WC14 Symposia Detail

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

 

Thursday, June 16

5. Defining Defusion: Structure, Intervention, and Effects of Cognitive Defusion in Research and Clinical Practice
Symposium (10:30am-Noon)
Components: Conceptual analysis, Literature review, Original data
Categories: Clinical Interventions and Interests, Clin. Interven. & Interests, Other, Defusion
Target Audience: Beg., Interm.
Location: Vashon 1

Chair: Theresa A. Morgan, Ph.D., Rhode Island Hospital, Alpert Medical School of Brown University
Discussant: J. T. Blackledge, Morehead State University

Defusion is integral to Acceptance and Commitment Therapy (ACT) and has a documented effect on treatment outcomes. It is targeted directly in ACT using a combination of experiential exercises, metaphors, and didactics that shift emphasis away from literal meanings, and highlight the independence of thought and behavior. Nevertheless, there is little research examining defusion’s primary structural components, assessment, and associations with related constructs. Moreover, targeted examinations of defusion interventions are rare, and its acceptability and effect in naturalistic treatment settings is not well established. This symposium presents three investigations of defusion including both experimental and applied studies in diverse populations. The first addresses the conceptual underpinnings, measurement, and structure of defusion across four samples. The second presents rapid effects of a technology-enhanced defusion technique on thought believability and distress in a clinical sample. The third discusses the effectiveness of initiating ACT-based treatment with defusion in an acute treatment setting.

• Examining the Structure and Construct Validity of Defusion and Decentering
Kristin Naragon-Gainey, Ph.D., University at Buffalo, the State University of New York
Kenneth G. DeMarree, Ph.D., University at Buffalo, the State University of New York

Defusion and decentering are related constructs that describe an objective, distanced, and open approach towards one’s internal experiences (Bernstein et al., 2015). Numerous measures of these constructs exist, but little is known about how they relate to one another or their ability to predict important outcomes like thought believability. Across four samples (clinical and non-clinical), we found that five measures of defusion and decentering were only weakly to modestly associated with one another. Item-level analyses revealed a two-factor structure, consisting of “Observer Perspective” and “(Lack of) Struggle with Thoughts,” which generally showed expected and distinct patterns of convergent and discriminant validity, although the latter factor had questionable discriminant validity viz-a-viz psychological distress. The factors also related differently to believability of positive vs. negative thoughts, which was partially explained by the predominance of negative items in defusion and decentering measures. Implications for the conceptualization and assessment of defusion are discussed.

• The Immediate Effect of Cognitive Defusion in a Clinical Sample: Distress, Believability, and the Role of Psychological Flexibility
Kristy L. Dalrymple, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Brandon A. Gaudiano, Ph.D., Butler Hospital; Alpert Medical School of Brown University
Lia Rosenstein, B.A., Rhode Island Hospital; Alpert Medical School of Brown University
Emily Walsh, B.A., Rhode Island Hospital; Alpert Medical School of Brown University

Defusion tasks (e.g., vocal repetition) result in greater reductions in distress and believability towards negative thoughts relative to thought control or distraction tasks (e.g., Masuda et al., 2009; 2010). A few studies have been conducted in clinical samples, but no known studies have examined the use of mobile technology to enhance the defusion effect. We previously conducted intermediate analyses of the effects of nontechnology and technology-enhanced defusion tasks compared to a thought distraction task on negative thoughts in a subsample diagnosed with a depressive disorder. The current study will present results from the final sample of 97 participants and explore the role of psychological flexibility. Results showed that defusion resulted in decreased believability from pre- to post-task compared to thought distraction. Greater psychological inflexibility was associated with less change in distress and believability in the thought distraction condition only. Additional findings, limitations, and implications of the findings will be discussed.

• Changes in Symptoms and Functioning After Initiating Treatment with Defusion
Theresa A. Morgan, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Brian Pilecki, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Catherine D'Avanzato, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Kirsten Langdon, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Darren Holowka, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Kristy Dalrymple, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Mark Zimmerman, MD, Rhode Island Hospital; Alpert Medical School of Brown University

Few studies examine the unique effect of defusion on clinical treatment, but those that do identify it as a significant contributor to positive outcomes (e.g., Levin et al., 2012; Bach & Hayes, 2002). Despite this, we could find no reported clinical protocols that begin treatment with defusion or that quantify the results of doing so. The current study examines the effect of applying defusion at intake in ACT-based group treatment. Participants include 750 patients in an open-enrollment, ACT-based partial hospitalization program, 144 of whom initiated treatment with defusion. Preliminary results showed that patients receiving defusion at intake reported significant improvement in symptoms and functioning 24 hours after initiating treatment. Group comparisons showed higher defusion and flexibility in the intake-defusion group 24 hours after initiating treatment, however these differences were no longer present at discharge. Clinical implications and issues that arise when applying defusion early in treatment will also be discussed.

Educational Objectives:
1. Describe the primary elements that underlie measures of defusion and decentering, evaluate the construct validity of existing defusion scales, and identify current challenges in measuring and conceptualizing defusion. 2. Describe the effects of nontechnology and technology-enhanced defusion tasks on negative thoughts compared to a thought distraction task, and the association between these effects and pre-task psychological flexibility. 3. Discuss the effectiveness and outcomes of applying defusion interventions at intake in acute psychiatric settings, and the clinical issues associated with this process.

 

9. Mindfulness and Acceptance-Based Interventions for PTSD in Acute and Complex Populations: Refining Treatment and Clarifying Mechanisms of Change
Symposium (10:30am-Noon)
Components: Literature review, Original data
Categories: Clinical Interventions and Interests, PTSD, partial hospitalization, Adults, veterans
Target Audience: Beg., Interm.
Location: Cascade 1B

Chair: Catherine D'Avanzato, Ph.D., Rhode Island Hospital
Discussant: Victoria M. Follette , Ph.D., Department of Psychology, University of Nevada Reno

ACT-based interventions have demonstrated efficacy for trauma-exposed populations. Given the complexity and functional impairment characterizing this population, ACT may be a particularly suitable intervention, as it has demonstrated improved outcomes among individuals who do not respond adequately to traditional behavioral therapies. This symposium will address two important gaps in the existing literature on ACT for PTSD: first, a lack of research investigating higher-level care settings which are increasingly serving this population and second, a need to clarify the pathways through which change in specific ACT processes influences outcomes. The first presentation (Megan Kelly) focuses on examining change in experiential avoidance as a mechanism underlying social support among returning Veterans. The second (Catherine D’Avanzato) and third (Kirsten Langdon) presentations highlight outcome data of a specialty PTSD partial hospital program, as well as underlying ACT mechanisms of change. Implications for refining existing ACT-based interventions for PTSD will be discussed.

• Experiential avoidance as a mediator of the association between posttraumatic stress disorder symptoms and social support: A longitudinal analysis
Megan Kelly, Ph.D., VISN 1 Mental Illness Research, Education, and Clinical Center, Bedford, MA, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Social and Community Reintegration Research Program, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; University of Massachusetts Medical School, Worcester, MA
Bryann B. DeBeer, Ph.D., Dept. of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX; Texas A&M University
Eric Meyer, Ph.D., Dept. of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX; Texas A&M University
Nathan Kimbrel, Ph.D., Durham Veterans Affairs Medical Center; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Duke University School of Medicine
Suzy Gulliver, Ph.D., Warriors Research Institute, Baylor, Scott & White Healthcare System, Waco, TX, USA
Sandra Morissette, Ph.D., The University of Texas at San Antonio, Department of Psychology

Veterans with PTSD often experience difficulties with social reintegration following deployment due to avoidance of social interaction. The present study evaluated whether experiential avoidance (Acceptance and Action Questionnaire – II ) mediated the association between PTSD symptoms (Clinician Administered Scale for PTSD) and post-deployment social support (Deployment Risk and Resilience Inventory – Post Deployment Social Support Questionnaire). Veterans (n = 145) who served in support of the conflicts in Iraq and Afghanistan participated in a study evaluating returning Veterans’ experiences. Results showed experiential avoidance was a significant mediator the relationship between lifetime PTSD symptoms and 8-month social support, indirect effect = -.0048 (95% CI: -.0074, -0.0029). Results also showed that experiential avoidance was a significant mediator of the association between baseline PTSD symptoms and 8-month post-deployment social support, indirect effect = -.0061 (95% CI: -.0101, -.0027). Experiential avoidance appears to be an important mediator between PTSD symptoms and social support following deployment.

• Effectiveness of an ACT-based Partial Hospitalization Program for PTSD: Trajectories of Change in PTSD symptoms and Core ACT Processes
Catherine D'Avanzato, Ph.D., Rhode Island Hospital, Providence, RI
Darren Holowka, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Kirsten J. Langdon, Ph.D., Rhode Island Hospital
Theresa A. Morgan, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Brian Pilecki, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Sarah McCutcheon, M.A., Rhode Island Hospital

ACT appears to be an efficacious and well-received intervention for trauma-exposed individuals (e.g. Walser et al., 2015; Mulick et al., 2011), however further research demonstrating its efficacy is needed. Further, as partial hospital programs are becoming an increasingly prevalent treatment modality for this population, more research is needed on the effectiveness of ACT for PTSD in acute care settings. The present study investigated the effectiveness of our ACT-based PTSD track in reducing PTSD severity, as indicated by the PTSD Check List (PCL), building upon past results indicating significant change in anxiety and depression symptoms. We first validated the PCL in our non-veteran sample, comprised of individuals exposed to diverse trauma types. A significant reduction in PTSD severity from pre to post-treatment was hypothesized and tested using structural equation modeling (N>300). Results on pre-post change in symptoms, quality of life, functioning, and ACT processes will be reviewed, as well as trajectories of symptom change over time. Implications for the refinement of ACT-based PTSD interventions in higher level care settings will be discussed.

• Experiential avoidance and mindfulness: Putative mechanisms underlying symptom change during intensive ACT-based treatment among a trauma-exposed population
Kirsten J. Langdon, Ph.D., Rhode Island Hospital
Darren Holowka, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Catherine D'Avanzato, Ph.D., Rhode Island Hospital
Theresa A. Morgan, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Brian Pilecki, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Sarah McCutcheon, M.A., Rhode Island Hospital
Kristy Dalrymple, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Mark Zimmerman, MD, Rhode Island Hospital; Alpert Medical School of Brown University

Recent research suggests that ACT may be an especially effective treatment for trauma-exposed populations, given its emphasis on encouraging participants to observe and accept unwanted thoughts, feelings, and memories (McLean & Follette, 2015; Woidneck, Morrison, & Twohig, 2014). The present study evaluated whether change in certain ACT-based processes, namely experiential avoidance and mindfulness, during participation in a specialized PTSD track within a partial hospital program, predicted improvement in symptom severity across treatment. Results indicated that decreases in experiential avoidance and increases in mindfulness were associated with reductions in PTSD, anxiety, depression, and anger severity across time. An examination of the differential effects of specific mindfulness facets in relation to symptom change will also be presented. These data highlight experiential avoidance and mindfulness as putative mechanisms underlying change in PTSD and related symptoms during intensive ACT-based treatment. Clinical implications for addressing experiential avoidance and encouraging mindful awareness in trauma-exposed populations will be discussed.

Educational Objectives:
1. Present data on the effectiveness of three ACT-based interventions for PTSD in novel populations and/or setting. 2. Examine the relation between specific ACT core processes and treatment outcome indices. 3. Discuss implications for developing and refining ACT interventions for PTSD in novel clinical settings and populations.

 

11. Pursuing a comprehensive assessment agenda for Functional Analytic Psychotherapy
Symposium (10:30am-Noon)
Components: Conceptual analysis, Didactic presentation
Categories: Performance-enhancing interventions, Superv., Train. & Dissem., Assessment
Target Audience: Interm., Adv.
Location: Cascade 2

Chair: Amanda M. Muñoz-Martínez, MSc., University of Nevada, Reno
Discussant: William C. Follette, Ph.D., University of Nevada, Reno

Research in Functional Analytic Psychotherapy (FAP) has advanced in different directions. Several methods have been implemented to identify how therapeutic relationship produce changes in-session and its effect on client’s natural contexts. However, FAP lacks of a coordinated methodological agenda that extends its empirical support in a functional perspective instead a topographical approach. This symposium addresses some issues to unstuck research progress in this therapeutic approach. First, we explored psychometric measurements that assess improvements in the interactions in-session and out-of-session, that could provide standardized parameters of clients improvements. Second, we discuss areas of influence on client's behavior and the complexities of functional assessment. Third, we propose implementing systematic functional descriptive analysis as an option, to guarantee the integrity of the independent variable and the reliability of the dependent variable, in FAP.

• Psychometric measurement of interactions in- and out-of-session
Timothy Feeney, University of Nevada, Reno
Cory Stanton, M.S., University of Nevada, Reno

Functional Analytic Psychotherapy (FAP) is an approach that assumes interpersonal interactions between the therapist and client account for a large proportion of the variance explaining therapeutic change. Measures have been developed that directly target features important to the intervention. These include measures that inform a functional case conceptualization, provide procedures for coding and analyzing the dyad, and measures of dependent variables. The field of interpersonal interventions is not limited to FAP; methods and measures have been developed that maintain features important to the analytic goals of FAP (prediction and influence). This paper will discuss measurement procedures that exist in FAP, what is missing, and what methods have been developed for other domains that may be adapted for research that takes a functional approach to the therapist-client dyad as a mechanism of change. The paper will explore the varying clinical and empirical implications for using these devices in a functional paradigm.

• Areas of influence on client behavior and the complexities of analysis
William C. Follette, Ph.D., University of Nevada-Reno

Functional Analytic Psychotherapy (FAP) is an approach to therapy that assumes there are functional and definable features of the therapeutic dyad. Further, these features account for a significant proportion of the variance that contribute to the probability of achieving an outcome favorable to both the therapist and the client. Some proportion of this variance will be called “client characteristics;” these are functional repertoires of behavior that may be under generalized stimulus control and interact with “therapist characteristics” in a way that increases or decreases the probability of achieving therapeutic goals. Other features that contribute to the variance will be discussed and include treatment fidelity, the supporting influences of the client’s direct acting environment, and how these interact with “client and therapist characteristics.” All of these units are functional and contextual and provide a dynamic view of the change process and create a context where attending to treatment adherence is insufficient.

• Assessing treatment integrity and reliability in FAP
Amanda M. Muñoz-Martínez, MSc., University of Nevada, Reno
Natalie Bennett, University of Nevada, Reno

Treatment adherence or treatment integrity, as the extent by which an intervention is implemented as intended, is an important aspect of research in psychotherapy. Strong conclusions cannot be drawn between the independent variable (treatment) and dependent variable (client’s behavior) unless it is known whether or not the therapist adhered to the treatment (Gresham, 2009). Otherwise, reliability of the dependent variable is fundamental to provide accurate conclusions about treatment effectiveness. Currently, Functional Analytic Psychotherapy (FAP) lacks standardized assessments of treatment integrity and reliability, given its emphasis on client–therapist functional interaction. We propose utilizing assessments that integrate descriptions of functional units of analysis by clients (CRB’s) and therapist’s (therapeutic rules) behaviors in-session to obtain inter-observer agreement as a feasible alternative to evaluate FAP therapist’s adherence and the consistency of therapeutic achievements across research in diverse domains.

Educational Objectives:
1. Describe the current state of assessment in Functional Analytic Psychotherapy and its impact on research progress. 2. Present alternative methods to evaluate FAP effectiveness, validity, and reliability, in- and out-of-session. 3. Discuss the importance of integrating measurements, that account for FAP effects with fidelity and control confounding variables in the therapeutic interaction.

 

16. ACT in Medicine: Efficient Contextual Interventions that Target Diverse Medical Populations
Symposium (10:30am-Noon)
Components: Original data
Categories: Behavioral medicine, Clin. Interven. & Interests, Behavioral Medicine
Target Audience: Beg., Interm., Adv.
Location: Mercer/Denny

Chair: Joanna J. Arch, University of Colorado Boulder
Discussant: Kirk Strosahl, Ph.D., Mountainview Consulting

The vast majority of adults with mental health problems present in medical settings; additionally, many medical conditions put adults at risk for mental health problems. These twin facts create a remarkable need for mental health professionals with knowledge of medical populations. Fast-paced medical settings demand brief, resource-efficient interventions that target transdiagnostic principles of change to quickly facilitate improvement. This symposium highlights ACT’s potential to flexibly intervene with diverse medical populations using targeted, efficient interventions. We will present original data from five studies in diverse medical populations that employ ACT interventions ranging from one-day workshops to weekly groups. We will also reflect upon the lessons learned from deploying ACT in medical settings. Our collective work demonstrates the feasibility and preliminary efficacy of applying ACT to address the psychosocial needs of diverse medical populations.

• One-Day Acceptance and Commitment Training Workshops Targeting Distress in Medical Populations
Lilian Dindo, Ph.D., Baylor College of Medicine
James Marchman, Ph.D., University of Iowa
Jess Fiedorowicz, M.D., Ph.D., University of Iowa
Ana Recober, MD, University of Pennsylvania

Management of chronic medical illnesses can be challenging. The challenge is accentuated by comorbid depression or anxiety, which interfere with motivation and drive. ACT provides a unified model of behavior change and has shown promise in treating depression, anxiety, and chronic medical conditions. Aim: To evaluate the efficacy of a 1-day ACT intervention on depression and anxiety in different medical populations. Study 1: patients with vascular disease and comorbid depression or anxiety were assigned to 1-day ACT plus Illness Management (ACT-IM) or Treatment as Usual (TAU); Study 2: patients with comorbid depression and migraine were assigned to ACT-IM or TAU. Results: In both studies, patients in the ACT-IM condition showed significantly greater improvements in depression, anxiety, and functioning at the 3- month follow-up compared to patients in TAU. The benefits and challenges of, and lessons learned from, implementing 1-day ACT workshops in medical contexts will be discussed.

• Acceptance and Commitment Therapy for medical patients with co-occurring psychiatric conditions
Megan Oser, Ph.D., Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School
Gabe Gruner, LICSW, Department of Psychiatry, Brigham and Women’s Hospital
Vanessa Alvarez, M.A., Department of Psychology, Suffolk University

We conducted a pilot feasibility test of an Acceptance and Commitment Therapy (ACT) group for medical patients with psychiatric conditions (N = 32). We characterize the sample; evaluate pre to post changes, and discuss lessons learned from embedding ACT in this medical context. Treatment completers did not differ from non-completers (n = 11) on baseline anxiety screener (PHQ-4), quality of life (SF-8), experiential avoidance (Acceptance and Action Questionnaire-II), anxiety sensitivity (Anxiety Sensitivity Index), and distress tolerance (Distress Tolerance Scale). However, non-completers endorsed significantly higher pre-treatment depressive symptoms (p = .01). Although improvements in experiential avoidance and anxiety sensitivity were observed, only distress tolerance (p = .03) and mental health related QoL (p = .01) significantly improved during treatment. Limitations of statistical analyses for a heterogeneous sample, the incubation period of capturing improvements in ACT, and adaptations for patients with medical conditions will be discussed.

• Integrating the ACT Matrix into Post-Surgical Pain Management
Aliza Weinrib, Ph.D., Toronto General Hospital; Department of Psychology, York University, Toronto
Muhammad Abid Azam, M.Sc., Toronto General Hospital; Department of Psychology, York University, Toronto
Janice Montbriand, Ph.D., Toronto General Hospital; Department of Psychology, York University, Toronto
Hance Clarke, MD, Ph.D., Dept. of Anesthesia and Pain Management, Toronto General Hospital
Timothy Gordon, MSW, Private Practice
Joel Katz, Ph.D., Toronto General Hospital; Department of Psychology, York University, Toronto

The Transitional Pain Service at Toronto General Hospital is a novel, multidisciplinary approach to managing pain after major surgery that incorporates an ACT Matrix protocol. The service provides acute pain care in-hospital for complex surgical patients and continued care for the 5-10% of patients who develop chronic post-surgical pain after hospital discharge. Early findings (N = 143) indicate that patients who participated in more than two sessions of the ACT intervention (n = 36) were able to reduce their opioid use after surgery more than patients who participated in less than two sessions (n = 32) or no sessions (n = 75). In addition, reductions in pain intensity for the 2+ session ACT group were associated with less depressive symptoms and reduced pain interference in daily activities; these correlations were not significant in patients who received less or no ACT treatment. Lessons learned from clinical implementation will be discussed.

• An Acceptance and Commitment Therapy Group Intervention for Cancer Survivors Experiencing Anxiety at Re-entry
Joanna J. Arch, Ph.D., University of Colorado Boulder, Department of Psychology and Neuroscience
Jill L. Mitchell, LCSW, Ph.D., Rocky Mountain Cancer Centers-Boulder; Tebo Family Medical Pavilion, Boulder, CO

Background: This paper will present data from a pilot study (n=42) investigating the preliminary feasibility and efficacy of an ACT group intervention for anxious adult cancer survivors. We will present “lessons learned” from this pilot study that we applied to our recently initiated randomized clinical trial (RCT) comparing ACT to usual care in community cancer care centers throughout Colorado (target n=100+). Methods: We assessed pilot study outcomes across a month-long multiple baseline period, mid-intervention, post-intervention, and 3-month follow-up. Results and Conclusions: Intent-to-treat, HLM analyses demonstrated robust improvement across all outcomes from the multiple baseline to Post, ps ≤ .05, ds = .21-.78, and FU, ps ≤ .01, ds = .37-1.00, with anxiety and depression symptoms showing the largest improvements. Change in cancer-related psychological flexibility predicted or nearly predicted subsequent change in 8 of 9 outcomes. Numerous “lessons learned” have facilitated a successful first year in the ongoing RCT.

Educational Objectives:
1. Describe adaptations of acceptance-based interventions for use with medical populations. 2. Use the broad range of psychological and health-related outcomes that acceptance-based interventions can impact. 3. Apply 'lessons learned' about implementing ACT interventions and research in diverse medical settings.

 

21. Receptivity to ACT as a Smoking Cessation Intervention for People with Mental Health Conditions
Symposium (2:45-4:15pm)
Components: Original data
Categories: Clinical Interventions and Interests, Smoking cessation
Target Audience: Beg., Interm., Adv.
Location: Vashon 1

Chair: Jaimee L. Heffner, Ph.D., Fred Hutchinson Cancer Research Center
Discussant: John Forsyth, University at Albany, State University of New York

People with mental health conditions have two to three times higher prevalence rates of cigarette smoking than people without these conditions, and quit rates are up to 50% lower. Standard treatment approaches for smoking cessation, based on US Clinical Practice Guidelines, do not address some of the unique barriers to quitting reported by smokers with mental health conditions, including fears about worsening mental health symptoms and smoking to “treat” symptoms of the disorder. ACT may be a better treatment model, helping smokers with mental health symptoms to quit through acceptance of these smoking triggers and identification of core values guiding quitting. As a step toward developing tailored ACT interventions for smokers with mental health conditions, the presenters in this symposium will provide evidence that smokers with posttraumatic stress symptoms (Dr. Kelly), social anxiety symptoms (Dr. Watson), and bipolar disorder (Dr. Heffner) respond favorably to ACT for smoking cessation.

• Receptivity of a Web-Delivered ACT Smoking Cessation Treatment for Smokers with Posttraumatic Stress Disorder Symptoms
Megan M. Kelly, Ph.D., Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; University of Massachusetts Medical School
Jaimee L. Heffner, Ph.D., Fred Hutchinson Cancer Research Center
Kristin E. Mull, M.S., Fred Hutchinson Cancer Research Center
Jonathan B. Bricker, Ph.D., Fred Hutchinson Cancer Research Center

An ACT smoking cessation treatment may be particularly helpful in addressing triggers related to stressful and traumatic life events, which are often substantial triggers for tobacco use. The present study evaluated the receptivity and engagement of a web-delivered ACT smoking cessation therapy by individuals who endorsed clinically significant posttraumatic stress disorders symptoms (measured on a 6-item abbreviated version of the PTSD checklist; n= 694) compared to those who endorsed fewer symptoms (n=622). Participants with clinically significant PTSD symptoms were less likely to login to the program (p=.002) than participants with fewer symptoms. However, participants with clinically significant PTSD symptoms were more satisfied with the program (p=.008) and felt like it was more useful for quitting (p=.042) than participants with fewer symptoms. Overall, people who endorse more clinically significant PTSD symptoms related to stressful life events appear to be more satisfied with a web-delivered ACT smoking cessation treatment.

• Smokers with Social Anxiety: Comparing Receptivity to Web-Delivered ACT vs CBT in the Large WebQuit Randomized Trial
Noreen L. Watson, Fred Hutchinson Cancer Research Center
Jaimee L. Heffner, Ph.D., Fred Hutchinson Cancer Research Center
Kristin E. Mull, M.S., Fred Hutchinson Cancer Research Center
Jonathan B. Bricker, Ph.D., Fred Hutchinson Cancer Research Center

Background: Smokers with social anxiety disorder (SAD) are less likely to quit smoking with standard treatments. ACT-based cessation programs might be better suited for these smokers, but no prior studies have tested this hypothesis. Methods: In a large general sample RCT (N = 2,637), we compared receptivity among smokers with SAD (n =796) randomized to an ACT (n=408) or a CBT (n=388) cessation website at 3-months post-randomization (91% follow-up). Results: Compared to those assigned to CBT, smokers with SAD assigned to ACT: (1) logged-in more often (M = 11 vs. 4 times; p <.0001), and (2) rated intervention exercises and the website as more useful (ps < .05). Conclusions: Socially anxious smokers were more engaged with and receptive to the ACT intervention. Since engagement predicts outcome, results show the potential value of ACT for socially anxious smokers. Implications for tailoring web-based interventions for this group will be discussed.

• “It’s Not as Much Willpower as It Is Embracing It and Letting It Go”: Qualitative Analysis of Response to an ACT Intervention for Smokers with Bipolar Disorder
Jaimee L. Heffner, Ph.D., Fred Hutchinson Cancer Research Center
Noreen L. Watson, Ph.D., Fred Hutchinson Cancer Research Center
Jennifer B. McClure, Ph.D., Group Health Research Institute
Robert M. Anthenelli, MD, University of California at San Diego
Sarah Hohl, M.P.H., Fred Hutchinson Cancer Research Center
Jonathan B. Bricker, Ph.D., Fred Hutchinson Cancer Research Center

Background: We previously pilot tested the first ACT smoking cessation intervention for smokers with bipolar disorder, delivered in combination with nicotine replacement therapy, and found promising end-of-treatment quit rates: 40% for face-to-face counseling and 33% for telephone counseling. To follow up on these preliminary findings, we qualitatively assessed participants’ receptivity to the intervention and how they implemented ACT skills in the quitting process. Method: We conducted semi-structured interviews with 10 participants who completed the ACT treatment. Two coders applied descriptive coding and an inductive content analysis approach to interviews. Results: Participants generally perceived ACT to have been helpful in their quitting process, as themes consistent with acceptance, defusion, present moment, self-as-context, values and committed action emerged from the interviews. Conclusions: The intervention was well-received by participants, and it helped them implement the core ACT change processes. Potential methods of refining the intervention based on participant feedback will be explored.

Educational Objectives:
1. Demonstrate knowledge of the acceptability of a web-based Acceptance and Commitment Therapy Smoking Cessation Treatment for Individuals with Posttraumatic Stress Disorde symptoms. 2. Describe why ACT-based interventions may be well-suited for smokers with SAD and identify at least one possible intervention target for smokers withSAD. 3. Describe how smokers with bipolar disorder implement ACT processes as part of a targeted treatment for smoking cessation.

 

23. Beyond the couch: Functional contextual applications for community mental health and behavior change
Symposium (2:45-4:15pm)
Components: Original data, Didactic presentation
Categories: Prevention and Community-Based Interventions, Clin. Interven. & Interests, HIV, Stigma, Refugees, Mindfulness, IPA
Target Audience: Beg., Interm.
Location: St. Helens

Chair: Daniel S. Steinberg, M.A., University of North Texas
Discussant: Anthony Biglan, Ph.D., Oregon Research Institute

Community public health is increasingly becoming an area of focus for psychologists. Rather than being concerned exclusively with the care of the individual, psychologists in the 21st century might work to assist communities to facilitate community decision-making and to assess the well-being of community members (Biglan and Smolkowski, 2002). To this end, psychological studies have been examining community issues, with a focus on community-wide issues and integration of interventions at the community-level. Three papers will be presented, each with qualitative data addressing a relevant community-level issue. The first is a study on stigma in younger men with HIV in an area with an active PrEP program, the second examines the physical and mental health benefits of community gardening in a refugee population, and the third explores mindfulness in public health interventions broadly, with a specific example of using mindfulness to increase antiretroviral adherence in adolescents living with HIV.

• The Changing Context of Stigma for Gay Men Living with HIV: Preliminary Findings
Matthew D. Skinta, Ph.D., ABPP, Palo Alto University
Benjamin Brandrett, University of California
Erin Margolis, Palo Alto University

Stigma has been a target of great importance in the field of HIV treatment and prevention, as it creates barriers to testing, regular medical contact, and adherence to anti-retroviral therapy regimens. Historically, stigma, shame, and fear of seroconversion have also created a de facto divide within sexual minority mens’ communities. This presentation will focus on ongoing data collection exploring the experience of young gay men (<40 years old) living with HIV in an urban area that has had one of the longest roll-outs of pre-exposure prophylaxis. Utilizing interpretive phenomenological analysis (IPA), a qualitative method that emphasizes the experience and behaviors of individuals grounded within a particular context, we will share preliminary themes in these men’s experiences. Discussion will also focus on the similarities between IPA and functional analysis in extrapolating important areas to consider in clinical and public health work.

• “As the seeds grow, so our minds grow too”: Mindfulness and cultural connections in community gardening among Bhutanese refugees
Monica M. Gerber, M.S., University of North Texas
Danielle N. Moyer, M.S., University of North Texas
Jennifer L. Callahan, Ph.D., ABPP, University of North Texas

Since 2008, almost 85,000 Nepali Bhutanese refugees have been resettled in the United States (Refugee Processing Center, 2015). Many refugees struggle to adapt to new lifestyles, economy, language, and social structures (APA, 2010; Pumariega, 2005). Unfortunately, mental health providers, typically operating from a Western perspective, have found it difficult to address the needs of this population (APA, 2010). In response to this challenge, refugee resettlement agencies throughout the country use community gardens to promote psychological healing, self-sufficiency, community engagement, and a return of human dignity. Nepali Bhutanese culture, typically communal in nature, strongly emphasizes the present moment and family functionality over individual experience (APA, 2010; Dutton, 2011). This paper will present data from an exploratory mixed methods study on community garden among Bhutanese refugees. Quantitative results will be briefly discussed, while qualitative themes of mindfulness and connection to cultural roots will be provided in depth.

• Integrating mindfulness based approaches to public health interventions: Looking at the methodological and practical issues
Stephanie V. Caldas, M.S., Johns Hopkins Bloomberg School of Public Health
Julie A. Denison, MHA, Ph.D., Johns Hopkins Bloomberg School of Public Health

Mindfulness-based strategies have gained popularity in the last few decades in clinical settings, and research has generated a rigorous body of empirical evidence to support its effectiveness at the individual level. This research shows the potential impact of mindfulness-based interventions on multiple health and behavioral outcomes in different settings, including schools and the community (Smout et al., 2008). However, there is a dearth of research that investigates the integration of mindfulness-based techniques as part of larger public health interventions. Research is needed to address the particular methodological and practical issues involved in the implementation of clinically developed techniques by community health workers. This paper will use a case of increasing ART adherence in adolescents living with HIV as a framework to discuss and understand these issues. Particularly, the challenges of interdisciplinary collaboration between clinical psychology and public health will be discussed.

Educational Objectives:
1. Analyze the impact of community context on HIV-related health and wellness. 2. Describe the facilitators and challenges of integrating mindfulness into community based public health interventions. 3. Describe observed benefits of community gardening in a refugee population, while highlighting the importance of community consultation and flexibility in program development and research with diverse populations.

