Thursday, 22 June
Friday, 23 June
Saturday, 24 June
Sunday, 25 June

Thursday, 22 June

11. Translational Research on Clinically Relevant Processes: Psychological Inflexibility, Hierarchical and Conditional Framing, Growth Mindset, and Self-Compassion
Symposium (11:00-12:30)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Behavioral medicine, Pattern of Psychological Inflexibility, Self-esteem, Growth mindset
Target Audience: Beg., Interm., Adv.
Location: Buhaira

This symposium presents a diversity of approaches to studying clinically relevant processes, ranging from analogue laboratory research to large-scale cross-sectional survey. The first paper in the symposium presents an analogue experimental study exploring the conditions that enhance avoidance behavior to the point of turning it into psychological inflexibility. The second study investigates whether different ways of framing task performance, either hierarchically (e.g., focusing on what you are doing is part of the task) or conditionally (e.g., focus on getting a good score), affects task persistence (motivation to persist in task), task performance, and self-efficacy and willingness to engage in the task. The third study presents a large-scale survey examining whether growth mindset can decouple the links between low self-esteem and outcomes such as poor academic achievement and low wellbeing. The fourth and last paper in the symposium presents research that has used the IRAP to explore the construct of self-compassion from the point of view of implicit verbal relations. Results show discrepancies between explicit and implicit measures of self-compassion. These different ways to assess self-compassion seem to capture different features of the construct itself.

• Conditions that Enhance Avoiding as Psychological Inflexibility
Adrián Barbero-Rubio, Ph.D., University of Almeria, Madrid Institute of Contextual Psychology
Carmen Luciano, University of Almeria

This study aimed to explore the conditions under which PI is enhanced through an experimental analogue of the elements involved in rigid dominance of avoidance psychological reactions. Firstly, 51 participants were randomly assigned to five experimental conditions to perform two experimental tasks. The tasks were designed to capture rigid psychological reactions. Secondly, four inflexibility protocols were designed with four different components of the learning process that might be involved in the natural developing a pattern of psychological inflexibility. The four inflexibility protocols and a control protocol were implemented to participants respectively in the five conditions. Finally, all participants repeated the experimental tasks. Results indicated significant lower performance in all the four conditions receiving the inflexibility protocol when compared to control participants. Results are discussed on the processes that enhance and disrupt the pattern of clinical inflexibility.

• Investigating the effect of Conditional vs Hierarchical Framing on Motivation
Varsha Eswara-Murthy, University College Dublin
Matthieu Villatte, Evidence-Based Practice Institute of Seattle
Louie McHugh, University College Dublin

Focusing on process not just outcome is often cited as an important part of living a meaningful life from a CBS point of view. The current study aimed to investigate whether task instructions that differed based on focusing on the process of completing a task, the outcome of completing a task, or both changed participants task performance and motivation. To that end, hierarchical (e.g., focusing on what you are doing is part of the task), conditional (e.g., focus on getting a good score) and a mixed condition (e.g., focus on engaging in the task and getting a good score) task instructions were compared. Participants completed an anagram task, followed by the presentation of scripts relating to the three separate framing conditions. Participants were subsequently exposed to a task persistence measure (i.e.,PASAT-C). Pre and post persistence task measures evaluating mood, self-efficacy and experiences of task participation were completed. A final anagram task was completed to evaluate the effect of framing condition on task performance and transfer of framing conditions across different tasks. Hierarchical and mixed groups outperformed the conditional group on measures of task performance and persistence. This effect was transferred to performance on the anagram task. Significantly increased self-efficacy, comfortableness and willingness was observed for both the hierarchical and mixed conditions over the conditional group with the hierarchical group outperforming the mixed group. This study highlights the potential differing effects framing tasks conditionally, hierarchically or both hierarchically and conditionally can have on motivation and task performance.

• The benefits of believing you can change: Growth mindset weakens the links between self-esteem and negative outcomes.
James Conigrave, Institute for Positive Psychology and Education
Professor Joseph Ciarrochi, Institute for Positive Psychology and Education
Assoc. Prof. Baljinder Sahdra, Institute for Positive Psychology and Education

Intervention-related research has suggested that there are two ways to combat the negative consequences of low self-esteem: improving the level of self-esteem, or decoupling or reducing the link between low self-esteem and negative outcomes. Prior evidence suggests that growth mindsets tend to prevent low-self-esteem from occurring in response to failure. However, little research has examined whether growth mindset can decouple the links between low self-esteem and outcomes such as poor academic achievement and low wellbeing. We sought to examine this possibility in female high school students (N = 489) and in a large sample of American adults (N = 7884). Moderation analyses in both samples showing that the links between low self-esteem and negative outcomes (wellbeing and achievement) were weaker for those with higher levels of growth mindset. People with low self-esteem may be especially likely to benefit from interventions boosting growth mindset.

• Using the IRAP to explore self-compassion and self-judgment
Andrea Compiani, Università IULM, Milano, Italy
Paolo Moderato, Università IULM, Milano, Italy
Giovambattista Presti, Kore University, Enna, Italy
Annalisa Oppo, Freud Universirty, Italy

Using the IRAP to explore self-compassion and self-judgment

12. Same Technology, Different Delivery: Varieties of Formats of ACT Interventions for Chronic Health Problems
Symposium (11:00-12:30)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Behavioral medicine, ACT Delivery in Chronic Ill Health
Target Audience: Beg.
Location: San Bernardo

David Gillanders, University of Edinburgh
Ray Owen, Herefordshire NHS

One of the remarkable features of ACT is that the exact same technology can be used with relatively little adaptation across a very wide variety of problem areas. This has pragmatic benefits for clinicians (who don’t need to learn multiple protocols, specific to each problem area) and has benefits for the progress of clinical science as data can accumulate faster across a breadth of areas. A further remarkable feature is the flexibility with which the same technologies can be delivered. This has benefits to organisations in terms of using ACT technology across a variety of service delivery models. In this symposium, presentations from three different groups, with three different health problems, using both high and low intensity intervention formats will be presented. This symposium will show delegates the flexibility of ACT technology in addressing diverse health complaints and its adaptability to a range of service contexts.

• Low intensity psychological intervention for Irritable Bowel Syndrome
David Gillanders, University of Edinburgh
Nuno Ferreira, University of Edinburgh
Eugenia Angioni, University of Edinburgh
Maria Eugenicos, University of Edinburgh
Sergio Carvalho, University of Coimbra

IBS is a functional GI disorder characterised by bowel pain, diarrhoea and constipation. People with IBS also often fear having bowel accidents, and experience shame and embarrassment. People with IBS often use strategies to control or avoid these experiences, which have the unintended consequence of putting life on hold, at great cost to living. Anxiety, depression and reduced quality of life are common consequences. In this study, a sample of 45 people diagnosed with treatment resistant IBS were given an ACT based self-help book and audio CD, “Better Living with IBS”. They completed standardised measures prior to receiving the book, approximately two months and six months later. Results showed that participants improved significantly in terms of IBS acceptance, IBS related anxiety, and IBS symptom severity, but did not improve in relation to avoidance or quality of life Results are discussed in relation to social processes of exposure and commitment.

• ACT for obesity: Clinical techniques and research outcomes
Dayna Lee-Baggley, Ph.D., Nova Scotia Health Authority

Obesity has been called a global epidemic that threatens the health of individuals and the healthcare systems of nations (WHO, 2000). While there is evidence for the effectiveness of weight loss programs in the short-term, long-term, sustainable changes in obesity remain elusive. The authors will present techniques, clinical examples, and research data from their ACT-based, 52-week, multidisciplinary group intervention for obesity. The authors will review the ways in which ACT principles and techniques can be used in the management of health behaviours for people living with obesity. In addition, the authors will discuss the ways in which ACT may be better able to address the long-term management of obesity. Finally, preliminary data from the program will be presented.

• A Randomized Controlled Trial of a Guided Self-Help Bibliotherapy Among Community Adults Suffering from Chronic pain
Frederick Dionne, Ph.D., Université du Québec in Trois-Rivières
Josée Veillette, Université du Québec in Trois-Rivières
Marie-Claude Blais, Ph.D., psychologue, Université du Québec in Trois-Rivières

In Canada, one in five people suffers from chronic pain, triggering annual costs of nearly 60 billion dollars. While Acceptance and Commitment Therapy (ACT) has proven to be effective in reducing disability and suffering among chronic pain patients, unfortunately, very few people have access to these treatments. Self-help guided interventions can improve access to treatment, but further studies are necessary to evaluate their efficacy. This randomized controlled trial evaluated the efficacy of a 8-week ACT guided self-help bibliotherapy, with minimum therapeutic contact, among community adults suffering from chronic pain. 130 participants were randomly assigned to an ACT intervention or waiting list condition. Results from a two-way ANOVA show a reduction in pain-related disability, depressive symptoms and psychological inflexibility in favor of the ACT group (interaction effects were found between group and time for all variables). Benefits sustained at 3-month follow-up. Results are discussed in terms of future research.

13. Be More Contextual, Behavioral, and Scientific in Your Practice: Using Single-Case Designs (SCDs)
Symposium (11:00-12:30)
Components: Conceptual analysis, Original data, Case presentation
Categories: Evolution, Professional Development, Single-Case Designs (SCDs)
Target Audience: Beg.
Location: Lebrija

Niklas Törneke, MD, Private Practice
Carmen Luciano, Ph. D., University of Almeria

Using single case designs (SCDs) methodology in inherently suitable in philosophy of our Contextual Behavioral Science (CBS). However, we cannot see many SCDs-based researches and practices in our World Conference and Journal of Contextual Behavioral Science. It’s true that randomized controlled trials might be critically important, the “gold standard”, in the Empirically Supported Treatment (EST) or Evidence-based Practice in psychology (EBPP) era, but it is one of many standards in our CBS enterprise. Moreover, we also attach great importance to generating practice-based evidence, not only evidence-based practice, in order to build a progressive science. The purpose of this symposium is to promote using SCDs methodology through reconsidering some gaps between research and practice, and showing some technical, practical and analytic innovations in this methodology.

• Bridging the gap between research and practice using single case designs.
Michael Twohig, Ph. D., Utah State University

Conducing research in an applied setting or job is difficult. Single subject designs (SSD) are great ways to test predictions and participate in research when larger studies are not feasible. For example, someone who naturally has a waitlist may conduct a nonconcurrent multiple baseline design while testing a treatment. ABAB designs are useful in settings such as schools or residential settings. This presentation will cover the ways in which a person who works in an applied setting may participate in research using SSD. In addition to guidance on design selection and practical suggestions for completing the study, some guidance on publication of SSDs will be offered. Ethical considerations of collecting data in a clinic setting will also be discussed.

• How to implement “treatment-evaluation” through using single-case designs (SCDs): Some new technical and practical innovations.
Takashi Muto, Ph. D., Doshisha University

Hayes, Barlow and Nelson-Gray (1999) described the differing features between treatment-evaluation and treatment-research. Treatment-evaluation are designed and executed according to therapeutic criteria, giving priority to the resolution of client problems and the satisfaction of client needs over identifying control variables. The purpose of this paper is to present some new technical and practical innovations in implementing “treatment-evaluation” through using SCDs, for example, Muto (2012) and Muto & Mitamura (2015). These innovations are as follows; a) measuring the therapy processes with high-technological but low-cost devices, for example, a small-and-easy-operating activity meter, GPS logger, and action-camera, and b) making graph of client’s data, in particular, making new cumulative graph.

• Non-parametric approaches to planning and analyzing single case design data.
Roger Vilardaga, Ph. D., roger.vilardaga.duke.edu.

Single Case Design analysis has traditionally relied on visual interpretation of changes in trend and level of repeated observations over time across phases. This is a powerful approach to data interpretation, but it has limitations. For example, it doesn't inform us about how likely it is that we would have found the same result by chance. Randomization tests were conceived by Donald Fisher, the father of statistics, in the mid 1930's, but they were so computationally challenging that he invented parametric statistics, a shortcut to statistical inference. With current computational capabilities, we have now the opportunity to stiffen single case design data interpretation by combining both visual and statistical tools. This talk will briefly describe the rationale and practical use of these novel statistical techniques from a contextual behavioral perspective.

14. Examining the Role of Psychological Flexibility Within Distinct Lesbian, Gay, Bisexual, Transgender, Queer and Intersex (LGBTQI) Populations
Symposium (11:00-12:30)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Other, LGBTQI populations, Diversity, Coping, Mental and behavioural health
Target Audience: Beg., Interm.
Location: Utera

Jo Lloyd, Ph.D., Goldsmiths, University of London
Laura Silberstein, Psy.D., The Center for CFT

Research indicates that LGBTQ people experience minority stressors, in addition to the general life stressors experienced by everyone, which are salient to their mental health and wellbeing (Meyer, 2003; Testa et al, 2015). Whilst minority stressors have their origins in oppressive social and cultural structures, they are believed to take root in LGBTQ people via psychological processes. Specifically, there are subjective/proximal stressors (e.g., internalised transphobia) which are thought to result from the internalisation of negative social attitudes (Meyer, 2003). There are also objective/distal stressors (e.g., homophobic discrimination) which are thought to gain psychological importance when they manifest in the immediate context of people’s thoughts, feelings and actions (Meyer, 2003). Since psychological processes appear to underpin the experience of minority stressors, we suggest that the way in which people respond to their internal psychological events may be central to how they cope with such stressors. To this end, this symposium examines the role of psychological flexibility within three distinct LGBTQ populations: A heterogeneous sample of LGBTQ people, transgender and gender nonconforming (TGNC) people and LGBTQ employees. The latter paper also extends to an analysis of how the concept of psychological flexibility can be used to design teams and organisations in which LGBTQ employees can thrive.

• The Protective Role of Psychological Flexibility in the Relationship between Minority Stressors and Mental Health in Transgender and Gender Nonconforming (TGNC) People in England
Jo Lloyd, Ph.D., Goldsmiths, University of London

In this study we examined the protective role of psychological flexibility in the relationship between three widely examined minority stressors experienced by transgender and gender nonconforming (TGNC) people (i.e., transphobic discrimination, identity nondisclosure and internalised transphobia) and the mental health outcomes of anxiety and depression. We examined our hypotheses in a cross-sectional sample of 921 TGNC people in England (This is T1 data from a two-wave longitudinal panel study; T2 data is due to be collected in August 2017). Analyses revealed that TGNC people with higher levels of psychological flexibility had lower levels of anxiety and depression compared to those with lower levels of psychological flexibility. Furthermore, psychological flexibility showed a buffering/protective effect; specifically, harmful relationships between minority stressors and mental health outcomes were weaker for TGNC people with higher levels of psychological flexibility. Theoretical and practical implications for psychological flexibility theory and minority stress research are discussed.

• Stigma in context: Psychological distress and coping style of gender and sexual minorities.
Lauren Griffin, University of Louisiana at Lafayette
Rebecca Copell, MSc., University of Louisiana at Lafayette
Emily Sandoz, Ph.D, University of Louisiana at Lafayette

People within the LGBTQ community are at increased risk of psychological distress, mental health symptomatology, and risk-taking behaviors (Kirsch, Conley & Riley 2015). Some have suggested that LGBTQ individuals do statistically show worse mental health because of a lack of social resources, alienation, discrimination, victimization, and abuse (Kirsch et al. 2015). Past studies do not offer insight into what differentiates well functioning individuals from distressed ones (Herek & Garnets, 2007). Some seem to experience both psychological well-being and distress simultaneously. It may be that these minorities had to adapt to environmental difficulties related to orientation while also developing resilience in the face of life stressors (Kirsch et al., 2015). The purpose of this study is to determine whether or not (1) LGBTQ people experience psychological distress from enacted stigma, and (2) if they do experience distress, types of coping styles utilized to mitigate distress will be explored.

• Helping Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) Employees Live Vital and Effective Lives: From Psychological Flexibility to Organisational Flexibility
Jo Lloyd, Goldsmiths, University of London

In this conceptual paper, we examine how psychological flexibility may help LGBTQ employees live vital and effective lives, even when they are experiencing difficult and/or challenging circumstances. Firstly, we inspect the manifestation of minority stressors in the workplace and the difficulties they may cause for LGBTQ employees. Secondly, we examine how individual-level training interventions that seek to enhance people’s psychological flexibility may be used to facilitate better mental health and performance in LGBTQ employees. Finally, we explore whether the concept of psychological flexibility can be used to design teams and organisations that are both mindful and committed to pursuing their values, such as supporting and developing the talents of their LGBTQ employees. To do so we draw upon the organisational flexibility model developed by Bond (2015) and use specific examples of how its key characteristics can be applied to create working environments in which LGBTQ employees can flourish whilst the organisation prospers.

19. Interfacing Conceptual and Experimental Analyses
Symposium (12:45-14:00)
Components: Conceptual analysis, Original data,
Categories: Relational Frame Theory, Clinical Interventions and Interests, Theoretical and philosophical foundations, Experimental Psychopathology, Anxiety, IRAP, Analogy, Coherence
Target Audience: Beg., Interm., Adv.
Location: Giralda V

Miguel Rodríguez-Valverde, Ph.D., University of Jaén, Spain

This tightly-packed 4-paper symposium examines the reticulation between RFT concepts and their experimental manipulation. Paper 1 summarizes multiple experiments in which the existing Relational Elaboration and Coherence (REC) model appears to fall short in explaining various IRAP performances. As an alternative, the authors propose the Differential-Arbitrarily-Applicable-Relational-Responding-Effects (DAARRE) model as a more dynamical conceptualization of the relational performances observed in the IRAP. Paper 2 seeks to enhance simple and complex repertoires of analogical reasoning as derived relational responding in undergraduates. The results show that the relational training protocol enhances both the fluency and the flexibility of participants’ ability to solve analogies. Paper 3 presents experimental manipulations of the nature and functions of relational coherence, by systematically comparing relationally coherent or incoherent networks of stimuli. In the Consistent Context, feedback was contingent on responding in accordance with the trained relations, while this did not apply in the Inconsistent Context (IC). The results suggest that coherence in and of itself may function as a powerful reinforcer. Paper 4 tackles the difficulties in experimentally manipulating the transfer of physiological fear. In an MTS study of equivalence relations, electric shock was differentially conditioned and eye blink was the main dependent variable. The paper explores the possible implications of the findings for our understanding of fear generalization as derived relational responding.

• The IRAP Has a Mid-Life Crisis: A Younger (and More Complex) Model is Needed
Martin Finn, Ghent University
Dermot Barnes-Holmes, Ghent University

The program of research reported in the current paper began with an attempt to replicate the instructional effects reported by Finn et al. (2016) when participants are exposed to relatively simple IRAPs. The initial attempt failed to replicate the original findings and produced results that were difficult to explain based on the Relational Elaboration and Coherence (REC) model. Across 5 experiments a number of key issues were explored in a largely inductive manner: (i) the role of pre-experimental history in completing latency-based measures; (ii) the impact of employing a “talk-aloud” procedure during the IRAP; (iii) the impact of different types of stimuli within the IRAP; and (iv) the extent to which structured post-IRAP self-reports predict REC model consistent effects. The results of these studies gave rise to a Differential-Arbitrarily-Applicable-Relational-Responding-Effects (DAARRE) model, which emphasizes the highly dynamic nature of the relational responding produced on even relatively simple IRAPs.

• Impact of a experimental protocol in fluency and flexibility of analogical reasoning
Asunta Utande, University of Almería
Carmen Luciano, University of Almería
Zaida Callejón, University of Almería

Analogical behavior is a key element in intelligence as good remains established in mainstream psychology. However, the processes involved in the analogy have recently begun to be isolated in an experimental way upon the basis on the Relational Frame Theory. Experimental studies have begun to go into the are of relating networks. However the processes involved are still needed to be isolated. In addition, the huge picture involves in this domains requieres experimental and applied studies going hand by hand to progress. The present study goes in this direction and tries to evaluate the impact of a protocol built of abstract and words analogies. 47 university students participants. Standard and non-standard analogical measures were taken before and after applying the protocol to 26 out of the 47 participants. In addition to pre-post measures, specific variables were measured during the implementation of the protocol. The results show an increase in fluency and flexibility of analogical reasoning in those participants who received the experimental protocol.

• The reinforcing function of Coherence
Zaida Callejón Ruiz, University of Almería
Carmen Luciano, University of Almería

The current study aimed to explore the reinforcing function of coherence. Twelve students participated in the following sequence: Firstly, conditional discrimination training was implemented for the formation of three 5-member (A to F) equivalence classes. In a second phase, they were exposed to a 54-trial block of mutual and combinatorial trials for stimuli A to D with the purpose of altering the previous network coherence. This was done by providing different feedback according to two contexts: Consistent Context (CC) in which the feedback was given contingent to participants’ responses in accordance with the relations trained. Inconsistent Context (IC) in which the feedback was randomly assigned but always joined with points. Test accuracy and latency as well as the level discomfort were recorded while testing on each context. Finally, in a third phase, participants were exposed to a test of derived relations with F stimuli while making choices of context preferences. Results showed that most of participants chose the consistent context and when having to choose between incoherent trials, response latency and discomfort increased. Findings suggest that coherence appears to function as a powerful reinforcer. Implications for further research and applied areas are discussed.

• An experimental analysis of the transfer of conditioned fear using blink-startle modulation as a measure.
Miguel Ángel López-Medina, M.Sc., University of Jaén, Spain
Miguel Rodríguez-Valverde, Ph.D., University of Jaén, Spain
Mónica Hernández-López, Ph.D., University of Jaén, Spain

From a contextual behavioral perspective, research on the transfer/transformation (also called symbolic generalization) of fear is key to understanding the genesis and maintenance of anxiety and its disorders. Although the basic working model (that conditioned physiological fear reactions may transfer amongst physically dissimilar but symbolically related, e.g., equivalent, stimuli) is taken for granted, the truth is that there is very limited empirical evidence proving this phenomenon under controlled laboratory conditions, and it has relied on skin conductance responses as the physiological measure of fear. Previous research from our lab failed to find transfer-of-fear effects with blink startle (a more adequate measure of fear conditioning, according to current psychophysiology standards). The present study attempts to overcome some methodological limitations of our previous research. Participants in this study underwent a matching-to-sample procedure for the formation of two equivalence classes. 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. Results are discussed in terms of their applied implications and relevance.

24. ACT Interventions for Health Problems
Symposium (12:45-14:00)
Components: Conceptual analysis, Literature review, Original data, Experiential exercises, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Behavioral medicine, Chronic Disease, Behavior Change, RFT, Cancer, Parents with children with chronic illness, Clinical Health Psychology, Neuropsychiatry, Neuropsychology
Target Audience: Beg., Interm.
Location: Buhaira

There is increasing evidence that acceptance and mindfulness-based treatments are useful in the areas of health psychology and behavioral medicine. Acceptance, mindfulness, and values have proven effective in improving the management of health and chronic illness. This symposium presents four papers that attest to the potential of acceptance-based interventions in a diversity of health problems. The first paper will present an overview of the literature relating ACT and chronic disease and will show the use of applied ways to use ACT interventions to change health behaviors through an RFT framework. The second paper presents a data-driven approach to intervention development. The aim of this study is to analyze the association of ACT components with patient-reported outcomes in order to develop a more patient-led, and clinically and cost-effective intervention for stressful psychological transitions after primary cancer treatment. The third study presents the results of a randomized controlled trial of a 4-session group-based ACT intervention for parents of children with asthma. The results of this study show that ACT is potentially more efficacious than an educational talk in helping parents to adjust in caring for their children with asthma. The last paper will present a detailed case series of routinely collected data from an UK National Health Service clinic offering ACT for functional neurological disorders (FND) like conversion disorder and other somatic symptom disorders. This novel and promising approach to the treatment of these disorders that are at the intersection of mental and physical health will be illustrated in a detailed case study.

