WC13 Symposia Detail

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Thursday, 16 July
Friday, 17 July
Saturday, 18 July
Sunday, 19 July

 

Thursday, 16 July

11. Applying CBS to Disadvantaged Groups in the Global Community: Data, Action Research and Implications.
Symposium (10:30-12:00)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Diversity
Target Audience: Beg., Interm., Adv.
Location: Estrel Saal C7

Chair: Beate Ebert, Clinical Psychologist, Private Practice
Discussant: Ross White, Ph.D., University Lecturer

The mission of CBS is to "create a behavioral science more adequate to the challenges of the human condition". One possible challenge the global community faces is the need to increase levels of engagement and involvement in pro-social behaviour towards disadvantaged groups. We would like to introduce 4 diverse areas in which contextual behavioral tools and thinking have been applied and evaluated: a Vietnamese population in Berlin, a West African population in Sierra Leone, and a group of lesbian, gay, bisexual and transgender (LGBT) employees in UK and the US. The last presentation looks at "well-served" populations and their likelihood to engage in pro-social behaviour towards under-served groups. Questions we address are: 1. How can we provide culturally adequate services in diverse contexts. 2. Do CBS treatments and attitudes apply to these kind of services. 3. What can we learn from diverse body and mind concepts, values systems etc.

• Implementing Acceptance and Commitment Therapy (ACT) for Vietnamese outpatients in Berlin: Symptom Presentation, Clinical Experiences and the Role of Culture in Shaping Personal Values.
Thi-Minh-Tam Ta, Ph.D., Consultant and clinical head of out-patient-Department University Hospital Charité Berlin

Beginning in 2010 we´ve provided psychotherapeutic care for Vietnamese migrants in Berlin. Since then mental health care utilization of this hard-to-reach migrant group has improved with more than 250 outpatients, mainly diagnosed with depression. First, we present cross-cultural differences in somatic symptom presentation in depression and share our experiences of more than 2 years, implementing and adapting ACT for small group therapy session in Vietnamese language. So far, our therapy programme contains 10 sections, which primarily focus on patients with depression, anxiety and chronic pain disorders. Given the importance of personal core values as an integral component of ACT we explore and share first data of an approach to elicit and cross-culturally compare relevant core values in Vietnamese migrants and German patients with a depression. In addition we will discuss whether and how stronger emphasis should be given to the endorsement of relational (family oriented) values. Educational Objective: Having attended this presentation the audience members will increase their understanding of the challenges faced in our efforts to implement ACT in a culturally different migrant group, in particular for Vietnamese patients.

• Investigating the Role of Contextual Behavioural Science in Sub-Saharan Africa
Hannah Bockarie, Social Worker, Director of commit and act psychosocial center in Bo, Sierra Leone
Corinna Stewart, B.A., Ph.D. Candidate, NUI, Galway

Commit and act is an NGO that aims to improve the capacity of local people living in Sub-Saharan Africa to alleviate trauma-related distress experienced by the populations living there. In recent years, the organization has been busy delivering training to non-specialist health workers who support people experiencing emotional distress in Sierra Leone and Uganda. This paper will present follow-up data for 40 non-specialist workers in Sierra Leone who have attended commit and act workshops in successive years. Specifically, the presentation will explore the stability of the individuals’ psychological flexibility (as measured by the AAQ-II) over a 15-month period. commit and act have also employed the PROSOCIAL approach with groups of people in Sierra Leone for Ebola prevention and other shared aspirations. Data relating to the PROSOCIAL approach will be presented and the implications that this has for the cross-cultural application of the PROSOCIAL approach will be discussed. LO: After this presentation the listeners should be able to discuss the cross-cultural use of the AAQ II and of the PROSOCIAL approach, considering the potential and the objections.

• The Role of Psychological Flexibility in Understanding Coping in Lesbian, Gay, Bisexual and Transgender (LGBT) Employees
Jo Lloyd, Ph.D., Lecturer and Programme Director, Goldsmiths’ Institute of Management Studies (IMS), London

Research has indicated that many LGBT employees experience discrimination in the workplace. This is problematic, not only for the employee’s mental health, but for organisations and communities in terms of disease burden. Alongside working towards eliminating the occurrence of workplace discrimination, it is important to examine ways of enhancing coping in LGBT employees. In this paper, we used a cross-sectional moderated mediation analysis on a sample of 300 UK and North American LGBT employees to examine whether higher psychological flexibility related to enhanced coping capability. We found that an indirect relationship between poor LGBT workplace climate and low employee engagement, via psychological distress, is lessened when people have higher levels of psychological flexibility. To our knowledge, this is the first empirical study to investigate psychological flexibility in LGBT individuals and thus represents a pioneering first step for CBS in addressing the human concern of sexuality and gender discrimination. Educational Objective: Having attended this presentation the audience member will be able to understand the difficulties faced by LGBT employees and discuss the potential for psychological flexibility, and CBS more broadly, to help alleviate these difficulties.

• Empathy, altruism and psychological inflexibility: the promise, the pitfalls and the data
Miles Thompson, Goldsmiths, University of London; University of the West of England (UWE)

One potential challenge for CBS in meeting the needs of disadvantaged and wider cultural groups is increasing levels of pro-social behaviour in more mainstream populations towards these groups. This presentation explores original cross sectional data (n=200+) from an online survey primarily involving non-clinical UK participants. The data examines the relationship between psychological inflexibility and other psychological variables traditionally associated with pro-social behaviour such as empathy and altruism. The data suggests the lack of a strong relationship between some of these variables. One potential problem may stem from using the AAQ-II in a pro-social context. However an alternative measure of psychological inflexibility, designed explicitly for this kind of research – also introduced as part of this presentation – found similar results. Another issue may be the traditional psychological conceptualisation of empathy and altruism itself. The implications for the ability of CBS to have a wider impact in increasing pro-social behaviour will be discussed.

Educational Objectives:
1. Get a new perspective on difficulties faced by diverse and disadvantaged cultures, within our Western countries or in low income countries. 2. Realize the potential of Contextual Behavioral Science and possible challenges or pitfalls to provide skills and perspectives to empower people in diverse cultural settings. 3. Learn to think creatively about methods for researching and evaluating the efficacy of CBS interventions within diverse populations.

 

14. New methods of assessment on Self-Compassion: Implicit and Explicit Measures
Symposium (10:30-12:00)
Components: Original data
Categories: Clinical Interventions and Interests, Performance-enhancing interventions, Superv., Train. & Dissem., RFT, IRAP, Self-Compassion
Target Audience: Beg., Interm.,
Location: Strassburg

Chair: Giovambattista Presti, M.D., Ph.D., University Kore Enna (Italy)
Discussant: Martin Brock, University of Derby

There are several models of self-compassion emerging based on distinct theories and research lines. The object of this symposium is to bring some different methodological issues related to the investigation of self-compassion and discuss about methodological alternatives (e.g. implicit measures, interviews). In the first section, it will be presented a cross-sectional data looking at relationships across depression, anxiety, self-compassion, psych flex and the components of self-compassion. From these data, it will be presented the compassionate flexibility model and a new assessment measure/interview. In the second section, it will be presented a series of papers that employ the Implicit Relational Assessment Procedure (IRAP) in the context of self-compassion. In the third section, it will be presented a data about a study employing the IRAP of self-acceptance of minor failures that every ACT therapist could commit in their work or day-to-day life and the results will be discussed in terms of self-compassion.

• The Development of Implicit Relational Assessment Procedure as a Measure of Acceptance of Failing and Succeeding Behaviors
Diana Bast, Maynooth University
Dermot Barnes Holmes, Maynooth University

In this section, it will be presented a series of papers that employ the Implicit Relational Assessment Procedure (IRAP) in the context of self-compassion. Specifically, studies that employ the IRAP as a measure of response biases related to emotional reactions and expected outcomes in the context of minor failings and successes in everyday life. The aim of this section is to present: (1) Development of an implicit measure of self- acceptance of minor failures (2) Determine if explicit and implicit measures of self-acceptance yield broadly similar or different results; (3) Determine if such measures should target flaws, faults, and shortcomings in a general or specific manner and if such measures differ depending on whether they target feelings or expected outcomes of “problem” behaviours; (4) Explore the relationships among implicit and explicit measures (e.g. self-compassion scale), in terms of associated feelings and outcomes, and various indicators of mental health and well-being.

• ACT Practitioner Implicit and Explicit Response to Failure and Success. Does Self-Compassion Matter?
Francesco Dell'Orco, IESCUM, Parma (Italia)
Davide Carnevali, University IULM, Milan (Parma)
Annalisa Oppo, Sigmund Freud Privat Universität, Milan (Italy) - IESCUM, Parma (Italy)
Giovambattista Presti, M.D, Phd, University Kore Enna (Italy)

Literature gave great attention to the study of Self-compassion because of its possible moderator effect both on psychopathological index and well being. This growing attention on Self-Compassion leads researcher and clinician to discuss around the issue of measure. How can we effectively measure self-Compassion? One of the most common way to assess Self-compassion is using explicit measures. However, although these measures have advantages, they have a major disadvantage, namely explicit measures are usually completed in the absence of time-pressure. In this way, persons are free to reflect at length on how to respond to each item. This disadvantage may be partially solved using IRAP. The primary goal of this study is to analyse implicit response to self forgiveness in two distinct populations which have been supposed to have a different learning history on behaviour that imply the construct of self-compassion: ACT-therapist versus Non-ACT therapist. Our results show that the variables that discriminate ACT-therapist from non-ACT therapist were Common Humanity scale (OR=2.22; 95%CI: 1.12-4.42), Isolation scale (OR=0.46; 95%CI: 0.23-0.88), and D-IRAP mean score “success negative feelings” (OR=0.19 95%CI:0.23–0.88).

• The Compassionate Mind Interview and Compassionate Flexibility
Dennis Tirch, PhD, Center for Mindfulness and CFT

The Compassion Focused Therapy (CFT) model delineates a series of attributes and skills that proceed from, and contribute to, the activation of compassion as an evolved social mentality. The Compassionate Mind Interview (CMI) is a semi-structured interview, designed to engage therapist and client in a mindful dialogue about the range of processes and skills involved in compassion. The interview is based upon ongoing international research on the assessment of components of compassion. The CMI is designed to help psychotherapists determine what will be most beneficial to emphasize in subsequent treatment planning and interventions. This presentation will walk through the use of The CMI, providing a case study illustrative of case conceptualization and treatment planning. Additionally, cross sectional data exploring relationships among self-compassion, psychological flexibility, depression and anxiety among 244 participants presenting for outpatient CBT will be reviewed, illustrating dimensions of compassion that inform the Compassionate Mind Interview.

Educational Objectives:
1. Measure self-compassion in clinical and non clinical/setting. 2. Apply the IRAP in assessing self compassion. 3. Utilize ACT Therapists skills.

 

15. ACT in Sports: Enhancing Performance and Measuring Sport-Related Psychological Flexibility
Symposium (10:30-12:00)
Components: Original data
Categories: Performance-enhancing interventions, Clin. Interven. & Interests, Sport performance enhancement, chess, hockey, AAQ, psychological flexibility
Target Audience: Beg., Interm., Adv.
Location: Room 30241

Chair: Bruno Carraça, Lisbon University
Discussant: Joseph Ciarrochi, Austrian Catholic University

Protocols based on acceptance and commitment therapy (ACT) are beginning to be applied to enhance sport performance. This symposium presents cutting-edge research concerning the efficacy of ACT protocols in improving performance of hockey and chess players and the measure of sport-related psychological flexibility. The first paper shows a randomized controlled study that analyzed the effect of a brief 4-session ACT protocol in improving hockey players’ performance compared to a waitlist control group. The second paper presents the psychometric properties of the Acceptance, Defusion and Action Questionnaire (ADAQ), which measures psychological flexibility in sport contexts. Lastly, the third paper presents an extension of previous evidence of the efficacy of ACT protocols in improving chess players’ performance.

• ACT for Athletes: A Randomized Controlled Trial
Tobias Lundgren, Stockholm University & Karolinska Institutet

The research interest on acceptance, mindfulness and values based skills training for athletes has been growing during the last 10 years but there is a lack of well-designed outcome studies available in the literature (Gardner & Moore, 2009). The aim of the study presented in this symposium was to develop and evaluate a brief 4-session skills training ACT intervention for hockeyplayers. The study employed a randomized controlled two group design with an ACT group and waitlist control. Outcome measures were goals, assists on ice and an expert group rating of performance. The preliminary results show a significant interaction effect on all outcome measures in favor of the ACT group. Final results and follow up will be presented at the conference.

• Acceptance, Defusion and Action Questionnaire: Evaluation of a Measure of Psychological Flexibility in Sport Settings
Stefan Holmström, Umeå University
Tobias Lundgren, Stockholm University & Karolinska Institutet

There has been an increasing interest in applying the concepts of acceptance, mindfulness, and value based intervention to enhance athletes’ psychological flexibility as well as their performance and wellbeing. Development of instruments for the measurement of psychological flexibility in sport settings has not kept the same pace. The Acceptance and Action Questionnaire II (AAQ-II; Bond et al., 2011) is often used to assess psychological flexibility in various interventions. However, AAQ-II provides a measure of the psychological flexibility in general. The purpose of this study was to develop and evaluate an instrument, the Acceptance, Defusion and Action Questionnaire (ADAQ), which measures psychological flexibility in sport contexts. A nine-item version of ADAQ was used for the study of 173 participants between the ages of 16 to 19. All of them were athletes at elite level in team and individual sports and enrolled at Swedish sport academies. Preliminary results from a confirmatory factor analysis indicated a reasonable fit of the model (Chi square=65,88; df=27; p-value=,000; RMSEA=,89). This and other psychometric results will be discussed.

• Improving Performance of Chess Players with and without Clinical Problems with Acceptance and Commitment Therapy: A Case Series Study
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Carmen Luciano, Universidad de Almería
Juan C. Suárez-Falcón, Universidad Nacional de Educación a Distancia

Brief protocols of acceptance and commitment therapy (ACT) has shown to be effective in improving performance of elite chess players’ without clinical problems (Ruiz, 2006; Ruiz & Luciano, 2009, 2012). However, the effect of full ACT protocols has not been tested and it remains unexplored whether ACT could improve chess performance of players with clinical problems. The current study presents three case studies with elite chess players, two of them suffering from anxiety disorders. Each participant was matched to a control participant according to having similar characteristics. Results showed that ACT was effective in treating the anxiety disorders and significantly improved the results of the three experimental participants according to an objective measure of chess performance. None control participant improved his results. The d-statistic for single-case designs by Hedges et al. (2012) yielded a large effect size for the participants who received the ACT intervention (d = .939).

Educational Objectives:
1. Describe how ACT can improve hockey players’ performance. 2. Describe how psychological flexibility could be measured in the sport context. 3. Describe how ACT can improve chess players’ performance with clinical and no clinical problems.

 

16. The role of Defusion in brief ACT Interventions: Finland Chapter Sponsored
Symposium (10:30-12:00)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Performance-enhancing interventions, Behavioral medicine, Depression, cognitive defusion, FACT obesity, social anxiety disorder
Target Audience: Beg., Interm., Adv.
Location: Room 30341

Chair: Giuseppe Deledda, Psy.D., Service Clinical Psycology, at “SacroCuore - Don Calabria” Hospital,Verona, Italy
Discussant: Ole Taggaard Nielsen, Psy.D., ACT Klinikken

There is substantial evidence of the benefits of brief interventions for a range of mental health problems. In this symposium the implementation and results of different brief interventions for depression, distress and coping with negative thoughts will be presented. The role of cognitive defusion as a mechanism of change and key factor for explaining early sudden gains will be discussed.

• Understanding Fast Improvement in a Brief ACT Intervention for Depression
Katariina Keinonen, Graduate Student, University of Jyvaskyla
Raimo Lappalainen, Professor of Psychology, University of Jyvaskyla
Heidi Kyllönen, MSc, University of Jyvaskyla
Piia Astikainen, Ph.D., University of Jyvaskyla

Background: The general aim of this study was to increase our knowledge and understanding of processes related to the fact that some clients benefit very fast from psychological interventions. Method: The data was comprised of 56 depressed clients receiving a six-session acceptance and values based intervention. Two groups were formed, based on whether the clients’ score on the BDI-II reflected a clinically and statistically significant change after two sessions, and analyzed for differences in treatment outcome. Results: The early gainers had superior treatment outcome both on the level of depressive symptomatology and psychological flexibility. In addition, early gains were associated with larger changes in the believability of depressive thoughts and hopefulness after two sessions. Conclusions: The results suggest that early changes have prognostic value in ACT-based interventions. Our results also draw our attention to defusion processes and hopefulness as possible key factors for explaining early sudden gains in psychological interventions.

• Targeting Psychological Distress with a Brief Defusion Intervention.
John T. Blackledge, Morehead State University
Richard Ward, Morehead State University
Gabriela Alshafie, Morehead State University
Kellen Crager, Morehead State University

Cognitive defusion refers to a variety of therapeutic techniques used in Acceptance and Commitment Therapy (ACT) that designed to help psychotherapy clients view their problematic thoughts in a less literal and serious fashion. The current study compared the distress-reducing effects of two variations of a common and brief ACT defusion technique relative to a brief "I'm having the thought that...." intervention intended to help subjects thing more rationally about personally held, distressing, negative self-judgments. The defusion intervention was significantly more effective at reducing distress than the control intervention.

• FACT*: Focused Acceptance and Commitment Therapy A Pilot Study to test two brief interventions in clinical populations
Roberto Cattivelli, Istituto Auxologico Italiano
Giada Pietrabissa, Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Italy; Department of Psychology, Catholic University of Milan, Italy
Martina Ceccarini, Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Italy; Department of Psychology, University of Bergamo, Italy
Valentina Villa, Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Italy
Annalisa Caretti, Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Italy
Arianna Gatti, Private Practice, Italy
Gian Mauro Manzoni, Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Italy; Faculty of Psychology, eCampus University, Italy
Gianluca Castelnuovo, Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Italy; Department of Psychology, Catholic University of Milan, Italy

Focused Acceptance and Commitment Theory focus on ways to improve behavioral flexibility for brief therapy and consulting settings and are consider cost-effective treatments, with equal or better outcomes compared with more traditional Cognitive Behavioral Treatments. FACT interventions are generally considered more sustainable and applicable than longer and more expensive treatment, especially for brief hospitalizations. In the first study we tested the effectiveness/efficiency of a FACT intervention, a brief 6 hour protocol for outpatient diagnosed with SAD, to change SAD-related behaviors directly observed during sessions and collected in directed ways between sessions. Preliminary findings of this pilot study are promising, suggesting an increase of adequate behaviors and a reduction of inappropriate ones. Psychometric measurements through Outcome Questionnaire 45.2 and AAQ-II are consistent with behavioral data. In the second study we use a very brief group FACT intervention for obese inpatients during a one-month rehab program during hospitalization. With this pilot study for a future, larger RCT we compare FACT intervention with well-established CBT treatment, preliminary findings seems to support the use of FACT to improve healthy life style in the obese population. In both cases we assess treatment fidelity through inter observer agreement to check consistency with manualized intervention such as Focused ACT.

Educational Objectives:
1. Describe a brief analogue component cognitive defusion intervention and its control intervention. 2. Teach the role of defusion and hope at early phases of ACT interventions. 3. Conduct a pilot study for a subsequent RCT.

 

17. Online ACT for Chronic Pain: Content, Novel Methods of Delivery, Feasibility, and Efficacy Across three Cultural Contexts
Symposium (10:30-12:00)
Components: Original data
Categories: Behavioral medicine, Clin. Interven. & Interests, Chronic Pain
Target Audience: Beg., Interm., Adv.
Location: Nizza

Chair: Lance McCracken, Ph.D., King’s College London & INPUT Pain Management, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
Discussant: Lance McCracken, Ph.D., King’s College London & INPUT Pain Management, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

Acceptance and Commitment Therapy (ACT) is associated with clinically meaningful improvements in daily functioning and quality of life in people with chronic pain. Most studies of ACT for chronic pain have occurred in the setting of highly specialized treatment centres, which are typically visited by a small proportion of people with chronic pain whose problems are relatively more complex. There is a need, therefore, to develop and evaluate forms of ACT-based treatment that are easier to access, more widely applicable, and more affordable. With the development of better, faster, and more widely available internet communication technologies, this is a natural resource to incorporate into such treatment developments. This symposium will identify key opportunities and challenges in the provision of ACT for chronic pain online. The speakers will discuss the development of three novel internet-based administrations of ACT for pain across three different cultural contexts: England, Germany, and Singapore. Emerging data describing the efficacy of these interventions will be presented. Opportunities for future treatment refinements and research will be discussed.

• Online Acceptance and Commitment Therapy for Individuals with Chronic Pain in the United Kingdom: Treatment Development, Research Protocol, and Preliminary Data
Whitney Scott, PhD, King's College London

Speaker 1 will describe the development of an English-language version of ACT online for chronic pain. The treatment was developed on the basis of previous research on ACT for pain and the online psychological treatment delivery literature. Three clinical psychologists with expertise in ACT for pain worked in collaboration with a digital media team with extensive experience developing web-based applications for the National Health Service in the United Kingdom. The content of the treatment program will be described, as will design features aimed to optimize participant engagement and retention. The speaker will describe the protocol for a small randomized controlled trial to test the feasibility of the intervention. Qualitative data examining patients’ experiences and satisfaction with the treatment will be presented. Preliminary quantitative outcome data will also be presented. Opportunities for refining the intervention and adapting the treatment for other patient groups will be discussed.

• Efficacy and Cost-Effectiveness of a Guided and Unguided Online-Based Acceptance and Commitment Therapy for Chronic Pain: a Three-Armed Randomized Controlled Trial
Jiaxi Lin, MSc, Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany
Marianne Lüking, Interdisciplinary Pain Center, University Medical Center Freiburg, Germany

Speaker 2 will present feasibility data on a study examining the efficacy and cost-effectiveness of guided and unguided versions of an online Acceptance and Commitment Therapy intervention for persons with chronic pain (ACTonPain) in Germany. In this ongoing pragmatic three-armed RCT aiming at a sample of 300 participants, the programs of guided and unguided ACTonPain are compared to a waiting list control group. Assessments take place before, 9 weeks after, and 6 months after randomization. The primary outcome is pain impairment; secondary outcomes include physical and emotional function, pain intensity, and ACT-related process variables. As yet, 42 participants have been randomized with 14 having filled out the post-assessment. Experiences on the program's usability and study recruitment will be discussed. Preliminary results of the efficacy-analyses will be presented. The study contributes to the improvement of the evidence-base for internet-based pain interventions and provides valuable information about treatment success and cost-effectiveness in relation to the degree of support provided by the intervention.

• Development and Feasibility of a Culturally Adapted Version of Internet-Delivered ACT for Chronic Pain in Singapore
Su-Ying Yang, MSc, King's College London; Pain Management Clinic at Tan Tock Seng Hospital, Singapore
,

Internet-delivered cognitive-behavioural therapy, including Acceptance and Commitment Therapy (ACT), has been shown to be effective in both physical and mental health domains, including chronic pain. These treatment methods have been shown to produce benefits for people with chronic pain in eight prior randomized-controlled trials and another eight effectiveness studies in the US, UK, Sweden, and Spain. However, little is known about the efficacy of this delivery method in South-East Asia, including Singapore, where widespread availability of the internet and smartphones makes internet-based treatments highly feasible. Therefore, this study developed an online-based ACT approach for a Singapore chronic pain population. The speaker will discuss the content, format, and delivery style of a novel internet-based ACT treatment that was tailored to be culturally sensitive and to address the specific needs of the Singapore chronic pain population. Preliminary data from an ongoing pilot trial combining face-to-face and internet-delivered treatment will also be discussed.

Educational Objectives:
1. Attendees will understand key issues in the design and delivery of internet-based administrations of ACT. 2. Attendees will be able to describe the state of the evidence regarding the efficacy of ACT online for pain. 3. Attendees will be able to identify future opportunities for refining online ACT for pain and for extending the research in this are.

 

18. A path from psychological inflexibility to psychological flexibility. Analyses of the components involved
Symposium (10:30-12:00)
Components: , Original data,
Categories: Relational Frame Theory, Inflexibility, flexibility, rumiation, acceptance, defusion
Target Audience: Interm., Adv.
Location: Cannes

Chair: Juan Carlos López López, University of Almeria
Discussant: Michael E. Levin, Utah State University

The Acceptance and Commitment Therapy (ACT) model is oriented to disrupt destructive experiential avoidance and to increase psychological flexibility. Experiential avoidance refers to a pattern of verbal regulation based on deliberate attempts to avoid and/or escape from private events experienced as aversive. This is problematic when it is maintained as an inflexible pattern that prevents the person from doing valued actions. Numerous studies have analyzed the role of experiential avoidance in experimental tasks or the impact of acceptance versus control strategies in experimental procedures that involved discomfort. However, the RFT experimental analyses of the avoidance-based regulation strategies involved in psychological inflexibility (1) and of the methods involved in its weakening as metaphors in the ACT model (2) as well as the role the key processes as acceptance or defusion in the flexibility when the discomfort plays (3) are still very scarce. The first study aims the point 1, the second study aims the points 1 and 2, and the third study covers the point 3.

• An Alternative Method to Induce Rumination
Nikolett Eisenbeck, M.A., University of Almeria. SPAIN
Carmen Luciano, Ph.D., University of Almeria. SPAIN

From a Relational Frame Theory (RFT) perspective, we understand the rumination as the expansion of the verbal network. The present study aimed to explore an RFT-based method to generate Rumination and compare its effects to Distraction. Effects of conditions were examined with a pre-post design among 28 participants. First, participants had to report a negative self-referential thought and assess it. Then, they were assigned in one of the two conditions. And finally, they had to reassess their negative thought. Mood checks were realized along the procedure. Results showed that the negative assessment related to the initial thought diminished in both conditions. However, in Rumination, the expansion of the verbal network enabled the transfer of aversive functions of the initial event to further elements of the network. Consequently, due to the presence of numerous aversive private events, the participants’ mood diminished. Results are discussed in terms of maladaptive functions of rumination.

• Experimental Analogue of Conditions that Enhance and Weaken the Psychological Inflexibility
Adrian Barbero-Rubio, M.A., University of Almeria. SPAIN
Carmen Luciano, Ph.D., University of Almeria, SPAIN

This preliminary study promotes the context of psychological inflexibility through an experimental analogue of conditions involved in rigid dominance of psychological reactions. And this context allows to analyze various components (metaphors) involved in breaking the pattern of inflexibility. For this, in the first phase, 30 participants were randomly assigned in three groups and performed the experimental task. The task was designed to capture rigid psychological reactions. In the second phase, group I and II participants received an Inflexibility-protocol and participants in group III participants received a Control-protocol. In Inflexibility protocol the participant performed exercises promoting the psychological inflexibility reactions to private events with aversive functions. In the third phase, all groups repeated the task. In the fourth phase, group I participants performed exercises for weaken the inflexibility pattern. Group II and III were controls. Finally, in the fifth phase, all groups repeated the task. Results indicate significant effects of protocol inflexibility on task performance (inflexibility group had low performance in comparison with the control group) and significant data in exercises designed to weaken this pattern (group I participants had better performance than the group II and III participants). It is argued on processes enhances and rupture of inflexibility clinic pattern.

• Examining the “Open” Responsive Style of Acceptance and Defusion Processes in Mediating Pain Interference and Psychosocial Adjustments to Pain Management
Vasilis Vasileiou, Department of Psychology, University of Cyprus, Cyprus
Maria Karekla, Ph.D., Department of Psychology, University of Cyprus, Cyprus
Orestis Kasinopoulos, Department of Psychology, University of Cyprus, Cyprus

Acceptance and defusion are two of the six processes of the Psychological flexibility model (PF; Hayes et al., 2012). These two processes together have been described as the “open” response style. Recent evidences have demonstrated that when these two processes are cultivated, positive treatment gains are made (Vowles, et al.2014). The aim of this study is to examine the mediating effects of defusion and acceptance, between pain interference and psychosocial variables of pain (e.g. anxiety, depression, pain intensity).160 chronic pain patients completed a packet of self-report questionnaires (AAQ, CPAQ, PIPS, CAMS, HADS etc). A series of SEM models showed an expected direction of loading values such that higher scores in acceptance and defusion were associated with lower pain intensity, emotional distress, and pain interference. Correlations among the latent variable and acceptance and defusion, were also significant. Dismantling studies and multivariate examination of the PF processes provide further evidence of the relevance of response styles and how they are related to patients function.

Educational Objectives:
1. Analyzing the components involved in the pattern of psychological inflexibility. 2. Generating inflexible patterns. 3. Describing the role of ACT processes in the pain interference.

 

30. ACTing for Global Smoking Cessation
Symposium (14:45-16:15)
Components: Original data
Categories: Behavioral medicine, Clin. Interven. & Interests, Prevention & Comm.-Based, Smoking cessation
Target Audience: Beg., Interm., Adv.
Location: Strassburg

Chair: Megan M. Kelly, Edith Nourse Rogers Memorial Veterans Hospital
Discussant: Maria Karekla, University of Cyprus

Despite decades of effort at smoking cessation, smoking continuous to be a significant problem worldwide, with millions of smoking related deaths every year. Smoking cessation methods to date (nicotine replacement, medication, CBT) have been moderately successful in achieving cessation goals. The ACT approach offers advantages over previous treatments as it includes elements for motivating individuals to make a quit attempt and deals with internal cues and reasons for smoking (and relapse). The present symposium will present advances in the area of smoking cessation utilizing the ACT technology. First a study examining the role of cognitive defusion vs. avoidance on smoking behavior will be presented. The second talk will present the feasibility and acceptability of ACT for U.S. Veterans with Posttraumatic Stress Disorder and Tobacco Addiction (ACT-PT). The final presentation will discuss the acceptability of an innovative technologically program (avatar led internet based intervention) based on ACT principles for smoking cessation among youth.

• The Effect of Cognitive Defusion on Smoking Behavior
Nic Hooper, University of the West of England
Charlotte Dack, University of Bath
Maria Karekla, University of Cyprus
Asli Niyazi, Middle East Technical University
Louise McHugh, University College Dublin

Investigating the individual components of Acceptance and Commitment Therapy (ACT) allows a microscopic view of which processes contribute towards successful behavior change. The current study aimed to determine whether cognitive defusion could be useful in reducing smoking behavior over a two-week period. Three groups of participants were asked to reduce their cigarette consumption for the first week. To aid them in their abstinence, group 1 received a defusion intervention, group 2 received an avoidance intervention and group 3 (waitlist control) received no intervention. In week 2 the instruction to reduce cigarette consumption was lifted. During both weeks all participants were required to monitor their smoking behavior via a tally diary system. Results indicated that the defusion group smoked significantly less than the waitlist control group per day during the intervention week and significantly less than the waitlist control and avoidance group during week 2 when the instruction to reduce cigarette intake was lifted. Defusion prompted a significant reduction in smoking behavior, suggesting that it is an important and active component of the ACT model.

• The Feasibility and Acceptability of an Acceptance and Commitment Therapy Smoking Cessation Treatment for U.S. Veterans with PTSD
Megan M. Kelly, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA

The present study evaluated the feasibility and acceptability of Acceptance and Commitment Therapy for U.S. Veterans with Posttraumatic Stress Disorder and Tobacco Addiction (ACT-PT), which focuses on helping Veterans overcome emotional challenges to quitting smoking. U.S. Veterans with PTSD (N=19) attended nine weekly individual counseling sessions and received eight weeks of nicotine patch. Primary outcomes included feasibility and acceptability of the intervention. The retention rate for ACT-PT was good (74%) and client satisfaction ratings were high. Participants made multiple quit attempts (M = 3.6, SD = 4.2) during the study period and were significantly more confident that they could quit smoking at three-month follow-up. At the end of treatment, 37% of participants were abstinent from smoking and 16% were abstinent at three-month follow-up. Smoking urges significantly decreased from baseline to the end of treatment and three-month follow-up. ACT-PT appears to be a promising smoking cessation treatment for Veterans with PTSD.

• Evaluating an Avatar led ACT Internet-Based Intervention for Smoking Cessation in Youth
Stella Nicoleta Savvides, University of Cyprus
Maria Karekla, University of Cyprus
Georgia Leonidou, University of Cyprus

Smoking remains a global concern and practices have not sufficiently accomplished cessation in youth. The present study aimed to create an Avatar led Acceptance and Commitment Therapy (ACT) internet-based intervention for smoking cessation and evaluate program satisfaction and effectiveness. Participants were 357 high school and university students, 15-28 years old (M = 21.06, SD = 2.96), randomized to either ACT or waitlist-control. Participants found the 6 online sessions satisfactory, useful, and motivating. Individuals in the treatment group had significantly higher quit rates than control (51.9% vs. 14.3%; OR = 6.46, 95% CI = 1.76 -23.71, p = .005) and significant improvements in smoking and ACT related measures. The treatment was found to work via its proposed mechanisms of action, as cognitive defusion mediated the relationship between group and cessation self-efficacy and intention to quit. Results are encouraging for the use of internet-based ACT, in smoking cessation for youth.

Educational Objectives:
1. To compare the effectiveness of cognitive defusion over avoidance strategies in smoking behaviors. 2. To examine the feasibility and acceptability of an ACT smoking cessation intervention for veterans with PTSD. 3. To present and examine the acceptability of an avatar led internet based intervention for smoking cessation targeting adolescent and young adult smokers not interested in quitting.

 

31. Living well with Illness: The Contribution of Psychological Flexibility to Identifying Transdiagnostic Treatment Targets
Symposium (14:45-16:15)
Components: Conceptual analysis, Original data, Didactic presentation
Categories: Behavioral medicine, Clin. Interven. & Interests, Psychological flexibility, Adults, Chronic Health Conditions
Target Audience: Beg.
Location: Room 30241

Chair: David Gillanders, University of Edinburgh
Discussant: David Gillanders, University of Edinburgh

Chronic illness is a global health concern and is increasing in the industrialised world due to population ageing. In this data driven symposium we will outline our approach to investigating the problem of living with long term and life limiting illness. We will outline the search for transdiagnostic treatment targets, derived from the psychological flexibility model. We have used cross sectional, longitudinal and intervention designs to investigate the relationships between traditional constructs and ‘third wave’ constructs in predicting important outcomes such as distress, disability and quality of life across a wide range of chronic health conditions. You will hear about this strategy applied to people living with chronic pain, cancer and a transdiagnostic group with a wide range of health conditions. You will hear about the comparative importance of constructs such as acceptance, illness beliefs and appraisals, coping strategies, cognitive fusion and self-compassion. We will also present the results of a novel intervention study, taking a transdiagnostic, group-based approach to people with diverse chronic health conditions.

• The Relationship between Acceptance, Catastrophising and Illness Representations in Chronic Pain
Nuno B. Ferreira, University of Edinburgh
Sujata Bose, NHS Tayside
Tammy Esrich, Worcestershire Health & Care NHS Trust
David Gillanders, University of Edinburgh

Cognitive and acceptance based approaches are used to help people live with chronic pain, though its unclear how these constructs relate to each other. In this cross sectional study of 150 people with chronic pain we examined how illness appraisals relate to catastrophising and acceptance of chronic pain. This study further examined how these processes relate to emotional and physical functioning in chronic pain. A distinct pattern of mediation was observed. The relationship between pain and distress was mediated by representations of pain as a highly emotive experience and by catastrophising; but not by acceptance. The relationship between pain and disability was mediated by acceptance and beliefs about consequences, but not by catastrophising. Different approaches to chronic pain rehabilitation emphasise different targets (changing illness representations and reducing catastrophising vs. acceptance and behavioural activation). This cross sectional study suggests that these processes may differentially influence outcomes.

