and well-controlled randomized study that replicated Hayes, Bissett, Korn, Zettle, Rosenfarb, Cooper, & Grundt, 1999. Acceptance methods drawn from the 1999 ACT book and from the Hayes et al. 1999 pain study (the methods used included an acceptance rationale, practicing awareness of experience, the “Passengers on the Bus” exercise, and the ‘Two Scales Metaphor’) increased pain tolerance and decreased pain ratings in a cold pressor task as compared both to suppression methods (based on thought stopping) and to participants preferred method of coping (which tended to include distraction, relaxation, and keeping the hand still). The latter two conditions did not differ from each other in the main analysis.

  Wetherell, J. L., Afari, N., Rutledge, T., Sorrell, J. T., Stoddard, J. A., Petkus, A. J., Solomon, B. C., Lehman, D. H., Liu, L., Lang, A. J., Hampton Atkinson, J. (2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain, 152, 2098-2107. DOI: 10.1016/j.pain.2011.05.016 RCT (N=114) comparing ACT and traditional CBT for chronic pain. Good outcomes over 6 months. No differences in outcomes. Treatment completers were more satisfied with ACT.

   

  Thorsell, J., Finnes, A., Dahl, J., Lundgren, T., Gybrant, M., Gordh, T., & Buhrman, M. (2011). A comparative study of 2 manual-based self-help interventions, Acceptance and Commitment Therapy and Applied Relaxation, for persons with chronic pain. The Clinical Journal of Pain, 27, 716-723. doi: 10.1097/AJP.0b013e318219a933. RCT (N = 90) of ACT versus applied relaxation using a combination of an initial face to face session, a 7 week self-help manual with weekly therapist telephone support, and a concluding face-to-face session. 6 and 12 mo follow up. Better outcomes for ACT in level of function, pain intensity, acceptance, and marginal life satisfaction. Depression and anxiety improved but no diff between conditions.

   

  Rost, A. D., Wilson, K. G., Buchanan, E., Hildebrandt, M.J., & Mutch, D. (in press). Improving psychological adjustment among late-stage ovarian cancer patients: Examining the role of avoidance in treatment. Cognitive and Behavioral Practice. RCT (N = 31; 47 originally but the rest died or entered hospice care) comparing ACT and traditional CBT approaches to women coping with end-stage gynecological cancer. Nice outcomes; dominantly in favor of ACT. By the way CBT is labeled "TAU" -- you have to look at the list of procedures to see that it was CBT.

   

  Arch, J., Eifert, G. H., Davies, C., Vilardaga, J. P., Rose, R. D., & Craske, M. G. (in press). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of Consulting and Clinical Psychology. RCT (N = 128; 52% female; 33% minority) of 12 sessions of ACT v. tradition CBT for heterogeneous anxiety disorders; both including behavioral exposure. Similar outcomes in several areas through 12 mo F-up but on the primary outcome measure -- blind clinical interviews on the clinical severity of anxiety problems using the ADIS interview -- ACT participants improve more in clinical severity from post to follow up than CBT (it is a very large effect: d = 1.33) and among completers their end-state clinical severity ratings were much better (d = 1.03). Better improvement for ACT in psychological flexibility (medium effect for completers: d = .59) for ACT; better quality of life at follow up (small effect: d = .43) for CBT. 

   

There are also studies showing that ACT methods can empower traditional behavioral methods, e.g.,

• Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy, 44, 1251-1263.

• Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35, 747-766.

More recently studies have explained the effect of some cognitive variables in ACT terms, e.g.,

• Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behavior Research and Therapy, 44, 1301-1320.

Some of the history of ACT, including its relation to CBT writ large, can be found in:

• Zettle, R. D. (2005). The evolution of a contextual approach to therapy: From Comprehensive Distancing to ACT. International Journal of Behavioral Consultation and Therapy, 1(2), 77-89.

Part of the ACT/ RFT movement is a "grand vision" to affect positive change on the culture more generally. Groups and organizations engage in practices that harm individuals, families, and the environment, yet there is little scientific understanding of how to bring about changes in these practices.

A number of professionals throughout the world are conducting research on such topics as stigma, prejudice, prevention, advertising, child rearing, and environmental preservation among other important issues.

Here is where you will find information on specific applications of ACT to cultural issues with links to relevant researchers and studies.

This page was last updated in 2014. For up-to-date information, go to the ACT Randomized Controlled Trials page, the State of the ACT Evidence page, and the Publications section.

The subsections divide the empirical ACT literature into several categories. If you have a study that should be added you can upload the actual publication into the publications section (login to your member account then go here to add a publication to the site).

You can't add the reference to the publication here directly, you have to email that information to the site editor and we will add it ... but if the publication itself is already uploaded we can link the reference here to that file so that people can find it and download it.

You can find outcome studies (Randomized Controlled Trials, RCTs) here.

The non-empirical literature on ACT / RFT (we are listing primarily ACT work here) is large. In order to make this list easy to update it is listed by year, but do note that this puts some of the important articles in the middle.

In Press

• Wilson, K. G., & Sandoz, E. K. (in press). Mindfulness, values, and the therapeutic relationship in Acceptance and Commitment Therapy. In S. F. Hick & T. Bein (Eds.), Mindfulness and the therapeutic relationship. New York: Guilford Press.

2008

• Blackledge, J. T., Moran, D. J., & Ellis, A. E. (2008). Bridging the divide: Linking basic science to applied psychotherapeutic interventions - A relational frame theory account of cognitive disputation in rational emotive behavior therapy. Journal of Rational-Emotive & Cognitive-Behavior Therapy.

• Pérez-Álvarez, M., García-Montes, J. M., & Perona-Garcelán, S. (2008). Changing relationships with voices: New therapeutic perspectives for treating hallucinations. Clinical Psychology & Psychotherapy, 15(2), 75-85.

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

2007

• Blackledge, J. T. (2007). Disrupting verbal processes: Cognitive defusion in Acceptance and Commitment Therapy and other Mindfulness-based Psychotherapies. The Psychological Record, 57(4).

• Chowla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology, 63(9), 871–890.

• Hayes, S. C., & Plumb, J. C. (2007). Mindfulness from the Bottom Up: Providing an Inductive Framework for Understanding Mindfulness Processes and their Application to Human Suffering. Psychological Inquiry, 18(4), 242-248.

• Pierson, H., & Hayes, S. C. (2007). Using Acceptance and Commitment Therapy to empower the therapeutic relationship. In in P. Gilbert & R. Leahy (Eds.), The Therapeutic Relationship in Cognitive Behavior Therapy (pp. 205-228). London: Routledge

• Twohig, M. P., Moran, D. J., & Hayes, S. C. (2007). A functional contextual account of Obsessive Compulsive Disorder. In D. Woods & J. Kanter (Eds.), Understanding Behavior Disorders. Reno, NV: Context Press.

• Twohig, M. P., & Hayes, S. C. (2007). Implications of verbal processes for childhood disorders: Tourette’s disorder, attention deficit hyperactivity disorder, and autism. In D. Woods & J. Kanter (Eds.), Understanding Behavior Disorders. Reno, NV: Context Press.

• Vilardaga, R., Hayes, S. C., & Schelin, L. (2007). Philosophical, theoretical and empirical foundations of acceptance and commitment therapy. Anuario de psicología, 38(1), 117-128.

2006

• Bond, F. W., Hayes, S. C., & Barnes-Holmes, D. ( 2006). Psychological Flexibility, ACT and Organizational Behavior. In S. C. Hayes, F. W. Bond, D. Barnes-Holmes, & J. Austin (Eds.), Acceptance and Mindfulness at Work: Applying Acceptance and Commitment Therapy and Relational Frame Theory to Organizational Behavior Management (pp. 25-54). Binghamton, NY: The Haworth Press.