• Health Behavior Change: How to use RFT principles and ACT interventions to change habits
Dayna Lee-Baggley, Ph.D., Nova Scotia Health Authority
Ray Owen, D. Clin Psychol, Wye Valley NHS Trust, Hereford, UK
Jason Lillis, Ph.D., Brown University

The purpose of this submission is to provide an overview of the literature relating ACT and chronic disease and to demonstrate the use of ACT techniques through an RFT framework. We will provide concrete, applied ways to use ACT interventions to change health behaviors (e.g., smoking, exercise, diet, medication use) as they relate to chronic conditions (e.g., chronic pain, obesity, diabetes). The theoretical and clinical applications will be framed through RFT. That is, participants will gain a better understanding of RFT principles and how to apply them to behaviour change. Health behaviors can be understood through relational frame networks, pliance, rule following and coherence. Participants will learn how to apply various relational frames (e.g., coordination, hierarchical) to “rules” that clients may present with in order to foster change. Participants will also learn how to use augmenting, tracking, functional coherence, and changing frames to create transformation of function to assist clients in behavior change.

• Psychological transition after primary cancer treatment: Component mapping using an Acceptance and Commitment Therapy (ACT) Framework for effective intervention development
Nick Hulbert-Williams, PhD, University of Chester
Brooke Swash, PhD, University of Chester
Pandora Patterson, PhD, CanTeen Australia and University of Sydney
Fiona McDonald, CanTeen Australia & University of Sydney
David Gillanders, DClinPsy, University of Edinburgh
Melissa Pilkington, MSc, University of Chester & Edge Hill University

Transitions between diagnosis, treatment and survivorship are psychologically stressful for cancer patients. As a values-based intervention, emphasising return to functional living, ACT may improve wellbeing in this population. This study investigates associations between ACT components and patient-reported outcomes in a cohort of cancer patients. Participants are being recruited in the UK, Canada and Australia using social media and through national cancer charities. Self-report questionnaires are completed at baseline, and three-monthly time intervals for two years thereafter. Questionnaires assess components of the ACT framework, fear of cancer recurrence, depression, anxiety, stress and quality of life. Recruitment is underway (n=47 to date). Baseline data analysis will be presented: these analyses yield novel data on comparative associations between ACT process measures and psychological outcomes. Using a ground-up, data-driven approach, we aim to use this study to develop more patient-led, and clinically and cost-effective interventions.

• The Efficacy of a Group-Based Acceptance and Commitment Therapy on the Psychological Flexibility and the Psychological Adjustment of Parents of Children with Asthma: A Randomized Controlled Trial
Yuen Yu CHONG, Ph.D student, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
Yim Wah MAK, Ph.D, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
Alice Yuen LOKE, Ph.D, School of Nursing, The Hong Kong Polytechnic University, Hong Kong

Enhancing the psychological flexibility (PF) of parents through Acceptance and Commitment Therapy (ACT) may help them to deal with their own psychological needs while managing the asthmatic condition of their children. A randomized controlled trial was employed to examine the efficacy of 4 weekly sessions of a group-based ACT intervention (ACT) in comparison with an asthma educational talk (Control), on the PF and the psychological adjustment of parents in raising their children with asthma. Assessments were conducted using the parental report before, immediately after and at 6 months after the intervention. One hundred and sixty-eight parents of children aged 3-12 years with asthma were consecutively recruited in a public hospital in Hong Kong. The results from generalized estimating equations showed that there were significant time-by-group interactions in the PF (p <.001) and in all the subscales assessing the psychological adjustment (ps ranged from <.001 to .026). The parents in the ACT group had a significant improvement in the PF when compared with those in the Control group at 6-month follow-up (d = 0.82). The study demonstrated that ACT is potentially more efficacious than an educational talk in helping parents to adjust in caring for their children with asthma.

• Using ACT to improve outcomes in functional neurological disorders (“conversion disorder”): A detailed case series.
Christopher D. Graham, University of Leeds

Functional Neurological Disorders (FND) include diagnoses such as non-epileptic attacks and functional movement disorders (limb weakness, paralysis etc). Aetiology and prognosis are unclear; yet, these conditions are presumed to have psychosocial causes. There are no treatments with high-quality empirical support. ACT has good face validity as at treatment approach, and has demonstrated efficacy in similar contexts. We present a case series of routinely collected data from an UK National Health Service clinic offering ACT for FND. Nine participants were included. Treatment comprised face-to-face tailored ACT, aiming to improve meaningful functioning. Participants attended six to 11 hour-long sessions. Outcomes (functioning [WSAS]; mood [CORE-10)) and psychological flexibility (AAQ-II) were recorded before each session. We will present data on session-to-session, and pre- to post- intervention (reliable change and clinically significant change), changes in variables. The treatment approach will be illustrated in one detailed case study. This is the first step in understanding whether ACT might prove useful in FND care.

25. Working with Values and Values-Consistent Behavior
Symposium (12:45-14:00)
Components: Conceptual analysis, Original data, Experiential exercises, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Educational settings, Supervision, Training and Dissemination, Functional contextual neuroscience and pharmacology, Relational Frame Theory, Other, Psychological Flexibility in Students, PTSD, Substance use disorders, Military veterans, Values, Committed action, Intellectual Disabilities, Autism, Teenagers
Target Audience: Beg., Interm., Adv.
Location: San Bernardo

Values are a key component of the psychological flexibility (PF) model, and values clarification and work in promoting engagement with valued actions are fundamental elements of ACT. Engagement in valued daily life actions is what makes life meaningful, according to the ACT model. The four papers in this symposium present a diversity of ways of working with values and values-consistent behavior. The first paper presents research that tested the effect of an online gamified app-platform designed to enhance psychological flexibility in order to achieve valued goals. College students were randomly assigned to one of two conditions: a gamified ACT intervention or an active control condition (traditional online games such as tetris, pinball, etc.). The main results show that the gamified ACT intervention enhanced PF, reduced procrastination behaviors, increased the accomplishment of valued goals, and increased academic performance. The app-platform seems to be an easy and efficacious way to enhance PF in order to increase goal valued performance and academic achievement in college students. The second paper in this symposium examines the connection between values and behavioral assignments in therapy. Using case examples drawn from a treatment outcome study of ACT for co-morbid PTSD and alcohol use disorders in US veterans, the presentation will focus on how to collaboratively develop values-consistent behavioral assignments in therapy, a challenge for novice ACT therapists that requires a deep understanding of the connection between values and commited action. The third paper will present an adaptation of the procedure (Hayes and Carrochi, 2015) to conduct a Values Conversation as a part of Preference Assessment of verbally competent people with intellectual disabilities. This procedure systematically uses the value altering effects of verbal stimuli to establish a verbal context to help the individual with intellectual disability engage in behavior consistent with long-term reinforcers, quality of life and personal values. The fourth and last paper in this symposium will discuss original data from a study with a community sample aimed at assessing psychometric properties of measures of values and values-consistent behaviour with adolescent population.

• Increasing psychological flexibility, goal valued performance and academic achievement in university students through a gamified online platform
Sara de Rivas, Universidad Autónoma de Madrid
Oscar Lecuona, Universidad Autónoma de Madrid
Luz Vilte, Universidad Autónoma de Madrid
Jennifer Moreno, Universidad Autónoma de Madrid
Raquel Rodríguez-Carvajal, Universidad Autónoma de Madrid

Current society presents a landscape of increasing demands where intellectual talent as well as concrete knowledge and education are important for academic and work success. However, there are other individual aspects less considered that are of key importance, and not explicitly included neither in the academic curricula nor in organizations formative courses and so on. These aspects regard self-regulation process in a broad sense of the term. That is, not only these aspects involve the way people relate to external events implicated in their academic or job goals (as for example scheduling, planning, etc.), but how people relate to their own internal events or experiences such as feelings of fear, laziness, unwanted thoughts of failure, goal clarity and so on. There are many applications created to help users planning and organizing their time and their external context to achieve their valued goals. However there are few apps designed to deal with the internal events such as emotions, thoughts and feelings that are involved in those moments when you are actually trying to achieve a valued goal. Even less applications in this area (if any) had scientifically tested their efficacy to do what they claim. In the present research we tested the effect of an online app-platform designed precisely to enhance psychological flexibility in order to achieve valued goals. Considering acceptance and commitment therapy, as well as gamification principles, different audio-visual and interactive elements were created and integrated to conform the platform. To test the effects of the platform 178 university students were randomly assigned to one of the conditions: platform condition (gamified act intervention) or active control condition (traditional online games such as tetris, pinball, etc.). In the platform condition, participants completed thirteen platform missions until reaching the end of the platform during a four weeks period. Mission duration was estimated in approximately 10-15 minutes. They were encouraged to complete only one mission per day, but they could use the platform (or the control) any time they wanted. All participants filled in questionnaires right before they started the study, one month after it, and at the end of the academic semester to fill in their academic achievement. Main results showed positive differences for psychological flexibility in time within the platform condition (Pillai’s trace F (1, 155) = 43.147, p <.001, partial η2 = .22), but not for the control condition (ns), and we found differences between platform and control conditions (Pillai’s trace time x condition: F (1, 155) = 17.439, p <.001, partial η2 =.10). In addition participants in platform condition reported that they had reduced their procrastination behaviors in a very significant way, as we found highly significant differences in time within the platform condition (Pillai’s trace F (1, 155) = 64.044, p <.001, partial η2 = .29), but not for the control condition, and differences between platform and control conditions (Pillai’s trace time x condition: F (1, 155) = 18.094, p <.001, partial η2 =.10). We also found differences regarding the degree participants felt they had accomplished their main valued goal (F (2, 157) = 4.381, p = .014), as well as regarding the degree they stayed on track to their personal value regarding that goal (F (1, 157) = 10.842, p = .001). Even more, we found statistical differences in academic performance, concretely in the number of curses they actually got tested, participants in the platform condition got tested in more courses than participants in the control condition (F (1, 174) = 9.062, p = .003, partial η2 = .05), and they passed the curses with more excellent grades we found statistical differences between conditions (F (1, 174) = 4.794, p = .030, partial η2 = .03), participants in the platform condition got more excellent grades than participants in the control condition. Finally, a SEM approach with multi-group analysis was conducted in an attempt to create an explanatory model of the intervention process. In such model, changes in psychological flexibility across time powerfully predicted changes in most of the variables therefore playing a central explanatory role. The platform seems to be an easy and efficacious way to enhance psychological flexibility in order to increase goal valued performance and academic achievement in university students.

• Putting values into action: Examining the connection between values and behavioral assignments from a study of ACT for co-occurring posttraumatic stress disorder and alcohol use disorders
Eric Meyer, PhD, VA VISN 17 Center of Excellence for Research on Returning War Veterans
Robyn Walser, PhD, National Center for PTSD-Dissemination and Training Division

Increased engagement in valued action is the desired behavioral outcome in ACT. Guiding clients in developing values-consistent behavioral assignments requires rich understanding of the connections between values and committed action. Our experience suggests that developing values-consistent behavioral assignments is challenging for many novice ACT therapists. This presentation will use case examples drawn from a treatment outcome study of ACT for co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorders (AUD) in U.S. military veterans. Data will be comprised of actual behavioral assignments developed during treatment and the values that clients identified as being connected with these assignments. Themes and life domains within which these assignments take place will be examined. Teaching will focus on how to collaboratively develop values-consistent behavioral assignments. Case illustrations will focus on how these assignments build sequentially over the course of treatment, supporting clients in developing progressively larger patterns of valued living.

• Altering the value of reinforcers: Values Conversations for Intellectual Disabilities
Giovanni Miselli, PhD BCBA, Fondazione Istituto Ospedaliero di Sospiro Onlus (CR) Italy
Roberto Cavagnola, Psy D., Fondazione Istituto Ospedaliero di Sospiro Onlus (CR)
Mauro Leoni, PhD, Fondazione Istituto Ospedaliero di Sospiro Onlus (CR), University of Pavia
Serafino Corti, PhD, Fondazione Istituto Ospedaliero di Sospiro Onlus (CR), Università Cattolica Brescia Italy
Francesco Fioriti Ed.D, Fondazione Istituto Ospedaliero di Sospiro Onlus (CR)
Giuseppe Chiodelli, MD; Laura Galli, MD; Michela Uberti, MD, Giovanni Michelini, PhD., Fondazione Istituto Ospedaliero di Sospiro Onlus (CR)

The motivational function exerted by verbal antecedents has been extensively approached from a theoretical perspective and within the direct conditioning paradigm (Valdivia, Luciano, Molina, 2006). Also the research concerning the alteration of the motivational function via verbal means are now increasing due to the impact of RFT. Following the work on Values (Wilson, K. G., Sandoz, E. K., Kitchens, J., & Roberts, M. E., 2010) we will present an adaptation of the procedure (Hayes and Carrochi, 2015) to conduct a Value Conversation as a part of Preference Assessment of verbally competent people with Intellectual Disabilities. The value altering effect of verbal stimuli will be systematically used to establish a verbal context to help the individual with Intellectual Disability engage in behavior consistent with long term Reinforcers, quality of Life and Personal Values. The procedure, video and result from the application of the Value Conversation will be presented.

• Values, values-consistent behaviour and wellbeing in adolescents
Davina Chauhan, NHS Lothian
Nuno Ferreira, University of Edinburgh
Paul M Morris, University of Edinburgh

This paper presentation will discuss original data from a community adolescent sample. The aims of the study were to assess a limited set of psychometric properties of measures of values and values-consistent behaviour with an adolescent population; (ii) to assess which values are endorsed by adolescents; and (iii) to explore whether values-consistent behaviour accounts for some of the variation in wellbeing scores beyond known correlates.

26. Reclaiming Health and Wellbeing for Populations Affected by War, Gender-Based Violence, and Other Adversity: CBS Strategies from Small to Large Scale
Symposium (12:45-14:00)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Supervision, Training and Dissemination, Functional contextual approaches in related disciplines, Relational Frame Theory, Humanitarian Emergencies, Implementation Science, Gender-based violence
Target Audience: Beg.
Location: Lebrija

Thomas Szabo, Florida Institute of Technology, Commit and ACT
Ross White, University of Liverpool

Armed conflicts have contributed to an estimated 65.3 million forcibly displaced people globally. Furthermore, many individuals live in contexts of ongoing adversity, poverty, and high rates of gender-based violence. These conditions have devastating and long-lasting impacts on health and wellbeing. Yet many individuals in these settings lack access to evidence-based care. It is essential that global efforts focus on rolling out effective interventions that can reach vast numbers of individuals, families, and communities. In such settings we need to develop innovative methods for implementation, training, and supervision, since there are often limited resources available. In this symposium, we will present recent developments from four organizations working to address these issues – Commit & Act, World Health Organization, Peter C Alderman Foundation, and War Child Holland. The interventions and implementation models discussed here range from small to large scale, from individual behavior to health-system building, and have both research and service focuses.

• Scalable psychological interventions in communities affected by conflict and other adversity: Case studies from the WHO Mental Health and Psychosocial Support in Emergencies programme
Felicity L. Brown, War Child Holland
Kenneth Carswell, World Health Organization
Mark van Ommeren, World Health Organization
Wietse A. Tol, Johns Hopkins Bloomberg School of Public Health, Peter C Alderman Foundation
Atif Rahman, University of Liverpool, Human Development Research Foundation
Jura Augustinavicius, Johns Hopkins Bloomberg School of Public Health
Marx Leku, Peter C Alderman Foundation

At a global scale, the number of individuals living with prolonged, disabling emotional distress is staggering, and this is even more the case in communities affected by humanitarian crises. In these settings there is a vast gap between psychological support required, and the available resources. In response, the WHO Mental Health and Psychosocial Support in Emergencies programme is focusing on systematically developing, culturally-adapting, and evaluating low-intensity psychological interventions that can be delivered by non-specialists and require few resources to reach larger numbers of individuals. As our first case study, we will report on the development, early piloting, and results of a pilot randomized controlled trial of an ACT-based guided self-help intervention conducted with the Peter C Alderman Foundation in northern Uganda with South Sudanese refugees. As our second case study we will report on a pilot randomized controlled trial of a transdiagnostic intervention incorporating problem-solving and behavioural techniques in Pakistan.

• A multi-level care-system for children affected by war: Feasibility data from War Child Holland’s work in Lebanon and Gaza
Kenneth E Miller, War Child Holland
Elise Griede, War Child Holland
Heba Ghalayini, War Child Holland OPT
Ali Jawad, War Child Holland Lebanon
Kate Roberts, War Child Holland OPT
May Aoun, War Child Holland Lebanon
Marx Leku, Peter C Alderman Foundation

Millions of children live in nations affected by war. Children exposed to war are vulnerable to increased rates internalizing and externalizing difficulties. There are a small but growing number of intervention studies conducted in an effort to improve child psychosocial outcomes after war. However, tremendous gaps exist in the ability to provide effective care that targets known risk factors at different ecological levels after war, including family environments, child protection risks, and poor quality education. We will present the vision and research and development agenda of War Child Holland to develop a multi-level care system, incorporating evidence-based interventions, alongside methods to improve access, acceptability, and quality. We will present feasibility data from Gaza and Lebanon for a parent-focused intervention that directly teaches parenting and mindfulness skills, with the aim of increasing parent psychological flexibility and overall wellbeing, and reducing reactive and harsh parenting. Future evaluation plans will be discussed.

• Microaggression, Intimate Partner Gender-Based Violence, and Behavioral Flexibility Training in Sierra Leonean Couples
Thomas G. Szabo, Florida Institute of Technology
Hannah Bockarie, Commit & Act, Sierra Leone
Jonathan Tarbox, University of Southern California
Ross White, University of Liverpool, UK
Corinna Stewart, National University of Ireland, Galway

Gender-based violence and microaggression are rarely studied by behavior analysts but likely entail a complex repertoire of physical, verbal and arbitrarily applied relational responding. Microaggression is particularly important to the reduction of gender-based violence because it often goes unnoticed and therefore unaddressed, but it predicts other more serious forms of aggression. Like most other operant behavior, it is reinforced without explicit awareness of its occurrence by the speaker or the listener. We conducted a multiple probe study across married couples in which microaggression and overtly aggressive behavior were recorded during and between sessions of a month-long, four-session behavioral flexibility training that was modeled on Acceptance and Commitment Therapy. The study was conducted in a small west African nation where gender-based violence is reported to be at pandemic levels. Microaggression, aggression, and collateral behavior (heavy drinking, drug use, and betrayal) decreased, whereas replacement behaviors increased. Implications and future research are discussed.

27. Avances en la Investigación con el IRAP: Aspectos de Relevancia Clínica y Metodológica
Symposium (12:45-14:00)
Components: Datos originales
Categories: Teoría de los Marcos Relacionales, Intervenciones y aspectos clínicos, Contextos educativos/escolares, , Otros, IRAP
Target Audience: Beg., Interm., Adv.
Location: Utera

Mónica Hernández-López, Ph.D., Universidad de Jaén
Giovambattista Presti, M.D., Kore University, Enna

El IRAP se ha convertido en un procedimiento popular dentro de la ciencia conductual contextual para la evaluación de repertorios verbales de carácter implícito. La investigación más reciente aborda dos cuestiones fundamentales. Por un lado la relevancia clínica de dichos repertorios y por otro las características metodológicas de la propia tarea. Este simposio incluye trabajos que abordan ambos aspectos. El primero de ellos es uno de las pocos trabajos que han utilizado el IRAP con población infantil y adolescente y está centrado en el estudio de respuestas relacionales implicadas en la evitación y aceptación de las propias emociones. El segundo aborda las creencias disfuncionales implícitas en cuidadores de personas mayores con demencia. El último trabajo se centra del estudio de los efectos de la inhibición de respuesta en la ejecución en el IRAP.

Evaluación de creencias disfuncionales implícitas en cuidadores informales de personas mayores con demencia a través de una tarea IRAP, La relación entre las creencias disfuncionales evaluadas de forma explícita (autoinformes) y el malestar emocional de los cuidadores no es consistente a través de los estudios. Este trabajo presenta una tarea computerizada basada en el Procedimiento de Ev
maria.marquez@uam.es, Sí

Andres Losada, PhD., Universidad Rey Juan Carlos
Un análisis de los efectos de la inhibición de respuesta sobre la ejecución en el IRAP, Una cuestión importante es en qué medida la ejecución en el IRAP se ve afectada por variables personales ajenas a la propia tarea. Una investigación previa de nuestro laboratorio exploró los posibles efectos que la inhibición de respuesta (medida a través)

34. New Data on Core RFT Concepts: Rules, Coherence, and Level of Derivation
Symposium (15:15-16:45)
Components: Conceptual analysis, Literature review, Original data
Categories: Relational Frame Theory, Theoretical and philosophical foundations, Rule Governed Behavior, Coherence, Derivation, Relational Responding
Target Audience: Interm., Adv.
Location: Prado

Ian Hussey, PhD, Ghent University
Ian Stewart, PhD, National University of Ireland, Galway

Relational Frame Theory aspires to provide a general framework for the prediction-and-influence of language and complex human behaviour in both laboratory and applied contexts. This symposium presents data from three lines of research on core RFT ideas. The first paper provides a conceptual outlines of relational coherence as an organizing and presents novel empirical data on affective and behavioural responses to coherent and incoherent networks. The second paper describes the RFT account of implicit attitudes. Data from three pre registered studies are presented which manipulate level of derivation and observes changes in effects on Implicit Association Test (IAT), providing initial but strong support for the influence of opportunities to derive on the strength of relational responding. The third paper describes Rule Governed Behaviour and presents novel data on derived insensitivity to changes in contingencies. Future directions for each line of work and implications for the study of the relational behaviours that constitute language will be discussed.

• Relational Coherence and Ambiguity: Behavioural and Affective Responses within a Novel Training Paradigm
Sam Ashcroft, University of Chester
Lee Hulbert-Williams, PhD, University of Chester
Kevin Hochard, PhD, University of Chester
Nick Hulbert-Williams, PhD, University of Chester

Relational coherence being a generalized operant is a fundamental assumption of Relational Frame Theory (RFT). Relational coherence is said to have reinforcing properties (Hayes, Barnes-Holmes & Roche, 2001). In other words, it is a driving and organising force within language and symbolic learning processes. In light of this importance, relational coherence plays a key role in the ‘multidimensional multilevel framework’, which currently steers many aspects of RFT research. Despite this centrality, behavioural responses to coherence have seldom been tested within CBS (Bordieri et al., 2016). We assessed and compared behavioural and affective responses to relational coherence and ambiguity using a novel training paradigm with 85 participants. Contrasting with Match-to-Sample, this paradigm trains unidirectional relationships using trial and error learning. We present results that answer and ask numerous questions regarding relational coherence. For instance, the impact of ambiguity and coherence on affective responses and response latencies.

• Testing the RFT account of implicit attitudes: Manipulating level of derivation of relational responding
Ian Hussey, PhD, Ghent University
Sean Hughes, PhD, Ghent University
Jan De Houwer, PhD, Ghent University

In the last decade, RFT researchers have taken an interest in the use of implicit measures such as the IRAP and IAT, and have provided a conceptual account of such behaviours (Hughes et al., 2012). However, little empirical work has tested this account to date. This paper examines one factor proposed to influence relational responding: the level of derivation of relational responding. Concepts will be outlined and data from three studies presented. These manipulate the level of derivation of relational responses and observe the impact on speed of relational responding. Studies employed open science principles, including pre-registration of hypotheses and making all materials and data available, therefore adding to the weight of evidence and providing large datasets for others. Results have direct relevant to an RFT account of the effects observed on implicit measures.

• Rule-Based Insensitivity Propagation through Equivalence
James Greville, PhD, Aberystwyth University
Jean-Louis Monestès, PhD, University of Grenoble Alpes
Nic Hooper, PhD, University of the West of England

Research on rule-governed behavior (RGB) suggests that rules can result in insensitivity to changes in environmental contingencies. Here, we assessed whether insensitivity to contingencies may propagate to novel stimuli via derived relational responding. Firstly, participants completed a task where they could score points by following simple rules (reinforcement schedules) in the presence of specific stimuli. Following equivalence training, participants exhibited rule-following in the presence of stimuli with no direct prior association with that rule, demonstrating derived generalization of RGB. Participants who were explicitly given this rule took longer to adapt their behavior to the new schedule thus demonstrating derived insensitivity to contingencies. These findings contribute to our understanding of perseverative behavior and psychological flexibility.