• Self-Compassion, Cognitive Fusion, Mental Adjustment and Avoidance as Predictors of Distress and Quality of Life in Adults with Cancer
Ashleigh Sinclair, NHS Tayside
Margaret McLean, NHS Grampian
Kirsten Jardine, NHS Grampian
David Gillanders, University of Edinburgh

This study explored the predictive power of self-compassion and cognitive fusion in determining distress and quality of life in cancer patients, in comparison to the well established predictors: mental adjustment and coping styles. A quantitative cross-sectional design was used. 114 adults with various cancer diagnoses completed measures of mental adjustment to cancer, coping, self-compassion, cognitive fusion, distress and quality of life. Hierarchical multiple regression was used to explore relationships between predictor variables, distress and quality of life. Although all predictors were individually related to distress and quality of life, in the final model only Cognitive Fusion and Emotional Avoidance were found to be significant predictors of distress, and Emotional Avoidance was the only significant predictor of quality of life. Interventions focused on reducing cognitive fusion and emotional avoidance, such as Acceptance and Commitment Therapy may be warranted in this population.

• Better Living with Illness: A Transdiagnostic Acceptance and Commitment Therapy Group for People with Chronic Illness
Linsay Brassington, NHS Fife / University of Edinburgh
Nuno B Ferreira, University of Edinburgh
Shona Yates, NHS Fife
David Gillanders, University of Edinburgh

Chronic illness is on the rise and is associated with increased risk of psychological problems. Functional commonalities across physical conditions suggests a transdiagnostic psychological intervention may be beneficial. An Acceptance and Commitment Therapy (ACT) group intervention was evaluated for people with chronic physical health problems. Participants with long-term health conditions were invited to an ACT group (n=53). Measures were completed at assessment, pre, post and 3-month follow-up. These assessed anxiety and depression symptoms, health perceptions, values-based living and acceptance. Period from assessment to pre intervention served as a control. Depression and anxiety symptoms reduced significantly from pre to post, compared to control period. Significant improvements were found in values-based living and acceptance, even though perception of health status did not change significantly. Group-based ACT interventions may be beneficial for chronic illness and can be delivered transdiagnostically.

Educational Objectives:
1. Compare traditional and third wave constructs in their relationship to outcomes for people with chronic illness. 2. Appreciate functional commonalities across diverse health conditions. 3. Understand the contribution of cross sectional research to treatment development.

 

32. Toward a Coherent Model of Scientific Progress: Translational Research in Contextual Behavioral Science
Symposium (14:45-16:15)
Components: Original data
Categories: Clinical Interventions and Interests, RFT, Translational research
Target Audience: Interm.
Location: Room 30341

Chair: Brooke M. Smith, Utah State University
Discussant: Michael E. Levin, Utah State University

One of the main aims of Contextual Behavioral Science is to create a reticulated, coherent model of scientific progress (Hayes, Barnes-Holmes, & Wilson, 2012). To this end, and for the benefit of science more generally, it is essential that our applied technologies be based on well-articulated theory supported by empirical evidence. It is also essential that issues encountered in applied practice help to guide the research questions asked in basic science laboratories. In order to achieve this level of coherence, we must bridge the gap between basic and applied science. This can only be achieved through ongoing communication and a specific focus on the translation of findings in one domain to that of the other. The papers in this symposium highlight ongoing work aimed at bridging the basic and applied domains through the application of translational research methods.

• Effects of Differential Rates of Alternative Reinforcement on Resurgence of Human Avoidance Behavior: A Translational Model of Relapse in the Anxiety Disorders
Brooke M. Smith, Utah State University
Michael P. Twohig, Ph.D., Utah State University

CBT is considered the gold standard in anxiety disorder treatments (e.g., Olatunji, Cisler, & Deacon, 2010). However, response rates remain relatively low (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012), and relapse is not uncommon, especially during long-term follow-up (Durham, Chambers, Macdonald, Power, & Major, 2003). Basic researchers traditionally conceptualize the mechanism of exposure as Pavlovian extinction, but this may overlook the important role of operant processes. Resurgence has been used as a model for investigating the elimination and relapse of operant behavior and may provide a promising analogue of treatment. Animal research has shown that, while higher rates of alternative reinforcement result in more comprehensive extinction of target behavior, they also result in greater resurgence once reinforcement has been removed (e.g., Sweeney & Shahan, 2013). This finding is somewhat counterintuitive and could have important implications for clinicians; however, it has yet to be investigated in humans or with respect to negatively reinforced avoidance behavior. This study takes a translational approach to investigating the effects of high and low rates of positive reinforcement of alternative behavior on extinction and resurgence of positively and negatively reinforced target behavior in humans using a computerized analogue computer task.

• Transformation of Extinction Functions Through Derived Relational Networks
Nolan Williams, University of Louisiana, Lafayette
Emily Sandoz, Ph.D., University of Louisiana, Lafayette

Avoidance is implicated in a variety of psychopathologies. As humans we have the unique ability to relate stimuli to one another in such ways that the functions of some stimuli can be changed based on their relationships with other stimuli. Research has recognized that if one stimulus of a relational network of equivalence acquires a fear eliciting function that this function will transfer to the other members in the same network. It has also been suggested that extinction of fear elicitation might transfer throughout relational networks, though the conditions under which this might occur are not well understood. This process can contribute to human suffering because it can lead to widespread avoidance and prevent us from living meaningful lives. The purpose of this study was to learn more about how extinction might transfer through derived relational networks and if so whether or not avoidance responding to these stimuli would cease. Results from this work could provide useful insights for exposure treatments.

• Examining Paranoia in a Non-Clinical Population Using the Implicit Relational Assessment Procedure (IRAP)
Corinna Stewart, M.A., National University of Ireland, Galway
Ian Stewart, Ph.D., National University of Ireland, Galway
Yvonne-Barnes Holmes, Ph.D., National University of Ireland, Maynooth

Recent research has indicated that paranoia is a complex, multi-dimensional phenomenon that exists on a continuum with normal experiences. This suggests that researching non-clinical paranoia may inform the understanding of clinical paranoia. Some have argued that the dimensions of distress, preoccupation, and conviction, as well as appraisals of paranoiac experiences, may be more relevant than the content of the belief alone with respect to situating an individual on the continuum from health to psychopathology. Recently, RFT researchers have demonstrated that the IRAP is a valuable measure for examining a range of factors in relation to clinically-relevant phenomena, including depression, OCD, and voice-hearing. The current paper reports analogous work focused on paranoiac experiences in a non-clinical population which involved collecting IRAP measures of affective responding (e.g., distress) and appraisals/cognitions (e.g., “I need to be on my guard”) in response to paranoiac stimuli. The implications of how particular patterns of responding may inform our understanding of paranoia will be discussed.

Educational Objectives:
1. Explain the importance of bridging basic and applied scientific domains. 2. Provide specific examples of findings from basic science that inform applied science and practice. 3. Describe current approaches to translational research methodology.

 

33. Mindfulness & Acceptance with Children and Parents: Italy Chapter Sponsored
Symposium (14:45-16:15)
Components: Conceptual analysis
Categories: Educational settings, Prevention & Comm.-Based, adhd, mindfulness, defusion, parent training, stress
Target Audience: Beg., Interm.
Location: Nizza

Chair: Francesca Pergolizzi, IESCUM, Parma,
Discussant: Lisa Coyne (tentative), Harvard Medical School, U.S.

The symposium ACT4KIDS includes three papers illustrating recent and innovative developments in the field of act ad applied to children's and parent's sufferance.The first research paper will discuss the validation process of CAMM and AFQ-Y with a sample of Italian adolescents as they are representative of the Northern and Southern regions of Italy. The second paper presents an innovative ACT oriented group training to promote psychological adjustment and flessibility in children with cognitive and behavioral disorders.In the last paper the data of a new protocol of an act oriented parent training for young children with ADHD vs CBT traditional parent training will be discussed. All the contributes are the product of SIG ACT for kids and teens, which since 2010 is committed to studying and disseminating ACT in clinical and non clinical contexts.

• ACT Assessment with Children and Adolescents: The Italian Version of AFQ-Y and CAMM
Arianna Ristallo, Università IULM, Milano
Marta Schweiger, Università IULM, Milano
Sara Della Morte, Università IULM, Milano
Giovambattista Presti, Ph.D., M.D., Università Kore, Enna
Francesca Pergolizzi, Ph.D., ESCUM, Parma

To date there is no validated Italian questionnaire to measure psychological flexibility in adolescents. The aim of the study is to assess the psychometric properties of The Avoidance and Fusion Questionnaire for Youth (Greco, Lambert & Baer, 2008) and of The Child and Adolescence Mindfulness Measure (Greco, Baer & Smith, 2011), two self-report measures based on ACT conceptual and clinical framework. Study population. 433 Italian students from different part of Italy, age 11-18 (mean= 13.79 sd=1.54), 39.1% male, 60.5% female. Instruments. AFQ-Y, CAMM, Child Behavior Checklist Youth Self Report (Achenbach, 2001) and Youth Quality of Life Questionnaire (Patrick & Edwards, 2002). Statistical analysis. Data show good internal consistency of AFQ-Y and CAMM (Cronbach's Alfa = .79) For AFQ-Y the EFA suggested a 3 factors solution that accounted overall for 44.24 % of the variance. For CAMM the EFA suggested a 1 factor solution that accounted for 42.88 % of the variance. Correlations among instruments were explored. Discussion. Results show that the Italian version of AFQ-Y and CAMM are consistent with the ACT model and have good psychometric properties. Results also indicate that higher level of psychological inflexibility and poor mindfulness skills are related to anxiety, psychopathological symptoms and with a lower quality of life. Implication for clinical practice and future research will be discussed.

• The Next Generation of ADHD Child Training: From Impulsive Behavior to Mindfulness for Value-Based Choices
Laura Vanzin, Psy. D., Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
Valentina Mauri, Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
Maria Enrica Sali, Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
Arianna Bonfanti, Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
Giovambattista Presti, Ph.D., M.D., KORE University, IESCUM, Italy
Massimo Molteni, M.D., Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) face many difficulties in paying attention, regulating emotions and controlling impulsive and automatic responses. Several types of psychological intervention have been developed to target difficulties of children with such diagnosis. In recent years research about the effects of mindfulness-based approaches showed promising results in reducing attention and behavioral problems. The aim of this work is to present the structure and the first results of an experimental, group-based, Acceptance and Commitment Training-oriented program for children and adolescents aged 8-13 with a primary diagnosis of ADHD. In this program awareness of the present moment, defusion and acceptance of the emotions are promote in order to diminish immediate response to thoughts and feelings with the final goal to help children reduce impulsive behavior and increase value-oriented choices. Perspective taking exercises are introduced to foster empathy and social sensitivity.

• ACT - Enhanced Behavioral Parent Training for Parents of ADHD Children
Anna Prevedini, Ph.D., IULM University Milan; IESCUM Italy
Francesca Pergolizzi, Ph.D., Iescum, Parma
Laura Vanzin, Psy.D., Istituto Scientifico Eugenio Medea IRCCS – Bosisio Parini -Italy
Giovambattista Presti, Ph.D., M.D., KORE University Enna; IESCUM Italy
Annalisa Oppo, Psy.D., IESCUM, ITALY
PAOLO MODERATO, Ph.D., IULM University, IESCUM ITALY

The present research attempts to enhance a Cognitive-Behavioral Parent Training (CB-PT) manualized protocol for parents of children with Attention Deficit/Hyperactivity Disorder (ADHD) with Acceptance and Commitment Therapy (ACT based Behavioral Parent Training; ACT-BPT), used as a way to foster psychological flexibility and reduce parents’ psychological barriers that may both restrict new behavior management skills acquisition, and reduce a regular parents’ attendance of the training. 51 parents of ADHD children, were assigned by convenience either to a twice-monthly 12-session CB-PT (n=35) or to a twice-monthly 12-session ACT-BPT (n=16). Participants were assessed with sellf-report measures of children’s problem behaviors, parents’ psychological well being and parents’ ACT processes. 13 participants to the ACT-BPT and 15 to the CB-PT completed the training. Drop-out was higher in the CB-PT group (18,7%) than in the ACT-group (57,14%) (c2 = 6.537; p=0.015), namely the attrition rate was about six-times higher (OR=5.77; 95% CI: 1.39 – 23.97) in the CB-PT group than in the ACT-BPT group. Our pre-post intervention results was that the ACT-BPT group showed significant differences at 14 sub-scales of the measures of children’s problem behaviors, showing an improvement. Meanwhile, only 3 sub-scales of children’s problem behaviors showed significant differences in the CB-PT group. No pre-post differences intervention emerged in the measures of parents’ wellbeing in both groups. Regarding processes measures, only MAAS showed significant pre-post intervention differences only in ACT-BPT group, and not in the expected direction, showing a reduction in mindful awareness and attention (z=-3,07, p=0,002). Results will be discuss in the light of process considerations and methodological limitations of the research and some key points for future investigations will be pointed out.

Educational Objectives:
1. Highlighting the peculiar features of ACT application with young people, particularly the need of balancing ecological value and creativity, and experimental control. 2. Describing different perspectives and outocomes between traditional CBT parent training and ACT training to cope with complex interactions with problematic sons. 3. Extending the international validity and applicability of CAMM and AFQ-Y and share these new tools with scientific community.

 

34. Programs for Children and Parents: Implementation and Effectiveness
Symposium (14:45-16:15)
Components: Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, ACT for childhood anxiety, Mindfulness, pregnancy, psychological flexibility, anxiety, depression
Target Audience: Beg., Interm.
Location: Cannes

Chair: Helen Bolderston, Ph.D., Bournemouth University, UK
Discussant: Giovambattista Presti, MD, PhD, Kore University, Enna (Italy)

To date, applications of ACT have concentrated predominantly on adult problems and populations. However, there is growing empirical support for ACT interventions for children and parents. This symposium presents three studies that evaluate intervention for young people with anxiety, pregnant women and parents in Uganda. The first study describes and evaluates an ACT treatment for children and adolescents with anxiety. The second study explores the effectiveness of a brief mindfulness-based intervention for pregnant women in terms of awareness and perceived stress. Finally, the third study presents a parenting program to improve child nutrition and stimulation in Uganda. Program dissemination and evaluation will be discussed.

• The “ProACTive” program for children with anxiety disorders – longitudinal data and community dissemination
Angela Dixon, PhD, Children's Hospital Westmead, Sydney, Australia
Jessica Swain, MPsych, University of Newcastle, Newcastle, Australia
Karen Hancock, PhD, Children's Hospital Westmead, Sydney, Australia
Siew Koo, M.Psych, Children's Hospital Westmead, Sydney, Australia
Cassandra Hainsworth, M.Psych, Children's Hospital Westmead, Sydney, Australia
Karen Munro, M.Psych, Children's Hospital Westmead, Sydney, Australia

Anxiety disorders are among the most common psychological problems experienced by children and adults worldwide. Around 75% of adult sufferers develop anxiety during childhood, making early identification and intervention crucial. This paper describes “ProACTive” - an ACT treatment for young people with anxiety using a CBT framework. ProACTive is a manualised, group treatment program developed for children (7 – 11 years) and adolescents (12 – 17 years) and empirically validated via the first randomised-controlled trial of its kind (N=158). Results of post-treatment and three-month follow-up demonstrated significant improvements compared to wait-list controls, and comparable gains to children receiving CBT only. Two-year follow-up results will also be presented, demonstrating maintenance of gains over time. Discussion of program dissemination and evaluation from the hospital setting into the public schools will also be included. This program is an evidence-based alternative to CBT that can be implemented for a pervasive psychological problem across a variety of contexts.

• Being a mindful mother: Application and efficacy of a brief mindfulness-based intervention on a pregnant women sample
Erika Melchiorri, Psy.D., Associazione Italiana Scienze Comportamentali e Cognitive, AISCC
Emanuele Rossi, Psy.D., Associazione Italiana Scienze Comportamentali e Cognitive, AISCC
Valentina Carloni, Psy.D., Associazione Italiana Scienze Comportamentali e Cognitive, AISCC
Alessia Panzera, Psy.D., Associazione Italiana Scienze Comportamentali e Cognitive, AISCC

Pregnancy and puerperium are characterized by deep biological and psychological changes, usually combined with thoughts, feelings and concerns about three main aspects: pregnant’s bodily experience and the representation of herself as a mom; expectations towards the future child; relationship with the partner. A non-clinical sample of pregnant women enrolled between 17 and 35 weeks gestation compiled a set of questionnaires assessing psychological wellbeing, anxiety, depression, mindfulness abilities and psychological flexibility. Then, they participated to a four-week mindfulness-based intervention aimed to increase their awareness and psychological flexibility. A week later, the future moms repeated the measures compilation to verify the intervention effectiveness. The current study shows that, for a pregnant woman, keeping present and aware about the changes, observing her thoughts and feelings without necessarily act on them and looking with curiosity and openness her own fears and concerns have important positive implications on psychological wellbeing.

• Integrating contextually-relevant behavioural science across maternal mental health and child stimulation practices in rural Uganda
Daisy Singla, Ph.D., McGill University

INTRODUCTION: In the last decade, a number of parenting programs have been effectively implemented in low- and middle-income countries (LMIC) to improve child nutrition and stimulation, two primary contributors to poor child development (Walker et al., 2007). Because young children are especially vulnerable and dependent on their mothers for nutrition and stimulation, researchers now also acknowledge the importance of maternal mental health on child development (Rahman et al., 2013). Brief, integrated programs have rarely been implemented; one challenge to integrating maternal mental health along with stimulation may be a coherent set of contextually-relevant practices. The objective of the current study is to examine how various psychotherapeutic techniques, under the message of ‘love and respect’, were adapted and incorporated in one theory-informed, parenting program in rural Uganda. METHOD: The current study took place within a larger cluster effectiveness trial in Lira, Uganda which found benefits to child development among children 12 to 36 months, and reduced their mothers’ depressive symptoms (Singla, Aboud & Kumbakumba, in review). 12 intervention clusters within community-based settings targeted parents on five key messages (diet, hygiene, play, talk and love and respect to promote mothers’ relationships with herself, her child and spouse) and were compared to 12 wait-list control clusters. Semi-structured interviews were conducted at midline with peer delivery agents (n=12) and mothers (n=31) who participated in the parenting program and at endline with supervisors (n=4). Content analysis was used to analyze qualitative data in terms of barriers and facilitators in relation to intervention content and delivery strategies. Recipient data on recall and enactment of practices along with their barriers and facilitators were coded and analyzed statistically. RESULTS: Among the five key program messages, ‘love and respect’ was the most practiced, easiest to implement, and mothers reported the most internal facilitators for this message. The common strategies shared by stimulation and maternal depression interventions allowed delivery agents to integrate seamlessly the two sets of messages using similar active-interactive techniques for behaviour change. Specifically, interactive and active strategies based on social cognitive learning theory, namely role play with peers, practice with children and problem-solving were reported as facilitators to intervention delivery. Home visits and the presence of an established NGO were also perceived to foster the therapeutic alliance between delivery agents and participants. DISCUSSION: Our results highlight the shared basis of social cognitive learning strategies among techniques used in maternal mental health and parenting stimulation interventions in LMIC communities. These findings are important to improve the content, delivery, and integration of contextual behavioural science in mother-child interventions in LMIC settings.

Educational Objectives:
1. Explain the ProACTive treatment program for children and adolescents with anxiety disorders, including utilization in a variety of contexts. 2. Conduct a brief mindfulness-based intervention on pregnant women 3. Describe the use of evidence-based psychological techniques within a theory-informed parenting framework in low-resource, global context.

 

38. Moving Forward on a Contextual Approach to Public Health
Symposium (16:30-17:45)
Components: Conceptual analysis, Original data
Categories: Prevention and Community-Based Interventions, Related FC approaches, Public Health and Prevention
Target Audience: Interm.
Location: Strassburg

Chair: Anthony Biglan, Oregon Research Institute
Discussant: Michael Twohig, Utah State University

This symposium will describe how contextual behavioral science can contribute to fulfilling its mission of creating a science that is “more adequate to the challenge of the human condition” (Hayes, Barnes-Holmes, & Wilson, 2013) by incorporating key elements of the public health framework. The symposium will present a public health framework for conceptualizing human wellbeing and sketch its implications for affecting wellbeing in entire populations. It will then present three examples of functional contextual research on three different aspects of wellbeing in populations. The symposium will begin with an introduction to the public health framework. Public health evolved out of often desperate efforts to control infectious diseases. However, the principles of tracking the incidence and prevalence of a disease, testing interventions to affect incidence and prevalence, and widely implementing programs, policies, and practices that affect the problem are relevant to virtually any problem of human wellbeing. We will then introduce the three papers to be presented and mention how they fit with the public health framework.

• A Public Health Approach to Increasing Psychological Flexibility
Andrew Gloster, Ph.D., University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology

This presentation will review the evidence on role of psychological flexibility in a range of psychological and behavioral problems. First, data from a representative sample of Switzerland (n=1035) will be examined. These data are some of the first nationally representative data collected and thus allow important predictions of population level trends. For example, these data will test the impact and importance of psychological flexibility as a moderator between “predictors” such as experienced adversity, stress, age, etc and “outcomes” such as mental distress, health-care seeking, exercise, nutrition, and well-being. Second, an example of “scaling-up” will be presented in which “highly stressed” people self-referred from an insurance company to take part in an online self-help program without any therapist contact. These data will be discussed within the context of developing a strategy for increasing the prevalence of psychological flexibility in entire populations.

• Targeting Prejudice/Stigma at a Public Health Level
Michael Levin, Utah State University
Jason Lillis, Weight Control and Diabetes Research Center, The Miriam Hospital/Brown Medical School
Jack Haeger, Utah State University

Prejudice and stigma are a key source of human suffering and conflict, affecting those belonging to a breadth of marginalized groups, be it based on race/ethnicity, religion, sexual orientation, psychological problems, weight, and so on. This presentation will explore a CBS approach to targeting prejudice/stigma, with an emphasis on how psychological flexibility might be applied and how such efforts could be scaled up to impact large numbers. Relevant research will be reviewed that highlight and extend the role of psychological flexibility processes in prejudice/stigma reduction including motivations to control prejudiced reactions, generalized prejudice, inter-group contact, perspective taking/empathy, and aversive racism. Based on this literature, potential methods for scaling up psychological flexibility interventions will be explored both in reducing prejudice/stigma and supporting those who are its target (e.g., coping with micro-aggressions, enacted stigma, self-stigma). Challenges in translating existing interventions to this area will be identified along with areas for future research.

• Internet-Delivered ACT in the Treatment of Sleeping Problems – Acceptability and Participant Experiences
Päivi Lappalainen, University of Jyväskylä, Finland
Raimo Lappalainen,, University of Jyväskylä, Finland
Sitwat Langrial, University of Oulu, Finland
Harri Oinas-Kukkonen,, University of Oulu, Finland

Introduction: Insomnia and sleep disorders are a common problem: about a third of the general population suffers from symptoms including difficulties in cognitive performance and psychological distress. Therefore, it is important to develop cost-effective and easily available methods to treat sleeping disorders. One of the possible treatment alternatives could be web-based interventions. Objectives and Methodology: The purpose of this RCT-study (N=86) was to determine the impact of a six-week non-guided web-based intervention based on Acceptance and Commitment Therapy on insomnia and dysfunctional beliefs about sleep. In addition, the aim was to investigate how people suffering from sleep problems accept a web-based treatment program without any support. Results: The results indicate that the web-based sleep intervention was well-received. The intervention impacted positively the quality of sleep and dysfunctional beliefs and attitudes about sleep. However, the between group effect sizes were small when compared to WLC. Discussion and Conclusion: Internet-delivered ACT for sleeping problems combined with weekly reminders was well-accepted by the participants.

Educational Objectives:
1. Educational Objective: Understand how ACBS principles can fit into a public health framework and identify examples. 2. Educational Objective: Learn potential ways psychological flexibility could be applied to target prejudice and stigma at a large scale. 3. Educational objective: Describe and understand how Internet-based interventions targeting psychological flexibility could be applied for larger populations.

 

39. Brief ACT Interventions: Understanding their benefit and processes of change: Mexico Chapter Sponsored
Symposium (16:30-17:45)
Components: Original data, Didactic presentation, Case presentation
Categories: Prevention and Community-Based Interventions, Clin. Interven. & Interests, Performance-enhancing interventions, Superv., Train. & Dissem., Other, Self-help and subclinical measures, Borderline Personality Disorder, depression
Target Audience: Beg., Interm., Adv.
Location: Room 30241

Chair: Lucia Engeli, Ph.D., Kantonsspital Aarau
Discussant: Kirk Strosahl, Central Washington Family Medicine

This symposium presents three studies that evaluate brief interventions in individual and group settings, based on ACT, DBT and FAP, using diverse populations. The first study tests the effect of a 6 hour protocol for social anxiety disorder. The second study compares DBT, ACT and ACT/FAP interventions for Borderline personality disorder against each other. Finally, the third study aims to examine the long-term benefits of a 4-session ACT-based intervention for depressive symptoms. Emerging data suggest the efficacy of these brief interventions. Study contributions, limitations and future directions will be discussed.

• Testing delivery modes for brief self-help for negative thinking.
Andreas Larsson, PhD, Private Practice
Nic Hooper, University of West England

Kazdin and Blase (2011) suggests self-help interventions as a possible prevention tool for the challenge that is the vast amount of suffering due to mental health problems. in The presented studies two techniques for coping with negative thoughts: cognitive restructuring and cognitive defusion are compared for relative effectiveness. The difference between the two studies were in delivery (i.e., one to one vs. online). In both studies participants were either provided with a cognitive restructuring, defusion or no instruction control technique to manage a personally relevant negative thought. Participants were reminded, via SMS messages, to use their assigned strategy in managing the thought across a five-day period. Pre- and postmeasures were the (1) believability, (2) comfort, (3) negativity and (4) willingness to experience their unwanted thought. The results indicate that both restructuring and defusion were effective in decreasing the believability and negativity, and increasing comfort and willingness to have the negative thought. Further analyses suggested that defusion tended to be more helpful than restructuring across all four domains and both delivery methods but that face-to-face delivery was more effective than online. The findings are discussed in terms of the efficacy of using defusion as a preventive strategy for managing unwanted thoughts.

• Comparison of 4 Brief Contextual Behavioral Interventions for Borderline Personality Disorder, the process of building an empirically supported treatment as usual.
Michel Reyes Psy.D., Contextual Science and Therapy Institute (Mexico City), National Institute of Psychiatry Ramon de la Fuente
Nathalia Vargas Psy.D., Contextual Science and Therapy Institute (Mexico City), National Institute of Psychiatry Ramon de la Fuente
Edgar Miranda M.Ps., Instituto de Terapias Contextuales (Mexico D.F.), Instituto Nacional de Psiquiatría Ramón de la Fuente

This paper describes the process of developing an empirically supported TAU for BPD in Mexico’s National Institute of Psychiatry. Four brief interventions (N=35 each) where assessed. A DBT informed treatment (individual + group sessions) was compared to an ACT treatment (individual + group) that showed better (but no statistically significant) impacts in BPD symptom severity, difficulties in emotion regulation, psychological flexibility, attachment, experience of self and significant less attrition and emergency services use at posttest. This same treatment was statistically superior in all variables (p≤.01) compared to an ACT therapy consisting only of the group sessions. Finally a mixed ACT/FAP intervention (individual + group sessions) showed better clinical impacts and was statistically superior (p≤.01) in attachment and treatment adherence, becoming the current TAU of the institution. Treatments characteristics and study design are described; and study contributions, limitations and future directions discussed.

• What happens after five years? - The long-term effects of a 4-session ACT-based intervention for depressive symptoms
Aino Kohtala, M.A., University of Jyväskylä; Kuopio Psychiatric Center
Raimo Lappalainen, Ph.D., University of Jyväskylä

Subclinical mood problems as well as clinical depression are at the top of the list in the most common psychological problems among clients seeking for psychological services (e.g. Kessler, Chiu, Demler, Merikangas, & Walters, 2005). Cognitive-behavioral therapies have been reviewed as empirically supported treatments for depression (Hollon & Ponniah, 2010), but there is uncertainty regarding the long-term benefits. The objective of our study was to examine the long-term (5-year) effects of a 4-session ACT-based intervention for depressive symptoms. Beyond the numerical data we are also interested in client experiences and how clients see the possible effect of those four meetings to their well-being. Originally 57 self-referred clients were randomized in two groups: treatment and waiting-list control, which was treated later with similar positive outcomes (Kohtala et al., in press). The groups were combined for the 6-month (n = 52) and 5-year (n = 30) follow-ups. The results show no difference between the post- and both of the two follow-up measurements indicating the maintenance of the treatment effect among 50% of the original clients. With-in group effect size (pre to 5-year follow-up) varied from 0.7 to 1.6 depending on the measure.

Educational Objectives:
1. Describe the relative effectiveness of defusion in guided and online self-help for negative thoughts. 2. Explain the different benefits and limitations of group, individual and combined intervention for BPD. 3. Discuss the future implications ofclient experiences and treatment outcomes.

 

40. Experimental analysis of brief Mindfulness and Defusion-based interventions
Symposium (16:30-17:45)
Components: Original data
Categories: Performance-enhancing interventions, Clin. Interven. & Interests, Beh. med., RFT, Mindfulness, Defusion, Online, Component Analysis
Target Audience: Interm.
Location: Room 30341

Chair: Luis Jorge Ruíz-Sánchez, Universidad de Almería
Discussant: Steven C. Hayes, University of Nevada

This symposium aims to present studies in the area of clinical protocol analysis. All three experiments analyze the key characteristics of their interventions and explain their results from a Relational Frame Theory (RFT) perspective. The first study examined the necessary amount of interactions in an online Acceptance and Defusion protocol in order to affect the participant’s behavior. The second study analyzed whether the use of first person and second person to refer to the participants’ thoughts during a Defusion interaction would change its efficacy. And the third study realized a detailed analysis of a mindfulness exercise, the Focused Breathing Exercise (FB) and suggested two key elements that may be responsible of its efficacy in controlled laboratory settings. Overall, these studies show that a detailed, RFT-based analysis of clinical protocols may enable to understand basic processes that operate in them and generate more efficient practices in the future.

• Analysis of Brief Online Acceptance and Defusion-Based Interventions
Karoly Kornel Schlosser, M.A., Goldsmith University of London
Nikolett Eisenbeck, M.A., Universidad de Almería

ACT is increasingly used in online interventions, however, it is still not completely clear what type of alterations are needed in order to adopt protocols to this platform. Therefore, the aim of the present study is to examine the efficacy of two ACT-based online protocols. 90 healthy participants were randomly assigned to an Acceptance and Defusion protocol (AD 1), a limited Acceptance and Defusion protocol (AD 2) and a non-intervention Control condition. Differences between AD 1 and AD 2 were based on the level of interaction required to complete from the participant. Effects of protocols were assessed by a cognitive test, manipulation checks and mood evaluations. Results suggested the superiority of AD 1 in cognitive performance and mood evaluations compared to the remaining two conditions. Results are discussed from a contextual-functional approach.

• Effects of Using the First and Second Person in Defusion Interactions
Víctor Callejón Ruiz, M.A., Universidad de Almería
Carmen Luciano, Ph.D., Universidad de Almería

This study analyzes the effects of using the first and second person to refer to the participants’ thoughts during a defusion interaction. Firstly, 30 participants realized a stressful task and their aversive task-related thoughts were collected. Secondly, they were randomly assigned to one of three conditions: First Person (FP), Second Person (SP) and Control. Participants received, respectively, a condition-consistent protocol. Thirdly, they repeated the stressful task. During the task they were listening their own aversive thoughts form an audiotape either in first or second person, depending on the experimental condition they were assigned to. In Control, the participants listened to a neutral audiotape. Fourthly, they repeated the task, but participants in FP listened their thoughts in second person and participants in SP listened them in first person. Self-reported measures and task performance suggested that the use of different persons during a defusion exercise may alter its effects.

• Component Analysis of the Focused Breathing Mindfulness Exercise
Nikolett Eisenbeck, M.A., Universidad de Almería
Carmen Luciano, Ph.D., Universidad de Almería
Sonsoles Valdivia-Salas, Ph.D., Universidad de Zaragoza
Juan Carlos López López, Universidad de Almería

The aim of the present study was to examine the components of the focused breathing mindfulness exercise (FB). It was analyzed whether removing certain elements of the exercise would change its efficacy. 62 healthy, mindfulness-naïve undergraduate students were randomly assigned to four conditions: FB, FB without attention refocusing practice of (FBWF; removal of hierarchical frame and behavior regulation cues), FB without connections with the experimental task (FBWC; removal of coordination frame cues with the task) and Control. The study used a pre-post design with the following outcome measures: the computerized version of the Paced Auditory Serial Addition Task (PASAT-C) along with measures of self-reported dysphoria and mood levels. Results showed that enhanced post-test performance on PASAT-C and lower post-test dysphoria levels could only be observed in the FB condition, indicating that the removed elements may be central parts of the exercise. Findings are discussed from a contextual-functional approach.

Educational Objectives:
1. Relational Frame Theory-based analysis of clinical protocols. 2. Explanation of basic processes in clinical interventions. 3. Enhancement the efficacy of defusion and mindfulness-based techniques.

 

41. Advances in ACT for Psychosis: Adaptations, Expansions, Adherence and Mechanisms
Symposium (16:30-17:45)
Components: Original data
Categories: Clinical Interventions and Interests, Clin. Interven. & Interests, Psychosis, PTSD, therapy adherence, mechanisms of change
Target Audience: Beg., Interm.
Location: Nizza

Chair: Eric Morris, Ph.D., La Trobe University
Discussant: Louise Johns, King's College London

Recovering from psychosis can be a huge challenge. Along with unusual experiences (such as paranoia, hearing voices and delusional beliefs) and negative symptoms (motivation, diminished affect), people can struggle with changes in emotional wellbeing and sense of identity. Due to stigma, people can feel shame and alienation from their communities. Contextual behavioural science may have much to offer in tackling these challenges, for individuals, families, and communities. ACT as a psychological therapy for psychosis is being refined through empirical study. This symposium will present advances in adapting ACT across the stages of psychosis and helping with key problems (trauma, positive symptoms, depression). Evaluations of ACT in early intervention, acute inpatient and community settings will be presented. We will discuss how to assess that therapists are delivering ACT for psychosis with fidelity, and describe an evaluation of the mechanisms of change in brief ACT groups for people recovering from psychosis.