 

25. Examining the Intersections: Stigma, Culture, and Minority Status from a Contextual Behavioral Science Perspective: Diversity Committee Sponsored
Symposium (2:45-4:15pm)
Components: Conceptual analysis, Literature review, Original data, Didactic presentation
Categories: Functional contextual approaches in related disciplines, Clin. Interven. & Interests, Prevention & Comm.-Based, Superv., Train. & Dissem., Prof. Dev., Theory & Philo., Psychological flexibility, Minority Stress Theory, HIV/AIDS, ACT, Sexual Minority Women, Immigrants
Target Audience: Beg., Interm.
Location: Cascade 1B

Chair: Kayla N. Sargent, M.A., Georgia State University
Discussant: Khashayar F. Langroudi, M.A., ASPP at Argosy San Francisco

Minority group members experience psychological distress and diagnostic disorders at disproportionately high levels relative to the general population (Syymanski & Stewart, 2010). Minority statuses themselves reflect social categories that are applied to groups of people based upon social differences such as sex, race, ethnicity, health (e.g. HIV/AIDS status), religion, size, ability, sexual orientation, expression of gender, and immigrant status. It is theorized that minority status itself is an incomplete and indirect predictor of heath disparities (Meyer, 2003). Instead, psychological and health disparities observed in marginalized communities result from well-learned verbal and sociocultural processes (Masuda et al., 2012), impacting those with HIV positive (Gonzalez et al., 2009), sexual minority (Yadavia & Hayes, 2012), and diverse ethnic statuses (Pascoe & Richman, 2009). This symposium seeks to highlight research that examines the direct predictors of minority outcomes, such as self-concealment, acculturation, and social support as well as offer a contextual behavioral framework for influencing adaptive changes both within these communities and in their broader cultural contexts.

• Examining Psychological Flexibility and Minority Stress in Sexual Minority Women
Kayla N. Sargent, M.A., Georgia State University
Akihiko Masuda, Ph.D., Georgia State University

Sexual minority women have unique experiences relative to majority populations (Selvidge, Matthews, & Bridges, 2008), and they are traditionally understudied and underserviced in our scientific and social communities. According to Minority Stress Theory (Meyer, 1995; Meyer, 2003), holding minority identities leads to sociocultural contexts in which experiences of prejudice, internalized sexism and heterosexism, as well as self-concealment. Psychological flexibility models have been used as a framework for predicting and influencing these contexts. Our sample of female college students (n=1555) demonstrates that self-reported lesbian or bisexual minority status (p < .001), but not ethnic minority status (p = .993), psychological distress (p < .001), and self-concealment (p < .001) predicted higher levels of psychological inflexibility, whereas mindfulness predicted less inflexibility (r2 = .51, p < .001). Application of these findings within a psychological flexibility framework will be discussed.

• The Perceived Social Support and Immigrants’ Acculturation Dynamics: The Impact of Support from Ethnic vs. the Wider Community
George Gharibian, Ph.D., Institute for Multicultural Counseling and Education Services

Factors impacting Immigrants’ acculturation dynamics and in turn the stress related to poor acculturation have been explored and examined in numerous research studies. One of these factors includes the immigrants’ perceived social support in the host country. Social support can be perceived from either immigrants’ ethnic community or support from the wider community. However, there are very limited studies that explore the differences between these two types of social supports. This research examines the acculturation dynamics of a group of first generation immigrants in the US and their perceived social support either from one’s ethnic or the wider community. This study hypothesizes that the perceived social support from the wider community have a stronger impact on better acculturation than the perceived support from one’s ethnic community. A bi-dimensional acculturation theory is considered in this study in which four acculturation categories of integration, assimilation, separation, and marginalization are identified. Additionally, analyses are made on acculturation dynamics and factors such as cultural background, the age at the time of immigration, education, marital status, income, physical or mental health concerns. In conclusion, the results of the findings are discussed and recommendations have been made.

• Using ACT to address HIV Stigma and promote Collective Empowerment in Ethnoracial Communities
Kenneth Fung, MD, University of Toronto
Josephine Wong, Ph.D., University of Toronto

Ethnoracial minorities often face discrimination at an interpersonal level and systemic level. These challenges are compounded when they have HIV/AIDS, where homophobia, sexism, racism, and xenophobia lead to intersecting marginalization. We will report on The Community Champions HIV/AIDS Advocates Mobilization Project, a community-based research, which evaluated ACT and Social Justice Capacity Building (SJCB) to decrease HIV/AIDS stigma among People Living with HIV (PLHIV) and Community Leaders (CL) from ethnoracial communities. A total of 35 PLHIV and 31 CL completed the interventions. Pre, post, and 9-month post-intervention quantitative data indicated that HIV stigma was reduced. Our qualitative data showed that experiential activities enhanced stigma reduction and collective empowerment by increasing their understanding of unique and common experiences of marginalization; promoting empathy and compassion for self and others; and inspiring hope and commitment for change. Finally, we will report on the project’s impact, including spin-off participant-driven initiatives and related research studies.

Educational Objectives:
1. Examine a framework for predicting and influencing minority stress related outcomes (e.g., stigma, self-concealment) in sexual minority women. 2. Describe the use of ACT related strategies to address HIV/AIDS stigma and promote collective empowerment in ethnoracial communities. 3. Describe the impact of the perceived social support of one's ethnic community in compared to the wider community on the acculturation dynamics of first generation US immigrants.

 

27. How to implement case study in the era of evidence-based practice in psychology (EBPP): Some new methods of measuring, graphing, and analyzing: Japan Chapter Sponsored
Symposium (2:45-4:15pm)
Components: Original data, Case presentation
Categories: Clinical Interventions and Interests, Superv., Train. & Dissem., Prof. Dev., EBPP
Target Audience: Beg.
Location: Elliott Bay

Chair: Takashi Muto, Ph.D., Doshisha University
Discussant: Steven C. Hayes, Ph.D., University of Nevada, Reno

As you know, evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. And the purpose of EBPP is to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention (APA, 2006). The purpose of this symposium is to promote implementation of evidence-based psychological PRACTICES in ACBS, through showing some new contrivance of measuring, graphing, and analyzing OUR real therapy-processes. This symposium has three parts as below: 1) Measuring the therapy processes with HIGH-TECH and LOW-COST devices, for example, a small-and-easy-operating activity meter, GPS logger, and action-camera, 2) making graph of your data, in particular, making CUMULATIVE graph, and 3) analyzing and evaluating your single-case data with STATISTICAL tools. Moreover, Dr. Steven Hayes will discuss the above JAPAN-WAY.

• Measuring clients' daily behavior with some high-tech devices
Kohei Hashimoto, B.A., Doshisha University

True behavioral therapists are eager to collect data on client’s BEHAVIOR in order to conduct precise pre-treatment assessments and evaluate the running treatment. We introduce three high-tech devices which enable many therapists to measure client’s behavior. (1) Active Pro HJA-750c (Omron Corporation) is a triaxial accelerometer which can measure various kinds of physical activity data. Firstly, we’ll explain what does physical activity means. Next we’ll show how to use this device and what we can measure with this device. (2) Super Trackstick (Telespial Systems) is a GPS logger: We can grasp client’s range of lives. We’ll show how to use this device and visualize the client’s real data. (3) Kodak PIXPRO SP360 (Eastman Kodak Company) is a potable camera which can be used as session recorder. We’ll propose that this recorder be the less stimulative device. We’ll show the real image and explain how to process the movie.

• Why do we make cumulative-graph of clients’ longitudinal data?
Asako Sakano, M.A., Doshisha University

The modern clinician is accountable for an improvement of clients to various people. As its method, we suggest creating and showing cumulative-graph of clients’ longitudinal data. Our presentation contains the following four topics. (1) What is the cumulative record?; we will briefly explain about its definition, required element, and history. (2) How to make a cumulative record; we will show the procedure of creating it using client’s real data of physical activity. (3) Strengths of the cumulative record; we will explain that the cumulative record make it easy for many people to capture the change of clients over time visually and intuitively. In this topic, we will compare a line graph of measured values and that of accumulated value. (4) Application of the cumulative record; we will show a new kind of cumulative record which includes an element of behavioral variation using client’s real data of valued action.

• Statistical analysis of single-case data: Useful tools for clinical activities
Naoki Manpuku, B.A., Doshisha University

Compared to group-designs, it’s likely that you are less familiar with statistical methods for single-case designs. This works as barrier to analyzing outcomes of your clinical activities. However, a lot of statistical analysis for single-case designs is proposed and we can use them more easily. We suggest how to use these statistical tools and what kinds of data are appropriate to make use of them. Our presentation consists of three following topics. (1) How to analyze client’s responses from questionnaire; this is commonly used in clinical settings and we will introduce a statistical method for it. (2) Examining cumulative records; this makes it easy to understand the change of clients over time and we will explain about a statistical tool of cumulative data. (3) Introducing a new index; statistical analysis for practical settings is developed and we will show a recent index of single-case research.

Educational Objectives:
1. Measure the date of therapy-process in clinical setting. 2. Design the cumulative graph of your data of therapy-process in clinical setting. 3. Evaluate your data of therapy-process in clinical setting with statistical analysis.

 

28. Expanding the reach of contextual behavioral science to older adult populations: Washington Chapter Sponsored
Symposium (2:45-4:15pm)
Components: Conceptual analysis, Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Beh. med., Older adults, gerontology
Target Audience: Beg., Interm.
Location: Puget Sound

Chair: Susan M. McCurry, Ph.D., University of Washington, School of Nursing, Seattle, WA
Discussant: Helen Bolderston, Ph.D., Bournemouth University, Bournemouth, Dorset, England

Globally, the number of individuals 60 years and older is expected to more than double by 2050. The U.N. International Plan of Action on Ageing (MIPAA) focuses on three priority areas: older persons and development; advancing health and well-being into old age; and ensuring enabling and supportive environments. This symposium presents three culturally diverse lines of research relevant to these priority areas and the contextual behavioral science community. Dr. Gillanders from the United Kingdom examines the relationship between psychological flexibility and the gerontological theory of Selection, Optimisation, and Compensation. Dr. McGowan presents data on an ACT-informed variation of CBT for insomnia that has been piloted with U.S. veterans with a variety of medical morbidities. Ms. Souza presents data from a Seattle-based participatory research study examining contextual challenges identifying and serving homeless older adults with cognitive impairment. Combined, the papers illustrate the complexity of serving this diverse and growing clinical population.

• Psychological flexibility in an aging population: Exploring the impact of age on psychological flexibility, the use of selection, optimisation and compensation strategies, and their relationship with living well
Dr. Victoria Thomson, Mental Health Older Adult Service, NHS Borders, Melburn Lodge, Borders General Hospital, Melrose, UK
Dr. Paul Graham Morris, Clinical Psychology, School of Health in Social Science, University of Edinburgh
Dr. April Quigley, Mental Health Older Adult Service, NHS Borders, Melburn Lodge, Borders General Hospital, Melrose, UK
Dr. David Gillanders, Clinical Psychology, School of Health in Social Science, University of Edinburgh

Background: Gerontological theories have been useful in adapting second wave CBT for working with older people, yet there have been few investigations of the relationships between constructs of the psychological flexibility model, constructs from gerontology, such as the Selection, Optimisation and Compensation (SOC) model and indices of wellbeing in older people. Method: A community sample of 203 people, aged 55 to 98 years, completed measures of psychological flexibility, SOC, wellbeing and distress. Correlation, multiple regression, and conditional process modelling was used to analyse the data. Results: A range of theoretically predicted relationships support the potential of the ACT model in older people, and also suggest a coherent integration between psychological flexibility and selection optimisation compensation theory. Discussion: Change and adaptation in older people can readily be conceptualised through a contextual behavioural science approach in ways that support and enhance current gerontological theory, leading to more developmentally targeted treatment strategies.

• Acceptance and the behavioral changes to treat Insomnia (ABC-I): A novel approach to treating insomnia among older adults
Sarah Kate McGowan, Ph.D., VA Greater Los Angeles Healthcare System
Lavinia Fiorentino, Ph.D., Moores Cancer Center, University of California-San Diego, San Diego, CA, USA
Najwa Culver, Ph.D., VA Greater Los Angeles Healthcare System
Morgan Kay, Ph.D., VA Greater Los Angeles Healthcare System
Jennifer L. Martin, Ph.D., VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, UCLA

Insomnia is a common and often severe problem, especially among individuals with complex medical and psychiatric conditions. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment; however, adherence to treatment recommendations is challenging, particularly among those with comorbidities. Interventions that enhance adherence and retention in insomnia therapies are needed. Acceptance and the Behavioral Changes to Treat Insomnia (ABC-I) is a novel treatment that incorporates elements of Acceptance and Commitment Therapy (ACT; Values, Committed Action, Acceptance, Mindfulness, Cognitive Defusion, Self as Context) with the behavioral interventions of CBT-I (Sleep Education, Sleep Restriction, Stimulus Control). In two pilot trials of ABC-I with older Veterans, one among women Veterans (N=4; age M=56.4years) and the other among male Veteran s (N=3; age M=72.7years), participants demonstrated significant improvements from pre- to post-treatment in the therapeutic direction on sleep outcomes. These results suggest the need for further research examining ABC-I as an alternative to CBT-I in older adults with insomnia disorder.

• Creating nurturing environments for homeless older adults with cognitive impairment: An exploration of barriers and opportunities
Anita Souza, Ph.D., University of Washington, School of Nursing, Seattle, WA, USA
Susan M. McCurry, Ph.D., University of Washington, School of Nursing, Seattle, WA, USA
Francesca Martin, Ph.D., Compass Housing Alliance, Seattle, WA
Robert M. Bowery, M.A., Compass Housing Alliance, Seattle, WA

Background: The number of older adults with cognitive impairment experiencing homelessness is rapidly increasing in urban communities. Creating environments attuned to both past influences and present needs of these individuals is complex for housing providers, social service agencies, and health professionals. Method: A community-based participatory process was utilized to develop and validate a semi-structured interview conducted with 10 homeless service providers in Seattle, WA. Points of service included shelters, transitional housing units, hygiene centers, and day programs. Interviews were recorded, coded, and analyzed for thematic content utilizing Dedoose. Results: The paper will present data on variables identified by service providers that influence organizational capacity to create a nurturing environment that supports the wellbeing of this population. Discussion: Creating nurturing environments for older homeless adults with cognitive impairment begins with cultural change amongst service providers and health care professionals. Functional contextualism provides a framework to begin examining and addressing these challenges.

Educational Objectives:
1. Assess how ACT can be integrated with Gerontological theory in theoretically coherent and clinically practical ways. 2. Assess the components of ABC-I and its application with older individuals. 3. Describe the challenges of developing nurturing environments for older homeless adults with cognitive impairment.

 

33. Exploring Psychological Flexibility Repertoires with the Implicit Relational Assessment Procedure
Symposium (4:30-5:45pm)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Theory & Philo., IRAP
Target Audience: Beg., Interm., Adv.
Location: Vashon 1

Chair: Travis Sain, Southern Illinois University
Discussant: Dermot Barnes-Holmes, Ghent University, Belgium

Acceptance and Commitment Therapy (ACT) and the Implicit Relational Assessment Procedure (IRAP) bear conceptual roots in the same theory of human cognition and behavior – Relational Frame Theory (RFT). In spite of this commonality, conceptual and empirical works specific to each currently have little in common. This symposium contains a collection of studies that may be viewed in one of at least two ways – as studies of ACT components involving measurement of relational repertoires, or as IRAP studies exploring possible avenues into clinically relevant behavior. These studies examine idiographic, “orthogonal”, and otherwise unconventional approaches to IRAP stimulus selection, and also use the IRAP both as an independent variable as well as a measure of dependent variables. We offer this symposium in the hopes of refining our future research, promoting research innovations and activities in other labs, and sparking debate about the reticulated model of contextual behavioral science.

• Me-Flexible, Me-Not-So-Flexible: A Preliminary Investigation of a Psychological Flexibility IRAP
Ryan Kimball, Southern Illinois University
Anke Lehnert, M.A., Southern Illinois University
Chad E. Drake, Ph.D., Southern Illinois University

Recent research has demonstrated the potential to measure experiential avoidance using the IRAP (Hooper, Villatte, Neofotistou, & McHugh, 2010; Drake, Timko, & Luoma, under review). The current study was designed to address some methodological limitations of existing studies, to broaden the scope beyond experiential avoidance, and to explore innovations in IRAP stimulus selection. 106 college students initially completed questionnaires designed to acquire specific information regarding their personal values and coping strategies which would serve as the IRAP stimuli. This idiographic approach was hypothesized to improve IRAP psychometrics for reliability and validity. Results revealed a combination of flexible and inflexible biases, as well as some support for convergent validity with self-reports, including a replication of counter-intuitive effects reported by Drake, et al. (under review). Future work in this area may benefit from further refinements of methodology as well as careful consideration of the expected relationship between psychological flexibility and IRAP performance.

• Get Out of Your Mind and Into the IRAP: Testing the Effectiveness of the IRAP as a Defusion Intervention
Travis Sain, M.A., Southern Illinois University
Samuel Kramer, M.A., Southern Illinois University
Chad E. Drake, Ph.D., Southern Illinois University

Previous research with the Implicit Relational Assessment Procedure (IRAP) has demonstrated the IRAP’s sensitivity to changes in psychological distress produced by defusion exercises (e.g., Kishita, Muto, Ohtsuki, & Barnes-Holmes, 2014). No known study has examined the IRAP’s potential as a defusion intervention itself, which could generate a program of research on the effectiveness of defusion activities, similar to that of Masuda, Hayes, Sackett, and Twohig (2004) with the Milk exercise. Two experiments utilized the IRAP as a defusion assessment instrument and intervention by altering IRAP stimuli, with the first assessing biases toward Abraham Lincoln and Adolf Hitler (N = 120), and the second assessing biases toward known individuals selected idiographically by participants (N = 150). Results revealed tentative evidence for changes from pre to post-assessment, and a number of possible confounds may provide suggestions for future studies with this paradigm while raising conceptual issues about the nature of the IRAP.

• Not all Trial-Types Are Created Equal: Investigating an Orthogonal Approach to Stimulus Arrangement with a Racial Attitudes Implicit Relational Assessment Procedure
Kail Seymour, M.S., BCBA, Southern Illinois University
Travis Sain, M.A., Southern Illinois University
Chad E. Drake, Ph.D., Southern Illinois University

The Implicit Relational Assessment Procedure (IRAP) proved useful for investigating implicit attitudes, including those for racial evaluations (Barnes-Holmes, Murphy, Barnes-Holmes, & Stewart, 2010; Drake et al., 2015). Many IRAP stimulus presentation permutations remain unexamined, including some potentially relevant to social and/or clinical concerns. In this study, racial categories (i.e., Black people; White people) and evaluative words (e.g., smart, stupid) were paired using standard IRAP (SIRAP), as well as an “orthogonal” (OIRAP), configurations. While both contained “White people-positive evaluation” and “Black people-negative evaluation” trials, the OIRAP presented previously unexplored trial-types: “Black people-White people” and “positive evaluation-negative evaluation”. . Self-report measures were also administered. Psychology research pool participants (n = 158) were quasi-randomly assigned to one of four condition orders. The SIRAP primed stereotypical race attitudes in subsequent OIRAP trials; bias decreased in SIRAP trials following OIRAP trials. These differences and other findings will be discussed along with future potential research directions.

Educational Objectives:
1. Describe the counter-intuitive results revealed for validity in this study. 2. Describe the IRAP stimulus selection strategy embraced for the defusion conditions in these studies. 3. Describe the four trial-types of an orthogonal IRAP containing stimuli for racial categories and evaluative words.

 

39. Challenges in the application of ACT in clinical psychiatric settings: Empirical data and clinical experiences: Psychosis SIG Sponsored
Symposium (4:30-5:45pm)
Components: Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Superv., Train. & Dissem., Psychosis, body dysmorphic disorder, autism
Target Audience: Beg.
Location: Puget Sound

Chair: Andreas Larsson, Ph.D., Karolinska Institutet, Department of Clinical Neuroscience & Centre for Psychiatry Research and Education
Discussant: Roger Vilardaga, Ph.D., University of Washington

Conducting research in clinical psychiatric settings presents significant challenges. Patients’ suffering is often severe, and organizational aspects might hinder the implementation of structured psychological treatment. In this symposium, empirical data are presented from three different projects concerning ACT for different diagnoses – psychosis, body dysmorphic disorder (BDD) and high functioning autism spectrum disorder (ASD). The first talk concerns training inpatient ward staff in using the ACT model with psychosis patients. Data suggest slight positive changes in psychological flexibility for patients and staff. The second talk describes the evaluation of an ACT group treatment intervention for BDD outpatients, with results showing significant reductions in BDD symptomatology. The third talk covers a research project on ACT adapted for students and psychiatric outpatients with ASD, where data indicate reduced levels of stress and autistic core symptoms. Presenters will share their data, as well as common clinical experiences of implementing ACT in clinical psychiatric contexts.

• Implementation of ACT training in a psychiatric ward: Clinical experiences and staff-patient outcomes
Mårten Tyrberg, M.Sc., Ph.D. student, Stockholm University; Västmanlands Hospital, Västerås, Sweden
Per Carlbring, Department of Psychology, Stockholm University
Tobias Lundgren, Ph.D., Karolinska Institutet and Department of Psychology, Stockholm University

Psychiatric ward staff members report low job satisfaction, and suffer from burnout to a higher degree compared to other fields. Furthermore, reports from both patients and staff indicate institutional aimlessness and lack of care content beyond medication and containment. Attempts at implementing various psychosocial interventions based on cognitive behavior therapy (CBT) have shown promise, but little systematic outcome data has been presented. This pilot study investigated the feasibility and effects of a 12-hour training in acceptance and commitment therapy (ACT), a CBT based psychotherapy model, on staff (n=20) and patients (n=9). The context was a psychiatric inpatient ward specializing in psychosis. The staff members of a neighboring unit acted as non-randomized controls. Mean difference scores suggest slight positive changes in psychological flexibility for patients and staff post-intervention. Results are discussed in light of methodological and institutional limitations, and clinical experiences.

• Acceptance and commitment therapy (ACT) and high-functioning autism spectrum disorder (ASD): A functional contextual approach to conceptualize and treat associated symptoms
Johan Pahnke, M.Sc., Ph.D. student, Karolinska Institutet, Department of Clinical Neuroscience & Centre for Psychiatry Research and Education
Johan Bjureberg, M.Sc., CPF, Karolinska Institutet
Timo Hursti, Department of Psychology, Uppsala University
Sven Bölte, KIND (Center for Neurodevelopment Disorders at Karolinska Institutet), Stockholm City Council
Tatja Hirvikoski, Ph.D., KIND (Center for Neurodevelopment Disorders at Karolinska Institutet), Stockholm City Council
Benjamin Bohman, Ph.D., Karolinska Institutet, Dept. of Clinical Neuroscience & Centre for Psychiatry Research and Education
Gerhard Andersson, Linköping University and Karolinska Institutet
Tobias Lundgren, Ph.D., Karolinska Institutet, Dept.of Clinical Neuroscience & Centre for Psychiatry Research and Education

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 an adapted ACT-protocol 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 ACT 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 ACT 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. Discuss ways of handling organizational challenges in implementation of psychological treatments. 2. Describe common obstacles in conducting clinical research in psychiatric settings. 3. Compare different diagnostic groups and identify similarities in treatment interventions.

 

Friday, June 17

45. Helping the helpers: ACT interventions for healthcare providers
Symposium (10:30am-Noon)
Components: Original data
Categories: Behavioral medicine, Org. Beh. Management, Workplace interventions
Target Audience: Beg.
Location: Vashon 1

Chair: Dayna Lee-Baggley, Ph.D., QEII Health Sciences Centre
Discussant: Patricia Robinson, Ph.D., Mountainview Consulting Group

Research shows that one third to half of North American and European physicians and nurses experience burnout (Canadian Medical Association, 2003; Hildebrandt, 2013; Medscape, 2016; Solar et al., 2008). In fact, US physicians suffer more burnout than any other American workers (Shanafelt et al., 2012). Despite these rates, physicians and nurses are often the less likely to seek help (e.g., Rosvold & Bjertness, 2002). Acceptance and mindfulness based workplace interventions have been shown to improve employees’ well-being and to decrease burnout (e.g., Lloyd, Bond, & Flaxman, 2013). This symposium highlights interventions based on Acceptance and Commitment Therapy (ACT) being offered to healthcare providers. Presenters will provide information on the nature of their programs, adaptations from other workplace interventions needed for a healthcare setting, and data on effectiveness. As an international expert in ACT in primary care settings, our discussant, Patricia Robinson, will discuss bringing ACT to a population in need of interventions yet often reluctant to seek personal help.

• Professional Resiliency Program for Healthcare Providers
Dayna Lee-Baggley, Ph.D., QEII Health Sciences Centre
Jill Chorney, Ph.D., Dalhousie University

We will present data on an empirically supported workplace program designed to improve the health and well-being of healthcare providers. Our Professional Resiliency Training Program is adapted from an evidence-based workplace program based on Acceptance and Commitment Therapy (ACT), designed to increase employee well-being by learning skills to work with negative feelings, thoughts, and sensations and to move toward valued behaviours (Flaxman, Bond, Livheim, Hayes, 2013). Although the Professional Resiliency Training Program has been demonstrated to be effective across a number of different workplace environments (see Bond, Hayes & Barnes-Holmes, 2006), there is less evidence of its effectiveness in hospital settings. We provide preliminary pre and post data of healthcare providers from a tertiary level hospital in Canada drawn from a larger randomized clinical trial currently in progress. Adaptations to the program made for a healthcare setting will also be discussed.

• Spirited Primary Care: A Brief Intervention for Primary Care Providers
Melissa Baker, Ph.D., HealthPoint
Patricia Robinson, Ph.D., Mountainview Consulting Group

We will provide intervention materials for a 3-session class designed to be acceptable to primary care providers, particularly those that self-identify work stress as a significant problem. Data concerning acceptability and revisions to the curriculum will be provided. Additionally, data on the Primary Care Provider Stress Checklist and the Primary Care Provider Acceptance and Action Questionnaire (Robinson, Gould, Strosahl, 2011) will also be provided. We will also share recommendations about changes to the system of care that are likely to enhance provider resilience.

• Professional Resiliency Training for Pediatric Providers: A Pilot Program
Sarah T Trane, Ph.D., Gundersen Health System
Jennifer Kleven, MD, Gundersen Health System

We will discuss the implementation of a pilot program designed to address physician and nurse practitioner resilience in a large health system. Participants included outpatient primary care and hospital based pediatric specialty providers with a range of years in practice from 1-34 years. Preliminary data using the Maslach Burnout Inventory (MBI; Maslach & Jackson, 1981, Maslach et al. 1996) and the ProQOL (Stamm, 2009) will be presented on our baseline (n=24) and post-intervention samples, noting that practitioners were free to choose to participate voluntarily in the program. There were anywhere from 3-15 practitioners within each group, with modal number attending at about 10 participants. The provider resiliency training program was adapted from an evidence-based workplace program based on Acceptance and Commitment Therapy (ACT; Flaxman, Bond, Livheim & Hayes, 2013) as well as published resilience intervention used with physicians (West, 2012), and designed to increase well-being by learning skills in mindfulness, boundaries, self care and valued actions. The opportunities and challenges within a busy healthcare environment will be discussed as well as ideas to improve overall psychological flexibility of health care providers.

Educational Objectives:
1. Describe the content of ACT program for healthcare providers. 2. Describe adaptations needed in providing ACT to healthcare providers. 3. Review data on the effectiveness of ACT programs for healthcare providers.

 

46. Using Psychological Flexibility to Reach Across the Barriers of Prejudice: Examinations of Obesity, Race, and Sexual Orientation Stigma
Symposium (10:30am-Noon)
Components: Original data
Categories: Clinical Interventions and Interests, ACT, psychological flexibility, stigma, obesity, sexual orientation, gender identity
Target Audience: Beg., Interm., Adv.
Location: Vashon 2

Chair: Regan M. Slater, Ph.D., Pittsburg State University
Discussant: Matthew Skinta, Ph.D., ABPP, Palo Alto University

The effects of stigma can be detrimental, not only to the person who is stigmatized, but also to the person holding the stigmatizing beliefs as it can prevent connection and understanding among people (Byrne, 2001; Masuda, Price, Anderson, Schmertz, & Calamaras, 2013). Psychological flexibility has been examined in relation to stigma in several areas including psychological disorders (Masuda et al., 2007), substance abuse counseling (Hayes et al., 2004), and obesity (Lillis, Hayes, Bunting, & Masuda, 2009). The data-based papers presented in this symposium offer an examination of the impact of psychological flexibility on stigma in three areas: obesity, race, and sexual orientation. This symposium addresses stigma from the perspective of the person being stigmatized, as well as from the stigmatizer. Implications for further application of psychological flexibility in these three areas will be discussed, and future directions in these and similar areas will be offered.

• When Thin Still Isn’t Good Enough: Residual Obesity Stigma and Psychological Flexibility
Emily R. Squyres, M.S., Louisiana Tech University
Lore M. Dickey, Louisiana Tech University

Given that the current ideal body shape is “thin,” it should not be surprising that overweight and obese individuals are stigmatized on a daily basis due to their weight (Puhl & Brownell, 2003). It seems like the only avenue that these individuals have in order to gain public approval is to lose weight. However, research has shown that obesity stigma extends to previously obese individuals who have lost weight and are now considered to be “thin” (Latner, Ebneter, & O’Brien, 2012). In the current study, participants read one of several vignettes about an individual who either: a) had a history of being thin and was currently thin, b) had a history of being obese and was currently thin, c) had a history of being obese and was currently obese, or d) had a history of being obese and was currently very thin. The relationship between residual obesity stigma across various body weights and psychological flexibility will be discussed.

• No Spice, No Rice: Developing a Measure of Sexual Racism
Yash Bhambhani, M.A., University of Mississippi
Maureen K. Flynn, Ph.D., Metropolitan State University of Denver
Kelly G. Wilson, Ph.D., University of Mississippi
Kate Kellum, Ph.D., University of Mississippi

Research on sexual racism is proliferating (Callander, Newman, & Holt, 2015; Han et al., 2015; Rudder, 2009). Researchers have found acceptability of online sexual racism to be linked to a lower multicultural attitude (Callander et al., 2015), and experiencing sexual racism to predict risky sexual behavior (Han et al., 2015). Researchers have studied sexual racism only qualitatively or with a few unstandardized questions. The aim of the present study was to develop a quantitative measure of sexual racism and evaluates its factor structure, reliability and validity. Relationship of sexual racism with psychological flexibility and other constructs were explored. The constructed scale can be useful in both clinical cases, and research contexts that aim to reduce racist attitudes.

• Psychological flexibility as a moderator between Hispanic undergraduates’ attitudes towards LGBTQ individuals and willingness to engage in behaviors that help the LGBTQ community
Maureen K. Flynn, Ph.D., Metropolitan State University of Denver

Although acceptance of LGBTQ individuals is increasing, they continue to experience negative responses from society. LGBTQ individuals can internalize such negative responses, which can lead to psychological difficulties (e.g., Meyer & Dean, 1998; Szymanski, Kashubeck-West, & Meyer, 2008). Interventions targeting psychological flexibility have been shown to decrease stigmatizing attitudes towards substance abusers (Hayes et al., 2004) and people with mental illness (Masuda et al., 2007). Psychological inflexibility is also related to attitudes towards other ethnicities (Levin, Luoma, Lillis, Hayes, & Vilardaga, 2014). The aims of this study were to examine 1) the relationship between psychological flexibility and homophobia and transphobia and 2) whether psychological flexibility moderates the relationship between negative attitudes towards LGBTQ individuals and willingness to engage in behaviors that help the LGBTQ community among Hispanic college students. In the current study, 237 Hispanic undergraduates completed a series of web-based surveys. Results and implications will be discussed.

Educational Objectives:
1. Explore and assess psychological flexibility and residual obesity stigma from the perspective of the stigmatizer. 2. Discuss why studying sexual racism is important and brainstorm strategies/interventions to reduce sexual racism. 3. Discuss and assess whether psychological flexibility is 1) related to homophobia and transphobia and 2) moderates the relationship between negative attitudes towards LGBTQ individuals and willingness to engage in behaviors that help the LGBTQ community.