35. Using Technology to Better Assess and Enhance Psychological Flexibility Among College and University Students
Symposium (15:15-16:45)
Components: Original data
Categories: Educational settings, Clinical Interventions and Interests, College/University
Target Audience: Beg., Interm., Adv.
Location: Nervión Arenal I

Frederick Dionne, Ph.D. and Simon Grégoire, Ph.D., Université du Québec à Trois-Rivières
Jacqueline Pistorello, University of Nevada, Reno

Many college and university students struggle with mental health problems that undermine both their quality of life and academic success. Recently, different mindfulness and acceptance-based interventions have been implemented throughout college and university campus to promote mental health among post-secondary students (Pistorello, 2013). Although encouraging, these interventions currently face two major challenges: 1) how can they be offered so they are easily accessible and cost-effective and 2) how can they be assessed with ecological validity? The symposium explores new ways of promoting and assessing psychological flexibility among students suffering from either stress, distress or procrastination using new technologies. Haeger and colleagues present the results from a Web-based online ACT therapy intervention (LifeToolbox) for distressed college students. Dionne and colleagues present a Web-based ACT program to reduce procrastination among university students. Grégoire and colleagues use a single-subject time-series design and the ecological momentary assessment method to examine day-to-day fluctuations in stress and psychological flexibility among students enrolled in a ACT intervention. These studies are discussed by Jacqueline Pistorello, Ph.D., and they will be space for questions from the audience.

• Initial findings from a randomized dismantling trial of the LifeToolbox website: A transdiagnostic online acceptance and commitment therapy intervention for distressed college students
Jack Haeger, M.S., Utah State University, Logan, Utah
Jennifer Krafft, B.A., Utah State University, Logan, Utah
Michael Levin, Ph.D., Utah State University, Logan, Utah

Mental health issues are common in U.S. college populations, impacting roughly 50% of students per year (Blanco et al., 2008). College counseling centers struggle to fully address this issue given funding and staffing limitations. Online self-help interventions offer a promising, cost-effective method for providing services to distressed college students, including those who may not otherwise seek help due to perceived stigma and logistical concerns. This study evaluated a web-based, transdiagnostic ACT intervention (LifeToolbox). By implementing a randomized dismantling trial, this study compared the efficacy of distressed students randomized to the following conditions: ACT-full (program including all ACT processes), ACT-mindful (limited to mindfulness components), ACT-Values (limited to values components), or waitlist. Key findings will be presented regarding the efficacy of comprehensive vs. targeted web-based interventions and their impact on specific processes of change, the effects of prompting methodology (email vs. phone coaching) on adherence and outcomes, and potential mediators and moderators of treatment outcomes.

• A Web-Based ACT Program to Reduce Procrastination Among University Students : The Results From a Pilot Study
Frederick Dionne, Ph.D., Université du Québec à Trois-Rivières
Guillaume Raymond, Ph.D. (c), Université du Québec à Trois-Rivières
Joel Gagnon, Ph.D (c), Université du Québec à Trois-Rivières
Simon Grégoire, Ph.D., Université du Québec à Montréal

Procrastination is typically defined as an irrational tendency to delay the beginning and/or end of an academic task. Almost 50% of students procrastinate consistently and problematically which leads to lower grade point average, longer task completion time, course withdrawals, stress and increased health risks. Effective interventions to help students overcome procrastination are still lacking. Studies on ACT and procrastination have shown empirical support from a theoretical and clinical standpoint. The purpose of this paper is twofold. Firstly, to present the content of an eight-week Web-based ACT program to reduce academic procrastination. Secondly, to summary preliminary results on its feasibility and efficacy. The sample is comprised of 35 university students (78% female) studying at Université du Québec à Trois-Rivières (UQTR) in Canada. Results showed that the program reduced self-reported procrastination with a small effect size. Overall, analyses showed that participants were satisfied with the program. Implications and future developments are discussed.

• Ecological Momentary Assessment of Stress and Psychological Flexibility Among College and University Students Taking Part in an ACT intervention
Simon Grégoire, Ph.D., Université du Québec à Montréal
Lise Lachance, Ph.D., Université du Québec à Montréal
Christophe Chénier, Université du Québec à Montréal

The aim of this intensive longitudinal study was to assess the sequence of daily changes taking place within College and University students who took part in an ACT intervention (http://www.korsa.uqam.ca/en/). Using a single-subject time-series design, we examined the within-person day-to-day fluctuations in stress and psychological flexibility and looked at the temporal associations between these variables over the course of the intervention. Students (N=30) were recruited in six Colleges and six Universities in Canada during fall 2016. They were asked to use a smartphone application five times per week during the intervention (five weeks) to report their momentary level of stress and psychological flexibility using a six items questionnaire. Results showed that about 43% of participants reported a decrease in their level of stress and an increase in their level of psychological flexibility throughout the intervention. About 30% of them reported that these variables neither increased nor decreased.

38. ACT Processes in the Workplace and in Organizational Settings
Symposium (15:15-16:45)
Components: Literature review, Original data,
Categories: Prevention and Community-Based Interventions, Organizational behavior management, Burnout, Forensic, Leadership, Sustainability, Work-related stress, Forensic, Intellectual Disabilities, Staff Burnout
Target Audience: Beg., Interm., Adv.
Location: Buhaira

This symposium focuses on the role of psychological flexibility and other ACT-relevant processes in employee wellbeing and employee performance in different work settings. The first and last papers explore the role of psychological flexibility in predicting employee well-being and its influence in burnout and job demands and satisfaction for employees working in highly demanding secure mental health settings. The second paper presents an RFT-based analysis of how to improve the effectiveness of leader communication in enhancing employee performance as related to individual employee values aligned with corporate social responsibility. The third paper in the symposium presents a data-driven intervention development study aimed at identifying the ACT components/processes that correlate better with work-related wellbeing in a population under high risk of work-related stress (oncology nurses), so as to tailor a specific ACT intervention targeted to this population. All in all, these four papers provide a broad overview of the application and great potential impact of ACT in the workplace and organizational settings.

• Working in a demanding environment: employee wellbeing in secure forensic settings
Nuno Ferreira, PhD, University of Edinburgh
Amelia Cooper, DClin, University of Edinburgh, The State Hospital

Introduction: Care professionals suffering with poor wellbeing is a phenomenon that has been found to have a damaging effect upon individual employees, service users and organisations. Employees working in forensic settings are believed to be at increased risk of poor wellbeing due to the unique demands of their working environment, including exposure to violence and aggression. Aims: To examine the ability of demands related to violence and aggression, and resources of two types (cognitive and contextual behavioural) to predict the wellbeing of employees in a high secure forensic mental health (FMH) hospital. Method: 142 employees at a high secure FMH hospital completed self-report questionnaires which examined their wellbeing (Burnout, psychological distress, turnover intention), perceptions of the prevalence of aggression, beliefs about safety, attitudes towards aggression, and psychological flexibility. Results: The results suggested that exposure to violence and aggression was not a good predictor of wellbeing. However, the beliefs staff held about safety and staff’s level of psychological flexibility were predictive of wellbeing (all outcomes excet turnover intention). Conclusions:Job demands related to staff’s cognitive appraisal of safety, and the contextual behavioural resource, psychological flexibility, were predictive of staff wellbeing. Further research using contextual behavioural interventions within forensic settings is recommended in order to develop the limited research on forensic professionals’ workplace wellbeing.

• Leader Communication and Employee Values: The Motivative Augmental in Leader Communication on Employee Performance of Environmentally Relevant Behaviors
Julia H. Fiebig, PhD, BCBA-D, Ball State University & ABA Global Initiatives

The importance of effective leadership practices in context of anthropogenic climate change is well established by policy negotiators and there has been an increasing trend of organizations creating leadership roles to address environmental issues (Karlsson et al., 2011). Organizational change efforts focused on corporate social responsibility (CSR) initiatives often generate significant costs for organizations without contributing to desired results, and messages from leaders to stakeholders in organizations do not frequently align with performance related to those messages (Peloza et al., 2012). There has been limited research that systematically addresses how leader communication influences employee performance related to CSR goals (Brammer, Millington, & Rayton, 2007). Relational frame theory, a behavior analytic account of language, allows for analysis of verbal stimuli as motivating operations in context of leader antecedent communication to employee behavior. This study examined the relationship between a leader�s verbal behavior and employee performance as related to individual employee values. In an analysis of employee reported values as related to human-caused climate change and effects of leader email communication on energy consumption based on those individual values, results provided compelling information about the potential utility of tailoring leader communication to employee values and provided findings that informed future research directions.

• The relationship between Acceptance and Commitment Therapy (ACT) processes and work-related wellbeing in UK nurses: an intervention development study.
William Kent, University of Chester
Dr Kevin Hochard, University of Chester
Professor Nick Hulbert-Williams, University of Chester

Oncology nurses are at especially high risk of work-related stress. This study aims to explore which components of the ACT intervention framework may be especially pertinent correlates of work-related wellbeing in this population to inform the development of an ACT-based intervention. Nurses from various specialties (including oncology) are being recruited from four NHS sites in England, UK. Data will be collected using an online self-report survey assessing ACT components, and stress, burnout, and compassion fatigue/satisfaction. Recruitment for this study launched in February and is expected to take 2-3 months (target sample size based on power calculation: n=103). Statistical analyses will provide empirical evidence for the applicability of ACT for this population in the context of managing stress, burnout and compassion fatigue. Using a data-driven approach to intervention development, this study will identify components especially important in an effective, population-targeted ACT intervention for oncology nurses.

• Burnout and Job Satisfaction in Secure Mental Health Settings; exploring the effects of Social Support, Psychological Mindedness and Psychological Flexibility
Nuno Ferreira, PhD, University of Edinburgh
Joanna Chabinska, University of Edinburgh, NHS Tayside

BACKGROUND: For staff working in Secure Mental Health Services, there is limited research on the indirect effects of internal processes (psychological flexibility, psychological mindedness) and external resources (social support) on the demands, burnout and satisfaction with work. OBJECTIVE: This study aimed to explore any direct relationships of subjectively perceived understanding, predictability, control (job demands) with burnout and job satisfaction, and in-direct effects of social support, psychological mindedness and psychological inflexibility on these relationships. METHODS: A cross-sectional design with quantitative measures was used Data gathered from 141 nursing staff working in secure mental health services (forensic - 58.65%; intellectual disability - 41.35%) was analysed using t-tests, bi-variate correlations, hierarchical regressions and a series of mediation, moderation and moderated-mediation analyses. RESULTS: Perceived understanding, predictability and control were relevant to job satisfaction but not all the burnout dimensions. Psychological inflexibility was a mediator and social support- an independent predictor in these relationships. Psychological mindedness was shown to be a relevant variables to the dimension of personal accomplishment. CONCLUSION: Job demands are likely to follow individualised pathways through which they contribute to job satisfaction and burnout. Social support and psychological flexibility are of significant value and must not be understated.

39. Perspective Taking and the Self: Measurement and Application
Symposium (15:15-16:45)
Components: Original data
Categories: Clinical Interventions and Interests, Relational Frame Theory, Perspective Taking and the Self
Target Audience: Beg.
Location: San Bernardo

Lin Yu, Kings College London
Priscilla Almada, University of Wollongong

The current symposium comprises three papers the unifying concern of which is selfing and perspective taking from a Contextual Behavioural Science (CBS) point of view. Paper 1 looks at the development of a measure of selfing that differentiates two distinct patterns of selfing behavior (i.e., self as distinction and self as observer). The second paper reports on a qualitative analysis of self-discriminations in adolescent responses to questions about their own and others perspectives. The final paper in the symposium looks at whether Antipsychotics impact on perspective taking (i.e., deictic relational responding) in patients with schizophrenia. Taken together the symposium offers new insights into a CBS account of selfing and perspective taking.

• The Self Experiences Questionnaire (SEQ): Preliminary analyses for a measure of self in people with chronic pain
Lin Yu, King’s College London
Sam Norton, King’s College London
Lance McCracken, King's College London

The purpose of the study was to develop a measure based on the three-facet conceptualization of self rooted in the Psychological Flexibility model. Participants included 528 adults referrals who completed twenty-nine items intended as the basis for a measure called the Self Experiences Questionnaire (SEQ). Factor analyses were conducted to reduce the item pool and explore underlying dimensions. Following item and scale analyses fifteen items were selected forming a preliminary two-dimensional scale (Self as distinction, Self as observer), overall α=.90. Adequate construct validity for the total score was supported through correlations with pain acceptance, r=.34, decentering, r=.66, and committed action, r=.36, all p<.001, as well as correlations with measures of patient functioning, after controlling for pain and process from the PF model, including: depression, β=−.15, p<.01, work and social adjustment, β=−.10, p<.05, and pain interference, β=−.11, p<.05. A preliminary measure of contextual self with adequate reliability and validity emerged here.

• Measuring occurrences of Self and Other in relation to mental health in adolescent speech
Orla Moran, University College Dublin
Priscilla Almada, University of Wollongong
Louise McHugh, University College Dublin

The importance of a healthy sense of self for adolescent mental health is well documented. According to CBS, there are three distinct self-discriminations, as well as three corresponding senses of other. Recent evidence suggests that these discriminations in naturally occurring speech are predictive of lower distress, as well as increased well-being, and psychological flexibility. This present study investigates these self discriminations in an adolescent sample, using a mixed methods design with opened-ended questions and quantitative measures of mental health, well-being, and experiential avoidance (N= 97; M= 15.66; SD = .518; 28 male). Participants were asked to respond to eight opened-ended questions regarding experiences involving a number of specified emotions. Participant responses were coded for occurrences of the three senses of self, and other as conceptualized by CBS using the coding frame developed by Atkins and Styles (2015). Study findings are discussed in relation to the benefits of using a behavioral measure of self-relating in adolescents.

• Do Antipsychotics Have Any Effect on Perspective Taking in Schizophrenia?
Ahmet Nalbant, Bakirkoy Research and Training Hospital for Mental Health and Neurological Diseases, Istanbul

Schizophrenia is a complex disorder with multidimensional symptom clusters that include positive, negative, affective, cognitive and sensory-motor symptoms. Beyond these symptom clusters, there are widely reported areas of disrupted functioning and among them; low social functioning is one of the most disabling. Other than well-defined symptom clusters, it seems social functioning in schizophrenia is partly due to low perspective taking performance between self and others. This study examines whether different antipsychotics have any effect on perspective taking (i.e., deictic relational framing) in people with schizophrenia and to investigate its processes along with psychotic symptoms from acute state to remission. Understanding the processes of the change between deictic framing and the symptomatology of schizophrenia might lead us developing better interventional models to improve social functioning in schizophrenia.

40. Análisis de los procesos terapéuticos y aplicaciones de la Terapia de Aceptación y Compromiso
Symposium (15:15-16:45)
Components: Conceptual analysis, Literature review, Original data, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Performance-enhancing interventions, Supervision, Training and Dissemination, Grief, Postvention, Suicide, ACT, Autoestigma Trastorno Mental Grave, Depression, Relación Terapéutica
Target Audience: Beg., Interm., Adv.
Location: Lebrija

El análisis de los procesos terapéuticos es un área de investigación de fundamental importancia para el avance de las terapias contextuales como la Terapia de Aceptación y Compromiso (ACT) y la Psicoterapia Analítico Funcional (FAP). El avance en este análisis puede permitir, entre otras cosas, avanzar en el diseño de aplicaciones novedosas de estas terapias. En este symposium se presentan cuatro trabajos que abordan ambas perspectivas. El primer trabajo está dedicado al análisis de los procesos comunes en las terapias contextuales y su efecto en el éxito de la intervención. El segundo estudio analizar los procesos verbales que acaecen en FAP. La tercera presentación explora la aplicación de ACT para los casos de duelo complicado debido a suicido. Finalmente, compara la aplicación de ACT versus terapia cognitivo conductual en la disminución del autoestigma de pacientes con trastorno mental grave.

• terapia de aceptación y compromiso para duelo complicado por suicidio
Jose I. Cruz Gaitán, Universidad de Guadalajara
Ivonne Corona Chavez, Universidad de Guadalajara

Este paper tiene el objetivo de servir como guía para los clínicos que desean trabajar con clientes que presenten problemas en el manejo del duelo por suicidio, siendo útil tanto de forma preventiva para disminuir el riesgo de presencia de un duelo complicado, así como para la intervención si ya está presente el duelo complicado en el cliente. La primera parte incluye su fundamentación teórica, explicando las características teóricas, etiológicas y sintomáticas del duelo, la segunda parte incluye la descripción, sesión por sesión, de las actividades que se realizarán en cada una de ellas para finalmente mostrar los hallazgos encontrados en la clínica de duelo por suicidio de la Universidad de Guadalajara en México.

• “Comparación del efecto de ACT versus terapia cognitivo-conductual en el afrontamiento del autoestigma en personas con Trastorno Mental Grave”
José Luís Arroyo Cifuentes, Línea de Rehabilitación Psicosocial Hospitalarias. Instituto ACT
Marisa Páez Blarrina, Instituto ACT

Cada vez existe más evidencia sobre el efecto negativo que el estigma social tiene sobre el funcionamiento psicosocial y calidad de vida de personas diagnosticadas de Trastorno Mental Grave (TMG). Por ello es preciso desarrollar estrategias de intervención eficaces. El presente estudio es un ensayo controlado aleatorio multicéntrico que tiene como objetivo obtener evidencia sobre la comparación entre los efectos de una intervención cognitivo-conductual y otra intervención ACT para abordar problemas relacionados con el autoestigma en una muestra de personas atendidas en dispositivos comunitarios. Se describirá la metodología empleada y el protocolo de intervención utilizado. Se analizarán resultados comparando el efecto que tienen las dos intervenciones en variables clínicas, autoestigma, funcionamiento e integración social, calidad de vida y adherencia al tratamiento. Finalmente se discutirán estos resultados, así como la importancia que estas intervenciones pueden tener a la hora de promover la calidad de vida y recuperación de personas con TMG.

• Análisis del proceso terapéutico en las Terapias Contextuales
Francisca López Ríos, Universidad de Almería
José Manuel García Montes, Universidad de Almería

Desde las terapias contextuales, en especial, ACT y FAP, se proponen procesos psicológica implicados en el desarrollo y mantenimiento de patrones de comportamiento problemáticos. Dichos procesos se han descrito en el hexaflex. En el presente estudio se registra sistemáticamente el comportamiento de terapeutas en 10 casos atendidos en la Unidad de Atención Psicológica de la Universidad de Almería. Las variables registradas se incluyen en una escala de 10 elementos terapéuticos tales como: validación de la experiencia, reconocimiento de la singularidad del paciente, escucha activa, técnica específica aplicada,... Al tiempo se registra el comportameinto del paciente: indicadores de fusión cognitiva, apatía o comportamiento no orientado, indicadores de apertura y disposición, indicadores de comporamiento comprometido. Los resultados permiten mostrar si elementos genéricos del comportamiento terapéutico debilitan la defusión cognitiva y potencian el comportamiento orientado a valores.

• Análisis de los procesos verbales en la relación terapéutica. Presentación de metodología y de caso tratado con terapias contextuales.
José Manuel Sánchez Olid, Universidad de Málaga
Luis Valero Aguayo, Universidad de Málaga

La evidencia muestra que la psicoterapia es eficaz, y que varios modelos que usan metodología diferente son igual de eficaces (Wampold, 1997).Estos factores comunes que parecen mostrarse en todas las terapias, independientemente del modelo y de la técnica empleada, son: apoyo, aprendizaje y acción según Grencavage (1990) y apoyo, persuasión y efecto placebo según Natan (2000). Aquí arrojaron luz Kohlenberg y Tsai (1991) con la presentación de la Psicoterapia Analítico Funcional y el concepto de Conducta Clínicamente Relevante (CCR): todo aquel comportamiento que ocurre en sesión y está relacionado con el problema que trae al paciente en consulta; establecen tres tipos: CCR1 representa el comportamiento del paciente en sesión que resulta problemático y por tanto se supone que debe desaparecer si la terapia avanza, CCR2 representa el comportamiento del paciente en sesión que resulta deseable y esperamos que aumente conforme avanza la sesión, y por último CCR3 que representa toda aquella interpretación que el paciente hace sobre su comportamiento y le resulta útil y funcional como regla a seguir para su propio avance. Los autores de PAF muestran que, en una buena relación terapéutica, el profesional es capaz de observar las CCR y comportarse en sesión de manera contingente a los resultados que se quieren conseguir. Estos antecedentes nos llevan al estudio de la relación entre Conducta Clínicamente Relevante, reglas verbales y contingencias realizadas por el terapeuta, y funcionalidad del comportamiento de ambos participantes en la terapia. Se relaciona con el resultado mismo de la terapia (éxito terapéutico en el caso de que así sea). Las conclusiones muestran el proceso de moldeamiento verbal y su relación con el éxito terapeutico. Se presenta la aplicación de la metodología de estudio en un caso clínico llevado a cabo.

41. Understanding Processes of Change Responsible for Successful Outcomes in Brief ACT Interventions
Symposium (15:15-16:45)
Components: Original data
Categories: Clinical Interventions and Interests, Supervision, Training and Dissemination, Mediational Analyses
Target Audience: Interm.
Location: Utera

Raimo Lappalainen, Ph.D., University of Jyväskylä, Finland
Arto Hiltunen, Ph.D., University of Karlstad, Sweden

Psychological flexibility has shown to be associated with psychological wellbeing. Also, the change in psychological flexibility during the intervention is connected to changes in psychological wellbeing. From the clinical point of view it would be important to know more closely the specific skills associated with psychological flexibility that lead to successful outcomes in psychological interventions. One way to increase our knowledge of the key processes of change is meditational analysis. The aim of the symposium is give a short introduction to the main idea in a meditational analysis, and present data from three interventions based on an ACT model that have applied meditational analyses. The first study will describe the role of psychological flexibility in weight management. The second study will show data from a web-based ACT intervention for sleeping difficulties and the third study will present observations from a web-based intervention for increasing wellbeing of university students.

• From aims to actions – The role of psychological flexibility in eating regulation
Essi Sairanen, Ph.D., University of Karlstad, Sweden

Acceptance and Commitment Therapy offers new solutions for the long-term weight management. This paper investigates the psychological mechanisms through which ACT is supposed to lead to adaptive eating regulation, that is, eating regulation based on personal values and weight-related psychological flexibility. Participants (N = 148) were adults with overweight who participated in an ACT-intervention (group or mobile). ACT aims to strengthen the connection between values and behavior, and identifies psychological inflexibility as a key barrier to engaging in values-consistent behaviour. Thus, it was hypothesized that psychological flexibility is a process that mediates the effect of value-based reasons (also called autonomous motivation vs. controlled motivation or tracking vs. pliance) on eating regulation and weight management. The present results indicated that improving participants’ autonomous motivation (tracking) and weight-related psychological flexibility can support weight management and encourage eating for physical reasons guided by hunger and satiety cues, and decrease using food as a reward or to emotionally comfort oneself. Weight-related psychological flexibility mediated the relationship between changes in autonomous motivation and eating behaviors as well as weight.

• Suppression of thoughts as a mediator of change in sleeping difficulties: Results from a non-guided online ACT-based program for adults
Raimo Lappalainen, Ph.D., University of Jyväskylä, Finland
Päivi Lappalainen, Ph.D., University of Jyväskylä, Finland

The purpose of this study was to examine the impact of web-based Acceptance and Commitment Therapy (ACT) program for sleeping difficulties among middle aged participants (n = 82). Participants filling the inclusions criteria (defined by Insomnia Severity Index, ISI), were randomized either to an iACT –group (n=42) or to a waiting list –control group (n=40). The iACT group received an ACT-based web-intervention that they were instructed to use over a period of 6-weeks. During this period they were sent reminders to use the program, but no personal support was offered. According to the Basic Nordic Sleep Questionnaire (BNSQ), the iACT had a significant impact on the frequency of sleeping difficulties and to the quality of sleep. However, the between group difference to the no-treatment control group was small (d=0.32). The iACT had also a significant impact on suppression of unpleasant thoughts as measured by White Bear Suppression Inventory (WBSI). The meditational analysis indicated that the changes in suppression of unpleasant thoughts (WBSI) mediated the chances in sleeping difficulties (BNSQ) during the intervention. This study suggests that suppression of unpleasant thoughts might be one of the variables that could be observed more closely when treating sleeping difficulties and insomnia, at least in ACT interventions applying web-based programs.