• Acceptance and Commitment Therapy in the Treatment of Comorbid PTSD and Psychosis: A Case-Series Analysis
Jens Einar Jansen, PhD, Psychiatric Research Unit & Early Psychosis Intervention Center Roskilde, Denmark

Background: Persons with psychosis often report high numbers of traumatic events both before and after the onset of illness. While post-traumatic symptoms are associated with more relapse, exacerbation of psychotic symptoms and reduced wellbeing, they are often overlooked in psychiatric services. Existing evidence-based interventions for PTSD also seem less equipped to deal with the complexity of comorbid psychosis and trauma. The aim of this study is to examine whether an ACT intervention is acceptable and effective in reducing PTSD symptoms in persons with psychosis. Method: A case-series analysis of four consecutively referred participants meeting ICD-10 criteria for a first-episode non-affective psychotic disorder and PTSD. Participants are offered a manualised ACT intervention of 12-15 sessions. The following measures will be administered at baseline, midway and end of treatment: BAI, BDI-II, IES-S, PCL-C and AAQ-II. Discussion: While ACT has shown promising results for the treatment of psychosis and PTSD separately, there are currently no studies on comorbid PTSD in persons with psychosis. Reducing PTSD symptoms in an early phase of a psychotic illness may reduce the risk of relapse and improve long-term recovery and wellbeing. This case-series could inform the choice of interventions in future larger scale studies.

• Assessing Therapist Fidelity in the ADAPT trial: A Pilot Trial of ACT for Depression after Psychosis
Ross White, PhD DClinPsy, University of Glasgow

The ADAPT trial is a is a pilot trial to determine the parameters of a larger, definitive multi-centre (UK wide) randomised controlled trial of Acceptance and Commitment Therapy for depression after psychosis (ACTdp). The trial has recruited individuals with a diagnosis of schizophrenia who also meet diagnostic criteria for major depression. The trial has investigated the (a) target Population (b) Intervention (c) Control and (d) Outcomes dimensions to inform building a future randomised controlled trial. Participants randomised to the ACT-intervention arm of the study have received up to 20 sessions of ACT. Two therapists have delivered the ACT intervention. Consent was obtained to make audio-recordings of the therapy sessions. This presentation will report on assessments of therapist fidelity made at the beginning and end of the ACT intervention with each of the participants, and the implications that this has for delivering ACT in the context of psychosis.

• Mechanisms of change in group ACT for psychosis: the ACT for Recovery trial
Eric Morris, Ph.D., La Trobe University
Emma O'Donoghue, DClinPsy, South London & Maudsley NHS Foundation Trust
Dr Joseph Oliver, Camden & Islington NHS Trust, London, UK
Louise Johns, King's College London
Suzanne Jolley, Ph.D., King's College London /South London & Maudsley NHS Foundation Trust

Acceptance and Commitment Therapy has demonstrate promise as a psychological therapy for people with psychosis. In offering choice to those accessing mental health services there is a need for interventions and formats that may engage a wide range service users, and be informed by recovery principles. In South London we developed ACT in a brief group format delivered in community settings that was found to be acceptable, accessible and improved well-being (the ACT for Life study). Building on this, we conducted the ACT for Recovery(ACTfR) trial, the first randomised controlled trial of ACT groups for people with psychosis (N = 51) and their carers (N=52). In this paper we will describe an evaluation of the mechanisms of change with these groups, with recommendations on the development of process measures in ACT for psychosis.

Educational Objectives:
1. Describe how ACT can be delivered in inpatient and community settings. 2. Explain several ways that treatment fidelity can be measured in ACT for psychosis studies. 3. Describe the adaptations of ACT as a potential intervention for trauma in first episode psychosis.

 

42. The Assessment of the six core processes: Development, Optimization and Validation of new Instruments
Symposium (16:30-17:45)
Components: Conceptual analysis, Literature review, Original data
Categories: Theoretical and philosophical foundations, Clin. Interven. & Interests, Prevention & Comm.-Based, Performance-enhancing interventions, Theory & Philo., Other, Measurement, Measurement & Practical Applications, Measurement of core ACT processes
Target Audience: Beg., Interm.
Location: Cannes

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

Acceptance and Commitment Therapy (ACT) emphasizes change across six core processes with the goal of promoting psychological flexibility (Hayes et al., 2006). Measures exist and are well-studied for some core processes, most notably mindfulness and values. However, these measures are often wordy, confusing, lengthy, or otherwise impractical for community settings. Moreover, processes such as committed action and self-as-context have few or no existing published measures. This presents a significant clinical research problem, with no way to fully assess process change in community, clinical, or global settings. This symposium presents three studies that developed and evaluated new instruments designed to assess ACT core processes or reviewed differences and their origins of existing measures. Implications for understanding the fundamental components of ACT and relation between measures and psychopathology and clinical interventions will be discussed.

• Experiential Avoidance: How Long Can We Keep Calm and Carry On?
Tamara Loverich, PhD, Eastern Michigan University

Experiential Avoidance (EA) is a key transdiagnostic construct and the most fundamental component of ACT, yet valid and reliable measurement of EA has been challenging. While the AAQ-II (Bond et al., 2011) was an improvement over its predecessors, it is not without problems, and the domain-specific versions, such as the AAQW (Lillis & Hayes, 2008), are psychometrically stronger than the general measures. Gamez et al. (2011) introduced a six factor measure of EA with improved psychometric properties, as well as a brief single factor version, the BEAQ, which also performs well. This looks like progress. However, each of these measures performs differently in studies examining EA. This paper reviews the differences and their origins, presents data from our lab and others that illustrates them, and discusses the implications for understanding EA and how it relates to psychopathology and clinical intervention. We conclude that the conflation of unwillingness and external behavioral avoidance is hampering our science.

• Initial Validation of the Hexaflex Process Assessment Scale
John T Blackledg, Morehead State University
Aaron Ellis, Morehead State University
Kellen Crager, Morehead State University

The current study evaluates the validity and reliability of a new self-report instrument designed to assess psychological processes central to Acceptance and Commitment Therapy, including acceptance, cognitive defusion, contact with the present moment, self as context, values, and committed action. Preliminary data in this ongoing study suggest the instrument correlates well with existing ACT process measures and may be a viable alternative in measuring changes in core ACT processes during interventions.

• Conceptual framework and design of a daily hexaflex measure: Development and results from a patient sample
Theresa Morgan, Ph.D., Brown University & Rhode Island Hospital
Kristy Dalrymple, Ph.D., Brown University & Rhode Island Hospital
Brian Pilecki, Ph.D., Brown University & Rhode Island Hospital
Catherine D'Advanzato, Ph.D., Brown University & Rhode Island Hospital
William Ellison, Ph.D., Brown University & Rhode Island Hospital
Mark Zimmerman, M.D., Brown University & Rhode Island Hospital

Acceptance and Commitment Therapy (ACT) emphases change across six core processes promoting psychological flexibility (Hayes et al., 2006). Measures exist and are well-studied for some core processes, most notably mindfulness and values. However, these measures are often wordy (e.g., items of upwards of 20 words each), confusing (e.g., double-barrelled items), lengthy (e.g., greater than 40 items), or otherwise are impractical for community settings. Moreover, processes such as committed action and self-as-context have few or no existing published measures. This presents a significant clinical research problem, with no way to fully assess process change in community, clinical, or global settings. We propose the first comprehensive 'hexaflex' measure by (1) identifying items from existing measures based on established psychometric properties (per Fossey, 2014) and (2) using cognitive interviewing (per Beatty & Willis, 2007) to adapt items based on participant feedback. The resulting items were administered daily to patients enrolled in an ACT-based partial hospital setting from February through May 2015. Results from each iteration of measure design will be presented, as well as the relation between final items, psychiatric symptoms, psychological flexibility, and functioning (measured daily and at intake/discharge). Patient feedback will also be discussed with implications for measurement design and implementation in community settings.

Educational Objectives:
1. Critique the construct validation and measurement of experiential avoidance. 2. Describe the development of a new, comprehensive ACT process measure. 3. Identify and describe common issues in measurement design for community settings, including psychometric, practical, and conceptual concerns. Assess the implications of construct validation for both the basic and applied science around experiential avoidance

 

 

Friday, 17 July

52. A Systematic RFT Analysis of Typical Defusion Exercises in ACT
Symposium (10:30-12:00)
Components: Original data
Categories: Clinical Interventions and Interests, RFT, Defusion, Relational Frame Theory, Acceptance and Commitment Therapy, Experimental tasks
Target Audience: Beg., Interm., Adv.
Location: Estrel Saal C7

Chair: Carmen Luciano, Universidad de Almería
Discussant: Niklas Törneke, Private practice

Defusion exercises are a very important part of Acceptance and Commitment Therapy (ACT). During the last few years, some studies have investigated the types of relational frames involved in typical defusion exercises (Luciano et al., 2011; Foody et al., 2013). The current symposium presents cutting-edge research that advances over previous studies by testing the effect of different relational components of defusion exercises. The first paper compares the effect of a control condition and two defusion protocols in dealing with cognitive tasks. Similarly, the second paper compares the differential effect of the two defusion protocols in tolerance tasks. Lastly, the third paper presents a further dismantling of the relational processes involved in defusion exercises and compared them in a single-case experimental design. Overall, the results of these studies are of great relevance to improve the defusion exercises typically used in ACT.

• Analysis of the Relational Frames Involved in Defusion Exercises and their Role on the Performance on Experimental Tasks
Juan C. López, Universidad de Almería
Carmen Luciano, Universidad de Almería

The aim of the current study was to analyze the efficacy of different relational cues involved in Defusion exercises on the performance on several tasks. Thirty-four participants performed were exposed to two experimental tasks which induced bodily discomfort and stress. Then, they were randomly assigned to three experimental conditions: Control, Defusion I and Defusion II. Control participants did not received any active protocol. Participants who received the Defusion I protocol performed exercises promoting flexibility and fluency in perspective taking to strengthen self-as-context using deictic cues. Lastly, participants in Defusion II performed the same exercises using not only deictic, but also hierarchical cues. Subsequently, participants were newly exposed to the two experimental tasks. Results indicate that all participants’ performance increased after the intervention; however, the Defusion II protocol showed better results than the other two conditions.

• The Differential Effect of Defusion Exercises Based on Deictic and Hierarchical Framing on Tolerance Experimental Tasks
Bárbara Gil-Luciano, Universidad de Almería
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Sonsoles Valdivia-Salas, Universidad de Zaragoza
Juan C. Suárez-Falcón, Universidad Nacional de Educación a Distancia

The study aimed to analyze the effect of two RFT-defined defusion protocols in altering the discriminative avoidant function of aversive private events. Thirty participants first responded to several questionnaires. Subsequently, they were exposed to two experimental tasks (pretest): a cold pressor test and the viewing of an aversive film. Participants were then randomly assigned to three experimental conditions: (a) a control condition, (b) a defusion protocol based on framing own behavior through deictic relations (Defusion I), and (c) a defusion protocol that also included hierarchical relations and giving regulatory functions to that discrimination (Defusion II). Lastly, participants were exposed again to the two experimental tasks (posttest). Results showed that participants who received the defusion protocols performed better in the posttest than the control participants and that participants in Defusion II showed higher tolerance than participants in Defusion I.

• Dismantling Relational Processes Involved in Defusion Exercises
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Carmen Luciano, Universidad de Almería
Juan C. Suárez-Falcón, Universidad Nacional de Educación a Distancia
Diana Riaño-Hernández, Fundación Universitaria Konrad Lorenz
Bárbara Gil-Luciano, Universidad de Almería

This study aimed to further dismantle the types of relational framings involved in defusion exercises with a single-case experimental design. During baseline, forty participants were repeatedly exposed to two experimental tasks: a cold pressor test and the Paced Auditory Serial Addition Test. Afterwards, participants were randomly assigned to one of the following experimental conditions: (a) Defusion I that receive a protocol based on framing own behavior through deictic relations, (b) Defusion II which also included hierarchical relations, (c) Defusion III which also included giving regulatory functions to the discrimination of own behavior, and (d) Defusion IV which also included an in session practice. Lastly, participants were repeatedly exposed to the experimental tasks to analyze the effect of the defusion protocols. Results will be discussed according to relational processes that seem to improve the efficacy of defusion exercises.

Educational Objectives:
1. Assess the relevance of having an RFT account of typical defusion exercises used in ACT. 2. List the critical relational frames involved in defusion exercises. 3. Compare the differential efficacy of defusion protocols including all critical relational processes versus reduced versions of them.

 

53. Acceptance and Values-Based Approaches for Youth and Young Adults
Symposium (10:30-12:00)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, acceptance and commitment therapy; web interventions; university students, nursing student, wellbeing, stress, depression, you
Target Audience: Beg., Interm.
Location: Estrel Saal C8

Chair: Tobias Lungren, Ph.D., Licensed psychologist, psychotherapist, Department of Psychology, University of Stockholm, Sweden
Discussant: Päivi Lappalainen, University of Jyväskylä, Finland

Early detection and access to evidence based interventions at young age may prevent development of psychological problems. In this symposium we will discuss about ACT-based interventions and assessment methods targeting youth and young adults. We will present follow-up results and participant experiences from two ACT-based randomized controlled studies delivered in Finland and Sweden in a university setting. In addition, we will present data from a study examining the psychometric properties of the Avoidance and Fusion Questionnaire (AFQ-Y) on inpatient youth compared to a same age control in a school setting. Thus, based on the data demonstrated in three papers we will present examples for both assessment and intervention tools for youth and young adults.

• Internet-based guided self-help ACT intervention for Enhancing the Psychological Well-Being of University Students: Results from a 1-year Follow-up Assessment
Panajiota Räsänen, Department of Psychology, University of Jyväskylä, Finland
Päivi Lappalainen, Department of Psychology, University of Jyväskylä, Finland
Raimo Lappalainen, Department of Psychology, University of Jyväskylä, Finland

Background: Universities are challenged in employing psychological interventions that could address the needs of larger groups of students in an easily accessible and cost-effective manner. The current study investigated a web-based psychological intervention, aiming at enhancing the wellbeing of university students while also focusing on transdiagnostic processes that might both prevent and alleviate a wide range of mental health issues. Method: Finnish students (N = 68;19-32 years old) were randomized to either a blended 7-week ACT web-based intervention or to a waiting-list control condition. Participants received two face-to-face meetings and personal weekly written feedback online from trained coaches. Results 1-year follow-up showed that the program was well-accepted and was significantly effective in promoting general well-being, life satisfaction, mindfulness skills while significantly reducing self-reported stress and depression in students. Conclusion: An internet-based guided ACT self-help program could be an effective and well-accepted alternative in enhancing the well-being of university students.

• A Randomized Controlled Pilot Trial of Acceptance and Commitment Training (ACT) for Preventing Stress-Related ill Health Among Future Nurses – Results from One and Two Years Post-Intervention
Elin Frögéli, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Petter Gustavsson, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Data from a prospective national cohort study show that levels of psychiatric symptoms are higher among nursing students than among professional nurses. Levels of stress-related ill health increase during nursing education and the increase is particularly pronounced between the second and forth semester indicating a need for an early intervention. In the year or 2011 a randomized controlled pilot trial of a 6 x 2 hour ACT group intervention was initiated and evaluated in a sample of 113 nursing students. Results showed the intervention to decrease experiential avoidance and increase mindful awareness. These changes were shown to mediate reductions in perceived stress and burnout at post-intervention and at a three month follow-up. The nursing students were then followed until graduation and at the symposium data from between group- and mediation analyses one and two years post-intervention will be presented.

• Psychological Inflexibility in Adolescence: Evaluation of the Avoidance and Fusion Questionnaire for Youth
Fredrik Livheim, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Background: Efforts to control unwanted thoughts and feelings, also referred to as experiential avoidance (EA), appear to be associated with a diverse array of psychological and behavioral difficulties. Research shows that interventions that reduce EA and help people to identify and commit to the pursuit of valued directions are beneficial for ameliorating diverse problems in living (Biglan et al. 2008). Aim: There are two overarching aims with this study 1) Make a Swedish validation of the AFQ-Y, 17 items, (Avoidance and Fusion Questionnaire for Youth), and 2) Examine levels of experiential avoidance among incarcerated youth compared to a control group of youth in school setting. Method: Swedish inpatient youth aged 15-17 (N = 164) answered the AFQ-Y, 17 twice. Swedish youth in schools aged 14-16 (N = 32) answered the AFQ-Y, 17 twice. Results and Conclusion will be presented at this symposium.

Educational Objectives:
1. Describe and discuss how to promote wellbeing and alleviate psychological problems in young adults and other populations through ACT web-based interventions. 2. Long-term effects of an ACT group intervention targeting stress-related ill health among nursing students. 3. Be able to describe and discuss the concept of experiential avoidance.

 

56. The Power of Love: Using FAP's Model of Social Connection to Address Global Concerns
Symposium (10:30-12:00)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Superv., Train. & Dissem., Theory & Philo., FAP, social connection, racism
Target Audience: Beg., Interm., Adv.
Location: Room 30241

Chair: Robert J. Kohlenberg, Ph.D., University of Washington
Discussant: Michel A. Reyes Ortega, Contextual Science and Therapy Institute (Mexico City), National Institute of Psychiatry Ramón de la Fuente

Social connection has been shown to be a strong predictor of our physical and mental health, surpassing the predictive force of major public health concerns such as cigarette smoking, obesity or hypertension. Functional Analytic Psychotherapy’s (FAP) model of Awareness, Courage, and Love (ACL) attempts to integrate existing research with established behavioral principles to offer interventions focused on improving social connection. In this symposium, we will propose a behavior analytic conceptualization of the model. Additionally, we will apply the ACL model to describe functional processes underlying social functioning of people with visible chronic conditions. Lastly, we will present research that uses the ACL model to address racism and social connection in a non-clinical population.

• A Behavior Analytic Conceptualization of Awareness, Courage, and Love as Functional Response Classes
Adam M. Kuczynski, B.S., University of Washington
Rodrigo N. Xavier, M. A., University of São Paulo
Alessandra Villas-Boas, M.A. Sonia Meyer, Ph.D. Chad Wetterneck, Ph.D. Gareth Holman, Ph.D. Robert J. Kohlenberg, Ph.D Mavis Tsai, Ph.D, Glenn Callaghan, Ph.D., Jonathan W. Kanter, Ph.D.

The terms “Awareness, Courage, and Love” have been used recently to describe common clinical targets in Functional Analytic Psychotherapy (FAP). These terms, however, have been criticized for their lack of behavioral precision. Given FAP’s contextual behavioral underpinnings, it is important to conceptualize awareness, courage, and love as tools that aid in the service of predicting and influencing. In this paper, the authors present a behavior analytic conceptualization of awareness, courage, and love as functional classes of operant behavior relevant to the broad domain of social connection. We believe this model will aid contextual behavioral researchers who wish to empirically investigate the mechanisms within FAP.

• Using Awareness, Courage, and Love to Improve Social Functioning: A Theoretical Model to Improve the Lives of Those with Visible Chronic Conditions
Joanna E. Dudek, M. A., University of Social Sciences and Humanities
Jonathan W. Kanter, Ph.D., University of Washington
Mavis Tsai, Ph.D., University of Washington
Adam M. Kuczynski, B.S, University of Washington
Pawel Ostaszewski, Ph.D., University of Social Sciences and Humanities
Robert J. Kohlenberg, Ph.D Mavis Tsai, Ph.D, Glenn Callaghan, Ph.D., Jonathan W. Kanter, Ph.D.

Those who suffer from visible chronic conditions (e.g., psoriasis, obesity, lipoedema) experience stigmatization that may lead to feelings of shame and social isolation. In this paper, the authors propose a theoretical model that delineates the functional processes of social isolation with respect to this population. More specifically, we propose an intervention informed by Functional Analytic Psychotherapy’s (FAP) model of Awareness, Courage, and Love to help improve interpersonal behavioral repertoires that may lead to improved quality of life in these patients.

• Practical Applications of Awareness, Courage, and Love: Solving Contemporary Issues through Social Connection
Michael Thurston-Rattue, B.A, University of Washington
Mavis Tsai Ph.D., University of Washington
Jonathan W. Kanter, Ph. D., University of Washington
Robert J. Kohlenberg, Ph.D., University of Washington
Adam M. Kuczynski, B.S., University of Washington

Functional Analytic Psychotherapy (FAP) presents a broad and flexible model of behavior change that hopefully is applicable across diverse contexts. Recently, a conceptualization of FAP targets in terms of awareness, courage and love has provided user-friendly in-roads into contexts in which improving social connection is a value and goal. In this paper, the authors describe several projects that utilize The ACL Model to target social connection in different groups of participants. More specifically, we will discuss a workshop-style intervention targeting racism within a North American student population, and a brief “coaching” intervention targeting interpersonal intimacy in a diverse non-clinical population.

Educational Objectives:
1. Describe the FAP's model of social connection. 2. Define awareness, courage and love using behavioral terms. 3. Know various applications of the ACL model and will be able to create intervention based on that model.

 

57. ACT at Work: The impact of PF on mental health and organizational factors
Symposium (10:30-12:00)
Components: Literature review, Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Org. Beh. Management, Prof. Dev., Sickness absence, special education students, minority groups
Target Audience: Beg., Interm., Adv.
Location: Room 30341

Chair: Patrizia Hofer, Ph.D. Candidate, University of Basel, Clinical Psychology and Epidemiology
Discussant: Frank Bond, Goldsmiths, University of London

Psychological Flexibility has been associated with mental health and behavioral effectiveness in the workplace. This symposium will describe the effect of Acceptance and Commitment Training on stress, work absenteeism, mental health and well-being across different occupational categories. The three studies presented in this symposium explore the efficacy of ACT alone and in combination with a workplace intervention, psychological flexibility in regard to work, acceptability and influence on organizational factors including goal setting, quality management, leadership procedures and HR policy.

• ACT and sickness absence – preliminary results from a randomized controlled trial
Anna Finnes, Karolinska Institutet, Stockholm
Joanne Dahl, Ph.D., University of Uppsala

Mental disorders including depression, anxiety, and adjustment problems are currently the most common reason for work absenteeism in Sweden. Evidence-based clinical treatments such as Cognitive Behavioral Therapy have resulted in significant and sustained improvement in clinical symptoms. However, the effect on duration of sick leave is variable and predominately negative, even indicating these interventions might prolong sick leave. With this in mind, we sought to determine the efficacy of Acceptance and Commitment Therapy (ACT) alone and in combination with a Workplace Intervention (WI) on the duration of sick leave and on mental health. We designed a randomized controlled trial with 359 participants on sick leave due to mental disorders, allocated into one of four treatment groups: 1) ACT, 2) WI, 3) ACT and WI in combination and 4) Treatment as Usual (controls). In addition, the possible mediating effect of psychological flexibility in regard to work, which is theorized to underlie the ACT model, was examined. Results from the three months follow up will be presented.

• Preparation for teacher collaboration in inclusive classrooms: stress reduction for special education students via Acceptance and Commitment Training
Simone Gebhard, Institute of Special Education, Department of Special Educational Psychology, Europa-Universität Flensburg
Dietrich Pülschen, Ph.D., Department of Psychiatry, University of Rostock

The integration and participation of people with disabilities in society is of global significance. Therefore Germany’s ratification of the UN Convention on the Rights of Persons with Disabilities is an important step which is accompanied by mayor changes in the education system. It is now intended that special education teachers work side-by-side with other teachers in one school for all children, irrespective of their needs. Here the organization of the collaboration process is in the hands of individual teachers and their coping capability. Teaching is perceived as a profession which is linked to high levels of stress. Only 65% of teachers in Germany reach retirement age while still in service, in many cases because of psychiatric illness. The additional challenge to collaborate with colleagues from different professional backgrounds and with varying levels of skills will potentially lead to further stress. Now we have to recognize that the great challenges of inclusion need to be accompanied by appropriate measures to be realised. Using a 2 (group affiliation) × 2 (measurement time) between subjects design the present study examined the effects of an Acceptance and Commitment Training on the subjective tension of a sample (N = 68) of students studying special education. Questionnaire and role plays were used to assess the collaborative competence and the subjective tension. From the data of this study it can be seen that an Acceptance and Commitment Training is an appropriate way to establish and develop collaboration skills and reduces high levels of subjective stress. Furthermore, the evaluation of the training indicates a high level of acceptance for it. In addition, practical relevance was underlined by all participants.

• Acceptance and Commitment Therapy with deaf clients: Staff training and organizational intervention
Leena Hassinen, MEd, Psychotherapist, Private Practice
Jouni Riihimäki, Service Director, Student of Economic Sciences, The Service Foundation for the Deaf

The Service Foundation for the Deaf has about 200 out-patients and 1000 service users. Most of them have quite severe disabilities, handicaps and/or mental health and social problems. The number of the staff members is 250.Since 2009 The Service Foundation has trained 42 staff members to use Acceptance and Commitment Therapy (ACT) with deaf clients. Staff members received a brief training in ACT including 16 hours lectures, 15 hours supervision, and reading material. Each staff member treated 1-2 clients for 8 – 15 times. As part of the training program several ACT metaphors and exercises were translated into the Finnish Sign Language. Training process indicated that counselors were able to deliver an ACT intervention using sign language after a relatively brief training. The intervention was well accepted by both the clients and the counselors, and showed encouraging effects on clients’ wellbeing as well as counselor’s quality of life. Results showed a significant progress in staff member’s well-being. On the organizational level these procedures had a significant influence on the foundation’s goal setting, quality management, leadership procedures and HR policy. As a result, ACT-approach is widely adaptedinthe Service Foundation for Deaf, on individual and organizational level. Keywords: deaf, sign language, staff training, organization intervention

Educational Objectives:
1. Compare and contrast the ACT model to dominant approaches in mental health care and the process of Return To Work after sickness absence. 2. Describe an appropriate measurement instrument for collaboration between teachers. 3. Discuss how ACT methods and principles can be applied in sign language.

 

58. Clinical Applications of RFT: Assessment and Formulation using Deictic Frames: A Case Series Analysis
Symposium (10:30-12:00)
Components: Conceptual analysis, Case presentation
Categories: Relational Frame Theory, Clin. Interven. & Interests, Theory & Philo., Relational Frame Theory - Clinical Applications
Target Audience: Beg., Interm.
Location: Nizza

Chair: Yvonne Barnes-Holmes, Ph.D., National University of Ireland, Maynooth
Discussant: Miles Thompson, Goldsmiths, University of London; University of the West of England (UWE)

Conceptual developments in Relational Frame Theory (RFT) are increasingly offering new insights into how the theory can be applied in clinical contexts. In line with these developments, this symposium presents three papers that summarize and analyze several case studies that highlight the integration of functional analysis and derived relational responding. The first paper, presented by Dr John Boorman, draws upon a complex looked after (LAC) adolescent case with significant relationship difficulties, to highlight how the relations among significant others can be conceptualized as relational networks. The second paper, presented by Dr Joe Oliver, focuses on an adult with long-standing difficulties with psychosis, to illustrate how RFT can be utilized to inform work with complex paranoia and low self trust. Both papers highlight the formulation of key functional analytic questions as an essential step toward the development of effective treatment strategies. The third paper, presented by Drs Yvonne Barnes-Holmes and Miles Thompson draws functional parallels across the two papers and highlights how RFT provides both the precision and complexity needed to understand and treat divergent and complex clinical cases.

• Bridging the Clinical Gap between ACT & RFT with Young People
Dr John Boorman, National Implementation Service, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, London, UK

There is an understanding amongst those who work with young people (12-18) that it can be both an extremely challenging and rewarding experience. During adolescence the sense of self is continuously evolving and developing (Harter, 1999; Rosenberg, 1986). Young people often experience difficulties with regards to how they compare themselves to others and where they fit in the world (DuBois & Hirsch, 2000). RFT has been empirically shown to offer a coherent understanding of the self, and attachment with the conceptualised self has be linked to a variety of functional difficulties. Acceptance and Commitment Therapy (ACT) and Relational Frame Theory (RFT) both fall under the wider umbrella of functional contextualism and contextual behaviour science. However, to date there has been little understanding of how these two areas can be combined clinically in a coherent and effective manner. This paper illustrates to therapists working with young people how to bridge this conceptual gap by clinically applying RFT through examining the therapeutic deictic and relational functional analysis. A clear theoretical understanding of RFT’s core concepts is provided in order to help transform their effectiveness in using ACT’s 6 clinical processes. Educational Outcome: Following this presentation the audience will be able to have a more coherent understanding of how ACT and RFT can be combined clinically to enhance the effectiveness of their clinical skills.

• Unlocking the Deictic: Using Verbal Functional Analysis in Working with Paranoia – A Case Study
Dr Joseph Oliver, Camden & Islington NHS Trust, London, UK

Paranoia in the general population is common and it has been estimated that 10-15% of people experience paranoid or suspicious beliefs (Freeman & Garety, 2006). Paranoid or persecutory delusions are a frequent symptom of psychosis and can significantly impact on an individual’s ability to engage in a full and meaningful life. Current cognitive behavioural understandings of paranoia emphasise reasoning biases, emotional processing and sense making of anomalous experiences (Freeman & Garety, 2004). Acceptance and Commitment Therapy (ACT) highlights the importance of the various unhelpful ways clients respond to the experience of paranoia, whilst developing skills to build values-based behaviours (Morris, Johns & Oliver, 2013). This paper seeks to extend these two models by using Relational Frame Theory (RFT) to provide a functional account of paranoia, using an illustrative case study. Emphasis will be given to deictic relations and the ways in which disturbances in the development of these relations may contribute to the on-going experience of paranoia. The paper will also highlight how the clinician can use the therapeutic relationship to target key relational networks implicated in the maintenance of psychological suffering and methods by which these relational networks can be altered. Educational Outcome: To understand how RFT can be used to provide a functional conceptualisation of paranoia.

• The Functional Overlap: Therapeutic Work Built on Deictic Foundations
Dr Yvonne Barnes-Holmes, National University of Ireland, Maynooth
Dr Miles Thompson, Goldsmiths, University of London; University of the West of England (UWE)

The third paper in this symposium seeks to draw out the functional similarities from the previous two case studies using an approach based on Relational Frame Theory (RFT; Hayes, Barnes-Holmes & Roche, 2001). Rather than focusing on the topographical differences between the cases, this part of the symposium will examine the functional overlap within these distinct cases when approached using an RFT account of deictic relations (Barnes-Holmes, Foody, & Barnes-Holmes, 2013). Rather than focusing on ACT, this final paper will highlight how it is possible to work clinically using an understanding of deictics. It will begin by highlighting previous attempts to address issues of self and perspective-taking in language able clinical populations, before presenting a new account more deeply embedded in an RFT led, functional account. The symposium aims to show how RFT knowledge and ACT-relevant clinical skills can be combined to provide a functional analytic guide to treatment. Educational outcome. Having seen this presentation the audience member should be able to describe and discuss the usefulness and possibility of applying an RFT account of deictic relations to topographically distinct but functionally similar therapeutic work.

Educational Objectives:
1. Develop the ability to help clients work with strong and powerful emotions. This will be demonstrated by two, separate clinical cases which apply RFT concepts clinically, including the transformation of emotional functions. 2. Enhance your ACT skills by utilizing the full power of relational perspective-taking and its implications for the self. Attendees will learn about the key elements of perspective-taking from an RFT analysis, including how it can be used with two, distinct clinical presentations. 3. Core RFT principles will be demonstrated in a user friendly and clinically accessible way to enable clinicians to develop compassion and empathy.

 

59. Shame, ACT Processes and their relation to Eating Disorders and Sexual Orientation
Symposium (10:30-12:00)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Clin. Interven. & Interests, Evo., Binge Eating Disorder, eating disorders, shame, sexual orientation, body image flexibility
Target Audience: Beg., Interm., Adv.
Location: Cannes

Chair: Orestis Kassinopoulos, Msc, University of Cyprus
Discussant: Grant Dewar, University of Adelaide

Shame has been suggested to play a central role in developing and maintaining psychopathology. Growing evidence has emerged supporting the use of Acceptance and Commitment Therapy to target shame. This symposium aims to investigate the association between shame, cognitive fusion and symptomatology and severity in eating difficulties and gay men. The effect of psychological flexibility on these relationships will be discussed.

• The role of shame and the entanglement with body image and eating in Binge Eating Disorder
Duarte, C., Cognitive and Behavioural Centre for Research and Intervention (CINEICC)
Pinto-Gouveia, J., Cognitive and Behavioural Centre for Research and Intervention (CINEICC)
Ferreira, C., Cognitive and Behavioural Centre for Research and Intervention (CINEICC)

This study examines the role of body image-related cognitive fusion, shame, depressive symptoms, weight and shape and eating concerns on binge eating, a public health problem associated with obesity and several physical and mental problems. Participated in this study 73 patients with Binge Eating Disorder (BED), evaluated with the Eating Disorder Examination 16.0D. Results revealed positive associations between binge eating symptomatology severity and depressive symptoms, shame, weight and shape concerns, eating concerns, and body image-related cognitive fusion. Cognitive fusion, shame and eating concerns emerged as the best predictors of binge eating. A path analysis showed that shame had a direct effect on binge eating, and an indirect effect through increased eating concern and body image-related cognitive fusion. The model explained 43% of binge eating severity. Findings suggest that in BED patients perceiving that others see the self negatively may become associated with an entanglement with thoughts and concerns about body image and eating, which may, in turn, fuel binge eating symptoms which may be conceptualized as a maladaptive avoidance strategy.

• The impact of traumatic features of shame memories and body image flexibility on eating psychopathology
Marcela Matos, Ph.D., CINEICC, University of Coimbra
Cristiana Duarte, PhD Student, CINEICC, University of Coimbra
Cláudia Ferreira, PhD, CINEICC, University of Coimbra
José Pinto-Gouveia, PhD, CINEICC, University of Coimbra

Shame has been regarded as playing a key role in body image and eating difficulties. The current study examines the impact of early shame memories on eating psychopathology severity and the mediator role of body image flexibility in this association. 466 women from the general population recalled a shame experience from childhood and adolescence and completed measures of traumatic features of that event, eating psychopathology and body image flexibility. Results indicated that eating psychopathology was positively associated with the traumatic features of shame memories and was negatively associated with body image flexibility. A mediation analysis indicated that the traumatic features of shame memories presented an indirect effect on eating psychopathology severity mediated by lower levels of body image flexibility, but also a significant direct effect, with the model explaining 55% of eating psychopathology severity. These findings suggest the importance of addressing body image flexibility, but also the relevance of targeting the traumatic features of shame memories in eating psychopathology.

• Psychological flexibility and self-compassion: An antidote against shame in homosexual men
Marcela Matos, Ph.D., CINEICC, University of Coimbra
Sérgio Carvalho, MSc., CINEICC, University of Coimbra
Marina Cunha, Ph.D., Instituto Superior Miguel Torga and CINEICC, University of Coimbra
Ana Galhardo, Ph.D., Instituto Superior Miguel Torga and CINEICC, University of Coimbra
Carlos Sepodes, Instituto Superior Miguel Torga

Early adverse experiences and feelings of shame are thought to be present among gay men. Growing evidence points to the pathogenic effects of shame memories and shame on psychopathological symptoms and to the protective role of psychological flexibility and compassion on these relationships. However, these associations have never been explored taking into account sexual orientation. Therefore, this paper investigates 1) the differences between heterosexual and homosexual men in shame memories, affiliative memories, internal shame, depressive symptoms, psychological flexibility and self-compassion; 2) the mediator effect of psychological flexibility and self-compassion on the relationships between shame and affiliative memories, and between internal shame and depression according to sexual orientation. 53 heterosexual and 53 homosexual men recalled a shame memory during childhood and adolescence and completed self-report measures of the variables being studied. Results show that homosexual men reveal significantly higher levels of shame memories, internal shame and depressive symptoms, and lower levels of affiliative memories, psychological flexibility and self-compassion. Furthermore, in homosexual men, psychological flexibility and self-compassion mediated the impact of shame memories and affiliative memories on shame and on depressive symptoms. These findings suggest that psychological flexibility and self-compassion are particularly relevant to develop among gay men as a way of decreasing the damaging impact of early negative experiences and shame.