• Hayes, S. C. (2006). Language, self, and diversity. In J. C. Muran (Ed.), Dialogues on difference: Diversity studies of the therapeutic relationship. Washington, DC: American Psychological Association.

• Hayes, S. C., & Duckworth, M. P. (2006). Acceptance and Commitment Therapy and traditional Cognitive Behavior Therapy approaches to pain. Cognitive and Behavioral Practice, 13, 185-187.

• Hayes, S. C., Luoma, J., Bond, F., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1-25.

• Kanter, J. W., Baruch, D. E., & Gaynor, S. T. (2006). Acceptance and commitment therapy and behavioral activation for the treatment of depression: Description and comparison. The Behavior Analyst, 29, 161-185.

• Roemer, L., Salters-Pedneault, K., & Orsillo, S. M. (2006). Incorporating mindfulness and acceptance-based strategies in the treatment of generalized anxiety disorder. In R. Baer (Ed.), Mindfulness-Based Treatment Approaches: Clinician's Guide to Evidence Base and Applications (pp 52-74). New York: Academic Press.

• Shenk, C., Masuda, A., Bunting, K., & Hayes, S. C. (2006). The psychological processes underlying mindfulness: Exploring the link between Buddhism and modern contextual behavioral psychology. In D. K. Nauriyal (Ed.), Buddhist thought and applied psychology: Transcending the boundaries. London: Routledge-Curzon.

• Walser, R. D., & Hayes, S. C. (2006). Acceptance and Commitment Therapy and trauma survivors. In V. Follette (Ed.), Trauma in context: A cognitive behavioral approach to trauma, Second Ed. New York: Guilford Press.

2005

• Bach, P. A., Gaudiano, B. A., Pankey, J., Herbert, J. D., & Hayes, S. C. (2005). Acceptance, mindfulness, values, and psychosis: Applying ACT to the chronically mentally ill. In R. Baer (Ed.), Mindfulness-based interventions: A clinician’s guide. San Diego: Elsevier.

• Baer, R. A., Fischer, S., & Huss, D. B. (2005). Mindfulness and acceptance in the treatment of disordered eating. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 23(4), 281-299.

• Batten, S. V., Orsillo, S. M., & Walser, R. D. (2005). Acceptance and mindfulness-based approaches to the treatment of posttraumatic stress disorder. In S. M. Orsillo & L. Roemer (Eds.), Acceptance and mindfulness-based approaches to anxiety: Conceptualization and treatment. New York: Springer.

• Ciarrochi, J., Robb, H., & Godsell, C. (2005). Letting a little nonverbal air into the room: Insights from Acceptance and Commitment Therapy: Part 1: Philosophical and theoretical underpinnings. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 23, 79-106.

• Ciarrochi, J., & Robb, H. (2005). Letting a little nonverbal air into the room: Insights from acceptance and commitment therapy: Part 2: Applications. Journal of Rational-Emotive & Cognitive Behavior Therapy, 23(2), 107-130.

• Dahl, J., & Lundgren, T. (2005). Behavior Analysis of Epilepsy: Conditioning mechanisms, be-havior technology and the contribution of ACT. The Behavior Analyst Today, 6(3), 191-202.

• Fletcher, L., & Hayes, S. C. (2005). Relational Frame Theory, Acceptance and Commitment Therapy, and a functional analytic definition of mindfulness. Journal of Rational-Emotive and Cognitive-Behavioral Therapy, 23(4), 315-336.

• Greco, L. A., Blackledge, J. T., Coyne, L. W., & Enreheich, J. (2005). Acceptance and mindfulness-based approaches for childhood anxiety disorders: Acceptance and Commitment Therapy as an Example. In S. M. Orsillo & L. Roemer (Eds.), Acceptance and Mindfulness-Based Approaches to Anxiety: Conceptualization and Treatment. New York: Kluwer/Plenum.

• Hayes, S. C. (2005). Stability and change in Cognitive Behavior Therapy: Considering the implications of ACT and RFT. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 23(2), 131-151.

• Orsillo, S. M., Roemer, L., & Holowka, D. (2005). Acceptance-based behavioral therapies for for anxiety: Using acceptance and mindfulness to enhance traditional cognitive-behavioral approaches. In S. M. Orsillo & L. Roemer (Eds.), Acceptance- and mindfulness-based approaches to anxiety: Conceptualization and treatment. New York: Springer

• Robb, H., & Ciarrochi, J. (2005). Some final, gulp, "words" on REBT, ACT & RFT. Journal of Rational-Emotive & Cognitive Behavior Therapy, 23(2), 169-173.

• Twohig, M. P., Masuda, A., Varra, A. A., & Hayes, S. C. (2005). Acceptance and Commitment Therapy as a treatment for anxiety disorders. In S. M. Orsillo & L. Roemer (Eds.), Acceptance and mindfulness-based approaches to anxiety: Conceptualization and treatment (pp. 101-130). New York: Kluwer/Springer-Verlag.

• Twohig, M., Pierson, H. M., & Hayes, S. C. (2005). Homework in Acceptance and Commitment Therapy. Chapter to appear in Kazantzis, N. & L'Abate, L. (Eds.), Handbook of homework assignments in psychotherapy: Research, practice, and prevention. New York: Springer.

• Zettle, R. D. (2005). The evolution of a contextual approach to therapy: From Comprehensive Distancing to ACT. International Journal of Behavioral and Consultation Therapy, 1, 77-89.

2004

• Barnes-Holmes, D., Barnes-Holmes, Y., Cochrane, A., McHugh, L., & Stewart, I. (2004). Psychological Acceptance: Experimental Analyses and Theoretical Interpretations. International Journal of Psychology and Psychological Therapy, 4, 517-530.

• Barnes-Holmes, D., Barnes-Holmes, Y., Hayes, S. C., & McHugh, L. (2004). Relational Frame Theory: Some Implications for Understanding and Treating Human Psychopathology. International Journal of Psychology and Psychological Therapy, 4, 355-375.

• Blackledge, J. T. (2004). Functional Contextual Processes in Posttraumatic Stress. International Journal of Psychology and Psychological Therapy, 4(3), 443-467.

• Coyne, L. W., & Wilson, K. G. (2004). The role of cognitive fusion in impaired parenting: An RFT analysis. International Journal of Psychology and Psychological Therapy, 4, 469-486.

• Hayes, S. C. (2004). Acceptance and Commitment Therapy and the new behavior therapies: Mindfulness, acceptance and relationship. In S. C. Hayes, V. M. Follette, & M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive behavioral tradition (pp. 1-29). New York: Guilford.

• Hayes, S. C. (2004). Acceptance and Commitment Therapy, Relational Frame Theory, and the third wave of behavior therapy. Behavior Therapy, 35, 639-665.

  Makes the case that ACT is part of a larger shift in the behavioral and cognitive therapies toward more contextual approaches

• Hayes, S. C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. F. (2004). DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies? Behavior Therapy, 35, 35-54.

• Hayes, S. C. & Shenk, C. (2004).Operationalizing mindfulness without unnecessary attachments. Clinical Psychology: Science and Practice, 11, 249-254.

• Luciano, M. C., Rodrí­guez Valverde, M., & Gutiérrez Martí­­nez, O. (2004). A proposal for synthesizing verbal contexts in Experiential Avoidance Disorder and Acceptance and Commitment Therapy. International Journal of Psychology and Psychological Therapy, 4, 377-394.