• Mindfulness skills as mediators of change in wellbeing and psychological symptoms? Results from a guided, online ACT-based program for university students.
Panajiota Räsänen, MSc., University of Jyväskylä, Finland
Raimo Lappalainen, Ph.D., 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.

42. Using Different Methods to Study Clinical Applications I
Symposium (15:15-16:45)
Components: Literature review, Original data
Categories: Relational Frame Theory, Clinical Interventions and Interests, Educational settings, Causal Efficacy, Inattention, Impulsivity,Children and Adolescent, IRAP, Psychological Inflexibility
Target Audience: Beg., Interm., Adv.
Location: Estepa

Benjamin M. Ramos, M.Sc., University of Edinburgh

This tightly-packed 4-paper symposium is the first of two to explore and discuss different methodologies for studying clinical applications of RFT, covering ADHD, psychological flexibility in children and adolescents, psychological inflexibility in police conflict, and Alzheimer’s Disease. Paper 1 conceptualizes the positive illusory bias in terms of derived causal efficacy and explores this behavior in the context of a series of Go/NoGo tasks. The results highlight the experimental and applied benefits of operationalizing this established effect in this functional-analytic way, and may speak directly to our understanding of impulsive behavior. Paper 2 uses the IRAP to explore psychological flexibility in children and adolescents, and its potential as an assessment tool. The results highlight the potential value of the procedure in this regard, as well as detecting inflexibility in adolescence that does not appear present in middle childhood. Paper 3 also examines psychological flexibility using the IRAP, but does so in the context of police conflict. Not only does the IRAP capture strong relations between inflexible reactions and feelings, but also produces interesting differential trial-type effects. There were also correlations among these effects and other standardized measures of flexibility. Paper 4 returns to trusted and traditional methods for exploring the impact of exemplar training of coordination, distinction, and comparison relations on participants diagnosed with Alzheimer’s Disease. The aim of this extended study, that includes a follow-up, is to determine the potential benefits on cognitive and executive functioning. The results point to the possibility of decelerating cognitive decline with relational training, with effects retained at follow-up.

• Feels Good to Be Among the Worst: A RFT Account of the Positive Illusory Bias
Benjamin M. Ramos, M.Sc., University of Edinburgh
Emily K. Sandoz, Ph.D., University of Louisiana at Lafayette
Caleb S. Fogle, University of Louisiana at Lafayette

Despite 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 termed the positive illusory bias (PIB; Owens et al., 2007). While in the normal population positive self-evaluations are not only the norm but also adaptive, the benefits are only maintained if the difference between the self-evaluation of performance and actual performance are slight. This may contribute to greater levels of inattention, impulsivity, and resulting dysfunction, as self-evaluation is rule-governed rather than a result of self-awareness. This study aimed to model the positive illusory bias using the principles of derived relational responding. Participants completed a series of Go/NoGo tasks with contextual cues that had derived causal efficacy functions through their relations with discriminative stimuli for high or low rates of responding. Simultaneously participants rated their experience of causal efficacy with each contextual cue before, during, and after each of the Go/NoGo tasks. The impact of derived causal efficacy was then examined in terms of errors of omission (inattention) and errors of commission (impulsivity) and compared to self-reported ratings of causal efficacy. We will then discuss this study as a potential Relational Frame Theory model of the PIB.

• The IRAP as an implicit measure of Psychological Flexibility in children and adolescents.
Gloria Torres-Fernández, M.Sc., University of Jaén, Spain
Mónica Hernández-López, Ph.D., University of Jaén, Spain
Miguel Rodríguez-Valverde, Ph.D., University of Jaén, Spain

Recent research has explored the use of the IRAP for the assessment of aspects related to Psychological Flexibility (PF) (Drake et al., 2016; Hooper et al., 2010; Kishita, et al., 2014). However, to date no published study has attempted to use the IRAP to explore PF in children or adolescents. The purpose of this study is to explore the applicability of the IRAP as a complementary tool for the assessment of PF during late childhood and adolescence. Our study is a cross-sectional study comparing one group of 5th grade primary school students (10-11 years old), one group of 1st grade secondary school students (12-13 years old) and one group of 3rd grade secondary school students (14-15 years old) amounting a total of 139 participants. Preliminary findings appear to show a small implicit inflexibility bias in secondary school participants, but not in primary school ones. These findings point to the IRAP as a potentially useful tool to investigate the development of psychological flexibility.

• The IRAP to measure Psychological Inflexibility in Police Conflicting Situations
Evangelina Ruiz García,
Carmen Luciano, University of Almería
Adrián Barbero-Rubio, Ph.D., University of Almeria, Madrid Institute of Contextual Psychology

The current study aimed to assess psychological inflexibility (PI) in police conflicting situations using the Implicit Relational Assessment Procedure (IRAP). Local policemen (N = 16) from a City Council in Spain completed several questionnaires (AAQ-II, CFQ and VQ) and a self-report measure of PI adjusted to police contexts. Then, participants were asked to complete an IRAP designed to measure PI feelings-reactions in conflict situations. Results showed that the IRAP captured strong relations between inflexible reactions to feelings in the whole sample: time-reactions were different when responding: (a) affirmatively to relations between inflexible reactions to feelings and negatively to relations between flexible reactions to feelings (consistent block) than when responding (b) affirmatively to relations between flexible reactions to feelings and negatively to relations between inflexible reactions to feelings (inconsistent block). Correlations among IRAP effect and other Psychological (In)Flexibility measures are discussed. These findings show that the IRAP can be a preliminary tool to measure PI.

• RFT based intervention for cognitive decline in Alzheimer’s patients: 3 month follow-up results of a clinical trial
Giovambattista Presti, Department of Human and Social Sciences, Kore University Enna Italy
Salvatore Torregrossa, Alzheimer and Dementia Unit – Neurodegenerative Disorders O.U.,A.S.P. 2 Caltanissetta Italy
Edoardo Cumbo, Alzheimer and Dementia Unit – Neurodegenerative Disorders O.U.,A.S.P. 2 Caltanissetta Italy
Bryan Roche, Maynooth University

Twenty-seven patients (15 (55,5%) female and 12 (44,5%) male) with a diagnosis of mild-to-moderate Alzheimer’s disease (AD) were enrolled in a prospective, randomized, 3 month, parallel-group trial to evaluate the efficacy of a computer assisted multiple-exemplar relational training (RFT), as add-on non-pharmacological therapy to cholinesterase inhibitors (ChEIs). Participants were exposed to SMART (Strengthening Mental Abilities with Relational Training) a multiple exemplar training in the relational frames of SAME, OPPOSITE, MORE THAN, and LESS THAN. Cognitive and executive functions were assessed at baseline, and at the end of training (3 months) and after 3 month follow-up (FU) using respectively MODA (Milan Overall Dementia Assessment), Coloured Progressive (CPM) and attentive matrices. Patients treated with RFT as add-on intervention (n=14) scored significantly better (p>0.05 vs baseline; p>0.05 vs ChEIs) on MODA, CPM and attentive matrices. Results were maintained at FU. Overall these data seem to suggest that an RFT-based training may slow down cognitive decline and improve general cognitive functioning in AD subjects treated with ChEI

Friday, 23 June

57. Experimental Analysis of Brief Defusion and Self-as-Context Interventions
Symposium (11:00-12:30)
Components: Original data
Categories: Clinical Interventions and Interests, Performance-enhancing interventions, Relational Frame Theory, Mindfulness, Perspective Taking, Defusion, Self-as-context
Target Audience: Beg., Interm.
Location: Buhaira

Martin O'Connor, MSc., Ph.D Candidate, University College Dublin
Nic Hooper, Ph.D, University of West England

The unifying concern of this symposium is the effectiveness of defusion, self-based and perspective taking interventions in coping with internal experiences. Particularly looking at their effect on the renewal of fear, negative and angry thoughts, as well as comparing their efficacy to common alternative interventions; exposure, focused breathing and restructuring exercises. The first study explores how self-based mindfulness techniques can specifically enhance therapeutic outcomes, by comparing a ‘self-as-context’ intervention to a focused breathing intervention. Findings highlight the efficacy of self-based mindfulness interventions as a superior strategy for managing negative self-referential thought over interventions that utilise present moment awareness alone. The second study compared the effectiveness of brief cognitive defusion and perspective taking interventions with a CBT based cognitive restructuring task for coping with angry thoughts and elevated state anger. Findings indicate that both cognitive restructuring and defusion are effective brief anger reduction techniques. The third study explores the use of perspective taking techniques to alter the contextual renewal of fear. It is proposed that self-as-context interventions may provide an experiential extinction context which is less subject to variability and can extend the generalisation of learning beyond the effects of just exposure.

• Comparing Self-as-Context and Focused Breathing Techniques for Coping with Negative Self-Referential Thoughts
Varsha Eswara Murthy, MPsychSc., Ph.D Candidate, University College Dublin
Louise McHugh, Ph.D, University College Dublin

The current study aimed to compare whether the effects of a self-as-context intervention differed from those of a focused breathing intervention for coping with a negative self-referential thought. Participants were asked to identify a personally relevant negative thought and given either a self-as-context, focused breathing or no-instruction control strategy to manage the negative thought over a five-day period. The self-as-context intervention involved the completion of the ‘observer you’ exercise daily, as well as utilising hierarchical metaphors as a coping strategy. The focused breathing group completed a focused breathing exercise daily and were given brief focused breathing exercises as a coping strategy. Findings indicate that the self-as-context intervention lowered believability, increased comfort, increased willingness and decreased negativity associated with the target thought significantly more than the focused breathing or control strategy. The focused breathing strategy also made significant gains in the same direction, however the control group did not. Frequency of target thought occurrence was reduced for both the self-as-context and focused breathing intervention and increased for the control group. Findings provide evidence for the efficacy of self-as-context interventions for managing negative self-referential thoughts.

• A Comparison of Brief Cognitive Intervention Methods for Anger Reduction
Tracey McDonagh, MPsychSc., Ph.D Candidate, University of Southern Denmark
Louise McHugh, University College Dublin

This exploratory study aimed to assess the potential effectiveness of three brief cognitive techniques when managing angry thoughts (i.e., defusion, restructuring and perspective taking). While cognitive restructuring is a common technique used in anger treatment, recent research has shown promising results in the effectiveness of using cognitive defusion with negative thoughts (Larsson et al., 2015). We hypothesised that this may generalise to negative thoughts generated by affective processes. Preliminary findings (N=55) suggest trait anger, state anger, ‘anger expression in’ and ‘anger expression out’, were predicted by effortful control. Self-compassion approached significance as a predictor of state anger. Interestingly, psychological flexibility was highly predictive of ‘anger expression in’. The findings also suggest that cognitive defusion and cognitive restructuring appeared to be effective brief anger reduction techniques. Perspective taking approached significance but appeared to be less effective; this may require further investigation.

• 'Self-as-context' perspective-taking and the contextual renewal of fear
Donal Campbell, University College Dublin
Marc Bennett, Ph.D, Trinity College Dublin
Louise McHugh, University College Dublin

Exposure therapy is considered an effective means of treating anxiety disorders and phobias, but its successful application is sometimes compromised by a mechanism of patient relapse called contextual renewal (CR). Research has indicated that the efficacy of exposure therapy is predicated upon the extinction of fear associated with a conditioned stimulus (CS). It is understood that extinction does not replace the fear association but rather represents new learning, and that the context in which the CS is subsequently encountered can determine which association is recalled. Thus a patient who encounters the problematic CS outside of the extinction context may experience a renewal of fear. While various methods of mitigating this effect have been investigated, findings are frequently inconsistent or clinically impractical. It is for this reason that the present research proposes a novel approach to preventing CR using the concept of the ‘self as context’. This perspective-taking manipulation may provide an experiential extinction context which is less subject to variability and can extend the generalisation of learning.

58. WorkACTive: ACTing on Sickness Absence and Return to Work
Symposium (11:00-12:30)
Components: Original data
Categories: Clinical Interventions and Interests, Performance-enhancing interventions, Behavioral medicine, Sick-leave, Return to work, Musculoskeletal disorders, Common Mental Disorder
Target Audience: Beg., Interm., Adv.
Location: San Bernardo

Jenny Thorsell Cederberg, Uppsala University

In 2004 JoAnn Dahl published a pilot study indicating that a brief ACT intervention reduced sick-leave and utilization of medical treatment resources in a Swedish sample. This study sparked several randomised clinical trials in both Norway and Sweden utilizing ACT in different return to work interventions for individuals on sick leave due to musculoskeletal- and common mental disorders. In the Nordic countries, there are unique opportunities to measure sickness absence and return to work due to the national registries and the public insurance systems where all legal residents are registered. This symposium presents results from three separate randomised clinical trials reporting on return to work and effects on sick-leave using registry data in Norway and Sweden as outcome measures. Welcome!

• Effects of multicomponent occupational rehabilitation on sickness absence and health outcomes: results of a randomized clinical trial.
Lene Aasdahl, Norwegian University of Science and Technology, Trondheim, Norway
Marius Fimland, Norwegian University of Science and Technology and Trondheim University Hospital, Norway

Aim: To evaluate effects of a multicomponent inpatient occupational rehabilitation program compared to a less comprehensive outpatient program for individuals on sick leave with musculoskeletal complaints or mental health disorders. Methods: In this randomized clinical trial a 4+4 days inpatient program offering Acceptance and Commitment Therapy (ACT), physical training and work related problem solving, was compared to an outpatient program offering six weekly group based ACT sessions. Results: 168 individuals were randomized to the inpatient program (n=92) or the outpatient program (n=76). The programs did not statistically differ in median number sickness absence days at 6 and 12 months follow-up or time to sustainable RTW (HR 0.74, 95% CI 0.48-1.32, p=0.165). Except slightly less pain reduction after the inpatient program, the health outcomes neither differed statistically significant. Conclusions: A 4+4 days multicomponent inpatient rehabilitation program was not superior to a less comprehensive outpatient program in improving RTW or health outcomes.

• Inpatient occupational rehabilitation based on Acceptance and Commitment Therapy (ACT) vs standalone outpatient ACT for patients sick listed with musculoskeletal or common mental disorders: A randomized clinical trial reporting on return to work, self-rep
Sigmund Ø. Gismervik, Norwegian University of Science and Technology, Trondheim, Norway
Marius Fimland, Norwegian University of Science and Technology and Trondheim University Hospital, Norway

Aim: To compare work and health related outcomes of two different ACT based interventions for patients on sick leave. Methods: Patients were randomised between a 3½ week inpatient rehabilitation program consisting of ACT sessions, physical exercise and work-related problem solving (n=86) or outpatient ACT with weekly 2½ hour group sessions over 6 weeks plus three individual sessions (n=80). Results: The hazard ratio for return to work was 1.9 (95% CI 1.2- 3.0) in favour of inpatient rehabilitation, and the median number of sickness days at 12 months was 85 (IQR 33-149) and 117 (IQR 59-189), respectively (p=0.034). Except for average pain (a minor reduction in favour of standalone ACT) there were no differences in self-reported anxiety, depression or health related quality of life. Conclusion: Inpatient rehabilitation was superior to standalone ACT in returning to work and reducing sick leave. Health outcomes were similar. Cost effectiveness needs to be assessed.

• Efficacy and cost-effectiveness of Acceptance and Commitment Therapy and Workplace Dialogue Intervention for workers on sickness absence.
Anna Finnes, Karolinska Institutet, Stockholm, Sweden
JoAnne Dahl, Uppsala University, Sweden

Aim: The aim of this trial was to determine the efficacy and cost-utility of Acceptance and Commitment Therapy (ACT) and the Workplace Dialogue Intervention (WDI), as stand-alone interventions and combined. Methods: We designed a randomized controlled trial with four treatment groups: ACT, WDI, ACT+WDI, and Treatment as Usual. Participants were in working age (n=352, 78.4% females) and on sickness absence from work due to depression, anxiety or stress. A cost-utility analysis was conducted alongside the RCT. Results: There were no differences between groups over time for sickness absence. For health outcomes, ACT and ACT+WDI were superior in comparison to TAU at post-measurement but not during the follow-up period. ACT was a cost-effective treatment alternative from a health-care perspective. Conclusions: Neither ACT, WDI or ACT+WDI were superior to TAU on improving RTW or for health outcomes during follow-up. ACT may be a cost-effective treatment alternative for common mental disorders.

59. Compassion at the Core: Providing Care for Sexual Minorities, Muslim Immigrants, and Families of Children with Autism
Symposium (11:00-12:30)
Components: Conceptual analysis, Literature review, Original data, Didactic presentation, Case presentation
Categories: Prevention and Community-Based Interventions, Clinical Interventions and Interests, LGBT, GSM, Muslim Immigrants, Autism, Compassion, Mindfulness
Target Audience: Beg., Interm.
Location: Lebrija

Kayla Sargent, M.A., Children's Healthcare of Atlanta
Kayla Sargent, M.A., Children's Healthcare of Atlanta

Whereas the embracement of diversity is a shared value among many of us, relatively little attention is directed to how the intersections of multiple sociocultural identities (e.g., gender, race, sexual orientation, etc.) and their social consequences unfold within the self as well as in relationships with others. The purpose of the present symposia is to shed light on the intersections of human identities and to promote humanization in broad contexts, from neurocognitive illnesses in medical settings to adjustment and acculturation in community settings. The symposia is both didactic and empirical; it starts with a brief introduction on intersectionality, including how it unfolds in our daily lives and for unique populations of interest: sexual and gender minority clients, Muslim immigrants, and families of children with Autism Spectrum Disorder. Experiences of these patients will be discussed from a perspective of various meaningful identities. The presenters aim to enhance perspective taking, increase awareness, and harvest inclusiveness by illuminating the ways in which all people hold various and multiple identities, how to cope with and integrate those identities in our lives and communities in accordance with our values, highlighting the impact that these experiences and cultural blueprints have in our lives. Subsequently, we present a CBS approach to working with three communities, using theory and applied science that can be broadly applied to working with broad groups of people.

• A compassion-based approach to working with sexual minority clients and their intersecting identities
Kayla N. Sargent, M.A., Children's Healthcare of Atlanta

The present talk will focus on providing compassion-based approaches to case conceptualization within a CBS framework. Whereas the field of behavioral health care has begun to pay greater attention to the impact of a minority status on health, behavioral health professionals may not adequately approach subgroups of minorities and their health, particularly multiple-minority individuals, such as ethnic minorities within the LGBT community. Multiple-minority status is found to be linked to greater emotional distress and hardship (Berdahl & Moore, 2006; Pak, Dion, & Dion, 1991), but professionals tend to focus exclusively on a single aspect of a person’s identity, such as gender, and its impact on the person’s health, while overlooking intersecting identities. One way to contribute to this field is to offer a potential working model that allows professionals to understand and promote the behavioral health of multiple-minority individuals. We think an acceptance- and compassion-based approach serves as such a model.

• Compassionate Alliance: Working with Muslim Immigrants through a Compassionate lens
Khashayar Farhadi Langroudi, Psy.D., Kaiser Permanente

Human beings have migrated since their early appearance in Africa. The origin of work migration is rooted in the Latin word migrātus (past participle of migrāre), which means to move from place to place, change position or abode. In today's world, more than 175 million people live outside of their country of birth (Stilwell, et al., 2003). Due to the recent world events, many Muslim immigrants have found their new home in the Western world such as Europe and the U.S. The purpose of this presentation is to employ the CBS approach to shed a pragmatic light on common challenges that the migrant might face. The presenters will provide some recommendations on how to navigate Muslim clients’ migration-related challenges in psychotherapy and foster a place for resilience and growth.

• Mindfulness and Compassion Training for Parents and Therapists of Children with Autism
Samuel Fernandez-Carriba, Ph.D., Emory University

CBCT is a mindfulness and compassion meditation protocol developed at Emory University. Recent research on the impact of six to eight weeks of CBCT practice on undergraduate students without prior experience in meditation shows reduced immune inflammatory and emotional distress responses to psychosocial stressors as well as enhancement of empathic accuracy when assigning emotions to other people’s faces with changes in the neurobiology supporting it. In addition, CBCT has shown benefits with typical children, at-risk adolescents in foster care, breast cancer survivors, medical students, veterans and prison inmates. We offer evidence from several pilot studies conducted with families and therapists of children with Autism Spectrum Disorder (ASD) at the Marcus Autism Center. Like traditional mindfulness programs, CBCT fosters self-regulation by bringing attention to the present moment experience. The compassion aspect of CBCT helps promotes “others-regulation” by helping practitioners develop affection for, positive connection with, and acceptance and understanding of others. Promising results from a series of quasi-experimental studies (without a control group) with parents of children with ASD suggest CBCT has the potential to help families accept their experience and become more aware of and utilize better the available social support. Preliminary findings on 9 caregivers included a significant decrease in perceived severity of the child’s symptoms (ABC) and in parent stress (PSI) as well as significant increase in acceptance (AAQ) and parenting sense of competence (PSOC). Mixed models were utilized to evaluate pre-post changes in scores at the 0.05 significance level. In addition, as CBCT promotes awareness of self and others and skills to relate to others, it has the potential to become an effective training on cultural/relational competence for providers. Data obtained from 22 therapists in another experimental study (with a control group) showed a significant decrease in stress (PSS) and increase in acceptance (AAQ) and cultural competence (CCC) for those who attended the CBCT program. Paired t-tests compared pre-post changes in experimental and control groups at the 0.05 significance level.

61. ACT in the Oncology Setting: Better Understanding How ACT Can be Used to Improve the Wellbeing of those Affected by Cancer
Symposium (11:00-12:30)
Components: Conceptual analysis, Original data
Categories: Behavioral medicine, Clinical Interventions and Interests, Cancer
Target Audience: Interm.
Location: Estepa

Lee Hulbert-Williams, PhD, University of Chester
David Gillanders, DClinPsy, University of Edinburgh

Psychological distress is common in those affected by cancer and is associated with poor quality of life, and possibly even premature mortality (Batty et al, 2017). Family members are not exempt from the adverse impact of cancer on psychological wellbeing: adolescent and young adult offspring of cancer patients are often overlooked (Patterson et al, 2013). Current evidence for the psychological intervention benefits for those affected by cancer is inconsistent and often time-limiting. ACT is more conceptually suitable to the nature of cancer-related distress (Hulbert-Williams et al 2016), and is gaining traction as pilot studies are published. This symposium presents data from three studies which inform how ACT can be integrated into cancer care. We explore the moderating role of psychological flexibility between unmet psychosocial and supportive care needs and distress; a group-based intervention for offspring of cancer patients; and, an ACT-enhanced communication skills training programme for oncology healthcare professionals.

• Psychological flexibility as a moderator of unmet psychosocial needs and psychological wellbeing in haematological cancer survivors.
Brooke Swash, PhD, University of Chester
Nick Hulbert-Williams, PhD, University of Chester
Ros Bramwell, PhD, University of Chester

Haematological cancers are noteworthy for high levels of associated psychological distress. The relationship between unmet psychosocial needs and patient-reported outcome is recognised, but process variables affecting this relationship are not well understood. We investigated the moderating effects of psychological flexibility in 91 haematological cancer survivors (53% female, mean age=62yrs). Participants completed questionnaires assessing unmet needs, anxiety, depression, quality of life, and psychological flexibility. Results indicate high prevalence of unmet needs, psychological distress, and poor quality of life in all sub-types of disease group. Significant correlations were found between all variables (r=2.98-8.20; all p<.05). Psychological flexibility significantly moderated the relationship between four unmet need domains with anxiety and quality of life (all p<.02), but not depression: need-outcome correlations were significant only where psychological flexibility was higher. Further research is needed to explore the nature of this moderation relationship further, and to develop interventions that target flexibility to improve psychological wellbeing in cancer survivors.

