anxiety

Acceptance and commitment therapy (ACT) has a small but growing database of support. One hundred and one heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned to traditional cognitive therapy (CT) or to ACT. To maximize external validity, the authors utilized very minimal exclusion criteria. Participants receiving CT and ACT evidenced large, equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction, and clinician-rated functioning. Whereas improvements were equivalent across the two groups, the mechanisms of action appeared to differ. Changes in "observing" and "describing" one's experiences appeared to mediate outcomes for the CT group relative to the ACT group, whereas "experiential avoidance," "acting with awareness," and "acceptance" mediated outcomes for the ACT group. Overall, the results suggest that ACT is a viable and disseminable treatment, the effectiveness of which appears equivalent to that of CT, even as its mechanisms appear to be distinct.

Carers of people with mental illness frequently report interpersonal difficulties in their caring relationship, and experiential avoidance likely contributes to these problems. This study aimed to examine the relationship between experiential avoidance and eight interpersonal problem domains amongst lay mental health carers, and tested the mediating role of attachment anxiety and hostility. In addition, an alternative (reverse) mediation was tested in which experiential avoidance played the mediating role. A cross-sectional community-based sample of 145 mental health carers completed a questionnaire containing demographics and measures of interpersonal problems, experiential avoidance, attachment anxiety and hostility. Results indicated the relationship between experiential avoidance and interpersonal problems was fully mediated for the interpersonal problem domains of cold/distant and socially inhibited. Partial mediation was evident for the vindictive/self-centered, non-assertive, overly accommodating, self-sacrificing and intrusive/needy domains. No mediation occurred for the domineering/controlling domain. Alternative (reverse) model findings indicated partial/full mediation for the overly accommodating, domineering/controlling and vindictive/self-centered domains, and no mediation for the remaining five domains. Although tentative, findings suggest a mechanism for the relationship between experiential avoidance and particular domains of interpersonal problems that warrants further investigation. The importance of our data is highlighted by the burden and difficult relationships experienced by mental health carers, that requires targeted and effective psychological treatment.

This study investigated the use of Acceptance and Commitment Therapy (ACT) as a treatment for music performance anxiety (MPA) in an uncontrolled pilot design. ACT is a newer, “third-wave” therapy that differs from previous MPA treatments, because its goal is not to reduce symptoms of MPA. Rather, ACT aims to enhance psychological flexibility in the presence of unwanted symptoms through the promotion of six core processes collectively known as the ACT “Hexaflex.” A small group of student vocalists (N = 7) from an elite choral college were recruited using objective criteria for evaluating MPA. Participants received 12 ACT sessions, and their baseline functioning served as a pre-treatment control. Treatment consisted of an orientation to ACT, identifying experientially avoidant behaviors, facilitation of Hexaflex processes, group performances in which valued behaviors were practiced in front of one another, meditations, homework, and completion of self-report measures before, during, and after treatment (at a 1- and 3-month follow-up). Improvements were observed in participants' cognitive defusion, acceptance of MPA symptoms, and psychological flexibility at post-treatment and follow-ups. Students also appeared to improve their performance quality and reduce their shame over having MPA. These results add to existing research suggesting ACT is a promising intervention for MPA, while also highlighting how vocal students may be less impaired by physical MPA symptoms.

This study marks the first application of Acceptance and Commitment Therapy (ACT) to the treatment of a university student with music performance anxiety (MPA). ACT is a newer, “third-wave” therapy that differs from previous MPA treatments, because its goal is not to reduce symptoms of MPA. Rather, ACT aims to enhance psychological flexibility in the presence of unwanted symptoms through the promotion of six core processes collectively known as the ACT “hexaflex.” For this study, an undergraduate violinist with debilitating MPA received a 10-session ACT treatment using a single-subject design. Treatment consisted of an orientation to ACT, identification of experientially avoidant behaviors, facilitation of hexaflex processes, in-session performances in which valued behaviors were practiced, meditations, homework, and regular completion of ACT-based and symptom-based measures. Clinically significant improvements were observed in her ability to accept and defuse from her anxious thoughts and feelings at post-treatment and at a 1-month follow-up. Her performance quality also improved at post-treatment. Although symptom reduction was not a goal, her MPA and overall distress were significantly reduced, and her perceived control over MPA significantly improved at post-treatment and follow-up. These results suggest ACT may be an effective treatment option for MPA and should be studied further.