 

49. Meta-Analysis in Contextual Behavior Science: A Symposium of Synthesis
Symposium (10:30am-Noon)
Components: Conceptual analysis, Literature review
Categories: Clinical Interventions and Interests, Other, Meta-Analysis
Target Audience: Beg., Interm., Adv.
Location: Cascade 1B

Chair: Fredrick Chin, M.A., University of Nevada, Reno
Discussant: Michael E. Levin, Ph.D., Utah State University

Meta-Analysis is a statistical technique used to combine data from several research studies to provide a quantitative review of the literature in a particular field. Meta-analyses use a common metric, or effect size, from several studies to tell a coherent story about the research studies analyzed. The resulting aggregate review provides a broad overview of the research findings within a given field, and play a pivotal role in establishing the overall efficacy of psychotherapy treatments. Though several meta-analyses have evaluated the application of contextual behavioral therapeutic approaches across broad domains (e.g. A-Tjak et al., 2015; Hayes, Luoma, Bond, Masuda, & Lillis, 2006), it is worthwhile to evaluate outcomes within a given functional problem with greater precision and depth. The current symposium plans to provide an in depth analysis of specific, novel areas in contextual behavior science. The topics reviewed will be Acceptance Commitment Therapy for substance use disorders, acceptance/ mindfulness for Type 2 Diabetes, and Functional Analytic Psychotherapy single-subject research.

• An Initial Meta-analysis of ACT for Substance Use Disorders
Eric Lee, M.A., Utah State University
WooLee An, Utah State University

In the past decade, multiple studies have examined the effectiveness of Acceptance and Commitment Therapy (ACT) for substance use disorders relative to other active treatments. The current meta-analysis examined the aggregate effect size when comparing ACT to other treatments (e.g., CBT, pharmacotherapy, 12-step, treatment as usual) specifically on substance use outcomes. A total of 10 randomized controlled trials were identified through systematic searches. A significant small to medium effect size was found favoring ACT relative to active treatment comparisons following treatment. Effect sizes were comparable across studies for smoking cessation (k = 5) and for other drug use disorders (k = 5). Based on these findings, ACT appears to be a promising intervention for substance use disorders. The current state and future directions of ACT for substance use disorders will be discussed.

• Mindfulness and Acceptance for Type 2 Diabetes: A Meta-Analysis
Leah Bogusch, M.A., Bowling Green State University
William H. O'Brien, Ph.D., Bowling Green State University

Among individuals with Type 2 Diabetes Mellitus (T2DM), diabetes-related distress is associated with decreased medication adherence and increases in blood glucose. Mindfulness and acceptance may be associated with reductions in diabetes-related distress and improved health outcomes in this population. The present study provides a quantitative review of 1) all studies utilizing mindfulness or acceptance interventions among individuals with T2DM in order to improve HbA1c, blood glucose, or self-management of blood glucose and 2) all cross-sectional studies examining relationships between mindfulness and acceptance, diabetes-related distress, and HbA1C, blood glucose, or self-management of blood glucose among people with T2DM. A literature search yielded 10 treatment-outcome and 14 cross-sectional studies. Meta-analytic results of mindfulness and acceptance-based interventions revealed a small, but reliable, impact on improving HbA1c and fasting blood glucose in comparison to control groups (d = .1822, CIbootstrap: -0.3364 to -0.0325).

• A Meta-Analytic Review of Functional Analytic Psychotherapy Single-Subject Research
Sonia Singh, M.A., Bowling Green State University
William H. O'Brien, Bowling Green State University

Functional Analytic Psychotherapy (FAP) is a contextual behavior therapy that utilizes basic behavioral principles to implement in-session change with the idea that these changes will generalize to outside-of-session settings. The therapist uses specific techniques designed to reduce problematic in-session behavior (CRB1s) and increase adaptive in-session behavior (CRB2s). A majority of the published studies in FAP are single-subject design. The current study synthesized data from FAP single-subject investigations using single-subject meta-analytic techniques. Percentage of non-overlapping data (PND) was calculated for graphed outcome data. The reliable change index (RCI) was calculated for questionnaire outcome data. Results indicated that cumulative PND for CRB1s was 57.76% and fell in the “moderately effective” range, and for CRB2s was 81.06% and fell in the “fairly effective” range. The overall RCI for was 4.03 which indicates that pre-post changes on questionnaire outcome data are large and statistically reliable.

Educational Objectives:
1. Articulate the synthesis of Acceptance and Commitment Therapy treatment/outcome studies for substance use disorders. 2. Describe acceptance and mindfulness related constructs and interventions within the context of Type 2 diabetes. 3. Demonstrate the quantification of efficacy for Functional Analytic Psychotherapy single-subject design research studies.

 

51. Incorporating ACT-based Interventions into University Classrooms: University Student Mental Health SIG Sponsored
Symposium (10:30am-Noon)
Components: Conceptual analysis, Literature review, Original data
Categories: Educational settings, Prevention & Comm.-Based, Depression, Anxiety
Target Audience: Beg., Interm.
Location: Cascade 2

Chair: Wanda L. Smith, Ph.D., McMaster University, Private Practice
Discussant: Jaqueline Pistorello, Ph.D., University of Nevada, Reno

As college educators, we want our students to live rich and meaningful lives. We want to expand our Reach of the foundational life skills needed to live such lives. This symposium focuses on the use of well-designed ACT-based interventions in university classrooms to enhance the psychological flexibility of students. This symposium contributes by describing an introduction level course that uses ACT-based personal goal setting, evaluating a university course aimed at promoting student psychological flexibility and describes a the effects of a brief versus an extended ACT intervention in a university classroom. Collectively, we offer different perspectives and approaches for incorporating ACT-based interventions into university classrooms. This symposium addresses implications for educators as they implement interventions for improving psychological flexibility. The discussion will attempt to integrate findings and suggest future directions.

• How to Give ACT Away 1.5 million People at a Time
Cody Christopherson, Ph.D., Southern Oregon University

Approximately 1.5 million US students enroll in an introduction to psychology course every year (Cush, & Buskist, 1997) and introduction to psychology is the second most popular college course in the US (National Center for Education Statistics, 2004). Most student will start and end their formal contact with scientific psychology with this course. Therefore, this is the single greatest direct contact that Psychologists will ever have with the general public who do not seek therapy and a prime opportunity for introducing contextual behavioral science and ACT broadly. In this presentation, I will demonstrate an incorporation of ACT into the applied component of the Introduction to Psychology curriculum. Specific components of ACT include contact with the present moment, values identification/clarification, and committed action. ACT activities can be easily adapted & incorporated into units on Psychopathology, Psychotherapy, Motivation & Emotion, Industrial & Organizational Psychology, or Health Psychology.

• Using ACT as a Tool to Holistically Prepare College Students
Anna Whitehall, M.A., Washington State Unviersity
Denise Yost, Ph.D., Washington State University
Laura Hill, Ph.D., Washington State Unversity

College is a time and place to holistically prepare emerging adults to be successful contributors to society in both discipline and life skills. Human Development (HD) 205 is an undergraduate communication and life skills course that focuses on developing students’ abilities to foster successful personal and professional relationships using psychological flexibility and values-based decision-making. Over the course of six semesters, we measured psychological flexibility in over 1,800 HD205 students using the Acceptance and Action Questionnaire. Paired pre- and post-semester participation surveys show small increases in psychological flexibility with trivial to small effect sizes of 0.03 (p = .53) to 0.12 (p = .03) in three of six semesters. Semesters with decreased psychological flexibility scores coincided with significant changes in course delivery methods, likely accounting for some of the observed variability among semesters, an area for future research. In additional to within-semester changes, changes in psychological flexibility from beginning-to-end of semester predict higher GPA 3 years later.

• Comparison of brief versus extended Acceptance and Commitment Therapy exercises introduced in a university classroom
Sarah Kupferschmidt, M.A., McMaster University and Mohawk College
Heather Poole, Ph.D., McMaster University
Wanda L. Smith, Ph.D., McMaster University and Private Practice

University students are increasingly suffering from anxiety and stress (Twenge et al, 2010). ACT has been shown to decrease stress and anxiety even when presented as a brief intervention in groups (Zettle & Rains, 1989; Bach & Hayes, 2002). We compared the effects of ACT on university students when training exercises were infused into two university classrooms on different schedules; one class received the training over 10 sessions (distributed training), the other class had the exercises compressed into two sessions at the end of the term (massed training). Students were assessed on various stress and ACT-relevant measures on the first and last days of class. Over the course of the semester, test anxiety decreased in both groups and Five-Facet Mindfulness Questionnaire – Observing subscale scores increased. Perceived Stress increased in students receiving massed ACT training, but remained stable in the distributed ACT training. Student feedback on the ACT activities was overwhelmingly positive. These results support ACT as a promising method for reducing student stress; different delivery schedules will be discussed.

Educational Objectives:
1. Prepare to seamlessly incorporate elements of ACT into an Introductory Psychology curriculum. 2. Demonstrate potential public health effects of incorporating ACT into a classroom setting. 3. Describe and compare the effects/impact of a brief and an extended ACT intervention in a university classroom.

 

53. Working Together: How Clinicians, Trainers, and Language Researchers can Increase the Reach of Psychosocial Interventions in an Era of Integrated Care
Symposium (10:30am-Noon)
Components: Conceptual analysis, Original data, Didactic presentation
Categories: Supervision, Training and Dissemination, Clin. Interven. & Interests, RFT, Other, Integrated Care
Target Audience: , Interm.
Location: Puget Sound

Chair: Douglas M. Long, Ph.D., Alpert Medical School of Brown University
Discussant: Kirk Strosahl, Ph.D., Mountainview Consulting Group

As psychosocial interventions are implemented in primary care settings, clinician skills can inform innovations in training and assessment methods that improve care efficiency and quality. This symposium will begin with process and outcome data from a four-week Focused Acceptance and Commitment Therapy (FACT) group implemented as part of routine clinical care in a Veterans Affairs integrated primary care setting (N = 51). A study will then be presented that investigated clinician perspectives on efforts to expand reach and efficiency through trainer-led and self-paced online trainings in Behavioral Activation (BA) that demonstrated differential improvements in skill (N = 80). Finally, data from a new method of training outcome assessment called Therapist Agreement with Sensitivity to Context (TASC) will be shared in demonstration how of a research strategy informed by Relational Frame Theory (RFT) can empower experiential trainings that influence how therapists “see” and “hear” their clients (N=398).

• The Efficacy of Focused Acceptance and Commitment Therapy Group Psychotherapy in a Veterans Affairs Integrated Primary Care Setting
Natalie G. Glover, Ph.D., VA Puget Sound Health Care System
Patrick D. Sylvers, Ph.D., VA Puget Sound Health Care System; University of Washington, Department of Psychiatry and Behavioral Sciences
Erika M. Shearer, Ph.D., VA Puget Sound Health Care System
Mary-Catherine Kane, Ph.D., VA Puget Sound Health Care System
Peter C. Clasen, Ph.D., University of Washington, Department of Psychiatry and Behavioral Sciences
Amee J. Epler, Ph.D., VA Puget Sound Health Care System
Jennifer C. Plumb-Vilardaga, Ph.D., VA Puget Sound Health Care System
Jordan T. Bonow, Ph.D., VA Sierra Nevada Health Care System
Matthew Jakupcak, Ph.D., VA Puget Sound Health Care System; University of Washington, Department of Psychiatry and Behavioral Sciences

Focused Acceptance and Commitment Therapy (FACT) is an abridged version of ACT, a trans-diagnostic approach to psychotherapy that views psychological rigidity as a ubiquitous phenomenon underlying psychopathology and behavioral problems. While there is a growing body of research on the efficacy of FACT for a variety of populations and disorders, there is little research to date on the efficacy of FACT when delivered in the group therapy milieu. This presentation will describe outcomes related to changes in psychological flexibility, health and mental health status, and symptom reduction among 51 Veterans who attended a four-week FACT group as part of routine clinical care in a Veterans Affairs integrated primary care setting. This project showcases an efficient and cost-effective treatment strategy that can be implemented in primary care settings to facilitate improvements in mental and physical health as well as overall quality of life.

• What Worked and How to Make it Better: Therapists’ Qualitative Feedback on Self-Paced Versus Trainer-Led Behavioral Activation Online Training
Ajeng J. Puspitasari, Ph.D., Indiana University
Jonathan W. Kanter, Ph.D., University of Washington
Jennifer C. Plumb-Vilardaga, Ph.D., VA Puget Sound Health Care System
Jordan T. Bonow, Ph.D., VA Sierra Nevada Health Care System

Online training is an initial strategy to disseminate evidence-based psychotherapies that allows broader reach and may be cost-effective. Two versions of online Behavioral Activation (BA) training were compared and those receiving trainer-led training showed significantly higher BA skills gain, although both groups showed significant improvements in skills. In the context of this previous trial, trainees (N = 80) who were randomly assigned to either the self-paced or trainer-led BA online training provided qualitative feedback on the specific features and overall quality of the training as well as future recommendations for the trainings. This qualitative study will be a foundation for future BA online trainings that further incorporate users’ perspectives. Results will also be relevant for other evidence-based psychotherapy online training.

• Therapist Agreement with Sensitivity to Context (TASC): Monitoring and Enhancing Clinical Training Outcomes
Douglas M. Long, Ph.D., Alpert Medical School of Brown University
Steven C. Hayes, Ph.D., University of Nevada, Reno

One desirable outcome of clinical training is for therapists to “see” and “hear” their clients in ways that help to create new opportunities for intervention. Therapist Agreement with Sensitivity to Context (TASC) is an assessment method that seeks to track this process as it develops. TASC involves quantitative comparisons between trainer and trainee verbal responses to videos of simulated therapy sessions. This presentation will describe data from a web-based ACT TASC prototype that was distributed to 209 participants in intensive experiential ACT workshops conducted by expert trainers and 189 undergraduates who had no training in ACT. This project illustrates a research design strategy that can be generalized to other therapy models, provides one empirical avenue by which Relational Frame Theory (RFT) can guide model development, and allows for the routine evaluation of training efforts in professional organizations and clinical practice settings.

Educational Objectives:
1. Describe the efficacy of Focused Acceptance and Commitment Therapy in a Veterans Affairs integrated primary care setting. 2. Describe how qualitative feedback from users can inform online training in evidence-based psychotherapy. 3. Describe how Therapist Agreement with Sensitivity to Context (TASC) may provide a clinically relevant method of tracking educational outcomes.

 

56. Conceptual Developments in RFT
Symposium (10:30am-Noon)
Components: Conceptual analysis, Original data
Categories: Relational Frame Theory, RFT, Relational Frame Theory, Learning
Target Audience: Interm., Adv.
Location: Mercer/Denny

Chair: Yvonne Barnes-Holmes, Ghent University
Discussant: Dermot Barnes-Holmes, Ghent University

There are a number of exciting and fundamental conceptual developments of RFT underway. These build firmly upon existing well-supported RFT concepts. The first paper in this symposium lays out the broadest and most fundamental expansion of RFT since the 2001 book. The MDML is a multi-dimensional, multi-level model of the different types of relational response, and the different dimensions along which these interact and can be assessed. The scond paper explores the merits of the concept of environmental regularities as a definition of learning and as a means of carving up learning research. This paper proposes that environmental regularities may unlock new empirical (and conceptual) possibilities for future RFT research. The third paper is empirical and describes three studies that represent the first attempt to systematically manipulate levels of derivation and complexity in an experimental setting. The results demonstrate how these two core concepts interact.

• A multi-dimensional multi-level framework for RFT
Dermot Barnes-Holmes, Ghent University

In a recent chapter (Barnes-Holmes, Barnes-Holmes, Hussey, & Luciano, 2016) we proposed a framework for analyzing the dynamics of arbitrarily applicable relational responding by conceptualizing such behavior in terms of multiple dimensions and multiple levels, and abbreviated the name of the framework, the MDML. The current paper will present an up-dated version of the MDML, the aim of which is to focus on those features of Relational Frame Theory that seem most in need of emphasis as we move forward with the reticulating model of basic and applied science that serves to characterize contextual behavioral science itself.

• Using the Concept of Environmental Regularities to Refine Our Understanding of Learning and Accelerate Research on RFT
Sean Hughes, Ghent University
Jan De Houwer, Ghent University

Although learning is a core concept in psychology, opinions often differ about what it means to say that learning has occurred. In this presentation we revisit and extend the work of De Houwer, Barnes-Holmes, and Moors (2013) who argued that learning can be conceived of as the impact of regularities in the environment on behavior. More specifically, we explore the merits of the concept of environmental regularities not only for the definition of learning but also as a way to carve up the realm of learning research. We will show how this concept can be useful not only in an analysis of learning research that predates the development of Relational Frame Theory (RFT) (i.e., Learning 1.0) but also in an analysis of learning as conceived of from the perspective of RFT (i.e., Learning 2.0). We believe that environmental regularities may unlock new empirical (and conceptual) possibilities for future work on RFT.

• Examining the Impact of Relational Complexity and Levels of Derivation on the Speed and Accuracy of Relational Responding
Sean Hughes, Ghent University

In a recent paper Hughes, Barnes-Holmes, and Vahey (2012) argued that the complexity of a relational response and the degree to which it has been previously derived can vary along continua from low to high. They also argued that these two factors may influence the speed and accuracy (or indeed any other property) of relational responding. The current work represents a first attempt to systematically manipulate levels of derivation and complexity in an experimental setting. In three different studies participants completed a relational training and testing procedure: in each case complexity was held constant within participants while levels of derivation were manipulated between participants. Results demonstrated that the speed with which a relational response was emitted depended not only on its (relational) complexity but also on levels of derivation. As levels of derivation increased the differences in response speed due to complexity decreased. Open questions and potential directions for future research are discussed.

Educational Objectives:
1. Demonstrate how the concept of environmental regularities can be used to improve the definition of learning . 2. Showcase how the concept of environmental regularities can help accelerate the study of Arbitrarily Applicable Relational Responding (AARR). 3. Highlight growing emphasis on relational coherence, complexity, and derivation in RFT. 4. Demonstrate conceptual developments within RFT.

 

61. RFT & Rule Governed Behavior: Conceptual and Empirical Developments
Symposium (2:45-4:15pm)
Components: Literature review, Original data
Categories: Relational Frame Theory, Clinical Interventions and Interests, RFT, Systematic Review, Pliance,Tracking, Augmenting, Pain, RFT, Rules, Valuing
Target Audience: Beg., Interm.
Location: Vashon 1

Chair: Yvonne Barnes-Holmes, Ghent University
Discussant: Jonathan Tarbox, FirstSteps for Kids

Rules are a critical concept in human learning, but have proven hard to define precisely and manipulate experimentally. The first paper in this symposium explores the utility of, and evidence for, the concepts of pliance, tracking, and augmenting. The paper systematically reviews their empirical basis and how each has been operationalized. The conclusions suggest that the data lags far behind theoretical and clinical applications, and the paper offers key directions for future research. The second paper is empirical and presents a study that systematically compares a derived versus instructed rule in a match-to-sample task, to determine the extent to which these might differentially influence resistance to new contingencies. The findings indicate differential effects for rules that are instructed directly versus those that are derived. The third paper, also empirical, presents four studies, again on the insensitivity effect, and explores the potential impact of three variables: pliance vs. tracking; social vs. self-generated; and pain vs. non-pain related consequence). The results suggest differential influences of these variables on insensitivity. The fourth paper, also empirical, examines the impact of derived values functions on behavioral flexibility and contingency insensitivity. The data suggest that insensitivity varies in terms of the salience of derived values functions.

• A Systematic Review of Research on Pliance, Tracking, and Augmenting
Ama Kissi, Ghent University
Sean Hughes, Ghent University
Geert Crombez, Ghent University
Jan De Houwer, Ghent University
Dermot Barnes-Holmes, Ghent University

Three types of rule-governed behavior - pliance, tracking, and augmenting - have enjoyed widespread theoretical and therapeutic appeal within the RFT and ACT literatures. Yet, to the best of our knowledge, the assumptions underpinning, and the distinctions between pliance, tracking, and augmenting seem to be rooted more in theory than in data. With this in mind, we conducted a systematic review to determine whether (a) empirical work corroborates the functional distinction between pliance, tracking, and augmenting, and (b) how each of these classes of rule-governed behavior has so far been operationalized. Our review indicates that the empirical literature currently lags far behind theoretical and clinical applications and that existing work on this topic could be improved in several notable ways. We conclude our talk by identifying what we consider to be key directions for future research in this area.

• The Impact of Derivation on Persistent Rule-following
Colin Harte, Ghent University
Yvonne-Barnes-Holmes, Ghent University
Dermot Barnes-Holmes, Ghent University
Ciara McEnteggart, Ghent University

Almost since its inception, Relational Frame Theory (RFT) has grappled with the impact of rules and instructions on derived relational responding. And yet, few basic experimental studies have investigated this important and complex phenomenon. In the current basic match-to-sample study, participants were given either a direct rule for responding or were required to derive the correct rule via a pre-experimental derivation training task. During the main task, the contingencies for correct responding changed without warning, and a second experimental manipulation varied the number of trials presented prior to the contingency change (i.e., 10 or 100). Our key aims, therefore, were to explore potential differences in terms of direct or derived rule-following and of short vs extended rule-following upon participants’ ability, or resistance, to adjust to the new task contingencies. Preliminary findings show some differences in rule-following across the four conditions and are discussed in terms of the relationship between persistence of rule-following and derivation.

• The Dark-Side of Rule-Governed Behavior: An Empirical Investigation of the Insensitivity Effect
Ama Kissi, Ghent University
Sean Hughes, Ghent University
Jan De Houwer, Ghent University
Geert Crombez, Ghent University

Within the RFT and ACT literatures psychological and health-related problems are often argued to stem from an over adherence to ineffective rules which prohibit contact with other contingencies in the environment (i.e., “the insensitivity effect”). Across four studies we investigated whether this insensitivity effect was moderated by three variables: the type of rule involved (pliance vs. tracking), the source of the rule (socially vs. self-generated) and the consequences of rule-following (pain vs. non-pain related consequences). In each case participants completed a conditional discrimination (MTS) task consisting of six blocks of trials. During the first three blocks socially provided rules were consistent with programmed contingencies. Then, unknown to participants, these rules became inconsistent with programmed contingencies during the second set of blocks. Results suggest that the insensitivity effect may be moderated more by the source of the rule (self-vs. social) than the type of rule involved (pliance vs. tracking). Open questions and future directions will be discussed.

• Values and Behavioral Flexibility: What are the effects of valuing on sensitivity to contingencies of reinforcement?
Gina Q. Boullion, M.S., University of Louisiana at Lafayette
Nolan R. Williams, University of Louisiana at Lafayette
Emily K. Sandoz, Ph.D., University of Louisiana at Lafayette

Contacting one’s values and engaging in behavior consistent with those values has been associated with improved physical and mental health (Nygren et al., 2005), increases in quality of life (Plumb & Hayes, 2008), and increases in overall well-being (Reker et al., 1987), among others. Values have long been vital to the psychological flexibility model (Hayes, Wilson, & Stroushal, 2012) and the topic of countless papers in the CBS community; however, relatively little investigation has been done in regards to how valuing effects behavioral variability and sensitivity to changing contingencies. It is thought that holding rigid ideas about what values one “must” pursue and how one must pursue them can create fused values, which can result in inflexible behavioral repertories and lowered ability to contact present contingencies of reinforcement (Plumb et al, 2009). The current study examined the impact of derived values functions on behavioral flexibility and sensitivity to changing contingencies of reinforcement. Preliminary data suggest that contingency sensitivity varied, depending on which derived values functions were made salient. Implications of contingency sensitivity in the presence of values and future directions will be discussed.

Educational Objectives:
1. Describe the current state of the research on pliance, tracking, and augmenting. 2. List 2 ways in which valuing effects behavioral variability. 3. Analyze the impact of values on sensitivity to reinforcement.

 

62. Self-Compassion and its Implications for Mental Health: Empirical Evidence and a Contextual Framework
Symposium (2:45-4:15pm)
Components: Conceptual analysis, Original data, Case presentation
Categories: Clinical Interventions and Interests, Theory & Philo., Self-Compassion
Target Audience: Interm., Adv.
Location: Vashon 2

Chair: Joanna J. Arch, University of Colorado Boulder
Discussant: Kristin D. Neff, University of Texas at Austin

This symposium aims to inform both the empirical and theoretical understanding of self-compassion – a topic of growing interest to researchers and clinicians alike. We pair two empirical papers with a theory-driven paper to demonstrate the contextual behavioral science conceptualization, measurable correlates, and biopsychological outcomes of self-compassion across experimental, community, and clinical settings. Specifically, the two empirical presentations focus on the implications of self-compassion for responding to social stressors (3 studies) and the specific correlates linking self-compassion to well-being (relative to compassion for others, 1 study). Thus, the empirical work addresses self-compassion’s link to well-being and potential to optimize social stressor responding. The final paper situates self-compassion within contextual behavioral science, showing how self-compassion informs case conceptualization and treatment particularly within the context of negative social emotions such as shame. Collectively, this symposium contributes to specifying the benefits, correlates, conceptualization, and clinical application of self-compassion.

• Comparing compassion for self and others: Impacts on personal and interpersonal well-being
Marissa Knox, University of Texas at Austin
Kristin D. Neff, Ph.D., University of Texas at Austin

To date almost no research has compared compassion for self versus others as they impact wellbeing. This study examined self-reports of self-compassion and other-compassion in a sample of community adults (N=1366) and Buddhist meditators (N=172). We found that among community adults, 6% displayed more self-compassion than other-compassion, 76% displayed more other-compassion than self-compassion, and 16% displayed the same levels of each. Results were almost identical among Buddhists. In both samples self- and other-compassion were only weakly correlated. In the community sample, self-compassion predicted most of the significant variance in personal wellbeing (e.g., happiness, life-satisfaction, depression, anxiety, stress, empathetic distress), while other-compassion was a stronger predictor of interpersonal outcomes (e.g., altruism, perspective-taking, and forgiveness). The Buddhist sample had similar results, except that self-compassion was the stronger predictor of perspective-taking and forgiveness, and both equally predicted empathetic distress. Few interaction effects were found. Implications of findings for interventions will be discussed.

• The Impact of Brief Self-Compassion Training on Responses to Social Stressors
Joanna J. Arch, Ph.D., University of Colorado Boulder
Lauren Landy, M.A., University of Colorado Boulder

Across three studies, we evaluate the impact of brief self-compassion (trained or induced) on social stressor responses. In Study 1, women (n=104) randomized to brief self-compassion training showed lower subjective anxiety and sympathetic responses to a social performance stressor, relative to rigorous control conditions. In Study 2, during recovery from a challenging social feedback task, adults with or without social anxiety disorder (SAD; n=57) were randomized to a self-compassion-induction or waiting period. Adults in the self-compassion condition reported lower anxiety, and those with SAD benefitted similarly as those without SAD. In Study 3, currently ongoing, we evaluate whether a self-compassion induction mitigates our finding that adults with SAD incorporate negative social feedback more quickly into their sense of self than positive social feedback. To the extent that self-compassion functions as a form of flexible perspective taking, these collective findings inform contextual behavioral approaches for addressing social anxiety and enhancing well-being.

• Contextual Behavioral Science, Perspective Taking, and Self-Compassion
Jason Luoma, Ph.D., Portland Psychotherapy Clinic, Research, & Training Center

This paper aims to contextualize the other papers in this symposium for the ACBS audience through the presentation of a contextual behavioral science (CBS) framework on self-compassion. From a CBS perspective, self-compassion relies centrally on the flexible use of perspective taking (i.e., deictic framing) and the effective transformation of emotional functions. From this vantage point, self-compassion can be seen as a form self-to-self relating, wherein a person responds to their own behavior with the same repertoires of caregiving and cooperation that one might apply to a friend or loved one. As such, self-compassion is a fairly complex cognitive task that requires the person to be able to observe their own behavior and access evolved caregiving responses and associated emotions that primarily evolved in response to others, but instead apply them to oneself. Examples of how this process is relevant in a clinical context will be provided.

Educational Objectives:
1. Describe how brief training in self-compassion effects responses to social performance stress. 2. Distinguish the well-being correlates of self-compassion and compassion from others. 3. Situate self-compassion within a contextual behavioral science framework.

 

63. Improving Outcomes and Better Understanding Processes: Using Smartphone Technologies in Clinical Research
Symposium (2:45-4:15pm)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, smart phone technologies
Target Audience: Beg., Interm., Adv.
Location: St. Helens

Chair: Andrew Gloster, University of Basel
Discussant: Todd Kashdan, George Mason University

Innovations in technology and their widespread use in the general population, such as with smart phones, has introduced new ways for psychologists to examine phenomena, access individuals in remote areas or hard to reach populations, and intervene. These new technologies allow for studying processes of treatments with the aim of improving outcomes. Event Sampling Methodology (ESM) is an ecologically sensitive methodology that captures events in participants’ chosen environments and in close proximity to when an actual behavior of interest occurs. The first paper in this symposium will present the use of smart phone technology to assess individuals diagnosed with MDD, Social Phobia and controls, using a one-week ESM paradigm. Results will be presented with suggestions about how better to promote well-being and pro-social activity in the flow of daily life while testing contextual behavioral theory. The second paper, examines the impact of enhancing face-to-face Acceptance and Commitment Therapy (ACT) smoking cessation with the use of treatment related text messages vs. providing only date and time of next session information. Data will be presented that shows that receiving content-related text messages leads to a decrease in CO exhalation levels when compared to the general text messaging suggesting that the use of ACT content messages leads to a higher utilization of taught techniques and thus improved treatment outcomes. The third study, will present data on how the receptivity and cessation outcomes of a smoking cessation are achieved with an ACT-conistent smartphone application.

• The Ups and Downs of a Flexible Life: Using ESM to Capture Daily Fluctuations of Emotions and Behaviors in Participants with Depression, Social Anxiety, & Controls
Andrew Gloster, Ph.D., University of Basel
Andrea Meyer, Ph.D., University of Basel
Roselind Lieb, Ph.D., University of Basel

Introduction: Event Sampling Methodology (ESM) assesses events in participants’ chosen environments, close to the occurrence of the behavior. ESM is ecologically sensitive while limiting recall bias. As such, ESM offers unique advantages to testing contextual behavioral predictions such as how psychological flexibility changes as a function of context and how this affects well-being. Method: Using smartphones, a one-week ESM paradigm with assessments every three hours assessed participants diagnosed with MDD (n=87), Social Phobia (n=41), and controls (n=87); [67% female]. Results: Over 90.4% (n=8240) of prompted assessments were completed. Preliminary models indicate that state levels of psychological flexibility moderated the relationship between stress and frequency of interacting with other people. Models will further differentiate between diagnostic groups, test for outcomes of pro-social behavior and well-being. Conclusions: These data offer suggestions about how to promote well-being and pro-social in the flow of daily life while testing contextual behavioral theory.

• Does the use of treatment content text message reminders enhance the utilization of ACT techniques and improve smoking cessation outcomes?
Maria Karekla, Ph.D., University of Cyprus
Andria Christodoulou, M.A., University of Cyprus

Introduction: Acceptance and Commitment Therapy (ACT) makes use of an individual’s values to motivate a change in behavior and has been shown quite effective for smoking cessation. Innovations in smart phone technology have led to individualized text messaging based interventions with the potential to attract and engage previously hard-to-reach groups, adolescents. However, to date differences between providing treatment-related content text messages vs. simple date and time of next appointment reminders has not been evaluated. This study aimed to compare the use of content specific (with an emphasis on linking smoking cessation to values) vs. general text messages in combination to ACT smoking cessation among adolescents. Method: 118 smokers were randomly assigned to one of two groups: an ACT relevant content SMS plus ACT group (8 sessions) vs. a general SMS plus ACT group smoking cessation. Carbon Monoxide (CO) exhalation levels and other smoking and ACT related variables were tested pre and post treatment. Results: Repeated measures ANOVAs indicated a significant reduction in CO upon completion of the intervention compared to pre-intervention levels, with the ACT-content SMS group having significantly lower post-intervention CO levels than the general SMS group. However, the groups did not differ on ACT related measures at post intervention. Conclusions: Both groups responded similarly to the learning of ACT content but differed only in their application of information to achieving smoking cessation, providing support for the importance of enhancing treatment content with regular text messages in-between sessions.