• TRUCE: The development and evaluation of an Acceptance and Commitment Therapy program for young people who have a parent with cancer.
Pandora Patterson, PhD, CanTeen Australia & University of Sydney
Fiona McDonald, PhD, CanTeen Australia & University of Sydney
Jospeh Ciarrochi, PhD, Australia Catholic University
Louise Hayes, The University of Melbourne
Danielle Tracey, Western Sydney University

Young people who have a parent with cancer experience significant unmet needs and elevated distress, however support to this vulnerable group is significantly lacking. An ACT-based manualised 7-session group program called Truce was developed for adolescents and young adults impacted by parental cancer. ACT was considered to be appropriate given its focus on helping create a full and meaningful life while accepting the pain that life invariably brings. Truce is currently being evaluated at 3-time-points (pre-, post-, 2-month follow-up questionnaires). Program fidelity and satisfaction is also assessed. Results indicate very high satisfaction (mean session interest=8.7/10) and there are promising preliminary outcome results focusing on core ACT processes such as psychological flexibility and mindfulness which are maintained at follow-up. Truce is showing promise as an intervention that is acceptable and effective for AYAs impacted by parental cancer, providing clinicians with a much needed program to assist these young people.

• ACT-enhanced communication skills training: development and evaluation of a training programme to improve psychosocial care in the cancer setting
Nick Hulbert-Williams, PhD, University of Chester
Lee Hulbert-Williams, PhD, University of Chester

Psychological suffering is ubiquitous with cancer and yet psychological support is often difficult to access. Healthcare workers in this setting are often driven—despite high stress and compassion fatigue—by work-related personal meaning. Medical training often instills a drive to ‘fix’ patients’ psychological suffering; we aimed to change the nature of clinical communication towards an ACT-consistent approach. Part self-development, our brief experiential communications skills workshop is underlined by applied RFT and ACT. Across three settings (two UK-based; one in Australia) including health service and charity sectors, we have trained over 150 people to date. Evaluation data is positive and shows a promising intention to use the skills learnt: 78% of participants from one of our recent trainings agreed that it had clear relevance to their work and 46% had already implemented the skills by follow-up. This training programme could bring benefit for both staff and patient wellbeing in the cancer setting.

68. Can ACT Help People with a Visible Difference?
Symposium (12:45-14:00)
Components: Original data, Didactic presentation, Case presentation,
Categories: Clinical Interventions and Interests, Other, Visible Difference
Target Audience: Beg., Interm., Adv.
Location: Buhaira

Dr. Nic Hooper, University of the West of England (UWE), UK.
Dr. Ray Owen, Consultant Clinical Psychologist, Wye Valley NHS Trust, UK.

As people with disfigurement often report psychological issues and as current interventions report little success with this population, some have suggested that the development of novel evidence-based interventions is essential. ACT is one such intervention, however, it has received very little empirical attention in this domain. In this symposium, three presenters on the cutting edge of the research area, will argue that ACT is well placed to help those with a visible difference. Joanna Dudek, who will present cross-sectional questionnaire data, will provide a rationale for using ACT with this population. Staci Martin will present what an ACT intervention might look like with the help of case examples. And Fabio Zuchelli will present a qualitative analysis that gives an insight into patients experience of ACT. Finally, Ray Owen will use his expertise to offer thoughts on ways to move the work forward in this area.

• Psychological flexibility and appearance-related distress in women with lipedema
Joanna E. Dudek, SWPS University of Social Sciences and Humanities
Wojciech Bialaszek, Ph.D., SWPS University of Social Sciences and Humanities
Pawel Ostaszewski, Ph.D., SWPS University of Social Sciences and Humanities

Visible differences can have a significant impact on the quality of life and wellbeing of individuals subject to stigmatization and self-stigmatization. However, psychological flexibility may prove to be an ability, which can be trained and developed, that promotes better adjustment to unpleasant external and internal experiences related to visible changes in the appearance. We conducted a cross-sectional study of 328 women with lipedema, a relatively common but still insufficiently known condition that can lead to disfigurement through uncontrollable accumulation of adipose tissue in the extremities. Women with greater psychological flexibility showed lower appearance-related distress. In the talk we discuss potential benefits of ACT-based interventions for people who are struggling with visible differences, entailed by our results.

• How to Use ACT when treating someone suffering as a result of a visible difference
Staci Martin, PhD, Clinical Consultant: Department of Psychology, George Washington University, Washington, DC.

Individuals with medical conditions sometimes have diseases or treatments that radically impact their appearance, such as disfiguring tumors, hair loss from chemotherapy, or swelling/weight gain from steroids. These physical aspects of disease can negatively impact quality of life (Wolkenstein et al., 2001). Mental health professionals can employ ACT techniques to target the anxiety, depression, and low self-esteem that often accompany these visible signs of illness. In this presentation, we will explore how medical patients with visible differences can practice acceptance of their condition hand in hand with self-compassion related to their anxious thoughts and self-criticism. Examples of how patients can use defusion to target thoughts about how people “should” react to their appearance will be presented. Finally, connecting with values is of pivotal importance, such as in the case of a person going through a treatment with appearance-altering side effects.

• The perspective of adults with psychosocial difficulties arising from a visible difference: Findings from a qualitative interview study.
Fabio Zucchelli, University of the West of England (UWE), UK.
Dr Olivia Donnelly, North Bristol NHS Trust
Dr Elisabeth Baker, Royal Free Hospital
Dr Nic Hooper Ph.D, University of the West of England (UWE), UK.
Dr Heidi Williamson Ph.D, University of the West of England (UWE), UK.

The aim of this presentation is to summarise qualitative interview findings from adults with a visible difference and related psychosocial difficulties, who have received individual Acceptance and Commitment Therapy. Visible difference refers to any congenital or acquired condition that creates an altered appearance. Some of those affected experience challenges such as social anxiety and body dissatisfaction (Norman & Moss, 2015). Evidence for ACT’s efficacy for both issues is burgeoning (e.g. Craske et al., 2014; Pearson et al., 2012). Psychologists at two specialist UK-based NHS psychological services for this client group primarily deliver ACT, based on a process-driven guide protocol. Researchers from the Centre for Appearance Research, UWE Bristol, are in the process of interviewing up to eight patients post-intervention from these sites to gain insights into their experience of ACT, with a view to identifying key components, exercises and other lessons for content development and also to inform a feasibility trial.

69. Cognitive Fusion in the Laboratory
Symposium (12:45-14:00)
Components: Original data
Categories: Clinical Interventions and Interests, Cognitive Fusion, Measurement, Virtual Reality, IRAP
Target Audience: Beg., Interm., Adv.
Location: San Bernardo

Helen Bolderston, Bournemouth University
Andrew Gloster, University of Basel

Cognitive fusion is a key process in the Psychological Flexibility Model of psychopathology. As such, it is important to investigate the role of fusion, under controlled laboratory conditions, as well as in the clinic. Greater variety in the methodologies used in such research will increase confidence in the conclusions drawn about fusion and defusion. This symposium therefore brings together three papers, each using innovative methods in laboratory-based studies, to investigate fusion and increase defusion. Helen Bolderston will introduce the State Cognitive Fusion Questionnaire, a self-report measure which may have particular utility in laboratory-based studies involving brief defusion interventions. Arianna Prudenzi will then present the findings of two studies testing the impact of a virtual reality task on defusion, in relation to negative self-referential thoughts. In the final paper, David Gillanders will discuss an IRAP study that examined relationships between cognitive fusion, implicit and explicit measures of worry, anxiety, mindfulness, engaged living and experiential avoidance. Andrew Gloster will then discuss the papers and their implications.

• The initial development of a state version of the Cognitive Fusion Questionnaire
Helen Bolderston, Bournemouth University
Georgia Turner, Bournemouth University
Holly Taylor, King's College, London
David T. Gillanders, University of Edinburgh
Alister Coleman, Bournemouth University

Cognitive fusion is hypothesised to play a significant role in the development and maintenance of mental health problems. The development of a psychometrically sound measure, the Cognitive Fusion Questionnaire (CFQ; Gillanders et al., 2014) has successfully facilitated research examining the role of fusion. However, the CFQ operationalises fusion as being trait-like. It is therefore possible it might not be sufficiently sensitive over short periods of time to detect change following the kinds of brief defusion interventions used in analogue studies. A state version of the CFQ has therefore been developed. This paper presents this new, state version of the CFQ, along with preliminary data indicating it is a reliable, valid measure of cognitive fusion. Data on its sensitivity to change compared to that of the original CFQ, will also be presented. Future research required to further validate the state CFQ will be discussed.

• Studying Cognitive defusion Through Virtual Reality: Two Exploratory Studies In The Management Of Negative Thoughts
Arianna Prudenzi, School of Psychology, University College Dublin
Louise McHugh, School of Psychology, University College Dublin
Brandan Rooney, School of Psychology, University College Dublin
Nanni Presti, Department of Human and Social Sciences, Kore University, Enna, Italy
Marco Lombardo, Behaviour Labs, Catania, Italy
Daniele Lombardo, Behaviour Labs, Catania, Italy

Virtual reality (VR) is of increasing interest to applied psychologists due to its potential for exposure learning. The current study comprises two experiments that aimed to examine the effect of a VR task on participants’ relationship with negative self referential thoughts (e.g., 'I am not good enough'). To that end, participants were instructed to select a thought that they were 'fused with' and to interact with this thought in a VR environment. In Study 1, 30 participants (age range: 18-65) across three groups (Cognitive Defusion, Distraction & Control) were tested pre and post VR task on trait fusion and their overall relationship with the negative thought. In Study 2, a further control group of VR only and a state measure of fusion were introduced. Overall the results indicate that VR, not only facilitates the management of negative thoughts, but that it generalises to a reduction in both trait (Study 1) and state (Study 2) fusion levels. The findings are discussed in terms of the utility of VR in applied settings.

• Implicit beliefs about worry, cognitive fusion and their relationships with anxiety and other aspects of psychological flexibility
David T. Gillanders, University of Edinburgh
Julie Dwyer, University of Edinburgh

Objective: Relationships between cognitive fusion, implicit and explicit measures of worry, mindfulness, engaged living, experiential avoidance and anxiety were explored. Method: 113 adults completed clinical interview, standardized questionnaires of the above constructs, and an IRAP operationalizing the functions of worry. Results: Cognitive fusion was associated with implicit relations about worry as both harmful and helpful. Fusion was also strongly associated with reduced valued living, reduced life fulfillment, and reduced mindfulness. Fusion was also associated with higher experiential avoidance, and psychological inflexibility. Fusion was not associated with an explicit measure of worrying, though surprisingly explicit worry was also not associated with anxiety. By contrast, implicit measures of worry and cognitive fusion were both associated with anxiety. Conclusions: Data provide further support for cognitive fusion as a process associated with undesirable outcomes. The pattern of associations is supportive of contextual behavioural theory at both the mid-level constructs and implicit relations.

71. Components that Maximize the Metaphor Effect I: Hierarchy, Perspective Taking, Relational Elaboration and Physicalization
Symposium (12:45-14:00)
Components: Conceptual analysis, Original data
Categories: Relational Frame Theory, Clinical Interventions and Interests, Metaphors
Target Audience: Beg., Interm., Adv.
Location: Utera

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

Acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is a contextual model of psychological intervention that aims to promote psychological flexibility. To accomplish this aim, metaphors are profusely used in ACT. One of the areas of human cognition most studied by relational frame theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001) is analogical reasoning. The link between ACT and RFT is becoming closer as a theoretical and empirical line of research is emerging that analyzes the components of metaphors that maximize the promotion of psychological flexibility (e.g., Foody et al., 2014; Ruiz & Luciano, 2015; Sierra, Ruiz, Flórez, Riaño-Hernández, & Luciano, 2016; Villatte, Villatte, & Hayes, 2015; Törneke, 2017). This symposium presents three empirical studies that extends previous research in this regard by analyzing the effect of hierarchical relations, cues to prompt perspective taking, the presentation of the metaphor in first or third person, and the metaphor physicalization.

• The effect of hierarchical and perspective taking cues in metaphor effect
Andrés Peña-Vargas, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Eduar Ramírez, Fundación Universitaria Konrad Lorenz
Paola Bernal, Fundación Universitaria Konrad Lorenz
Nikol Pardo, Fundación Universitaria Konrad Lorenz
Alejandra Orozco, Fundación Universitaria Konrad Lorenz
Bárara Gil-Luciano, Madrid Institute of Contextual Psychology

The role of hierarchical framing has been found to be especially relevant in promoting psychological flexibility in typical defusion exercises (e.g., Foody et al., 2014; Luciano et al., 2011; Gil-Luciano et al., 2017). However, the effect of including hierarchical relations between the person and her private events in metaphors has not been demonstrated. Additionally, the effect of cues that prompt temporal perspective taking has not been analyzed. Accordingly, this study analyzed the effect of both variables by conducting a factorial 2x2 design. Eighty participants provided informed consent and were exposed to the cold-pressor task (CPT). After that, participants were randomly allocated to one of the four experimental conditions and listened to an audio that presented a metaphor in which the independent variables were manipulated. Lastly, participants were exposed again to the CPT. Results are discussed in terms of the interactive effect of both independent variables.

• The role of deictic framing and relational elaboration in metaphor effect
Eduar Ramírez, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Paola Bernal, Fundación Universitaria Konrad Lorenz
Andrés Peña-Vargas, Fundación Universitaria Konrad Lorenz
María B. García-Martín, Fundación Universitaria Konrad Lorenz
Bárara Gil-Luciano, Madrid Institute of Contextual Psychology

This experiment analyzes the effect of two independent variables in the metaphor effect: (a) presenting the metaphor by asking the individual to imagine herself as the protagonist of the story or by imagine that the protagonist is a third person, and (b) the inclusion of relational cues that prompt for the relational elaboration of the rules that might be derived according to the metaphor content. Eighty undergraduates participated in this 2x2 factorial design. After signing the informed consent, participants were exposed to the cold-pressor task (CPT). Then, participants were randomly assigned to one of the four experimental condition and listened to an audio that presented a metaphor in which the independent variables were manipulated. Subsequently, participants were exposed to the CPT again. Lastly, participants responded to tests of empathy and imagination. Results are discussed in terms of the participant’s tolerance to the CPT and the variables that moderate the effect of the independent variables.

• The effect of physicalizing metaphors in promoting behavioral change
Paola Bernal, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Andrés Peña-Vargas, Fundación Universitaria Konrad Lorenz
Eduar Ramírez, Fundación Universitaria Konrad Lorenz
Daniela Salazar, Fundación Universitaria Konrad Lorenz

One guideline that is often provided in ACT books and workshops is that to physicalize metaphors can improve their effect. This study aims to analyze this point by conducting an experimental analogue. Sixty participants were randomly assigned to the two experimental conditions: Physicalization vs. No Physicalization. After signing the informed consent, participants responded to several self-report measuring experiential avoidance and the tendency to engage in ruminative thinking. Subsequently, participants were exposed to a 3-minute rumination induction task and a working memory test. Participants then received one of two protocols that consisted of one metaphor that aimed to promote defusion from ruminative thinking. The only difference between conditions was that in one condition the metaphor was physicalized while in the other not. Lastly, participants were exposed again to the rumination induction task and the working memory test.

82. Advances in the Application of Acceptance and Commitment Therapy in Autism
Symposium (15:15-16:45)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Relational Frame Theory, Autism, ACT
Target Audience: Beg., Interm., Adv.
Location: Buhaira

Thomas G. Szabo, Florida Institute of Technology
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz

The application of acceptance and commitment therapy (ACT) in autism is increasing during the last years. ACT has been shown to be useful in the counseling of parents of children with autism, but there is less evidence of the applicability of ACT in the treatment of children with autism. This symposium presents cutting-edge research in this topic using single-case experimental designs. The first paper presents the effect of a brief ACT-based intervention to change the pattern of behavior displayed by children with autism when playing games. The second paper describes the effect of a two-day ACT training with parents of children with autism. The training was directed to disrupt parents’ session avoidance. Lastly, the third paper shows the effect of ACT training as an approach to parents’ private events. Specifically, the study describes an intervention focused on values-directed behaviors in parents of children with autism.

• Benefits of Acceptance and Commitment Training for children with autism
Thomas G. Szabo, Florida Institute of Technology
Madison Wood, Florida Institute of Technology
Gina Hansen, Florida Institute of Technology
Jessica Bentley, Florida Institute of Technology

Children with autism often display inflexible behavior when playing games. This behavior is often negatively reinforced in that it results in decreased time spent in aversive social settings. To the child, short term benefits of this avoidance are coupled with log term problems, such as removal from social milieus and constrained repertoires under tight aversive control. In the current study, we asked to what extent will inflexible behavior decrease and manding-for-rule-changes increase after a two-hour training in behavioral flexibility (ACT) conducted in a home setting with a function-based treatment and specific, measurable replacement behaviors. Results and implications for future research are discussed.

• Acceptance and Commitment Training for parents of children with autism
Thomas G. Szabo, Florida Institute of Technology
Jana Gleason, Florida Institute of Technology
Asia Murdy, Florida Institute of Technology
Deena Garman, Florida Institute of Technology
Cassie Rushford, Florida Institute of Technology
David Scribner, Florida Institute of Technology

Parents want ABA treatment to improve their children's lives, but parent session avoidance is negatively reinforced. This is a significant challenge for behavior therapists, because the window in which verbal skills can be taught to a child with autism closes by the time the child is twelve years old. Additionally, behavior analysts do not have access to reinforcers for parent engagement in ABA work outside of session and limited access to reinforcers for their participation during sessions. Negative reinforcement traps are coupled with positive reinforcement traps and these are overlaid with rule insensitivity that further cements parent avoidance of the private events that accompany their participation in ABA work. In this study, we evaluated a method of addressing both indirect-acting (verbal) and direct-acting contingencies in a two-day Acceptance and Commitment Training. Results and implications for future research are discussed.

• Acceptance and Commitment Training for parents of children with autism
Evelyn Gould, FirstSteps for Kids, Inc.

Behavioral parent training is a critical component of effective treatment for children with autism, however, engaging parents effectively can be extremely challenging. Despite evidence that private events can strongly influence parent behavior and training outcomes, the topic has received minimal attention in the behavioral literature thus far. Acceptance and Commitment Training (ACT) is a contemporary behavioral approach to increasing adaptive, flexible repertoires of behavior, by reducing control by problematic rule-deriving and rule-following. This study is one of the first to examine the effects of ACT on values-directed behavior in parents of children with ASD. A nonconcurrent multiple baseline across participants indicated that ACT resulted in increased parent engagement in values-directed behavior. Gains were maintained post-training, with training effects most prominent at follow-up, more than 6 months post-training. Exploratory data suggested that ACT may also have resulted in substantial decreases in parental experiential avoidance and notable increases in self-compassion

83. Addressing Mental Health Stigma
Symposium (15:15-16:45)
Components: Conceptual analysis, Literature review, Original data, Didactic presentation
Categories: Prevention and Community-Based Interventions, Educational settings, Stigma
Target Audience: Beg., Interm., Adv.
Location: San Bernardo

Kenneth Fung, University of Toronto
Josephine Pui-Hing Wong, Ryerson University

Mental health stigma remains one of the major barriers towards people seeking timely assessment or receiving appropriate care. Further, psychosocial and cultural factors interact, intersect, and exacerbate stigma. In this symposium, we will explore mental health stigma in several diverse populations, including undergraduate university students in North Texas US, East Asian women in Montreal Canada, and Asian men in Toronto Canada. Psychosocial interventions will be discussed, including the use of ACT in particular to address stigma.

• Preventing progress: Barriers to seeking psychological treatment
Teresa Hulsey, B.A., University of North Texas
Danielle N. Moyer, MS, University of North Texas
Amy R. Murrell, PhD, University of North Texas

Although most college campuses provide affordable mental health resources for students (Reetz, Krylowicz, & Mistler, 2014), many emerging adults in need of help appear not to utilize these services (American College Health Association, 2014). Therefore, a better understanding of the underlying processes that prevent college students from seeking psychological treatment is needed. This paper examines barriers to seeking mental health treatment in an undergraduate population. Participants (n = 965) completed online measures of self-stigma and perceived public stigma of seeking treatment, intentions to seek treatment, attitudes and beliefs toward seeking treatment, experiential avoidance, and psychological distress. Data is being analyzed now. A binomial logistic regression will be used to identify significant barriers to seeking treatment. The role of each barrier to seeking treatment in the context of a college campus will be discussed.

• Improving attitudes toward mental illness among East Asian women: A mixed-methods study
Sumin Na, Department of Educational and Counselling Psychology, McGill University
Momoka Watanabe, Department of Psychology, Concordia University
Andrew G. Ryder, Department of Psychology, Concordia University
Kenneth Fung, Department of Psychiatry, University of Toronto
Josephine Wong, Daphne Cockwell School of Nursing, Ryerson University
Laurence J. Kirmayer, Division of Social & Transcultural Psychiatry, McGill University

The present study examined the effectiveness of acceptance and commitment therapy (ACT) and mental health literacy (MHL) group interventions among East Asian Canadian women. East Asian Canadian women (N = 91) were randomly assigned to ACT, MHL or a no intervention control. The authors assessed for stigma toward mental illness and attitudes toward help-seeking pre-intervention, post-intervention and at 3-month follow-up. Participants also took part in focus groups following the interventions for a more nuanced understanding of potential effects of the interventions. The quantitative results indicated that ACT and MHL reduced mental illness stigma and improved attitudes toward help-seeking compared to the control group, and some of the effects were retained at 3-months. Qualitative findings captured the process mechanisms of change and differences between the two interventions that could not be captured through the quantitative measures. The authors discuss implications for mental health promotion initiatives in diverse communities and program evaluation.

• Use of ACT in Reducing Stigma and Training Mental Health Ambassadors Among Asian Men – The Toronto Site Results
Kenneth Fung, MD FRCPC MSc, University of Toronto
Rick Sin, MSW, PhD (ABD), Ryerson University
Amy Bender, RN, PhD, University of Toronto
Yogendra Shakya, PhD, Access Alliance
Sepali Guruge, RN, PhD, Ryerson University
Souraya Sidani, RN, PhD, Ryerson University
Naila Butt, MD, MPH, Amplify Change
Josephine Pui-Hing Wong, RN PhD, Ryerson University

Strength In Unity is a multi-site community-based research that engages Asian Canadian men to examine the effectiveness of Acceptance and Commitment Therapy (ACT) and Contact-Based Empowerment Education (CEE) in reducing mental health stigma and mobilizing participants as Mental Health Ambassadors. Asian men, aged 17 and older, community leaders (CL) and those living with or affected by mental illness (LWA) are randomized to receive ACT, CEE, both, or psychoeducation. Scales are administered pre-, immediate-post, 3-month, and 6-month post-intervention. Over 500 Asian men completed the intervention in Toronto. ACT and the combo groups had increased psychological flexibility. All groups had decreased stigma in the Authoritarianism Subscale, with the CEE group having reductions in other subscales. Internalized stigma was reduced in the Combo group. Over 2500 activity logs captured health promotion activities. Focus groups elucidated the psychosocial and cultural factors affecting the mental health of Asian men.

84. Psychological Flexibility Model in Severe Psychological Problems
Symposium (15:15-16:45)
Components: Literature review, Original data, Didactic presentation
Categories: Functional contextual approaches in related disciplines, Other, Psychological Flexibility Model in Chronic Severe Psychological Problems
Target Audience: Beg., Interm., Adv.
Location: Lebrija

Dr Eric Morris, La Trobe University Psychology Clinic,Melbourne, Australia
Joe Oliver, University College London

Investigations about psychological flexibility (PF) in severe psychological problems (like schizophrenia and bipolar disorder) remains as an empty field at contextual behavior science arena. What about the PF level in people who diagnosed bipolar disorder and schizophrenia? Which processes of PF differs at people who suffers from these severe psychological problems when compare with control group? Which processes of PF are more relevant with the functionality of patients? How about perception of situation in bipolar disorder group when experiencing stressful life events? Does the usage of avoidance strategies vary from people that diagnosed bipolar disorder from control group? These three study try to serves a humble contribution to all these questions.