Educational Objectives:
1. Demonstrate the role and significance of shame on cognitive fusion, an important change process in the treatment of eating disorders. 2. Discuss the impact of early experiences of shame and affiliation on internalized shame and depressive symptoms among gay men and recognize the need for continuing social change and of developing a more accepting stance towards gay men in the global community. 3. Describe the role and significance of shame memories and body image inflexibility in eating psychopathology.

 

71. Von den Grundlage zur Praxis: drei kontextuelle Psychotherapiemethoden in der Depressionsbehandlung
Symposium (14:45-16:15)
Components: Conceptual analysis, Literature review, Didactic presentation
Categories: Clinical Interventions and Interests, Beh. med., Depression, Functional Contextualism
Target Audience: Beg., Interm.
Location: Strassburg

Chair: Ulrich Schweiger, M.D., Professor at the Department of Psychiatry and Psychotherapy, Lübeck University
Discussant: Thorsten Kienast, M.D., Private Professor and Researcher, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, University Medicine Berlin

Die psychotherapeutische Behandlung von depressiven Störungen hat innerhalb der vergangenen 20 Jahre deutliche Fortschritte erzielt. Die wissenschaftliche Datenlage belegt vor allem den Einsatz von Psychotherapiemethoden, die unter dem Namen kontexutelle Psychotherapiemethoden zusammengefasst werden. Dazu gehören unter anderem die Acceptance und Committment Therapy (ACT), Behavioral Activation (BA) und das Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Gemeinsam ist allen Verfahren, dass sie nicht nur die Veränderung der Auftretenshäufigkeit von Verhalten in den Fokus der Behandlung nehmen, sondern vor allem dem Kontext und der Funktion von psychologischen Phänomenen besondere Aufmerksamkeit schenken. Wissenschaftstheoretisch stehen sie im Einklang mit Ferster`s funktionsanalytischem Modell der Depression. Alle Verfahren gehen davon aus, dass ein bestimmter Kontext in einem Verstärkerdefizit resultiert. Welche Aspekte des jeweiligen Kontextes gesehen werden ist jedoch sehr unterschiedlich. Während sich ACT und BA vor allem auf intrapsychische und extrapsychische Prozesse des Patienten konzentrieren, beschäftigt sich CBASP schwerpunktmäßig mit dem interpersonellen Kontext. Dieses Symposium stellt die Grundkonzepte von ACT, BA und CBASP in der Behandlung von depressiven Störungen vor. Unter Berücksichtigung der aktuellen Datenlage wird ihre jeweilige Stellung innerhalb der kontextuellen Psychotherapiemethoden zusammengefasst und diskutiert. LITERATUR Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press Martell CR, Addis ME and Jacobson NS (2001) Depression in Context: Strategies for Guided Action. New York: W. W. Norton & Company, Inc. McCullough J.P. (2000) Treatment for Chronic Depression. Cognitive Behavioral Analysis System of Psychotherapy. New York: Guilford Press.

• ACT in der Behandlung von Depressiven Störungen
Maria Kensche,M.D, EOS Clinic für Psychotherapy, Alexianer Münster GmbH

Als kontextuelles Psychotherapieverfahren ist ACT inzwischen gut für die Behandlung von depressiven Störungen evaluiert. ACT vertritt ein Psychopathologiemodell, welches dem Phänomen der Erlebnisvermeidung die entscheidende Rolle bei der Entstehung und Aufrechterhaltung von Depressionen zuspricht. Erlebnisvermeidung beschreibt das Bemühen einer Person, unangenehme Affekte, Gedanken und Erinnerungen auszulöschen. Akzeptanz wird in ACT als Alternative zum Vermeidungsverhalten gelehrt. Gedanken und Gefühle werden nicht modifiziert, sondern in ihrer Wirkung durch eine Entkopplung vom Handlungsdrang geschwächt. Auf diese Weise kann beispielsweise die Bereitschaft, Niedergestimmtheit auch langfristig auszuhalten, ohne zu dysfunktionalen Verhaltensstrategien wie sozialem Rückzug zu greifen, erhöht werden. Dieses Vorgehen eröffnet für die Behandlung von depressiven Patienten interessante Perspektiven. Dieser Beitrag stellt die aktuelle Datenlage über den Einsatz von ACT bei diesem schwierigen Patientenklientel vor. LITERATUR Bohlmeijer E, Lamers SMA, Fledderus M (2015) Flourishing in people with depressive symptomatology increases with Acceptance and Commitment Therapy. Post-hoc analyses
of a randomized controlled trial Behaviour Research and Therapy 65: 101-106. A-Tjak JG et al. (2015) A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychother Psychosom;84:30-6.

• Behavioral Activiation als kontextuelle Behandlung für depressive Störungen
Ulrich Schweiger, M.D, Professor at the Department of Psychiatry and Psychotherapy, Lübeck University

Der Vortrag stellt das aktuelle Modell von Behavioral Activation (BA) vor. BA ist eine Behandlungsmethode für depressive Störungen, die sich aus dem behavioralen Modell der Depression heraus entwickelt hat. Dieses Modell wurde ursprünglich von Ferster und Lewinsohn vorgeschlagen. Im Zentrum des Modells stand ursprünglich der Aufbau angenehmer Aktivitäten. Im aktuellen Modell wurde dies durch das Konzept der werteorientierten Aktivitäten aus der Acceptance and Committment Therapie ersetzt. Weiterhin wurde das Konzept des entgegengesetzten Handelns um emotionale Blockaden zu überwinden aus der dialektisch-behavioralen Therapie übernommen. BA nimmt an, dass Depression im Kontext negativer Lebensereignisse entsteht. Dies führt zu einer verminderten positiven Verstärkung von adaptiven Verhaltensweisen und in der negativen Verstärkung von Vermeidungsverhalten. Die Folge ist eine verminderte Aktivität in wertgeschätzten Bereichen und ein vermehrtes Auftreten von Verhaltensweisen, die negativ verstärkt werden. BA geht davon aus, dass Kontakt mit einem breiten Spektrum von Verstärkern erforderlich ist, um das Leben als sinnvoll zu empfinden. Der Vortrag gibt eine kurze Einführung in das Modell von BA und die zugrunde liegenden kontextuellen Annahmen und stellt die zugrunde liegende Evidenz für die Anwendung bei depressiven Störungen dar. LITERATUR Martell-CR, Dimidjian-S, Herman-Dunn-R (2013) Behavioral activation for depression. Guilford, New York. Kanter-JW, Busch-AM, Rusch-LC (2009) Behavioral Activation, Routledge, Hove

• Ist CBASP eine evidenzbasierte kontextuelle Behandlung für chronisch depressive Patienten?
Philipp Klein, M.D., Department of Psychiatry and Psychotherapy, Lübeck University

Das Cognitive Behavioral Analysis System of Psychotherapy (CBASP) wurde von James McCullough zur Behandlung chronischer Depression entwickelt. Der Fokus der therapeutischen Arbeit liegt auf den Konsequenzen des eigenen zwischenmenschlichen Verhaltens. Dabei erlernen die Patienten einen Problemlösealgorithmus zur Bewältigung zwischenmenschlicher Schwierigkeiten unter besonderer Berücksichtigung des gegenwärtigen Kontexts. Dabei werden auch prägende Beziehungserfahrungen der Patienten berücksichtigt. Der Vortrag beginnt mit einer kurzen Zusammenfassung des CBASP-Models und geht dann der Frage nach, inwieweit CBASP bereits als evidenzbasierte Therapiemethode gelten kann. LITERATUR Klein JP, Belz M. Psychotherapie Chronischer Depression. Praxisleitfaden CBASP. Göttingen: Hogrefe (2014). Kensche M, Schweiger U, Klein JP. Störungsorientierte Behandlung der Chronischen Depression nach dem CBASP-Konzept. PSYCH up2date (2014) 8:297-308.

Educational Objectives:
1. Die Grundkonzepte von ACT, BA und CBASP in der Behandlung von depressiven Störungen verstehen. 2. Wesentliche Gemeinsamkeiten und Unterschiede von ACT, BA und CBASP in der Behandlung von depressiven Störungen ableiten und innerhalb der kontextuellen Psychotherapie einordnen können. 3. Die wissenschaftliche Evidenz von ACT, BA und CBASP in der Behandlung von depressiven Störungen kennen.

 

72. Healthier lifestyle and Better Wellbeing by Using ACT - Affecting Intuitive Eating, Physical Activity and Self-Stigma
Symposium (14:45-16:15)
Components: Conceptual analysis, Original data
Categories: Behavioral medicine, Clin. Interven. & Interests, Prevention & Comm.-Based, Overweight, ACT, psychological flexibility, mindfulness, healthy life style chioces, self-stigma
Target Audience: Beg., Interm.
Location: Room 30241

Chair: Päivi Lappalinen, M.A., University of Jyväskylä
Discussant: Maria Karekla, Ph.D., University of Cyprus

WHO has classified overweight, obesity and physical inactivity as major health risks worldwide. However, current research suggests that directly focusing on weight and physical activity behaviour may not be a sustainable strategy for healthy lifestyle and promote long-term lifestyle changes. Subsequently, it is recommended that increasing general health related behaviors rather than decreasing e.g. weight in itself, may be alternative target of treatment. These three studies aim to investigate if interventions based on Acceptance and Commitment Therapy (ACT) can promote healthy lifestyle choices and reduce the impact of self-stigma related to weight. Acceptance of psychological and physical discomfort may play an important role related to enhancing eating behavior and physical activity. The findings suggest that ACT interventions for lifestyle changes work through enhanced ability to continue with valued activities when confronted with negative emotions and thoughts.

• Developing a Physically Active lifestyle Based on Acceptance and Commitment Therapy
Anu Kangasniemi, MSc, LIKES – Research Center for Sport and Health Sciences

This presentation aims to describe a RCT to promote a change in physical activity among physically inactive adults. Participants were randomly allocated to a feedback or ACT-based group intervention. The primary outcome was physical activity. In addition, participants´ cognitions related to physical activity were evaluated at baseline and three- and six-month follow-ups. No difference was observed in the change of mean physical activity level between feedback and ACT-based groups over time. However, the cognitions related to physical activity and exercise improved more in the ACT+FB than in the FB group. After re-analyzing the data among non-depressive participants, higher stability was observed in the individual’s maintenance of physical activity in the ACT+FB group. Acceptance of discomfort was associated with the increase in physical activity in the ACT+FB group. Acceptance also mediated the association between self-efficacy and changes in physical activity.

• Psychological Flexibility Mediates Changes in Intuitive Eating in Acceptance-, Value- and Mindfulness-based Interventions
Essi Sairanen, MSc, University of Jyväskylä

The current research suggests that dieting is not a sustainable strategy for weight loss and does not promote a healthy lifestyle. Methods to foster an adaptive eating, along with how to prevent and treat obesity, need to be explored. One adaptive form of eating that has recently gained recognition is intuitive eating, which is a style of eating that focuses on eating motivated by physical reasons, with an individual relying in their connection with and understanding of physical hunger and satiety cues, rather than on emotional or environmental motivators (Tylka, 2006). This presentation is based on two studies investigating relationships between intuitive eating, psychological flexibility and mindfulness skills in overweight adults reporting symptoms of perceived stress and enrolled in a psychological lifestyle interventions (N= a.300). The present results indicated that weight related psychological flexibility mediated intervention effect on intuitive eating and weight in ACT based interventions (group and mobile).

• Evaluation of a Self-Help Program Based on Acceptance and Commitment Therapy to Promote Quality of Life and Reduce the Impact of Weight-related Stigma Among individuals with Overweight: a Multiple Baseline Design
Emma Wallin, MSc, University of Uppsala
Erik Olsson Thomas Paling Sandra Weineland Joanne Dalh ,

Overweight and obesity is classified by WHO as a major threat to modern day health in the world. However, returning to and maintaining a normal weight over time among those who have established an overweight has been shown to be very difficult. Subsequently, it is recommended that increasing general health related behaviors rather than decreasing weight in itself be the target of treatment. In this study we will investigate if an intervention based on Acceptance and Commitment Therapy (ACT) can promote healthy life style choices and reduce the impact of self-stigma related to weight among individuals with a BMI over 25 (overweight). A Single Subject multiple baseline design (N= 6) with temporal staggering and randomization of treatment onset will be used. Participants will be recruited thorough a stratified non-probability sampling technique.

Educational Objectives:
1. Learn how to promote a physically more active lifestyle by using Acceptance and Commitment Therapy (ACT). 2. Learn what means intuitive eating and how it could be promoted. 3. Receive basic understanding of self-stigma related to weight.

 

73. RFT-Based Analysis of Complex Human Behavior: Time, Hierarchy and False Memories
Symposium (14:45-16:15)
Components: Original data
Categories: Relational Frame Theory, Related FC approaches, Verbal Behavior
Target Audience: Beg., Interm., Adv.
Location: Room 30341

Chair: Adrián Barbero-Rubio, Universidad de Almería
Discussant: Paul M. Guinther, Portland Psychotherapy

This symposium aims to present studies that show how can be modelled in the laboratory complex human behavior by following the functional contextual approach to human language and cognition outlined by Relational Frame Theory (RFT). This approach let to analyze, with experimental procedures, the role of verbal behavior in a contextually controlled way. The first paper established two arbitrary stimuli as BEFORE and AFTER relational cues and examined the transformation of functions according to temporal relations with new stimuli. Similarly, the second paper analyzed complex patterns of hierarchical relational responding and transformation of functions in a hierarchical network when several functions were given to some stimuli of the hierarchy. And the third study addressed the false memory phenomena in a laboratory controlled way, analyzing this behavior in terms of RFT-based analysis. Overall, the results of these studies are relevant to understand complex behaviors from an analytic functional-contextual approach.

• Evidence of Transformation of Functions through Temporal Relations. A Preliminary Study
Juan C. López, Universidad de Almería
Carmen Luciano, Universidad de Almería
Zaida Callejón, Universidad de Almería

The aim of the current study is to demonstrate the transformation of functions accordingly temporal relations. Twenty college students participated. In Phase 1, two arbitrary stimuli were established as BEFORE and AFTER relational cues and this repertoire was tested. In Phase 2, participants were asked to follow arbitrary temporal instructions to ensure they had acquired it and behaved according to temporal relations. Two differential contingences were associated to two arbitrary stimuli during Phase 3. Then, participants were exposed to two test of transformation of functions. The first one (Phase 4) participants had to choose which stimulus they preferred. In the second test, (Phase 5) participants had to allow the continuation of images or escape in relation of the image that was appeared on screen. The results show the transformation of functions to other elements of temporal sequences and add evidence respect the complex behavior of human language.

• Model of Complex Hierarchical Responding
Lidia Budziszewska, Universidad de Almería
Carmen Luciano, Universidad de Almería
Enrique Gil, Universidad de Almería

Participants were involved in an experiment where they learned to respond according to a hierarchical framing based on the formation of several contextual cues following the studies by Gil, Luciano, Ruiz(2014), Slattery&Stewart (2014).Then hierarchical network was established using the previously trained relational cues. Several functions were given to stimuli of the hierarchy and testing proceeded to discover if the response would emerge in accordance with the derived relations of hierarchy.Results are discussed and limitations are identified for further studies.

• Creating False Memories through a Respondent-Type training (ReT)
L. Jorge Ruiz-Sánchez, Universidad de Almería
Carmen Luciano, Universidad de Almería
Paul M. Guinther, Portland Psychotherapy

The Derived Relational Intrusions Following Training (DRIFT) paradigm has shown to be an effective procedure to demonstrate the effect of MTS training on False memory phenomena while permitting an exploratory analysis of semantic versus associative (co-occurrence) effects (Guinther & Dougher, 2010). However, this study does not rule out the possibility that stimulus co-occurrence can influence semantic relatedness, associative strength or false memory phenomena. In fact, verbally competent adults can form equivalence relations with respondents-type procedures. The present experiment pretends: a) to explore the influence of co-occurrence effect on the formation of semantic relations and false recalls using a type-respondent training, and b) analyze the effect of equivalence testing on the formation of false recall. The role of co-occurrence and equivalence testing in the formation of false memories are discussed.

Educational Objectives:
1. Analyze complex human behaviors from a functional-contextual approach. 2. Describe experimental procedures as laboratory controlled way to understand the role of verbal behavior. 3.Discuss the results from a RFT-based analysis.

 

75. Training Therapists in Awareness, Courage, and Love: New Data for the Functional Analytic Psychotherapy Group Training Model
Symposium (14:45-16:15)
Components: Conceptual analysis, Literature review, Original data
Categories: Supervision, Training and Dissemination, Clin. Interven. & Interests, Prof. Dev., Functional Analytic Psychotherapy, FAP
Target Audience: Beg., Interm.
Location: Cannes

Chair: Gareth Holman, Ph.D., Private Practice
Discussant: Dennis Tirch, Ph.D., The Center for Mindfulness and Compassion Focused Therapy

As a functional contextual, principle-based treatment focused on interpersonal therapy process, Functional Analytic Psychotherapy (FAP) has naturally evolved methods of supervising and training that are experiential and directly train therapist interpersonal processes. In other words, therapists learn FAP by doing: applying the FAP principles across an expanding range of contexts, including their personal lives. In recent years, we have made a more systematic effort to formalize these methods into a coherent model of psychotherapy training and also to study the impact of FAP training on therapist outcomes such as burn-out and work quality. This symposium presents the emerging conceptual model - focused on the application of principles in natural social contexts (e.g. therapist consult groups) to shape flexible behavioral repertoires related to Awareness, Courage, and Love - followed by results from two new empirical studies of FAP therapist training.

• The Impact of Awareness, Courage, Love, and Behaviorism for Therapists: A Functional Contextual Model of Therapist Training
Gareth Holman, Ph.D., Private Practice
Jonathan Kanter, Ph.D., University of Washington
Mavis Tsai, Ph.D., University of Washington
Robert Kohlenberg, Ph.D., University of Washington

Conventional group training methods such as workshops improve knowledge of treatment principles but often have limited impact on therapist skills. Functional Analytic Psychotherapy (FAP), a functional contextual, principle-based approach to therapy process, has adopted a training method that directly shapes relevant therapist skills in the natural social context of therapist training groups and daily life. The skills we target may be conceptualized under the broad framework of Awareness, Courage, and Love - FAP’s evolving framework for describing the components of impactful social connection. Taken together, the ACL framework presents a coherent model of therapy relationships and our training method represents a means of training therapy relationship skills. This paper presents our evolving model of FAP training and reviews the literature - from therapy relationships to therapist training - relevant to this approach.

• Reducing Burn-out and Improving Organizational Climate in a BPD Clinic with FAP Therapist Training
Michel A. Reyes, Psy.D., Contextual Science and Therapy Institute (Mexico City), National Institute of Psychiatry Ramón de la Fuente
Jonathan Kanter, Ph.D., University of Washington
Maria Santos, M.S., University of Wisconsin, Milwaukee

A repeated measures design was conducted to assess a the impact of 6 sessions of FAP Therapist Training for a team of 6 therapists working in a Borderline Personality Disorder (BPD) clinic in a public mental health institution in Mexico City. Variables assessed include Burnout (MBI) and working climate (EMCO). Results showed a significant decrease in Burnout over time (F(2, 4)=26.22, p=.005, partial η2=.93), from pre- to post-intervention (t (5)=5.377, p=.003 two-tailed, η2=.85), and from pre-intervention to 7 week follow-up (t (5)=7.066, p=.001 two-tailed, η2=.91). Improvements in organizational climate were found over time as well (F(2, 4)=8.628, p=.035, partial η2=.81), pre- post (t(5)=-4.389, p=.007, η2=.79) and pre- follow (t(5)=-4.526, p=.006, η2=.8). Results were consistent across sub-scales and all therapists showed reliable change in both outcomes, supporting the hypothesis that FAP training helps decrease emotional burden and improve working relationships in therapeutic teams who work with challenging clients as those with BPD.

• Effects of Functional Analytic Psychotherapy on Therapist Trainees in Singapore: A Pilot Study
Emma Waddington, Ph.D., National University of Singapore, Singapore
Shian-Ling Keng, Ph.D., National University of Singapore, Singapore
Michelle Tan Su Qing, B. Soc. Sci., National University of Singapore, Singapore
Bernice Lin Xiang Ting, National University of Singapore, Singapore
Clare Henn-Haase, Psy.D., National University of Singapore, Singapore
Jonathan Kanter, Ph.D., University of Washington

This presentation reports preliminary findings from a randomized controlled trial that examined the effects of a Functional Analytic Psychotherapy (FAP) experiential therapist training program on empathy and self-compassion among therapist trainees in Singapore. Twenty-five students enrolled in a master’s in clinical psychology program in Singapore were recruited and randomly assigned to receive either 8 weekly sessions of experiential FAP training or to a waitlist condition. They completed the Self-Compassion Scale (SCS) and the Interpersonal Reactivity Index (IRI) before and after the intervention. Preliminary analyses using mixed-model ANOVA found that compared to the waitlist group, those in the intervention group reported significant increases in perspective taking, F(1, 21) = 10.47, p = .004, and the tendency to identify with others in the context of fictional situations (e.g., movie characters), F(1, 21) = 4.77, p = .04, from pre- to post-intervention. The intervention group also reported trend-level increases in self-compassion, F(1, 21) = 3.24, p = .09, and decreases in feelings of distress that result from observing others’ negative experiences, F(1, 21) = 3.85, p = .06. There were no significant between-group differences in changes in empathic concerns. The results suggest that FAP may be a promising intervention in improving self-compassion and several aspects of empathy among therapist trainees. Implications of the findings are discussed in relation to the local cultural context.

Educational Objectives:
1. Understand a functional contextual model of the therapy relationship and therapist skills. 2. Describe the hypothesized mechanisms by which FAP Therapist Training may impact therapist relationship skills. 3. Review strengths and weaknesses of data supporting the efficacy of FAP Therapist Training.

 

80. Advances in Assessment and Training in Perspective-Taking: Spain Chapter Sponsored
Symposium (16:30-17:45)
Components: Original data
Categories: Relational Frame Theory, Clin. Interven. & Interests, Performance-enhancing interventions, self-flexibility, deictic relations, IRAP
Target Audience: Interm.
Location: Strassburg

Chair: Juan Carlos López, M.A., University of Almeria
Discussant: Louise McHugh, University College Dublin

Mainstream psychology has considered that the Perspective-Taking (PT) is the ability of an individual to interpret another person’s behavior (e.g. private or public events), being an important part of social interactions and of the self-knowledge. From Relational Frame Theory approach the PT is based on deictic relations, such as I-YOU, HERE-THERE, and NOW-THEN. This approach allows to establish behavioral procedures to develop and improve these complex skills in typically and atypically developing populations. The first two studies try to advance in the training in PT and the third study provides a new evaluation procedure of PT. Concretely, the first one aims to train self-flexibility in adolescents using two experimental conditions: Flexible-self training using deictic relational frames versus Theory of Mind training. The second one examined the effect of different ways of presenting the perspective-taking protocol on deictic relational responding in normally developing children. Finally, the third study aimed to assess relational flexibility under deictic cues using the Implicit Relational Assessment Procedure (IRAP).

• Examining the Effects of Training Self-Flexibility Compared to Theory of Mind in Young People
Orla Moran, University College Dublin
Louise McHugh, Ph.D, University College Dublin

Approximately 20% of young people experience clinically significant mental health concerns in a given year. The emergence of these problems can be linked to a dysfunctional sense of self. Widespread empirical evidence indicates the importance of self-development during adolescence. Contextual Behavioral Science (CBS) identifies a 3-step model for the development of a flexible-self. Step 1 involves training perspective relational frames. Step 2 involves empathy training via the transformation of emotional functions. Step three involves deictic Self-as-Context training. The present study aims to train self-flexibility in adolescents using three online sessions with corrective feedback. Flexible-self training is also compared to Theory of Mind training. Outcome measures of self-esteem, self-compassion, depression, anxiety, stress, well-being, emotional acceptance, and cognitive avoidance, were examined at pre, post and follow-up, and process measures of empathy, mindfulness, self-as-context and perspective-taking were examined at each time-point. Implications and suggestions for future research targeting self-flexibility in adolescents are discussed.

• Different Variations of Perspective-Taking Protocol to Assess Deictic Relational Responding in Children
Mª del Mar Montoya Rodríguez, M.A., University of Almeria
Francisco J. Molina Cobos, PhD, University of Almeria

Many studies have investigated the Relational Frame Theory approach to perspective taking through a protocol developed by Barnes-Holmes, which designed to target explicitly the perspective-taking frames. The present study examined the effect of different ways of presenting the perspective-taking protocol in normally developing children. In Condition 1, a range of visual aids were employed with each trial. In Condition 2, no visual aids were employed. In Condition 3, visual aids were employed separating the part of the reversal of each question. In Condition 4, the most of the trials did not necessarily include the words I, you, here, there, now, and then. Furthermore, each trial used different scenarios from each other and the part of the reversal of each question was separated. It is hoped that the results of this work may help to develop systematic behavioral tools for analyzing and training perspective-taking in individuals who show deficits in this area.

• Implicit Relational Assessment Procedure (IRAP) to Evaluate Deictic Relational Responding
Adrián Barbero-Rubio, M.A., University of Almeria
Juan Carlos López, M.A., University of Almeria
Carmen Luciano, PhD, University of Almeria
Nikolett Eisenbeck, M.A., University of Almeria

The current study aimed to assess relational flexibility under deictic cues using the Implicit Relational Assessment Procedure (IRAP). College students (N = 35) from a Spanish university completed a self-report measure of perspective-taking and a deictic relational task (DRT) that involved reversed and double-reversed trials. Then, participants were asked to complete an IRAP designed to measure flexibility in perspective framing. Results showed, firstly, that the IRAP captured the flexibility when they were asked to change the perspective and the complexity involved in different trial types. On the other hand, the lowest DIRAP was related with high deictic ability showed in the DRT. These findings show that the IRAP can be a relevant tool to measure how flexible they are in deictic framing.

Educational Objectives:
1. Implement CBS -based interventions for self-flexibility and perspective taking. 2. Compare different and new procedures of perspective taking. 3. Analyze the flexibility under deictic cues using IRAP.

 

81. Working the Matrix on Interpersonal Settings: Building Empaty, Pro-Sociability and ACL
Symposium (16:30-17:45)
Components: Conceptual analysis, Literature review, Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Clin. Interven. & Interests, Matrix
Target Audience: Beg., Interm.
Location: Room 30241

In this Symposium we will present different clinical experiences and some conceptual issues related to the ACT-Matrix work in interpersonal problems. The Matrix is an interactive diagram for training psychological flexibility in any context with many populations. Since its creation by Kevin Polk, Jerold Hambright and Mark Webster, the Matrix has been broadly used to train individuals in a functional contextual point of view and valued driven behavior. In our practice, we have found that this model is specially useful and can serve as a powerful tool for interpersonal problems that are frequent in clients diagnosed with personality disorders and other complex psychological disorders. In the first presentation, we will present some basis to effectively integrate ACT and FAP principles using the Matrix. In the second one, we will show how to develop functional understanding of behavior (CRB3), and CRB2 generalization to the natural environment (O2) using the Matrix in Borderline Personality Disorders. Finally, we will present some clinical examples of improving empathy trough flexible perspective taking training, and also some conceptual issues about deictic relational responding as the core process "inside" the Matrix.

• A Deep Integration of ACT and FAP trough the MATRIX
Benjamin Schoendorff MA MSc M.Ps, Contextual Psychology Institute. Quebec, Canada

In this presentation it will be shown the integrative use of FAP and the Matrix, to help clients (and clinicians) achieve rapid and lasting change in interpersonal settings. We have found the matrix to be an ideal tool to practice therapeutic-relationship focused ACT and integrate the tools of functional analytic psychotherapy (FAP - Kohlenberg& Tsai, 1991). The matrix is ideally suited to help clients notice the interpersonal functions of their behaviour, which is very useful in clients that present difficulties related to interpersonal adjustment. The therapist can show the client what shows up in his matrix as a function of client behavior and can train perspective taking skills that allow clients to increase their awareness to the contingencies of their behavior, by multiple exemplar training. It will be presented some practical interventions using the Matrix model and some clinical outcomes we observed.

• “How” is important: The Mmatrix as Functional Analytic Psychotherapy Rule 5 and CRB3 Evoking Tool
Michel André Reyes Ortega, Psy D., Contextual Science and Therapy Institute (Mexico City); National Institute of Psychiatry Ramón de la Fuente

Functional Analytic Psychotherapy (FAP) is an interpersonal therapy focused on the contingent interpersonal reinforcement of clients desirable behaviors evoked within the therapy session (CRB2s), the client development of a functional understanding of behavior (CRB3), and CRB2 generalization to the natural environment (O2). FAP therapist follow 5 Rules to achieve this aim, Rule 5 refers to the use of different procedures to develop CRB3 and O2s. This presentation shows the Matrix as a Rule 5 tool as it’s used in a FAP group therapy for Borderline Personality Disorder called Awareness, Courage and Love (ACL) skills training. Through the Matrix, ACL are defined as interpersonal “How is important”, CRB3s are developed through discrimination of toward and away moves, and inner obstacles to ACL are identified. This presentation show the integrative use of FAP and the Matrix, and invite FAP therapists to add it to their Rule 5 repertoire.

• Building Empathy trough the Matrix
Fabián Olaz, Psyd, Faculty of Psychology. University of Cordoba (Argentina)

Despite the centrality of empathy to our development and social adjustment, training empathy is still a challenge in our clinical interventions. May be the more frequent approach in traditional CBT is improving empathy through training in communication skills, emotional disclosure and topographically oriented non verbal behavior training. Following a contextual behavioral approach, in this paper we propose that perspective taking and changing relation to the Self are core process to improves empathy, trough basic process of deictic relational responding that allows us to take the perspective of others. To illustrate clinically this point of view, we present some exercises using the Matrix to train flexible perspective taking skills in clients with interpersonal problems.

Educational Objectives:
1. Assistant will be able to describe some components and applications of the ACT Matrix to interpersonal problems. 2. Integrate interventions using the Matrix with other clinical models. 3. Understand some RFT process involved in working with the Matrix in interpersonal problems.

 

82. Using Basic Science and RFT to Study ACT Processes of Change
Symposium (16:30-17:45)
Components: Conceptual analysis, Original data
Categories: Relational Frame Theory, Theory & Philo., Basic science
Target Audience: Interm.
Location: Room 30341

Chair: Brooke M. Smith, Utah State University
Discussant:Emily Sandoz, University of Louisiana, Lafayette

ACT processes and techniques are theoretically based on the basic sciences of behavior analysis and RFT. The degree to which ACT is empirically supported by basic science has been a matter of some debate, however (McEnteggart, Barnes-Holmes, Hussey, & Barnes-Holmes, 2015). Because of CBS’s emphasis on a coherent model of science, it is important that the empirical links between ACT’s therapeutic principles and their theoretical bases be examined and continually advanced (Foody et al., 2014). The papers presented in this symposium explore recent laboratory findings that may help to inform the theoretical basis of processes of change and therapeutic techniques within ACT.

• Transformation of Thought Suppression Functions Via Same and Opposite Relations
Nic Hooper, Ph.D., University of the West of England
Ian Stewart, Ph.D., National University of Ireland, Galway
Paul Walsh
Ronan O’Keefe
Rachael Joyce
Louise McHugh, Ph.D., University College Dublin

This presentation describes the transformation of thought suppression functions via ‘same’ and ‘opposite’ relations. In Experiment 1 participants were given training and testing with the aim of generating same and opposite relational responding in two five-member relational networks. They then had to suppress a target word from one of the two networks, while words appeared individually onscreen including the target, and words either in the same (target) or a different (nontarget) network. They could remove any word by pressing the spacebar. Findings showed more frequent and faster removal of the target than other words and of words in the target network than other words. Experiment 2, the aim of which was to include predominantly ‘opposite’ relations in the relational networks, produced a similar but weaker pattern. Experiment 3 replicated Experiment 2, while showing that opposite relations produced a more conventional transformation of functions in a context other than thought suppression.

• Enhancing the Efficacy of the Focused Breathing Mindfulness Exercise
Nikolett Eisenbeck, University of Almería
Carmen Luciano, Ph.D., University of Almería
Sonsoles Valdivia-Salas, Universidad de Zaragoza

The aim of this study was to examine possible additional elements to the classic focused breathing mindfulness exercise (FB) in order to enhance its efficacy. 67 healthy undergraduate students were randomly assigned to five conditions: FB, Control, FB with a simple values protocol (FBV), FB with a simple values protocol and an extra attention focusing training (FBFV) and FB with double values protocol and extra attention focusing training (FBFVV). The study used a pre-post design with different outcome measures: the Paced Auditory Serial Addition Task (PASAT-C), stress and mood levels. Results indicated that improved performance on the PASAT-C along with elevated relaxation levels were observed in all mindfulness conditions, but not in the Control. Additionally, FBFVV was better at enhancing performance on the PASAT-C than the FB, suggesting that the addition of the double values protocol and the refocusing training significantly elevated the efficacy of the exercise.

• Development of an Implicit Measure of Emotional Judgments: Relations to Experiential Avoidance and Public Speaking Performance
Jack A. Haeger, Utah State University
Michael E. Levin, Ph.D., Utah State University
Gregory S. Smith, Ph.D., Chrysalis Utah

A key contributor to experiential avoidance, theoretically, is the overextension of verbal problem solving to inner experiences (i.e., certain emotions are “bad” and need to be removed/controlled). Implicit measures provide a venue to study the automatic/immediate judgments of emotions as they are experienced and to test whether such judgments predict experiential avoidance and functional impairment. Not only can this help understand how verbal processes contribute to experiential avoidance, but such implicit measures can broaden the methods used to assess ACT-relevant processes. This study aimed to validate a novel measure of implicit emotional judgments and examine it as a predictor of responding to a public speaking task with a sample of undergraduate students. Results will be presented regarding the relationship of implicit emotional judgments to reactions to a public speaking task (performance, emotional reactivity, use of avoidant coping strategies, behavioral avoidance) as well as self-report measures of experiential avoidance.

Educational Objectives:
1. Describe recent empirical work underlying ACT processes of change. 2. Discuss the conceptual basis of various ACT processes of change. 3. Discuss the importance of clarifying and building upon theoretical conceptualizations and empirical evidence for ACT processes of change and middle level terms.

 

83. Implementing 3rd Wave Therapies in Multidisciplinary Psychiatric Settings- Is it Feasible, is it Working?: Contextual Medicine SIG Sponsored
Symposium (16:30-17:45)
Components: Original data
Categories: Functional contextual approaches in related disciplines, Other, ACT with inpatients
Target Audience: Interm., Adv.
Location: Nizza

Chair: Joris Corthouts, MSc, Psychosis Section, St Hiëronymus, St Niklaas, Belgium
Discussant: Eric Morris, Ph.D., La Trobe University, Melbourne, Australia

In recent years, the research base supporting Acceptance and Commitment Therapy (ACT) for heavy consumers of inpatient health care is growing (see for example the research on psychosis by Gaudiano & Herbert, 2006; White et al., 2011; Bach, Hayes & Gallop, 2012; Shawyer et al., 2012). In this symposium three teams will present their findings and experiences with ACT - along with Basal Exposure Therapy (BET) - in different residential care settings situated in Germany, Sweden and Norway. We’ll be discussing the various methods of administering third wave therapies in this context, the indicators that were used to compare this approach with treatment as usual and the findings. Future research on how to implement ACT in a ward context will also be highlighted.