• Wilson, K. G. & Murrell, A. R. (2004). Values work in Acceptance and Commitment Therapy: Setting a Course for Behavioral Treatment. In Hayes, S. C., Follette, V. M., & Linehan, M. (Eds.) Mindfulness & Acceptance: Expanding the cognitive-behavioral tradition (pp. 120-151). New York: Guilford Press.

2003

• Baer, R. A. (2003). Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice, (10)2, 125-143.

• Hayes, S. C., Masuda, A., & De Mey, H. (2003). Acceptance and Commitment Therapy and the third wave of behavior therapy (Acceptance and Commitment Therapy: een derde-generatie gedragstherapie). Gedragstherapie (Dutch Journal of Behavior Therapy), 2, 69-96.

• Hayes, S. C., & Pankey, J. (2003). Psychological acceptance. In W. O'Donohue, J. Fisher, & S. C. Hayes (Eds.), Cognitive-behavior therapy: Applying empirically supported techniques in your practice (pp. 4-9). New York: Wiley.

• Hayes, S. C. & Wilson, K. G. (2003). Mindfulness: Method and process. Clinical Psychology: Science and Practice, 10, 161-165.

• Pankey, J. & Hayes, S. C. (2003). Acceptance and Commitment Therapy for psychosis. International Journal of Psychology and Psychological Therapy, 3, 311-328.

2002

• Bond, F. & Hayes, S. C. (2002). ACT at work. In F. Bond & W. Dryden (Eds.), Handbook of Brief Cognitive Behaviour Therapy. Chichester, England: Wiley.

  This chapter has a fairly complete treatment manual for the treatment of stress in the workplace using ACT. It was the manual for the study above.

• Hayes, S. C., (2002). Buddhism and Acceptance and Commitment Therapy. Cognitive and Behavioral Practice, 9, 58-66.

• Hayes, S. C. (2002). Acceptance, mindfulness, and science. Clinical Psychology: Science and Practice, 9 (1), 101-106.

• Hayes, S. C., Niccolls, R., Masuda, A., & Rye, A. K. (2002). Prejudice, terrorism, and behavior therapy. Cognitive and Behavioral Practice, 9, 296-301.

• Hayes, S. C., & Pankey, J. (2002). Experiential Avoidance, Cognitive Fusion, and an ACT Approach to Anorexia Nervosa. Response: ACT Approach to Anorexia. Cognitive and Behavioral Practice, 9, 243-247.

• Hayes, S. C., Pankey, J., Gifford, E. V., Batten, S., and Quiñones, R. (2002). Acceptance and Commitment Therapy in the treatment of experiential avoidance disorders. In T. Patterson (Ed)., Comprehensive Handbook of Psychotherapy, Volume 2: Cognitive / Behavioral / Functional Approaches (pp. 319-351). New York: Wiley.

• Hayes, S. C., Pankey, J., & Gregg, J. (2002). Anxiety and Acceptance and Commitment Therapy. In E. A. Gosch & R. A. DiTomasso (Eds.), Comparative treatments of anxiety disorders (pp. 110-136). New York: Springer.

• Zettle, R. D. & Hayes, S. C. (2002). Brief ACT treatment of depression. In F. Bond & W. Dryden (Eds.), Handbook of Brief Cognitive Behaviour Therapy (pp. 35-54). Chichester, England: Wiley.

2001

• Blackledge, J. T. & Hayes, S. C. (2001). Emotion regulation in Acceptance and Commitment Therapy. Journal of Clinical Psychology, 57, 243-255.

• Dougher, M. J. & Hayes, S. C. (2000). Clinical behavior analysis. In M. J. Dougher (Ed.) Clinical Behavior Analysis (pp. 11-26). Reno, NV: Context Press.

• Follette, V. M., & Batten, S. V. (2000). The role of emotion in psychotherapy supervision: A contextual behavioral analysis. Cognitive and Behavioral Practice, 7(3), 306-312.

  Describes a contextual approach to psychotherapy supervision, using a model derived from Acceptance and Commitment Therapy and Functional Analytic Psychotherapy.

• Follette, W. C. and Hayes, S. C. (2000). Contemporary behavior therapy. In C. R. Snyder and R. Ingram (Eds.), The handbook of psychological change (pp. 381-408). New York: Wiley.

• Hayes, S. C. (2000). Acceptance and Commitment Therapy in the treatment of experiential avoidance disorders. Clinician’s Research Digest (Supplemental Bulletin 22, June, 1-2).

• Hayes, S. C. & Batten, S. V. (2000). A primer of Acceptance and Commitment Therapy. European Psychotherapy, 1, 2-9.

• Hayes, S. C. & Bissett, R. T. (2000). Behavioral psychotherapy and the rise of clinical behavior analysis. In J. A. Austin & J. E. Carr (Eds.), Handbook of applied behavior analysis (pp. 231-245). Reno: Context Press.

• Hayes, S. C. & Gregg, J. (2000). Functional contextualism and the self. In C. Muran (Ed.), Self-relations in the psychotherapy process (pp. 291-307). Washington, DC: American Psychological Association.

  Deals with the self issue.

• Hayes, S. C., & Wilson, K. G. (2000). Why it is crucial to understand thinking and feeling: An analysis and application to drug abuse. The Behavior Analyst, 23, 25-43.

• Luciano, C. & Hayes, S. C. (2001). Treating experiential avoidance. International Journal of Clinical and Health Psychology, 1, 109-157.

2000

• Pistorello, J., Follette, V. M., & Hayes, S. C. (2000). Long-term correlates of childhood sexual abuse: A radical behavioral perspective. In M. J. Dougher (Ed.) Clinical Behavior Analysis (pp.75-98). Reno, NV: Context Press.

• Wilson, K. G., & Hayes, S. C. (2000). Why it is crucial to understand thinking and feeling: an analysis and application to drug abuse. The Behavior Analyst, 23, 25-43.

• Wilson, K. G., Hayes, S. C., & Byrd, M. R. (2000). Exploring compatibilities between Acceptance and Commitment Therapy and 12-Step treatment for substance abuse. Journal of Rational-Emotive and Cognitive Behavior Therapy, 18, 207-232.

1999

• Hayes, S. C., & Toarmino, D. (1999). The rise of clinical behaviour analysis. The Psychologist, 12, 505-509.

• Hayes, S. C., Wilson, K. G., & Gifford, E.V. (1999). Consciousness and private events. In B. Thyer (Ed.), The philosophical legacy of behaviorism (pp. 153-187). Lancaster, UK: Kluwer.

• Wilson, K. G. & Blackledge, J. T. (1999). Recent Developments in the Behavioral Analysis of Language: Making Sense of Clinical Phenomena. In M. J. Dougher (Ed.), Clinical behavior analysis. Reno, NV: Context Press.

1998

• Friman, P. C., Hayes, S. C., & Wilson, K. G. (1998). Why behavior analysts should study emotion: The example of anxiety. Journal of Applied Behavior Analysis, 31, 137-156.

• Gifford, E. V. & Hayes, S. C. (1998). Functional contextualism: A pragmatic philosophy for behavioral science. In W. O’Donohue & R. Kitchener (Eds.), Handbook of behaviorism (pp. 285-327). New York: Academic Press.

• Hayes, S. C., Gregg J., Wulfert, E. (1998). Akzeptanz- und commitment- therapie: ein radikal behavioraler ansatz. In Sulz, Serge K. D. (Ed.), Kurz psychotherapien: Wege in die zunkunft der psychotherapie. (pp.145-162) CIP-Medien: München, Germany.