• Single Arm Trial of the SmartQuit Acceptance & Commitment Therapy Smartphone Application for Smoking Cessation
Jonathan Bricker, Ph.D., Fred Hutch Cancer Research Center & University of Washington
Wade Copeland, M.S., Fred Hutch Cancer Research Center & University of Washington
Jaimee Heffner, Ph.D., Fred Hutch Cancer Research Center & University of Washington

Introduction: There are 500 English-language smartphone applications (“apps”) for quitting smoking, downloaded over 3.2 million times in 2012-2013. Their ubiquity makes apps a potentially helpful cessation aid, especially for smokers who are hard to reach. We explored this potential through evaluating the receptivity and cessation outcomes for the SmartQuit app that follows Acceptance & Commitment Therapy (ACT). Methods: Participants were 99 adult smokers (at least 5 cigarettes/day) who were 78% female and 60% unemployed. Results: The follow-up data retention rate at the 2-month follow-up was 85%. Regarding receptivity, 85% of participants were satisfied with the app, 82% found ACT exercises useful, and 93% reported the app was easy to use. The quit rates at the 2-month follow-up were 21%. Among program completers, the quit rates at 2-month follow-up were 33%. Conclusion: SmartQuit was well-received and showed promising quit rates among the challenging population of primarily low SES female smokers.

Educational Objectives:
1. Describe how technologies can be use to promote outcomes. 2. Describe how ACT consistent variables unfold in daily life and in individually applied interventions. 3. Explain the relationship between process and outcome using ecologically sensitive data.

 

65. Processes of Change
Symposium (2:45-4:15pm)
Components: Conceptual analysis, Literature review, Original data
Categories: Prevention and Community-Based Interventions, Clinical Interventions and Interests, Edu. settings, Org. Beh. Management, Theory & Philo., RFT, Cognitive defusion, coping with stress, anxiety, component analysis, resilience, mindfulness, values, non-clinical
Target Audience: Beg., Interm., Adv.
Location: Cascade 1B

Chair: Rebecca Schneider, M.A., University of Colorado Boulder
Discussant: Chad E. Drake, Ph.D., Southern Illinois University

Understanding processes of change can shed more light on the progression of psychological inflexibility as well as guide more targeted interventions. Coping with stress, negative thoughts, and emotion has received considerable attention from different theoretical perspectives. In this symposium, we examine the process of coping from a contextual behavior perspective. For instance, individual differences in coping with stress may be better explained by cognitive defusion. We will discuss 3 studies that show how cognitive defusion may add to theories of coping in understanding how individuals relate to stress. We will also present data on a comparison of cognitive restructuring and cognitive defusion approaches to negative thoughts, including an RFT-based analysis of both techniques. A study of a mindfulness-only intervention versus an ACT intervention will be presented as well as a discussion of contexts in which each approach might be more appropriate. We will also discuss the predictive relevance of emotion regulation skills - targeted by mindfulness- and acceptance-based therapies - in the development of physical and social anxiety via a longitudinal study. Together, these studies can help us better understand and target processes that might be critical to enhancing well-being.

• Defusion or restructuring as a question of human language
Andreas Larsson, Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services

Humans have this amazing ability to make thoughts seem completely real. In more technical terms we have difficulty discriminating derived stimulus reactions from direct contingencies. This is one reason language place such a large role in psychopathology. For this reason a central part of psychotherapy involves providing clients with coping strategies for negative thoughts. Cognitive restructuring and cognitive defusion are two of the most common such methods. However they derive from two different theoretical outlooks, one is Acceptance and Commitment Therapy, reticulatedly related to RFT and based in functional contextualism and the other is Cognitive Therapy, a more mechanistic model. This presentation will give a common, RFT-based description of both methods and present data comparing them both. In a recent study (Larsson et al., 2015) 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 differences in the contextual language cues provided in the different interventions for managing unwanted thoughts.

• The Longitudinal Effect of ACT-Targeted Emotion Regulation Strategies on Anxiety Levels in Youth
Rebecca Schneider, M.A., University of Colorado Boulder
Joanna Arch, Ph.D., University of Colorado Boulder
Ben Hankin, University of Denver

Objective: There is growing evidence linking emotion dysregulation to anxiety. However, few studies have examined this relationship longitudinally or developmentally. Additionally, no studies have specifically examined the predictive relevance of the emotion regulation skills taught in mindfulness- and acceptance-based therapies. We explore whether specific ACT-targeted emotion regulation processes differentially predict specific anxiety symptoms over time among children and adolescents. Methods: Initial emotion non-awareness, nonacceptance, and difficulties with goal-directed behavior (corresponding to the ACT processes of awareness, acceptance, and committed action) were assessed in a community sample (n = 312, age range = 8-16, mean age = 11.68, 59% female, 69% Caucasian). Social anxiety, separation anxiety, and physical anxiety symptoms were assessed every 3 months for 3 years. Hierarchical linear modeling was used to examine the concurrent and longitudinal effects of emotion dysregulation assessed at baseline or 18 months on anxiety. Results: After controlling for depression, age, and gender, all three processes concurrently predicted physical and social anxiety, and all but nonacceptance predicted separation anxiety. Only difficulties with goal-directed behavior, however, predicted longitudinal change in separation anxiety over time with covariates. Additionally, emotion non-awareness and difficulties with goal-directed behavior predicted subsequent changes in social anxiety. Conclusions: Emotion dysregulation may serve as a potential risk factor for the development of anxiety symptoms among youth. It may be beneficial to target reductions in maladaptive strategies in prevention or intervention work.

• Transfer of fear measured with blink-startle modulation
Miguel Rodriguez-Valverde, Ph.D., University of Jaén, Spain
Monica Hernandez-Lopez, Ph.D., University of Jaén, Spain
Miguel A. Lopez-Medina, B.Sc., University of Jaén, Spain

Research on fear conditioning is key to understanding the genesis and maintenance of anxiety disorders. A still scarce but growing evidence shows that physiological fear reactions may transfer amongst physically dissimilar but symbolically related (e.g. equivalent) stimuli. The limited investigation published to date has relied on skin conductance responses as its main measure. Thus far, no published studies have analyzed this phenomenon using more emotionally sensitive psychophysiological measures, like blink startle. Participants (N=20) in this study underwent a matching-to-sample procedure for the formation of two equivalence classes (A1-B1-C1-D1 and A2-B2-C2-D2). Then, one element from each class was used in a differential aversive conditioning procedure (CS+: B1; CS-: B2) with electric shock as the UCS. Eye-blink startle (measured as EMG activity of the orbicularis oculi muscle after a burst of white noise) was the main dependent variable. Preliminary results from transfer tests show potentiation of blink startle with C1 and D1, but not with C2 and D2.

Educational Objectives:
1. Describe the evidence for ACT versus mindfulness-only group interventions on how individuals cope with stress. 2. Describe the longitudinal relationship between emotion regulation and anxiety. 3. Analyze the main psychophysiological measures used in research on the derived transfer of fear.

 

69. Promoting psychological flexibility in laboratory, exceptionally gifted children, and victims of sexual violence
Symposium (2:45-4:15pm)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, RFT, Laboratory study, exceptionally gifted children, sexual violence
Target Audience: Beg., Interm., Adv.
Location: Puget Sound

Chair: Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Discussant: Carmen Luciano, Universidad de Almería

Promoting psychological flexibility is the main aim of acceptance and commitment therapy (ACT). This symposium presents three studies focused on promoting psychological flexibility in several contexts. The first presentation consists of a laboratory study that first modelled a pattern of psychological inflexibility in participants’ behavior and then compared a brief protocol to promote psychological flexibility versus a control condition. The second study presents the effect of a brief ACT protocol applied to exceptionally gifted children experiencing significant levels of school maladjustment. The protocol was focused on disrupting rumination and procrastination, and promoting psychological flexibility while facing with boring and unattractive tasks. Lastly, the third study shows the effect of a 4-session ACT protocol applied to adolescent who suffered conflict-related sexual violence in Colombia. Overall, the current symposium shows the several levels of analysis of the promotion of psychological flexibility via ACT interventions.

• The weakening of psychological inflexibility: Analysis of the epitaph exercise
Adrián Barbero-Rubio, Universidad de Almería
Carmen Luciano, Universidad de Almería

The Acceptance and Commitment Therapy (ACT) model is oriented to disrupt psychological inflexibility (PI) and to increase psychological flexibility (PF). Recent laboratory studies have analyzed the conditions under which ACT exercises impact on enhancing PF. However, these studies do not establish a context of PI which the conditions for its weakening can be isolated. This preliminary study analyzes these conditions by designing experimental analogs of ACT-based exercises. This study had five phases: (1) eighteen participants were randomly assigned to two groups, responded to questionnaires and were exposed to an experimental task with discomfort to capture rigid psychological reactions; (2) both groups received an Inflexibility-protocol; (3) all groups were re-exposed to the experimental task; (4) group I received a Flexibility-protocol (the epitaph exercise) dedicated to weaken the PI while group II received a control-protocol; (5) all participants repeated the experimental task. Results indicate significant effects the Flexibility-protocol on increasing task performance.

• Effect of a brief ACT protocol in improving school adjustment of exceptionally gifted children
María Belén García-Martín, Fundación Universitaria Konrad Lorenz
Katherine Barreto, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz

An exceptionally gifted child stand out in general intelligence, easily learns contents of any domain, and demonstrate behavior more sophisticated than his/her reference group. However, a good number of exceptionally gifted children presents school maladjustment due to experiencing school tasks as low-demanding and boring. This usually leads to emotional difficulties and scholar failure. The current study describes the effect of a brief acceptance and commitment therapy (ACT) intervention focused in disrupting rumination and procrastination, and increase valued actions in exceptionally gifted children. A multiple-baseline designs across participants was used with 5 children experiencing significant levels of school maladjustment. All children were identified as exceptionally gifted by means of intelligence quotient and learning potential tests. Results are discussed in terms of how psychological flexibility can enhance the use of high-level cognitive abilities and put them at the service of valued behavioral directions.

• Use of Acceptance and Commitment Therapy with female adolescents exposed to conflict-related sexual violence: Experiences in Colombia
Melissa Schellekens, Private Practice
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz

Over fifty years of internal armed conflict in Colombia has involved unprecedented levels of conflict-related sexual violence perpetrated against women and girls, to which adolescents are particularly vulnerable. This study examined the effects of a 4-session group protocol on the values adherence behaviour and life functioning of adolescent females exposed to conflict-related sexual violence. The protocol proposed in this study incorporates elements of the DNA-V framework and an art-based process. A group of females aged between 13 and 18 participated in a randomised controlled study of the protocol. They were sourced through a local non-governmental organisation operating in regions of Colombia with high levels of conflict. The protocol appears to be an initial step toward enhancing research into ACT-based treatments for adolescents with trauma symptoms. Additional research proposed includes investigation into scaling-up use of this protocol across large numbers of adolescent females in Colombia.

Educational Objectives:
1. Model psychological (in)flexibility in a laboratory setting. 2. Apply ACT to improve school adjustment in exceptionally gifted children. 3. Explain the relevance of promoting psychological flexibility in victims of sexual violence.

 

74. Effect of brief ACT protocols focused on disrupting worry and rumination in clinical and nonclinical participants
Symposium (4:30-5:45pm)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, RFT, Worry, Rumination, Emotional Disorders, Couples
Target Audience: Beg., Interm., Adv.
Location: Vashon 1

Chair: Bárbara Gil-Luciano, Madrid Institute of Contextual Psychology
Discussant: Carmen Luciano, Universidad de Almería

The current symposium presents cutting-edge research in the application of brief acceptance and commitment therapy (ACT) protocols focused on disrupting negative repetitive thinking (RNT). RNT in the form of worry and rumination has been robustly identified as a transdiagnostic factor implicated in the onset and maintenance of emotional disorders. The symposium presents three studies in which ACT protocols were focused from the very beginning in decreasing RNT levels. The first study shows the effect of a one-session ACT protocol applied to individuals suffering from moderate emotional symptoms and experiencing dysfunctional worry/rumination for at least six months. The effect sizes of the intervention were very large. The second study aims to extend the previous findings to improving couple relationship in cases where one of the members showed high levels of RNT. The third study analyzes the effect of a 4-session protocol to treat moderate to severe depression and generalized anxiety disorders.

• Acceptance and commitment therapy to disrupt negative repetitive thinking: A randomized multiple-baseline design
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Diana Riaño-Hernández, Fundación Universitaria Konrad Lorenz
Juan C. Suárez-Falcón, Universidad Nacional de Educación a Distancia
Carmen Luciano, Universidad de Almería

Repetitive negative thinking (RNT) in the form of worry and rumination has been robustly identified as a transdiagnostic factor implicated in the onset and maintenance of emotional disorders. The current study analyzed the effect of a one-session acceptance and commitment therapy (ACT) protocol in disrupting RNT using a two-arm, randomized-multiple baseline design. Participants were 11 adults experiencing RNT that interfered in their functioning for at least the last six months. Five RNT-related measures were administered: a daily RNT self-register, measures of pathological worry, rumination (reflection and brooding), and frequency with negative thoughts. Ten participants showed significant reductions in at least half of the RNT measures. Effect sizes were very large in most RNT-related measures (Cohen’s d from .93 for reflection to 2.15 for worry) and in valued living (d from .77 to 2.35), emotional symptoms reduction (d = 1.71), experiential avoidance (d = 2.09), and cognitive fusion (d = 2.23).

• Improving couple relationship by reducing worry and rumination through a brief ACT protocol
Diana García-Beltrán, Fundación Universitaria Konrad Lorenz
Andrea Monroy, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz

Repetitive thinking in the form of worry and rumination about the couple relationship can have a deleterious effect in couple satisfaction for several reasons such as: not being present while sharing time with the couple, doubts about continuing or breaking the relationship, maintaining toxic relationships, jealous, etc. The current study aims to explore the effect of a brief acceptance and commitment therapy (ACT) protocol in improving satisfaction with couple relationships through reducing worry and rumination. The ACT protocol was based on the study by Ruiz, Riaño-Hernández, Suárez-Falcón, and Luciano (2016) that showed very large effect sizes of a one-session protocol in disrupting general worry and rumination. A multiple-baseline design was conducted with participants who were unsatisfied with their couple relationships and showed significant levels of worry/rumination that interfered adequate functioning in this area. Results will be mainly discussed in terms of participants’ progression in having a valued couple relationship.

• Effect of a transdiagnostic ACT protocol focused on disrupting negative repetitive thinking
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Diana Riaño-Hernández, Fundación Universitaria Konrad Lorenz
Juan C. Suárez-Falcón, Universidad Nacional de Educación a Distancia
Carmen Luciano, Universidad de Almería

The current study aims to analyze the effect of a 4-session acceptance and commitment therapy (ACT) intervention focused on disrupting worry and rumination in the treatment of emotional disorders. Both worry and rumination usually serve an experiential avoidance function and have been robustly identified as transdiagnostic factors implicated in the onset and maintenance of emotional disorders. A multiple baseline design was implemented with participants suffering from depression and/or generalized anxiety disorder. Dependent variables were daily measures of repetitive thinking and weekly self-reports of emotional symptoms, worry, rumination, negative thoughts, valued living, experiential avoidance, and cognitive fusion. Initial results show that most participants obtained significant clinical improvements. The results will be discussed highlighting the need to conduct a randomized clinical trial comparing the effect of this protocol with a standard ACT protocol to treat emotional disorders.

Educational Objectives:
1. Describe the role of worry/rumination in the etiology and maintenance of emotional disorders. 2. Demonstrate worry/rumination as important experiential avoidance strategies. 3. Analyze the effect of ACT protocols focused on disrupting worry/rumination in clinical and nonclinic participants.

 

78. Investigating the effects and processes of brief ACT interventions with different populations
Symposium (4:30-5:45pm)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Edu. settings, ACT, brief interventions, youth, university students, wellbeing, stress, depression, anxiety
Target Audience: Beg., Interm.
Location: Cascade 1B

Chair: Raimo Lappalainen, Ph.D., Department of Psychology, University of Jyväskylä, Finland
Discussant: Jacqueline Pistorello, University of Nevada, Reno

Brief psychological interventions offer several advantages, and they are used frequently in clinical practice. The form of delivery of interventions with less than 10 sessions can vary from individual and group treatments to different forms of web- and mobile-approaches. This symposium aims at describing the effects of 6-7 session ACT interventions. Three studies will be presented describing interventions offered to adolescents (15-20 years old, n = 160), young adults (19-32 years old, n = 68) and middle-aged clients with depression (n = 56). The interventions were delivered either in a group format or as individual sessions combined with an internet-program and face-to-face. We will discuss the effectiveness and usefulness of these short ACT interventions to different populations and crucial psychological processes and mechanisms of change possibly explaining the effects.

• A controlled trial of Acceptance and Commitment Training (ACT) for treating comorbid psychosocial problems among inpatient youth
Fredrik Livheim, MSc., licensed psychologist, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

Background: Youth sentenced to inpatient care is a group often burdened with severe comorbid problems. The current quasi-experimental outcome study investigated the possible effects of an ACT group-based intervention as an adjunct to treatment as usual (TAU). Method: This study involved 160 Swedish youth (15-20 years old) sentenced to institutional care. Ninety-one adolescents were in units that received ACT + TAU, and the remaining adolescents were in units that received TAU, only. The ACT group-based intervention consisted of 6 sessions á 2 hours. Results: The ACT groups as an addition to TAU significantly lowered youth levels of anxiety, depression, anger, drug- and alcohol use, conduct problems, hyperactivity, criminality and increased psychological flexibility, prosocial behaviours and Self-Concept. Conclusion: This 12-hour ACT group-based intervention could be an effective tool in enhancing the well-being of youth with psychosocial problems.

• Mindfulness as a mediator of change in wellbeing, stress, and symptoms of depression: Results from a guided online ACT-based program for university students
Panajiota Räsänen, MSc., Licensed Psychologist, Department of Psychology, University of Jyväskylä, Finland
Asko Tolvanen, Department of Psychology, University of Jyväskylä, Finland

A web-based, coach-guided ACT 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 has been previously found to be an effective alternative in reaching the needs of the university population (Räsänen et. al, 2016). The present study explored the possible mediators of change accounting for outcomes in that previously reported randomized trial. Our primary goal was to examine whether changes in mindfulness skills would mediate changes in psychological wellbeing, perceived stress and symptoms of depression in the participants (N = 68; 85% female; 19-32 years old). Results showed that Non-Reactivity was the primary mediator that partly explained changes in all outcome measures. This study is a first step toward understanding the potential mechanisms of change taking place in online, guided ACT-based programs. The implications and limitations of the findings are discussed.

• Fast improvement during a brief 6 –session ACT intervention: The phenomena and discussion of processes
Katariina Keinonen, Department of Psychology, University of Jyväskylä, Finland
Raimo Lappalainen, Department of Psychology, University of Jyväskylä, Finland

Objective: Sudden gains, abrupt reductions in symptom severity, have been shown to occur in various treatment settings resulting in better treatment outcome. We were interested in investigating the amount of clients showing fast improvement and whether process measures such psychological flexibility were associated with early improvement. Method: The data consisted of 56 participants with diagnosed major depressive disorder. They were offered a 6 session individual ACT intervention, and classified to (fast) improvers and non-improvers based on changes in symptoms of depression during first two weeks of intervention. Results: About 25% of the clients improved very fast (between group ES for BDI-II g =1.44 after two sessions). During the 6 –session intervention, the pattern of change was different in psychological flexibility, believability on depression thoughts and for hopefulness between the improvers and non-improvers. Conclusions: Changes in psychological flexibility could be associated with fast improvement in brief psychological interventions.

Educational Objectives:
1. Describe and discuss the effects of this ACT-intervention among Swedish incarcerated youth. 2. Identify and discuss how mindfulness skills may mediate changes in psychological wellbeing, perceived stress and symptoms of depression in an online, guided ACT program for university students. 3. Explain individual differences in interventions effects and possible psychological processes associated with these differences.

 

80. This Modern (Evaluative) World: Exploring Contemporary Approaches to Assessing and Addressing Stigmatizing Attitudes toward Psychological Struggles
Symposium (4:30-5:45pm)
Components: Conceptual analysis, Literature review, Original data
Categories: Functional contextual approaches in related disciplines, Clin. Interven. & Interests, Assessment, Stigma, Intervention
Target Audience: Beg., Interm., Adv.
Location: Puget Sound

Chair: Chad E. Drake, Ph.D., Southern Illinois University
Discussant: Chad E. Drake, Ph.D., Southern Illinois University

Verbally competent human beings readily engage in comparative and evaluative relational responding. Given the social nature of our species, these proclivities readily enter into our perspectives on self, social identity, and social classification. Of particular concern are the types of perspectives that lead to stigmatizing attitudes. While stigma may be readily recognized for group comparisons along racial, sexual, or religious categories, stigmatizing attitudes toward those who struggle with psychopathology are also common and damaging (e.g., Link, Struening, Rahav, Phelan, & Nuttbrock, 1997). This symposium will focus on mental illness stigma with an emphasis on contemporary approaches to assessing attitudes: two studies utilizing a paradigm involving evaluation of faux “tweets” via twitter.com as well as a study with the Implicit Relational Assessment Procedure. Using multiple analytic and methodological strategies, issues of predictive validity and intervention strategies will be examined.

• Judgment on the bus goes round and round: Decreasing mental illness stigma by expanding the context
Teresa Hulsey, B.A., University of North Texas
Melissa L. Connally, M.S., University of North Texas
Danielle N. Moyer, M.S., University of North Texas
Taylor Lincoln, B.A., University of North Texas
Amy R. Murrell, Ph.D., University of North Texas

Approximately 1 in 5 American adults experience mental health difficulties (U.S. Department of Health and Human Services, 2014). Yet, mental health stigma remains one of the most frequently identified barriers to seeking treatment (Corrigan, 2004). One factor that contributes to mental health stigma is the tendency to over attribute behaviors to internal factors, while under attributing behaviors to external factors (i.e., fundamental attribution error; Ross, Greene, & House, 1977). This paper will examine the impact of contextual information on stigmatizing attitudes toward an ambiguous mental health scenario. Participants (n = 483) were presented a series of faux tweets with increasingly elaborate contextual information, and their attitudes were assessed after each tweet. A mixed factor repeated measures ANOVA will explore changing attitudes toward mental health over time. The role of psychological distress, experiential avoidance, and mental health history in relation to these changes will also be examined.

• Helpers Can Be Haters, Too: Examining Substance Misuse Stigma Among Therapists with the IRAP
Trent Codd, EdS, Cognitive-Behavioral Therapy Center of WNC, P.A.
Sunni Primeaux, M.A., Southern Illinois University
Sam Kramer, M.A., Southern Illinois University
Chad E. Drake, Ph.D., Southern Illinois University
Christeine M. Terry, Seattle Psychology, PLLC

Substance misusers are more stigmatized than individuals with other health conditions (Rao et al. 2009). In addition to affecting social status, employment, and housing, stigma has also been recognized as a barrier to treatment (Gary, 2005). Unfortunately, research has shown that stigma is not only found among the general population but among mental health professionals as well (Maslach, Jackson, & Leiter, 1996). The current study examined stigma toward substance misusers among 38 mental health professionals with traditional self-report methods as well as the Implicit Relational Assessment Procedure (IRAP). Preliminary analyses revealed a mixture of IRAP effects as well as some evidence for convergence between the IRAP and explicit measures. Additionally, the IRAP was found to predict willingness to write letters of support for employment and disability applications for substance users. Future research may focus on altering the content strategy of the IRAP and/or broadening the focus of assessment.

• Three tweets to the wind: Decreasing substance use stigma in 140 characters or less
Ethan G. Lester, B.S., University of North Texas
Danielle N. Moyer, M.S., University of North Texas
Amy R. Murrell, Ph.D., University of North Texas

Substance use and misuse are highly stigmatized mental health issues in the United States (Livingston, Muilne, Fang, & Amari, 2011), despite research supporting the critical role of environmental and contextual risk factors (Stone, Becker, Huber, & Catalano, 2012). The fundamental attribution error (FAE; Ross, Greene, & House, 1977) provides one explanation for this discrepancy. The FAE is the propensity for an individual to overly attribute behavior to dispositional characteristics while ignoring potential external causes of behavior. Increasing contextual information may decrease the frequency of committing the FAE (Quattrone, 1982). After receiving contextual information via faux tweets, 483 undergraduate students responded to an ambiguous situation related to substance use. Contextual information was presented hierarchically, and participants rated their attitudes towards an individual each time. A mixed factor repeated measures ANOVA will evaluate changes in stigmatizing attitudes over time, and in relation to attributional complexity, intolerance, and mental health history.

Educational Objectives:
1. Demonstrate the relationships among contextual information, stigmatizing attitudes, distress and treatment, and experiential avoidance. 2. Describe the evidence for the predictive validity of the substance misuse IRAP. 3. Demonstrate the impact of contextual information on stigmatizing attitudes and discuss the implications for substance use stigma, specifically.

 

82. RFT & Relational Coherence
Symposium (4:30-5:45pm)
Components: Conceptual analysis, Original data
Categories: Relational Frame Theory, Theory & Philo., RFT, Experimental Analysis of Behavior, IRAP
Target Audience: Beg., Interm., Adv.
Location: Pine

Chair: Yvonne Barnes-Holmes, Ghent University
Discussant: Nic Hooper, Ph.D., University of West England

The concept of coherence has been used in psychology for a long time, but has thus far escaped behavior analytic scrutiny. And yet, coherence, defined provisionally as deriving relational responses that are congruent with one another, appears to play a key role in many complex verbal behaviors. The first paper in this symposium highlights recent efforts to explore the reinforcing properties of relational coherence. The results suggest that coherence has appetitive properties and that contextual factors influence the relative reinforcing value of coherence. The second empirical paper determines whether incoherence is aversive. The results show strong pereferences for contextual coherence, in terms of both facial expression and the AAQ. The third paper, also empirical, explores the IRAP’s use of the response options “True” and “False” as relational coherence indicators (RCIs), and determines whether these influence IRAP performances. The findings indicate that Crels and RCIs should not be considered as functionally equivalent, and the use of different types of response options requires systematic analysis.

• Chasing Coherence: Recent Refinements in a Reinforcer Assessment Paradigm
Sean Hughes, Ph.D., Ghent University
Michael Bordieri, Ph.D., Murray State University

Coherence, preliminary defined as deriving relational responses that are congruent with one another, is argued to play a key role in many complex verbal behaviors. While previous accounts of coherence have been mainly conceptual in nature (e.g., the relational elaboration and coherence model; Barnes-Holmes, Barnes-Holmes, Stewart, & Boles, 2010), recent empirical work has sought to investigate relational coherence in the laboratory (Bordieri, Kellum, Wilson, & Whiteman, 2016; Wary, Dougher, Hamilton, & Guinther, 2012; Quinones & Hayes, 2014). In this paper we highlight some recent efforts to explore the reinforcing properties of relational coherence. Results from a series of studies suggest that coherence has appetitive properties for many participants and that contextual factors can manipulate the relative reinforcing value of coherence. Our findings partially support the assertion that coherence is a reinforcer for verbally competent humans. Implications for future research and paradigm development will be discussed.

• Analytical Perspective of Coherence
Zaida Callejón, Ph.D. candidate, Universidad de Almería
Carmen Luciano, Ph.D., Universidad de Almería
Juan Carlos López-López, Ph.D. candidate, Universidad de Almería

The current study aimed to check the reinforcing function of coherence. Specifically, this study analyzed if the incoherence experience is felt as an aversive event. Nine undergraduate students participated and followed the next sequence: (1) Firstly, they received conditional discrimination training for the formation of three 5-member equivalence classes. Subsequently, (2) they were exposed to a 24-trial block to assess mutual and combinatorial relations providing feedback to establish three contexts defined on the basis of different contingencies: a) coherent feedback based on the previous training was provided contingent to participants’ responses; b) consequences were randomly assigned as incoherent context; c) without feedback. During this phase, the response latency and participants’ facial expressions were recorded. In addition, participants were asked to rate their experiences of discomfort and sense of control on each context. Finally, (3) participants were exposed to a test of derived relations along with a choice procedure to determine their preferences based on the different context previously trained as a, b, or c. Results showed that most of participants (88%) preferred coherent context. During incoherent trials, an increased response latency and facial expressions of discomfort were detected. Moreover, the AAQ-II negatively correlated to selecting incoherent context (r = -.631). The findings suggest that coherent context, in which sense making is likely, is the most preferred.

• The Similarities and Differences between “Similar” and “Different” and “True” and “False” in Relational Frame Theory: Analyzing Relational Contextual Cues versus Relational Coherence Indicators using the IRAP
Emma Maloney, Maynooth University
Dermot Barnes-Holmes, Ghent University

Early studies using the Implicit Relational Assessment Procedure (IRAP) involved using relational contextual cues (Crels) as response options. A large number of IRAP studies, however, have also employed relational coherence indicators (RCIs), the two most common being “True” and “False”. The untested assumption was that the nature of the response options should have no impact on IRAP performance. The current study addressed this gap in the literature. Undergraduate participants were exposed to two IRAPs, one employing the Crels “Similar” and “Different” and the other employing the RCIs “True” and “False”. When participants first completed an IRAP using the Crels and then completed a second IRAP using the RCIs there was a significant reduction in the effect and it also became non-significant (from zero). This finding indicates that Crels versus RCIs should not be considered functionally equivalent and the use of different types of response options requires careful and systematic analysis.

Educational Objectives:
1. Describe recent refinements and limitations of an experimental preparation designed to assess relational coherence. 2. Evaluate the reinforcing properties of coherence and discuss the influence of contextual factors. 3. Analyze empirically the reinforcing function of coherence and assess if the incoherence experience is felt as an aversive event.

 

Saturday, June 18

89. RFT & Experimental Analyses of Psychological Suffering
Symposium (10:30am-Noon)
Components: Conceptual analysis, Original data
Categories: Relational Frame Theory, Clin. Interven. & Interests, RFT, IRAP, clinical applications of RFT, obesity
Target Audience: Interm., Adv.
Location: Vashon 2

Chair: Yvonne Barnes-Holmes, Ghent University
Discussant: Yvonne Barnes-Holmes, Ghent University

RFT-based empirical analyses of various aspects of psychological suffering are greatly in demand and this symposium represents further moves in that direction, in terms of phobia, hearing voices, obesity, and body image. The first paper presents two IRAP studies as a measure of spider fear, approach, and avoidance. The results show that in the context of a live spider (but not a molt), the IRAP predicts spider approach, and provides evidence of the separation of fear, avoidance, and approach at the implicit level. The second paper uses the IRAP to understand voice hearing. The results indicate that both non-clinical and clinical voice hearers show implicit negativity to voices, while accepting positive voices and avoiding negative voices. The demonstrates the utility and precision of the IRAP in this domain. The third paper again uses the IRAP in three studies that manipulate food deprivation with clinically obese and normal-weight participants. The results show that automatic food-related cognition is moderated by weight status and food deprivation. The fourth paper presents the The Body Image Flexibility Assessment Procedure (BIFAP) as a measure of psychological flexibility with body image and reviews the data thus far, including convergence with the IRAP.

• An RFT analysis of the derived transformation of Spider Fear, Avoidance and Approach, measured by the Implicit Relational Assessment Procedure (IRAP)
Aileen Leech, Ghent University
Dermot Barnes-Holmes, Ghent University
Lara Madden, National University of Ireland Maynooth

Over 20 years ago, behavioral researchers began to use the derived transformation of functions as a paradigm to explore how verbally-able humans come to both fear and avoid stimuli in the absence of direct stimulus pairings. The current research examined the use of the Implicit Relational Assessment Procedure (IRAP) as a measure of spider fear, approach and avoidance. The research comprised 2 studies. Study 1 employed two IRAPs, one targeting spider fear, the other targeting spider approach/avoidance. The FSQ and a BAT using a spider molt were also employed. The data showed that both IRAPs failed to predict performances on the BAT. Study 2 was similar to Study 1, but used a live spider. Results here, however, showed that the IRAP did predict performance on the BAT, and provided evidence of the separation of fear, avoidance and approach at the implicit level.