• Stop Thinking, Start ACTing: The Effectiveness of Acceptance and Commitment Therapy in an Inpatient Sample of a Psychiatric Department
Mareike Pleger, M.Sc. Psych, Ev. Krankenhaus Königin Elisabeth Herzberge, Germany
Psych. Karolin Treppner, M.Sc. Psych, Humboldt-University, Berlin, Germany
Albert Diefenbacher, Prof., Ev. Krankenhaus Königing Elisabeth Herzberge, Germany
Christoph Schade, Dr., Ev. Krankenhaus Königing Elisabeth Herzberge, Germany
Claudia Dambacher, Dipl.-Psych., Ev. Krankenhaus Königing Elisabeth Herzberge, Germany
Ronald Burian, Dr, Ev. Krankenhaus Königing Elisabeth Herzberge, Germany
Thomas Fydrich, Prof., Humboldt-University, Berlin, Germany

Objective. ACT is a contextual approach, which expands traditional CBT by, inter alia, mindfulness and valued living. It has not been unequivocally clarified yet, if ACT is superior to CBT. Although ACT is increasingly applied in clinical practice, only little research has been conducted in this field. Our study aims to explore the therapeutic effect of ACT and CBT groups within a naturalistic setting, taking possible influencing factors into account. Method. Sixty-seven inpatients of a German psychiatric department were assessed with respect to different symptom measures as well as ACT-specific outcomes. Results. ACT and CBT proved to be equally effective treatments regarding symptom reduction. ACT-specific variables turned out to have an influence on therapeutic success. Conclusion. Results suggest ACT to be an equivalent alternative to CBT. Findings are discussed in terms of to what extend outcomes of ACT and CBT are distinct and which variables may be influential.

• ACT for Psychotic Inpatients, Broad Implementation in a Swedish Context
Mårten Tyrberg, M.Sc. Psych., Stockholm University, Sweden
Tobias Lundgren, PhD, Stockholm University, Sweden
Per Carlbring, Stockholm University, Sweden
Thomas Fydrich, Prof., Humboldt-University, Berlin, Germany

In this part of the symposium, pilot results from a small study on a clinical sample in Sweden will be presented. A total of 21 psychotic inpatients were randomized either to treatment as usual (TAU) or TAU plus a short ACT intervention, on average 2 sessions. Groups were measured for rehospitalization and values-based living at pretreatment, post treatment and four month follow-up. Results indicate that the ACT group was rehospitalized to a lesser extent than the TAU group, although the difference was not statistically significant. Also, the ACT group scored higher on the Valued based living (Bull’s-Eye Values Survey) at follow-up, the difference being marginally significant. The results expand somewhat upon previous findings in the same population (Bach & Hayes, 2002; Gaudiano & Herbert, 2006), by indicating that ACT might affect values-based living in addition to decreasing need for rehospitalization.

• Basal Exposure Therapy 24/7: From Poly-Pharmacy and Mechanical Restraints to Second Order Change and Empowerment
Arne Lillelien, M., Vestre Viken Hospital Trust, Norway
Trym Nordstrand Jacobsen, M, ACT&BET Instituttet

Basal Exposure Therapy (BET) was developed for marginalized patients who are heavy consumers of inpatient mental health care and subjected to extensive poly-pharmacy and use of force. These patients typically present with schizophrenia spectrum disorders or complex PTSD with co-morbid personality disorders. BET is theoretically founded in cybernetics and existentialism, with a clinical model that also emphasizes principles from the behavior therapy tradition, including ACT. BET has been developed to both suit and take advantage of the inpatient psychiatric setting, making it a thorough 24/7 approach for fostering psychological flexibility and autonomy. Experiences with implementing BET as a comprehensive 24/7 treatment modality will be shared, along with clinical data from a 10 year period.

Educational Objectives:
1. Audience will be able to describe differences in the therapeutic effect of ACT and CBT for inpatients. 2. Audience will be able to describe effects of ACT-implementation on rehospitalization and values-based living. 3. Audience will know about the basic clinical elements of Basal Exposure Therapy and data collected so far.

 

84. ACT for Autism, Classroom-stress and at-risk parents
Symposium (16:30-17:45)
Components: Original data, Experiential exercises, Didactic presentation
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Edu. settings, Prof. Dev., Parenting, Children, ACT and autism spectrum disorder, Special Education Students
Target Audience: Beg., Interm., Adv.
Location: Cannes

Chair: Vasilis S. Vasiliou, MS, University of Cyprus, ACTHealthy Lab
Discussant: Jacqueline A-Tjak, Msc, PsyQ

This symposium presents three new studies that address the mental health and well-being of children, adolescents and parents. The first study offers new evidence about the impact of an ACT-based group intervention for parents with children with behavioral and emotional difficulties. The second study focuses on stress of special education classrooms? in collaboration situations in inclusive work settings and furthermore examines the effects of an Acceptance and Commitment Training on collaborations skills and stress. Finally, the third study conceptualizes the psychopathology associated with high-functioning autism from a functional contextual perspective and examines the effect of an ACT intervention for autism.

• ACT-based parenting for at-risk families: the Confident Carers Cooperative Kids program.
Mark Donovan, University of Wollongong, Australia
Kathryn Briscoe-Hough, University of Wollongong

This paper provides early data for at-risk parents attending the Confident Carers Cooperative Kids program. CCCK is a 9 week ACT-based group intervention for parents raising primary school aged children with behavioural and emotional difficulties. It was specifically developed to increase the engagement and perseverance of at-risk parents, and to infuse families with flexible ACT-based cultural practices. The CCCK program uniquely integrates parenting concepts and activities theoretically based on a blend of Neurobiology, Attachment Theory, Social Learning Theory and Behaviourism, but delivered within an ACT framework. Early data presented in this paper supports the hypothesis that CCCK is able to help those families who are most in need. This paper also showcases some of the images, metaphors and exercises from the program.

• The impact of an Acceptance and Commitment Training for special education students: psychoneuroendocrinological findings
Dietrich Pülschen, Ph.D., Department of Psychiatry, University of Rostock
Simone Gebhard, Institute of Special Education, Department of Special Educational Psychology, Europa-Universität Flensburg

Teaching is perceived as a profession which is linked to high levels of stress. Only 65% of teachers in Germany reach retirement age while still in service, in many cases because of psychiatric illness. The additional challenge to collaborate with colleagues from different professional backgrounds and with varying levels of skills will potentially lead to further stress. Such stress-related psychological states and processes might affect biological stress- responsive systems which are supposed to be involved in the pathogenesis of stress-related diseases and disorders in the long term. In this study, HPA axis responses to collaboration situations in role plays were examined by measuring salivary cortisol to test whether collaboration in inclusive work settings is accompanied by altered HPA axis stress responses in healthy special education students (N=38). Additionally, the sympathetic system activity reflected by the salivary alpha amylase was measured together with the coping behaviour of the students (stress management questionnaire and behaviour assessment). The sample was then split into an experimental and a control group. The experimental group received a weekly Acceptance and Commitment Training (1,5 h each session) for three month. Furthermore the study examines the effects of the Acceptance and Commitment Training which is expected to establish and develop collaboration skills and to reduce high levels of subjective stress. Also salivary samples were taken from both groups at the second time of measurement. Work in progress – we will have the final results in the End of February 2015. (Data for Baseline and first time of measurement is already collected.)

• Acceptance and commitment therapy (ACT) and high-functioning autism spectrum disorder: a functional contextual approach to conceptualize and treat associated symptoms
Johan Pahnke, clinical psychologist, PhD student, KIND (Center for Neurodevelopment Disorders at Karolinska Institutet), Karolinska Institute, Stockholm city council
Tobias Lundgren, PhD, licensed psychologist, psychotherapist, Affiliated researcher, Department of psychology, Stockholm university Karolinska institute, Stockholm city council
Johan Bjureberg, licensed psychologist, PhD student, CPF, Karolinska Institute
Timo Hursti, associate professor, Department of psychology, Uppsala university
Sven Bölte, professor, KIND (Center for Neurodevelopment Disorders at Karolinska Institutet), Karolinska Institute, Stockholm city council
Tatja Hivikoski, neuropsychologist, PhD, KIND (Center for Neurodevelopment Disorders at Karolinska Institutet), Karolinska Institute, Stockholm city council

Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with depression, anxiety and stress, and decreased quality of life. ACT processes target core difficulties in ASD, such as psychological inflexibility, although not yet evaluated for this population. Study 1: Using a quasi-experimental design we evaluated the treatment for 28 students with ASD (aged 13–21). Levels of stress, hyperactivity, and emotional distress were significantly reduced and pro-social behavior was increased. Study 2: Using an open trial design the treatment was evaluated for adults (n=10; age range 25-65 years) in an outpatient psychiatric context. Levels of stress were significantly reduced and quality of life increased. Study 3: Using an RCT design we evaluated the treatment for 40 adults with ASD in an outpatient psychiatric context. Preliminary data showed significantly reduced stress and psychiatric symptoms, and increased psychological flexibility and quality of life. Autistic core symptoms were also reduced.

Educational Objectives:
1. Explain how ACT-based images, metaphors and experiential exercises can engage at-risk families and improve outcomes. 2. Train teachers to establish and develop collaboration skills and reduces high levels of subjective stress. 3. Conceptualize the psychopathology associated with high-functioning autism spectrum disorder (ASD) from a functional contextual perspective.

Saturday, 18 July

95. Continuing Developments in Measuring ACT Processes
Symposium (10:30-12:00)
Components: Conceptual analysis, Literature review, Original data
Categories: Theoretical and philosophical foundations, Clin. Interven. & Interests, RFT, Measurement
Target Audience: Interm.
Location: Estrel Saal C6

Chair: Tami Jeffcoat, University of Nevada, Reno
Discussant: Helen Bolderston, Bournemouth University, UK

As research and practice continue with Acceptance & Commitment Therapy and Relational Frame Theory, so do attempts to measure psychological and behavioral processes relevant to them. This symposium includes discussion of recent and ongoing empirical work in measuring ACT processes. The symposium will include discussion of research-programme development in this area and recommendations for collaborative work. New data will be presented on developing measures of self-as-context , perspective-taking, cognitive defusion, and values-based living.

• The Development and Initial Validation of The Cognitive Fusion Questionnaire
David T. Gillanders, University of Edinborough
Helen Bolderston, Bournemouth University

This talk will outline practical details of questionnaire development, some aspects of measurement theory, and some of the tensions between psychometric approaches and ideographic approaches to measurement. It will also show how a programme of research can be developed through sharing, collaboration and graduate student supervision. ACBS is unique in providing a context that fosters such an approach to tool development.

• Measuring Values and Committed Action with the Engaged Living Scale
Hester R. Trompetter, University of Twente, Enschede
P.M. Ten Klooster, University of Twente, Enschede
K.M.G. Schreurs, University of Twente, Enschede
M. Fledderus, University of Twente, Enschede
G. J. Westerhof, University of Twente, Enschede
E.T. Bohlmeijer, University of Twente, Enschede

Until recently, process measures to study the aspects of values and committed action from the psychological flexibility model were only scarcely available. The Engaged Living Scale (ELS: Trompetter, ten Klooster, Schreurs, Fledderus, Westerhof & Bohlmeijer, 2013) was developed to fill this gap. This talk will focus on the development of evaluation of the 16-item ELS. In both a healthy adult sample and a chronic pain sample, the final 16-item ELS has good factor structure, internal consistency and construct validity through significant relations with other ACT process measures and outcome measures, such as depression and acceptance. Additionally, the ELS has good incremental validity over and beyond other ACT process measures. The use of the ELS as a process measure of engaged living is discussed in light of other existing questionnaires to measure values and committed action, such as the Committed Action Questionnaire (CAQ) and Valued Living Questionnaire (VLQ).

• Development of the Reno Inventory of Self-Perspective, Measuring Self-as-Context and Perspective-Taking
Tami Jeffcoat, University of Nevada, Reno
Steven C. Hayes, University of Nevada, Reno
Thomas Szabo, Florida Tech School of Behavior Analysis

The construct of Self-as-Context is a component process in the model of psychological flexibility as applied in Acceptance and Commitment Therapy (ACT), an empirically supported behavioral treatment. ACT targets six core psychological processes, one of which is the perspective taking skill termed self-As-context (SAC). In research and practice it had been customary to use tools that are theoretically related to SAC such as perspective-taking (of others) or empathy measures approximate self awareness and self perspective-taking within an ACT model. Recently self report measures have been in development to specifically capture the ACT self-as-context process. The present study is an attempt to evaluate the psychometric properties of a self-report measure of the abilities of I/here/now perspective-taking. Data on the new measure (2 samples greater than 600N each) will be presented, as will new data on the Self as Context Scale (SACS) and Deictic Relational Task (DRT).

Educational Objectives:
1. Examine the psychometric properties of measures such as the developing CFQ, ELS, RISP, SACS and DRT. 2. Describe how a global community can pool resources to develop measurement tools. 3. Become generally informed on existing process measures for aspects of the psychological flexibility model.

 

96. Values, Flexibility in Eating disorders
Symposium (10:30-12:00)
Components: Original data
Categories: Prevention and Community-Based Interventions, Clin. Interven. & Interests, Eating Behavior, Values, Binge Eating, Obesity
Target Audience: Beg., Interm., Adv.
Location: Estrel Saal C7

Chair: Siri Ming, M.A., Private Practice
Discussant: Georg Eifert, Ph.D., Chapman University

Treatment of eating disorders can be challenging, with even state-of-the-art cognitive-behavioral treatments achieving only moderate success. The three paper presented in this symposium examine different ACT Interventions and the role of ACT relevant constructs for eating-related difficulties. The first study assesses a.) the possible impact of social stress on eating behavior and b.) the utility of values writing as a possible brief intervention for improving eating behavior. The second study conceptualizes binge-eating symptoms from an ACT perspective and examines the role of body image flexibility, emotional eating and binge eating symptoms. Finally, the third study describes the components of an integrative third wave group program for binge eating in obesity, identifies the main psychological processes targeted and evaluates its effect.

• Bullet Proof Vest: Can Values Writing Be a Protective Intervention Against the Impact of Social Stress On Eating Behavior
Emmy LeBleu, University of Louisiana at Lafayette
Emily Sandoz

Eating is an important behavior. In humans eating is directed by a host of environmental influences, including the social environment that they are immersed in. Social situations can have both negative and positive impacts on eating behavior depending on the experience. Individuals who are obese or overweight experience greater amounts of social stress in the form of discrimination and exclusion than normal weight controls. Unfortunately, being ignored by others has been found to increase consumption of palatable foods, which could perpetuate the obesity struggle in a cyclical manner. Fortunately, writing about what one cares about (i.e. one’s values) has been found to attenuate the impact of being ignored or ostracized. This presentation will explore data related to the impact of a one time valued writing exercise on the eating behaviors of obese and non-obese participants following an experience of ostracism.

• Binge eating as an avoidance of negative emotions: The buffering effect of body image flexibility
Duarte, C., Cognitive and Behavioural Centre for Research and Intervention (CINEICC)
Pinto-Gouveia, J., Cognitive and Behavioural Centre for Research and Intervention (CINEICC)

Body image inflexibility has been conceptualized as an important process involved in the vulnerability to and treatment of eating psychopathology, namely binge eating. The current study examined the moderator effect of body image flexibility on the association between emotional eating and binge eating symptomatology. Participants comprised 216 women from the general population who completed measures of body image flexibility, emotional eating and binge eating symptomatology severity. Correlational analyses indicated moderate negative associations between body image flexibility, emotional eating and binge eating severity. Results also showed that body image flexibility moderated the association between emotional eating and binge eating severity. The model explained 60% of the variance of binge eating severity, suggesting that in women who present the tendency to eat in response to negative emotions, those with higher psychological flexibility regarding body image, present lower engagement in binge eating. Findings suggest the relevance of addressing emotional eating and the ability to accept negative emotional states without engaging in reactive avoidance strategies, in binge eating prevention and treatment.

• BEfree – A group programme for Binge Eating in Obesity: preliminar results
Sérgio Carvalho, MSc, CINEICC - University of Coimbra
Lara Palmeira, MSc, CINEICC - University of Coimbra
Paula Castilho, PhD, CINEICC - University of Coimbra
José Pinto-Gouveia, MD, PhD, CINEICC - University of Coimbra

Binge eating (BE) has been associated with an early onset of obesity, its maintenance and severity, and worsened outcomes in response to weight loss treatments. Recently, BE has been conceptualized as an affect regulation strategy aiming at avoiding unwanted internal experiences (e.g. negative affect, shame, self-criticism), although current interventions have neglected these aspects. The aim of this study was to test the efficacy of a 12-session acceptance, mindfulness and compassionate-based group programme for BE in obesity (BEfree). The sample was composed by 32 subjects randomly assigned into two conditions: 1. BEfree (n = 12); 2. TAU (n= 20). Pre to post-test differences in both groups were assessed using the Wilcoxon signed-rank test. Results showed that participants in BEfree significantly decreased levels of binge eating (BES), depressive symptoms (BDI-I), shame (OAS), self-criticism (FSCSR), body image cognitive fusion (BI-CFQ), body image psychological inflexibility (BI-AAQ), and increased levels of quality of life (ORWELL97) and engaged living (ELS). No differences were found in these measures in the control (TAU) condition, except for a significant increase in shame (OAS).

Educational Objectives:
1. Assess the utility of values writing as a possible brief intervention for improving eating behavior. 2. Explain the role of body image flexibility as a buffer on the association between emotional eating and binge eating symptoms. 3.

 

99. Applying Contextual Behavioural Science to Meet the Needs of People with Intellectual Disabilities and Those who Support them: A multiple systems approach
Symposium (10:30-12:00)
Components: Conceptual analysis, Original data, Case presentation
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Intellectual Disabilities, Positive Behaviour Support
Target Audience: Beg.
Location: Strassburg

Chair: Steve Noone, Ph.D., Northumberland, Tyne and Wear NHS Foundation Trust
Discussant: Nick Gore, Tizard Centre, University of Kent

One of the goals for proponents of Contextual Behavioral Science is to develop a “coherent and progressive science of human action that is more adequate to the challenges of the human condition”. In order to progress towards this aim, CBS must be applicable to the millions people with an intellectual disability (PWID) worldwide. Adaptations are essential due to the nature of intellectual disability and the likelihood that PWID are reliant on paid and unpaid support. Recent scandals of the institutional abuse of PWID have prompted policy makers in the UK to promote a Positive Behaviour Support model of care, which, with its behavioural roots and its emphasis on improving quality of life, appears compatible with CBS philosophies. This symposium will present case study work in which ACT interventions have been adapted to meet the needs of PWID, a paper on presenting ACT resilience training to direct care staff, and a theoretical paper considering how systems thinking can add to the multiple contextual influences involved in working with this client group in a CBS-consistent way.

• Adapting ACT interventions for Adults with Intellectual Disabilities
Dr Mark Oliver, Northumberland, Tyne and Wear NHS Foundation Trust

People with intellectual disabilities (PWID) frequently experience psychological distress and can present with behaviour that challenges services. The nature of their impairments makes it difficult for them to access mainstream services and access talking therapies without adaptations. Particular elements of the ACT model are especially problematic in this regard; being either highly abstract and reliant on sophisticated verbal understanding which is difficult for PWID, or that assume a level of control over life choices that may not be reflective of the realities of life for people reliant on paid and unpaid carer support. This paper will present case study examples of successful adaptations to the ACT model as well as areas of the model that have been less successfully applied, or that reveal particular considerations for the clinician working in this field.

• Acceptance and Commitment Therapy (ACT) based Resilience Training for Healthcare Staff
Janet Harrison, Northumberland, Tyne and Wear NHS Foundation Trust

Staff supporting individuals with chronic health needs – such as intellectual disability – experience higher levels of work-related stress than other employed adults. Stressful working environments are linked to increased sickness and absence, reduced productivity in the longer term leading to burnout and increased vulnerability to building negative cognitions. Studies using Acceptance and Commitment Therapy (ACT) in organisational studies have demonstrated beneficial effects in mediating the cognitive factors leading to stress. This presentation describes a study in which ACT based training workshops were delivered to healthcare practitioners. The workshops focused on mindfulness and values based approaches with home practice review. Data will be presented showing significant improvements in general mental health, and levels of burnout, as well as significantly reduced levels of cognitive fusion. The findings will be discussed in relation to meeting the needs of people with intellectual disabilities.

• Working with the System – Individual Agency, Staff Teams, Organisations and Culture
Dr Matt Selman, Northumberland, Tyne and Wear NHS Foundation Trust

People with intellectual disabilities (PWID) often live in a context where they have little personal agency; being dependent on paid or unpaid carers for many aspects of their lives. The carers themselves operate within the context of the organisations that employ them (or values held within a family) that shape their pattern of care. Organisations, in turn, are influenced by the context of market forces, government policy, and legal requirements. When referrals are made to healthcare agencies these contextual factors influence both the type of interventions that are likely to be effective and also the ability to implement these interventions. When healthcare agencies become involved they too form a context that can at times both help or hinder the process. This presentation explores these contextual systems and how this understanding of working with PWID may inform broader service considerations.

Educational Objectives:
1. The learner will appreciate the challenges inherent in applying ACT to an intellectual disabilities population. 2. Will be able to describe the evidence for applying ACT resilience training to healthcare staff. 3. will be able to assess the utility of considering the person with intellectual disability as embedded within multiple systems of influence.

 

100. New findings and procedures in the field of Relational Frame Theory
Symposium (10:30-12:00)
Components: Conceptual analysis, Original data, Didactic presentation
Categories: Relational Frame Theory, Clin. Interven. & Interests, Theory & Philo., Related FC approaches, RFT, IRAP, cultural adaptation, self-esteem, academic cheating, work and leisure time, Dark Triad of Personality
Target Audience: Beg., Interm., Adv.
Location: Room 30241

Chair: Joanna E. Dudek, M. A., University of Social Sciences and Humanities
Discussant: Yvonne Barnes-Holmes, Ph.D., National University of Ireland, Maynooth

Gaining psychological knowledge about human cognition poses a challenge due to difficulties in measurement of patterns of thinking, beliefs that may not be readily accessible. One of the ways to meet that challenge is the Implicit Relational Assessment Procedure (IRAP), which allows measurement of relational networks and implicit attitudes. This symposium aims do discuss the application of IRAP across different contexts. The first paper presents the process of adaption of the IRAP for Polish circumstances concerning self-esteem, academic cheating and work and leisure time. The second paper focuses on using IRAP to explore automatic evaluations regarding life and death, examining the role of psychological flexibility on implicit outcomes. Finally, the third paper employs IRAP in self-forgiveness.

• The Cultural Adaptation of Implicit Relational Assessment Procedure (IRAP) in Poland
Magdalena Hyla M.A., University of Silesia in Katowice
Lidia Baran, M.A., University of Silesia in Katowice
Karina Atłas, M.A., University of Silesia in Katowice
Elżbieta Sanecka, M.A., University of Silesia in Katowice
Irena Pilch, Ph.D., University of Silesia in Katowice

Psychological knowledge about human cognition poses a challenge for the measurement of patterns of thinking, beliefs and their connection to behaviour. One of the ways to meet that challenge is the Implicit Relational Assessment Procedure (IRAP) which allows measurement of relational networks and implicit attitudes. However, implementation of this measurement procedure in non-English speaking countries requires consideration of the relevant cultural and linguistic circumstances. The aim of this paper is to present the process of the adaptation of the IRAP for Polish circumstances conducted at the University of Silesia in Katowice. Authors will discuss preparation and conduct of the pilot study (creation of the test script, selection of the linguistically appropriate stimuli, and comments about the procedure received from the participants) and the first three full-scale research projects concerning self-esteem, academic cheating and work and leisure time (difficulties with stimuli selection, specificity and conclusions regarding applying the method in Poland).

• Implicit Responses to Life and Death: Implications for Suicidality and Psychological Suffering
Laura Rai, National University of Ireland, Maynooth
Yvonne Barnes-Holmes, National University of Ireland, Maynooth
Darren Clarke, National University of Ireland, Maynooth
Ciaran Hyland, National University of Ireland, Maynooth
Claire Murray, National University of Ireland, Maynooth

The current paper focuses on using the Implicit Relational Assessment Procedure (IRAP) to explore automatic evaluations regarding life and death. 180 undergraduate participants completed two IRAPs and a number of self-report measures targeting depression, anxiety, hopelessness and self-esteem. Specific response patterns on the IRAP distinguished participants scoring highly on these self-report measures from normative participants. For example, normative participants showed a greater bias towards 'I don't deserve a negative life' than participants who scored high on measures of sub-clinical depression. Findings also highlighted the role of psychological flexibility as a mediator of the implicit outcomes. That is, participants who scored high on experiential avoidance showed stronger and more rigid responses on the IRAP. Implications of the current findings and the predictive validity of implicit measures will be discussed within the domains of suicidality and psychopathology more generally.

• The Development of Implicit Relational Assessment Procedure as a Measure of Self-Forgiveness of Failing and Succeeding Behaviors
Diana Bast, Maynooth University
Dermot Barnes-Holmes, Maynooth University

It will be presented a series of papers, including cross cultural studies with ACT therapists, that employ the Implicit Relational Assessment Procedure (IRAP) in the context of self-forgiveness. Specifically, brief and immediate relational responses (BIRRs) and extended and elaborate relational responses (ERRs) related to feelings and expected outcomes in the context of minor failings and successes. The studies aimed (1) to develop an IRAP of self- forgiveness of minor failures; (2) determine if BIRRs and ERRs yield similar or different results; (3) determine if such measures should target failures in a general or specific manner and if such measures differ depending on whether they target feelings or expected outcomes of “problem” behaviours; (4) explore the relationships among implicit and explicit measures in terms of associated feelings and outcomes, and various indicators of mental health, (5) to test if the self-forgiveness IRAP was sensitive to an Acceptance Commitment Therapy (ACT) training. The results indicate that BIRRs may diverge from EERRs, but when BIRRs reflect problem behaviours specific to the individual participants, correlations with measures of psychopathology may emerge. Besides, the history of ACT training appears to produce an IRAP performance that could be explained by an openness to negative feelings not observed for the control group.

Educational Objectives:
1. Describe theoretical basis and practical applications of IRAP as a method of implicit attitudes measurement. 2. Apply implicit findings to an RFT conceptualisation of psychological suffering. 3. Explore the relationships among implicit and explicit measures (e.g. self-compassion scale), in terms of associated feelings and outcomes, and various indicators of mental health and well-being.

 

101. Deepening into the Acceptance and Commitment Therapy (ACT)
Symposium (10:30-12:00)
Components: Case presentation
Categories: Clinical Interventions and Interests, Clin. Interven. & Interests, RFT, ACT, Fibromyalgia, Elderly, Depression, orientation problem
Target Audience: Beg., Interm., Adv.
Location: Room 30341

Chair: Lidia Budziszewska, University of Almeria & Sinews MTI Multilngual Therapy Institute
Discussant: Lance Mccracken, King's College London, Guy's and St. Thomas' NHS Foundation Trust

Acceptance and Commitment Therapy (ACT) is rooted in a functional analysis of human language known as Relational Frame Theory (RFT). As such, it is not exclusively oriented to a specific population, and nor is a set of exercises or metaphors. On the contrary, clinical ACT methods consist of multiple interactions oriented to change the context of participant’s private events in order to alter their problematic verbal regulation. In this session we present the application of ACT and brief ACT-based protocols to three different populations, emphasizing the importance of RFT in clinical setting: a) elderly nursing home residents with depressive symptomatology; b) fibromyalgia and c) a case study of experiential avoidance, spatial-orientation and self-sufficiency problems.

• A Brief Acceptance and Commitment Therapy (ACT) protocol for Elderly Nursing Home Residents with Depressive Symptomatology
Luis Jorge Ruiz Sanchez, Universidad de Almería
Carmen Luciano, Universidad de Almería
Adrián Barbero Rubio, Universidad de Almería
Adolfo Cangas, Universidad de Almería

Depression is widely prevalent in nursing home residents. However, this population remains unobserved and undertreated. The present study explored the applicability of brief ACT-based protocol to three elderly residents, aged 65 to 84 years old, with depressive symptomatology. The treatment sessions were directed to experience the result of a spiral of unsuccessful effort in relation to personal values; clarifying valued trajectories and learning to verbally discriminate between the ongoing private events (self-as-process) from the person who is experiencing it (self-as-context). Numerous experiential exercises and physical metaphors were used to promote an effective regulation of behavior. The results suggest that this brief ACT protocol produced significant increases on value-consistent behaviors in all subjects at 5 and 12 months follow-up. Clinical improvements were also obtained in psychological flexibility, value-consistent behavior and depressive symptomatology scores.

• A Brief Acceptance and Commitment Therapy Protocol in a Patient Diagnosed with Fibromyalgia
Víctor Manuel Callejón Ruiz, Universidad de Almería
Carmen Luciano, Universidad de Almería

Fibromyalgia is a health problem that is increasing its high prevalence. The treatment is usually carried out as program to alleviate the physical symptoms through a multidisciplinary approach, although the long-term effects have shown to be minimal. Acceptance would respond to experiences related to pain without trying to control or avoid when these are limiting the quality of life. For all this is done a brief intervention protocol from ACT. This intervention is oriented to increase the flexibility to sensations such as pain for increased involvement in activities that are important for the patient. The sessions contained metaphors and exercises with the main elements of ACT. The results highlighted an increase in the valued activities carried out during each day by the patient. Furthermore, the impact of fibromyalgia on the patient decreased in all areas.

• An Intervention Based on Acceptance and Commitment Therapy (ACT) to Enhance Self-Sufficient Skills in a Chronic Case with Spatial Orientation Problem
Adrián Barbero Rubio, Universidad de Almería
Carmen Luciano, Universidad de Almería
Nikolett Eisenbeck, Universidad de Almería
Juan Carlos López, Universidad de Almería

This presentation is a case study of a 34-year-old male (R) with severe deficits in self-sufficiency regards to spatial orientation, self-care and social interactions. The analysis was realized from a functional-contextual perspective, showing an avoidance-based, destructive pattern that consisted of a variety of inflexible rules and responses. This pattern was mainly characterized by an automatic need to only respond to pleasant stimulation. Therefore, in most activities that would have made the client independent, R experienced them as tiresome, boring and monotonous and showed severe attentional disengagement. The problem was conceptualized on the basis of overprotective and dependent family interactions. An intervention based on ACT was selected by its commitment to basic research of the processes involved in the therapeutic change. The results support the suitability of this therapeutic approach in chronic cases.

Educational Objectives:
1. Analysis of clinical cases Relational Frames Theory. 2. Clarification of the processes involved in Acceptance and Commitment Therapy (ACT). 3. Consideration of intervention from Acceptance and Commitment Therapy in different disorders.

 

102. From Computer Games to Avatar Led Treatments: Adapting ACT to Creative Internet Based Programs for the Prevention and Treatment of Various Problems
Symposium (10:30-12:00)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Internet based interventions
Target Audience: Beg., Interm., Adv.
Location: Nizza

Chair: Maria Karekla, University of Cyprus
Discussant: Raimo Lappalainen, University of Jyväskylä, Finland

Internet based adaptations of effective face-to-face programs have become popular in recent years, as they offer various advantages over traditional modalities of treatment delivery and present solutions to problems that have traditionally prevented individuals from seeking treatment. Internet based programs offer the advantages of being easily accessible to even remotely located clients, clients can access programs at their own time and place and proceed at their own pace, and can be presented in formats that become attractive even in difficult to reach populations (e.g. adolescents). This symposium will present three papers utilizing various aspects of internet based interventions grounded in Acceptance and Commitment Therapy principles. These programs reach a wide range of audiences (from chronic pain to depression to eating disorders) and are created utilizing different creative internet-based aspects (adaptation of face-to-face protocol, avatar led, gamefied intervention). The creation of these programs will be presented and obstacles faced as well as creative solutions found will be discussed. The initial acceptability of the programs for the targeted populations will be presented.

• “This gave me many new thoughts and means to cope with life.” Internet-delivered ACT for depression: Participant and coach experiences
Lappalainen, Päivi, University of Jyväskylä, Finland
Lappalainen, Raimo, University of Jyväskylä, Finland

Improving access to psychological treatments for common mental disorders is a priority worldwide. Interned delivered treatments offer a solution and additional advantages: are accessible regardless of time and place and enable working at his/her own time and pace. This study aimed to investigate the effects, and acceptability of a guided web-based ACT intervention for depressive symptoms without any face-to-face contact. Depressed participants (n =39) were randomly assigned to an Internet-delivered ACT (iACT) or a wait list control condition. They were assessed with standardized self-report measures at pre-, post-, and 12-month follow-up. The iACT comprised of homework assignments and online feedback given by psychology students, and weekly reminders. The results showed a clear reduction in most measures at post-treatment and 12-month follow-up. The iACT was well-accepted by both clients and student therapists. iACT without face-to-face sessions but combined with weekly contact via Internet and reminders, is possibly an alternative for mild-to-moderate depression.

• Gamifying an ACT treatment for the Prevention of Eating Disorders among Adolescent and Young Adult Females
Patrisia Nicolaou, University of Cyprus
Maria Karekla, University of Cyprus

Eating Disorders (EDs) constitute a serious public health issue affecting mainly women and develop in adolescence or early adulthood. Prevention of EDs is paramount however, prevention approaches to date have not been uniformly effective. Computer-assisted health interventions grounded in solid theoretical accounts of EDs (e.g. psychological flexibility model) have the capability to improve upon the prevention of EDs. This paper will present the development of an innovative internet based program based on ACT principles and created as a game for adolescent and young adult women. Participants follow the life of a character undergoing challenges (enters a reality fashion show) and assist her so as to overcome body related thought and emotion difficulties and learn to live a more experientially accepting, full and valued life. This interactive program will be presented and preliminary results as to its acceptability will be presented.

• Adaptation of an ACT Based Intervention to a Digital Intervention for Chronic Pain
Orestis Kassinopoulos, University of Cyprus
Vasilis Vasileiou, University of Cyprus
Maria Karekla, University of Cyprus

Acceptance–based psychological interventions have been receiving empirical support. Yet financial barriers for the healthcare system and chronic pain patients as well as obstacles regarding physical access to treatment, highlight the need for innovative cost-reducing digital interventions. To date, there have only been two internet-delivered interventions based on ACT and Chronic Pain (Buhrman et al., 2013; Hester et al., 2014). However, none was adapted in a way to increase adherence rates, a problem often faced by digital interventions. Our adaptation of an ACT-protocol for chronic pain sufferers to a digital intervention aims to improve the human-computer interaction with the use of a persuasive system design, Avatars, short and limited number of sessions aimed at maximum efficiency. The process of converting a face-to-face Acceptance and Commitment Therapy intervention to both a web-based and a mobile-application is described. Obstacles arising during the adaptation and creative solutions to them will be discussed.

Educational Objectives:
1. To propose the utilization of smart internet based technology for the creation of ACT based programs for various problems. 2. To discuss obstacles presented in the creation of internet based programs and propose creative solutions. 3. To present the acceptability of ACT internet based programs to therapists and clients.