We will briefly examine the implication of a multi-dimensional and multi-level view of evolution for addressing the role and function of survival circuits in the context of human cognition, and the underlying emotional, memory, and behavioral processes both impact. It is our contention that human cognition can partially direct and channel these more ancient neurobiological regulatory systems. We argue that while survival circuits can be helpful or hurtful to human functioning, they are particularly likely to be problematic when they occur in the context of cognitive processes that have become automatic and well-practiced, and thus beyond normal conscious processes of cognitive control. Psychotherapy can be of help in increasing access to such ‘unconscious’ process, reducing their automatic impact, and allowing human goals and values to over-ride maladaptive processes engaged by survival circuits.

Background:

Substance dependence disorder is a psychiatric disorders with different factors that influence its nature, severity, outcome, and treatment options.

Objectives:

This study evaluates the effectiveness of Acceptance-Commitment Therapy (ACT) to decrease anxiety and depression in patients with opioid dependencies who are undergoing methadone maintenance treatment (MMT).

Materials and Methods:

The present study was done in Mashhad from 2011-2012. Twenty-eight patients (18-50 yr) with opioid dependency who were on MMT were selected using purposive sampling and were divided equally between case and control groups. The case group received 8 sessions of individual psychotherapy with ACT. The level of depression and anxiety of these patients were measured using the Beck Depression Inventory-II and Beck Anxiety Inventory before the initiation of ACT as a pretest, 2 weeks after the termination of ACT as the posttest, and 3-months after the termination as a follow-up. The collected data was analyzed with SPSS (ver. 20) using χ2, paired t-test, ANOVA, and MANOVA.

Results:

The pretest-posttest-follow up of anxiety showed no significant differences between the two groups (P = 0.05); however, the case group had lower depression scores in the posttest and follow-up than the control group (P = 0.04). Evaluating the results of the case group revealed that depression significantly decreased in the posttest group when compared to the pretest (P = 0.01) and there were no significant decreases in the follow up compared to the pretest (P = 0.34).

Conclusion:

Short-term ACT for opioid dependent patients on MMT are not associated with a significant decrease in the level of anxiety; however, it is associated with a significant decrease in the level of depression. Nonetheless, this reduction was not maintained long term.

Identifying modifiable risk factors is requisite for preventing stress-related psychopathology, but few prospective studies have examined their impact on the emergence of psychological dysfunction. Trait anxiety (TA), anxiety sensitivity (AS), and experiential avoidance (EA) were assessed in 161 soldiers awaiting deployment. Soldiers also completed repeated in-theater assessments of stressors, post-traumatic stress (PTSS), anxiety, and depression symptoms. Multilevel models tested predictions that each trait would independently and jointly amplify stressors’ impact on symptoms. TA increased risk for anxiety (r = .19, p = .020), but not stressors’ anxiogenic effects (r = .14, p = .080), whereas TA reduced stressors’ impact on depression (r = .18, p = .038) and PTSS (r = .28, p = .001). AS increased risk across symptoms (r's = .26–.31, p's ≤ .002), but did not moderate stressors’ anxiogenic effects (r = .15, p = .074). EA's stress-moderating effects depended on levels of TA and AS (r's = .22–.27, p's ≤ .010). Findings suggest TA and EA may interact in ways to enhance resilience, whereas AS may reliably potentiate the pathogenic effects of stress. Support is given for examining the contextualized influence of individual differences, and their dynamic interactions in predicting soldiers’ reactions to war-zone stressors.

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To-date no models adequately address the higher vulnerability of women to anxiety pathology, in contrast to other disorders, such as depression where ruminative thinking has been identified as accounting for women's greater risk. This investigation examines the hypothesis that gender differences in coping, with women relying more on specific types of avoidance, may in part explain women's anxiety risk. Coping, experiential avoidance, anxiety symptoms, anxiety sensitivity and perceived stress due to life stressors were assessed in a community sample (N=456). Women were more likely to meet clinical screening cut-offs for anxiety disorders, report more symptoms and experience greater anxiety sensitivity than men. They also reported greater reliance on avoidant coping and experiential avoidance, which were associated with increased anxiety. Gender moderated coping effects so that the coping style that mostly differentiated women from men in predicting anxiety was behavioral disengagement. To the contrary, self-reported stress due to life events did not significantly explain anxiety gender effects as no significant moderation by gender was observed. Results suggest that greater reliance on avoidance, especially behavioral avoidance, may be associated with increased vulnerability to anxiety specifically among women.

To find the full text version of this article and others (as well as download a full text .pdf.), ACBS members can visit the ScienceDirect homepage here.