• Towards a Relational Frame Theory Understanding of Voice Hearing
Ciara McEnteggart, Ghent University
Yvonne Barnes-Holmes, Ghent University
Dermot Barnes-Holmes, Ghent University
Jos Egger, Radboud University

The current study used the Implicit Relational Assessment Procedure (IRAP) as a step towards a more functional-analytic approach to understanding of voice hearing, by exploring the potentially different implicit reactions of clinical and non-clinical groups to voices. In doing so, we attempted to parse out emotional versus behavioral responses toward voices (n=55) using a Valence and an Acceptance IRAP. Both non-clinical and clinical voice hearers showed implicit negativity in the Valence IRAP, and clinical and non-clinical voice hearers implicitly accepted positive voices and avoided negative voices in the Acceptance IRAP. Furthermore, acceptance of positive voices correlated with high psychological inflexibility, and acceptance of negative voices correlated with overall voice acceptance. The current study demonstrates the utility and precision of the IRAP in this domain, and it is through this precision that we may begin to look at the functional-analytic processes at work in voice hearing experiences.

• Obesity, Food Restriction, and Implicit Attitudes to Healthy and Unhealthy Foods: Lessons Learned from the Implicit Relational Assessment Procedure
Ian McKenna, Maynooth University
Sean Hughes, Ghent University
Dermot Barnes-Holmes, Ghent University
Maarten De Schryver, Ghent University
Ruth Yoder, St. Columcille’s Hospital, Loughlinstown
Donal O'Shea, St. Columcille’s Hospital, Loughlinstown

It has been argued that obese individuals evaluate high caloric, palatable foods more positively than their normal weight peers, and that this positivity bias causes them to consume such foods, even when healthy alternatives are available. Yet when self-reported and automatic food preferences are assessed no such evaluative biases tend to emerge. We argue that situational (food deprivation) and methodological factors may explain why implicit measures often fail to discriminate between the food-evaluations of these two groups. Across three studies we manipulated the food deprivation state of clinically obese and normal-weight participants and then exposed them to an indirect procedure (IRAP) and self-report questionnaires. We found that automatic food-related cognition was moderated by a person’s weight status and food deprivation state. Our findings suggest that the diagnostic and predictive value of implicit measures may be increased when (a) situational moderators are taken into consideration and (b) we pay greater attention to the different ways in which people automatically relate rather than simply categorize food stimuli.

• The Body Image Flexibility Assessment Procedure: Development of a Behavioral Measure of Body Image Flexibility
Emily K. Sandoz, Ph.D., University of Louisiana at Lafayette
Jessica Auzenne, University of Louisiana at Lafayette
Nolan Williams, University of Louisiana at Lafayette
Grayson Butcher, University of Louisiana at Lafayette
Gina Boullion, University of Louisiana at Lafayette

Assessing private events has always presented a challenge to behavior analysis (see Wolf, 1978). Assessing responses to private events (e.g., psychological flexibility and its components) complicates that challenge even further (e.g., Hayes et al., 2004). The Body Image Flexibility Assessment Procedure (BIFAP) was developed as a behavioral measure of psychological flexibility with body image. The BIFAP presents a series of tasks that train, using principles of RFT, body image and values functions to arbitrary stimuli, then assess the flexibility of responding to compound stimuli with body image and values functions. The current series of studies will review the development of the BIFAP along with the convergence between BIFAP performance and two other measures of body image flexibility –a Body Image Implicit Relational Assessment Procedure (IRAP; Barnes-Holmes et al., 2006), which assesses brief immediate relational responses to body image stimuli, and daily self-reported body image flexibility via Ecological Momentary Assessment. Aspects of both divergence and convergence will be discussed in terms of validity of the BIFAP, and the complexity of assessment of private events.

Educational Objectives:
1. Explain what the IRAP can tell us about the separation of implicit fear, approach, and avoidance. 2. Describe a behavioral conceptualization of body image flexibility. 3. Design an IRAP to assess an individual's relationship with food and body image. 4. Describe convergence and divergence among approaches to assessing body image flexibility.

 

90. RFT & Education
Symposium (10:30am-Noon)
Components: Conceptual analysis, Literature review, Original data
Categories: Relational Frame Theory, Edu. Settings, Children, IRAP
Target Audience: Interm.
Location: St. Helens

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

While RFT has seen increasing application to psychological therapy, its potential benefits in remedial education remain largely untapped. This symposium presents three areas of research that attempt to tackle this important gap. The first paper investigates the potential of, and preliminary data from, PEAK -- a comprehensive remedial learning package designed to establish derived relational responding and its precursors in individuals who display deficits in these critical developmental repertoires. The second paper represents one of the first RFT studies to establish problem solving skills in people who do not have them. Problem solving is taught via multiple exemplar training to children with autism. The effects of the intervention are evaluated in a multiple baseline across learners, and although the required duration of training differs across individuals, the treatment is generally effective and results in the generalized ability to solve novel problems. The third paper is one of a small number of IRAP studies conducted with children, and specifically measures psychological flexibility in 10-year olds. The IRAPs assessed attitudes toward happiness and sadness, and whether these emotions were perceived as barriers to performing valued activities. The results show a positive bias toward happiness and an indication that neither emotion is perceived as a barrier, interpreted here as evidence of high psychological flexibility.

• Using RFT to teach higher order language and cognition skills to children with autism
Jacob H. Daar, M.A., Southern Illinois University
Mark R. Dixon, Ph.D., Southern Illinois University

Since its inception, practitioners of behavior analysis have striven to understand all aspects of human behavior. One of the more daunting tasks has been the study of the complex human repertoires of verbal behavior. While some progress has been made in this area, traditional conceptualizations of verbal behavior have yielded few applied successes in producing repertoires that extend beyond the most basic of verbal operants. One contemporary approach, Relational Frame Theory (RFT), provides a promising base for launching behavior analysis into a greater understanding and more effective practice of teaching verbal behavior. The current talk will report upon a series of the studies that sought to establish language skills in children with Autism Spectrum Disorder by establishing and building upon repertoires of arbitrarily applicable derived relational responding. Demonstration of the acquisition of complex skills, such as perspective-taking, temporal referencing, inclusion through hierarchical relations and more, will be presented with an emphasis on teaching procedure, the transfer of non-arbitrary relational training to arbitrarily applicable relations, and program adjustment. Implications for future research and the inclusion of RFT based programming in current early intervention and language acquisition curriculums will be discussed.

• Evaluation of a Relational Frame Theory Approach to Teaching Problem-Solving Skills to Children with Autism
Jonathan Tarbox, FirstSteps for Kids
Lisa Stoddard, FirstSteps for Kids
Ashely Farag, FirstSteps for Kids
Erica Christin, FirstSteps for Kids
Amanda Mury, FirstSteps for Kids

Problem solving is a complex behavior that has been the subject of very little previous behavioral conceptual or empirical research. Skinner defined a problem as a situation in which a consequence would be reinforcing, if only the individual possessed the behavior needed to bring it about. Colloquially speaking, a problem is a situation in which one knows what one wants but one does not know what to do to get it. Skinner suggested that the behaviors one engages in that eventually result in making the effective terminal response available are, themselves, to be considered problem-solving behaviors. Problem solving, then, in large part, involves talking to oneself about potential future behaviors and what their outcomes might be. Put another way, problem solving involves deriving multiple rules about potential future actions and their consequences. Relational Frame Theory (RFT) provides a practical analysis of rule-deriving, based on conditional relating and multiple exemplar training. Despite the utility of this analysis, little to no RFT research of which we are aware has attempted to establish problem solving skills in people who do not have them. Children with autism have documented difficulties with problem solving and could therefore benefit from such research. In the current study, Problem solving was taught via multiple exemplar training to children with autism. The component behaviors include identifying the problem, explaining why it’s a problem, creating multiple possible solutions, selecting the solution most likely to be effective, implementing the solution, self-monitoring the success of the solution, and altering the solution if it is not successful. The effects of the treatment were evaluated in a multiple baseline across learners. The required duration of training differed across individuals but the treatment was generally effective and resulted in the generalized ability to solve novel problems.

• Using the IRAP as a measure of psychological flexibility in children
Gloria Torres-Fernandez, M.Sc., University of Jaén, Spain
Monica Hernandez-Lopez, Ph.D., University of Jaén, Spain
Miguel Rodriguez-Valverde, Ph.D., University of Jaén, Spain

The IRAP is a useful method for the measurement of implicit attitudes in several domains. Nonetheless, there is nearly no published research about its implementation with children. This study explores its applicability for measuring psychological flexibility in 10-year old children. Forty-three participants performed two IRAP tasks. The first one assessed attitudes towards emotions of happiness and sadness; the second one assessed whether these emotions were perceived as barriers to performing valued activities. Participants also completed explicit measures of psychological flexibility (AFQ-8Y) and emotional intelligence (EQi-YV). Results show a positive bias towards happiness with the first IRAP. The second IRAP shows no evidence of bias (neither being happy nor being sad were perceived as barriers for performing valued activities). The results from IRAP 2 can be interpreted as indicative of a high degree of psychological flexibility, although they do not correlate with AFQ-8Y scores. These findings point to the IRAP as a potentially useful tool to investigate psychological flexibility.

Educational Objectives:
1. Describe an RFT analysis of problem solving behavior as rule deriving. 2. Describe Skinner's behavioral conceptual analysis of problems and problem solving. 3. Describe an RFT-based intervention to teach children problem solving skills.

 

92. Analyses of the relational processes that improve the effect of metaphors and defusion exercises
Symposium (10:30am-Noon)
Components: Conceptual analysis, Original data
Categories: Relational Frame Theory, Clin. Interven. & Interests, Metaphors, Defusion
Target Audience: Beg., Interm., Adv.
Location: Cascade 1B

Chair: María Belén García-Martín, Fundación Universitaria Konrad Lorenz
Discussant: Carmen Luciano, Universidad de Almería

Research based on relational frame theory (RFT) can be very useful to improve the effect of the techniques used in acceptance and commitment therapy (ACT) such as metaphors and defusion exercises. The current symposium presents studies that try to advance in this direction. The first study shows an analogue study with a pain tolerance task. The main independent variable was the presence or absence of common physical properties to the discomfort experienced during the task in a metaphor that highlighted the benefit of tolerating pain in order to advance in a valued direction. The second study shows the result of a brief ACT protocol with physicalized metaphors versus the same protocol without physicalizing the metaphors. Lastly, the third study presents an experimental analysis of the transformations of functions involved in defusion exercises using the performance on an attentional task as the dependent variable.

• Increasing the effect of metaphors by including common physical properties with the discomfort
Marco Sierra, Fundación Universitaria Konrad Lorenz
Lorena Flórez, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Diana Riaño-Hernández, Fundación Universitaria Konrad Lorenz
Carmen Luciano, Universidad de Almería

This study aims to extend the findings of the basic relational frame theory (RFT) study by Ruiz and Luciano (2015) concerning analogy aptness. These authors found that analogies with common physical properties (CMP) were considered as more apt than purely relational analogies. In this study we try to advance in the clinical implication of the previous finding by designing an analogue study using the cold-pressor as a pain tolerance task. Eighty participants were exposed to a pre-intervention cold-pressor task and then were randomly assigned to four conditions: (1) a metaphor involving personal values and CMP with the discomfort experienced during the task, (2) a metaphor with values but without CMP, (3) a metaphor without values and with CMP, (4) a metaphor without values and without CMP. Subsequently, participants were re-exposed to the cold-pressor task. Results will be discussed highlighting the promotion of metaphor efficacy by incorporating CMP.

• Do we need to physicalize metaphors?: An experimental study with a 1-session ACT protocol
Lorena Flórez, Fundación Universitaria Konrad Lorenz
Marco Sierra, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Diana Riaño-Hernández, Fundación Universitaria Konrad Lorenz
María Belén García-Martín, Fundación Universitaria Konrad Lorenz
Katherine Barreto, Fundación Universitaria Konrad Lorenz

Metaphors are a widely used clinical tool in acceptance and commitment therapy (ACT). However, the analysis of the metaphor elements that potentiate their effect is still scarce. One guideline that is often provided in ACT books and workshop is that physicalize metaphors can improve their effect. This study aims to analyze this point by applying two almost identical 1-session ACT protocols: one that only introduced metaphors verbally and one that introduced the same metaphors in a physical way. Thirty participants suffering from mild to moderate emotional symptoms and dysfunctional worry and rumination were recruited. The ACT protocols were based on the 1-session protocol conducted by Ruiz, Riaño-Hernández, Suárez-Falcón, and Luciano (2016) and focused on reducing worry and rumination levels. Primary outcomes were measure of repetitive negative thinking and emotional symptoms, whereas process measures included experiential avoidance, cognitive fusion, and valued actions.

• The effects of different types of relational framing in defusion interactions on attentional performance
Juan C. López-López, Universidad de Almería
Carmen Luciano, Universidad de Almería

The current study aimed to analyze the effects of the relational framings involved in defusion on attentional performance. Fifty-two participants completed several questionnaires and two experimental tasks which induced discomfort (pre-test). Then, they were randomly assigned to one of the following conditions: (a) Defusion I, where participants received a protocol based on framing own behavior in distinction with the deictic ’I’, (b) Defusion II also included the hierarchical framing, (c) Defusion III added the regulatory functions, (d) Defusion IV included the discrimination of defused behaviors, and (e) Control, which did not include any active component. Finally, participants were re-exposed to the experimental tasks (post-test). Results indicate that all participants’ performance increased after the intervention. However Defusion III and IV showed better results than Control condition and Defusion I and only Defusion IV showed superiority to Defusion II. The relevance of these data is discussed in terms of improving defusion interactions.

Educational Objectives:
1. Explain the potential of RFT research to improve the effect of techniques used in ACT. 2. Describe some of the relational processes responsible for the effect of metaphors according to RFT. 3. Explain the relational processes underlying the effect of defusion exercises.

 

96. Delivering ACT in Technology-Based Formats: Outcomes, Processes, and Provider Attitudes
Symposium (10:30am-Noon)
Components: Original data
Categories: Clinical Interventions and Interests, Technology
Target Audience: Interm.,
Location: Puget Sound

Chair: Kristy Dalrymple, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Discussant: Roger Vilardaga, Ph.D., University of Washington

Research in recent years has explored internet and mobile technology interventions as treatment options to address logistical barriers to effective treatment (Barak et al., 2008). For example, these delivery formats may be more cost-effective, reduce the risk of dropout (Hedman et al., 2011), improve adherence rates (Andersson, 2009; Carlbring et al., 2011), address varied learning styles and education levels, and provide ongoing opportunities for independent skill learning and application. Thus far, ACT-based internet and mobile interventions have demonstrated efficacy, but additional research in this area is needed to refine them and maximize their “reach.” The first presentation will discuss the development and initial outcomes of a brief, values-based internet-delivered adjunctive program for depression and anxiety. The second will present results from a smartphone-based just-in-time adaptive intervention for adherence to a weight loss diet. The third will discuss results from an ACBS member survey assessing therapist attitudes towards ACT-based mobile apps.

• Development of a Brief, Values-Based Online Adjunctive Intervention for Depression and Anxiety
Kristy Dalrymple, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Michael Levin, Ph.D., Utah State University
Jack Haeger, B.A., Utah State University
Emily Walsh, B.A., Rhode Island Hospital
Lia Rosenstein, B.A., Rhode Island Hospital
Brandon Gaudiano, Ph.D., Butler Hospital; Alpert Medical School of Brown University

Many studies have examined online treatments as primary therapeutic programs, but few have examined their use as adjunctive treatments in routine clinical practice. Some data suggest a stronger effect when they are used as adjunctive treatments compared to primary programs (Spek et al., 2007). Internet-based ACT treatments have shown efficacy in the treatment of a variety of problems, and have proven to be a viable therapeutic option (e.g., Lappalainen et al., 2013; Bricker et al., 2013). The aim of the present study is to develop and pilot test a 4-session values-based online program as an adjunctive treatment for depression and anxiety in routine clinical practice settings. Sixteen participants have been enrolled thus far, with data collection ongoing. Changes in depression and anxiety symptoms, valued living, and psychological flexibility over the 4 sessions will be presented. Additional results (e.g., acceptability/feasibility), limitations, and implications of the findings will be discussed.

• A Preliminary Investigation of a Just-In-Time Smartphone Application to Promote Dietary Adherence
Stephanie P. Goldstein, B.S., Drexel University
Evan Forman, Ph.D., Drexel University
Brittney C. Evans, Drexel University
Stephanie M. Manasse, Drexel University
Adrienne S. Juarascio, Ph.D., Drexel University
Meghan L. Butryn, Ph.D., Drexel University

Lack of success in weight loss programs can be attributed to poor adherence to dietary recommendations, i.e., dietary lapses. As such, we have set out to create a smartphone-based system, called DietAlert that utilizes machine learning to predict lapse behavior and deliver tailored, momentary interventions. Preliminary quantitative and qualitative results suggest that participants (current n=12) were highly satisfied with the app (M=6.42/7.00) and felt that it enhanced awareness of behaviors contributing to lapses. Currently 159 interactive interventions have been developed based on principles of acceptance and commitment therapy, dialectical behavior therapy, social cognitive theory, and the transtheoretical model of behavior change. Clarity, satisfaction and preliminary effectiveness of the intervention-capable app will be presented. Overall, results will be used to evaluate the potential of DietAlert and similar systems to meaningfully improve weight loss and other health behaviors.

• Use, preferences, and barriers with ACT-related mobile apps: Results from a survey of ACBS members
Michael E. Levin, Ph.D., Utah State University
Benjamin Pierce, Utah State University
Michael Twohig, Ph.D., Utah State University

The use of mobile apps to support mental health care is a growing trend and several ACT-related mobile apps have recently been developed. However, little is known about the use, attitudes, and needs of mental health providers in using ACT-related mobile apps. An improved understanding could inform more effective development, dissemination and implementation of ACT-related apps in clinical work. The current survey study assessed 356 ACBS members regarding their use, interest, preferences and barriers to using ACT-related mobile apps. Results suggest participants were not familiar with (65%) and rarely used these apps with clients (65%). However, the vast majority (93%) were interested in using ACT apps. Patterns were identified in terms of highly and poorly rated app features/functions as well as barriers to app use (e.g., lack of guidelines, ethical concerns, privacy). Results of the survey are discussed in the context of ongoing development and implementation efforts with ACT-related apps.

Educational Objectives:
1. Describe the development and preliminary results of a brief, values-based online adjunctive intervention for depression and anxiety in routine clinical practi. 2. Describe the phases of development for a just-in-time smartphone application that promotes dietary adherence and use this knowledge to develop similar smartphone apps for other health behaviors. 3. Explain barriers and facilitators to using ACT-related mobile apps in clinical work.

 

97. Building an Empirical Bridge: Linking Technique to Evaluation in Applications of the Matrix: Mexico Chapter Sponsored
Symposium (10:30am-Noon)
Components: Original data
Categories: Clinical Interventions and Interests, The Matrix, Research Design
Target Audience: Interm., Adv.
Location: Pike

Chair: Benjamin Pierce, M.S., Utah State University
Discussant: XXX,

The Matrix (Polk & Schoendorff, 2014) has emerged as a popular experiential clinical model among ACT therapists and practitioners, yet has received little research attention may be because its recent dissemination. Despite a variety of applications among clinicians, coaches, and consultants, the extent to which the Matrix improves outcomes as a stand-alone or adjunctive intervention remains unclear from an empirical standpoint. Further, there exist few recommendations for how to track client progress with a Matrix-based intervention, or incorporate the Matrix into a research paradigm. Therefore, this symposium presents diverse applications of the Matrix and methods for studying it in clinical and coaching applications. It attempts to bridge the gap between the technique and empirical evaluation by providing a range of examples of how to study the Matrix in practice settings. Further, it discusses the promise and challenges of conducting applied research with the Matrix model.

• Testing the Matrix as an Enhancement of ACT for People Diagnosed with BPD
Michel Reyes, Ph.D., Contextual Behavioral Science and Therapy Institute (Mexico City)
Benjamin Schoendorff, M.A., MSc., M.Ps., Contextual Psychology Institute (Quebec)
Nathalia Vargas, Psy.D., Contextual Behavioral Science and Therapy Institute (Mexico City)
Edgar Miranda Terres, MPs, CBS and Therapy Institute, Mexico City; Mexico's National Institute of Psychiatry (INPRF)
Arango, I., Mexico National Institute of Psychiatry

A pre-posttest with six months follow RCT (n=71) was conducted to test ACT Matrix clinical value as an addition to an already tested traditional ACT treatment for BPD diagnosed clients. The study consisted of two group´s receiving ACT (n=34) or ACT+Matrix (n=37) treatment. T test analysis showed statistically significant p ≤ .05) and large size effects (d ≥ .80) improvements in posttest and follow up scores compared to prestest in BPD symptom severity, psychological flexibility, emotion regulation and self-stability self-administered questionnaires. T test between groups showed statistically significant and large size effects in favor of ACT+Matrix group at posttest and follow up. Mediation analysis indicate that psychological flexibility mediated change in BPD symptoms in both groups. This results suggest Act Matrix significantly enhanced classic ACT impact, and provides evidence of ACT Matrix clinical value as a functional contextualist tool that improves psychological flexibility.

• Developing an “easy to use” visual analysis of clinical data using the Matrix
Fabián Olaz, Psy.D., Integral Center of Contextual Psychoterapies, Cordoba, Argentina

Currently, many clinicians have chosen to integrate different interventions into matrix work noticing their clients becoming more engaged and interventions becoming simpler. Olaz (in preparation) developed a simple protocol using a special worksheet developed by Schoendorff to work with depressive clients doing Behavioral Activation. I this presentation I will show an evidence-based procedure to conduct visual analyses of single-subject data using the Matrix. Specifically, I will show the results of a N=1 (ABAB) design carried out to provide evidence of a Matrix based Behavioral Activation intervention for a male client, with depressive symptomatology. Taking into consideration that visual analysis of data is the basis of single-subject research participants will learn an easy way to make visual representations and will be able to apply this procedure to their clients and to continue this Matrix research trend in clinical settings.

• Prompting the “Away-Towards” Distinction in Matrix-Based Health Behavior Change
Benjamin Pierce, M.S., Utah State University
Michael E. Levin, Ph. D., Utah State University
Benjamin Schoendorff, M.A., M.Sc., M.Ps., Contextual Psychology Institute (Quebec)

The Matrix was developed as a way to succinctly demonstrate core concepts in Acceptance and Commitment Therapy (ACT). One of these concepts is the distinction between behaviors intended to move “towards” values versus “away” from unwanted inner experiences. Despite its centrality to the Matrix, scant research has examined whether the “away-towards” distinction helps people make values-consistent choices or fosters psychological flexibility. Therefore, this study examined the utility of prompting “away-towards” discrimination in a Matrix-based coaching intervention for health behavior change. The coaching paradigm with app-based prompting will be presented, along with the results of ecological momentary intervention (EMI) data from a mixed college student and community sample. The implications of the study findings for understanding mechanisms of change within Matrix-based interventions will be discussed. Recommendations for ecologically prompting ACT processes using Matrix will be provided.

Educational Objectives:
1. Provide a variety of examples of how to monitor client progress using the ACT Matrix from diverse applications. 2. Describe current approaches to studying the Matrix from diverse methodologies and in diverse applied settings. 3. Identify possible benefits and challenges associated with conducting research on the Matrix.

 

99. Which Skills for Whom?: Identifying and Applying Mindfulness Skills in Diverse Populations
Symposium (10:30am-Noon)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Mindfulness, Meditation
Target Audience: Beg., Interm., Adv.
Location: Mercer/Denny

Chair: Brian Pilecki, Rhode Island Hospital; Alpert Medical School of Brown University
Discussant: Dennis Tirch, The Center for Compassion Focused Therapy

Mindfulness-based treatments (MBTs) are increasingly popular for a range of medical and psychiatric problems. They have shown to provide efficacious and effective treatment, particularly for anxiety and depression (Hofmann et al., 2010) but also for overall well-being (Carmody & Baer, 2008). However, there is no consensus regarding the definition of mindfulness, which may comprise several facets or processes. This impacts both researchers—whose outcomes may be obfuscated by poor measurement/definitions—and clinicians, who may struggle to clarify targets of change. This symposium presents three investigations into specific mindfulness components across diverse populations. The first presents concurrent analyses of mindfulness skills, symptoms, and impairment in psychiatric and medical outpatients. The second presents results from an acute-care setting, assessing characteristics and treatment outcomes in patients choosing to attend meditation groups. The final presents results of an innovative mindfulness-based intervention targeting self-care in healthy adults and its impact on different aspects of mindfulness.

• Concurrent relations between mindfulness processes, psychiatric symptoms, and functioning in psychiatric and pre-bariatric surgery outpatients
Theresa A. Morgan, Rhode Island Hospital; Alpert Medical School of Brown University
Kristy Dalrymple, Rhode Island Hospital; Alpert Medical School of Brown University
Brian Pilecki, Rhode Island Hospital; Alpert Medical School of Brown University
Catherine D'Avanzato, Rhode Island Hospital; Alpert Medical School of Brown University
Kirsten Langdon, Rhode Island Hospital; Alpert Medical School of Brown University
Darren Holowka, Ph.D., Rhode Island Hospital; Alpert Medical School of Brown University
Mark Zimmerman, Rhode Island Hospital; Alpert Medical School of Brown University

Links between (1) mindfulness and psychiatric symptoms and (2) mindfulness and functioning are well-established. However, few studies examine unique contributions of mindfulness to symptoms and functioning concurrently. A single exception assessed this model only in alcohol use (Fernandez et al., 2010). We present results analyzing concurrent relations between symptoms, functioning, and mindfulness processes in two transdiagnostic samples. Participants included 1099 psychiatric outpatients and 1820 bariatric surgery candidates, each of whom completed the Five-Facet Mindfulness Questionnaire (FFMQ) as well as established measures of symptoms and psychosocial functioning. Results showed that four of five mindfulness facets (Observe, Act with Awareness, Nonjudge, Nonreact) related to symptoms and functioning in both samples. However, direct and indirect effects modeled varied between samples, suggesting differential import of mindfulness skills in each group. The fifth scale (Describe) was dropped from both models. Additional findings, limitations, and implications for the conceptualization and assessment of mindfulness will be discussed.

• Initial Results of a Daily Meditation Group for Patients in an ACT-Based Intensive Partial Care Program
Brian Pilecki, Rhode Island Hospital; Alpert Medical School of Brown University
Theresa A. Morgan, Rhode Island Hospital; Alpert Medical School of Brown University
Matthew Multach, Rhode Island Hospital
Kristy Dalrymple, Rhode Island Hospital; Alpert Medical School of Brown University
Catherine D'Avanzato, Rhode Island Hospital; Alpert Medical School of Brown University
Darren Holowka, Rhode Island Hospital; Alpert Medical School of Brown University
Mark Zimmerman, Rhode Island Hospital; Alpert Medical School of Brown University

An optional meditation group was offered to patients in an ACT-based partial hospitalization program. Adapting meditation to this severe population will be discussed, as well results related to satisfaction and acceptability. Demographic differences between patients who choose to attend will be discussed, suggesting which types of patients may mostly benefit from mindfulness training. Preliminary results show trends towards being female (78.95) and having attended at least some college (79.2%). Differences between attending and non-attending patients will show whether daily meditation has an incremental impact mindfulness skills that relate to improved treatment outcomes. Preliminary results of 107 patients suggest that despite equal baseline scores, patients who attended the meditation group had higher scores on the FFMQ (Baer et al., 2006) subscale of observing (3.1) and nonreacting (2.4) than patients who did not attend (2.7;2.0; t = -2.66, p = .01; t = -2.3, p =.03).

• The Effectiveness of a Mind-Body Training to Foster Self-Care in Health Professionals
Myriam Rudaz, Utah State University
Brooke Smith, Utah State University
Sarah Potts, Utah State University
Michael Levin, Utah State University
Michael Twohig, Utah State University

Although working as a health professional can lead to satisfaction, health professionals are also vulnerable to develop compassion fatigue and burnout. We present preliminary result of graduate students in applied programs that were randomly assigned to either a brief mind-body training using Mindfulness-Based Stress Reduction (MBSR) and values-oriented Acceptance and Commitment Therapy (ACT) or to a waitlist control group. The training consisted of one mind-body day and four booster sessions over the course of four weeks. In addition, participants were invited to use a mindfulness or values mobile app. Self-reported questionnaires measuring five aspects of mindfulness (observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience), self-care, stress, burnout, compassion fatigue/satisfaction, self-compassion, and acceptance were administered at three time points: before the mind-body day, 4 weeks after, and 8 weeks after the mind-body day. The results will be discussed in the light of feasibility and acceptance of the mind-body training for health professionals as well as which aspects of mindfulness seem to be most relevant for this population.

Educational Objectives:
1. Explain conceptual and methodological limitations in studying mindfulness. 2. Demonstrate a greater understanding of issues in adapting mindfulness-based interventions to specific populations. 3. Describe examples of future research studies needed in helping to further clarify the multi-faceted nature of mindfulness skills.

 

104. Eating Disorder Interventions
Symposium (2:45-4:15pm)
Components: Original data
Categories: Clinical Interventions and Interests, Beh. med., Anorexia Nervosa, Eating Disorders
Target Audience: Beg., Interm., Adv.
Location: Vashon 1

Chair: Ashley A. Moskovich, Ph.D., Duke University Medical Center
Discussant: Adria Pearson-Mauro, PhD, University of Colorado, Denver

Eating disorders and efforts to control weight are major issues for our population. These studies will discuss findings on two groups who struggle with these issues – people with Anorexia Nervosa and people with Type 1 Diabetes (T1D). Anorexia Nervosa (AN) is one of the deadliest psychiatric conditions and is extremely challenging to treat. According to a contextual approach, rigid rule-following might be a significant factor in the behavior of those with AN. We present data from a study on the relationship between insensitivity to contingencies and tolerance of uncertainty in adults weight-recovered from AN. In another study, we examined the effect of an ACT-based family treatment for adolescents with AN with particular attention to psychological flexibility and anxiety reduction as processes of change in adolescent and parent behavior. We also present data from studies on the impact of negative affect, distress, and avoidance related to Type 1 Diabetes (T1D) and eating disorders and proper insulin administration. We describe how we are translating these findings into an ACT-based mobile intervention to improve management in the natural environment as well as how these findings might inform practice within endocrinology clinics to reduce the incidence of EDs in this vulnerable population.

• Diabetes Distress and Avoidance: Key Contributors to Life-Threatening Eating Disorders in Type 1 Diabetes
Ashley A. Moskovich, Ph.D., Duke University Medical Center
Natalia O. Dmitrieva, Ph.D., Northern Arizona University
Nancy L. Zucker, Ph.D., Duke University Medical Center
Lisa K. Honeycutt, M.A., Duke University Medical Center
Rhonda M. Merwin, Ph.D., Duke University Medical Center

Eating disorders (EDs) are common among young women with type 1 diabetes (T1D) and incur 3-fold increased risk of early and severe diabetes-related medical complications and premature death (1-2). Studies indicate EDs in T1D do not respond optimally to conventional ED treatments (3), suggesting unique contributory factors that are not adequately addressed with extant treatments. T1D is an autoimmune disorder in which individuals survive by self-administering insulin based on current blood sugar and insulin-to-carbohydrate ratios. This is an inherently imprecise system that incurs health consequences irrespective of how well it is implemented. Among individuals with T1D, ED symptoms may function to manage distress related to living with a chronic illness in which there is little certainty or control over negative outcomes. Eighty-three adults (63 with EDs and 20 T1D controls) completed a comprehensive assessment battery, including 28-day retrospective recall of ED symptom frequency and 3 days of momentary assessment in the natural environment. We conducted a series of theoretically driven tests to identify factors accounting for the greatest variance in ED symptom severity, including traditional predictors of EDs (e.g., perfectionism) and diabetes-specific factors (diabetes distress and avoidance). Diabetes distress and avoidance were the strongest predictors, accounting for 56% variance in ED symptomatology over the past 28 days, 38% variance in metabolic control and 11-38% variance in frequency of binge eating and insulin restriction for weight loss over the 3-day period (ps< .05). We describe how these findings might inform practice within endocrinology clinics to reduce the incidence of EDs in this vulnerable population. (5R01 DK-089329-03, Merwin).