 

103. Embracing Psychological Flexibility: Relationship with life quality and satisfaction and executive functioning
Symposium (10:30-12:00)
Components: Conceptual analysis, Original data, Case presentation
Categories: Educational settings, Clin. Interven. & Interests, Prevention & Comm.-Based, Performance-enhancing interventions, Edu. settings, psychological inflexibility, life engagement, college students, SUD, ( executive functions, Mindfulness), adolescence, research, mindfulness, avoidance, cognitive fusion, thought suppression
Target Audience: Beg., Interm., Adv.
Location: Cannes

Chair: Charles Benoy, MSc, ACT-based Behavior Therapy Inpatient Unit Universitäre Psychiatrische Kliniken Basel, Switzerland
Discussant: Fabian Olaz, Faculty of Psychology. University of Cordoba (Argentina)

There has been substantial evidence for the health benefits of psychological flexibility across different populations. This symposium presents the finding of three studies analyzing the relationship between psychological flexibility and different outcomes in two student populations and a population institutionalized for severe substance abuse. The first study aims to analyze the relationship between psychological flexibility, life commitment and satisfaction and alcohol consumption in students. The second study examines the correlations between psychological flexibility, quality of life and wellbeing in a non-clinical sample of adolescents. Finally, the third study demonstrated the impact of an ACT intervention on executive functions in participants institutionalized for severe substance abuse.

• Psychological Inflexibility and Life Engagement as predictor of Drug Consumption and Life Satisfaction in a College Students in Ecuador
Pablo Ruisoto, Ph.D, University of Salamanca
Silvia Vaca, Ph.D., Universidad Técnica Particular de Loja
Esther Gimeno, University of Salamanca

In Ecuador, the use of psychoactive substances is a social problem based on their impact on health and social costs, particularly in the adolescent population. Psychological inflexibility and vital commitment are two central concepts in ACT leading to multiple behavioural problems. This study aims to analyze the relationship between the degree of psychological inflexibility and life life commitment with alcohol consumption and life satisfaction. More than 3,000 students from University of Southern Ecuador were surveyed using AUDIT to measure alcohol consumption, AAQ -7 to assess psychological inflexibility and LET to assess life commitment. An additional item was included to assess life satisfaction (LSQ). The results support the value of these variables to predict problematic alcohol consumption and life satisfaction. The implications for the design of programs aimed at preventing alcohol consumption among college students are discussed.

• A new pearl in the oyster: An exploratory study about the incidence of psychological flexibility on quality of life and psychological wellbeing in adolescence
Emanuele Rossi, Psy.D., Associazione Italiana Scienze Comportamentali e Cognitive, AISCC
Erika Melchiorri, Psy.D., Associazione Italiana Scienze Comportamentali e Cognitive, AISCC
Alessia Panzera, Psy.D., Associazione Italiana Scienze Comportamentali e Cognitive, AISCC

Acceptance and Commitment Therapy emphasizes six core processes as positive psychological skills: acceptance, being present, defusion, self-as-context, values, committed action. Being psychologically flexible allows people to get a richer and values-directed life, increasing psychological wellbeing and reducing perceived stress. This study investigates the correlations between psychological flexibility, quality of life and wellbeing in a non-clinical sample of about 600 Italian adolescents. The used measures are: STAI –Y and SAFA (anxious, depressive, somatic symptoms) AFQ-Y (cognitive fusion, experiential avoidance, behavioral ineffectiveness) CAMM (lack of present-moment awareness, non-judgmental and non-accepting responses to private events) MAAS-A (presence/absence of attention to/awareness of what is happening in the present moment), SCS (self-compassion), PSS (perceived stress), SLSS and BMSLSS (life-satisfaction), SHS (subjective happiness), DAS (dysfunctional attitudes), FMI (mindfulness) QUEVA (quality of life), A-DES (dissociation). Measures assessing psychological distress result significantly positively correlated with measures assessing psychological inflexibility, dissociation, perceived stress and significantly negatively correlated with instruments evaluating mindfulness, quality of life, subjective happiness. These data were compared with those obtained in a previous exploratory study (Rossi, Melchiorri et al., 2014) about psychological flexibility and distress, supporting the initial hypothesis.

• ACT Training Effects on Mental Health, Psychological Flexibility and Executive Functions for participants institutionalized for severe substance abuse – A targeted ACT Manual and Individual Follow-up Effect Analyses of Data from a Pilot Study in Sweden
Gabriella Svanberg M.Sc. (2015), Institute for the Psychological Sciences
Ingrid Munck, Ph.D, University of Gothenburg, Sweden

Recent studies, suggest that prefrontal activities such as executive functions can be improved by mindfulness training. This led us to believe that the mindfulness based ACT intervention may have a positive impact on executive functions. In this pilot study we measured ACT Training Effects on Mental health, Psychological Flexibility and Executive Functions for participants institutionalized for severe substance abuse within The National Board of Institutional Care of Sweden. The effectiveness was assessed before and after a SUD targeted 6 session ACT manual. Individual follow-up data was collected in ten clinical scales from 18 participants at the beginning and end of the 3 week ACT-intervention. Results from the pilot study show the greatest positive effects on psychological flexibility among the 10 assessment scales confirming that ACT training is useful for institutionalized clients. A strong positive trend was also shown for the executive functions especially for Inhibitory control and Task-monitoring.(148 words)

Educational Objectives:
1. Evaluate psychological inflexibility and life engagement as predictors of drug consumption an large sample of college students. 2. Apply the association between psychological flexibility and perceived stress in clinical practice. 3. Implement a SUD targeted ACT intervention to institutionalized clients.

 

112. Case studies of Acceptance and Commitment Therapy with children
Symposium (14:45-16:15)
Components: Original data, Case presentation
Categories: Clinical Interventions and Interests, Edu. settings, RFT, Children, ACT, RFT, anxiety disorders
Target Audience: Beg., Interm., Adv.
Location: Estrel Saal C7

Chair: Lidia Budziszewska, Universidad de Almería
Discussant: Lisa Coyne, Suffolk University

There is still scarce empirical evidence concerning the use of Acceptance and Commitment Therapy (ACT) in children. The current symposium aims to discuss the implementation of ACT in this population by providing several clinical case studies. First, three case studies with children presenting school-related anxiety disorders will be presented discussing the tools used as a function of the developmental of their verbal behavior. Second, the case of an exceptionally gifted, 11-year-old girl with social relationships issues is presented. The treatment involved a brief, 4-session, ACT intervention. Lastly, the integration of ACT and Functional Analytic Psychotherapy (FAP) is discussed in relation to the treatment of an 8-year-old boy suffering from bullying episodes, impulsive behaviors, and problems initiating and maintaining peer relationships.

• Anxiety disorders in Kids: A Brief Overview of a Contextual Approach to Child Intervention
Giovambattista Presti, Department of Human and Social Sciences, Kore University, Enna (Italy)
Giulia Mazzei, IESCUM and ACT-Italia, Milano, Italy
Daniela Sterniqui, IESCUM and ACT-Italia, Milano, Italy
Gaia Oldani, IESCUM and ACT-Italia, Milano, Italy
Francesca Pergolizzi, IESCUM and ACT-Italia, Milano, Italy
Paolo Moderato, Istituto G. Fabris, IULM University, Milan (Italy)

ACT was designed to face psychological inflexibility as an effect of verbal rules and experiential avoidance in place in adulthood. However there is nothing in the clinical model or in Relational Frame Theory (RFT) that suggests that it could not also be effective with verbally competent children. ACT therapy with kids does not depart from the traditional hexaflex based protocols. However some tweaks to the typical metaphors and experiential exercises are necessary. Three clinical cases of kids presenting school-related anxiety disorders are discussed to show the broad range of clinical tools that a contextual behavioral science offers to clinicians. Those tools will be discussed as a function of the developmental range of how their verbal behavior repertoire contributes to their inflexible behavior. To create clinically meaningful context of changes it is necessary to (re)create overarching verbal environments familiar to children. A functional analysis of each case orients the choice of the clinician and the way the treatment protocol is developed. More traditional behavioral tools, like a token economy, are embedded into ACT informed protocols, depending on the functional link between the problematic behavior that occurs at home and at school and language development.

• ACT-Based Brief Intervention with an Adolescent with Difficulties in Social Relationships: A Case Study
Juan C. López, Universidad de Almería
Adrián Barbero-Rubio, Universidad de Almería
Carmen Luciano, Universidad de Almería

The participant of this case study was an exceptionally gifted, 11-year-old girl who had important difficulties in social relationships in her high-school. Her pattern of verbal regulation was characterized by avoiding aversive private events and neglecting valued actions in the area of social relationships. A brief, 4-session, ACT intervention was implemented. The patient showed significant improvements in her social life, which was maintained during the follow-up. The application of several experiential exercises and metaphors adapted to the problem are discussed.

• Integrating ACT and FAP with Children: A Case Example with a 8-Year-Old Boy Suffering from Bullying
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Carmen Luciano, Universidad de Almería
Rosa M. Vizcaíno-Torres, Universidad de Almería

Although the integration of acceptance and commitment therapy (ACT) and functional analytic psychotherapy (FAP) is relatively usual in the treatment of adults, few efforts has been conducted to date in the work with children. The current paper discusses the potential synergic effect of integrating these therapeutic approaches by presenting the case of an 8-year-old boy, Pablo, suffering from bullying episodes, impulsive behaviors, and problems in initiating and maintaining peer relationships. A brief, five-session intervention integrating strategies from ACT and FAP was conducted. The therapeutic relationship and in-session behavior were used as the source to shape social skills and psychological flexibility. After the intervention, Pablo stopped experiencing bullying episodes and his relationships with other children significantly improved because of his new social skills and the reduction of impulsive reactions. These improvements were maintained and increased during the one-year follow-up.

Educational Objectives:
1. List the empirical evidence of ACT with childre. 2. Describe how ACT can be adapted to the work with childre. 3. Analyze the integration of ACT and FAP in the work with childn.

 

113. RFT, ACT and Developing Accounts of Coercion, Prosocial Behavior, and Social Conflict
Symposium (14:45-16:15)
Components: Conceptual analysis, Original data
Categories: Theoretical and philosophical foundations, Prevention & Comm.-Based, Evo., Org. Beh. Management, RFT, prosocial behavior, coercion, scalable conflict model
Target Audience: Interm.
Location: Estrel Saal C8

Chair: Tami Jeffcoat, University of Nevada, Reno
Discussant: Anthony Biglan, Oregon Research Institute

Social processes have been subjected to RFT accounts and explanations within contemporary evolutionary science. Furthermore, they are implicitly related to components of the Psychological Flexibility Model. This symposium includes discussions of those accounts, explanations, and relationships. Talks include both empirical data and conceptual discussion on our more and less favorite social processes. In these talks, prosocial tendencies and global citizenship behavior as well as coercion and social conflict are discussed from RFT, Evolutionary, Psychological Flexibility theoretical perspectives.

• I-You, Here-There, Now-WHAT?!: Why it’s so Hard to do the Right Thing?
Priscilla Almada, University of Wollongong
Louise McHugh, University College Dublin, Ireland

While perspective taking (PT) has been found to be strongly related to prosocial behavior, the core functional units that are responsible for this relationship are not well understood. Deictic relational responding research has begun to provide a better understanding of what produces observed changes in PT ability. This study will examine how 1) differences in deictic relational ability are related to: general prosocial tendencies, global citizenship behavior (a more specific and advanced form of prosocial behavior), and coercive tendencies, and 2) what psychological variables moderate this relationship (i.e. mindfulness, empathy, psychological flexibility, self compassion, etc.).

• The Impact of Coercive Processes on Human Wellbeing
Anthony Biglan, Oregon Research Institute

Until recently behaviorist accounts of human behavior were seen as incompatible with evolutionary theory. However, Wilson, Hayes, Biglan, & Embry (2014) review the history of evolutionary thinking about human behavior and point out that B. F. Skinner “regarded the open-ended capacity for behavioral and cultural change as both (1) a product of genetic evolution and (2) as an evolutionary process in its own right.” They go on to argue that selection of behavior and of symbolic processes by their consequences are themselves evolutionary process and that taking these propositions seriously allows an integration of major traditions within the basic behavioral sciences, such as behaviorism, social constructivism, social psychology, cognitive psychology, and evolutionary psychology, which are often isolated and even conceptualized as opposed to each other. In this presentation, I will elaborate on one of the most important developments in research on the variation and selection of human social behavior, the study of coercive social interactions. I will review basic studies in coercive social interactions and the contribution that such interactions make to the antisocial behavior, marital conflict, and depression. I will describe the development of powerful prevention and treatment interventions that have been derived from this work.

• Flexible Social Conflict
Tami Jeffcoat, University of Nevada, Reno

Conflict Management and Mediation work is a set of theories, models, practices, and loose research agenda involving both empirical and philosophical analyses. The literature and members in these fields concur that intra-personal behavior is not only relevant to conflict management but also an important part of managing conflict between parties of all sizes. The implications of the analogous relationship between inner conflicts and conflicts among parties have not been carefully discussed in the literature, however. This talk argues that intra-personal conflict is social where it involves language-related cognitive processes. It discusses the analogy of intra-personal to extra-personal conflict systems. It proposes models of flexible social conflict versus intractable conflict, scaled from models of individual psychological flexibility versus pathology. These models are argued to be relevant to conflicts of various forms and sizes and may be useful in guiding management and mediation toward more constructive conflict processes. The aim of this paper is to facilitate discourse related to managing and mediating conflict systems, and to stimulate empirical work and improved practices in these fields.

Educational Objectives:
1. Describe what the recent research and RFT tells us about prosocial behavior. 2. Understand an evolutionary account of social processes or how coercive behavior may be prevented or treated. 3. Examine the scalability of the Psychological Flexibility Model to larger units of social behavior.

 

116. The Role of Acceptance and Commitment Therapy for Improving Sleep
Symposium (14:45-16:15)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Chronic Insomnia, ACT, MBSR
Target Audience: Beg., Interm., Adv.
Location: Room 30241

Chair: Guy Meadows, Ph.D., The Sleep School
Discussant: Frank Bond, Goldsmiths, University of London

Sleep is one of the most underrated performance enhancer with the power to determine our daytime mental, emotional and physical health. Developing ways in which to improve this natural phenomenon could prove essential for managing long term health. Three researchers will present sleep data from work and clinical settings, proposing the potential role of Acceptance and Commitment Therapy for improving sleep.

• The Effectiveness of a Workplace ACT Intervention Compared to MBSR Training for Sleep
Dr Vasiliki Christodoulou, Anakampsi - Substance Misuse Service, Limassol

A number of studies indicate that mindfulness meditation improves sleep and results in a decrease of sleep-interfering processes (eg, stress). The first paper describes main outcomes of a randomized controlled trial that compared a brief mindfulness-based stress reduction program to an acceptance and commitment therapy program for sleep quality and stress. It was examined whether the two programs resulted in analogous improvements. Two-hundred health workers were randomly allocated in one of three conditions; a four-session group acceptance and commitment training (66), a four-session group mindfulness-based stress reduction training (58) and a waitlist (76). Participants completed outcome and mediation measures at baseline (T1), post 4 weeks (T2), post 10 weeks (T3), post 16 weeks (T4), and at follow-up, 22 weeks (T5). The results indicated a significant improvement on sleep over time for both ACT and MBSR compared to the waitlist.

• ACT and MBSR Interventions for Sleep: An Investigation of Mechanisms
Dr Joe Oliver, Camden & Islington NHS Trust, London, UK

The second paper uses data from the above-mentioned RCT to investigate mediatonal pathways to determine the mechanisms by which the ACT and MBSR interventions worked. Improvements on sleep at follow-up for the ACT group were mediated by increases in behavioral activation and reduction in stress while for the MBSR group there was evidence of mediation through increases in psychological flexibility. The study indicates that both brief ACT and MBSR training are helpful interventions in improving sleep though outcomes may result through different mechanisms.

• The Effectiveness of ACT for Insomnia - An Initial Clinical Study
Dr Guy Meadows, The Sleep School

The purpose of this study was to evaluate the effectiveness of using Acceptance and Commitment Therapy (ACT) for adult chronic insomnia. ACT seeks to improve sleep quality, by increase people’s willingness to experience the conditioned physiological and psychological discomfort commonly associated with not sleeping. This is compared with traditional cognitive behavioural Therapy for insomnia (CBT-i), which bases many of its approaches on symptom reduction, a reason cited poor treatment adherence in the long term. 14 chronic insomnia sufferers (Aged 46±9yrs, 8 Females & 6 Males, Insomnia Severity Index score - 21±4) attended a one day workshop involving 6 hours of ACT training. During the day the attendees leant to apply acceptance, mindfulness, defusion, valued living and committed action tools to create their own personal sleep plan to implement over time. A range of quantitative and qualitative sleep measurements, as well as acceptance and mindfulness questionnaires were performed 1 week pre workshop and then at 5 and 10 weeks and 6 and 12 months post workshop. The results demonstrated a significant improvement in sleep quality and acceptance measures over time. This initial clinical study suggests ACT to be an effective treatment for overcoming chronic insomnia and warrants the need for further research into this important area.

Educational Objectives:
1. To understand the differential impact of ACT and MBSR interventions on sleep outcomes in workplace settings. 2. To understand the different pathways by which ACT and mindfulness interventions can impact on sleep outcomes. 3. To understand the clinical effectiveness of using ACT for insomnia within a one day workshop setting.

 

117. Do it yourself: Innovative Delivery Methods on the Rise
Symposium (14:45-16:15)
Components: Original data, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Beh. med., Superv., Train. & Dissem., health anxiety, smoking cessation, self-help, subclinical measures
Target Audience: Beg., Interm., Adv.
Location: Room 30341

Chair: Shane McLoughlin, National University of Ireland Galway
Discussant: Ditte Hoffmann Jensen, Arhus University Hospital, Denmark

Innovative Delivery Methods may facilitate the spread of evidence-based therapies and offer the opportunity to extend care to populations that might be difficult to reach with traditional forms of treatment. The three studies in this symposium discuss the feasibility of internet-delivered ACT for Health Anxiety, Predictors of participation of smokers in a telephone-based ACT for smoking cessation program and the development of self-help for negative thoughts measured by a unique rating form. Benefits and Challenges of new delivery methods will be discussed.

• Feasibility study of internet-delivered Acceptance and Commitment Therapy for Health Anxiety
Ditte Hoffmann Jensen, psychologist, Aarhus University Hospital, Denmark
charlotte ulrikka rask, MD, Ph.D., Aarhus University Hospital, Denmark
Lisbeth Frostholm, Ph.D., Aarhus University Hospital, Denmark

Background: Health anxiety (HA), or hypochondriasis, is characterized by a preoccupation with fear of having a serious illness, which interferes with daily functions and persists despite medical reassurance. HA is costly in terms of patients’ use of health care services, and untreated the disorder seem to be chronic. Aim: To develop an internet-delivered Acceptance and Commitment Therapy (iACT) program for HA, based on an existing ACT-group manual, and to test its feasibility in an open trial before a larger randomized controlled trial. Methods: 10 patients with severe HA will receive 7 sessions of iACT, which is a guided self-help program containing psycho education, written exercises, mindfulness and value-based exposure. During treatment, email support will be provided. Self-report questionnaires will be obtained at baseline and at end of treatment. Illness worry (Whiteley-7) will be the primary outcome measure. Perspective: iACT for HA may be a feasible and flexible treatment form, which can be delivered to a broader patient population, e.g., younger patients or patients with less severe symptoms.

• Predictors of the participation of smokers in a proactive telephone-based, acceptance and commitment therapy for smoking cessation program
YW Mak, Ph.D, School of Nursing, The Hong Kong Polytechnic University
AY Loke, Ph.D, School of Nursing, The Hong Kong Polytechnic University

Objective: The objective of this study is to identify the predictors of participation for a smoking cessation programme among smoking clients of primary health care settings with intention to quit smoking. Design: The smoking clients of 6 different primary health care settings were interviewed and invited to take part in a telephone-based smoking cessation program. The characteristics of participants and the predictors of participation were analyzed by chi-squared test and by logistic regression. Results: A total of 30,784 clinic attendees were approached in which 3890 (12.6%) smokers were screened and identified. All 184 eligible smokers with intention to quit smoking completed the baseline questionnaire and were asked for participation in which 106 (57.6%) agreed to participate in the research. The analysis showed that the predictors of participation in a pro-active smoking cessation program are having secondary educational level or above, perceived craving as an influential factor of cessation, having intention to quit smoking in the coming month, being confident in quitting smoking, and being psychologically flexible. Conclusions: Recruitment approaches should be refined according to the identified factors to target those who might decline an invitation to participate in a smoking cessation program.

• Developing self-help for negative thoughts measured by a unique rating form
Andreas Larsson, PhD, Private Practice
Nic Hooper, University of West England
Louise McHugh, University College Dublin

Over the course of five studies (in Larsson, 2014, unpublished PhD dissertation) a measure that was adapted from Healy et al. (2008) where ten positive and ten negative statements are ranked on (1) believability, (2) comfort, (3) negativity by adding and (4) willingness to experience was used in five studies as a non-clinical measure of negative thinking. Following a reasoning from RFT that anything can be uncomfortable and data from another adaptation of the Healy et al (2010) measure where the positive statements became negative (r=.72), uncomfortable (r=.79) or the subject became unwilling to experience (r=.70) if they were rated as unbelievable (Duff, Larsson & McHugh, under review), a version has been developed and tested where the subject chooses a thought that they themselves find believable, uncomfortable, negative and that they are unwilling to experience. Data shows that this measure is both correlated with clinically relevant measures and sensitive to a brief defusion intervention in two studies, also when compared to a brief cognitive restructuring intervention (1.37 < Cohen’s d < 5.00) showing this to be an interesting addition to the ACT research portfolio. Healy, H., Barnes-Holmes, Y., Barnes-Holmes, D., Keogh, C., Luciano, C., & Wilson, K. G. (2008). An Experimental Test of Cognitive Defusion Exercise: Coping With Negative and Positive Self-Statements.

Educational Objectives:
1. Discuss considerations in adapting face-to-face treatment to internet-based treatment. 2. Describe the flow of participation of a smoking cessation programme for subjects recruited from primary health care settings. 3. Explain the need for sub-clinical measures of negative private content in the context of prevention.

 

119. Prosociality and Prevention: Evolution Science SIG Sponsored
Symposium (14:45-16:15)
Components: Conceptual analysis, Literature review, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Edu. settings, Evo., Superv., Train. & Dissem., Cultural adaptations, Leadership Efficacy, evolutionary science
Target Audience: Beg., Interm.
Location: Cannes

Chair: Sigmund Gismervik, M.D., Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim
Discussant: Louise Hayes, Orygen, The National Centre of Excellence in Youth Mental Health

This symposium presents three studies that discuss different aspects of intervention strategies to increase wellbeing and ameliorate diverse problems in living in entire populations. The first study discusses ACT for use in low-resource settings and focuses on community engagement and cultural adaption processes to deliver an intervention for maximum real-world impact. The second study examines the clinical relevance of epigenetic mechanisms for practical clinical intervention strategies. Finally, the third study describes, how ACT and PROSOCIAL design principles were integrated into a course for improving community wellbeing and how to adapt course objectives to various group settings.

• LOW INTENSITY ACT INTERVENTIONS FOR PEOPLE LIVING IN ADVERSITY: GLOBAL MENTAL HEALTH PERSPECTIVES
Felicity L Brown, PhD, World Health Organization
Mark van Ommeren, PhD, World Health Organization
Wietse Tol, Johns Hopkins University

Psychological and substance use disorders are the leading cause of disability worldwide, and the financial and societal impact is significant. However, the majority of people with mental health problems globally do not have access to adequate treatment. Improving access to services, particularly in low and middle-income countries, is a well-recognized public health priority. The World Health Organization’s Comprehensive Mental Health Action Plan 2013-2020 emphasizes that all individuals affected by psychological disorders should be able to access high quality, culturally-appropriate health and social care in a timely manner, promoting recovery. Within the Department of Mental Health and Substance Abuse at the World Health Organization, a current priority is the development and evaluation of innovative methods for delivery of evidence-based treatment, which is affordable, not-for profit and culturally adaptable. These interventions must be suitable for low-resource settings, and in particular suitable for humanitarian settings in which mental health needs are high, yet access by mental health professionals may be severely restricted. This presentation will discuss the utility of ACT for use in such contexts, outline several current and proposed projects that utilize ACT-based techniques within low-intensity interventions, and describe a detailed protocol for community engagement and cultural adaptation processes to deliver an intervention that has maximum real-world impact.

• Epigenetics and implications for clinical intervention and prevention strategies.
josephine Loftus, Princesse Grace Hospital, Monaco

Epigenetics and implications for clinical intervention and prevention strategies. The scientific concept of the gene has changed from that of a fixed, structural entity to a more functional construct defined by its context ie the organism’s behaviour and its environment. Behaviour and the environment can contribute to the modification of gene function through epigenetic mechanisms and raise the possibility that life experiences including adverse events may be recorded in the genome thus modifying brain function. Epigenetic changes may be reversible. Family studies have shown that children of severely mentally ill parents have a 5 to 6 fold increase in psychopathology. Findings in relation to early adverse life experiences and epigenetics have implications for early intervention strategies such as ACT to modify behaviour and the environment The aim of this paper is to review the literature on epigenetic mechanisms and the implications for psychotherapy and the planning of prevention strategies .

• ACTivating University Students for Social Changemaking using PROSOCIAL
Larry Dumka, Ph.D., Sanford School of Social and Family Dynamics - Arizona State University

To date, applications of ACT have focused predominantly on individual wellbeing and, more recently, on improving couple and parent-child relationships. This paper presents how the ACT model and the PROSOCIAL group design principles were integrated into a university Social Changemaking course to engage students in improving community wellbeing. Students worked in teams to conduct social change projects in collaboration with community human services organizations. Students reported increasing their self-efficacy and psychological flexibility as they addressed internal, team, and contextual barriers to implementing their project. This paper outlines the core content and processes of the Social Changemaking course and provides guidance for adapting course components to diverse settings (businesses, congregations) and to different types of community change initiatives (policy making, grassroots organizing, and social entrepreneurship).

Educational Objectives:
1. Apply a systematic approach to community engagement and cultural adaptation of psychological interventions. 2. Explain the clinical relevance of epigenetic mechanisms. 3. Explain how to adapt Social Changemaking course objectives to various group settings.

 

122. Overcoming the stigma of getting therapy: New technology-based ACT interventions with Potential for Broad Scale Impact on Mental Health: ACTing with Technology SIG Sponsored
Symposium (16:30-17:45)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Technology
Target Audience: Beg., Interm., Adv.
Location: Estrel Saal C7

Chair: Victoria Follette, Ph.D., University of Nevada, Reno
Discussant: Victoria Follette, Ph.D., University of Nevada, Reno

The world of therapy is changing. Today, people suffering with a broad array of mental health problems can choose to see a therapist in an office or do something completely different: get therapy online either as a stand-alone intervention or a complement to traditional face-to-face therapy. The potential benefits of new technologies are huge: access to care for people who are stigmatized about their mental health problems and about entering therapy, low cost, and potentially effective. Not a replacement for face-to-face therapy, web-based therapy opens up ACT to people who might not otherwise seek help and may make them more willing step up care to see a therapist if needed. The ACBS community is recognizing this fundamental change through the ACTing with Technology SIG, which supports these three cutting-edge presentations: (1) Dr. Levin will present new results from a randomized trial testing a web-based ACT program to help college students with a wide variety of mental problems; (2) Dr. McLean will present outcome data from her new web-based ACT program for coping with trauma; (3) Dr. Kaipainen will present outcome data from a new web-based ACT program to help people reduce social anxiety. Dr. Follette will lead a discussion on the potential of new technologies to expand the reach of ACT interventions and overcome the stigma of seeking therapy.

• Testing a Transdiagnostic Web-Based ACT Self-Help Program for College Students
Michael E. Levin, Ph.D., Utah State University
Jack Haeger, PhD, Utah State University
Michael Twohig, PhD, Utah State University

Innovative approaches are needed to improve engagement in psychological services among college students. Websites provide a promising way to deliver treatment while overcoming student barriers including time, access, cost, and stigma; particularly if they can be applied transdiagnostically for a range of problems. This presentation will report a RCT testing a six-session web-based ACT program designed to treat the range of problems college students seek help for by targeting psychological inflexibility. We will describe our development method, which allows for rapid prototyping and iterative revisions without developer costs. The results comparing ACT to waitlist will be reported with a sample of 200 distressed college students on outcomes including depression, anxiety, academic distress, relationship problems, eating concerns, and substance use. Program acceptability/usage will be reported and whether usage predicts improvements in outcomes. Results will be discussed in relation to lessons learned with ACT program development and future research directions.

• ACT for Trauma Related Problems: Outcome Data from a Web-based Intervention
Caitlin McLean, PhD, University of Nevada, Reno
Devika Fiorillo, PhD, Emory University
Victoria Follette,PhD, University of Nevada, Reno

While a number of case studies and unpublished clinical trials have demonstrated the utility of ACT for trauma related problems, rigorous outcome studies are more limited. Moreover, research suggests that web-based interventions are important new tools in disseminating treatment. This study provides important preliminary data on ACT and is the first web based treatment for interpersonal trauma survivors (combat trauma has been delivered using a range of technologies). The current study is a pilot evaluation of a six-session ACT intervention for interpersonal trauma. Participants were a community sample of 22 women trauma survivors who had experienced rape, CSA, and CPA. Pre, mid, and post-treatment measures include PCL-5(PTSD), psychological flexibility, and depression. Participants reported increases in functioning, including reduced symptoms of PTSD, t(18.23)=-5.63, p<.001, d=-1.36, and improvements in psychological flexibility, t(18.65)=-2.98, p<.01, d=-0.71. Results on completers versus non-completers, system usability, and client satisfaction will be discussed.

• Hold Your Nerve: Impact and uptake of an ACT-Based Online Social Anxiety Programme in Finnish and UK Community Settings
Kirsikka Kaipainen, Ph.D., Headsted Limited
Toni Vanhala
David Lees
Päivi Lappalainen
Raimo Lappalainen, University of Jyväskylä

Social anxiety affects one third of people within their lifetimes. They do not usually seek help before co-morbidities emerge. Online interventions can provide low-barrier support and effective self-help. The online Hold Your Nerve programme was launched in September 2014 in Finland as a free service for anyone suffering for social anxiety symptoms. Social anxiety level was measured in the beginning of the programme using Mini-Social Phobia Inventory (range 0-12). Afterwards, users were invited to complete an online post-survey assessing social anxiety and user experiences. In January 2015, 771 users had registered to the programme and 44 social anxiety sufferers had responded to the post-survey. The average decrease in social anxiety was 1.1 points (pre 8.3, post 7.2, p=.004) and 96% recommended the programme to others. Comparison data from the United Kingdom's implementation trials will be available in late spring 2015. We discuss implementation challenges of online programmes in community settings.

Educational Objectives:
1. Learn development strategies and lessons learned in creating web-based ACT programs. 2. Learn the content and treatment outcomes of a web-based ACT program for trauma. 3. Learn the content and treatment outcomes of a web-based ACT program for social anxiety.

 

124. Brief Mindfulness and Acceptance-Based Interventions in Group Settings
Symposium (16:30-17:45)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Beh. med., Mindfulness, Acceptance, Inmates, Parents
Target Audience: Beg.
Location: Strassburg

Chair: David Carreno, M.A., Universidad de Almería
Discussant: Lisa Coyne, Ph.D., Suffolk University, The New England ACT Institute

This symposium presents three studies that evaluated brief acceptance and mindfulness-based interventions in group settings. The studies used diverse populations (undergraduate students, parents of children with behavioral difficulties and inmates) and aimed to adapt their methods to the special circumstances of their participants. The first study was an experiment that analyzed the efficacy of a single mindfulness technique (the focused breathing exercise) among healthy undergraduate students. The second study created a 5-session intervention for parents of children aged 5-17 with severe emotional and behavioral difficulties. Finally, the third study evaluated an 8-session protocol among violent male prisoners compared to a treatment as usual condition. Overall, these studies suggest that even very brief acceptance and mindfulness-based protocols can significantly influence the behavior of the participants.

• Effects of a Brief Mindfulness Intervention on Cognitive Tasks and Mood Evaluations
Nikolett Eisenbeck, M.A., Universidad de Almería
Carmen Luciano, Ph.D., Universidad de Almería
Sonsoles Valdivia-Salas, Ph.D., Universidad de Zaragoza

The aim of this study was to evaluate effects of a group-based mindfulness exercise on cognitive performance and mood evaluations. 47 healthy undergraduate participants were randomly assigned to either a Mindfulness or a Control condition. In Mindfulness, a single session of the focused breathing exercise (FB) was implemented, while participants in the Control listened a neutral audiotape. A pre-post design with two cognitive tasks (an attention task and a memory task) and mood evaluations (Positive and Negative Affect Schedule) was implemented. Results showed no significant effects of the FB protocol on mood evaluations and on the attention task when compared to the Control condition. Nonetheless, participants in the FB condition responded significantly better on the memory task. Results are discussed in comparison with previous studies.

• ACT for Parents: An Open Trial with Parents Raising a Child with Severe Emotional and Behavioral Problems
Carlos E. Rivera, M.S., Suffolk University, The New England ACT Institute
Lisa Coyne, Ph.D., Suffolk University, The New England ACT Institute
Mitch Abblett, Ph.D., Suffolk University, The New England ACT Institute, McLean Child and Adolescent OCD Institute at Harvard Medical School

Whether improving parent mindfulness and acceptance may have a positive influence on parents’ sense of efficacy in raising their youngsters, level of self-compassion, and their quality of life is an empirical question. The present study seeks to address this question through piloting a five-session Acceptance and Commitment Therapy (ACT) parenting workshop with parents of children aged 5-17 with severe emotional and behavioral difficulties in a day-treatment school setting. We expected that parents would find the program acceptable and feasible, and that those who reported post-program increases in acceptance and mindfulness would also report reduced parenting stress, distress, improved quality of life, improved parenting efficacy, and increased reliance on positive, rather than maladaptive, parenting strategies. As an exploratory hypothesis, we were interested in the relationship between improvements in parent functioning and their relationship to parent and teacher-reported child behavioral and emotional functioning. Information was collected at baseline, post-treatment, and 3-month follow-up.

• A brief Acceptance and Commitment Therapy-Based Intervention Among Violent Male Inmates
Katalin Scheitz, M.A., Jász-Nagykun-Szolnok Megyei Büntetés-végrehajtási Intézet
Nikolett Eisenbeck, M.A., Universidad de Almeria
Boglárka Szekeres, M.A., Jász-Nagykun-Szolnok Megyei Büntetés-végrehajtási Intézet
Juan Carlos López López, Universidad de Almería
Adrián Barbero-Rubio, University of Almería, Spain

The aim of the present study was to evaluate the efficacy the Acceptance and Commitment Therapy (ACT) in penitentiary contexts. Thus, the effects of a brief, 8-session ACT group intervention (N = 9) were compared with a treatment as usual (TAU) condition (N = 9) among male inmates who were in pre-trial detention of extremely violent crimes. The ACT protocol consisted of mindfulness, acceptance and values work adapted to the special circumstances of the participants. The TAU consisted of exercises about drug abuse and stress reduction. Participants were assessed at the beginning of the intervention, at the end of the intervention, at 3-months and 6-months follow-up. Self-report questionnaires and external evaluators were used to assess the behavior of the inmates. Results at post intervention and follow-up indicated that ACT was more successful in increasing effective actions among the participants.