• Investigation of psychological flexibility model in patients with schizophrenia
Alparslan Cansiz, MD, Siverek State Hospital, Sanliurfa, Turkey
K. Fatih Yavuz, MD, Istanbul Bakirkoy Research and Training Hospital for Psychiatry and Neurology,Istanbul, Turkey
Ahmet Nalbant,MD, Istanbul Bakirkoy Research and Training Hospital for Psychiatry and Neurology,Istanbul, Turkey
Merve Terzioğlu,MD, Istanbul Bakirkoy Research and Training Hospital for Psychiatry and Neurology,Istanbul, Turkey

Current research aims to provide a contribution to psychological flexibility model’s view to schizophrenia. The study, included 110 patients who had been diagnosed with schizophrenia and 110 healthy volunteers. Participants in both groups filled Sociodemographic Data Form (SDF), Cognitive Fusion Questionnaire (CFQ), Valued Living Questionnaire (VLQ), Self-as-Context Scale (SACS), Freiburg Mindfulness Inventory (FMI) and Acceptance and Action Questionnaire-II (AAQ-II), in addition, to schizophrenia group, Positive and Negative Syndrome Scale (PANSS) and Quality of Life Scale (QoLS) were applied by clinicians. In the schizophrenia group scores of AAQ-II and CFQ were higher; and SACS, FMI and VLQ were found lower. Furthermore, the PANSS positive subscale, SACS and AAQ-II scores on the schizophrenia group; PANNS negative subscale, SACS, VLQ, FMI and AAQ-II scores were found associated. The scores of the functionality of the patients are determined to be associated with SACS and VLQ points. Our findings are indicating that schizophrenia patients were more inflexible than psychologically healthy individuals.

• Response Styles And Avoidance Strategies In Manic Episode and Remission Period of Bipolar Disorder
Sevinc Ulusoy,MD, Istanbul Bakirkoy Research and Training Hospital for Psychiatry and Neurology,Istanbul, Turkey
Okan Ufuk İpek, MD, Igdir State Hospital, Igdir, Turkey
K. Fatih Yavuz, MD, Istanbul Bakirkoy Research and Training Hospital for Psychiatry and Neurology,Istanbul, Turkey

This study aims to investigate relations between stress, cognitive and emotional maladaptive processes in bipolar disorder from the psychological flexibility model perspective. The study consists of 74 participants who diagnosed Bipolar I Disorder (BD 1)-Manic Episode, 67 participants in remission period and 70 healthy controls. Sociodemographic Data Form, Leahy Emotional Schema Questionnaire (LESQ), Ruminative Thinking Style Questionnaire (RTSQ), Penn State Worry Questionnaire (PSWQ), Stress Appraisal Measure Dispositional (SAM-DF) and State Form (SAM-SF) and Acceptance and Action Questionnaire II(AAQ-II) were applied to both of the groups. Participants with BD 1, both of the remission and manic episode group, have higher scores in ‘treat’ and ‘uncontrolled’ subscales of SAM- DF/SAM-SF. ‘Lower ruminative response style and higher worry was found in manic episode group than healthy controls . Also BD 1 group has higher scores at AAQ- II than the control group. Our results indicate that BD 1 patients have lower psychological flexibility and use more avoidance strategies in the presence of difficult thoughts and emotions than psychologically healthy individuals.

• PSYCHOLOGICAL FLEXIBILITY IN BIPOLAR DISORDER
Hasan T. Karatepe, Asst.Prof., Medeniyet University, Psychiatry Department, İstanbul, Turkey
Murat Aktepe, MD, Arnavutköy State Hospital, İstanbul, Turkey
K. Fatih Yavuz, MD, Istanbul Bakirkoy Research and Training Hospital for Psychiatry and Neurology,Istanbul, Turkey

The goal of this study is to invertigate all processes of psychological flexibility in individuals with bipolar disorder. Our hypothesis is the level of psychological flexibility is less in people who diagnosed bipolar disorder than control groups. 101 euthymic participants of bipolar I disorder being treated in outpatient clinic and 100 volunteers who had no psychiatric complaints between age of 18-65 were included into the study. Cognitive Fusion Questionnaire (CFQ), Values Living Questionnaire (VLQ), Self-as-Context Scale (SACS), Freiburg Mindfulness Inventory (FMI) and Acceptance and Action Questionnaire (AAQ-2) were applied to both of the groups. It has been detected that bipolar disorder group has higher scores at AAQ-2 and CFQ with lower scores at SACS, FMI and VLQ-part II than the control group. VLQ-part I didn't show significant statistical difference between two groups. Data obtained from our research indicates that individuals with bipolar disorder are psychologically more inflexible than control group.

85. Recent Innovations in Applying Acceptance and Commitment Therapy and the Psychological Flexibility Model to Chronic Pain
Symposium (15:15-16:45)
Components: Original data,
Categories: Clinical Interventions and Interests, Behavioral medicine, ACT, Chronic Pain, Psychological Flexibility, Online Treatments, Self-as-Context, Assessment
Target Audience: Beg.
Location: Utera

Lance M. McCracken, Ph.D., King's College London
Lance M. McCracken, Ph.D., King's College London

Acceptance and Commitment Therapy (ACT) is considered an empirically supported treatment with “strong research support” for chronic pain, and there is growing evidence that improvements in facets of psychological flexibility account for improvements in chronic pain outcomes. At the same time, more research is needed to understand how to maximize the effectiveness of ACT for chronic pain, with a particular focus on mechanisms underlying treatment. To this end, the development and refinement of assessment measures of psychological flexibility is an important line of investigation. Research and treatment development is also needed to increase the accessibility of ACT for people with chronic pain. This symposium will present recent innovations in the application of ACT and the psychological flexibility model for chronic pain. In particular, the symposium will focus on recent validation studies of novel assessment measures of psychological flexibility, and data linking changes on these new measures to improved chronic pain outcomes. The symposium will also provide data supporting a novel low-intensity treatment delivery approach for increasing the accessibility of ACT for chronic pain.

• Validation of an efficient 3-item measure to assess “open, aware, and engaged” in people with chronic pain
Whitney Scott, Ph.D., King's College London
Lance M. McCracken, Ph.D., King's College London

The originally proposed six facets of the psychological flexibility model have more recently been described in terms of behaviour that is “open, aware, and engaged”. This condensed three-part process has the advantage of being easy to communicate to patients and potentially efficient to track in the course of treatment delivery. Therefore, we sought to validate a brief, three item assessment measure with one item each reflecting qualities of open, aware, and engaged behaviour. This three item measure was completed by 250 patients with chronic pain receiving ACT-based treatment provided by a multidisciplinary group of clinicians. This measure was completed before and after treatment, along with full-length process measures of acceptance, cognitive defusion, and committed action, and outcome measures of pain-related disability and depression symptoms. This presentation will discuss data regarding the reliability, validity, and predictive utility of the three item “open, aware, and engaged” measure with respect to the full-length process measures.

• Change in “Self-as-Context” (“Perspective-taking”) Occurs in Acceptance and Commitment Therapy for People with Chronic Pain and is Associated with Improved Functioning
Lin Yu, King’s College London
Dr. Sam Norton, King's College London
Prof. Lance M. McCracken, King's College London

Research on the psychological flexibility (PF) model in the context of chronic pain has largely neglected the process of self-as-context, until recently. This study investigates whether ACT is associated with an effect on self-as-context (SAC) and whether this effect is linked to treatment outcomes in people with chronic pain. Participants included 412 adult patients with chronic pain. Participants completed measures of treatment processes (SAC, pain acceptance) and outcomes (pain-related interference, work and social adjustment, depression) before treatment, post-treatment, and at nine-month follow-up. Results from paired sample t-tests suggested participants significantly improved on all process and outcome variables at post-treatment (d=.38 to .98) and nine-month follow-up (d=.24 to .75). 42.0% to 67.5% participants showed meaningful improvements on each outcome at post-treatment and follow-up. Regression analyses with residualized change scores from process and outcome variables, and bivariate growth curve modeling suggested that change in SAC was associated with change in outcomes (β=-.21 to -.31; r=-.16 to -.46). Results support a role for change in SAC in treatment as the PF model suggests.

• ACT Psychological Flexibility Processes and Traditional CBT Variables Involved in a Mixed Self-Help/Online Treatment for Chronic Pain
Marie-Eve Martel, M.A., Psy.D.(c), Université du Québec à Trois-Rivières
Whitney Scott, Ph.D., King's College London
Frédérick Dionne, Ph.D., Université du Québec à Trois-Rivières
Josée Veillette, Psy.D.(c), Université du Québec à Trois-Rivières
Joseph Chilcot, Ph.D., King's College London
Lance M. McCracken, Ph.D., King's College London

Acceptance and Commitment Therapy (ACT; Hayes et al., 2012) is considered an empirically supported treatment with “strong research support” for chronic pain (APA, 2013), but accessibility of this type of treatment remains an important challenge. Therefore, self-help books or internet-delivered versions of ACT for chronic pain are promising because they offer a potentially cost-effective treatment option that requires little support from a therapist, and can be widely accessible. This presentation will discuss data from a randomized control trial using a mixed self-help/online treatment for chronic pain compared to a waitlist control. The study was conducted in Quebec (Canada) and the sample consists of 130 French-speaking individuals recruited from the community with various types of chronic pain. The treatment was given over a period of eight weeks and included minimal therapist contact. In addition to measures of distress and disability, psychological flexibility processes and traditional CBT variables such as pain self-efficacy and kinesiophobia were assessed at pre-treatment and post-treatment for both groups, and at a twelve-week follow-up for the group receiving the treatment. Treatment outcome data will be presented, along with the results of mediation analyses to determine the relative contribution of changes in psychological flexibility and traditional CBT processes to changes in treatment outcomes.

86. ACT and Mindfulness-Based Interventions for Youth
Symposium (15:15-16:45)
Components: Original data, Experiential exercises, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Performance-enhancing interventions, Educational settings, Relational Frame Theory, Other, Children, Adolescents, OCD, RFT, Educational settings
Target Audience: Beg., Interm.
Location: Estepa

Lisa W. Coyne, Ph.D., McLean Hospital/ Harvard Medical School
Louise Hayes, Ph.D., University of Melbourne

Acceptance and Commitment Therapy (ACT) and mindfulness-based approaches with adults have received great research and clinical interest in recent years. Evidence suggesting that these approaches are effective in promoting psychological health and well-being has been expanding. As such, these approaches have started to be applied for children and youth with beneficial results, however this research is still in an embryonic state. This symposium will explore the adaptation and application of ACT and mindfulness-based interventions and processes in children and adolescents in different settings. Topics examined will include the use of ACT, mindfulness, and values to enhance exposures for adolescents with OCD, helping young children to tact their private experiences, and the use of a two-session ACT workshop for cultivating emotional health in elementary school children.

• A Case Study Exploring ACT and Mindfulness Interventions for a 16-Year Old Latino Male with Severe OCD
Carlos E. Rivera, M.S., Suffolk University; Child & Adolescent OCD Institute at McLean Hospital/ Harvard Medical School
Maria G. Fraire, Ph.D., McLean Hospital/ Harvard Medical School
Lisa W. Coyne, Ph.D., Child & Adolescent OCD Institute at McLean Hospital/ Harvard Medical School

While exposure and response prevention (ERP) is considered the gold standard behavioral intervention for obsessive-compulsive disorder (OCD), a number barriers limit ERP’s efficacy including drop-out rates of 25% (Abramowitz et al., 2009) and treatment refusal. Existing research on acceptance and commitment therapy (ACT) and other acceptance- and mindfulness-based interventions for OCD suggests these interventions are effective in treatment progress and outcome, and may facilitate ERP. The aim of the present case study is to explore an adolescent’s experience with severe OCD while receiving acceptance- and mindfulness-based treatment at an inpatient residential unit for youth with OCD. We will discuss how mindfulness, acceptance, and values could facilitate the use of ERP, the youth’s personal direct report of his experiences with acceptance and mindfulness, previous interventions, symptom remission, and treatment maintenance plan.

• Teaching Children and Adolescents to Tact and Discriminate with ACT for Better Emotion Regulation and Valued Behaviour
Timothy Gordon, MSW, RSW, The Zen Social Worker, Independent Practice

ACT has been demonstrated to work in clinical settings with children (Swain, Hancock, Dixon, Bowman, 2015) and adolescents (Hayes & Sewell, 2011) however little has been demonstrated in ACT’s clinical literature to assist young client populations with deficits in their ability to tact to private experiences, specifically to identify painful private stimulus events such as thoughts, feelings, sensations, and memories. The current case study presents original data and case examples of young client populations practicing an adaptation of McHugh, Bobarnac, Reed’s (2011) teaching situation-based emotions to improve their ability to tact to painful private experiences. Discussion will include producing improvements for working with difficult emotions in clinical settings with young populations, examples of techniques and specifics methods will be demonstrated, methodological caveats, and further research implications for research will also be discussed.

• ACTmind: A mindfulness and Acceptance and Commitment Therapy program for cultivating emotional health in elementary school children
Maria Karekla, Ph.D., University of Cyprus
Anthoula Papageorgiou, B.A., University of Cyprus

The purpose of the present study was to examine the feasibility, acceptability and preliminary effectiveness of a mindfulness and ACT two-session workshop for cultivating emotional health in elementary school children. Sessions comprised of teaching mindfulness and present moment awareness skills, acceptance of all internal experiences, and how to act based on what is important for them even in the presence of fearful thoughts and emotions via the use of experiential exercises and metaphors. Results suggest that the program is feasible and well accepted by elementary school children. Students’ avoidance and unwillingness to experience scary and worrisome thoughts decreased from pre to post during session one and overall from session one to two, suggesting that learning occurred and students started to become more open to experiencing negative thoughts. It was also indicated that students found the program to be very helpful and that they would participate in such a program again in the future.

Saturday, 24 June

97. Self-Compassion and Compassion in Clinical Intervention: Testing New Models, Processes, and Methods
Symposium (11:00-12:30)
Components: Original data
Categories: Clinical Interventions and Interests, Other, Compassion
Target Audience: Beg., Interm.
Location: Nervión Arenal I

Jason Luoma, Ph.D., Portland Psychotherapy Clinic, Research, & Training Center
Paul Gilbert, Ph.D., University of Derby

This symposium brings together three data-based presentation relating to data on compassion and self-compassion in clinical contexts. The first paper presents data from two studies examining the relationships between self-compassion and psychological flexibility measures, with an aim to clarify the conceptualization of and operationalization of these related constructs. The second paper presents data from two studies involving a very brief intervention involving participants practicing the Compassionate Self meditation, using an online audio guided exercise. The first study examines the effect of cognitive restructuring as opposed to Compassionate Self imagery in affecting dehumanized perceptions and avoidance of images of homelessness under experimental conditions. The second study examines the effect of a brief Compassionate Self intervention on body shame and anxiety among a sample of undergraduate students. The third paper presents pilot data on a novel group intervention for highly self-critical and shame prone people that focuses on using perspective taking interventions to help participants develop greater self-compassion and a sense of belongingness.

• A closer look at The Compassionate Self imagery meditation: initial research validating the utility of a foundational CFT component
Dennis Tirch, Ph.D., The Center for Compassion Focused Therapy

Every mental health intervention and contemplative tradition that targets the training of mindful compassion uses imagery exercises to evoke an experience of our compassionate minds. CFT, The Mindful Self Compassion Program, and Compassion Focused ACT all deploy functionally similar meditations and imaginal exercises as a part of their interventions. Foundational to CFT, The Compassionate Self Imagery meditation is a brief and frequently used practice that guides a person through a process of experiencing themselves as a compassionate being. Previous outcome research has demonstrated the effectiveness of interventions using this imagery practice. This presentation looks at two studies involving a very brief intervention involving participants practicing the Compassionate Self meditation, using an online audio guided exercise. The first study examines the effect of cognitive restructuring as opposed to Compassionate Self imagery in affecting dehumanized perceptions and avoidance of images of homelessness under experimental conditions. The second study examines the effect of a brief Compassionate Self intervention on body shame and anxiety among a sample of undergraduate students. These studies will be compared to an earlier study using a very similar intervention to address body shaming in a clinical population. Potential applications of this imagery practice, including clinical implications, possible counter-indications, and limitations will be discussed.

• Psychological flexibility and self-compassion: two processes or two conceptualizations?
Stanislaw Malicki, Akershus University Hospital

There is robust evidence of the impact of both self-compassion and experiential avoidance on mental health. Research has also shown strong correlation between measures of both transdiagnostic processes. However, the question of how they are interrelated needs further investigation, as it may bear significant clinical implications. Both constructs were proposed and operationalized within various scientific traditions and paradigms. Thus, instead of translating one in terms of another, the paper approaches the question of their interrelationship by presenting a set of correlational data and statistical analyses linking them to variables that may be used in building cross-theoretical models. The first, completed study, investigates interrelations between self-compassion, experiential avoidance, adult attachment and early childhood experiences. The second, still running study investigates the link between self-compassion, different measures of experiential avoidance, self-criticism, social safeness and measures of anxiety and depression. As the second study is to be completed by the end of 2017, the paper presents partial data.

• Big Heart, Open Wide: Overview and Pilot Data on a Novel Group Therapy for People who are Highly Self-Critical and Shame Prone
Jason Luoma, Ph.D., Portland Psychotherapy Clinic, Research, & Training Center
Jenna LeJeune, Ph.D., Portland Psychotherapy Clinic, Research, & Training Center
Melissa Platt, Ph.D., Private Practice

Self-criticism and shame are transdiagnostic factors that contribute to a variety of psychological problems. As an extremely social species, humans function best when having they have a sense of belonging. Shame threatens this sense of belonging, especially when chronic and repeated. Thus, the central target of the 9-session group treatment is decreasing the sense of isolation and other-ness associated with chronic shame and self-criticism. The intervention is guided primarily by insights from affective science and contextual behavioral science, particularly work on flexible perspective taking. We will provide an overview of the treatment approach and present pilot data from pre-treatment, post-treatment, and one-month follow up for the initial cohort of participants (n=8). Initial data show comparable effect sizes to other treatments targeting this population and preliminary support for the idea that belongingness and a sense of “common humanity” are important mechanisms of action.

100. Understanding the Effects of Psychological Flexibility and Improving ACT Specific Skills Using Smartphone Technologies
Symposium (11:00-12:30)
Components: Original data
Categories: Clinical Interventions and Interests, Clinical Interventions and Interests, Performance-enhancing interventions, Depression, Social Phobia, Smartphones, Ecological Momentary Assessment, Coaching, Patients, College Students, RCT
Target Audience: Beg., Interm.
Location: Buhaira

Charles Benoy, MSc, Psychiatric Hospital of the University of Basel, Switzerland
Andrew T. Gloster, Prof. Dr., University of Basel, Department of Psychology, Division of Clinical Psychology and Intervention Science, Basel, Switzerland

Smartphone technologies represent an essential part of our daily life and their importance is increasing each year. By 2020 the number of smartphone users worldwide is predicted to have roughly doubled compared to 2014 . Smartphones allow new ways of analyzing psychological processes, including ACT specific aspects. In this symposium, three papers will be presented that use smartphones in clinical and analogue research. The first two focus on how Ecological Momentary Assessment (EMA) can be implemented in a clinical sample. The first paper thus examines the association between different types of social interactions and psychological flexibility, while the second paper explores how memory of events is associated with psychological flexibility. The third paper focuses on how skills can be delivered via smartphone, and provides input on future app development and face-to-face therapy by examining which ACT skills are most effective in-the-moment based on individual and contextual variables.

• “I’d like to see you – except when I don’t”: Types of Social Interaction and Psychological Flexibility – Preliminary Results
Jeanette Villanueva, MSc, University of Basel, Department of Psychology, Division of Clinical Psychology and Intervention Science, Basel, Switzerland
Andrea H. Meyer, PhD, Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
Thorsten Mikoteit, Dr. med., University of Basel, Psychiatric Hospital, Centre for Affective, Stress and Sleep Disorders, Basel, Switzerland
Jürgen Hoyer, Prof. Dr., Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
Martin Hatzinger, Prof. Dr. med., Psychiatric Services Solothurn and University of Basel, Switzerland
Roselind Lieb, Prof. Dr., University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology, Basel, Switzerland
Andrew T. Gloster, Prof. Dr., University of Basel, Department of Psychology, Division of Clinical Psychology and Intervention Science, Basel, Switzerland

Social interactions (SIs) are an integral part of human beings. Nevertheless, for some people, SIs cause discomfort and fear. As a result, some people avoid interactions or choose interactions perceived as less threatening (for example, those that do not involve face-to-face interactions). In this study participants’ choice of interaction type (face-to-face, phone, Internet/chat or other) and whether psychological flexibility (PF) facilitates such choices, is examined. This study investigated 284 individuals (Major Depressive Disorder, Social Phobia, Controls) via smartphones in an Ecological Momentary Assessment (EMA) for one week. We captured 5616 social interactions in participants’ naturally selected environments. Preliminary results indicate that the probability of choosing face-to-face and phone interactions differ with the level of PF. Given that PF is relatively low in many forms of psychopathology, models will further examine differences across groups with a diagnosis of Major Depression Disorder or Social Anxiety Disorder, in comparison to healthy controls.

• Remember, remember: Evaluating the Memory-Experience Gap for Psychological Flexibility using Ecological Momentary Assessment — Preliminary Results
Marcia T. B. Rinner, MSc, University of Basel, Department of Psychology, Division of Clinical Psychology and Intervention Science, Basel, Switzerland
Andrea H. Meyer, PhD, Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
Thorsten Mikoteit, Dr. med., University of Basel, Psychiatric Hospital, Centre for Affective, Stress and Sleep Disorders, Basel, Switzerland
Jürgen Hoyer, Prof. Dr., Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
Martin Hatzinger, Prof. Dr. med., Psychiatric Services Solothurn and University of Basel, Switzerland
Roselind Lieb, Prof. Dr., Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
Andrew T. Gloster, Prof. Dr., University of Basel, Department of Psychology, Division of Clinical Psychology and Intervention Science, Basel, Switzerland

People have difficulty accurately recalling their experiences – a phenomenon referred to as the Memory-Experience Gap (MeG). Nevertheless, clinical assessments overwhelmingly rely on retrospective recall. The aim of this paper is to investigate the effect of psychological flexibility (PF) on the MeG. Ecological Momentary Assessment (EMA) collects data in participants’ own chosen environment close to the time of experiences of interest. Thus, EMA as administered by smartphones, is considered the method of choice to examine the MeG. Data stem from 118 patients with Major Depression, 47 patients with Social Phobia and 119 healthy controls. We compared >10,000 EMA assessments to retrospectively recalled PF levels from the previous week. Preliminary results showed that participants inaccurately recall their level of PF. These data contribute to the understanding of the relation between PF and the MeG, and underline the importance of the MeG to understand research using retrospective recall of PF.

• Evaluating methods for teaching psychological skills through smartphones: A randomized control trial of the revised ACT Daily mobile app
Jack Haeger, M.S., Utah State University, Logan, Utah
Michael Levin, Ph.D., Utah State University, Logan, Utah
Benjamin Pierce, M.S., Utah State University, Logan, Utah

Mobile apps 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 skills based on clients’ responses. ACT Daily integrates these strengths with an ecological momentary intervention approach that prompts users to check-in with distress levels and ACT processes, followed by a recommended ACT skill tailored to check-in data. Pilot studies displayed improvements on depression/anxiety symptoms, ACT processes, and effective skill use in-the-moment. This study extends this research with a RCT design, applying an updated version of ACT Daily within an undergraduate sample across three conditions: assessment-only, random-skills, and tailored-skills. Results will be presented regarding app efficacy, methodology, and conditions leading to effective use of specific skills. Findings may inform app development and face-to-face therapy by examining which ACT skills are most effective in-the-moment based on individual and contextual variables.

102. Developing and Adapting ACT for Group Work: Lessons from the Inpatient Ward, and the Community
Symposium (11:00-12:30)
Components: Original data, Experiential exercises, Didactic presentation
Categories: Clinical Interventions and Interests, Other, Psychosis, Extreme states, Inpatient, Community Mental Health, Compassion, University Clinic
Target Audience: Beg., Interm., Adv.
Location: Lebrija

Angus Maxwell, Waitemata District Health Board, Auckland New Zealand
Eric Morris, La Trobe University

Group ACT provides opportunities to learn from others’ experiences, act out metaphors and exercises, and provide a small community context for developing psychological flexibility. In this symposium teams from three countries will present on their development and implementation of ACT groups for inpatient and community mental health settings. Participants in these groups have had experience of psychosis and/or extreme psychological distress. The symposium will offer an opportunity to understand the nature of working with this population, the challenges of setting up such groups and the differing formats they can take. The presenters will cover structure, content and outcomes from their groups. Initial outcome data, qualitative feedback and experiences from individual cases will be described.