• Rigid Rule-following and Intolerance of Uncertainty in Anorexia Nervosa
Ashley A. Moskovich, Ph.D., Duke University Medical Center
Rhonda M. Merwin, Ph.D., Duke University Medical Center
Nancy L. Zucker, Ph.D., Duke University Medical Center

Anorexia nervosa (AN) is characterized by rigid rule-following (e.g., calorie limits) despite negative and potentially life-threatening outcomes (1). A neuropsychological account attributes this rigidity to neurocognitive deficits in cognitive flexibility (i.e., the inability to shift mental sets) (2). The current paper presents data suggesting that rigid adherence to rules in AN may be formulated as avoidant behavior that emerges in contexts of uncertainty. We administered the Wisconsin Card Sorting Task (WCST) to 36 adults weight-recovered from AN (AN-WR) and 38 control participants (CN). The WCST requires individuals to formulate rules (e.g., sort according to shape) and then adjust their rules in response to task contingencies. We tested the relationship between perseverative errors (i.e., failure to adjust to new contingencies) and intolerance of uncertainty. As expected, the AN-WR group made a greater number of perseverative errors relative to the CN group (p<.01). Perseverative errors were related to intolerance of uncertainty exclusively in the AN-WR group (p<.05). Findings suggest that individuals with AN may rigidly adhere to rules as a way to decrease the experience of uncertainty, but that this in turn decreases sensitivity to environmental feedback. Individuals with AN may therefore benefit from targeted interventions that increase behavioral flexibility in the presence of uncertainty.

• Psychological Flexibility as a Process of Change in the Treatment of Anorexia Nervosa
Rhonda M. Merwin, Ph.D., Duke University Medical Center
Ashley A. Moskovich, Ph.D., Duke University Medical Center
Lisa K. Honeycutt, M.A., Duke University Medical Center
Nancy L. Zucker, Ph.D., Duke University Medical Center
James D. Herbert, Ph.D., Drexel University
C. Alix Timko, Ph.D., Children's Hospital of Philadelphia
Natalia O. Dmitrieva, Ph.D., Northern Arizona University

Anorexia nervosa (AN) is the deadliest of the psychiatric conditions and remains one of the most challenging to treat (1). Outcomes have improved over the last 20 years with family based treatment (FBT), but only half the adolescents treated achieve full remission (2). This has resulted in augmentation of FBT in effort to potentiate treatment effects (3-4). However, treatment augmentations are occurring largely in the absence of data on the processes by which individuals with AN improve. We describe a series of analyses examining processes of change among adolescents with AN treated with an ACT-based family treatment. Forty-seven adolescents completed 6 months of treatment and 3 months of follow-up. We tested an increase in psychological flexibility and a decrease in anxiety (over the course of treatment) as competing hypotheses of processes of change in adolescent AN, and examined relative contribution of change in the adolescent versus change in the parents in predicting outcomes. An increase in adolescent psychological flexibility over the course of treatment predicted decreased AN symptomatology at post-treatment (ps< .05), with a similar trend at follow-up. An increase in mother psychological flexibility accounted for additional variance in adolescents’ eating concerns and predicted lower levels of parent expressed emotion (known to be associated with poor prognosis) (5-6) at end-of-treatment (ps<.05). Decreases in parent or child anxiety, in contrast, were less consistently associated with outcomes and accounted for less variance in AN symptoms.

• Using Mobile Technology to Reach Individuals with Type 1 Diabetes Intentionally Withholding Insulin to Lose Weight
Rhonda M. Merwin, Ph.D., Duke University Medical Center
Natalia O. Dmitrieva, Ph.D., Northern Arizona University
Ashley A. Moskovich, Ph.D., Duke University Medical Center
Lisa K. Honeycutt, M.A., Duke University Medical Center
Nancy L. Zucker, Ph.D., Duke University Medical Center
Richard S. Surwit, Ph.D., Duke University Medical Center
Mark Feinglos, MD, Duke University Medical Center

Individuals with type 1 diabetes (T1D) who restrict insulin to control weight are at high risk for diabetes-related complications and premature death (1-3). However, little is known about this behavior or how to effectively intervene. We used ecological momentary assessment (EMA) methods to identify real time precursors to intentional insulin restriction among 83 individuals with T1D. Participants reported emotions, eating, and insulin dosing throughout the day using their cellular telephone. Linear mixed models were used to estimate the effects of heightened negative affect (e.g., anxiety) prior to eating and characteristics of eating episode on risk of insulin restriction. Individual differences in average negative affect impacted the likelihood of restricting insulin such that a one unit increase in average negative affect above the sample mean more than quadrupled the odds of insulin restriction (OR, 6.77; p<0.01). Momentary increases in anxiety and guilt/disgust 60 minutes prior to eating further increased odds of restricting insulin at the upcoming meal (OR, 1.72–1.84; ps<.05). Insulin restriction was more likely when individuals reported that they broke a dietary rule (e.g., “No desserts.”) (OR, 11.07; p<.001). Results suggest that insulin restriction might be decreased by helping T1D patients respond effectively to heightened negative affect and encouraging patients to take a less rigid, punitive approach to diabetes management. We describe how we are translating these findings into an ACT-based mobile intervention to improve management in the natural environment (5R01 DK-089329-03, Merwin; 1 R21 DK106603-01; Merwin).

Educational Objectives:
1. Describe neurocognitive differences observed among individuals with anorexia nervosa (e.g., deficits in set-shifting) behaviorally. 2. Discuss how psychological flexibility as a process of change may inform the continued evolution of family-based treatment in adolescent anorexia nervosa. 3. Describe how findings are being translated into an ACT-based mobile intervention to reduce insulin restriction for weight control in the natural environment.

 

105. To blend or not to blend: Advantages of mixing ACT with new technologies
Symposium (2:45-4:15pm)
Components: ,Didactic presentation
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Beh. med., Technology
Target Audience: Beg., Interm., Adv.
Location: Vashon 2

Chair: Ellen Excelmans, Psy.D., Learn2ACT, Belgium
Discussant: Michael E. Levin, Ph.D., Utah State University, Logan, Utah

Technology permeates our world: in a relatively short period of time, the internet, smartphones, and tablets have become an essential part of our lives. It is therefore not surprising that these new technologies have also started to play a significant role in mental health care. The possibilities are enormous and many of our clients are ready for change. To the ACT-therapist, however, the added value of these new technologies is not always clear. Technology surely can’t replace the therapist, but blending technology with our therapeutic work has it’s benefits. Furthermore, when direct therapy isn’t an option due to perceived stigma or logistical barriers, technology can provide an alternative method for intervention. In this symposium we present four mobile applications developed by and for ACT-therapists. We examine how these apps can enrich our therapeutic work, provide support to individuals outside of the therapy room, and also reflect on their limitations.

• Learn to Quit: Rationale, ideation, design and testing of a smoking cessation app for people with psychiatric disorders
Roger Vilardarga, Ph.D., University of Washington, Department of Psychiatry and Behavioral Sciences
Javier Rizo, B.A., Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
Emily Zeng, B.A., Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
Julie A. Kientz, Ph.D., Department of Human Centered Design and Engineering, University of Washington, Seattle, WA
Brian Marr, MBA, Smashing Ideas, Seattle, WA
Chad Otis, B.A., Smashing Ideas, Seattle, WA
Richard Ries, MD, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA

Smoking rates in the US have been reduced in the last decades to 17% of the general population. However, up to 88% of people with psychiatric symptoms still smoke, leading up to high rates of disease and mortality. Therefore, there is a great need to develop smoking cessation interventions that are inexpensive, have high reach and can be used in conjunction with health providers. Contextual behavioral science and digital technology design can be leveraged together to address this need. In this presentation we report the rationale, ideation, design and testing of a novel smoking cessation app for people with a diagnosis of schizophrenia, schizoaffective and bipolar disorder, and chronic recurrent depression. With the collaboration of Smashing Ideas, a leading partner in the design of digital experiences, we will describe the development of Learn to Quit, an ACT smoking cessation app that promotes quitting through Learning, Practice and Play. Funding: National Institute of Drug Abuse (1K99DA037276-01) to RV

• Learn2ACT: A 'handy' life compass
Ellen Excelmans, Psy.D., Learn2ACT, Belgium
Bart Roelands, M.E., Learn2ACT, Belgium
Richard Ries, MD, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA

Learn2ACT was developed as an answer to certain needs in our clinical practice. We were looking for a way to help our clients work on what they've learned in therapy outside the therapy room. A mobile app seemed the solution. It provides the oppurtinity to monitor and intervene in-time and in-place. We will present the functionalities of Learn2ACT and show some premilinary research data. In our research we examined the added value of the Learn2ACT app to the satisfaction and the effectiveness of an ACT group treatment. Participants of ACT groups from three mental health care services in Flanders took part in the study. A pre- and post-assessment of quality of life and psychological flexibility (OQ-45, VLQ and FIT-60) was conducted. We found that people with a positive attitude towards technology benefit the most from the app. mHealth seems to be a virtual food for someone who's hungry.

• Using mobile technology to augment therapy and provide self-help: Preliminary research findings with the ACT Daily mobile app
Jack A. Haeger, B.A., Utah State University, Logan, Utah
Michael E. Levin, Ph.D., Utah State University, Logan, Utah

Mobile applications are a promising technology for improving mental health services. These programs are readily available throughout the day, provide a convenient system to monitor and prompt skill use, and can tailor content based on clients’ responses. Thus, a mobile app could be used to integrate a high frequency/low intensity skill coaching program into clients’ daily life. In response, we developed ACT Daily, a prototype mobile app that utilizes an ecological momentary intervention design that prompts the user throughout the day to check-in with distress levels and ACT processes, followed by a recommended tailored intervention based on check-in data. Results will be presented on three studies: 1) ACT Daily as an adjunct to face-to-face ACT therapy, 2) self-guided ACT Daily as a support for individuals on a college counseling center waitlist, and 3) RCT comparing self-guided ACT Daily to a waitlist condition with depressed and/or anxious college students.

• Understanding Requirements for Self-Experimentation to Tailor the Effectiveness of Mobile Interventions for Smoking Cessation
Arpita Bhattacharya, M.S., Dept. of Human Centered Design and Engineering, University of Washington, Seattle, WA
Sean A. Munson, Ph.D., Dept. of Human Centered Design and Engineering, University of Washington, Seattle, WA
Roger Vilardaga, Ph.D., Dept. of Psychiatry and Behavioral Science, University of Washington, Seattle, WA
Julie A. Kientz, Ph.D., Dept. of Human Centered Design and Engineering, University of Washington, Seattle, WA
James Fogarty, Ph.D., Dept. of Human Centered Design and Engineering, University of Washington, Seattle, WA
Jasmine Zia, MD, Division of Internal Medicine, University of Washington, Seattle, UW

Quitting smoking can be better supported with provider expertise and guidance. However, strategies that work for one individual might not work for others. Trying strategies unsystematically can lead to inconclusive results and client burden. A mobile application that walks participants through a systematic process of self-experimentation could address this need. We interviewed 28 providers to understand their smoking cessation counseling experience and obtained their feedback on low fidelity prototypes of a smoking cessation mobile application based on the concept of self-experimentation. We analyzed these interviews to identify design requirements for the application to support expertise of providers in various behavioral strategies such as ACT. Providers emphasized the need for an individualized approach to counselling and enabling clients with a tool to evaluate interventions systematically based on their own tracking data. Findings from this study will inform the design of a framework for self-experimentation that individualizes support for smoking cessation. Funding: 2015 UW Innovation Award to AB, SM, JK, and RV; NIDA (1K99DA037276-01) to RV.

Educational Objectives:
1. Describe the design and the development process of four ACT applications. 2. Apply ACT applications in therapy. 3. Explain the added value of using apps in combination with therapy and explore how apps can be used outside of therapy in a self-help format.

 

108. Substance Use and CBS
Symposium (2:45-4:15pm)
Components: Conceptual analysis, Literature review, Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Theory & Philo., RFT, Mindfulness, Motivational Interviewing, Substance Abuse
Target Audience: Beg., Interm., Adv.
Location: Cascade 1B

Chair: Aaron L. Bergman, M.A., M.S., Pacific University
Discussant: Don Sheeley, M.D.,

Substance abuse presents a significant economic and public health burden. To address this growing crisis, further development and understanding of effective treatment approaches are needed. Relapse following treatment for substance use disorders is highly prevalent, and craving has been shown to be a primary predictor of relapse. The results from a Mindfulness-based Relapse Prevention intervention on the relationship between cravings and relapse will be presented. In addition, data from a study examining the role of psychological flexibility and specific facets of mindfulness in predicting cravings will be discussed. Another issue in substance abuse is faced by parents struggling with a substance using child face a dearth of evidence-based practitioners and resources at a moment of tremendous need, leaving them few reasonable options. We will discuss the development of a Parent-to-Parent “shared experience” national coaching network based on the research-supported principles embedded in Motivational Interviewing (MI) and Community Reinforcement and Family Therapy (CRAFT) and present pilot data from 50 coaching cases. Last, a conceptual paper exploring the refinement of MI technology over time and accounting for them in relational frame theory (RFT) terms to show where MI is consistent or inconsistent with other CBS approaches will be presented including suggestions for increasing harmony between the two.

• Clarifying the Relationship Between Substance Craving, Mindfulness, and Psychological Flexibility
Aaron L. Bergman, M.A., M.S., Pacific University
Josh Kaplan, B.A., Pacific University
Michael Christopher, Ph.D., Pacific University
Sarah Bowen, Ph.D., Pacific University

Substance abuse presents a significant economic and public health burden. To address this growing crisis, further development and understanding of effective treatment approaches are needed. Interventions intended to increase psychological flexibility and mindfulness have demonstrated promising outcomes in addictions treatment. Psychological flexibility and mindfulness appear conceptually related, both demonstrating meditating roles between treatment and outcomes across contexts. The current study attempted to clarify the relationship between psychological flexibility and mindfulness by examining how these constructs predict craving, a primary predictor of relapse. Hierarchical liner regressions suggested mindfulness was significantly negatively associated with craving (β=-.29, p < .001), but psychological flexibility only yielded a trend-level relationship (β = .10, p=.07). Subsequent regression models examined specific facets of mindfulness. Results demonstrated Acting with Awareness (β=-.31, p < .001) and Non-reactivity (β = -.15, p=.015) accounted for variance in craving, while psychological flexibility did not (β = .07, p = .280). These findings suggest that mindful awareness and non-reactivity should be a central target for addiction intervention, above and beyond psychological flexibility. Clinical implications are discussed.

• Combining Shared Experience and Evidence-Based Models In Addiction: Development of a Parent-to-Parent Coaching Network
Jeff Foote, Ph.D., Center For Motivation and Change

Parents struggling with a substance using child face a dearth of evidence-based practitioners and resources at a moment of tremendous need, leaving them few reasonable options. “Self-help” options (typically 12-Step “Anon” programs) can provide support, but offer little in the way of evidence-based understandings or practices. We discuss development of a Parent-to-Parent “shared experience” national coaching network based on the research-supported principles embedded in Motivational Interviewing (MI) and Community Reinforcement and Family Therapy (CRAFT). Parents coach other parents in communication, positive reinforcement and self-care strategies, also incorporating their own strengths and experience, an approach found highly acceptable to other parents, potentially addressing the low penetrance of evidence-based strategies among families and extending evidence-based practices to a wider range of under-served communities. Coaching also provides a healing and self-sustaining role for parents, potentially impacting the long-term sustainability of a self-help coaching network. Pilot data on 50 coaching cases will be presented.

• Mindfulness practice moderates the relationship between craving and substance use in a clinical sample
Matthew Enkema, University of Washington
Sarah Bowen, Ph.D., Pacific University

Objective: Relapse following treatment for substance use disorders is highly prevalent, and craving has been shown to be a primary predictor of relapse. Mindfulness-based relapse prevention (MBRP) is a psychosocial aftercare program integrating mindfulness and cognitive-behavioral approaches, aimed at reducing the risk and severity of relapse. Results from a recent randomized clinical trial demonstrate enhanced remission resilience for MBRP participants versus both cognitive-behavioral and treatment-as-usual controls. The current study investigated between-session formal and informal mindfulness practice, a hypothesized primary mechanism of action in this treatment, as an attenuating factor in the relationship between craving and substance use. Method: Participants in this secondary analysis were 57 eligible adults who completed either inpatient treatment or intensive outpatient treatment for substance use disorders, were randomized in the parent study to receive MBRP, and completed relevant follow-up assessments. Results: For formal mindfulness practice at post-course, both number of days per week (p=.006) and number of minutes per day (p=.010) significantly moderated the relationship between craving at post-course and number of substance use days at 6-month follow up. Informal practice did not significantly influence the craving-use relationship in this analysis. Conclusions: These results indicate that increasing formal mindfulness practice may reduce the link between craving and substance use for MBRP participants and enhance remission resiliency.

• Integrating Motivational Interviewing into Contextual Behavioral Science
Sean P. Wright, M.A., M.S., LMHC, Lutheran Community Services Northwest

Motivational Interviewing (MI) is a widely used therapeutic approach to support behavior change that is of increasing interest to the contextual behavioral science (CBS) community. Christopher and Dougher (2009) provided a behavior-analytic account (including derived relational responding) of MI that was fundamentally sound. That account was of necessity brief on details about how MI guides the therapist to increased contextual control of therapeutic responses to client verbal behavior. Moreover, MI has continued to develop in recent years, most notably abandoning the term “client resistance” (which had historically acquired strong contextual control over therapist behavior when clients were labeled resistant) in favor of the term “discord” in order to foster more effective therapist responses. This conceptual paper explores the refinement of MI technology over time and accounts for them in relational frame theory (RFT) terms to show where MI is consistent or inconsistent with other CBS approaches. After reviewing the developments in MI over time (including the recent addition of action reflections), I highlight the strengths of MI in using deictic framing to reduce pliance and counterpliance, the benefit of transforming the stimulus function of ambivalence (changing the relational response of opposition between client change and sustain talk into a part/whole relational response), and the benefit of the therapist discriminating client responses into one of the trans theoretical model’s stages of change (Prochaska and DiClemente, 1983) in order to have effective contextual control over therapist response (stage matching). I also illustrate how MI’s focus on the content of verbal behavior is problematic as suggested by the RFT literature, particularly early work on the problems with self-rules (Hayes, 1989). Finally, suggestions for making MI more experiential are presented to increase the effectiveness of MI and harmonize it with other applied CBS approaches.

Educational Objectives:
1. Describe the relationship between psychological flexibility, mindfulness, and craving in the context of addiction treatment. 2. Describe evidence-based models (including the key elements from MI and CRAFT) for helping families deal with substance abuse issues in their children. 3. Apply RFT principles to identify how motivational interviewing techniques (OARS skills, importance/confidence ruler, etc.) attempt to transform stimulus functions of client change/sustain talk.

 

109. RFT & Deictic Relations: Experimental & Applied Analyses
Symposium (2:45-4:15pm)
Components: Original data
Categories: Relational Frame Theory, Clinical Interventions and Interests, Superv., Train. & Dissem., IRAP, perspective taking training, adults, austism, tutors, ABA
Target Audience: Interm., Adv.
Location: Cascade 1C

Chair: Ciara McEnteggart, Ghent University
Discussant: Louise McHugh, University College Dublin

The deictic relations appear to be critical to clinical applications of RFT, but more sophisicated empirical work is needed to understand these complex relations and how they operate in therapeutic contexts. The first empirical paper in this symposium uses the IRAP to investigate the strength or flexibility of deictic relations. Strong, significant IRAP effects on I-I and OTHERS-OTHERS are interpreted as inflexible deictic responding, with weaker or more flexible responding on I-OTHERS and OTHERS-I. While the data are preliminary, the current methodology may provide a useful alternative procedure for the study of deictic relations. The second paper uses the IRAP to study self-forgiveness in ABA tutors, following three conditions: training in perspective-taking, relaxation, and control. The findings help us to explore the relationship between perspective-taking and self-forgiveness. The third paper also explores self-forgiveness using the IRAP, but with ACT versus CT practitioners. These two groups show different implicit profiles on the IRAP that appear to be in line with their training histories.

• An RFT analysis of perspective-taking in a non-clinical sample using the Implicit Relational Assessment Procedure (IRAP)
Deirdre Kavanagh, Ghent University
Yvonne Barnes-Holmes, Ghent University
Dermot Barnes-Holmes, Ghent University
Ciara McEnteggart, Ghent University

Perspective-taking has been argued to be a key process in the development of “self”, particularly within Relational Frame Theory (RFT). The current study investigated the strength or flexibility of perspective-taking relations in a non-clinical sample using the Implicit Relational Assessment Procedure (IRAP). Thirty-five participants completed a simple perspective-taking IRAP that comprised four trial-types: I-I; OTHERS-OTHERS; I-OTHERS; and OTHERS-I. The results showed strong, significant IRAP effects on both the I-I and OTHERS-OTHERS trial-types, interpreted as inflexible deictic relational responding. Weaker IRAP effects on the I-OTHERS and OTHERS-I trial-types may suggest weaker or more flexible patterns of deictic responding. While the data are preliminary, the current methodology may provide a useful alternative methodology for the study of deictic responding.

• Measuring the effect of a RFT-based perspective-taking intervention on explicit and implicit self-forgiveness in ABA tutors
Diana Bast, Universidade Federal de São Carlos
Ian Stewart, National University of Ireland Galway
Celso Goyos, Universidade Federal de São Carlos
Dermot Barnes-Holmes, University of Ghent

This study will examine the effects of a RFT-based perspective-taking intervention on implicit and explicit self-forgiveness in Applied Behavior Anaysis (ABA) tutors. Forty eight ABA-trained tutors will be randomly assigned to one of three conditions: (i) perspective-taking, in which participants are trained to take perspective on past failures in their work with autistic clients; (ii) an active control (relaxation) condition; or (iii) a no-treatment control condition. All participants will be assessed both pre- and post-intervention using measures of self-forgiveness and psychological health. To measure self-forgiveness, an Implicit Relational Assessment Procedure (IRAP) will be used in addition to conventional self-report measures. Mixed group design statistics will be used to compare the effects of the interventions both within and across groups. This will be the first study to examine the effects of a function-analytically defined perspective-taking intervention on multiple indices of psychological health including implicit self-forgiveness.

• ACT & CBT Therapists: Self Compassion Behavior and Implicit and Explicit Response to Failure and Success
Annalisa Oppo, Psy.D., Sigmund Freud University, Milan Italy
Davide Carnevali, Ph.D., IULM, Milan
Francesco Dell'Orco, Ph.D., IESCUM, Milan, Italy
Chiara Manfredi, Ph.D., Studi Cognitivi, Modena, Italy
Giovambattista Presti, MD, Ph.D., Kore University, Enna, Italy

The key elements of Self-compassion as defined in the evolutionary compassion focus therapy (CFT) are conceptually related to hexaflex processes in very clear ways: Motivation to Care for Well-Being (values), Sensitivity to Suffering (Contact with the present moment), Sympathy & Empathy (flexible perspective taking), Distress Tolerance (Acceptance), Non-Judgement (defusion) and Committed Action to alleviate suffering in our lives. One of the most common way to assess Self-compassion is using explicit measures that capture, according to REC model, the Extended and Elaborated Relational Responses (EERR). However there are other form of relational responding (Brief and Immediate Relational Responding (BIRR) that can capture different aspects of the behavioral repertoire. The primary goal of this study is to analyse explicit and implicit response to self-forgiveness in therapists with different training history. Fifty-five therapists were recruited in this study: 32 ACT therapists and 23 CT therapists.CT therapists and ACT therapists reported similar scores on Self Compassion Scale. However CT therapists and ACT therapists report different implicit profile that seems to be in line with their training history. These results will be presented.

Educational Objectives:
1. Describe a new protocol on perspective taking for self-forgiveness. 2. Explain how an RFT-based intervention can impact on attitudes (implicit and explicit). 3. Describe differences in explicit and implicit tool to assess self compassion construct.

 

112. Trauma, BPD, Suicide
Symposium (2:45-4:15pm)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Performance-enhancing interventions, Theory & Philo., Functional contextual approaches in related disciplines, Suicide, PTSD, Borderline Personality Disorder, Veterans, ACT Matrix, Emotion Regulation, Rumination, Self
Target Audience: Beg., Interm., Adv.
Location: Puget Sound

Chair: Sean M. Barnes, Ph.D., Rocky Mountain Mental Illness Research, Education, and Clinical Center
Discussant: John Donahue, Psy.D., University of Baltimore

Cognitive fusion with the content of thoughts and the conceptualized self can perpetuate symptoms of various disorders, such as BPD and PTSD. This symposium explores different approaches to understanding and treating these disorders, including, a technique from Vippasana meditation, the ACT Matrix, and Dialectical Behavior Therapy (DBT) with Prolonged Exposure (PE). The first study examined the impact of mental noting - a Vipassana meditation technique in which practitioners silently label thoughts as they arise - on participants’ experiences of suicide-related thoughts. Another study presents three-years of outcome data from the 12-week DBT-PE “Journeys” Intensive Outpatient Program at the Minneapolis VA, as well as an overview of the structure of program implementation. Additionally discussed will be how functional contextualism has been used in this program as a guiding philosophical approach to effectively integrate multiple behavioral therapies into one success treatment flexible enough to address the complexities of co-morbid conditions. A comparison between ACT alone and ACT with the Matrix for people diagnosed with BPD and reasons for different findings will be discussed. In addition, a CBS analysis of why some trauma survivors go on to develop rigid and ineffective rumination and others do not will be presented.

• Does Mental Noting Decrease Cognitive Fusion with Suicide-Related Thoughts?
Sean M. Barnes, Ph.D., Rocky Mountain Mental Illness Research, Education, and Clinical Center
Lindsey L. Monteith, Rocky Mountain Mental Illness Research, Education, and Clinical Center
Lisa A. Brenner, Ph.D., Rocky Mountain Mental Illness Research, Education, and Clinical Center
Jeri E. Forster, Ph.D., Rocky Mountain Mental Illness Research, Education, and Clinical Center
Theresa D. Hernández, Rocky Mountain Mental Illness Research, Education, and Clinical Center
Nazanin H. Bahraini, Ph.D., Rocky Mountain Mental Illness Research, Education, and Clinical Center

Cognitive fusion with suicidal ideation can perpetuate rumination, distress, and the intensity of suicidal urges (Luoma & Villatte, 2012). Mental noting is a Vipassana meditation technique in which practitioners silently label thoughts as they arise. It shares many similarities with popular ACT mindfulness and defusion exercises. The current study examined the impact of mental noting on participants’ experiences of suicide-related thoughts. We hypothesized that simulated mental noting would result in less self-reported distress and physiological arousal, and that qualitative reports would reflect greater defusion from suicide-related thoughts. Thirty-four participants who reported recently being distressed by suicidal ideation were randomized to a control group or a simulated mental noting group. Following baseline assessment, all participants were presented with their suicide-related thoughts written on note cards and were asked to read them aloud. Participants randomized to the simulated mental noting condition were asked to categorize the thoughts (e.g., “judging”, “planning”); participants in the control condition were not asked to categorize thoughts. Objective data indicated similar levels of self-reported distress and physiological arousal across groups. A lack of initial reactivity may have limited our ability to detect potential differences related to the simulated mental noting. Qualitative data is being coded to determine whether mental noting and/or viewing suicide-related thoughts on cards subjectively decreases cognitive fusion with such thoughts. Implications for the use of ACT with suicidal patients will be discussed.

• Considering the Self: Exploring the Interplay of Post-Trauma Cognitions and the Conceptualized Self
Lia Stern, M.A., Clark University
Kathleen Palm Reed, Ph.D., Clark University

Trauma-related rumination is a well-documented factor related to PTSD symptom development and maintenance (Clark & Ehlers, 2007). Research suggests that trauma-related rumination originates in early attempts to derive insight from traumatic experiences (Tait et al., 2014; Lindstrom, Cann, Calhoun, & Tedeschi, 2013). However, it remains unclear why some trauma survivors go on to develop rigid and ineffective rumination and others do not. A contextual behavioral science model of behavior change suggests that individuals who endorse a conceptualized sense of self, or rigidly defined personal narrative, will likely develop experiential avoidance when confronted with ego-dystonic experiences or emotions (Hayes, Pistorello, & Levin, 2012). Among trauma survivors, this process may become more pronounced as they try to understand why and how such horrific events have happened to them. Thus, individuals who demonstrate a more conceptualized sense of self prior to trauma exposure may be more likely to develop post-trauma ruminatory behaviors than their cognitively flexible counterparts. We propose that this rumination stems from cognitive processes related to (1) heightened emotional avoidance and/or (2) struggling to integrate the traumatic material into a rigidly bounded conceptualized sense of self.

• Comparison and mechanisms of change between two Group-Treatments for people diagnosed with BPD: ACT and a Matrix enhanced ACT treatment: Mexico Chapter Sponsored
Michel A. Reyes Ortega, Ph.D., Contextual Behavioral Science and Therapy Institute, Mexico City
Nathalia Vargas Salinas, Ph.D., Contextual Behavioral Science and Therapy Institute, Mexico City
Benjamin Schoendorff, MPs, Contextual Psychology Institute, Quebec
Edgar Miranda Terres, MPs, CBS and Therapy Institute, Mexico City; Mexico's National Institute of Psychiatry (INPRF)

A pre-posttest design was conducted to test ACT Matrix impact as an addition to an already tested 16 sessions ACT group treatment for people diagnosed with BPD. The only difference between treatments was that the ACT+Matrix group completed a Matrix as debriefing exercise after every session. ANOVA showed intragroup statistically significant differences (p≤.05) and big size effects (d≥.80) improvements in BPD symptom severity, psychological flexibility and emotion regulation self-administered questionnaires in both groups. ANOVA between groups found significant differences and medium (d≥.50) size effects in posttest in favor of ACT+Matrix group (n=14). Psychological flexibility mediated BPD symptoms change in ACT group (n=16), but not in ACT+Matrix group. These results suggest ACT Matrix enhanced ACT impact, possibly due to BPD clients neuropsychological characteristics. Future research is needed to test the hypothesis the Matrix impact on perspective taking as mechanism of change.

• Welcome to the Third Wave: Lessons Learned from Integrating DBT and PE into One Effective Treatment for Military Veterans
Ren Stinson, Ph.D., Minneapolis VA Health Care
Ethan McCallum, Ph.D., Minneapolis VA Health Care
Emily Voller, Ph.D., Minneapolis VA Health Care
Laura Meyers, Ph.D., Minneapolis VA Health Care

“The third wave reformulates and synthesizes previous generations of behavioral and cognitive therapy and carries them forward into questions, issues, and domains previously addressed primarily by other traditions, in hopes of improving both understanding and outcomes” (Hayes, 2004). To address the high rates of psychological trauma faced by military veterans the Veterans Health Administration (VHA) has prioritized the use of evidence-based treatments (EBTs) across all 1,700 sites of care. While helpful for many veterans with Post-Traumatic Disorder (PTSD), these cognitive behavioral treatments for PTSD have been less effective in treating some co-occurring conditions – for example PTSD and Borderline Personality Disorder (BPD). Research has demonstrated that integrating Dialectical Behavior Therapy (DBT) and Prolonged Exposure (PE) is an effective approach to treating co-occurring PTSD-BPD (Harned, Korslund, and Linehan, 2014). This paper presents three-years of outcome data from the 12-week DBT-PE “Journeys” Intensive Outpatient Program at the Minneapolis VA, as well as an overview of the structure of program implementation. Additionally discussed will be how functional contextualism has been used in this program as a guiding philosophical approach to effectively integrate multiple behavioral therapies into one success treatment flexible enough to address the complexities of co-morbid conditions.

Educational Objectives:
1. Describe the role and significance of the conceptualized self in post-trauma rumination. 2. Explain the benefits and limitations of the presented ACT interventions for BPD diagnosed clients. 3. Describe the role and significance of psychological flexibility in the BBP symptoms reduction.

 

119. RFT: Novel Approaches & Analyses
Symposium (4:30-5:45pm)
Components: Original data
Categories: Relational Frame Theory, RFT, Other, IRAP, Network Models
Target Audience: Beg., Interm.
Location: Vashon 2

Chair: Yvonne Barnes-Holmes, Ghent University
Discussant: Yvonne Barnes-Holmes, Ghent University

There are over 50 published studies on the IRAP, but as the measure is increasingly used for more complex and applied purposes, there is increasing need for systemtaic methodological and analytical scrutiny. The first empirical paper in this symposium determines whether response inhibition is related to performance on the IRAP. The findings show that neither response inhibition nor self reported attentional control correlate with the IRAP. These findings suggest that the IRAP is resistant to response inhibition as a source of potentially contaminating individual differences. The second paper presents three studies that investigate the impact of different types of instruction on the IRAP. The findings illustrate that type of instruction influences the strength and direction of trial-type effects, and suggest that instructions interact with the order in which IRAP blocks are presented. The third paper explores the potential use of a network analysis for analyzing IRAP data. To first illustrate a network analysis, a cross-sectional dataset are presented, followed by an IRAP dataset. The fourth paper similarly explores the Probabilistic Index (PI) is an alternative effect size measure to the D algorithm typically used in IRAP research. The PI appears to be robust against outliers, has a sound interpretation in cases of non-normality and/or heteroscedasticity, and offers a clear interpretation of the data. To examine the potential of this new scoring algorithm, IRAP data are reanalyzed, and show a systematic improvement in the estimated reliability compared to the D-score, without reducing existing correlation coefficients.