Educational Objectives:
1. Adapt acceptance and mindfulness-based protocols to group settings. 2. Adapt acceptance and mindfulness-based interventions to diverse populations. 3. Analyze and enhance efficacy of brief interventions.

 

125. Mindfulness Interventions: Reducing stress and promoting wellbeing and valued behavior
Symposium (16:30-17:45)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Org. Beh. Management, Other, Mindfulness, ACT, burnout, Mindfulness experimental research
Target Audience: Beg., Interm., Adv.
Location: Room 30241

Chair: Mathias Funke, Private Practice
Discussant: David Gillanders, University of Edinburgh

Previous research demonstrated that mindfulness interventions could effectively reduce different mental health problems in both clinical and nonclinical populations. The three studies presented in this symposium examine the relationship between mindfulness, stress, wellbeing and valued behavior. The first study evaluates the effect of a mindfulness- and value-based intervention on recovery from work burnout, taking into account the importance of work-site factors. The second study extends current knowledge by examining the mindfulness state that is elicited in a lab setting. Finally, the third study examines the effect of a mindfulness-based intervention for oncology nurses on mindfulness, ACT relevant constructs and a range of negative mental health outcomes.

• Exploring group and individual level connections between mindfulness skills and burnout – Results from Muupu-research
Anne Puolakanaho, Ph.D., University of Jyväskylä
Sanna Kinnunen, M. A., University of Jyväskylä

Background: There exist limited studies combining mindfulness skills and work-site factors when explaining burnout experiences. Furthermore, little is known of the individual outcome profiles among participants of mindfulness and value-based intervention for burnout. Aims: Muupu-research (randomized control trial, n=109+109) aims to examine the effectiveness of intervention based on mindfulness- program (MBSR, MBCT) and value-based methods (from ACT) to the recovery from work burnout. The 8-week Muupu-intervention is delivered using jointly face-to-face group meetings and web-based program. Methods: Muupu-research elucidates aforementioned issues using SEM (cross-sectional data) and mixture modeling (longitudinal data) techniques. Results: The results suggest that both mindfulness skills and work-site factors have unique and significant association with burnout. In Muupu-research several individual outcome profiles were found that differed on the development of mindfulness skills and burnout during the 6-month follow-up. Implications: This kind of brief, structured intervention is cost-effective way to promote employee well-being in varying settings.

• Mindfulness state and its benefits for planning towards valued goals: an experimental approach
SARA DE RIVAS, PHD, UNIVERSIDAD AUTONOMA DE MADRID
RAQUEL RODRIGUEZ-CARVAJAL, UNIVERSIDAD AUTONOMA DE MADRID
CARLOS GARCÍA-RUBIO, UNIVERSIDAD AUTONOMA DE MADRID
MARTA HERRERO, UNIVERSIDAD AUTONOMA DE MADRID

So far the experimental research on mindfulness is scarce. In our first study we addressed a main issue of applying mindfulness in the lab setting: to actually check for the mindfulness state that is elicitated by the instructions in non-regular mindfulness practitioners. For this purpose, 92 participants were randomly assigned to one of four experimental conditions: mindfulness1, mindfulness2, mindfulness3 and control (relaxation). Using Toronto Mindfulness State scale pre and post punctuations where obtained in each of the conditions. Results showed positive elicitation of the mindfulness state in all mindfulness conditions we found significant main effects for time (Pillai’s trace F (1, 82) = 60.059, p < .000) and significant effects for the interaction time x condition (Pillai’s trace F (3, 82) = 4.870, p < .004). In a study 2, we tested the hypothesis that mindfulness would enhance the identification of critical situational cues in the process of planning. For this purpose, 139 participants were randomly assigned into one of the four experimental conditions. In each condition they were primed with either control, abstract, concrete or mindfulness-mindset. Then, they were asked to identify critical situational cues to solve personal conflicts within a value-context. Results show significant effects regarding the identification of critical situational cues (F=2.899, p=.037). Participants under the mindfulness-mindset condition identified more critical situational cues (M=6.21) than the other conditions (M(control)=5.16, M(concrete)=5.09 and M(abstract)=5.23). Global results (study 1) indicate that it is possible to elicit an actual mindfulness state in the lab setting through brief mindfulness instructions, and that bringing the attention to the present moment might help other psychological processes such as perception and identification of critical cues and the subsequent formation of plans (study 2) that subsequently enhance value-oriented behavior and well-being

• The efficacy of a mindfulness-based intervention for oncology nurses
Joana Duarte, MSc., CINEICC, University of Coimbra, Portugal
José Pinto-Gouveia, CINEICC, University of Coimbra, Portugal

Although the causes and negative consequences of work-related stress among nurses are well known (e.g., burnout, compassion fatigue), there is a lack of empirical studies about effective ways to reduce or prevent such problems. Mindfulness-based programs have proven to be effective in reducing stress and improving health and well-being in a variety of populations, and few recent studies seem to support they might also be effective for stress-related health problems. This study aimed to test the efficacy of a 6-week, mindfulness-based intervention for oncology nurses. In total, 39 nurses participated in the study, and were randomly assigned to either an experimental (n=19) or a control group (n=20). Due to dropouts or incompletion of all measurements, data were analyzed for 15 participants from the experimental group and 13 participants from the control group. Several measures were used to asses the program’s efficacy, namely: burnout and secondary traumatic stress (STS), depression, anxiety and stress symptoms, rumination, experiential avoidance, self-compassion and mindfulness facets. Results demonstrated significant improvements in nurses' burnout, STS, depression and stress symptoms, experiential avoidance, rumination, self-compassion and non-judge mindfulness facet. No significant differences were found in the control group. Participants also reported that the intervention was very important to them, and helped them change their relation to their negative thoughts and emotions and how they typically reacted to difficult situations. These results are promising for the use of mindfulness-based interventions with this population.

Educational Objectives:
1. Describe the role and significance of mindfulness skills and work-site factors when explaining burnout. 2. Discuss and critique mindfulness effects found in the experiments. 3. Evaluate the feasibility of a mindfulness-based intervention program for a specific population (oncology nurses) conducted in a work setting.

 

126. Valued living: Assessment and Interventions
Symposium (16:30-17:45)
Components: Conceptual analysis, Original data, Didactic presentation
Categories: Prevention and Community-Based Interventions, Clin. Interven. & Interests, Performance-enhancing interventions, Edu. settings, Org. Beh. Management, Prof. Dev., Other, Teachers, coping with stress, valued living
Target Audience: Beg., Interm., Adv.
Location: Room 30341

Chair: Grayson Butcher, University of Louisiana at Lafayette
Discussant: Emily Sandoz, University of Louisiana at Lafayette

The primary objective of ACT is not to merely provide symptomatic relief, but to enhance valued living. The third paper presented in this symposium focus on the effect of an ACT intervention in the workplace on valued living and its assessment. The first paper examines the changes in valued living, general health and work-related psychological flexibility after an ACT intervention for teachers. The second paper compares a traditional mindfulness with an ACT intervention in the workplace and investigates whether adding values and targeting mindfulness at valued life domains truly adds value. The third paper analyzes changes in valued action during the process of cognitive-behavioral therapy. Pros and cons of various ways to measure valued action will be described and critically discussed.

• The impact of an Acceptance and Commitment Training for teachers: reducing stress and promoting psychological well-being and valued living
Simone Gebhard, Institute of Special Education, Department of Special Educational Psychology, Europa-Universität Flensburg
Dietrich Pülschen, Ph.D., Department of Psychiatry, University of Rostock

Teaching is perceived as a profession which is linked to high levels of stress. Numerous studies confirm that not many teachers in Germany reach retirement age while still in service, in many cases psychiatric diagnoses are associated with these early retirements. The development of this kind of disorders is often related to the malfunction of the stress system. Besides the biological stress response of the body there is also a cognitive stress-component, which is characterized by an increased mental occupation with stressful burdening thoughts and so called aversive cognitions like i.e. sorrowful thoughts and self-criticism. By changing the way of dealing with those aversive cognitions through a cognitive behavioural intervention a person´s individual coping capability could be improved. Acceptance and Commitment Therapy (ACT) is a promising approach to be used in a teacher training for the prevention of stress and the promotion of psychological well-being. Using a wait-list control design the present study examined the effects of an Acceptance and Commitment Training on work related psychological flexibility (WAAQ*), general health (GHQ-12*) and valued living (VLQ*) of a sample of teachers (N= 26). Work in progress – we will have the results in the beginning of March 2015.

• Valued living and its measurement: A critical reappraisal
Juergen Hoyer, Ph.D., TU Dresden
Jasmin Colic, B.Sc., TU Dresden
Andrew T. Gloster, Ph.D., University of Basel

We investigated a) the psychometric criteria of the Valued Living Questionnaire (VLQ; German version), b) whether non-ACT CBT enhances value-oriented action, c) whether value-oriented action predicts successful therapy, and d) whether a gain in value-oriented acting can explain that some patients are satisfied with treatment despite insufficient symptom reduction. We analyzed pre/post/follow-up data of over 500 patients at a university psychotherapy clinic, all assessed with standardized interviews. Questionnaires included the VLQ; Beck Depression Inventory (BDI); Brief Symptom Inventory (BSI), and treatment satisfaction. VLQ moderately correlated with the BDI, but not with the BSI. Significant improvement in value-oriented action was found (d = .33). VLQ values predicted treatment success and stability of outcome. Value-oriented action also explained treatment satisfaction significantly, even if symptom reduction was statistically controlled for. Our findings confirm some validity aspects, but the low incremental validity has to be critically discussed.

Educational Objectives:
1. Explain how to apply ACT to establish and develop collaboration skills and reduces high levels of subjective stress. 2. Design research studies comparing ACT and mindfulness-only interventions. 3. Analyze changes in valued action during the process of cognitive-behavioral therapy.

 

127. ACT for sleeping problems and PTSD
Symposium (16:30-17:45)
Components: Original data
Categories: Clinical Interventions and Interests, Clin. Interven. & Interests, Beh. med., Insomnia; Sleep disturbances; PTSD; Higher level care settings
Target Audience: Beg., Interm., Adv.
Location: Cannes

Chair: Corinna Stewart, B.A., Ph.D. Candidate, NUI, Galway
Discussant: Darrah Westrup, Ph.D., Independent Practice

The three studies in this symposium present new findings on ACT interventions for sleeping problems and PTSD. The first study examined the effect of an ACT intervention for non- or partial responders to CBT with primary insomnia on sleep quality and quality of life. The second study investigated the effect of a specialty track to tailor an existing ACT program to specific needs of patients with PTSD on treatment outcomes in a hospital setting. Finally, the third study aims to examine the effect of a group-based ACT for sleep disturbances. Findings regarding different sleep-related and clinical outcomes, as well as the combination of technology and ACT-based group interventions will be discussed.

• Quality of Life Improvements after Acceptance and Commitment Therapy (ACT) in Nonresponders to Cognitive Behavioral Therapy for Primary Insomnia (CBT-I)
Elisabeth Hertenstein, University Medical Center Freiburg
Nicola Thiel, University Medical Center Freiburg
Marianne Lüking, University Medical Center Freiburg
Dieter Riemann, University Medical Center Freiburg
Kai Spiegelhalder, University Medical Center Freiburg
Christoph Nissen, University Medical Center Freiburg

Background: Cognitive behavior therapy for insomnia (CBT-I) improves subjective and objective parameters of sleep in patients with primary insomnia (PI). However, the perception of poor sleep and an impaired quality of Life (QoL) often persists despite treatment. This study aimed to provide first evidence that Acceptance and Commitment Therapy (ACT), an intervention including mindfulness and value-based changes of behavior, can improve subjective sleep quality and QoL in patients with chronic PI. Methods: Eleven patients with chronic PI who were non- or partial responders to CBT-I were included. Data were collected 6 weeks prior to the intervention (T-1), directly before (T0) and after the intervention (T1), and at 3-months follow-up (T2). The intervention consisted of six ACT sessions in an outpatient group setting. Primary outcomes were sleep-related QoL (Glasgow Sleep Impact Index), global QoL (World Health Organization Quality of Life scale) and subjective sleep quality (measured by sleep diaries). Results: Ten patients completed the study, one dropped out due to scheduling problems. All measures remained stable between T-1 and T0. Significant improvements after the intervention were observed for sleep-related QoL, global QoL, and subjective sleep quality (ANOVA with factor Time, post-hoc contrasts T1 and T2 vs. T0, all Ps<.05, large effect sizes). Subjective total sleep time, sleep onset latency and wake time after sleep onset did not significantly change across the study. Conclusions: The findings provide preliminary evidence that ACT might improve subjective sleep quality and the QoL in patients with PI.

• Development and Pilot-Testing of a Specialty PTSD Track within an Acceptance-based Partial Hospitalization Program: Impact on PTSD Outcomes
Catherine D'Avanzato, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Darren Holowka, Rhode Island Hospital
Theresa A. Morgan, Rhode Island Hospital; Alpert Medical School of Brown University
Kristy Dalrymple, Rhode Island Hospital; Alpert Medical School of Brown University
Mark Zimmerman, Rhode Island Hospital; Alpert Medical School of Brown University

Numerous clinical trials have demonstrated ACT’s efficacy in treating a broad spectrum of psychopathology. However, no published studies to our knowledge have been based on partial hospital settings, and few studies have examined ACT in inpatient settings. As partial hospital programs are increasingly common and present many challenges to applying ACT unique from outpatient clinics, studies which modify and test ACT in these settings are critical. Previously, we demonstrated the efficacy of an ACT based partial hospital program in improving symptom severity, functioning, and ACT-relevant change mechanisms in patients with diverse diagnoses. The purpose of this study was to investigate whether establishing a specialty track to tailor our program to the specific needs of patients with PTSD may enhance their treatment outcomes. Individuals with a PTSD diagnosis who were enrolled in the PTSD specialty track were compared to patients with PTSD who completed the general program on measures of symptom severity, functioning, quality of life, and ACT processes, both daily, as well as at intake and discharge. Preliminary results suggested a trend in which patients within the PTSD track exhibited greater improvement on measures of symptom severity. Data collection is ongoing, which will increase power to detect group differences. We will discuss implications for the development and implementation of ACT-based interventions in higher level care settings.

• ACT for sleep disturbances - an RCT-study investigating Acceptance and Commitment Group Therapy for treatment of insomnia
Raimo Lappalainen, Ph.D., Dept of Psychology, University of Jyväskylä
Päivi Lappalainen, M.A., Dept of Psychology, University of Jyväskylä
Sonja Pelkonen, M.Sc., Dept of Psychology, University of Jyväskylä
Niina Puha, M.Sc., Dept of Psychology, University of Jyväskylä
Ville Suutari, M.Sc., Dept of Psychology, University of Jyväskylä
Elina Naamanka, M.Sc., Dept of Psychology, University of Jyväskylä

Introduction: Sleep disturbances occur in about 10% to 15% of the general population and are often associated with stress, illness and aging. Therefore, treatments targeting this common problem are needed. Objectives and methodology: The aim of this study (N= 65) was to examine the effect of Acceptance and Commitment Group Therapy for participants suffering from sleep disturbances. The treatment consisted of six weekly group sessions from which the first one was held individually via phone. The impact of the study was measured with 15 questionnaires assessing sleep, psychological flexibility and physical and psychological well-being. Results: There was a significant difference between the groups in perceived severity of insomnia, sleep-related dysfunctional cognitions, psychological distress, severity of depressive, anxiety and stress symptoms, and dispositional and state hope over time. Discussion and conclusion: The study showed that the ACT-based group intervention can be effective to treat sleep disturbances. Further research studying processes of insomnia is still needed.

Educational Objectives:
1. Apply ACT to patients with insomnia. 2. Describe pilot data on the effectiveness of a specialty track designed to tailor an existing acceptance-based partial hospitalization program to patients with PTSD. 3. Apply a group-based ACT intervention for sleep disturbances.

 

Sunday, 19 July

135. Taking to the field: Applying the Third-Wave to Sports and Athletics: Sport, Health, and Human Performance SIG Sponsored
Symposium (9:00-10:15)
Components: Conceptual analysis, Original data
Categories: Performance-enhancing interventions, AAQ, Sports, Competition
Target Audience: Beg., Interm., Adv.
Location: Estrel Saal C7

Chair: Raimo Lappalainen, University of Jyväskylä Finland
Discussant: Frank Bond, Goldsmiths, University of London

Beyond applications to improve technical proficiency within athletics, there is a growing interest in psychological skills. Third-wave behavioral approaches are a natural fit. This symposium will offer some conceptual directions for the integration of contextual behavior science to areas of sports and fitness. As well as present recent empirical investigations, and their implications for applying the psychological flexibly model to competitive and recreational sport.

• AAQ for Hockeyplayers: AAQ-H, a Psychometric Evaluation
Tobias Lundgren Ph.D, Psychology Department, University of Stockholm, Sweden

Experiential avoidance and psychological flexibility is at the core of psychopathology and has shown to correlate with behavior effectiveness (Bond et al 2011). In this study the AAQ was adjusted to ice hockey-players and the psychometric properties of the instruments was evaluated. N= 96, ice hockey players at different levels of expertise. Factor analysis showed three main factors, present moment awareness, values and acceptance. The preliminary results show that AAQ-H predicts outcomes on ice and has good criterion related validity. The results show that thoughts and feelings effects performance and suggests that there is a need to evaluate interventions targeting these processes.

• AAQ-II and Its Application to High Performance Populations
Patrick Smith, University of Nevada, Reno
Emily Leeming, University of Nevada, Reno
Steve Hayes, University of Nevada, Reno

The application of the (AAQ-II) is becoming more prevalent across ACT, RFT, and CBT practitioners. As discussed in the development of the original AAQ, sensitivity of the assessment and discrimination ability for specific populations may vary. This presentation will discuss AAQ-II scores collected from college athletes training in CrossFit (N=122). Data suggests that the 7 question assessment in this population is significantly lower than validation averages. Compared to original AAQ-II validation testing (N=206, M=21.41, SD=7.97), athletes scored significantly lower (M=14.46, SD=6.03). The presentation will discuss the potential difficulty in the AAQ-II to detect and discriminate levels of psychological inflexibility among certain competitive athletic populations. Current data, also suggests that more research and potentially developing an athletic specific AAQ maybe necessary to delineate psychological flexibility and inflexibility among high performance populations.

• Applying the Psychological Flexibility Model to Resiliency in Completive Sport
Emily Leeming, University of Nevada, Reno
Steve Hayes, University of Nevada, Reno
Patrick Smith, University of Nevada, Reno

This presentation will serve to expand and follow up on data presented at ACBS Minneapolis on resiliency/mental toughness in competitive athletes. Psychological resiliency is said to be a distinguishing feature between good athletes and great athletic champions but this concept has yet to be studied with scientific rigor. Athletes were exposed to three kinds of specific statements designed to increase performance during a multi-round, high stress, isometric hold test. Two statements were suggested by traditional sports psychology (a statement to focus on the task and a statement to distract from the high demand), and one suggested by relational frame theory (a statement to focus on willingness to persist in the face of aversive emotions). The willingness statement led to decreased rates of fatigue across repeated hold exposures, and improved athlete’s ability to predict task failure. Data from this within-subject methodology will presented. Additionally, data from a larger trial, currently being conducted, will also be presented. Implications and future directions from investigations will be discussed.

Educational Objectives:
1. Identify challenges in assessing high performance populations, discuss psychological flexibility interventions to sports, identify "high performance" populations.

 

138. ACTing Across Contexts: Religion, Diagnostics and Private Events
Symposium (9:00-10:15)
Components: Conceptual analysis, Literature review, Original data
Categories: Organizational behavior management, Clin. Interven. & Interests, Org. Beh. Management, Theory & Philo., Other, Psychotherapy, Psychological Inflexibility across disorders, Philosophy of psychology
Target Audience: Beg., Interm.
Location: Strassburg

Chair: Ronald Burian, M.D., Psychiatric hospital , Königin Elisabeth Herzberge“, Berlin (KEH)
Discussant: Lidia Budziszewska, University of Almería & Sinews MTI Multilingual Therapy Institute

The studies presented in this symposium discuss the application of Act within different religious contexts and different aspects relevant to ACT, including the concept of private events and transdiagnostic processes. The first paper focuses on the relation between the religious attitude and psychotherapy in Muslim country and examines the differences and similarities between Islamic Spiritual Therapy and ACT from an Islamic point of view. The second paper critically analyzes the concept of private events and discusses an alternative perspective based on the notion of “complexity“. Finally, the third paper investigates psychological inflexibility as a transdiagnostic process in depressive, anxiety and eating disorders with and without comorbid personality disorders in psychiatric inpatients.

• A Comparison between Islamic Spiritual Therapy (IPS) and Acceptance Commitment Therapy (ACT)
Dr Tahereh Seghatoleslam, University of Malaya , Centre of Addiction Sciences UMCAS) Malaysia Shahid Beheshti University of Medical Sciences ,Tehran Iran
Hussain Habil, University of Malaya , Centre of Addiction Sciences UMCAS) Malaysia

This study has clarified the differences and similarities between ISP and ACT from an Islamic point of view. It showed that there are a lot of similarities and a few differences in ISP and ACT principles. However, in Islam, everything is related to Allah, and it is said that everything is done in the name Allah; therefore, the Holy Quran emphasises on some actions that are mentioned as “Wajib”, which means they are compulsory, and stresses on the importance of avoiding any unacceptable Islamic behaviour which is a cardinal sin in the Holy Quran. Whereas in ACT, cognitive avoidance is not encouraged. In Islam, there are five prayer times that are “Wajib” (Compulsory) for all Muslims. It is similar to mindfulness in ACT that is the cause of consciousness. The Holy Quran orders that you have to be conscious and be responsible for all of your actions and behaviour to yourself and to other people. Otherwise, you are committing Haram. “Haram” is a religious word that is opposite of Wajeb, which means “compulsory to be avoided”. In the Islamic point of view, it is also recommended that the values play an important role in both personal and social life. These values developed the framework of a cognitive life. Regarding the time as mentioned by ACT, the moment is one of the principles that was proposed by Steven Hays. Moreover, Islam mentions that you should always be aware of the future and think of life in the next world. It is also mentioned that if you care about life in the other world, your future will be blessed by Allah. These dimensions are considered completely in the original paper.

• Is privacy a necessary concept in contextual approach?
Henrique Mesquita Pompermaier, MSc., Universidade Federal de São Carlos

A behavior analytic approach of subjective phenomena, in a great measure, was developed based on the concept of private events (and the notion of privacy implied on it). In this sense, the called “private events theory” was assumed as the model for behavior analysis to comprehend and study some psychological phenomena. Contextual behavioral scientists argue that, in some senses, a simple behavior analytic approach is limited and must be corrected or complemented by a contextual comprehension. Notwithstanding, some of these authors maintain private event as a central concept in their propositions. The present work aims to dispose some critical arguments in sense of arguing that, focusing on contextual contingencies involved in subjective phenomena, the concept of private events is not only needless, but also misleading and incoherent. We alternatively suggested that the notion of privacy can be replaced by the notion of complexity.

• Psychological Inflexibility- a transdiagnostic process?
Jannika De Rubeis, MSc, MAS, EOS-Klinik für Psychotherapie, Münster, Germany
Maria Kensche, Dr. med., EOS-Klinik für Psychotherapie, Münster, Germany
Fabrizio De Rubeis
Diane Lange, Dr., EOS-Klinik für Psychotherapie, Münster, Germany
Markus Pawelzik, Dr. med., EOS-Klinik für Psychotherapie, Münster, Germany

Identifying transdiagnostic models has received growing attention in clinical psychology (Nolen-Hoeksema & Watkins, 2011). Motivated by Levin and colleagues (2014), we investigated psychological inflexibility (PI) as a transdiagnostic process relevant to depressive, anxiety and eating disorders with and without comorbid personality disorders (PD) in psychiatric inpatients. This preliminary sample consists of 287 inpatients (70.7% female) between 15 and 73 years of age. All patients completed self-report measures of general distress, PI and structured diagnostic interviews. PI was significantly higher in patients with PD compared to depression and anxiety disorders. There was no difference in PI between eating disorders and PD. These results remain even after controlling for global symptom severity. Data were analyzed for each diagnostic subgroup separately, with and without comorbid PD. The results are discussed in terms of the merit of understanding psychological inflexibility as a transdiagnostic process and the need for investigating personality disorders in ACT research.

Educational Objectives:
1. Clarify the relation between the religion attitude and psychotherapy in Muslim country. 2. Discuss alternative perspectives based on the notion of "complexity". 3. Discuss the significance of assessing psychological inflexibility as a transdiagnostic process.

 

139. Current RFT Research on Analogical Reasoning
Symposium (9:00-10:15)
Components: Original data
Categories: Relational Frame Theory, Edu. settings, RFT, analogical reasoning, intelligence
Target Audience: Beg., Interm., Adv.
Location: Room 30241

Chair: Carmen Luciano, Universidad de Almería
Discussant: Ian Stewart, National University of Ireland, Galway

Analogical reasoning has been a privileged topic in Relational Frame Theory (RFT) research. This symposium presents current cutting-edge research concerning some aspects of analogical reasoning. The first paper aims to extend previous studies using the Relational Evaluation Procedure (Stewart et al., 2004) to allow the evaluation of networks involving relations of coordination, difference, and opposition and to study for the first time quasi-analogies, which involve establishing relations other than coordination between networks. The second study aims to extend a recent research that showed that common physical properties among relational networks improve analogy aptness (Ruiz & Luciano, 2015). Specifically, this new study analyze whether common physical properties also facilitate analogy derivation about analogy aptness analyze whether common physical properties facilitate analogy derivation. Lastly, the third study analyzed the effect of an analogical reasoning training protocol based on RFT to improve analogical skills in adolescents.

• Training Relational Responding Between Functionally Non-equivalent Relational Networks using the Relational Evaluation Procedure (REP): A Preliminary Model of Quasi-analogy
Shane McLoughlin, National University of Ireland Galway
Ian Stewart, National University of Ireland Galway

Relational Frame Theory (RFT) researchers define analogical responding as the establishment of frames of coordination between functionally equivalent relational networks. One strand of RFT research has used the Relational Evaluation Procedure (REP) to provide a generative model of analogy thus conceptualized. Specifically, this previous work established functions of ‘SAME’ and ‘DIFFERENT’ and ‘YES’ and ‘NO’ in arbitrary stimuli and subsequently tested choosing either ‘YES’ or ‘NO’ in the presence of (i) ‘statement’ networks involving SAME and DIFFERENT relations between novel arbitrary nonsense syllables and (ii) analogical ‘question’ networks that required derivation of relations between stimuli given in (i). The current study extended this model by using the REP to allow evaluation of networks involving ‘opposite’ in addition to ‘same’ and ‘different’ relations and to facilitate not just analogies (sameness between derived relational networks), but also quasi-analogies involving relations of distinction and opposition between networks. Implications and future directions are discussed.

• Common Physical Properties Among Relational Networks Facilitate Analogy Derivation
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Carmen Luciano, Universidad de Almería

This study aimed to analyze whether common physical properties facilitate analogy derivation. Participants were randomly assigned to the experimental or the control condition and formed three separate relational networks. In the experimental condition, the node stimuli of Networks 1 and 2 contained color spots. In the control condition, only the node stimuli of Network 1 had color spots. Participants had to identify twelve proposed analogies as correct or incorrect. In the experimental condition, three of the six correct analogies involved relating combinatorial relations of sameness from relational Networks 1 and 2 (i.e., analogies with common physical properties) while the remaining three correct analogies involved relating Networks 1 and 3 (i.e., exclusively relational analogies). All analogies in the control condition were exclusively relational analogies. Experimental participants responded more accurately and faster to analogies with common physical properties than to exclusively relational analogies whereas control participants did not show a differential performance.

• The Effect of an RFT-Based Training in Analogical Reasoning in Adolescents
Asunta Utande, Universidad de Almería
Carmen Luciano, Universidad de Almería
Sonsoles, Valdivia-Salas
Juan C. López, Universidad de Almería

The present study aimed to evaluate the effect of a training protocol on analogical reasoning based on the RFT conceptualization of analogy. The protocol was formed by multiple examples of coordination among different types of relations. Two types of participants (adolescents showing high and low learning achievements) were divided, respectively, in two conditions: the experimental condition which received the analogy-based protocol, and the control conditions which did not. Pre and post-tests measures in formal tests (DAT and D-70) were taken as well as measures related to their achievement in math and language school classes. Results showed differential effects on the dependent variables as well as in regard to the type of participants. Practical implications of these findings are discussed.

Educational Objectives:
1. Describe the RFT model of analogical reasonin 2. Demonstrate that the RFT model can be extended to analyze higher-order operants not conceptualized within mainstream psychology and to analyze the determinants of analogy aptness. 3. Implement RFT training protocols to improve analogical reasoning skills.

 

140. Treatment of Personality Disorder and Comorbid Substance Addiction: Clinical Approaches Suggested by ACT, DBT and Schema Therapy
Symposium (9:00-10:15)
Components: Literature review
Categories: Clinical Interventions and Interests, Beh. med., Personality Disorder and comorbid Substance Use Disorder
Target Audience: Beg.
Location: Room 30341

Chair: Thorsten Kienast, M.D., M.B.A., Dpt of Psychiatry and Psychotherapy, Charité Campus Mitte, University Medicine Berlin
Discussant: Ulrich Schweiger, M.D., Professor at the Department of Psychiatry and Psychotherapy, Lübeck University

A large number of studies have shown that various psychotherapeutic methods have a positive effect on the course of addiction and comorbid personality disorders when patients are treated separately. Co-morbid occurrence of both disorders is common but a chronologically separated treatment often leads to renewed occurrence of the symptoms of the initially treated disorder. Failures of abstinence motivation, severe drug craving and the activation of dysfunctional behavior patterns frequently lead to renewed consumption of addictive substances. Dialectic behavior therapy, dual focus schema therapy, and acceptance and commitment therapy offer promising treantment approaches for this group of patients. This symposium summarizes the current state of knowledge and introduces all three methods by highlighting the core therapeutic strategies.

• Core strategies in Dialectical Behavior Therapy (DBT) for Patients with Personality Disorder and Comorbid Addiction
Thorsten Kienast, MD, MBA, Dpt of Psychiatry and Psychotherapy, Charité Campus Mitte, University Medicine Berlin

Borderline personality disorder (BPD) affects 2.7% of adults. About 78% of adults with BPD also develop a substance use disorder (SUD) or addiction at some time in their lives. These persons are more impulsive and clinically less stable than BPD patients without substance dependency. DBT-SUD integrates effective strategies for the therapy of substance use disorders such as dialectical abstinence, attachment strategies, specific skills to cope with substance use disorder as well as effective therapeutic interventions for the treatment of substance addiction including the attendance of self-help groups and counselling. This paper outlines the defining principles and evidence of DBT-SUD in treating patients suffering form both BPD and SUD or addiction.

• Core strategies in Schema Therapy (ST) for Patients with Personality Disorder and Comorbid Addiction
Eckhard Roediger, MD, Institute of Schema Therapy, Frauenlobstr. 64, 60487, Frankfurt, Germany

Dual Focus Schema Therapy (DFST) has been established in 1998 by Samuel Ball. He developed and evaluated a 24-week manual-guided individual cognitive-behavioral therapy approach for patients suffering from both, personality disorder and substance addiction. It integrates relapse prevention with targeted intervention for early maladaptive schemas and coping styles. This paper outlines the defining principles and evidence of DFST when treating patients suffering form both personality disorder and substance addiction.

• Core Strategies in Acceptance and Commitment Therapy (ACT) for Patients with Personality Disorder and Comorbid Addiction
Maria Kensche, MD, EOS Klinic for Psychotherapy, Alexianer Münster GmbH, Germany

To date, ACT is a third wave behavioral therapy with empirical evidence in the treatment of drug abuse but also in personality disorders. As a contextual behavioral intervention it provides its own model of psychopathology named experiential avoidance (EA). EA is the phenomenon that occurs when a person is unwilling to experience particular unpleasant private experiences and takes steps to alter these experiences and/or the discomfort associated with them. Growing evidence has highlighted EA as a core of problem behavior in many psychiatric disorders. ACT uses acceptance, mindfulness and values-directed behavior change strategies in order to decrease reliance on EA. This may be particularly valueable in the treatment of comorbid personality and substance addicted patients. By increasing willingness to tolerate withdrawal experiences and associated fears it may prevent the typical flight back to drug use at the first signs of withdrawal. This paper summarizes the current evidence in this field.

Educational Objectives:
1. Recite different behavioral therapeutic approaches. 2. Know evidence based facts about the effectiveness. 3. Compare core techniques of 3 different clinical therapy approaches for ACT, DBT and ST in the treatment of patients with comorbid personality disorder and addiction.

 

141. Thinking Outside the Box: ACT Interventions with Non-Clinical Populations
Symposium (9:00-10:15)
Components: Literature review, Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Edu. settings, GRE, "Street Psychology", Body Image, Bibliotherapy, Self-Help
Target Audience: Beg.
Location: Nizza

Chair: Benjamin Ramos, University of Louisiana at Lafayette
Discussant: Tony Biglan, Ph.D., Oregon Research Institute

Suffering is a ubiquitous human experience. Approximately 26.4% of the population in the United States and 8.2% - 20.5% of the population of Europe met criteria for at least one mental disorder as described in the DSM-IV-TR. Yet only 35.5% to 50.3% of these people have the resources or time to seek out psychotherapeutic treatment in developed nations (Demyttenaere, 2004). The purpose of this symposium is to explore and assess the efficacy of ACT interventions with non-clinical populations or with those who are unable to afford treatment. Whether it is an ACT-based intervention prior to taking an examination that will determine your future, a self-help book for those distressed by their internalized body image, or simple ACT interventions using “street psychology” with the homeless, interventions available outside of the clinic can be a valuable tool for the clinician to use with those in crisis or are otherwise unable to seek help.

• Love Thy Body: The Effectiveness of Flexibility-Based Bibliotherapy for Body Image
Lauren C. Burns, University of Louisiana at Lafayette
Grayson Butcher, University of Louisiana at Lafayette
Benjamin M. Ramos, University of Louisiana at Lafayette
Lauren Griffin, University of Louisiana at Lafayette
Emily K. Sandoz, University of Louisiana at Lafayette

“Body image” is a term used to describe behaviors evoked by the body, including private behaviors like body-related thoughts and feelings, and public behaviors, such as body checking or grooming. For some individuals, body image has little impact on their behavior while for others the experience of their body can be aversive and disruptive to daily functioning. Emerging research suggests that building body image flexibility, or the capacity to experience the full range of body-related experiences without engaging in avoidance, can help to improve wellbeing amongst those with body image struggles. This population, however, tends not to present for treatment, requiring alternative means of intervention. This study examined the impact of a flexibility-based self-help book, Living with Your Body and Other Things You Hate on body image disturbance and overall wellbeing. Preliminary data are promising. Implications for further research and for intervention will be discussed.