• ACT in acute settings: using multidisciplinary Group work
Joris Corthouts, Psychiatric Hospital Sint Hiëronymus, Sint Niklaas, Belgium

In 2010 PC St Hiëronymus chose to implement ACT (together with recovery) as the main therapeutic approach for working with psychosis at an in-patient ward. Next to individual work, open and closed group-sessions are delivered by a multidisciplinary team. Different group-formats of delivering ACT have been developed since the start. This part of the symposium will focus on the methodology that was used for integrating ACT in a multidisciplinary team and how the group-formats got their current practice. As an example there will be summary of a client’s progress highlighting the different aspects of treatment.

• The Recovery ACT: evaluation of a group program for people with psychosis in the community
Eric Morris, La Trobe University, Melbourne, Australia
Jesse Gates, NorthWest Mental Health, Melbourne Australia
Jacinta Clemente, NorthWest Mental Health, Melbourne Australia
Eliot Goldstone, NorthWest Mental Health, Melbourne Australia
Alana Cross, NorthWest Mental Health, Melbourne Australia
John Farhall, NorthWest Mental Health, Melbourne Australia

The Recovery ACT is an 8-session group program for people with psychosis adapted from the UK to an Australia outpatient community team context. The group focuses on developing key ACT processes of mindfulness, willingness and valued action through the use of experiential exercises, with ‘Passengers on the Bus’ used as a central metaphor. We have completed three rounds of groups across three community teams, with 5 to 12 participants in each group. We evaluated the feasibility, acceptability and core ACT processes using a pre-post mixed methods group design. Questionnaires included a qualitative examination of participant’s experience, and quantitative measures of acceptance/action, values, cognitive fusion, mindfulness, recovery, and clinical and symptom changes. Participants reported the groups have been helpful at normalising experiences, developing valued action and increasing understanding of individual experience. Initial data indicates participants experienced positive changes in values/action, clinical outcomes and process of recovery.

• ACT for recovery – An Acceptance and Commitment Therapy Group for community mental health clients
Angus Maxwell, Waitemata District Health Board, Auckland, New Zealand
Nic Hughes, Waitemata District Health Board, Auckland, New Zealand
Claire Turner, University of Auckland

Development of an open two hour Acceptance and Commitment Therapy Group in a community mental health setting. The 12 week group is divided into three, four week modules. Each module has a different focus; the first being a general ACT model, the second with a focus on psychotic phenomena experiences, and the third integrating self-compassion . The group is both experiential and didactic in nature. There are up to twelve participants and three facilitators; one of whom is an experienced based expert and graduate of earlier groups, adding an important element of service user perspective and bringing validity to the process. The group utilises pre and post measures including the CORE-34, the CORE-10, the AAQ-II and the FSCRS. Qualitative feedback is also collected from group participants and from clinicians whose clients access the group.

103. Using the IRAP to Explore Emotions and Deictics
Symposium (11:00-12:30)
Components: Didactic presentation
Categories: Relational Frame Theory, Clinical Interventions and Interests, Theoretical and philosophical foundations, Relational Frame Theory, Other, IRAP, Perspective-taking, Emotions
Target Audience: Beg., Interm., Adv.
Location: Utera

Louise McHugh, University College Dublin

This tightly-packed 4-paper symposium explores various ways in which the IRAP can be used to study emotions (Papers 1 and 2) and self (Papers 3 and 4). Paper 1 uses the IRAP to explore the transformation of emotional functions, following a multiple exemplar training procedure, and highlights concordance of effects on the two procedures. Paper 2 is also concerned with studying emotions using the IRAP. A large sample of participants are presented with an IRAP involving male and female faces with 6 standard emotions. Comparing the IRAP with the explicit measure highlights a lower emotional threshold and no differences between males and females. Paper 3 is among the first to use the IRAP to study the self as deictic relational responding, and is particularly novel in incorporating all three types of deictic relations. The results highlight the IRAP’s ability to target these relations successfully, and concord with existing distinctions in terms of levels of relational complexity. Paper 4 again tests the utility of the IRAP as a measure of interpersonal deictic relations and attempts to replicate the only published study in this area. In a novel development, Paper 4 separates I and YOU into two IRAPs, presented in a natural language format. The differential performances in the two IRAPs supports the view that participants respond differently to I than YOU.

• An RFT analysis of deictic relational responding 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 appears to be a key process in the development of “self”. Under the rubric of Relational Frame Theory (RFT), researchers have investigated the role of deictic relational responding in the analysis of self in relation to others, place, and time, primarily through the use of an extended developmental protocol (Barnes-Holmes, 2001). In a move towards extending methodologies for studying deictic relational responding, Study 1 here employed the Implicit Relational Assessment Procedure (IRAP) to measure deictic flexibility regarding I versus OTHER. In short, participants were required to coordinate their own physical characteristics with I (i.e., I-I), and the physical characteristics of others with OTHER (Other-Other). The results showed strong, significant effects on both the I-I and Other-other trial-types, suggesting inflexible deictic relational responding. However, responding on the other trial-types (I-Other and Other-I) showed some flexibility in responding. Nonetheless, it could be argued that these IRAP trial-types did not require participants to actually take the perspective of another. In Study 2, we presented two Natural Language IRAPs (one that was I-focused and one that was Others-focused) that required participants to respond to both positive and negative statements about themselves and others. Initial data from this study suggests that this methodology is moving us a step closer toward the development of an IRAP that requires an individual to respond on the basis of the perspective of another. Hence, we are beginning to move towards a more precise analysis of the role of deictic relational responding in perspective-taking.

• Perspective-Taking through the IRAP.
Juan C. López, Ph.D., Universidad de Almería
Adrián Barbero-Rubio, Universidad de Almería & MICPSY
Carmen Luciano, Universidad de Almería & MICPSY
Zaida Callejón, Universidad de Almería

The current study aimed to advance into the analysis of relational flexibility through an innovative IRAP application to measure perspective-taking (PT) framing. For this, undergraduate students (N = 50) completed several explicit measures such as a self-reported questionnaire (IRI) and a behavioural task (DRT), which were included to explore the validity of the IRAP to measure the relational framing involved in PT. Subsequently, the participants were asked to complete a PT-IRAP, which included not only interpersonal deictic (I-You) or spatial (here-there) as previously done (Barbero et al., 2015) but temporal (then-now) framings. The findings showed that the DIRAP trial-types were a precise indicator of relational flexibility in PT. In addition, the analysis pointed out to the differential relational complexity per type of deictic involved: interpersonal, spatial or temporal; being the latter those in which higher latency were obtained. These data are in line with previous attempting to create a PT-IRAP and might be a cutting point moving forward a more precise analysis of perspective-taking.

• Woman and man face to face: implicit recognition of varying threshold of facial emotions
Annalisa Oppo, SFU, Milano (ITALY)
Valeria Squatrito, Kore, Enna (ITALY)
Enrica Basile, Kore, Enna (ITALY)
Giovambattista Presti, Kore, Enna (ITALY)

In a social context, having a successful social interaction may be due to recognition of a particular stimulus as an “emotional stimuli” and, maybe, emotional facial expressions are the most salient stimuli. Literature mainly focused on recognition of facial expressions used only intense exemplars and the role of soft expression remain unclear at the explicit level and mainly unstudied at the implicit level. The aim of this study was to assess an “emotional threshold” both at explicit and implicit level, using implicit relational assessment procedure (IRAP) for the latter one. One hundred and thirty six participants were enrolled in this study, and 104 (76.5%) participants achieved established criteria for accuracy. Assessment included explicit measures that evaluated self-compassion skills and depressive symptoms. A standardized set of graded, from full expression to neutral, emotional faces adapted by Gao & Maurer, D. (2009) were used. Specifically, photographs of one female model and one male model showing intense facial expressions of the six basic emotions (happiness, sadness, fear, anger, disgust, and surprise) and photographs of one female model and one male model showing graded facial expression (25%). Results showed that the “emotional threshold” is higher at the explicit level than at the implicit level (IRAP d-score for 25% trial type= 0.27; p<.001). Furthermore the threshold is similar for man and women and it is unrelated to the model (male or female).

• Transformation of emotional functions in comparison relations evaluated by Likert scales and IRAP.
João Henrique de Almeida, Universidade Federal de São Carlos
William Ferreira Perez, Paradigma centro de ciências do comportamento
Júlio César de Rose, Universidade Federal de São Carlos

Transformation of emotional functions have been considered, by some researchers, difficult to be observed in abstract stimuli with no topographical characteristic that facilitate this process (e.g. it was observed for head silhouettes but not for meaningless words or pictures). The present experiment employed a complex multiple exemplar training containing a variety of comparison relations among stimuli (non-arbitrary: size and amount; and arbitrary: numbers and words) for teaching undergraduates two contextual cues of comparison. Later, eleven undergraduates were trained to establish comparison relations between meaningless stimuli (grey spheres with nonsense words labels). One of this spheres were paired to faces expressing happiness. The transformation of functions to derived stimuli was evaluated by explicit (Likert) and implicit measures (IRAP). Nine of the eleven participants transformed the emotional function and responded in the Likert scales consistently with the relational training. A T-test show that D-IRAP scores had statistically significant negative effects for sphere A (“smallest”) related to “more happy” and for statistically significant effect for sphere D (“biggest”) related to “more happy”, both consistent with the training realized. These results permit to infer that many difficulties reported in the literature could be due the characteristics of the multiple exemplar training realized. A multiple exemplar training that presents a huge variety of stimuli with different properties may enable the adequate transformation of functions.

104. The Measure(s) of Our Commitment to Science: A Review of How Contextual Scientists Measure Behavior
Symposium (11:00-12:30)
Components: Conceptual analysis, Literature review, Original data
Categories: Theoretical and philosophical foundations, Performance-enhancing interventions, Measurement
Target Audience: Beg., Interm., Adv.
Location: Estepa

Kendra Newsome, Fit Learning
Ian Stewart, National University of Ireland Galway

Both the basic and applied wings of contextual behavior science share an interest in the prediction and influence of human behavior as it occurs in the natural environment. They also share a strong conceptual adherence to the tenants of natural science, with carefully vetted investigative and explanatory constructs. A review of the Journal of Contextual Behavior Science, however, reveals a division between how the basic and applied domains measure behavior, as well as the conspicuous shortage of analyses of ‘free-operant’ behavior. In this symposium we will review the tenants of a natural science and discuss their implications for how we ought to measure free-operant behavior. Additionally, we will demonstrate how adherence to natural science measures can provide a common analytic lens across both basic and applied domains. A common way of measuring our subject matter affords a more coherent and comprehensive science of behavior, better able to achieve our shared analytic goals.

• The “Stuff” of Science: What being committed to science means for science itself.
Timothy C. Fuller, University of Nevada, Reno
Donny Newsome, Fit Learning
Kendra Newsome, Fit Learning

A commitment to science requires that we declare what science we want to be committed to. Science, as an enterprise, sets out to provide a context from which its workers can produce statements about what is observed. Contextual behavior science (CBS) has done a laudable job outlining the values its workers need to bring to their scientific work, but what about science itself? If we want to commit to a thing called science, it is useful then to consider several basic tenets of science and thereby establish a foundation from which we can evaluate the behaviors of CBS workers. This presentation sets out to review what we think the basic tenets of a natural science are, where they have come from, and the implications these tenets have on the analytic activities of CBS scientists.

• A commitment to science means zero percent correct.
Donny Newsome, Fit Learning
Kendra Newsome, Fit Learning
Timothy C. Fuller, University of Nevada, Reno

The focus of this presentation will be a review of measurement practices in the Journal of Contextual Behavior Science as they pertain to both free and discrete operant paradigms. In the context of that analysis, we will discuss the merits of various measurement tactics relative to the standards of a thoroughgoing natural science of behavior. Specifically, we will orient to the problems with non-dimensional measures of behavior (percent correct) and self-report (surveys, questionnaires) and advocate for an increasing focus on free-operant behavior and the natural dimensions thereof (count, rate, latency, duration, magnitude, etc.).

• How contextual behavior science ‘measures up’ to the natural sciences.
Kendra Newsome, Fit Learning
Donny Newsome, Fit Learning
Timothy C. Fuller, University of Nevada, Reno

The solving of applied problems does not require new measures. Skinner put forth the use of rate of response as his biggest contribution to behavior science. This orientation to measuring our subject matter yielded a science of behavior aligned with other natural sciences. The closer our measures are to our subject matter of interest, the better we are positioned for discoveries that can readily traverse the basic and applied domains. This presentation will discuss the continuity afforded when natural sciences employ the approach to measurement across all areas of scientific activity. This alignment, present in other natural sciences, allows for basic research to directly inform applied research and for applied research to directly inform clinical practice.

111. New Directions in Learning Research
Symposium (12:45-14:00)
Components: Conceptual analysis, Literature review, Original data
Categories: Theoretical and philosophical foundations, Performance-enhancing interventions, Theoretical and philosophical foundations, Relational Frame Theory, Learning
Target Audience: Interm.
Location: Nervión Arenal I

Jan De Houwer, Ghent University
Jan De Houwer, jan.dehouwer@ugent.be

Learning research focusses on ways in which organisms adapt to their environment during their lifetime. It thus provides a cornerstone for any science of behavior, including contextual behavioral science. Moreover, Relational Frame Theory (RFT) not only has its origins in learning research but also has important implications for learning research. In this symposium, we explore new directions in learning research that were inspired by RFT. Hayes reminds us that RFT provides a radical new perspective on traditional forms of learning such as operant conditioning and provides new evidence from applied work that supports this view. In line with RFT's emphasis on relational processes, Hussey and Stewart present new evidence on relational learning, more specifically behavior change that results from relations between relations. During the discussion, De Houwer analyzes the conceptual implications of this work, including the way it relates to learning research in general.

• Is Derived Relational Responding Learned?
Steven C. Hayes, University of Nevada
Mark Dixon, PEAK
Jordan Belisle
Anne Blevins

The core conception of Relational Frame Theory is that derived relational responding is itself learned, and that once learned it in turn alters much more ancient learning processes. This talk will outline available evidence on these points, and will present new data using the PEAK curriculum showing that direct training of traditional verbal operants (PEAK-DT) and their generalization (PEAK-G) does not increase derived relational responding, but that application of the PEAK module for equivalence (PEAK-E), does do so. These results provide additional support for view that derived relational responding is acquired as an operant.The implications of this idea for behavioral and cognitive accounts of language and cognition will be briefly explored.

• The Implicit Association Test as an analogical learning task
Ian Hussey, Ghent University
Jan De Houwer, Ghent University

The Implicit Association Test (IAT) is a popular tool for measuring attitudes. We suggest that performing an IAT could, however, also change attitudes via analogical learning. For instance, when performing an IAT in which participants categorize (previously unknown) Chinese characters, flowers, positive words, and negative words, participants could infer that Chinese characters relate to flowers as negative words relate to positive words. This analogy would imply that Chinese characters are opposite to flowers in terms of valence and thus that they are negative. Results confirmed that learning via analogy can take place when performing an IAT. We discuss the implications of our findings for research on analogy and research on the IAT as a measure of attitudes.

• Empirical advances in studying relational networks
Shane McLoughlin, University of Chichester
Ian Stewart, National University of Ireland Galway

The relating of relations is a key feature of the development of complex relational networks. Despite this, thus far there has been little empirical study of this phenomenon, outside of analogy. The latter, which involves coordination of relational networks, is indeed an important example of the relating of relations but there are other examples that can also be involved in complex relational framing. Experiment 1 extended previous research by exploring non-coordinate relating of relations in adult participants. First, Crel functions of YES, NO, SAME, DIFFERENT, and OPPOSITE were established in arbitrary stimuli using a multi-stage Relational Evaluation Procedure (REP). Then participants were tested for the evaluation of various forms of relating of relations including deriving coordination, distinction and opposition relations between relations. Three out of four participants showed predicted patterns of behavior. In Experiment 2, these same three participants showed transformation of contextual control functions via the relation of relational networks. Implications and future research directions are discussed.

112. Experimental and Clinical Analyses of Rumination and Repetitive Negative Thinking
Symposium (12:45-14:00)
Components: Conceptual analysis, Original data
Categories: Relational Frame Theory, Clinical Interventions and Interests, ACT, Emotional disorders
Target Audience: Beg., Interm., Adv.
Location: Buhaira

Ángel Alonso, Madrid Institute of Contextual Psychology
Carmen Luciano, Universidad de Almería

The current symposium presents RFT and ACT research on rumination and repetitive negative thinking (RNT). The first study investigates mood-congruent memory as one of the relational processes involved in rumination. The study aimed to explore the extent in which negative-mood induction produces mood-congruent bias for stimuli with aversive rather than appetitive functions during a free recall task. The second study analyzed the relations between thoughts that trigger rumination by conducting an analog study involving rumination induction procedures. Furthermore, the study also analyzed the effect of defusion protocols involving different degrees of hierarchical framing in the context of rumination. Lastly, the third study presents a summary of three clinical studies with brief and preliminary RNT-focused ACT protocols applied to emotional disorders. In conclusion, this symposium is a good representation of the reticular model of scientific research supported by contextual behavioral science.

• A Relational Frame Theory Account of Mood-Congruent Memory
L. Jorge Ruiz-Sánchez, Universidad de Almería
Carmen Luciano, Universidad de Almería

Mood-Congruent Memory refers to when people’s memories match how they feel, such that when they are in a negative mood, they have more unpleasant than pleasant memories. We aimed to explore the extent in which negative-mood induction produces mood-congruent bias for stimuli with aversive rather than appetitive functions during a free recall task. Three 6-member equivalence classes were established under contextual control using pseudo-words. A1 and B1 were trained to participate in an equivalence class with C1, D1, E1 and F1 (Class 1) in one context (Context 1), and with C2, D2, E2 and F2 (Class 2) in another context (Context 2). A third class (A3-F3) was established in both contexts. B1 and C1 were conditioned negatively using shocks in Context 1 while B1 and C2 were positively conditioned using earning points in Context 2. Finally, participants were asked to recall the pseudo-words related to B1 in a new context (Context 3) after the implementation of neutral and negative-mood induction protocols.

• The hierarchical organization of triggers for rumination
Bárbara Gil-Luciano, Madrid Institute of Contextual Psychology
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz

Problematic rumination and worry are common denominators to many psychological disorders. These strategies are based on going around private events that seem to be organized at different levels as might be a hierarchical organization. The present study is exploring this with two ruminative induction protocols and its impact of ulterior intervention protocols. Forty participants were recruited in a Spanish University and randomly distributed in two conditions. All them went to phase 1: pre-test measures (questionnaires and in-live task). All them were evaluated in regard to discomfort and strength of own thoughts and emotions. Then, in phase 2, part of the participants went to one of two ruminative induction protocols. In phase 3, post-test measures were taken. Phase 4 consisted in all of them receiving a protocol in order to establish a hierarchical relation with their own's emotions and thoughts. Finally, all them went to phase 5 for additional post-test II measures. Results are discussed in terms of the relations involved in trigger for worry and rumination and the effect of the protocols to disrupt them.

• Effect of RNT-focused ACT protocols for emotional disorders.
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Cindy L. Flórez, Fundación Universitaria Konrad Lorenz
María B. García-Martín, Fundación Universitaria Konrad Lorenz
Diana García-Beltrán, Fundación Universitaria Konrad Lorenz
Andrea Monroy-Cifuentes, Fundación Universitaria Konrad Lorenz
Diana Riaño-Hernández, Fundación Universitaria Konrad Lorenz
Marco A. Sierra, Fundación Universitaria Konrad Lorenz

This paper summarizes the results obtained in several studies that tested the effect of brief protocols of ACT focused on reducing repetitive negative thinking (RNT) in the form of worry and rumination. All studies were preliminary and used single-case experimental designs. In the first study, the effect of a 2-session RNT-focused ACT protocol was implemented in 10 participants with moderate to severe emotional symptoms. In the second study, a 3-session protocol was applied with 6 individuals showing comorbid and severe levels of depression and generalized anxiety disorder (GAD). Lastly, in the third study, the same 3-session protocol was applied to 3 individuals showing GAD with the main domain of worry being the couple relationship. The results of the three studies showed very large effect sizes in symptoms reduction, measures of RNT, and ACT processes, with all participants showing clinically significant changes.

113. A New Measure of Psychological Flexibility Based (more) on RFT
Symposium (12:45-14:00)
Components: Conceptual analysis, Literature review, Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Theoretical and philosophical foundations, Psychometrics, Measuring Psychological Flexibility
Target Audience: Interm.
Location: San Bernardo

Frank W. Bond, Ph.D, Goldsmiths, University of London
Dermot Barnes-Holmes, Ph.D., Ghent University

ACT and RFT theories are complex webs of ideas and constructs that researchers and clinicians constantly explore, and these efforts reveal new insights that, together with basic research, suggest new ways of understanding and measuring processes such as psychological flexibility (PF). This symposium discusses both the theoretical (Torneke et al., 2016) and empirical (Luciano et al., 2009) work that has led to the development and then testing of a new measure of PF, the Psychological Flexibility Indicator (PFI). In addition, research into this new measure reveals not only its psychometric properties, but it also critically suggests core issues concerning how we understand psychological flexibility, how we can enhance it clinically, and how we can begin to develop methodologies to better understand this construct.

• Why do we need a new measure of psychological flexibility?
Yvonne Barnes-Holmes, Ph.D., Ghent University

Early in the development of relational framing, relations of coordination are established between “I”, “me”, my own name, my own thoughts, feelings and my own behaviour. Similarly, relations of distinction are established between “I” and “you”, “others”, "other names"; temporal relations are also established between "now" and "then". Furthermore, research has shown that a hierarchical relation with my own behaviour is likely to be relatively effective and beneficial (e.g., Luciano et al., 2009). Such theory and recent research has led to a new exploration of RFT concepts, such as perspective taking and hierarchical framing (Torneke et al., 2016), to see how they can inform our understanding and measurement of psychological flexibility. This paper discusses these empirically based theoretical advances to show how they can inform clinical practice and how such advances may provide an opportunity for us not only to better understand and improve psychological flexibility but to measure it.

• Psychometric properties of the Psychological Flexibility Indicator (PFI)
Frank W. Bond, Ph.D, Goldsmiths, University of London
Joda Lloyd, Ph.D., Goldsmiths, University of London

This paper discusses why theoretical and empirical advances, in conjunction with limitations of the AAQ-II, warranted a new measure of psychological flexibility. It presents studies that tested the the initial item pool of this new measure of psychological flexibility, the Psychological Flexibility Indicator (PFI) (Bond, Lloyd, Barnes-Holmes, Torneke, Luciano, Barnes-Holmes, Guenole, in prep), its item reduction procedures, and its eventual factor structure that reveals insights into both to RFT and ACT theory and practice. Data from at least four studies will identify the measure's psychometric properties, including its factor structure, reliabilities, concurrent and predictive validates, and its performance in relation to the AAQ-II. Discussion will focus on psychometric, clinical and theoretical implications of these findings for both RFT and ACT.

• Measuring psychological flexibility is needed but how? Implications for basic and clinician domains
Carmen Luciano, Ph.D., University of Almeria

As discussed in this symposium, measuring psychological flexibility is a complex process that requires extensive knowledge of the theory underlying its definition. As has been noted in other papers, perspective and hierarchical framing are at the core according the experimental data (e.g., Luciano et al., 2011, Gil-Luciano et al., 2016; López, 2016), however, the way to measure those processes is not an easy endeavour, and further research is still needed to understand them more. Based on experimental research, this paper discusses different methodologies to measure it and its difficulties.