• Response inhibition and IRAP performance
Miguel A. Lopez-Medina, BSc, University of Jaén, Spain
Miguel Rodriguez-Valverde, Ph.D., University of Jaén, Spain
Monica Hernandez-Lopez, Ph.D., University of Jaén, Spain

The present study explores if the ability to inhibit prepotent responses (response inhibition) is related to performance on the IRAP. A simple, generic IRAP (samples: Pleasant/Unpleasant; targets: positively valenced words/negatively valenced words) was used with non-clinical adult participants (N=93). In addition, the Attentional Control Scale (ACS) was used as a self-report measure of attentional capabilities. A subset of participants (N=49) also underwent the stop-signal task, a specific reaction-time based measure of response inhibition. Results indicate that response inhibition does not correlate with performance on the IRAP, either with D-IRAP scores or with percentages of correct responses. Self reported attentional control (ACS scores) correlated only moderately (r=-0,23; p=0,03) with the amount of exposures to practice blocks necessary to reach the test phase in the IRAP, but not with IRAP performance during the test phase (either in terms of D scores or percentage of correct responses). These findings appear to indicate that the IRAP as a measure is resistant to response inhibition as a source of potentially contaminating individual differences.

• The Impact of Instruction Type on IRAP Effects
Martin Finn, Ghent University
Dermot Barnes-Holmes, Ghent University
Ian Hussey, Ghent University
Joseph Graddy, University of Waikato, New Zealand

The procedural variables that impact the effects generated by the Implicit Relational Assessment Procedure (IRAP) have not been subjected to a systematic experimental analysis, in spite of increasing use of the procedure in applied and clinical settings. The introductory instructions issued to participants are one such variable. The current study investigated the impact of different types of instruction across three experiments in a sample of university undergraduates. The findings of these experiments illustrate that the type of instruction influences the strength and direction of the trial-type effects that are produced by the measure. The results also suggest that the instructions interact with the order in which the IRAP blocks are presented (i.e. history-consistent first versus history-inconsistent first). These findings have implications for the assessment of relational responding.

• Exploring behavior-behavior relations by network models: An introduction and illustration using Applied Research Findings and IRAP Data
Maarten De Schryver, Ghent University
Dermot Barnes-Holmes, Ghent University

Based on graph theory, network analysis appears to be a promising method to obtain a more comprehensive view on the interaction between behaviors, and between behaviors and contexts. In a network analysis, constructs are conceptualized as networks of related observable variables and variables as 'autonomous causal entities in a network of dynamical systems'. While first introduced as an alternative measurement model (i.e. to relate observable variables to a construct), a network model seems also well-suited as a structural model (i.e. to relate constructs to one another). For illustrative purposes, we analyze a cross-sectional dataset containing information about stressors and PTSD symptoms of 445 youths gathered in Northern Uganda. A further illustration is provided using basic research data from the IRAP.

• The Probabilistic Index: A new effect size measure for the IRAP
Maarten De Schryver, Ghent University
Dermot Barnes-Holmes, Ghent University

Scoring algorithms are an important feature of implicit methodologies, such as the Implicit Relational Assessment Procedure. The IRAP currently employs an algorithm based on a D-effect size, but several authors have questioned the appropriateness of this. The Probabilistic Index (PI) is an alternative effect size measure that appears to be robust against outliers, has a sound interpretation in cases of non-normality and/or heteroscedasticity, and offers a clear interpretation of the data. To examine the potential of this new scoring algorithm, we re-analyzed data from an IRAP study using the PI and found a systematic improvement in the estimated reliability compared to the D-score, without reducing existing correlation coefficients. The PI will also likely increase the face validity of the IRAP.

• You Think You Can, You Think You Did: The Impact of Derived Causal Efficacy on Inattention and Impulsivity
Benjamin Ramos, University of Louisiana at Lafayette
Emily Sandoz, Ph.D., University of Louisiana at Lafayette

Individuals that struggle with inattention, hyperactivity, and impulsivity experience difficulties in several life domains including struggles in academia (Breslau, Miller, Chung, & Schweitzer, 2011), interpersonal relationships (Friedman et al., 2003), marital satisfaction (Eakin et al., 2004), and occupational performance (Barkley, Murphy, & Fischer, 2008). In spite of a history of academic and social failures, many individuals with ADHD maintain a self-protective bias in which they maintain high self-evaluations of causal efficacy (Owens et al., 2007). This may contribute to increased levels of inattention, impulsivity, and resulting dysfunction, as self-evaluation is rule-governed rather than a result of self-awareness and discrimination. This study aimed to examine how derived causal efficacy might impact inattention and impulsivity. Participants completed a series of Go/NoGo tasks with and without contextual cues that had derived causal efficacy functions through their relations with discriminative stimuli for high or low rates of responding. The impact of derived causal efficacy was then examined in terms of errors of omission (inattention) and errors of commission (impulsivity). Implications for behavioral interventions for ADHD will be discussed.

Educational Objectives:
1. Analyze the potential contaminating effects of individual differences on IRAP performance. 2. Discuss inattention and impulsivity as complex operant human behavior. 3. Explain the methodology and results of the study as an assessment of the role of causal efficacy in ADHD.

 

120. Expanding the Toolbox: Some Initial Research with a Collection of New ACT-Relevant Self-Report Measures
Symposium (4:30-5:45pm)
Components: Conceptual analysis, Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Superv., Train. & Dissem., Psychological Measures, Values, Psychological Flexibility, Assessment
Target Audience: Beg., Interm., Adv.
Location: St. Helens

Chair: Ryan Kimball, Southern Illinois University
Discussant: Amy R. Murrell, Ph.D., University of North Texas

Although measures of ACT-relevant processes are gradually appearing, some ACT processes lack measures that are useful in a clinical setting and/or lack well-established psychometrics. The areas of values and committed action, in particular, seem to be relatively under-addressed upon review of ACT outcome studies. This seems especially problematic in light of valued action as a primary outcome focus with ACT treatment. Furthermore, psychological flexibility is a complex and multifaceted treatment target, and existing measures either focus on individual repertoires organized by the Hexaflex or an unbalanced collection of them. This symposium offers a collection of studies intended to offer additional measures to the ACT practitioner’s toolbox, as well as a review of initial data with each. Specifically, two presentations will discuss new measures of values and committed action, and one presentation will discuss a brief but comprehensive measure of the entire Hexaflex.

• Values Measure Fight Club: An Initial Comparison and Evaluation of the Valued Time and Difficulty Questionnaire
Ryan Kimball, Southern Illinois University
Sam Kramer, Southern Illinois University
Sunni Primeaux, Southern Illinois University
Chad E. Drake, Ph.D., Southern Illinois University

Although measures of values have existed for decades (Beierlein, et al., 2012; Rokeach, 1974), few measures have been developed for clinical use and/or by ACT treatment developers. The Valued Time and Difficulty Questionnaire (VTDQ) was derived from the Valued Living Questionnaire (Wilson, Sandoz, Kitchens, & Roberts, 2010) and developed within a clinical context to provide a more accessible measure of values and committed action. Self-report data was gathered via Amazon’s mTurk from a large and diverse sample (n=425). Results indicated that the three scales of the VTDQ (importance, time on valued action, and difficulty due to private events) exhibited good internal consistency and convergent validity with other values measures. Additionally, the Importance and Time scales were significantly correlated with measures of life satisfaction and quality of life. These results will be discussed as well as how the VTDQ may be used to inform treatment in a broad population.

• Last Week Tonight!: Constructing and Evaluating a Weekly Hexaflex Assessment (WHA)
Kail Seymour, Southern Illinois University
Sunni Primeaux, Southern Illinois University
Travis Sain, Southern Illinois University
Chad E. Drake, Ph.D., Southern Illinois University

The Hexaflex model of Acceptance and Commitment Therapy (ACT) emphasizes six content areas that guide treatment delivery, all of which comprise a psychological flexibility model of mental health. Current measures of psychological flexibility either measure specific areas of the Hexaflex (Gillanders, 2014; Wilson, Sandoz, Kitchens, & Roberts, 2010) or measure psychological flexibility without a balanced approach across the six areas (Bond et al., 2010). Because a brief and balanced measure of all six areas may have value for clinicians (e.g., to help structure sessions, provide a progress measure, etc.), the Weekly Hexaflex Assessment (WHA) was created by an ACT practicum team. This talk will present preliminary supportive data for the WHA from a sample of college undergraduates (n = 131) regarding internal reliability and convergent validity with other psychological flexibility measures. The results suggest a need for revision of certain items and, perhaps, a different approach to WHA item generation.

• I Can’t Get No Valued Action: Exploring the Valued Action and Satisfaction Questionnaire
Travis Sain, Southern Illinois University
Sunni Primeaux, Southern Illinois University
Chad E. Drake, Ph.D., Southern Illinois University

Acceptance and Commitment Therapy emphasizes values consistent action, but few measures developed by ACT practitioners or researchers target values repertoires. Measures that have been developed such as the Valued Living Questionnaire (Wilson, Sandoz, Kitchens, & Roberts, 2010) have limited databases, and have shown psychometric shortcomings (Vanbuskirk, et al., 2012). The current study administered the Valued Action and Satisfaction Questionnaire (VASQ), a new measure of values and committed action, to 131 participants at a mid-western American university to assess reliability and validity. Comprised of three subscales (importance, valued action, satisfaction with action), the VASQ was compared to various measures of psychological flexibility repertoires (e.g., Acceptance and Action Questionnaire) and quality of life (e.g., Flourishing Scale). Significant correlations were found between the VASQ subscales, psychological flexibility, and quality of life. Results provide evidence for further exploration of the VASQ as a measure of values and committed action.

Educational Objectives:
1. Describe the subscales of the VTDQ. 2. Identify the Hexaflex/Inflexahex repertoire for each item of the WHA. 3. Describe the psychometric properties of the VASQ.

 

122. Innovative randomized trials of Acceptance and Commitment Therapy addressing weight management
Symposium (4:30-5:45pm)
Components: Original data
Categories: Behavioral medicine, Clin. Interven. & Interests, overweight, obesity
Target Audience: Beg.
Location: Cascade 1B

Chair: Niloofar Afari, Ph.D., VA Center of Excellence for Stress and Mental Health & Department of Psychiatry, University of CA, San Diego
Discussant: Jonathan Bricker, Ph.D., Fred Hutchinson Cancer Research Center, Division of Public Health, & Department of Psychology, University of Washington

Two-thirds of Americans are overweight or obese and the prevalence is growing across the globe. A handful of studies suggest that Acceptance and Commitment Therapy (ACT) may show promise in improving weight management and emotional or other disordered eating patterns that contribute to overweight and obesity. This symposium features several recent randomized trials that use ACT in novel ways to address weight control and related eating patterns. The innovative approaches include integrating ACT with traditional weight loss protocols, using ACT to augment other weight control programs, and examining the generalizability of ACT skills from tobacco cessation to weight loss. Other unique characteristics include the delivery of ACT in workshops, brief group settings, and apps. Findings and lessons learned from these studies can guide future research on method of delivery, duration, and potential moderators in effective use of ACT for weight management and related eating behavior.

• A comparison of different approaches for utilizing Acceptance and Commitment Therapy to improve long-term weight control
Jason Lillis, Ph.D., The Miriam Hospital & Brown Medical School
Rena Wing, Ph.D., The Miriam Hospital & Brown Medical School

This paper will give an overview and results from 2 randomized trials that attempt to improve long-term weight control by adding ACT to traditional weight loss methods. The first study (n=162) integrated ACT with traditional methods and compared it to current gold standard weight loss intervention on 24-month weight loss. The second study compared the use of a back-end workshop, comparing an ACT workshop, a Self-Regulation workshop, and a self-monitoring only condition among participants who had completed a 3-month on-line weight loss program and lost at least 5% of their starting weight. Results indicate ACT could be helpful for improving long-term weight control. Potential mechanisms, advantages and disadvantages of different approaches, implications and future directions will be discussed.

• Brief ACT for binge eating as an adjunct to the MOVE! Program: The B-ACT trial for veterans
Kathryn M. Godfrey, M.S., San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology
Jessica Gundy Cuneo, Ph.D., VA San Diego Healthcare System
Jennifer Salamat, B.A., VA San Diego Healthcare System
Autumn Backhaus, Ph.D., VA San Diego Healthcare System
Niloofar Afari, Ph.D., VA Center of Excellence for Stress and Mental Health & Dept. of Psychiatry, University of CA, San Diego

The B-ACT study was a randomized controlled trial of an ACT group intervention for binge and emotional eating as an adjunct to Veterans Health Administration’s standard behavioral weight loss intervention (MOVE!). Participants who completed the 8-week MOVE! program were recruited and randomized to receive four 2-hour weekly ACT or active control groups. 150 veterans were screened for the study, and 90 were randomized. 81 participants (90%) completed at least 3 group treatment sessions and follow up assessments post-treatment, at 3 months post-treatment, and at 6 months post-treatment. Results will be presented from outcomes including self-reported binge eating, psychological flexibility, quality of life, and measured BMI. Strengths and weaknesses of the current trial, lessons learned, and next steps for ACT for binge eating as an adjunct to standard weight control services in veteran and active duty populations will be discussed.

• Change in weight and drinking in ACT vs. CBT smoking cessation app users: Results from a pilot randomized trial
Emily Y. Zeng, B.S., Fred Hutchinson Cancer Research Center, Division of Public Health, Seattle, WA
Jaimee L. Heffner, Ph.D., Fred Hutchinson Cancer Research Center, Division of Public Health, Seattle, WA
Kristin E. Mull, M.S., Fred Hutchinson Cancer Research Center, Division of Public Health, Seattle, WA
Jonathan Bricker, Ph.D., Fred Hutchinson Cancer Research Center, Division of Public Health, & Dept. of Psychology, University of Washington

Anecdotal evidence from ACT studies suggests that participants generalize smoking cessation skills to other health domains. This study explores whether users of an ACT vs. CBT-based cessation app are more likely to show changes in weight and alcohol use. Using generalized linear models, we compared changes in weight, body mass index, number of typical drinks, and hazardous drinking at two-month follow-up between ACT (n=98) and CBT app users(n=98). Although differences were not statistically significant, ACT users reported weight loss (-1.4 vs 0.2; p=0.156) and decrease in BMI (-0.3 vs -0.1; p=0.144). CBT users had a greater reduction in number of typical drinks (-0.6 vs -0.3; p=0.461) and were less likely to be a hazardous drinker (13% vs 20%; p=0.188). Given the suggestive, but inconclusive evidence of differences between treatment groups on weight change and drinking, future studies should evaluate ACT’s potential as a multiple health behavior change intervention.

Educational Objectives:
1. Describe the results of two NIH funded trials testing ACT methods for weight loss, with particular focus on the strengths and weaknesses of each approach. 2. Describe the design and results from the B-ACT trial and describe how findings are being applied to future weight control research. 3. Explain the potential for ACT to concurrently address smoking and weight control and analyze the generalizability of ACT across health domains.

 

123. Awesome Papers 1
Symposium (4:30-5:45pm)
Components: Conceptual analysis, Literature review, Original data, Case presentation
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Behavioral medicine, Educational settings, Superv., Train., & Dissem., RFT, Other, Technology, Children, Dyslexia, Literacy Skills, Young Adults, ACT, Partial Hospitalization Program, Serious and persistent mental illness (SMI), health promotion, community-based participatory research
Target Audience: Beg., Interm., Adv.
Location: Cascade 1C

Chair: Candice Fieg, Epworth Clinic Camberwell, Melbourne, Australia
Discussant: Staci Martin, PhD, National Institutes of Health

Contextual behavioral science (CBS) approaches using Acceptance and Commitment Therapy (ACT) and Relational Frame Theory (RFT) have been employed across a large variety of problems with significant success. CBS approaches can be applied towards helping those with obsessive compulsive disorder (OCD), children with learning disorders, young adult patients with severe, comorbid, and diverse presentations of psychopathology, and people living with serious and persistent mental illness (SPMI). The first study explores the delivery of a 10-session “ACT for OCD group program” in a private not-for-profit hospital day program setting in Melbourne, Australia and will provide an overview of the program structure, and demonstrate the facilitation of experiential exercises in a group setting. The second study will present applications based on derived stimulus relations for children aged from 7 to 10 years old and diagnosed with dyslexia and dysgraphia. The third study will discuss a specialty young adult track developed from a general ACT-based program to meet the specific needs of those with severe, comorbid, and diverse presentations of psychopathology. The fourth study will present results of a pilot intervention grounded in ACT principles, delivered by peer support specialists in a community mental health setting, designed to help SPMI consumers initiate and sustain health-promoting behavior.

• Expanding our Therapeutic Tools for the OCD Toolbox: ACT for OCD Group Therapy
Candice Fieg, Epworth Clinic Camberwell, Melbourne, Australia

For some time now we have understood CBT/ERP as the first line of treatment for OCD. Increasing research is reflecting the clinical experience that treatment is not always straight forward, and many individuals with OCD either do not complete, or don't respond adequately to CBT/ERP. Emerging evidence is demonstrating that Acceptance and Commitment Therapy (ACT) is an effective approach to treating OCD and can help clients to live meaningful lives. This paper explores the delivery of a 10-session “ACT for OCD group program” in a private not-for-profit hospital day program setting in Melbourne, Australia. This paper will provide an overview of the current literature, the benefits that group therapy may offer to individuals and explore the feasibility of delivering “ACT for OCD” in a group format. The paper will provide an overview of the program structure, and demonstrate the facilitation of experiential exercises in a group setting. The paper will explore process issues and how to work with barriers that arise unique to working with a group of differing individuals at various stages in recovery.

• Can reading be an easy game?: Using RFT to improve literacy skills in children with learning disorders
Margherita Gurrieri, Psy.D., IESCUM, ACT-Italia (Italy)
Melissa Scagnelli, Psy.D., Ph.D., BCBA, IULM University, Milan (Italy)
Davide Carnevali, Psy.D., BCBA, IULM University, Milan (Italy)
Giovambattista Presti, MD, Ph.D., Università Kore, Enna (Italy)
Paolo Moderato, Ph.D., IULM University, Milan (Italy)

The prevalence of children diagnosed with learning disorders is rising year after year. A number of specific techniques have been developed by behavior analysts to teach or improve reading and writing abilities. 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. Ten children aged from 7 to 10 years old and diagnosed with dyslexia and dysgraphia have been exposed to a training based on a conditional discrimination procedure with arbitrary matching to sample. Data indicated that the intervention had positive outcomes in terms of accuracy from pre-intervention to follow up. Pre-post treatment and follow up scores in standardized tests for dyslexia will be discussed.

• Initial Results of a Specialty Young Adult Track within an ACT-based Partial Hospitalization Program
Brian Pilecki, Rhode Island Hospital; Alpert Medical School of Brown University
Theresa A. Morgan, Rhode Island Hospital; Alpert Medical School of Brown University
Stephanie Czech, Rhode Island Hospital
Catherine D'Avanzato, 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

At an ACT-based partial hospitalization program, patients with severe, comorbid, and diverse presentations of psychopathology have been shown to have improved outcomes via reduces symptoms and improved functioning (D'Avanzato et al. 2013). A specialty young adult track (ages 18-26) was added to meet the specific needs of this vulnerable population. This presentation will discuss how the general ACT-based program was adapted to fit the needs of young adults. In addition, acceptability of this program will be discussed. Patients completed daily satisfaction surveys of the young adult groups and preliminary results (N = 466) suggest that on a likert-type scale from 0 to 6, young adult patients rate the groups as useful (5.0), are satisfied with the way the groups are structured (5.0), and rate the group leader as helpful (5.5). While data collection is ongoing, additional results of outcome measures on anxiety, depression, and functioning will also be reported.

• Health Self-Management Support using Acceptance and Commitment Therapy in a Community Mental Health Setting: An Intervention Delivered by Peer Support Specialists: Contextual Medicine SIG Sponsored
Adrienne Lapidos, Ph.D., University of Michigan
Mary Ruffolo, Ph.D., University of Michigan

Although not a federally designated health disparity population, people living with serious and persistent mental illness (SPMI) face some of the most profound health inequities in the nation, with life expectancies up to 25 years less than average, and elevated risk for preventable chronic conditions including diabetes and cardiovascular disease (Svendsen, 2006). There is strong need for physical health promotion within SPMI consumers’ chosen medical home, often their local Community Mental Health (CMH) agency. Peer support specialists are a rapidly growing sector of the American mental health workforce whose services can be defined as the social, emotional, and instrumental support that is provided by people who have a mental health diagnosis, for people sharing a similar mental health diagnosis. Acceptance and Commitment Therapy (ACT) has been found to improve the quality of life of people living with SPMI and in people living with medical conditions (e.g. Bach & Hayes, 2002; Dindo, 2015), and there is interest in expanding the reach of ACT beyond traditional sectors. The current paper presents results of a pilot intervention grounded in ACT principles, delivered by peer support specialists in a CMH setting, designed to help SPMI consumers initiate and sustain health-promoting behavior. The chief goal of the pilot was to determine if ACT shows promise as a feasible approach that can be added to the existing toolkit of peer-delivered practices that promote physical health. The paper will present the following (1) a brief introduction to the “scandal of premature mortality” (Thornicroft, 2011) facing the SPMI community; (2) a brief introduction to the benefits of “reverse integration,” or bringing physical health care to specialty mental health settings, (3) a detailed description of the process of training peer support specialists in ACT-consistent health promoting interventions, including use of community-based participatory research methodology, and (4) a summary of preliminary pilot data. The presentation will contain video clips of the 3 peer support specialists discussing what it was like for them to learn about ACT and to help create the ACT-consistent interventions within the communities they serve and to which they belong. This research was made possible by a grant from the Vivian A. and James L. Curtis Research and Training Center Pilot Grant Program.

Educational Objectives:
1. Explain an overview of the possible applications with children diagnosed with learning disorders. 2. Describe how ACT may complement the scope of practice of Peer Support Specialists. 3. Adapt and apply Acceptance and Commitment Therapy based interventions in a group setting for treatment of OCD.

 

124. How Does ACT Enhance Our Understanding of Exposure?
Symposium (4:30-5:45pm)
Components: Original data, Case presentation
Categories: Clinical Interventions and Interests, Exposure, Anxiety, OCD
Target Audience: Beg., Interm.
Location: Puget Sound

Chair: Eric B Lee, M.A., Utah State University
Discussant: John P Forsyth, Ph.D., University at Albany, SUNY

We all know that exposure is a critical component of anxiety and OCD work. Yet, there is still much room for improvement, as exposure processes remain unclear and many people do not benefit from or refuse exposure-based treatment. Modern approaches to exposure, such as ACT, might improve treatment outcomes by helping people better engage in exposure work. Additionally, gaining a greater understanding of processes underlying exposure could enhance therapeutic techniques, also leading to improved outcomes. The current symposium will present data on the beneficial effects of acceptance, mindfulness, and values on exposure work. Topics examined will include, “white-knuckling” (i.e., experiential avoidance) as a potential barrier to successful OCD treatment, the effect of incorporating ACT part way through traditional exposure work, and the impact of a values-based intervention on the influence of fear within exposure treatment.

• Does white-knuckling take the punch out of ERP?
Carlos E. Rivera, M.S., Suffolk University
Grace Gu, M.S., Suffolk University
Nathaniel Van Kirk, Ph.D., OCD Institute at McLean Hospital; Harvard Medical School
Lisa W Coyne, Ph.D., Suffolk University

Exposure and response prevention (ERP) is considered the gold standard behavioral intervention for obsessive-compulsive disorder (OCD). However, a number of possible barriers limit ERP’s efficacy. One potential barrier is white-knuckling, defined as a form of experiential avoidance characterized by cognitive strategies to avoid, suppress and/or distract from unpleasant experiences that emerge when a person engages in ERPs. We believe interventions that incorporate acceptance and mindfulness to traditional ERP may help diminish a person’s tendency to engage in avoidance during exposure, increasing contact with unpleasant events, therefore leading to more effective exposure intervention and outcomes. The aim of our study is to explore the relationship between mindfulness and acceptance within an ERP based treatment and how changes in experiential avoidance across treatment may impact outcome. We use data from patients with OCD and staff from an intensive residential OCD treatment facility.

• ACT & ERP for OCD: Tracking ACT Processes in a Single-Case Design Study
Brian Thompson, Ph.D., Portland Psychotherapy Clinic, Research, & Training Center

In this single case design study conducted within a private practice setting, ACT-related processes were tracked to explore whether core ACT processes are uniquely impacted by ACT interventions (e.g., Twohig, Whittal, Cox, & Gunter, 2010). One adult participant who met OCD criteria completed daily ratings of OCD (i.e., minutes ritualizing) and ACT processes (i.e., willingness; defusion; adapted from Forman et al., 2012) throughout treatment. Treatment consisted of an 18-session ERP protocol based on Foa et al. (2012). At a predetermined point, ERP was suspended, and the participant received 4 sessions of ACT (e.g., Eifert & Forsyth, 2005). Following the ACT phase, ERP was resumed until completion. Visual analyses of the graphed time series data indicated shifts from change-based to acceptance-based processes across ACT and second ERP phases. ACT core process willingness increased during ACT and second ERP phases. ACT core process cognitive defusion appeared to be less impacted.

• Transforming Fear: The Impact of a Brief Values-Based Intervention on Avoidance Behavior in an Exposure Context
Timothy R. Ritzert, M.A., University at Albany, SUNY
Augustus Artschwager, University at Albany, SUNY
Christopher R. Berghoff, University of Mississippi Medical Center
John P. Forsyth, Ph.D., University at Albany, SUNY

This study evaluated a novel, ecologically-valid values intervention designed to increase approach toward a feared stimulus using operant principles. Spider fearful participants were randomized to a values (n = 24) or control (n = 24) condition and completed a spider behavioral approach task (BAT). Values participants were reinforced for each completed BAT step, in a manner that allowed them to live the value of helping people in need. Results showed that values participants completed relatively more steps on the BAT (t[27] = 3.98, p = .001, d = 1.46). Both conditions reported similar distress levels during the task. Notably, the relation between baseline spider fear and BAT steps completed was moderated by condition (p = .010). Spider fear predicted approach behavior to a markedly lower degree in the values condition (r = -.33) relative to the control condition (r = -.82), suggesting the values intervention reduced the degree to which fear influenced behavior.

Educational Objectives:
1. Demonstrate the role of mindfulness and acceptance in behavioral exposure for OCD. 2. Describe changes in ACT-related process in combined ERP and ACT treatment for OCD. 3. Explain how and why to use values in an exposure context.

 

Sunday, June 19

127. Ecological momentary assessments (EMA) to measure ACT processes and behavioral health across populations
Symposium (9:00-10:15am)
Components: Original data, Case presentation
Categories: Behavioral medicine, Clin. Interven. & Interests, Performance-enhancing interventions, Theory & Philo., contextual assessment, ACT, technology, mobile devices
Target Audience: Beg., Interm.
Location: Vashon 1

Chair: Javier Rizo, B.A., University of Washington, Psychiatry & Behavioral Sciences
Discussant: Michael Levin, Ph.D., Utah State University, Psychology

Ecological momentary assessment (EMA) is an essential tool for contextual behavioral scientists. By allowing a more precise measurement of the antecedents, and consequences of behavior it enables a functional analysis of behavior in context. The design of these tools offers revolutionary capabilities for contextual behavioral science to better describe, understand, predict and modify behaviors. In combining both assessment and intervention, these mobile technologies could lead to improvements in behavioral health across a variety of populations. Contextual behavioral models such as Acceptance and Commitment Therapy (ACT) provide a useful perspective of behavior change in designing EMAs and interpreting data collected from mobile devices and self-report. In these 4 talks we present the development, ideation, and conceptual issues related to measuring ACT processes for behavioral health outcomes across populations.

• Using mobile technology to examine contextual predictors of outcomes in individuals experiencing psychosis following a hospital discharge
Ethan Moitra, Ph.D., Brown University
Brandon A. Gaudiano, Ph.D., Brown University & Butler Hospital
Carter H. Davis, B.A., Butler Hospital
Michael F. Armey, Ph.D., Brown University & Butler Hospital

Schizophrenia and other manifestations of psychosis are a major cause of disability worldwide. Although various pharmacological and psychosocial interventions have been developed for treating patients with psychosis, relapse rates are high and long-term recovery remains elusive for many individuals. Thus, there is an urgent need to better understand the contextual factors that contribute to psychosis and its management so that they can be better targeted in future interventions. Ecological Momentary Assessment (EMA) is a dynamic procedure that permits the measurement of variables in natural settings in real-time through the use of brief assessments delivered via mobile electronic devices. We used EMA to examine a variety of contextual factors (e.g., social support, treatments, coping strategies) in relation to fluctuations in symptoms and functioning in 55 patients with psychosis. We will present data on real-time predictors of clinical outcomes and discuss how these factors could be addressed in a contextual behavioral framework.

• Using ecological momentary assessment to examine impact of self-regulation choice on affect
Angela Cathey, M.A., Wichita State University
Roger Vilardaga, Ph.D., University of Washington & Evidence-based Practice Institute
Jeff Swails, M.A., Wichita State University
Robert Zettle, Ph.D., Wichita State University

It is widely accepted that choice of affect regulation method may impact later functioning. Despite this, few studies have examined how these processes unfold in-the-moment. Examination of these processes via Ecological Momentary Assessment (EMA) allows for cross validation of self-report measures and insight into real-time change. We examined responses to self-report measures of affect (anxiety and dysphoria) and tendency towards various self-regulation choices and compared in-the-moment reports of anxiety, dysphoria, and self-regulation. We also examined time-varying and lagged associations between affect and self-regulation choices over time. Participants were 127 undergraduates at a Midwestern university who completed self-report measures and 21 days of EMA. We will present data comparing self-report and EMA data. Data on the associations between affect and emotion regulation choice over time will also be presented. Results will be discussed in relation to a contextual behavioral framework.

• Design and integration of an ecological momentary assessment and intervention of ACT for smoking cessation in those with serious mental illness
Javier Rizo, B.A., University of Washington, Psychiatry & Behavioral Sciences
Roger Vilardaga, Ph.D., University of Washington, Psychiatry & Behavioral Sciences
Julie Kientz, Ph.D., University of Washington, Human Centered Design & Engineering
Richard Ries, MD, University of Washington, Psychiatry & Behavioral Sciences

Mobile technology allows not only implementation of ecological momentary assessments (EMA) of ACT processes and outcomes, but also ACT ecological momentary interventions (EMIs). Integrating EMAs and EMIs can be burdensome for the end user, and poses a design challenge for the researcher. As mobile phones become more prevalent across populations, they provide ripe opportunity to develop tools for both EMAs and EMIs. Understanding the factors around smoking cessation is important for creating effective mobile interventions, especially for those with serious mental illness who smoke at rates much higher than the general population. In this talk we discuss the design and implementation of an EMA feature as part of an ACT smoking cessation app for people with psychiatric disorders tested in a series of 10 Single Case Design trials. We cover our EMA design, present background mobile analytics data, and offer recommendations and lessons learned from the implementation of our chosen design.

• Contextual behavioral assessment of psychological flexibility using wearable sensors
Jennifer Villatte, Ph.D., University of Washington, Psychiatry & Behavioral Sciences
Peter Clasen, Ph.D., University of Washington, Psychiatry & Behavioral Sciences
Javier Rizo, B.A., University of Washington, Psychiatry & Behavioral Sciences

Self-reports of psychological flexibility are linked to important clinical outcomes and predict individual responses to stressful life events and psychological treatment. However, few studies have identified valid and reliable behavioral indicators of psychological flexibility or their relation to clinically relevant outcomes in real time. The current study sought to identify markers of psychological flexibility that can be assessed in real-time via contextual behavioral sensors embedded in wearable devices. For 30 days, adults with modifiable health risks wore a wristband that captured continuous sensor data (e.g., optical heart rate, GPS, accelerometer, gyrometer, barometer, altimeter, skin temperature and galvanic skin response). We examined correlations between self-report measures of psychological flexibility and wearable sensor data and tested the validity of real-time psychological flexibility markers to predict health and quality of life. We will discuss results of this exploratory study in the context of developing contextual behavioral measures using novel methodologies and analytic strategies.