• Just Breathe: The impact of a Mindfulness Intervention on GRE Preparation Behaviors and GRE Related Anxiety
Emmy Lebleu, University of Louisiana at Lafayette
Rachael Judice, University of Louisiana at Lafayette
Alyson Giesemann, University of Louisiana at Lafayette
Nolan Williams, University of Louisiana at Lafayette
Benjamin M. Ramos, University of Louisiana at Lafayette
Madison A. Gamble, University of Louisiana at Lafayette

The Graduate Record Examination, commonly known as the GRE, can be a great challenge to students hoping to further their education through graduate schooling. Many students struggle with GRE-related anxiety, which they often respond to by avoiding preparation altogether. While this results in short-term relief it only increases anxiety in the long run by making poor performance more and more likely. Common interventions to improve GRE preparation focus on describing the test and instructing test-taking strategies, with the assumption that anxiety will decrease as students become more prepared. Acceptance and Commitment Training (ACT) offers a different approach, directly targeting flexibility and breadth in the student’s behavior in the context of GRE-related anxiety. This study compared the differential impacts of a traditional GRE preparation workshop with an ACT intervention targeting GRE-related anxiety. Training flexibility with anxiety, through ACT, may increase students’ preparation behavior to a greater degree than traditional GRE workshops.

• Treating Homeless People with High Levels of Comorbidity Using ACT, a Couple of first steps for ‘Street Psychology’?
Olof Molander, Ph.D., Pelarbacken

People that are homeless are scoring high on almost all measures of ill health. It is recommended that all mental health programs for homeless individuals should have an integrated approach that accommodates and meets the need of co-occurring mental health and substance misuse disorders. The need for effective, simple treatment interventions targeting comorbidity of addiction/psychiatry is large, in the health care of homeless patients as well as in the general population. From a functional contextual perspective ‘addictive-’, ‘depressive-’, ‘anxiety’- and "stress-’ behaviors might share the same function; and might therefore be treated using an ACT approach promoting behavior change. This is not a presentation of data. The presentation entails a definition of the population of the homeless in Sweden along with a presentation of the types of psychological problems found in ‘Street Psychology’. A functional contextual behavior analytical conceptualization is suggested and a plausible treatment model presented.

Educational Objectives:
1. To examine the implications of an ACT-based self-help study and evaluate its validity and effectiveness in Contextual Behavioral Science. 2. Explore the impact of a mindfulness supplemented GRE Prep procedure on engagement in test preparation behaviors. 3. Learn more about the psychological problems found in Swedish ‘Street Psychology’, and ACT treatment for people that are homeless.

 

142. The Many Faces of FAP: International Perspectives: FAP SIG Sponsored
Symposium (9:00-10:15)
Components: Conceptual analysis, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Prof. Dev., Theory & Philo., Cross-cultural dissemination; ACT - FAP interactions
Target Audience: Interm.
Location: Cannes

Chair: Luc Vandenberghe, Ph.D., Pontifical Catholic University of Goias - Brazil
Discussant: Benjamin Schoendorff, Institut de Psychologie Contextuelle

This symposium discusses the practice of Functional Analytic Psychotherapy (FAP) related to a variety of clinical and cultural issues. Several experiences are presented to argue the scope and range of FAP as a clinical strategy, including its contribution to tackling client resistance in therapy, providing depth and reach in couple therapy and its flexibility in overcoming cultural boundaries. Bringing these three papers together, illustrates the potential benefits for FAP in diverse settings and contexts.

• FAP Strategies as a Way for Empowering the Therapeutic Relationship with "Resistant" Clients
Katia Manduchi, Ph.D., Private Practice; Affiliated with Iescum. Italy

The paper presents a couple of individual cases treated with FAP strategies as a main resource for enhancing behavioral changes. The first case regards a 28 years old woman with a diagnosis of OCD. The second case focuses on a 21 years old man affected by psoriasis, and panic disorder. In both cases, FAP strategies and the therapeutic relationship built on the principles of FAP perspective were a main key. From the beginning of the treatment, the focus on what was going on between the client and the therapist was the main stone that built the soil for a more resistant a quicker change in the life of the clients. In both cases, the measures of change were verified through 2nd and 3rd wave therapy instruments that showed positive results and some notable differences between the beginning to the end of the treatment.

• FAP for Couples Therapy in a Latin American Community Setting
Luc Vandenberghe, Ph.D., Pontifical Catholic University of Goiás; Brazil.

The present paper illustrates and discusses the role of the logical sequence underlying Functional Analytic Psychotherapy in the process of change of two couples treated in a Brazilian community health setting. The two case studies concern two heterosexual couples seeking help for longstanding problems in their relationship. In both case studies, the interaction with the therapists offered opportunities for the man and the woman in the couple to develop the relational behavior they needed to make their relationship blossom. The logical sequence is identified and illustrated with fragments of treatment sessions. Challenges and possibilities for FAP as a clinical style for couples therapy are discussed.

• FAP and Polish Culture
Joanna Dudek, University of Social Sciences and Humanities; Warsaw. Poland.

Functional Analytic Psychotherapy (FAP), with constantly increasing number of studies and publications, has an important place among the Third Wave Behavior Therapies. Despite its growing popularity in the United States, Latin America and several European countries, FAP is still almost unknown in Poland. Taking into account all the benefits and possible obstacles of FAP dissemination in Poland, we discuss cultural-bound aspects, that are worth considering in the process of introducing FAP to clinical work, training and research.

Educational Objectives:
1. Share FAP based practices in clinical settings around the world. 2. Open a space for dialogue between practitioners of dissimilar cultural backgrounds. 3. Discuss critical possibilities and challenges involved in adopting FAP as an approach for different settings.

 

145. RFT and Reading: From Textual Behavior, to Reading Comprehension and Dyslexia: Italy Chapter Sponsored
Symposium (10:30-12:00)
Components: Conceptual analysis, Original data, Case presentation
Categories: Educational settings, Clin. Interven. & Interests, RFT, Children, Autism, Dyslexia, Reading
Target Audience: Beg., Interm.
Location: Estrel Saal C7

Chair: Paolo Moderato, Istituto G. Ferraris, IULM University, Milan
Discussant: Ian Stewart, University of Galway, Ireland

Relational frame Theory (RFT) provides both a theoretical and an applied framework to understand language and other related cognitive skills including complex repertoires like reading. One mechanism that is enlightened is how symbolic behavior comes to bear and how sound, written word and “meaning” come to be equivalent in frames of coordination. In addition it provides a framework to create programs to “teach reading” as an emergent relational response without directly targeting this behavior. Looking at this skill from an RFT perspective helps also conceptualizing and creating effective reading curricula without implying a vocal response. In addition it offers tools to deal with dyslexia, which, within this framework, can be conceptualized as behavior not controlled by relevant stimulus conditions. We will offer an overview of an RFT perspective in reading and curricula to derive this response without teaching it directly in neurotypical, autistic, non vocal and dyslexic children.

• Reading as Derived Relational Responding in Vocal and Non Vocal Children with Special Needs: Cmbinatorial Effects of two Stimulus Control Strategies
Giovambattista Presti, MD, PhD, Kore University, Enna (Italy)
Melissa Scagnelli, IULM University, Milan (Italy)
Maria Josè Sireci, Kore University, Enna (Italy)
Claudio Premarini, Department of Child Neuropsychiatry and Neurorehabilitation; "Eugenio Medea" Scientific Institute, Bosisio Parini, Lecco, Italy.
Paolo Moderato, IULM University, Milan (Italy)

Relational Frame Theory (RFT) offers a framework to understand language and other related cognitive skills including complex repertoires like reading. One mechanism that RFT enlightens is how symbolic behavior comes to bear and how sound, written word and “meaning” come to be equivalent within a frame of coordination. In addition while explaining the emergence of this complex responses this framework is directly related to programs that can “teach reading” without directly targeting this behavior. On a theoretical level it challenges Skinner Verbal Behavior’s definition of the textual behavior and reading comprehension as the results of many behaviors including intraverbal. Another challenge comes from the definition of textual behavior as a vocal response related to a visual stimulus. Following this definition non vocal subjects might not be suitable to learn reading. We trained, vocal autistic, non vocal autistic and non vocal brain damaged children in a conditional discrimination task to match a printed word in uppercase letters (A stimulus) with its picture (B stimulus) and the picture (B stimulus) with its printed word in lower case letters (C). Each stimulus class included three members. So, after testing for mutual and combinatorial entailment relations, we tested also other combinatorial relations namely A-D (reading printed words in uppercase letters), C-D (reading printed words in uppercase letters) and D-A and D-C (choosing uppercase and lowercase printed words conditionally to an auditory stimulus) relations for the vocal children who were able to tact the picture at baseline. Non vocal children where tested in an auditory discrimination task only. Carefully planning of re-combinative strategy led to a progressive reduction of the number of trials for reaching master criterion in the A-B/B-C training and eventually to spontaneous reading of words never trained before, including non sense words. Non vocal children were also able to match never heard non sense words to their printed equivalent.

• Teaching Reading to Preschool Neurotypical Children
Melissa Scagnelli, IULM University, Milan (Italy)
Giovambattista Presti, Kore University, Enna (Italy)
Davide Carnevali, IULM University, Milan (Italy)
Paolo Moderato, IULM University, Milan (Italy)

Reading and writing are a foundational skills that are essential for effective interaction with one’s environment. They are also the foundation upon which the learning curriculum at school are based on. These skills, however, are difficult to teach to many students. Our research has the objective to evaluate the effectiveness of training based on the principles of Relational Frame Theory in promoting the acquisition of reading lower case and uppercase printed word, as a derived relational response and to identify variables that are involved in the reading learning acquisition process. Training procedure consisted in two different procedures: a pencil and paper procedure and a specific ipad application. Data demonstrates the efficacy of both of them in teaching reading to preschool children.

• Teaching Reading and Writing to Dyslexic and Dysgraphic Children: Exploratory Studies Using an RFT Perspective
Margherita Gurrieri, IESCUM and ACT-Italia (Italy)
Melissa Scagnelli, IULM University, Milan (Italy)
Davide Carnevali, IULM University, Milan (Italy)
Giovambattista Presti, Kore University, Enna (Italy)
Paolo Moderato, IULM University, Milan (Italy)

Reading and writing are fundamental skills, essential for effective interactions with the environment. Learning disorders (dyslexia, dysgraphia, dyscalculia) are considered lifelong conditions that, in some cases, affect many parts of a child's life: school, daily routines, relational life. Relational Frame Theory provides both a theoretical and an applied framework to understand language and other related cognitive repertoires including reading and writing. Applications based on derived stimulus relations have been demonstrated effective in teaching reading, spelling and math skills to persons with different difficulties and learning histories, generating behaviors not explicitly taught. The current paper presents data from exploratory studies with dyslexic and dysgraphic children exposed to a conditional discrimination procedure with arbitrary matching to sample in which the kids have been trained to match pictures to printed words and to copy printed words. Mutual and combinatorial entailment relations have been tested, demonstrating the formation of an equivalence class. Data indicated that the intervention had positive outcomes in terms of accuracy from pre-intervention to follow up. Pre-post treatment changes in standardized tests for dyslexia will be discussed.

Educational Objectives:
1. Introduce RFT perspective on reading and reading comprehension. 2. Offer an overview of the possible applications with neurotypical children and children with special needs. 3. Challenge some of the common assumptions on reading that come from internalistic theories.

 

146. ACT for physical health problems: Benefits for patients with headache, cancer and chronic health problems
Symposium (10:30-12:00)
Components: Conceptual analysis, Literature review, Original data
Categories: Clinical Interventions and Interests, Beh. med., Acceptance, anger, coping, headache patients, Medication Overuse Headache (MOH), ACT, Cancer, children with chronic health problems
Target Audience: Beg., Interm.
Location: Strassburg

Chair: Bartosz Kleszcz, M.A., Zacznij Żyć Private Practice
Discussant: Lisbeth Frostholm, Aarhus University Hospital, Denmark

ACT has been shown to be beneficial for different physical health problems. This symposium presents three studies that evaluated interventions for or examined the relationship between ACT Processes and different physical health conditions. The first study aims to investigate the relationship between acceptance, anger and coping styles in headache patients. The second study provides a conceptual overview of the proposed perspective shifts in cancer care, explores the association between psychological flexibility and commonly used outcome measures and discusses challenges and barriers for ACT in cancer care. Finally, the third study assesses the effect of an acceptance-based intervention on parents and children with chronic physical and mental problems with various health indicators.

• Acceptance, anger and coping styles in headache patients (MOH)
Giuseppe Deledda, Psy, Service Clinical Psycology, at “SacroCuore - Don Calabria” Hospital,Verona, Italy
Margherita Zamboni, Psy, Service Clinical Psycology, at “SacroCuore - Don Calabria” Hospital,Verona, Italy
Eleonora Geccherle, Psy, Service Clinical Psycology, at “SacroCuore - Don Calabria” Hospital,Verona, Italy
Fabio Marchioretto, Med, Neurology Unit, at “SacroCuore - Don Calabria” Hospital,Verona, Italy
Claudio Bianconi, Neurology Unit, at “SacroCuore - Don Calabria” Hospital,Verona, Italy

Background The aim of this study is to investigate the relationship between the acceptance (psychological flexibility), anger and coping styles in headache patients with MOH (Medication overuse headache). Methods Patients were assessed at pre-treatment ACT based (3 sessions during hospitalization’s ten day) with standardized self-report measures (Migraine Disability Assessment (MIDAS), GHQ-12, Buss-Durkee Hostility Inventory (BDHI), COPE-NVI, SCL-90, Distress Thermometer and AAQ-II). Results Seventy-five patients were recruited (61 women; M 48.28 years, SD 11,34). Data showed a negative correlation between AAQ2 and BDHI; higher level of acceptance, lower is the total score of the BDHI (r= -0,464**, p<0,01) and related subscales (TAssault= -0,291*, TResetiment= -0,490*, TSouspiciousness= -0,408*, TGuilt= -0,297*). The same occurs with GHQ12, on general health (r= -0,424**,p<0,01) and GSI (r= -0,624**, p<0,01). Moreover AAQII scores show a significative negative correlation with social support (r = -0.336, p=0.005 ) and avoidance coping strategies (r= -0.310, p=0.011). Conclusions The findings put more emphasis on the relevance of interventions focused on the psychological flexibility (ACT) for headache patients.

• Timing is everything: why changing perspectives in the psychological care of cancer patients makes ACT a timely and much needed intervention.
Nicholas J. Hulbert-Williams PhD, University of Chester UK
Lesley Storey PhD, Queen's University Belfast, UK
Brooke Swash, University of Chester, UK & University of Cambridge, UK
Clare Charman, University of Chester, UK
Kelly Wilson PhD, University of Mississippi

Distress is common in cancer patients, and yet evidence for the benefits of psychological interventions is inconsistent. Recent years have borne witness to shifting perspectives within the field of psychosocial oncology, for example, away from focussing on clinical co-morbidity (e.g. anxiety, depression) to greater appreciation of the problematic nature of sub-clinical distress, and away from solely encouraging ‘fighting spirit’ coping approaches. This presentation beings with a conceptual overview of these perspective shifts, and how these have become, perhaps coincidentally, aligned with contextual behavioural science. We then outline the results of our pilot empirical work which explores: (a) statistical associations between psychological flexibility and commonly used patient-reported outcomes measures; and (b) perceived acceptability of ACT-based interventions from patient and healthcare professional perspectives. The talk closes with discussion of the challenges and barriers we must overcome for ACT to be used broadly within the cancer care setting.

• Acceptance-based intervention for parents and children with chronic health problems: a systematic review and meta-analysis
Yuen Yu Chong, PhD student, School of Nursing, The Hong Kong Polytechnic University
Yim Wah Mak, Ph.D, Assistant Professor, School of Nursing, The Hong Kong Polytechnic University
Alice Yuen Loke, Ph.D, Professor, School of Nursing, The Hong Kong Polytechnic University

Background Managing pediatric chronic health problems requires a lifelong commitment among children and their families. Evidence from systematic review showed that both children with chronic health problems and their parents are at risk of a number of negative psycho-social well-being. Acceptance-based intervention, including Acceptance and Commitment Therapy (ACT), Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT) may help this vulnerable population. Objective To assess the effect of acceptance-based intervention on parents and children with chronic physical and mental problems with various health indicators: physical and mental health as well as quality of life for children; mental health, quality of life and family functioning for parents. Methods Randomized controlled trials (RCTs) were searched from 1946 to January 2015 from the following databases: CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO. A reference search and citation search of all the included studies were conducted in order to identify additional studies that were not included in the above databases. The standard methodological procedures in data collection and analysis were adhered to the Cochrane Collaboration. Results A total of five RCTs involving 312 participants, of which 81 were parent-child dyad and 231 were children only, were included in the review. No trials involved only parents as participants. Of the 5 RCTs, three of them (179 participants, of which 39 parent-child dyad and 140 children only) examined the effect of acceptance-based intervention (ACT in 2 studies, MBSR in 1 study) on children diagnosed with chronic mental health problems such as anxiety, depression and mood disorder on their depressive symptoms when compared to treatment-as-usual (TAU). At post-intervention, the overall effect on reducing child depressive symptom was significant with a small to medium effect size (SMD= -0.41, 95%CI: -0.77 to -0.11). No heterogeneity was noted between studies (Chi2=0.45; df=2; P=0.80; tau2=0.00) and the quality of evidence of this outcome was good. One study compared ACT with multidisciplinary care on children with chronic pain. Their effects on child physical and mental health outcome were comparable. One study investigated the effect of MBCT with TAU on depressed children, and the overall mental health status was significantly improved. No studies had reported parental outcomes and family functioning outcomes. Conclusion This review provided us information about the current applications of acceptance-based intervention in helping children with chronic health problems, in particular those with mental health problems, in reducing depressive symptoms when compared to treatment as usual. Effects on parental health outcomes, family functioning and quality of life of the parents are not discovered in the reviewed studies.

Educational Objectives:
1. Describe current application of acceptance-based intervention, including Acceptance and Commitment Therapy, Mindfulness Based Stress Reduction, Mindfulness Based Cognitive Therapy, for children with chronic physical and mental health problems and their parents in terms of their health outcomes. 2. Discuss the implications for clinical practice and future research about acceptance-based intervention on populations with chronic health problems. 3. Intrepret how broader conceptual shifts in psychosocial oncology align with contextual behavioural science

 

147. University Students and Psychological Flexibility: Deepening Our Understanding
Symposium (10:30-12:00)
Components: Original data
Categories: Educational settings, Clin. Interven. & Interests, College students
Target Audience: Beg., Interm., Adv.
Location: Room 30241

Chair: Lanaya Ethington, Ph.D., University of Iowa Counseling Services
Discussant: Anthony Biglan, Ph.D., Oregon Research Institute

Psychological flexibility (PF), or the lack thereof, has been repeatedly associated with a number of mental health issues, such as depression and anxiety, in cross-sectional studies with college students. Less is known about the relationship of PF to university students’ struggles longitudinally or to university student functioning per se; nor do we know the role that different facets of PF play as transdiagnostic predictors of psychological problems with students. This symposium will present data obtained from university students in the U.S. and Australia, deepening our understanding of PF and university student mental health, cross-sectionally and prospectively.

• Psychological Flexibility Correlates With and Predicts Suicidality in College Students
Jacqueline Pistorello, Ph.D., University of Nevada, Reno Counseling Services
Steven C. Hayes, Ph.D., University of Nevada, Reno
John Seeley, Ph.D., Oregon Research Institute
Derek Kosty, Ph.D., Oregon Research Institute

The purpose of this study was to examine the relationship of self-reported psychological flexibility to self-reported or blind clinical interviews of suicidality in college students (n = 732). The present study examined their correlation at college entrance; whether psychological flexibility at entry predicted changes in suicidality over the next three years; and whether changes over that time in psychological flexibility predicted changes in suicidality. In all three analyses, psychological flexibility measures correlated with and predicted suicidality. For example, psychological flexibility as measured by the AAQ-II and suicidal intent as measured by the BDI item #9 correlated at baseline (r=.35, p<.0001); baseline AAQ score predicted changes in suicidal intent over the next three years (t=6.20, p<.0001), and changes in the AAQ related to changes in suicidal intent over that 3-year period (t=8.88, p<.0001). Similar patterns were seen with other flexibility and suicidality measures.

• Examining Facets of Psychological Inflexibility as Transdiagnostic Predictors of Psychological Problems with College Students
Jack A. Haeger, B.A., Utah State University
Michael E. Levin, Ph.D., Utah State University
Benjamin Pierce, B.A, Utah State University

Psychological inflexibility includes a set of pathological processes such as experiential avoidance, cognitive fusion, inflexible attention, deficits in perspective taking, and lack of values clarity. Previous research has primarily focused on using the Acceptance and Action Questionnaire (AAQ) as a measure of psychological flexibility/inflexibility, and has found that the AAQ is predictive of a broad range of psychological problems. However, it is unclear the degree to which each theorized facet of psychological inflexibility contributes to psychological problems. This presentation will report the results of a 1-month longitudinal study with over 300 college students, which sought to examine specific facets of psychological inflexibility as transdiagnostic predictors of psychological problems. Results will be reported with measures of values, cognitive fusion, present moment awareness, acceptance, and inflexibility in relation to measures of anxiety, depression, addiction, eating problems, academic distress, and relationship problems.

• University Student success in Australia: The vital Ingredient of Psychological Flexibility
Philomena Renner, Ph.D., University of Sydney Counselling and Psychological Services

In 2012, a student mental health survey was conduced in a major Australian University to capture rates of reported psychological distress and psychological flexibility. In this sample of university students aged 16–25 years, 43% reported taking one or more days out of role in the previous month—this is considerably higher than that reported by the general population. Furthermore, the psychological distress levels of the students in this study were higher than that found in the general population of Australian young adults. This is consistent with the notion that the university environment is psychologically distressing for many young people, and that increased levels of distress are associated with lower functioning. Interestingly, students who experienced high psychological distress, but possessed greater psychological flexibility, reported less impairment in functioning. This supports the notion that psychological flexibility is a protective factor. Findings will be discussed in terms of potential applications within the university environment.

Educational Objectives:
1. Describe the relationship of psychological flexibility to suicidality in college students. 2. Learn about how specific facets of psychological flexibility relate to a range of problems among college students. 3. Describe the relationship of psychological flexibility to university student functioning.

 

148. Basic Research on Relational Frame Theory and its Implications for Global Concern Problems: Spain Chapter Sponsored
Symposium (10:30-12:00)
Components: Conceptual analysis, Literature review, Original data, Didactic presentation
Categories: Relational Frame Theory, Derived relational responding, Coherence, Insensitivity to Contingencies
Target Audience: Beg., Interm., Adv.
Location: Room 30341

Chair: Nikolett Eisenbeck, University of Almeria
Discussant: Yvonne Barnes-Holmes, Ph.D., Ghent University, National University of Irland Maynooth

This symposium presents three new studies about some basic behavioral processes involved in Relational Frame Theory. The first study offers new evidence about the impact of breaking derived relations. Here we will see how equivalence relations within a set of stimuli can be inter-dependent so that the breaking of its coherence can alter previous and potential relations. Subsequently, the second study analyses the reinforcing power of coherence by showing how individuals prefer contexts that make sense for them instead of incoherent contexts. Finally, the third study focuses on insensitivity to contingencies by analyzing the transfer of rules via equivalence relational responding. The aim of the symposium is not only providing information about these processes but also showing different examples of their implications for global concern problems.

• Breaking Derived Relational Responding in a Single Set of Stimuli: The Phenomenon of Derived Broken Equivalence
David Carreno, University of Almeria
Carmen Luciano, University of Almeria

This study analyzes the phenomenon of derived broken equivalence within a single set of stimuli in 52 participants. Derived broken equivalence consists on responding without equivalence in non-trained situations as a result of breaking previous equivalence relations. To achieve this aim, we carried out two experiments using a match-to-sample task with three phases each. The option ‘none of them is correct’ was strategically included among comparisons. In Phase 1, relations A1-B1, A2-B2, C1-B1, C2-B2 were trained and it was tested for equivalence. In Phase 2, equivalence relations A2-C2, C2-A2 were explicitly broken. In Phase 3, a novel stimulus D was incorporated in each class. Finally, participants were tested to observe whether the trained broken equivalence had altered other relations. The results demonstrate that the breaking of some equivalence relations can alter either previous or potential equivalence relations. These results also question the methodology to break equivalence responding encountered so far.

• A New Analysis of Making-Sense: Exploring Reinforcing Properties
Zaida Callejón Ruiz, University of Almeria
Carmen Luciano, University of Almeria
Juan Carlos López López, University of Almeria

Sense making is a powerful reinforcer developed in the own personal history. The current study seeks to provide empirical evidence on how individuals show a preference towards coherent responding. In Phase 1, participants were exposed to a match-to-sample (MTS) task designed to establish four contexts. In the first context, positive and negative feedback was provided contingent on participants’ perfor¬mance. In the second, this negative and positive feedback always was paired with unpleasant slides. In the third and fourth context, feedback was presented independent of performance. Then participants were asked about their degree of distress and sense of control through self-report. In Phase 2, participants were finally placed in a choice procedure to determine their preferences for each kind of task as well as to measure their self-generated rules. The findings suggest that coherent contexts, in which sense making is possible, are generally preferred by verbally competent humans.

• Insensitivity to Contingencies by Rules Transferred Via Equivalence Relational Responding
James Greville, Swansea University
Nic Hooper, University of the West of England
Jean-Louis Monestes, University of Grenoble

This study assessed whether a previously learned rule would transfer to other members of a stimulus class through derived generalization and result in insensitivity to changes in contingency. Participants completed three tasks: Firstly, a points-scoring task was used to establish two simple rules through use of reinforcement schedules attached to stimuli A1 and B1. Secondly, participants underwent equivalence training in which two stimulus classes were established (A1, A2, A3 and B1, B2 and B3). Finally, participants re-engaged in the points scoring task with the new stimuli (A2, A3, B2, B3) but with the schedules attached to the stimulus classes switched. It was hypothesized that participants would show derived insensitivity to this reversal of rules and persist with the behaviour that was previously successful. However, the results obtained did not support these predictions. We would welcome feedback from the ACBS community on how this research could be improved.

Educational Objectives:
1. Demonstrating the impact of breaking derived relations upon human behavior. 2. Analyzing the role of coherence in the maintenance of psychopathology. 3. Analyzing the impact of rules transferred via derived relational responding upon environmental changes.

 

149. Applying Functional Contextualism to Issues of Gender, Sexuality, and Identity
Symposium (10:30-12:00)
Components: Conceptual analysis, Literature review, Original data
Categories: Prevention and Community-Based Interventions, Clin. Interven. & Interests, Prevention & Comm.-Based, Edu. settings, Related FC approaches, Other, LGBTQ, Gender, Identity
Target Audience: Beg., Interm., Adv.
Location: Nizza

Chair: Grayson Butcher, University of Louisiana at Lafayette
Discussant: Aisling Curtin, ACT Now Ireland

Issues related to gender, sexuality, and identity have only recently been reassessed in light of new approaches. As research continues to be conducted on these topics, outdated and reified concepts, often founded upon structural thinking, are being discarded in favor of more functional and pragmatic lines of inquiry. Investigations of the stigmatization of marginalized groups such as the LGBTQ community and those with nonconforming gender identities, while important, only provide insight into part of the complex context within which these issues are continually occurring. Analyses of the contextual factors contributing to stigma, psychological distress and inflexibility, and discrimination are necessary from a functional contextual perspective. This symposium will address multiple efforts being made to further our understanding of issues of gender, sexuality, and identity as they impact our daily experiences, our lives, and our culture.

• Beyond Sexuality: Psychological Inflexibility, LGBTQ Stigma, and Responsiveness to Education-Based Stigma Interventions
Madison Gamble, University of Louisiana at Lafayette
Lauren Burns, University of Louisiana at Lafayette
Lauren Griffin, University of Louisiana at Lafayette
Emily Sandoz, Ph.D., University of Louisiana at Lafayette

Stigma associated with marginalized groups is quite common. The Lesbian Gay Bisexual Transgender and Queer/Questioning (LGBTQ) community are frequent victims of stigma. LGBTQ persons are often subjected to discrimination, harassment, and violence. Educational interventions have addressed stigma with mixed results. Factors that have yet to be addressed, such as psychological inflexibility, may play a role. Recent investigations on stigma reveal that psychological inflexibility might 1) facilitate stigma, and 2) interfere with new learning that could undermine stigma. The current study examined the relationship between psychological flexibility, LGBTQ stigma, and responsiveness to an education intervention. Participants reported explicit attitudes toward the LGBTQ community, along with behavioral intentions, before being exposed to an educational intervention designed to decrease LGBTQ stigma. Preliminary data suggest that psychological flexibility predicts stigma and responsiveness to education interventions designed to decrease stigma. Implications for integrating flexibility-based interventions with education will be discussed.

• Bridging the Gap: The Effects of Gender Identity on Physical Activity
Garret Cantu, University of Louisiana at Lafayette
Madison Gamble, University of Louisiana at Lafayette
Ryan Albarado, University of Louisiana at Lafayette
Alyson Giesemann, University of Louisiana at Lafayette
Benjamin Ramos, University of Louisiana at Lafayette
Emily Sandoz, Ph.D., University of Louisiana at Lafayette

The assumptions surrounding gender identity have undergone a significant change in recent years, where the emphasis is now placed on one’s identity as the internalized experience of gender that may or may not be congruent with the individual’s biological sex. Unfortunately, nonconforming individuals are more likely to experience discrimination in society than others, which can have a significant impact on the individual. The experience of discrimination and the discord between physical appearance and self-identified gender may exacerbate body image distress as nonconforming adolescents and young adults engage in less vigorous physical activity (Calzo et al., 2014) in comparison to those who are more satisfied with their bodies and engage in greater amounts of exercise (Fountoulakis & Grogan, 2012). In this study, ecological momentary assessment was used to determine the effects of discrimination, body image disturbance, and body image flexibility on patterns of physical activity in the participants’ daily experiences.

• Gender Diversity and Identity
Laura Silberstein, Psy.D., The Center for Mindfulness and Compassion Focused Therapy

This paper explores the existing literature on gender diversity and identity. Traditionally, gender has been approached as a binary categorical system with empirical focus on gender stereotyping (Zosuls, Miller, Ruble, Martin, & Fabes, 2011). This antiquated view of gender may benefit from a more pragmatic perspective and functional approach (Ruble, Martin, & Berenbaum, 2006; Sylvester and Hayes, 2010; Weinstein, Wilson, Drake, & Kellum, 2008). This paper explores the functional dimensions of gender at the level of individuals, groups, and societies. The aim is to highlight behaviors and processes of interest in research and clinical work, such as social stigma, oppression, and the maladaptive adherence to arbitrary rule governed behavior, expressed at multiple levels of human behavior. Finally, this paper is a call for CBS research and application of flexible perspective taking, with precision, depth, and scope, to further understanding these processes and their impact our lives and our world.

Educational Objectives:
1. Attendees will be made knowledgeable of various ways in which discrimination, body image issues, and body image flexibility factor into the physical activity of individuals with various gender identities. 2. Attendees will be able to discuss the impact that stigma and psychological flexibility have on the marginalized group of LGBTQ persons. 3. Attendees will gain a review and exploration of the existing research and overview of the capacity for CBS to provide a pragmatic perspective and functional approach to gender related diversity, inequality and identity.

 

150. Current findings in RFT and Implications
Symposium (10:30-12:00)
Components: Conceptual analysis, Original data, Experiential exercises, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, RFT, Psychopathology, RFT, Deictic relations, Theory of Mind
Target Audience: Beg., Interm., Adv.
Location: Cannes

Chair: Terry de Luca M. Ed Leadership., MA Counselling, Teacher, ACT Education Directorate and Independent Schools. Counsellor in private practice
Discussant: Francisco Ruiz, Fundación Universitaria Konrad Lorenz

The two studies presented in this symposium discuss new findings and procedures in the field of RFT. The first study focuses on the context mapped out by ACT practitioners working with Self Compassion and will highlight the specific therapeutic work required for workable self forgiveness based on the relational frame theory approach. The second study investigates the generalization of exclusion functions via ’Same’ and ‘Opposite’ relations and discusses implications for understanding the impact of exclusion along with future research.

• Religion and Spirituality and Transcendence, and the Imperatives for RFT Based Response to Psychopathology and Psychotherapy which Address Workable Self Forgiveness.
Grant Dewar, University of Adelaide

The edited book Relational Frame Theory a Post-Skinnerian Account of Human Language and Cognition edited by Hayes Barnes-Holmes and Roche, considers the important role of relational frame theory in addressing the experience of spirituality transcendence and God. The approach outlined regarding psychopathology and psychotherapy contains within it important implications for work which focuses specifically on self forgiveness in response to the pervasiveness of human psychopathology. Forgiveness and self forgiveness as therapeutic approaches have been either assumed as being part of self compassion or as an area which is addressed by psychologists and counsellors from a religious context. This presentation will focus on the context mapped out by work being done ACT practitioners working with Self Compassion and will highlight the specific therapeutic work required for workable self forgiveness based on the relational frame theory approach elucidated in the “purple book” . The presentation will include data provided from series of outcomes for client case studies who have been taken through a developing protocol on self forgiveness which addresses the costs and benefits of bidirectional transformation of functions, thought suppression ineffective coping is styles and reason giving. The protocol is base on work by Harris, Toerneke, Ramenero, Villatte and Villatte and outlines the importance of values, acceptance and willingness of experiencing pain in the presence of values, addressing shame, guilt, remorse and reparative action within a framework of perspective taking present focused action and committed action to work towards rebuilding lives based on values. The presentation will also identify the important links to spirituality and transcendence which allow all to consider the therapeutic benefits whether they come from a religious background or from a background of non-theism.

• The Transformation of Social Exclusion Functions through Same and Opposite Relations
Anita Munnelly, University College Dublin
Charlotte Dack, University of Bath
Louise McHugh, University College Dublin

The present study sought to investigate the generalization of exclusion functions via ‘Same’ and ‘Opposite’ relations. Participants were first exposed to nonarbitrary relational training and testing using the Relational Completion Procedure (RCP) to establish the contextual functions of ‘Same’ and ‘Opposite’ for two arbitrary images. Next, participants were exposed to arbitrary relational training and testing to establish responding to nonsense words in accordance with the relational frames of ‘Same’ and ‘Opposite’. Participants were first trained on: Same A1-B1, Same A1-C1, Opposite A1-B2, and Opposite A1-C2, followed by testing with novel stimulus combinations (Same B1-C1, Same C1-B1, Same B2-C2, Same C2-B2, Opposite B1-C2, Opposite C2-B1, Opposite B2-C1, Opposite C1-B2). Participants were then exposed to the Cyberball exclusion conditioning game in which one stimulus (B2) from the relational network was employed as the Cyberball exclusion game name. During a subsequent transformation of function questionnaire, participants were asked to rate how included or excluded they thought they would be from other games, corresponding to members of the relational network. Findings showed the derived generalization of exclusion functions from the directly trained exclusion game (B2) to the derived ‘Same’ game (C2). In addition, participants rated that they felt they would be ‘more’ included in games (B1 and C1) that were previously established as being ‘Opposite’ to the trained exclusion game. Implications for understanding the impact of exclusion along with future research directions are discussed.

Educational Objectives:
1. Identify and describe how Self forgiveness protocols sit within the context of Relational Frame Theory. 2. Assess and compare and describe the links and differences in self compassion approaches and self forgiveness approaches. 3. Apply new evidence bassed approaches to current client needs.