• Walser, R. D. & Hayes, S. C. (1998). Acceptance and trauma survivors: Applied issues and problems. In V. Follette, J. Ruzak, & F. Abueg (Eds.), Trauma in context: A cognitive behavioral approach to trauma (pp. 256-277). New York: Guilford Press.

1997

• Hayes, S. C., & Gifford, E. V. (1997). The trouble with language: Experiential avoidance, rules, and the nature of verbal events. Psychological Science, 8, 170-173.

• Hayes, S. C., & Ju, W. (1997). The applied implications of rule-governed behavior. Chapter in W. O’Donohue (Ed.), Learning and behavior therapy (pp. 374-391). New York: Allyn & Bacon.

• Robinson, P. & Hayes, S. C. (1997). Acceptance and commitment: A model for integration. In N. A. Cummings, J. L. Cummings, & J. N. Johnson. (Eds.), Behavioral health in primary care: A guide for clinical integration (pp. 177-203). Madison, CT: Psychosocial Press.

• Wilson, K. G., Hayes, S. C., & Gifford, E. V. (1997). Cognition in behavior therapy: Agreements and differences. Journal of Behavior Therapy and Experimental Psychiatry, 28, 53-63.

1996

• Hayes, S. C., Wilson, K. W., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152-1168.

1995

• Hayes, S. C., Follette, W. C. & Follette, V. (1995). Behavior therapy: A contextual approach. In A. S. German & S. B. Messer (Eds.), Essential psychotherapies: Theory and practice. (pp. 128-181). New York: Guilford Press.

• Hayes, S. C., & Wilson, K. G. (1995). The role of cognition in complex human behavior: A contextualistic perspective. Journal of Behavior Therapy and Experimental Psychiatry, 26, 241-248.

1994

• Hayes, S. C. (1994). Content, context, and the types of psychological acceptance. Chapter in Hayes, S. C., Jacobson, N. S., Follette, V. M. & Dougher, M. J. (Eds.), Acceptance and change: Content and context in psychotherapy (pp. 13-32). Reno, NV: Context Press.

• Hayes, S. C. & Wilson, K.G. (1994). Acceptance and Commitment Therapy: Altering the verbal support for experiential avoidance. The Behavior Analyst, 17, 289-303.

  An entry into ACT and its implications … but the ACT book is now better.

1993

• Hayes, S. C. (1993). Rule governance: basic behavioral research and applied implications. Current Directions in Psychological Science, 2, 193-197.

• Hayes, S. C., & Wilson, K. G. (1993). Some applied implications of a contemporary behavior-analytic account of verbal events. The Behavior Analyst, 16, 283-301. An entry into RFT and its implications … but the RFT book is now better.

• Kohlenberg, R., Hayes, S. C., & Tsai, M. (1993). Radical Behavioral Psychotherapy: Two contemporary examples. Clinical Psychology Review, 13, 579-592.

1992

• McCurry, S., & Hayes, S. C. (1992). Clinical and experimental perspectives on metaphorical talk. Clinical Psychology Review, 12, 763-785.

• Hayes, S. C. (1992). Verbal relations, time, and suicide. In S. C. Hayes & L. J. Hayes (Eds.), Understanding verbal relations (pp. 109-118). Reno, NV: Context Press.

  More basic but another early paper putting together RFT and the theory of psychopathology that underlies ACT

• Hayes, S. C., & Hayes, L. J. (1992). Some clinical implications of contextualistic behaviorism: The example of cognition. Behavior Therapy, 23, 225-249.

1990 and earlier

• Hayes, S. C., Kohlenberg, B. S. & Melancon, S. M. (1989). Avoiding and altering rule-control as a strategy of clinical intervention. In S. C. Hayes (Ed.), Rule governed behavior: Cognition, contingencies, and instructional control. (pp. 359-385). New York: Plenum.

  The first paper to try to put together RFT and ACT

• Hayes, S. C. & Melancon, S. M. (1989). Comprehensive distancing, paradox, and the treatment of emotional avoidance. In M. Ascher (Ed.), Paradoxical procedures in psychotherapy (pp. 184-218). New York: Guilford.

  An early ACT chapter

• Hayes, S. C. (1987). A contextual approach to therapeutic change. In N. Jacobson (Ed.), Psychotherapists in clinical practice: Cognitive and behavioral perspectives (pp. 327-387). New York: Guilford.

  The first full-length presentation of the ACT model (then known as "Comprehensive Distancing"

• Hayes, S. C. (1984). Making sense of spirituality. Behaviorism, 12, 99-110.

  Sometimes it helps to see beginnings to understand what happens later. This odd little paper does that. It is a mix of philosophical moves and interests that is clearly on the way to ACT, RFT, deictic frames, a transcendent sense of self, defusion, mindfulness, contextual use of language, and other issues that are much clearer now. If you like the history of ideas and like ACT / RFT, this is a fun read.

• Zettle, R. D., & Hayes, S. C. (1982). Rule governed behavior: A potential theoretical framework for cognitive behavior therapy. In P. C. Kendall (Ed.), Advances in cognitive behavioral research and therapy (pp. 73-118). New York: Academic.

The file at the bottom of the page (the ACT handout) lists most ACT publications out or in press as of Winter 2013. It also list all of the ongoing major research projects we know about.

This is a modified list of features that Dermot Barnes-Holmes presented at the first ACT Summer Institute in Reno in 2003. I (SCH) have added a few things as well A List of Features that ACT Laboratory-Based Component Studies and Experimental Analogs of ACT Processes Should Contain Here is a list of features that we consider to be essential for conducting top quality experimental research that is designed to model and test ACT processes in laboratory component research. There are almost certainly others and the relative emphasis that is placed on each one will vary as a function of the research question and overall design of the study.

In general remember that the purpose of laboratory-based component research is primarily theoretical, so be very clear about the ideas you are testing. If you want to see if these ideas make a practical, clinical difference, that requires clinical research. But it is better to test the clinical implications of theoretical ideas that work, so laboratory-based component research is very important as part of a broader research strategy.

Here are the design features to consider:

1. The experimenter should be blind to the intervention applied to each participant (or the procedure automated; see below).

2. The experimental conditions must balance as much as possible for all relevant attribute variables (e.g., gender, psychopathology, unless the attribute(s) is the target of the analysis).

3. The experimenter should not be personally familiar with the participants and if they are, familiarity should be balanced across conditions.

4. The different interventions should be balanced in all possible ways, except for the critical difference you are seeking to manipulate (e.g., they should be the same length; they require similar levels of engagement with the material; if exercises are used that are appropriate for both conditions, they should be used in both; working should be matched where possible; method of delivery should be identical; etc).

5. The interventions should connect directly to the experimental challenge. In a pain tolerance study, for example, each of the interventions should focus on pain not anxiety or anger etc. (unless different foci are the target of the study).

6. Points 4 and 5 should be checked and supported by independent raters.

7. Where possible and appropriate, the procedure should involve requiring participants to articulate in their own words the intervention strategy that is being provided. Ideally this should be done at regular points throughout the intervention.

8. The verbal material produced under point 7 should be checked by independent raters to determine that participant “understanding” did not differ significantly across conditions, and to ensure that the manipulation successfully altered the intended behavioral process.

9. Participants should be reminded briefly of the relevant intervention strategy before the presentation of each physical or psychological challenge (e.g., CO2 inhalation, electric shock delivery, emotionally aversive pictures or video clips, spider BAT, etc).

10. Ideally, the entire procedure, including pre-intervention baseline, intervention, and post-intervention tasks should be automated. For example, the intervention could be presented via audio or video clips and these can then be checked by independent raters. Moreover, others can then take your automated procedure and attempt to replicate in a different lab. If automation is not possible, then every session should be videotaped to check for fidelity. If only some sessions are videotaped, then the experimenter should not know which ones are being taped.

