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.