Educational Objectives:
1. Describe ecologically valid predictors of clinical outcomes in psychosis and interpret them from a contextual behavioral perspective. 2. Describe ecologically assessment of affect and affect regulation and interpret them from a contextual behavioral perspective 3. Describe the process of developing ecological momentary assessments to be utilized with mobile technology, and within a contextual behavioral perspective, create more effective interventions.

 

129. Sport and CBS
Symposium (9:00-10:15am)
Components: Original data
Categories: Educational settings, Prevention and Community-Based Interventions, Performance-enhancing interventions, Beh. med., Theory & Philo., Other, Sport, psychological flexibility, self-compassion, well-being, children
Target Audience: Beg., Interm.
Location: St. Helens

Chair: Stefan Holmström, Department of Psychology, Umeå University, Sweden
Discussant: xxx Silberstein, xxx

Athletes face a number of challenges in their lives, from overtraining, and maintaining a healthy diet, to dealing with pressure. When faced with obstacles, psychological flexibility may play a key role in helping athletes stay physically and mentally healthy. We examine the relationship between psychological flexibility, self-compassion, fear of failure and if these factors can predict psychological well-being in young elite athletes. We also present a two-part study that identified needs for, developed and implemented, and assessed an ACT-based healthy eating intervention for parents of youth athletes. Data at a two-month follow up will also be discussed. Finally, we will examine the relationship between ACT components – including mindfulness – and overtraining in athletes. These studies demonstrate the importance of psychological flexibility for the health of athletes. Implications for continuing to help athletes using CBS approaches will be discussed.

• Psychological flexibility, self-compassion, and well-being among youth elite athletes
Stefan Holmström, Department of Psychology, Umeå University, Sweden
John Jansson, Department of Psychology, Umeå University, Sweden

Elite youth athletes with dual careers are under pressure to thrive in sport as well academically. Mental factors are important for development in both the short and long perspective. Psychological flexibility and self-compassion has in earlier studies been highlighted as vital aspects for enhancing athletes’ performance and their well-being. The purpose of this study was to examine the relationship between psychological flexibility, self-compassion, fear of failure and if these factors can predict psychological well-being in young elite athletes. Participants are between 16 and 19 years old and compete on junior elite level in both team and individual sports, and were enrolled at a Swedish sport academy. The results shows that psychological flexibility and self-compassion can predict psychological well-being. This point out the necessary for athletes to develop both psychological flexibility and self-compassion to enhance psychological well-being.

• Facets of mindfulness as possibly preventing factors of overtraining in elite sports
Daniel Birrer, Swiss Federal Institute of Sport Magglingen
Gareth Morgan, Swiss Federal Institute of Sport Magglingen
Philipp Röthlin, Swiss Federal Institute of Sport Magglingen

In search of optimal training gain, athletes push their training load to the extreme resulting in many being overtrained (Peterson, 2005). Overtraining represents a severe problem for the affected athlete. To date personality traits haven’t been linked to the overtraining syndrome (OTS). The data presented stems from an online survey of 155 Swiss elite athletes from 28 different sports. Using the overtraining definition of the European College of Sports Science (Meeusen et al., 2006) rigorously, 29% of the athletes were classified as having overtrained at least once in their ongoing career. Data showed that not overtrained athletes are significantly higher in global trait mindfulness. However, not all ACT components were significantly related with OTS. Further, controlling for cognitive anxiety only affected the results in a few components. Teaching athletes mindfulness and psychological flexibility might be a way to prevent undesired states of overtraining in the long run.

• Health kick: Promoting healthy eating in youth sport using an ACT-based intervention
Cassandra Pentzien, Bowling Green State University
Dara R. Musher-Eizenman, Ph.D., Bowling Green State University

Prior research has called into question the health benefit of participating in youth athletics for children (Nelson et al., 2011). This two-part study identified needs for, developed and implemented, and assessed an ACT-based healthy eating intervention for parents of youth athletes ages 8-14. Participants of Study I (N=29) responded to twelve Ecological Momentary Assessment (EMA) prompts, and indicated that youth athletes consumed significantly more fast food on game days than practice days (t(21)=3.448, p=0.002) and on game days than non-sport days (t(24)=4.440, p<0.001). Based on these results, fast food consumption on game days was targeted most centrally during the Study II intervention. Participants of Study II (N=31) attended an individual 1-hour ACT-based healthy eating intervention, which included psychoeducation and experiential components addressing defusion, values, and committed action (Harris, 2009; Miller, C’de Baca, Matthews, & Wilbourne, 2001). Theory of Planned Behavior measures were given pre-workshop, immediately following the workshop, and at two month follow up. Participant report of behavioral intention and perceived behavioral control significantly increased from pre-workshop to immediate follow up (t(30)=4.055, p<0.001; t(30)=2.170, p=0.038), and this increase was maintained at two-month follow up (t(24)=3.288, p=0.003; up (t(24)=2.066, p=0.05). Subjective norms and attitudes were also impacted by the intervention. While no significant differences were found for consumption of fast food using EMA, consumption overall decreased somewhat from Study I to Study II (t(26)=1.593, p=0.123). The results of this study suggest that brief ACT-based intervention with parents may have a positive impact on the eating habits of youth athletes.

Educational Objectives:
1. Identify the relation between psychological flexibility, self-compassion with psychological well-being among youth elite athletes. 2. Describe the health risks and benefits of participating in youth athletics. 3. Explain how a pilot brief ACT-based intervention impacted Theory of Planned Behavior variables.

 

131. Training perspective taking in children with Autism, in the laboratory, and in the clinic
Symposium (9:00-10:15am)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, RFT, Perspective Taking
Target Audience: Interm., Adv.
Location: Cascade 1B

Chair: Josh Kaplan, Pacific University
Discussant: Carmen Luciano, University of Almeria

Flexible responding to the thoughts and feelings of the self and others is an integral part of healthy social and psychological functioning. Whereas perspective taking and empathy are frequently considered to reflect innate abilities (e.g., from mechanistic and organismic approaches), from behavior analytic and functional contextual approaches they alternatively can be considered to reflect learnable behavioral repertoires. To that end, we present three empirical papers reaching across different settings and levels of application and each informed by Relational Frame theory to guide the development of effective perspective taking training techniques. The first paper focuses on interpsychic (i.e., social) perspective-taking training techniques that improve interpersonal functioning in Autistic children, the second focuses on increasing the specificity of the RFT framework in influencing derived perspective taking (e.g., Theory of Mind) in verbally competent adults, and the third paper focuses on intrapsychic perspective taking (i.e., self-as-context) in clinical settings deploying ACT and Matrix interventions.

• Teaching Components of a Perspective-Taking Repertoire to Children with Autism Using an RFT-Based Protocol and Fluency-Based Instruction
Thomas G. Szabo, Ph.D., BCBA-D, Florida Institute of Technology
Kelli Smith, Florida Institute of Technology

Perspective-taking can be viewed as a composite of coordinated verbal repertoires that include emotion recognition, awareness of others’ informational states, as well as false belief and deception detection. RFT provides an account of perspective-taking as generalized operant behavior based on a history of reinforcement for relational responding in accordance with deictic frames of I-YOU, HERE-THERE, and NOW-THEN. Children with autism provide a unique window into the processes involved in developing a finely discriminated perspective-taking repertoire because they show notable weaknesses in this skill set compared to other areas of learning. Added to that, children with autism progress in this area slow enough for researchers to track the impact of small changes in instructional technology. We taught children with autism two perspective-taking composites - deictic framing and emotion recognition - with a package intervention that included direct instruction, fluency-based instruction, and multiple exemplar training. We assessed deictic framing and emotion recognition directly, and subsequently assessed independent initiations and responses to others’ bids for social engagement. All learners showed strong improvement in the component skills that were directly taught. Additional training was needed to increase social engagement with peers.

• Contextual Control of Derived Perspective Taking Using an Operant Relational Triangulation Perspective Taking Protocol
Paul Guinther, Ph.D., Portland Psychotherapy

Under the established Relational Frame Theory deictic paradigm for understanding perspective taking behavior (Barnes-Holmes, Barnes-Holmes, & Cullinan, 2001), the deictic pairings I-You, Here-There, and Now-Then are considered to be mutually-entailed relational frames on par with non-deictic relations such as More-Less. However, a pattern of function transformation consistent with these alleged relational pairings is underspecified by the deictic paradigm (e.g., a change in the function of a stimulus that is Here does not entail any particular transformations in the function of a stimulus that is There). Empirical support for the deictic paradigm is largely grounded in the Barnes-Holmes Perspective Taking Protocol (BH-PTP; McHugh, Barnes-Holmes, O’Hora, & Barnes-Holmes, 2004), a multiple choice questionnaire that is useful in some contexts but has limited utility in demonstrating and training perspective-dependent derived relations. To remedy some of these shortcomings, I have developed an alternative relational triangulation paradigm supported by empirical demonstrations of derived perspective taking with fully specified perspective-dependent function transformations using an operant match-to-sample Relational Triangulation Perspective Taking Protocol (RT-PTP).

• The ACT Matrix as an effective cue for deictic framing
Benjamin Schoendorff, M.A., MSc., Contextual Psychology Institute, Montreal, Quebec, Canada

The Matrix delivers ACT through multiple exemplars of using a graphic visual cue. With it, experiences and behavior are sorted along two perpendicular axes. The vertical axis invites discriminating between experience observable through the five senses (including overt behavior) and inner or mental experience (including covert behavior while the horizontal axis invites discriminating between behavior under the (largely aversive) control of unwanted inner experience and behavior under the appetitive control of verbally constructed reinforcers (values). Preliminary data with BPD suggests that the ACT Matrix may lead to significantly higher effect sizes than non-matrix ACT in important variables including psychological flexibility. Whereas psychological flexibility appears as a mediator of non-matrix ACT, it may not be a mediator of matrix ACT. We will discuss how perspective-taking as a putative mediator and how the matrix may provide a powerful cue to train deictic framing, as sorting experience and behavior in its 4 quadrants leads users to acquire a “You-There-Then” perspective on their “I-Here-Now” experience.

Educational Objectives:
1. Describe how to construct deictic framing instruction and assessment exercises using direct instruction and multiple exemplars in a fluency-based protocol. 2. Explain the shortcomings of the BH-PTP and established RFT deictic paradigm of perspective taking, and weigh the merits of the alternatively proposed RT-PTP and RFT triangulation paradigm of perspective taking. 3. Describe how the ACT matrix promotes deictic framing.

 

135. Behavioral Health Applications
Symposium (9:00-10:15am)
Components: Conceptual analysis, Original data, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Prevention & Comm.-Based, Beh. med., Oncological patients, Self-Other, Group Therapy, Chronic Pain, resilience training for adults
Target Audience: Beg., Interm., Adv.
Location: Puget Sound

Chair: Taryn L. Gammon, M.A., California School of Professional Psychology
Discussant: Megan Oser, Ph.D., Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School

ACT and other third wave approaches are increasingly being applied in behavioral health settings. Oftentimes, these approaches are combined with other proven components from other packages to improve their effectiveness. Three conditions that commonly pose behavioral challenges to individuals diagnosed with them are breast cancer, chronic pain, and congenital heart disease (CHD). We present data from an Interpersonal ACT protocol intervention group for women with breast cancer. The protocol includes six consecutive weekly sessions and four monthly follow-up sessions on three main topics: the suffering linked to oncological disease, the side effects of therapy and the physical changes. We will also present a novel interdisciplinary program for chronic pain that integrates acceptance and self-compassion principles into a medical context. This program emphasizes building psychological and physiological resilience to manage chronic pain through self-compassion cultivation, physiological self-regulation and education, mindfulness and interoceptive training, core values clarification, and embodied mindful movement. In addition, we will report on the evaluation of a group ACT resilience training program that incorporates ACT processes to target empirically identified resilience protective factors for adults with CHD. Results from pre- and post-intervention and follow-up will be presented.

• An Intra-personal and Inter-personal level (Self-Other) Acceptance and Commitment Therapy (ACT) intervention group protocol for women with breast cancer: ACT for Health SIG Sponsored
Giuseppe Deledda, Psy.D., Service Clinical Psycology, “Sacro Cuore-Don Calabria” Hospital of Negrar, Verona, Italy
Sara Poli, Psy.D., Service Clinical Psycology, “Sacro Cuore-Don Calabria” Hospital of Negrar, Verona, Italy
Matteo Giansante, Service Clinical Psycology, “Sacro Cuore-Don Calabria” Hospital of Negrar, Verona, Italy

Aim: The aim of this paper is to present an Interpersonal ACT protocol intervention group for women with breast cancer. Method: The protocol includes six consecutive weekly sessions and four monthly follow-up sessions on three main topics: the suffering linked to oncological disease, the side effects of therapy and the physical changes. The focus of the intervention was the “Self-” and the “Self-Other” non-acceptance” and the impact of them on suffering and on the possibility to act consistently with own values (eg. act for health, act for a good relationship of love). Results and Conclusions: We observed an increase in the acceptance of Self as context, despite of the difficulty of the patients to face the encounter with own Self and the Other, which, within the group, can become the mirror of the Self. Finally patients' thoughts seem to move more freely, giving space to new and more functional repertoires.

• Integrating Self-Compassion into Interdisciplinary Chronic Pain Treatment
Taryn L. Gammon, M.A., California School of Professional Psychology

To address the need for treatment models for chronic pain that reach through disciplinary and orientation-specific barriers, a novel interdisciplinary program for chronic pain that integrates acceptance and self-compassion principles into a medical context will be presented. This program, Therapeutic Self-Care, emphasizes building psychological and physiological resilience to manage chronic pain through self-compassion cultivation, physiological self-regulation and education, mindfulness and interoceptive training, core values clarification, and embodied mindful movement. The intervention represents a practical integration of current research into the psychological benefits of self-compassion (e.g., Sirois, 2015); the effectiveness of mindfulness and acceptance-based interventions for chronic pain (e.g., Vowles, Sowden, & Ashworth, 2014); and the neurobiological correlates of pain, self-compassion, and mindfulness (e.g., Arch et al., 2014, Hallman et al., 2011; Zeidan, 2015). Research on the effectiveness of Therapeutic Self Care in a hospital setting demonstrates improvements in pain, depression, self-compassion, self-regulation, and opioid medication use among patients with chronic pain. A case example and practical applications of these skills for clinicians working with pain conditions will be discussed.

• ACT for Adult Congenital Heart Disease
Kenneth Pakenham, Ph.D., University of Queensland
Bronwyn Steele,

This presentation reports on the evaluation of a group ACT resilience training program called READY for adults with congenital heart disease (CHD). READY incorporates ACT processes to target empirically identified resilience protective factors (Burton et al, 2010). ACT processes, protective factors and the corresponding domains of human functioning are incorporated into a READY resilience framework. In view of specific CHD characteristics, a modified briefer version of the program was used (n = 17). A single intervention condition design with pre- and post-intervention and follow-up assessments was used. Preliminary analyses showed improvements in resilience F(1.34, 21.49) = 4.61, p = .034, ηp2 = .22, depression χ2 (2) = 10.08, p = .005, quality of life χ2 (2) = 7.70, p = .019, and values F(2, 32) = 3.71, p = .036, ηp2 = .19. Qualitative data from focus groups with three different stakeholders will be presented (n = 12 patients, n = 3 caregivers, n = 5 clinicians). Results of final analyses will be reported.

Educational Objectives:
1. Describe the rationale for incorporating self-compassion into mindfulness and acceptance-based interventions for chronic pain. 2. Utilize ACT processes to target resilience protective factors in the context of chronic illness. 3. Explain an ACT-based resilience training program for chronic illness.

 

141. ACT for Obesity and Weight-Related Stigma: Concept and Treatment
Symposium (10:30am-Noon)
Components: Original data
Categories: Clinical Interventions and Interests, Beh. med., Weight-Related, Health
Target Audience: Interm.
Location: Vashon 2

Chair: Sarah Potts, M.S., Utah State University
Discussant: Emily Sandoz, Ph.D., University of Louisiana Lafayette

Obesity and weight-related issues are significant public health problems in the United States affecting nearly 70% of American adults, estimating around $147 billion per year (Ogden, Carroll, Kit, & Flegal, 2014). Individuals who are obese are also often adversely impacted by the public attitude and stigma associated with being overweight (Lillis, Luoma, Levin, & Hayes, 2010). While the severity of this health problem has consistently increased and numerous treatments seek to target the problem of weight, there are few treatments that are successful in weight loss and maintenance. This suggests the importance for better understanding the relationship between weight stigma and behaviors and also for developing alternative, novel approaches to obesity and weight-related issues. Preliminary studies suggest ACT is promising as a novel and essential treatment target for overweight and obese individuals, as it highlights acceptance and willingness for experiencing psychological experiences while increasing values-consistent behavior. Three studies with original data investigating the role of weight stigma and eating concerns will be discussed.

• A randomized controlled trial for weight loss targeting individuals with high internal disinhibition: The Acceptance Based Behavioral Intervention (ABBI) trial
Jason Lillis, Ph.D., The Miriam Hospital; Brown Medical School
Heather Niemeier, Ph.D., University of Wisconsin
J. Graham Thomas, Ph.D., The Miriam Hospital; Brown Medical School
Jessica Unick, Ph.D., The Miriam Hospital; Brown Medical School
Kathryn M. Ross, Ph.D., The Miriam Hospital; Brown Medical School
Tricia Leahey, Ph.D., University of Connecticut
Katie Kendra, Ph.D., The Miriam Hospital; Brown Medical School
Leah Dorfman, Ph.D., The Miriam Hosptial

Behavioral weight control programs produce clinically meaningful weight losses; however, outcomes have high variability and maintenance is problematic. The current study, an NIH-funded RCT testing a novel approach, Acceptance-Based Behavioral Intervention (ABBI), which combines techniques from standard behavioral treatment (SBT) and Acceptance and Commitment Therapy (ACT) among individuals reporting high internal disinhibition who typically respond poorly to standard interventions. 162 overweight and obese adults (mean BMI 37.6) who reported high internal disinhibition as measured by the Internal Disinhibition subscale of the Eating Inventory were randomly assigned to treatment (ABBI/SBT). Mean weight loss at 24 months was -5.4kg for ABBI and -3.5kg for SBT. The ABBI group had a softer regain curve (4.9kg vs 7.5kg for SBT) from peak weight loss to the end of the study. Significant differences between groups were found on change in values-consistent behavior, but not weight-related experiential avoidance. Implications and future directions will be discussed.

• You’re fat!: Is psychological flexibility related to stigmatizing experiences and disordered eating for the obese?
Emily R. Squyres, M.S., Louisiana Tech University, University of Louisiana Lafayette
Emily K. Sandoz, Ph.D., University of Louisiana Lafayette
Katie Kendra, Ph.D., The Miriam Hospital; Brown Medical School
Leah Dorfman, Ph.D., The Miriam Hosptial

The public attitude towards obese individuals focuses more on negative stereotypes than underlying psychological components that lie at the heart of the struggle (Latner, O’Brien, Durso, Brinkman, & MacDonald, 2008). Many people who struggle with their weight are found to be very rigid in thought processes regarding food (Darby, Hay, Mond, Rodgers, & Owen, 2007). Perhaps it is not the content of food and body-related cognitions that is important, but the inflexibility with which they are held. The current study investigated the relationships among avoidant eating behavior, perceived stigmatization, self-stigmatization, and psychological flexibility in an obese population using Ecological Momentary assessment. Participants responded to four text messages a day for seven days, three of which were provided them with a link to the Periodic Assessment of Stigmatizing Experiences, and one text message providing a link to the Daily Eating Survey.

• Delivering acceptance and commitment therapy through guided self-help for weight self-stigma: Results from an open pilot trial
Michael E . Levin, Ph.D., Utah State University
Sarah Potts, Utah State University
Jack Haeger, Utah State University
Jason Lillis, Ph.D., The Miriam Hospital; Brown Medical School

Obesity is a prevalent and costly public health problem in the US; however, existing psychosocial interventions designed to promote weight loss are not sufficient, tending to only produce small weight loss outcomes with significant weight gain over time. Stigmatization of obese individuals is highly prevalent in our society, occurring across a range of life contexts, yet little research has sought to develop interventions in this area. Preliminary research suggests ACT is an efficacious intervention in targeting weight self-stigma in a general treatment-seeking obese sample. A guided self-help Acceptance and Commitment Therapy (ACT) treatment was used as a novel approach for individuals with weight concerns. Participants were assigned to phone coach and completed 7-weeks study by reading The Diet Trap and completing journaling and weekly quizzes. Results suggest significant sustained changes in weight-related stigma (3-month follow-up: F(9)=32.23, p<.01), among other variables. Clinical application and user-centered feedback will be discussed.

Educational Objectives:
1. Discuss role and significance of values consistent behavior within weight loss and weight-related interventions. 2. Explain role of psychological inflexibility and negative stereotypes as predictor of increased perceived self-stigma. 3. Analyze the relationship between experiences of stigmatizing events, disordered eating behaviors, and psychological flexibility for those struggling with obesity.

 

144. Awesome Papers 2
Symposium (10:30am-Noon)
Components: Conceptual analysis, Literature review, Original data, Experiential exercises, Didactic presentation, Case presentation
Categories: Performance-enhancing interventions, Clinical Interventions and Interests, Prevention & Comm.-Based, Edu. settings, Superv., Train., & Dissem., Theory & Philo., Functional contextual approaches in related disciplines, ACT Training Program on Acceptance of Autistic Children by Their Mothers, Low-intensity ACT interventions, OCD, Psychological flexibility, Outcome research
Target Audience: Beg., Interm., Adv.
Location: Cascade 1B

Chair: Felicity L Brown, PhD, Harvard University
Discussant: Douglas M. Long, Ph.D., Alpert Medical School of Brown University

As research on acceptance and commitment therapy (ACT) continues to accumulate, the need for studies on applications of ACT in more diverse settings and communities are becoming more apparent. Although there is some evidence for the applicability of ACT across cultures, more research is needed in this area. In addition, the role of psychological flexibility in therapeutic outcomes warrants further study. We present results from a study was conducted in Tehran, Iran, to evaluate the effectiveness of ACT on the acceptance of children with autism by their mothers. We will also present the development of an ACT-based guided self-help intervention for use in low-resource humanitarian settings, and describe the adaptation process, novel delivery method and results of a feasibility pilot with South Sudanese refugees living in northern Uganda. Pilot implementation results, challenges and lessons learned will be discussed. Last, data from a study involving therapists who were not generally ACT-congruent on whether psychological flexibility may be a central ingredient in change will be presented.

• The Effectiveness of Acceptance and Commitment Training Program on Acceptance of Autistic Children by Their Mothers
Ahmad Beh-Pajooh, Ph.D., Professor, University of Tehran, Iran
Sara Pazoki, M.A., Psychology University of Tehran, Iran

This study was conducted to evaluate the effectiveness of the acceptance and commitment training on the acceptance of autistic children by their mothers. The method of the study was quasi-experimental with pre-test, post-test, and follow-up design. The study population included the whole mothers whose autistic child was receiving training and rehabilitation services in Nedaye Asre Rehabilitation Center for Autistic Children, Tehran, Iran in academic year of 2015-16. Using convenience sampling, eleven mothers who had autistic child were selected as the sample group which received acceptance and commitment training in nine two-hour-sessions. As a research tool, the second edition of acceptance and action questionnaire was administered and analyzed based on data using t-test. Data analysis of the results revealed that there was a significant difference between the results of the pre-test, post-test and follow-up. The results confirmed that the acceptance and commitment training has been effective on mothers' accepting their autistic child, by increasing psychological flexibility and decreasing experiential avoidance.

• The Relationship between Psychological Flexibility and Treatment Outcomes
Melissa Daniel, Richmont Graduate University
Timothy Sisemore, Ph.D., Richmont Graduate University

This study explores changes in psychological flexibility as a result of psychotherapy, and ways that those changes may be related to the overall treatment outcome. The agent of change in psychotherapy has long been debated, but it has been commonly accepted that the therapeutic alliance is a central catalyst to change. Qualitative factors of the therapist such as warmth and acceptance have been previously explored (Wampold, 2001), but no consensus has been reached regarding the central mechanism of change within the relationship. The introduction of psychological flexibility as a therapeutic focus in ACT has raised the question of its role in the process of change. This study aims to understand whether psychological flexibility may be a central ingredient in change, or another measure of patient global distress. Data from a psychotherapy outcomes project were compiled which measured patients’ (n = 1664) global functioning, social functioning, global distress, and psychological flexibility (as measured by items from the AAQ-II) in various stages of treatment. The therapists were varied in theoretical approach, and not generally ACT-congruent therapists. Correlational analysis showed that changes in global functioning and changes in psychological flexibility were significant and strong predictors of change in symptoms (r =.73 for symptoms and .69 for functioning, exceeding predictions based on reliability., both at p < .0001). Factor analysis showed flexibility to load on a common factor of improvement, and the three items had a strong alpha of .78. Flexibility was second only to change in functioning in predicting symptom reduction, These findings support the hypothesis that increasing psychological flexibility may be a key factor in positive changes from psychotherapy, and may do so through impacting overall functioning and thus reducing symptoms. Implications for future developments in treatment and interventions from an ACT perspective are discussed.

• Development and Pilot of an ACT-Based Guided Self-Help Intervention for South Sudanese Refugees Living in Uganda
Felicity L. Brown, Ph.D., Harvard University
Wietse Tol, Ph.D., Johns Hopkins University
Kenneth Carswell, DClinPsy, World Health Organization
Mark van Ommeren, Ph.D., World Health Organization

This paper will present the development of an ACT-based guided self-help intervention for use in low-resource humanitarian settings, and describe the adaptation process, novel delivery method and results of a feasibility pilot with South Sudanese refugees living in northern Uganda. The findings of a comprehensive needs assessment indicated high levels of psychological distress and experiences of sexual and gender-based violence in this population, continued ethnic tensions, and “over-thinking”, with limited access to mental health and psychosocial services. The results of a systematic cultural and contextual adaptation process indicate support and excitement for the intervention, with changes made to ensure comprehensibility, relevance, and acceptability of the ACT intervention. Pilot implementation results, challenges and lessons learned will be discussed, along with the possible benefits of the delivery approach for generalizability of the intervention to different settings and dissemination in difficult environments.

Educational Objectives:
1. Utilize ACT for mothers who have autistic children in order to enhance the acceptance of their autistic children. 2. Describe the “active ingredient” in the therapeutic relationship from the perspective of ACT, as compared to traditional views of the therapeutic relationship and what makes therapy work. 3. Describe an adaptation process for taking interventions to new cultures and contexts, and current challenges and innovations in developing interventions that are adaptable and scalable.

 

146. Functional Analytic Psychotherapy interventions across populations: Mexico Chapter Sponsored
Symposium (10:30am-Noon)
Components: Original data
Categories: Clinical Interventions and Interests, Other, FAP
Target Audience: Interm.
Location: Puget Sound

Chair: Daniel Maitland, Ph.D., University of Washington
Discussant: Matthew Skinta, Ph.D., ABBP, Palo Alto University

Functional Analytic Psychotherapy (FAP) is a powerful intervention that has shown potential across presenting problems. FAP has also seen an increase in utilization with different demographic populations and for those seeking increase the quality of their relationships with other individuals. As the scope of the intervention increases, so does the definition of a successful intervention. This symposium provides three data-based examples of the scope of FAP as an intervention and techniques that can be used to capture variables that may be crucial in clinical outcomes. Specifically, we will be talking about FAP as an adjunct treatment for Borderline Personality Disorder, as an intervention for enhancing the relationship between two individuals, and as a general social functioning intervention. The populations utilized in these studies differed significantly showing the utility of FAP across both clinical and demographic populations. Presentations will detail both process and outcome variables that are central to FAP.

• FAP impact, and mechanisms of change, as an adjunct treatment for people diagnosed with BPD
Michel A. Reyes Ortega, Ph.D., Contextual Behavioral Science and Therapy Institute (Mexico City)
Nathalia Vargas Salinas, Ph.D., Contextual Behavioral Science and Therapy Institute (Mexico City)
Jonathan W. Kanter, Ph.D., University of Washington
Mavis Tsai, Ph.D., Private Practice

An RCT was conducted to test the impact of Functional Analytic Psychotherapy (FAP) on individuals diagnosed with Borderline Personality Disorder (BPD) who had finished treatment-as-usual at a public mental health institution in Mexico City. Participants received either 18 sessions (9 individual and 9 group) of FAP (n=22) or Social Skills Training (n=22). T-test analyses found statistically significant (p ≤ .05) and large (d ≥ .80) effects for FAP at post-test compared to pre-test in BPD symptom severity, intimacy, experience of self and emotion regulation according to self-administered questionnaires. Between-groups analyses found statistically significant and large effects in favor of FAP with the biggest differences observed with our measure of intimacy. Regression analyses found that experience of self mediated changes in emotion regulation (R2=.325), and emotion regulation mediated BPD symptom reduction (R2=.457) in the FAP group. These results suggest FAP’s possible utility as an adjunct treatment for BPD and experience of self as a possible FAP-specific mechanism of change.

• The in vivo process in FAP: The relationship to outcomes, adherence, and client experience
Lindsey E. Knott, M.A., Western Michigan University
Rachel A. Petts, M.A., Western Michigan University
Rebecca A. Rausch, Western Michigan University
Daniel W. M. Maitland, Ph.D., University of Washington
Scott T. Gaynor, Ph.D., Western Michigan University

In vivo (IV) work is a distinctive feature of FAP. IV work in FAP involves the therapist attempting to apply contingencies in session to decrease (i.e., gently punish or extinguish) problematic response classes and increase (i.e., evoke and reinforce) more adaptive response classes (i.e., a differential reinforcement procedure). A recently conducted randomized controlled trial found superior outcomes for FAP compared to watchful waiting (WW). In addition, session ratings of general adherence (a standard approach to assessing treatment fidelity in efficacy research) to the FAP rules suggested FAP sessions were unique. The present study attempts a more detailed analysis. Following Kanter et al. (2003), each turn of speech will be coded as IV (talk directed at the therapy process, therapy relationship, or in the moment interactions) or not. It is hypothesized that the IV rate will be higher in FAP than WW, providing another indicator of treatment fidelity. Also, examined will be the relationship between IV rates and coded adherence scores (to determine if the global adherence ratings offer a convenient proxy for such detailed coding), client session ratings (to determine if IV rate is linked to session evaluations), and treatment outcome (to see if IV rate is linked to change).

• The role of the vulnerability-responsiveness relation in individuals attempting to increase social intimacy
Daniel W. M. Maitland, Ph.D., University of Washington
Jonathan W. Kanter, University of Washington
Mavis Tsai, Private Practice

One of the defining characteristics of Functional Analytic Psychotherapy is that of a safe, intense, and authentic and powerful relationship between the therapist and client. One possible explanation for the development of this intense relationship is what researchers term the vulnerability-responsiveness relation. In the current study, an investigation of the application of the vulnerability-responsiveness relation will be explored in dyads who wish to become closer to one another. 32 dyads of individuals (friends, family members, romantic partners) wishing to feel more connected with one another were recruited and received a weekly training that had the dyads engage in the vulnerability-responsiveness relation. In pre, post, and follow-up assessments, the dyad’s responses were coded for the components of the vulnerability-responsiveness relation. The results show the promise of an observer based coding system for assessing interactions that include the vulnerability-responsiveness relation as well as how those codes correlate with measures of interpersonal styles.

Educational Objectives:
1. Discuss the specific benefits of incorporating Functional Analytic Psychotherapy (FAP) as an adjunct treatment for BPD diagnosed clients in contrast with traditionally used interventions. 2. Explain several approaches to determining treatment adherence to FAP principles when applied in efficacy studies and what the resulting data suggest. 3. Describe and utilize the process involved in building relationships as well as the clinical utility of this process as it relates to FAP.