11. All participants should be asked to summarize at the very end of the experiment the strategy they employed during the study so that these can be checked by independent raters.

12. Other questions of relevance should also be asked that might alter the interpretation of results. For example the participant might be asked to rate the likability or believability of the experimenter (including any video- or audio-based material), expectations for performance on the task, relevance of intervention to "real life", etc.

13. Ideally, some form of standardized self-report or other instrument should be developed to measure the extent to which participants understand and apply specific strategies.

14. For ACT / RFT studies the design of the protocols should be tied clearly to RFT concepts. Studies should not just grab a metaphor or exercise without working through how the metaphor/exercise is predicted, theoretically, to influence the participants’ responses in your study.

15. If the study is a group design it should be adequately powered to test the key hypotheses, especially if null results are to be meaningful. For example, if an interaction is possible, each individual cell size must have a large enough N to test that interaction at an adequate level (say, power of .8 assuming a sensible effect size)

16. If mediational analyses are important, the study must be powered to test these analyses. 17. Especially if null results are predicted, make sure the actual measurement characteristics, outliers, and similar issues do not undermine the calculated power.

18. Meta-analyses of ACT micro-component studies show that in general, rationale-alone interventions are weak (and without the controls specified above they are often difficult to interpret because it is not known what participants actually did in response to the rationale). If the purpose is to examine ACT components, consider including more active and experiential elements.

19. If testing multiple ACT components, consider how to assess for changes in multiple ACT processes and whether comparison conditions should tease apart the impact of individual components.

Attached you will find a series of components (e.g., video, visual basic programs, instructions, etc.) used in ACT micro studies examining the role of values in performance during a cold-pressor pain tolerance task. The study from which these components come is not yet published but many similar studies have used these components in the Barnes-Holmes laboratory at NUI-Maynooth. We hope that they will prove useful to you in developing your own studies. They have been uploaded to the site as compressed zip files but they should be able to be opened easily as their individual files once downloaded.

We are in the process of testing the effects of a self-as-context intervention on two measures of task persistence (breath holding and a difficult math task). We used an active control condition involving the same metaphor and exercise, but emphasizing self-as-content and emotion control strategies throughout. The results of the intervention will be analyzed soon and included on this page.

We would really appreciate any feedback regarding the intervention scripts. If you have any comments or suggestions please contact Mike Levin at levinm2@gmail.com.

Data to be presented at
Levin, M., Waltz, T.J., Yadavaia, J.E. & Hayes, S.C. (2008). Examining the effect of a self as context intervention on multiple measures of task persistence. Paper presented at the 34th Annual Convention of the Association for Behavior Analysis International, Chicago, IL.

 Campell-Sills, L., Barlow, B.H., Brown, T.A. & Hofmann, S.G. (2006). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy, 44, 1251-1263.

Abstract

The present investigation compared the subjective and physiological effects of emotional suppression and acceptance in a sample of individuals with anxiety and mood disorders. Sixty participants diagnosed with anxiety and mood disorders were randomly assigned to one of two groups. One group listened to a rationale for suppressing emotions, and the other group listened to a rationale for accepting emotions. Participants then watched an emotion-provoking film and applied the instructions. Subjective distress, heart rate, skin conductance level, and respiratory sinus arrhythmia were measured before, during, and after the film. Although both groups reported similar levels of subjective distress during the film, the acceptance group displayed less negative affect during the post-film recovery period. Furthermore, the suppression group showed increased heart rate and the acceptance group decreased heart rate in response to the film. There were no differences between the two groups in skin conductance or respiratory sinus arrhythmia. These findings are discussed in the context of the existing body of research on emotion regulation and current treatment approaches for anxiety and mood disorders.

Protocol included below

Eifert, G. H. & Heffner, M. (2003). The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 34, 293-312.

Abstract

The present study compared the effects of creating an acceptance versus a control treatment context on the avoidance of aversive interoceptive stimulation. Sixty high anxiety sensitive females were exposed to two 10-min periods of 10% carbon dioxide enriched air, an anxiogenic stimulus. Before each inhalation period, participants underwent a training procedure aimed at encouraging them either to mindfully observe (acceptance context) or to control symptoms via diaphragmatic breathing (control context). A third group was given no particular training or instructions. We hypothesized that an acceptance rather than control context would be more useful in the reduction of anxious avoidance. Compared to control context and no-instruction participants, acceptance context participants were less avoidant behaviorally and reported less intense fear and cognitive symptoms and fewer catastrophic thoughts during the CO2 inhalations. We discuss the implications of our findings for an acceptance-focused vs. control-focused context when conducting clinical interventions for panic and other anxiety disorders.

The intervention protocol is included below quoted from Heffner (2000).

Feldner, M. T., Zvolensky, M. J., Eifert, G. H., & Spira, A. P. (2003). Emotional avoidance: An experimental tests of individual differences and response suppression during biological challenge. Behaviour Research and Therapy, 41, 403-411.

Abstract

The present study examined the affective consequences of response inhibition during a state of anxietyrelated physical stress. Forty-eight non-clinical participants were selected on the basis of pre-experimental differences in emotional avoidance (high versus low) and subjected to four inhalations of 20% carbon dioxide-enriched air. Half of the participants were instructed to inhibit the challenge-induced aversive emotional state, whereas the other half was instructed to simply observe their emotional response. Participants high in emotional avoidance compared to those low in emotional avoidance responded with greater levels of anxiety and affective distress but not physiological arousal. Individuals high in emotional avoidance also reported greater levels of anxiety relative to the low emotional avoidance group when suppressing compared to observing bodily sensations. These findings are discussed in terms of the significance of emotional avoidance processes during physical stress, with implications for better understanding the nature of panic disorder.

The intervention protocol is included below quoted from Feldner (2003).

Forman, E.M., Hoffman, K.L., McGrath, K.B., Herbert, J.D., Brandsma, L.L. & Lowe, M.R. (2007). A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study. Behaviour Research and Therapy, 45, 2372-2386.

Abstract

The present study utilized an analog paradigm to investigate the effectiveness of two strategies for coping with food cravings, which was theorized to be critical to the maintenance of weight loss. Ninety-eight undergraduate students were given transparent boxes of chocolate Hershey’s Kisses and instructed to keep the chocolates with them, but not to eat them, for 48 h. Before receiving the Kisses, participants were randomized to receive either (a) no intervention, (b) instruction in control-based coping strategies such as distraction and cognitive restructuring, or (c) instruction in acceptance-based strategies such as experiential acceptance and defusion techniques. Measures included the Power of Food Scale (PFS; a measure of psychological sensitivity to the food environment), self-report ratings of chocolate cravings and surreptitiously recorded chocolate consumption. Results suggested that the effect of the intervention depended on baseline PFS levels, such that acceptance-based strategies were associated with better outcomes (cravings, consumption) among those reporting the highest susceptibility to the presence of food, but greater cravings among those who scored lowest on the PFS. It was observed that craving self-report measures predicted chocolate consumption, and baseline PFS levels predicted both cravings and consumption. Results are discussed in terms of the implications for weight loss maintenance strategies.

Protocol included below

Gutierrez, O., Luciano, M. C., Rodríguez. M., & Fink. B. (2004). Comparison between an Acceptance-based and a Cognitive-Control-Based Protocol for coping with pain. Behavior Therapy, 35, 767-783.

Abstract

This study compares specific acceptance-based strategies and cognitive-control-based strategies for coping with experimentally induced pain. Forty participants were randomly assigned to an acceptance-based protocol (ACT), the goal of which was to disconnect pain-related thoughts and feelings from literal actions, or to a control-based protocol (CONT) that focused on changing or controlling pain-related thoughts and feelings. Participants took part in a nonsense-syllables-matching task that involved successive exposures to increasingly painful shocks. In both conditions, the task involved an overall value-oriented context that encouraged the participants to continue with the task despite the exposure to pain. At times throughout the task, participants were asked to choose to continue with the task and be shocked or stop the task and avoid being shocked. Each choice had specific costs and benefits. Participants performed the task twice, both before and after receiving the assigned experimental protocol. Two measures were obtained at pre- and post-intervention: tolerance of the shocks and self-reports of pain. ACT participants showed significantly higher tolerance to pain and lower believability of experienced pain compared to the CONT condition. Conceptual and clinical implications are discussed.

Protocol included below

Kehoe, A., Barnes-Holmes, Y., Barnes-Holmes, D., Cochrane, A. & Stewart, I. (2007). Breaking the pain barrier: Understanding and treating human suffering. The Irish Psychologist, 33(11), 288-297.

This article (see link above to download) describes the intervention components in detail starting on page 292.

Keogh, E., Bond, F. W., Hanmer, R. & Tilston, J. (2005). Comparing acceptance and control-based coping instructions on the cold-pressor pain experiences of healthy men and women. European Journal of Pain, 9, 591-598.

Abstract

The current study reflects recent developments in psychotherapy by examining the effect of acceptance-based coping instructions, when compared to the opposite, more control/distraction-based instructions, on cold-pressor pain. Since previous research indicates gender differences in how people cope with pain, we also sought to determine whether differences would be found between healthy men and women. As predicted, results indicated that women reported lower pain threshold and tolerance level than did men. Furthermore, the acceptance-based instruction resulted in lower sensory pain reports when compared to the opposite instructions. Finally, for affective pain, acceptance instructions only benefited women. These results suggest that acceptance-based coping may be particular useful in moderating the way in which individuals, especially women, cope with pain.

The intervention protocol is included below quoted from Keogh et al. (2005).

Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35, 747-766.

Abstract

The effects of acceptance versus suppression of emotion were examined in 60 patients with panic disorder. Prior to undergoing a 15-minute 5.5% carbon dioxide challenge, participants were randomly assigned to 1 of 3 conditions: a 10-minute audiotape describing 1 of 2 emotion-regulation strategies (acceptance or suppression) or a neutral narrative (control group). The acceptance group was significantly less anxious and less avoidant than the suppression or control groups in terms of subjective anxiety and willingness to participate in a second challenge, but not in terms of self-report panic symptoms or physiological measures. No differences were found between suppression and control groups on any measures. Use of suppression was related to more subjective anxiety during the challenge, and use of acceptance was related to more willingness to participate in a second challenge. The results suggest that acceptance may be a useful intervention for reducing subjective anxiety and avoidance in patients with panic disorder.

Protocol included below

Masedo, A.I. & Esteve, M.R. (2007). Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress. Behaviour Research and Therapy, 45, 199-209.

Abstract
Wegner’s Theory of Ironic Processes has been applied to study the effects of cognitive strategies to control pain. Research suggests that suppression contributes to a more distressing pain experience. Recently, the acceptance-based approach has been proposed as an alternative to cognitive control. This study assessed the tolerance time, the distress and the perceived pain intensity in three groups (suppression, acceptance and spontaneous coping groups) when the participants were exposed to a cold pressor procedure. Two hundred and nineteen undergraduates volunteered to participate. The suppression group showed the shortest tolerance time and the acceptance group showed the longest tolerance time. The acceptance group showed pain and distress immersion ratings that were significantly lower than in the other two groups, between which the differences were not significant. In the first recovery period, the suppression group showed pain and distress ratings that were higher than in the other two groups. In the second recovery period, although the acceptance group showed pain and distress ratings that were significantly lower than in the other two groups, the suppression and the spontaneous coping groups did not differ. The presence of a ‘rebound’ of physical discomfort and the effects of suppression on behavioural avoidance are discussed. These results support the acceptance approach in the management of pain.

The full intervention protocol is included below in Spanish as well as a quoted section from the article describing the intervention in English.

Páez-Blarrina M., Luciano C., Gutiérrez-Martínez O, Valdivia S., Ortega J. and Rodríguez-Valverde M. (2008). The role of values with personal examples in altering the functions of pain: Comparison between acceptance-based and cognitive-control-based protocols. Behaviour Research and Therapy, 46 , 84-97.

Abstract

The purpose of the present study was twofold. First, to compare the effect of establishing a motivational context of values on pain tolerance, believability, and reported pain, with three experimental conditions: pain acceptance (ACT condition), pain control (CONT condition), or no values (untrained condition). Second, the study aimed to isolate the impact of adding the corresponding coping strategies to both the ACT and the CONT conditions. Thirty adults were randomly assigned to one of the three experimental conditions. The participants went through the pain task in two occasions (Test I and Test II). In Test I, the effects of the ACT-values protocol (which established pain as part of valued action), the CONT-values protocol (which established high pain as opposed to valued action), and the no-values protocol, were compared. In Test II, the effect of adding the corresponding coping strategy to each condition (defusion for ACT vs. suppression for CONT) was examined. Test I showed a clear superiority of the ACT-values protocol in increasing tolerance and lowering pain believability. In Test II, the superiority of the ACT protocol was replicated, while the CONT protocol proved useful to reduce reported pain, in accordance with previous studies.

Protocol included below

Roche, B., Forsyth, J.P. & Maher, E. (2007). The impact of demand characteristics on brief acceptance- and control-based interventions for pain tolerance. Cognitive and Behavioral Practice, 14, 381-393.

Abstract

The present analog study compared the effectiveness of an acceptance- and control-based intervention on pain tolerance using a cold pressor task, and is a partial replication and extension of the Hayes, Bissett et al. (Hayes, S. C., Bissett, R.T., Korn, Z., Zettle, R. D., Rosenfarb, I. S., Cooper, L. D., & Grundt, A. M. (1999). The impact of acceptance versus control rationales on pain tolerance. The Psychological Record, 49, 33-47) study. Our aim was to test the effects of a nonspecific source of therapeutic change within the context of ACT therapy. Otherwise healthy undergraduates (N=20) were exposed to a cold pressor task before, immediately after, and 10 min following one of the two interventions. Half of the participants also were assigned to a high demand characteristic condition in which the experimenter maintained close physical proximity, eye contact, and placed subtle social pressure on participants to please the experimenter. The results showed that the most important factor influencing latency to withstand the cold pressor task was social pressure. The acceptance-based intervention was more subject to demand than the control strategy. Evaluative ratings of pain were unaffected by the demand manipulation. The current data suggest that demand characteristics can exert a significant positive impact on the outcome of therapeutic protocols. The implications of this view for acceptance- and control-based psychosocial interventions are discussed.

Intervention script quoted from article below

Vowles, K., McNeil, D.W., Bates, M., Gallimore, P. & McCall, C. (2007). Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain. Behavior Therapy, 38, 412-425.

Abstract 

Psychosocial treatments for chronic pain are effective. There is a need, however, to understand the processes involved in determining how these treatments contribute to behavior change. Control and acceptance strategies represent two potentially important processes involved in treatment, although they differ significantly in approach. Results from laboratory-based studies suggest that acceptance-oriented strategies significantly enhance pain tolerance and behavioral persistence, compared with control-oriented strategies. There is a need, however, to investigate processes of acceptance and control directly in clinical settings. The present study investigated the effects of three brief instructional sets (pain control, pain acceptance, continued practice) on demonstrated physical impairment in 74 individuals with chronic low back pain using an analogue experimental design. After controlling for baseline performance, the pain acceptance group demonstrated greater overall functioning on a set of 7 standardized physical tasks relative to the other two groups, which did not differ from one another. Further, the acceptance group exhibited a 16.3% improvement in impairment, whereas the pain control group worsened by 8.3% and the continued practice group improved by 2.5%. These results suggest that acceptance may be a key process involved in behavior change in individuals with chronic pain.

Protocol included below.

Terrific folks at the University of Leeds have put together the ACT Fidelity Measure (ACT-FM).

About the ACT-FM

This measure is intended to be used by clinicians who are experienced in ACT and understand the principles of the approach. It can be used to rate clinician fidelity to ACT in a variety of contexts (e.g . as a tool to evaluate your own or another clinician’s practice, or as a research tool). The items capture four key areas within ACT: Therapist Stance, Open Response Style, Aware Response Style and Engaged Response Style. These are outlined below with definitions. There are items to score the therapist’s behaviours as consistent and inconsistent with these areas. For example, within the Open Response Style section, an ACT consistent item is ‘Therapist gives the client opportunities to notice how they interact with their thoughts and/or feelings (e.g . whether avoidant or open)’ and an ACT inconsistent item is ‘Therapist encourages the client to “think positive” or to substitute negative for positive thoughts as a treatment goal’. This is because it is possible to be both ACT consistent and inconsistent within the same therapy session, which may be useful to record for research or training purposes. The consistent and inconsistent items are not opposites of each other. If rating the inconsistent items is not relevant for your purposes, then please feel free to omit these items.
 

The full document is attached.

Here are the adherence manuals used in the NIMH-funded randomized trial of ACT vs. PRT (Progressive Relaxation Training) for the treatment of Obsessive Compulsive Disorder (Investigators: Michael Twohig & Steven Hayes). Twohig, M.P., Hayes, S.C., Plumb, J.C., Pruitt, L.D., Collins, A.B., Hazlett-Stevens, H., & Woidneck, M.R. (2010). A randomized clinical trial of acceptance and commitment therapy vs progressive relaxation training in the treatment of obsessive compulsive disorder. Manuscript under review. For questions about the use of the ACT manual, please contact Jen Plumb. For questions regarding the use of the PRT manual, please contact Holly Hazlett-Stevens at the University of Nevada Reno.

Below you will find the manual used in the NIDA-funded smoking cessation study conducted at the University of Nevada Reno. Please contact Heather Pierson for additional information about this manual. 

This manual was adapted by Stephanie H. Best, MA from a line of adherence manuals used in various ACT and other studies.

The manual below is being used in a NIMH-funded study to prevent mental health issues in college students. It was modified by Steve Hayes.

Ok, I admit it. This is a bit of a mess.

I think there are perhaps hundreds of predictions that can be made from
ACT and RFT that are reasonably novel, and the ACT and RFT books contain
dozens of them. But they have never been all pulled together; and many new ones come up
every month.

Getting these in order is a project that is going to take a long time and a lot of people.
This process ont he website will have that in shape over time but in the meantime it seemed that a quick and dirty process would be worthwhile, so I challenged the list serves. This list, raw and unfiltered, is the result. Some of these ideas are great. Some seem off. And anyone was and is allowed to play. But it seemed more important to get people thinking than to get it right if "right" meant that some "leader" says "this is right."

If you have ideas, back up to the next highest level and add a child page and put yours out there!

- S

Steve Hayes

-------------

Things from Mike Twohig

These are the places where ACT will be different than BT, CT, or CBT
in the treatment of OCD or possibly other anxiety disorders (I am
more on top of the OCD data):

1. ACT based exposure will result in a greater ability to engage in
daily activities (or have a higher quality of live score)

2. Cognitions will be less believable (greater decreases in scores
on TAF scale) in ACT

3. ACT will be more acceptable (lower drop-outs, higher scores on
acceptability measures) than traditional BT / CBT methods

4. Clients will be more willing to confront feared stimuli in ACT

5. Therapists will rate administering the ACT intervention as more
acceptable

6. ACt will get better results at FU, but not necessarily at post

7. CT/ CBT will result in greater decreases in obsession at post,
but maybe not at FU (ACT will decrease obsessions at FU, but not
necessarily at post)

8. Outcomes on the ACT side will be mediated by changes in
willingness, defusion, and ability to act in a valued direction with obsessions

9. ACT will do particularly well with really difficult cases –
possibly even ERP failures

10. Avoidance of obsessions will better predict severity of OCD than
severity of obsessions (although greater avoidance should predict
greater intensity)

-------------

I'm not sure who did these. Could be me (Steve Hayes) ... sounds familiar

Challenging dysfunctional beliefs (Crel interventions) can at times increase their functional importance
(have a Cfunc effect)

You will be able to see the entangling impact of challenging dysfunctional beliefs
at the neurobiological level (e.g., laterization; more activation of verbal areas;
more stress hormones)

Cfunc manipulations will generally have a more positive impact than Crel interventions with
chronic psychological conditions

Crel interventions will have greatest impact in unfamiliar areas (e.g., clarifying values)
than in correcting familiar ones (e.g., struggles)

Measures of the ACT model (EA, fusion, inflexibility) will mediate the relationship between most forms existing of coping
and outcomes

You will see the effect of each of the elements of the ACT model (defusion, acceptance, values etc) at the
neruobiological level

You will get greater generalization across areas of struggle through ACT methods than
you will with traditional CT/CBT methods

ACT methods combined with traditional behavioral methods will be more effective generally than these behavioral methods alone

ACT will produce better effects with more severe and treatment resistant clients than will traditional CT/CBT methods; in
general that will not be true (or as true) with low intensity cases

------------------

Elaborating relevant verbal networks will reduce the believability of problematic thoughts (e.g., delusional beliefs/irrational beliefs) more than will disputing/challenging the thoughts. (Patty Bach)

----------------

'cognitive restructuring" will be demonstrated to work (when it does), via defusion and not belief/thought modification.

Frank Gardner

----------

in prospective studies (e.g. with adolescents), measures of EA and fusion (with negative OR POSITIVE beliefs about self) will predict onset mental health problems; similarly, measures of experience of self as context/transcendental self will predict resilience to upsetting life events.

janet wingrove [janetwingrove@gmail.com]

--------------

Disruptions in a spoken sample may decrease pre-post therapy/pre-post
sessions (controlled for spoken samples w/o therapy).

Long-term decreases in ACT compared to other therapies (pre-post
therapy) may speak to a removal of a maintaining reinforcer as opposed
to a momentary disruption that might be seen in pre-post session
information.

ivancicmartin [martin.ivancic@jirdc.org]

---------------

- (I'm working on) a comparison of CBT-biopsychosocial models and ACT/RFT models with a heavy weight on differences in ecological (and clinical) validity and functional outcome. Prediction: ACT/RFT models are more ecological valid, easier to translate in clinical interventions and have a better predictive validity on functional outcome criteria (planning to make a difference in 'solid' versus 'soft' outcome criteria to review research)

Marco Kleen
Health Psychologist, Pain team Univesity Center of Rehabilitation Groningen

-------------

In end-of-the-year Jean Dixon fashion, I'll throw in a prediction:

Often therapy uses multiple exemplars to shape functional deictic framing.
Helping people frame their clinically-relevant, evaluative self-talk
occuring HERE and NOW as THERE and THEN will likely move the AAQ-2, some
measures of "pathology" and reduce defusion.

DJ Moran

------------

Some predictions I came to think of:

ACT will help individuals to develop more behavioral flexibility, which will mean:

> motor skills will be acquired faster in an ACT+instruction+exercise condition compared to an instruction+exercise condition

> motor skills will be performed more fluently and with less training in an ACT condition

> the reported diversity of emotional experience will increase

> the observed diversity of emotional expressions (e.g. measured with Ekman's FACS) will increase

> self-ratings of goal-orientation and value-orientation will show a decrease in goal-orientation and an increase in value-orientation (e.g. in disputes with others the frequency of looking at the relationship will increase while the frequency of striving to be right will decrease)

Sorry, if others already posted similar things. I did not go through all the emails of the last few days already.

Rainer Sonntag

------------

JoAnne Dahl

1. ACT short term treatment (cheaper because shorter time and less
staff needed compared to large multidisplinary staff) empowers the
individuals own motivation by means of values work and creates more
long lasting behavior change and less pliance (short term changes
that are rule governed).

2. ACT will in the short term produce lower ratings on quality of
life that will increase significantly by the one year follow-up.
Since people are so adaptable, the initial life quality ratings will
show an adaption to a low level and ACT (especailly with the values
work) works at supporting people to see the descrepancy between one's
valued living and how one actually lives today. That descrepancy can
be devasting and that shows up in the lower quality of life ratings
and it takes time to build back up a valued life if the person has
been living in experiential avoidance.

3. ACT treatment increases "acceptance" of "clean" pain
(unconditioned response of pain to aversive stimuli) as a normal and
important phenonmena to value. And distinquishes and challenges
"dirty" pain as the conditioned thoughts and avoidance behaviors it
is. In so doing, increases in acceptance will predict increase in
activity, life quality and function.

4. ACT will be more acceptable (lower drop-outs, higher scores on
acceptability measures)

5. Clients will be more willing to confront feared stimuli since they
are working in their context of values.

6. Therapists working with ACT and chronic pain will be less "burned
out" as compared to other CBT treatments because they will not have
to "coach" the clients thru exposure of feared, painful stimuli.

7. Better results at FU

8. ACT will not result in less reports of pain but in greater
acceptance and function. Acceptance will come first and mediate
greater results in quality of life and function at follow up.

9. Outcomes on the ACT side will be mediated by changes in
willingness, defusion, and ability to act with pain.

10. ACT will do well with prevention of pain and sick leave directly
at the work site and with very difficulty clients on long term sick
leave that have failed in other programs

---------------

Ken Carpenter

I think some differences may appear under the following conditions:

1. individuals on the low end of the defusion continuum (or high end of the fusion continuum) should fair better in ACT than CBT.

(ACT directly targets this behavior thus should do a better job of building it into an individual’s repertoire comapred to CBT which does not explicitly shape it, but needs it to be established in order for individuals to test the validity of their cognitions *have to step outside a thought to evaluate it).

2. Defusion in the context of acceptance should produce greater behavioral flexibility than defusion in the context of testing content. This may be testable in both in treatment outcome and analogue/lab tests in which individuals are presented with distracter stimuli in the context of completing tasks and are given different techniques to cope with what comes up. (Steve * i think some of your lab studies on coping statements in the presence of aversive stimuli are a good starting framework for developing these kind of lab based process models). I would also predict the differences between the 2 contexts (acceptance vs challenge/test) to vary along the experiential avoidance continuum- greater group difference on the upper end (greater) EA continuum.

3. I think another area (need to think through this more) is the different predictions RFT makes concerning the stimulus control of deriving relations (thus proposing a more dynamic process and situational specific relating responses) versus the more static nature of schema. I may be wrong here, but I think a successful CBT intervention would be xpected to result in the alteration of schema - thus among those who are CBT successes * would there be a stance that resurgence should not occur since the relations having been stored and static are now changed? RFT/ACT is more likely to handle/predict resurgence even among those who are treatment responders.

RFT

Responding in accordance with a coherent relational network will take less time (on average) than responding in accordance with an incoherent network (subject, of course, to the usual caveats concerning individual histories).

Another one -- Relating derived relations will produce some of the same effects that have been observed for analogical reasoning (that might be in the review piece?).

RFT models of semantic relations, analogy, executive function tasks, perspective-taking and the like should produce neural effects that overlap to some degree with the effects observed in the mainstream neuro-cog literature.

Increasing the extent, flexibility, and fluency of relational frames,
relational networks, relating relations, relating relational networks, the transformation of functions, and contextual control over each of these, should impact positively on a variety of standard measures of human language and cognition.

Things posted to the Academy list in June

New things RFT does. RFT:

Provides new ways to do language training

Has lead to a new and increasingly empirically supported psychotherapy
(ACT) and to quite number of new psychotherapy techniques

Suggests how to establish a sense of self in children

Shows some of how to train children in "theory of mind"

Gives a process account of mindfulness

Predicts how many basic cognitive skills form

Predicts new ways to increase openness to new learning

Explains some of where psychological rigidity comes from

Leads to a new model of psychopathology

Suggests some of the core skills involves in language and its subskills such as analogy and metaphor

Shows why existing information processing research in specific areas (e.g., analogy) is flawed and show how to correct that flaw

Predicts new methods how to increase some intellectual abilities

Predicts new methods for how to increase motivation verbally

Predicts some new methods to decrease motivation verbally

Has lead to new ways we might assess current cognitive relations

Explains some of why cognitive fusion emerges, why it is harmful, and what to do about it

Explains some of why experiential avoidance emerges, why it is harmful, and what to do about it

Provides unexpected predictions about neurobiological responses to specific cognitive tasks

What happens to Crel and Cfun in RFT studies when you teach folks to apply defusion during testing, and or when you teach defusion, train, and then test? I am thinking of M Dougher's recent study with > or < relations with shock. I wonder whether defusion would alter the transformation, perhaps leading subjects to not rip off the shock electrodes in the context of > relation. I wonder whether defusion would strengthen or perhaps weaken Crel and/or Cfun. My guess is that it may result in more rapid learning of Crel, but knock out Cfun. This would be cool to show. Maybe someone has done this, but if not we really should cook up some experiments along these lines.

-j forsyth

1. Additional corollary hypotheses:
(A) Speed of acquisition of AARR during an REP task (i.e., number of trials needed to respond consistently correctly) will correlate significantly and inversely with verbal IQ. (can’t recall off hand if Denis O’Hora has already tested this specifically yet).
(B) This one would be a doozie to quantify and test, but it follows from RFT: Subjects presented with a novel metaphor who generate higher numbers of apt comparisons (especially in shorter amounts of time) will perform better (i.e., will respond correctly more frequently and given less training trials) in an REP task that assesses their ability to correctly derive relations after two previously trained frames are brought into coordination.
2. Additional corollary hypotheses:
(A) AARR in fully verbal subjects will fail to occur over time within an experimental context, given a consistent lack of reinforcement for AARR and/or consistent punishment of AARR within that context.
3. Additional corollary hypotheses:
(A) The same established verbal relation (e.g., A is similar to B, which is similar to C) can be shown to accompany different functional transformations across different experimental contexts.
(B) Identical functional transformations can be shown to be achieved through the training of different verbal relations.

J T

read some RFT-research on the change of psychological function of stimulus C by putting it in relation with A-B (sexual excitement, taste preference, mood). What if C is relationally framed with 2 different classes: A-B-C, and X-Y-C. And let's say A is experienced a bit negative, and X also a bit negative. Would C become experienced more negative, than when it's framed with only one class? This might be an operationalisation of multiple small life experiences leading to a larger reaction.

De Groot, Francis [francis.de.groot@fracarita.org]