115. Acceptance, Mindfulness and Compassion-Based Interventions for Problem Eating Behaviors
Symposium (12:45-14:00)
Components: Literature review, Original data
Categories: Clinical Interventions and Interests, Functional contextual approaches in related disciplines, Binge Eating Disorder, Overweight and Obesity, ACT, Mindfulness
Target Audience: Beg., Interm., Adv.
Location: Utera

Increasing evidence points to the relevant potential impact of acceptance, mindfulness, and compassion-based interventions on health problems related to eating behaviors. This symposium presents four papers that focus on the application of such interventions to problems ranging from binge eating to obesity and overweightness. The first paper presents data on the efficacy of a low intensity pilot intervention for binge eating disorder aimed at promoting the development of compassion, mindfulness and psychological flexibility, with results showing a significant decrease in binge eating symptomatology and increases in body image-related psychological flexibility. The second paper presents follow-up results (up to 6 months) of an acceptance, mindfulness and compassion-based group intervention (Kg-Free) for obese and overweight women without binge eating disorder. Results show reductions in weight self-stigma, unhealthy eating patterns, and an improvement in quality-of-life. The third paper presents an innovative integration of ACT and wearable technologies (activity tracker and mHealth tools) for the development of an effective intervention in fostering healthy lifestyles for obese individuals. Finally, the fourth paper presents a review of the literature on the application of broadly defined mindfulness procedures (comprising MBSR, ACT, meditation, and mindful eating) as an agent for change in eating behaviors (weight reduction and prevention and treatment of eating disorders).

• The efficacy of a low intensity compassion, mindfulness and acceptance-based intervention for binge eating
Cristiana Duarte, Msc, Ph.D. Candidate, Cognitive and Behavioural Centre for Research and Intervention (CINEICC), Faculty of Psychology and Educational Sciences, UC
José Pinto-Gouveia, MD, Ph.D., Cognitive and Behavioural Centre for Research and Intervention (CINEICC), Faculty of Psychology and Educational Sciences, UC
James Stubbs, Ph.D., Appetite Control and Energy Balance Research Group, School of Psychology, University of Leeds

Evidence shows that shame, self-criticism and psychological inflexibility play a significant role in the development and maintenance of Binge Eating Disorder (BED). Interventions that target these processes and promote the development of compassion, mindfulness and psychological flexibility may be particularly suitable to treat this clinical condition. A recent pilot study tested the efficacy of a low intensity 4-week compassion, mindfulness and acceptance-based intervention – CARE (Compassionate Attention and Regulation of Eating Behaviour) – in women from the general community diagnosed with BED. Results revealed significant reductions in binge eating symptomatology, body shape and weight overvaluation, self-criticism and indicators of psychopathology; there were significant increases in body image-related psychological flexibility and in the ability to engage in compassionate actions. Most effects were stable at 1-month follow-up. Results suggest that innovative interventions focused on developing mindfulness, compassion and acceptance competencies may have beneficial impacts in eating behaviour and psychological adjustment in individuals with BED.

• Follow-up results from an acceptance, mindfulness and compassion-based group intervention (Kg-Free): Exploring who benefited the most from the intervention?
Lara Palmeira, CINEICC, Cognitive and Behavioral Research Centre, University of Coimbra
Marina Cunha, CINEICC, Cognitive and Behavioral Research Centre, University of Coimbra; Miguel Torga Superior Institute (ISMT), Coimbra, Portu
José Pinto-Gouveia, CINEICC, Cognitive and Behavioral Research Centre, University of Coimbra

Kg-Free is a 12-session group intervention that includes mindfulness, ACT and (self)compassion components for women with overweight and obesity without binge eating disorder. Results from the randomized controlled trial revealed that the intervention was effective in reducing weight self-stigma, unhealthy eating patterns and improving quality-of-life. This study aims to explore changes in outcomes at 3 and 6-months follow-up and to examine whether changes in main outcomes at follow-up were significantly different depending on baseline differences. Overall, 53 women with a mean of 42.55 years old (SD=9.05) and a mean BMI (Kg/h2) of 34.09 (SD= 5.30) participated. Results suggest significant improvements from baseline to 3-and 6-months follow-up in all outcomes. We also explored if changes in weight self-stigma, unhealthy eating behaviors, and quality-of-life at follow-up were significantly different depending on participants’ baseline levels of self-criticism and external shame. Clinical implications will be discussed.

• ACTonHEALTH study: promoting Psychological Flexibility with Activity Tracker and mHealth tools to foster healthy lifestyles for Obese Individuals
Giorgia Adelaide Varallo Del Signore, Istituto Auxologico Italiano - Clinical Psychological Lab
Roberto Cattivelli, Istituto Auxologico Italiano IRCCS, Department of Psychology, Catholic University of Milan, Milan, Italy
Margherita Novelli, Istituto Auxologico Italiano IRCCS
Alessandro Musetti, Department of Literature, Arts, History and Society, University of Parma, Parma, Italy
Chiara Spatola, Istituto Auxologico Italiano IRCCS, Department of Psychology, Catholic University of Milan, Milan, Italy
Emanuele Cappella, Department of Psychology, Catholic University of Milan, Milan, Italy

Obesity and overweight are growing steadily and becoming a global epidemic. Recent researches report a 64% of the adult population as overweight. The social and economical impact is increasing and the most of the rehabilitation programs, while effective in the short term, do not produce long lasting results. From a behavioral perspective an explanatory model can describe the phenomena with the lack of sources of reinforcement related to healthy habits in the daily-life context. The goal of this work, combining Acceptance and Commitment Therapy and Wearable Technology, is to develop an effective intervention, efficient and sustainable, which continues after ending of structured rehabilitation programs, providing adequate contingencies of reinforcement in the natural environment, integrating systematic measurements, continuous feedbacks and individualized, values-based objectives. Related goal-setting show a shift from results linked with weight loss towards action connected with healthy life-style.

• Mindfulness, Acceptance and Commitment Therapy, and Nutrition
Vivian Costa Resende Cunha, MSc, Pontifícia Universidade de Goiás, Brasil
Sônia Maria Mello Neves, PhD, Pontifícia Universidade Católica de Goiás, Brasil

The concept of mindfulness originates from oriental meditation practices and, since the early 90s, this practice has been used in psychology by contextualist behavior therapies and other public health disciplines. Using the PubMed database, 60 papers were found in the last 8 years that addressed mindfulness techniques for weight loss, for prevention and treatment of diseases or eating disorders, and as an agent for change in eating behaviors. Papers that related mindfulness for weight control had an n of 22, of which 4 used Acceptance and Commitment Therapy (ACT), 5 used meditation practices as a protocol, 8 used mindful eating practices, 2 used the Mindfulness Based Stress Reduction (MSBR) protocol, and 3 were systematic reviews and meta-analyses on mindfulness and weight loss. The mindfulness techniques has mostly been used by Nutrition professionals as an end in itself and not as part of psychotherapeutic treatment.

122. A Functional Direction: Understanding the Symptoms of Psychosis Using Relational Frame Theory
Symposium (15:15-16:45)
Components: Conceptual analysis, Original data, Didactic presentation, Case presentation
Categories: Relational Frame Theory, Clinical Interventions and Interests, , Theoretical and philosophical foundations, Functional contextual approaches in related disciplines, Psychosis
Target Audience: Interm.
Location: Prado

Corinna Stewart, School of Psychology, National University of Ireland, Galway
Dr. Eric Morris, La Trobe Psychology Clinic, School of Psychology and Public Health, La Trobe University, Melbourne, Australia

While the positive symptoms of psychosis have long garnered attention in clinical, cognitive, and neuropsychology, these phenomena have yet to be systematically explored within CBS. Recently however, there has been a “call to arms” for systematic, inductive and empirically informed functional analyses of delusions (Stewart, Stewart, & Hughes, 2016), dissociation and auditory hallucinations (McEnteggart et al., 2016). This symposium comprises researchers and clinicians working together to bring an Relational Frame Theory (RFT) approach to understanding, researching and supporting individuals with unusual experiences and psychosis. Drawing upon recent developments in “clinical RFT”, we present an overview of how persecutory delusions may be conceptualized in RFT terms and present data from preliminary research investigating threat anticipation and avoidance generalization. We then demonstrate how RFT can be used to inform case conceptualization and therapeutic intervention via a case study on persecutory delusions. Finally, we reflect on promising research directions, challenges, and the clinical implications of adopting an RFT approach to delusions and psychosis more generally. It will be argued that a contextual approach to understanding the experiences of psychosis has the potential to identify environmental influences that may lead to better-informed psychological interventions to help those distressed and disabled by these experiences.

• An RFT approach to the study of persecutory delusions
Corinna Stewart, School of Psychology, National University of Ireland, Galway
Dr. Sean Hughes, Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
Dr. Ian Stewart, School of Psychology, National University of Ireland, Galway

Persecutory delusions are the most prevalent sub-type of delusional beliefs and are associated with a range of clinical phenomenon, including poor social functioning, anxiety, and depression. There has been a dearth of research investigating persecutory delusions from the functional-analytic perspective. This paper provides a starting point for functionally-oriented researchers and clinicians interested in this phenomenon. Drawing on RFT research, we provide a substantially bottom-up, functional interpretation of persecutory delusions. Specifically, we define delusional beliefs as behaviors (i.e., derived relational responding; DRR) and attempt to identify the learning histories and environmental factors supporting this behavior. DRR may be responsible for formation and generalization of fear, threat-beliefs, avoidance, and other psychological properties characteristic of persecutory delusions, especially for stimuli and events never previously contacted. Data is presented investigating generalization of threat anticipation and avoidance functions to stimuli not directly paired with interpersonal threat. Educational objective: To conceptualize persecutory delusions from an RFT perspective.

• A functional analytic perspective on paranoia: A case study
Dr. Joe Oliver, University College London & Camden and Islington NHS Foundation Trust
Dr. Yvonne Barnes-Holmes, Department of Experimental Clinical and Health Psychology, Ghent University, Belgium

There is an increasing interest among members of the CBS community in how therapies, especially Acceptance and Commitment Therapy (ACT), can be more directly informed by RFT. The current paper presents an on-going case summary in which ‘verbal functional analysis’ and the ‘drill-down’ featured strongly in case formulation and clinical focus. The case involved an adult woman with paranoia, who had been diagnosed with psychosis, and had an extended history of familial and other abuse. The paper highlights the importance of the deictic relations and how disturbances in the development of these relations may contribute to experiences of paranoia. This complex case illustrates the broad utility, and functional-analytic focus, of using conceptual developments in RFT to guide clinical work. Educational objective: To understand how RFT can be used to provide a functional analytic account of paranoia.

• Using ‘verbal functional analysis’ and the ‘drill down’ in complex clinical cases
Dr. Yvonne Barnes-Holmes, Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
Dr. Ciara McEnteggart, Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
Dr. Joe Oliver, University College London & Camden and Islington NHS Foundation Trust

The current paper is part of an ongoing effort to better connect or stretch RFT to the complexities of clinical phenomena. Drawing upon the case study presented in Paper 2, the current paper illustrates the way in which verbal functional analysis and the drill-down featured strongly in the case formulation and clinical focus. First, verbal functional analysis is an approach to identifying and targeting the relational networks that seem to be clinically relevant, to create broad and flexible repertoires of relational responding. Second, the drill-down aims to provide a bottom-up approach to the relational processes (with specific focus on the deictic relations) of the therapeutic alliance. The paper attempts to illustrate how therapeutic work can remain closely connected to basic theory and argues that it will be important in future work to further expand these connections with ongoing developments in RFT. Educational objective: The paper aims to illustrate how therapeutic work can remain closely connected to the basic concepts of RFT.

123. Shifting the Focus from Feeling Good to Doing Well: Empirical Studies on Valued Aspirations and Behaviors, and Their Implications for Clinical Practice
Symposium (15:15-16:45)
Components: Conceptual analysis, Literature review, Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Theoretical and philosophical foundations, Functional contextual approaches in related disciplines, Measurement
Target Audience: Beg., Interm.
Location: Nervión Arenal I

Professor Joseph Ciarrochi, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, NSW, Australia
Dr. Baljinder Sahdra, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, NSW, Australia

Acceptance and Commitment Therapy (ACT) focuses on altering the environment to activate value consistent behavior rather than altering internal mental states. In support of this conceptual and clinical orientation towards valued action, this symposium includes three presentations providing evidence for the importance of values and behavior in promoting positive functioning. Using diverse samples and methodologies, we will demonstrate that the intention to behave in line with one's values, as well as the behaviors themselves, reduce suffering and promote well-being. What you want to do, what you say you do, and what you actually do, all play a role in enhancing well-being. Furthermore, it is crucial to know the function of valued behaviors, not just those behaviors in isolation. The symposium will reinforce key principles of ACT through a holistic lens and empirically demonstrate that the contextual and functional details are key in identifying and encouraging valued action.

• Expanding the circle of aspirations: Intrinsic value patterns relate to positive functioning when they centre on community giving
Emma Bradshaw, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, NSW, Australia
Dr. Baljinder Sahdra, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, NSW, Australia
Professor Joseph Ciarrochi, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, NSW, Australia
Dr. Philip Parker, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, NSW, Australia
Tamás Martos, Department of Personality, Clinical and Health Psychology, University of Szeged, Szeged, Hungary
Professor Richard Ryan, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, NSW, Australia

Aspirations can be extrinsic (wealth, fame and attractiveness) or intrinsic (personal growth, relationships, community giving and health). It is often assumed that intrinsic is “good” and extrinsic is “bad” for well-being. However, typically observed small correlations between intrinsic and extrinsic values suggest that they are not universally divergent and may even be convergent in some people. Bifactor structural equation modelling and latent profile analysis of two independent samples from Australia (N=1632) and Hungary (N=3370) yielded three replicable latent profiles: Disengaged from relationships and health (P1); Aspiring for interpersonal relationship and health (P2); and aspiring for community relationship and giving (P3). P1 reported the lowest levels of positive functioning and P3 the highest, even after controlling for the individual aspirations. These results suggest that extrinsic aspirations may not be inherently negative if the aspiration profile favors intrinsic values, and that community involvement is important for well-being.

• The Six Ways to Well-Being (6WWeb): A new measure of behaviors that reduce mental ill-health and promote well-being
Geetanjali Basarkod, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, NSW, Australia
Professor Joseph Ciarrochi, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, NSW, Australia
Dr. Baljinder Sahdra, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, NSW, Australia

CBS-based interventions limit direct attempts to change emotional states like anxiety, and focus on activating value-consistent behaviors. However, most CBS outcome studies focus on emotional states. The Six Ways to Well-being (6WWeB) measures behaviors that are theorized to promote well-being: connecting with others, challenging oneself, giving, engaging in physical activity, embracing the moment, and caring for oneself. The measure also assesses motivation for each behavior (autonomous versus controlled). American (N = 1800) and Australian (N = 1563) participants completed the 6WWeb and related measures. Structural equation models including factors of autonomy and pressure in general and specific to each of the six domains fit the data well. The 6WWeb predicted substantial variance in mental–ill health and well-being, and related in theoretically expected ways to personality. The 6WWeb may be a useful outcome measure that orients clients towards activating value-consistent behavior rather than reducing symptoms.

• Increasing valued behaviors precedes reduction in suffering
Professor Andrew Gloster, University of Basel, Department of Psychology, Division of Clinical Psychology and Intervention Science, Basel, Switzerland
Dr. Jens Klotsche, German Rheumatism Research Centre Berlin, Leibniz Institute, Epidemiology Unit, Berlin, Germany
Professor Joseph Ciarrochi, Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, NSW, Australia
Prof. Georg Eifert, Chapman University, Orange, CA, USA
Dr. Rainer Sonntag, Private Practice, Olpe, Germany
Prof. Hans-Ulrich Wittchen, Technische Universität Dresden, Department of Psychology, Institute for Clinical Psychology and Psychotherapy, Dresden, Germany
Prof. Jürgen Hoyer, Technische Universität Dresden, Department of Psychology, Institute for Clinical Psychology and Psychotherapy, Dresden, Germany

Psychological flexibility theory suggests three key processes of change: increases in value-directed behaviors, reduction in struggle with symptoms, and reduction in suffering. We hypothesized that ACT would 1) increase valued behaviors and 2) exact change such that increases in valued action and decreases in struggle would precede change in suffering. Data were derived from a randomized clinical trial testing ACT for treatment-resistant patients with primary panic disorder (n= 41). Valued behavior, struggle, and suffering were assessed at each of eight sessions. Valued actions increased during therapy such that the discrepancy between what one said is important and what they actually did decreased. Struggle with symptoms and suffering also changed throughout therapy. Levels of valued behaviors influenced subsequent suffering, but the other two variables did not influence subsequent levels of valued action. These finding supports a central tenet of ACT that increased (re-)engagement in valued behaviors precedes reductions in suffering.

126. Development and Validation of Measures of Processes of Contextual Therapies
Symposium (15:15-16:45)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Theoretical and philosophical foundations, Adolescents, ACT Assessment, Measurement, Emotion Regulation
Target Audience: Beg., Interm., Adv.
Location: Buhaira

The development of psychometrically sound scales that measure the most relevant processes of contextual therapies is an important endeavor. A good number of scales have been designed in the last years; however, more research is still needed on adapting these scale to different languages and to design new and enhanced scales. This symposium presents advancements in this direction. The first presentation will present psychometric data of the Italian adaptation of the Child and Adolescent Mindfulness Measure (CAMM) and the Avoidance and Fusion Questionnaire for Youth (AFQ-Y). The second presentation will present data that supports the use of a new scale, the Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT). Lastly, the third paper will present a new scale that measures regulation difficulties associated with emotional overcontrol.

• Mindfulness Skills, Psychological Flexibility and Internalizing problems in adolescents: ACT-oriented measures for clinical assessment
Marta Schweiger, IULM University, Milan - Italy
Arianna Ristallo, IESCUM, Italy
Annalisa Oppo, Sigmund Freud University , Milan - Italy
Francesca Pergolizzi, IESCUM, Italy
Nanni Presti, Kore University, Enna - Italy
Paolo Moderato, IULM University, Milan - Italy

Providing psychometrically sound instruments is necessary in order to guide treatment decisions consistent with ACT processes. There are only few ACT-oriented self-reports tailored on young people: Child and Adolescent Mindfulness Measure (CAMM) and Avoidance and Fusion Questionnaire for Youth (AFQ-Y). Italian version of those measures (I-CAMM and I-AFQ-Y) had been validated and they showed good psychometric properties. 1336 participants, aged between 11 and 18, were enrolled in twelve schools all over Italy. The first aim of the study is to identify cut-offs that optimize sensitivity and specificity of I-CAMM an I-AFQ-Y in order to detect adolescents with internalizing problems assessed by Youth Self-Report (YSR): cut-offs are 24 for the I-CAMM and 11 for the I-AFQ-Y. Furthermore using a Classification Tree Analysis (CTA), groups of adolescents with specific characteristics are identified: in anxious-depressed adolescents, Withdrawn/Depressed symptoms are associated with low mindfulness skills, while Somatic/Complaints symptoms are associated with psychological inflexibility. Finally, correlation of ACT questionnaire with anxiety and depression measures (RCMAS-2 and CDI) are presented. The detection of homogeneous groups with specific behavioral patterns can help clinicians in decision making process about treatment. The potential uses of the I-CAMM and I-AFQ-Y in research and clinical practice are discussed.

• Development and continuing validation of the Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT)
David L. Dawson, DClinPsy, University of Lincoln
Nima Golijani-Moghaddam, University of Lincoln

Extant ACT process measures are typically circumscribed in their focus and have been subject to critique in terms of validity and conflation with distress measurement. In this presentation, we describe the development and ongoing validation of a new general measure of ACT processes (the CompACT). In phase one, ACT experts rated the face and content validity of 106 items using a Delphi consensus methodology, producing an initial 37-item measure. In phase two, a general population sample (N=377) completed this measure; exploratory factor analysis suggested a theoretically-coherent three-factor structure for a 23-item version of the CompACT. Work from these phases was recently published in JCBS. During this presentation, phase-three results (confirmatory factor analysis and assessment of test-retest reliability, using an independent sample [N~440]) will be reported for the first time. Results from previous phases indicate that the CompACT holds promise as a valid measure of general ACT processes.

• A transdiagnostic approach to emotion regulation: The development and validation of two scales of emotion regulation
Lauren Borges, Ph.D., Rocky Mountain Mental Illness Research, Education, and Clinical Center
Amy Naugle, Ph.D., Western Michigan University

Recent research suggests the transdiagnostic role of emotion regulation in the development and maintenance of psychopathology. Extant scales of emotion regulation, however, do not capture the transdiagnostic scope of this construct. These measures neglect the emotion regulation difficulties associated with emotion overcontrol. To address these gaps in the literature, a scale of emotion undercontrol and a scale of emotion overcontrol were developed from 305 undergraduates who completed preexisting measures of emotion regulation and personality. The emotion regulation strategies most predictive of personality disorders and traits associated with emotion overcontrol (e.g., Obsessive Compulsive Personality Disorder; propriety) and emotion undercontrol (e.g., Borderline Personality Disorder; disinhibition) formed item pools for exploratory factory analyses. Resulting from these analyses, two scales were formed which shared dimensions of emotional avoidance, emotion identification, emotional control, and emotional interference. The undercontrol scale included three unique factors of emotional tolerance, emotional reactivity, and emotional expressivity whereas emotional judgment and emotional reappraisal represented two unique facets to emotional overcontrol. These scales were found to be reliable and valid in the current sample. Implications for assessing emotion regulation and future directions for research are discussed.

• The Development of the Flexibility of Responses to Self-Critical Thoughts Scale (FoReST)
Ross White Ph.D, DClinPsy, University of Liverpool
Peter Larkin, NHS Greater Glasgow and Clyde
Annette Lloyd, NHS Greater Glasgow and Clyde

Background: This paper reports on the development of ‘The Flexibility of Responses to Self-Critical Thoughts Scale’ (FoReST); a measure specifically designed to assess psychological flexibility in relation to self-critical thoughts. Method: In Study 1, a convenience sample of 253 adults was recruited to investigate the factor structure and construct validity of the FoReST in a non-clinical sample. In Study 2, a total of 132 individuals attending Primary Care and Community Mental Health Teams in two health trusts in the UK participated in an investigation of the factor structure, construct validity and internal consistency in a clinical sample. Results: In both studies a two-factor (unworkable action and avoidance) structure for the FoReST was identified. The measure demonstrated good internal consistency, concurrent validity and predictive validity in both studies. Conclusions: The FoReST appears to be a valid assessment measure for administering to individuals with and without mental health difficulties. This measure could have important application for evaluating third wave therapies such as Acceptance and Commitment Therapy (ACT) and Compassion Focused therapy (CFT).

127. Research on the Negative Effects of Experiential Avoidance
Symposium (15:15-16:45)
Components: Original data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Behavioral medicine, Theoretical and philosophical foundations, Experiential avoidance, Aggression, Borderline Personality Disorder, Military Sexual Trauma, Smoking cessation
Target Audience: Interm.
Location: San Bernardo

The analysis of the negative effects of experiential avoidance in mental health and quality of life variables has been one the most productive areas of research within the Contextual Behavioral Science. However, experiential avoidance is so pervasive that many relations with other processes and outcomes remain uninvestigated. This symposium will present research that advances in this direction. The first presentation will show the attentional correlates of experiential avoidance in dementia caregivers. The second paper examines the role of experiential avoidance in the relationship between Borderline Personality features and aggression. The third presentation will discuss psychological flexibility in reference to professional mental health staff, personally and professionally. Overall, these presentations show the pervasive and counterproductive nature of experiential avoidance.

• Attentional correlates of Experiential avoidance in dementia caregivers
Isabel Cabrera, Ph.D, Universidad Autónoma de Madrid
María Márquez-González, Ph.D, Universidad Autónoma de Madrid
Andrés Losada, Universidad Rey Juan Carlos de Madrid
Carlos Vara, Universidad Autónoma de Madrid
Laura Gallego-Alberto, Universidad Autónoma de Madrid

Cabrera, I., Márquez-González, M., Losada, A., Vara, C., & Gallego-Alberto, L. Background: Experiential avoidance in caregiving (EAC) has been related to dementia family caregivers´ distress. This study aims to explore EAC-related attentional biases. Method: Ninety-one caregivers completed: a) a dot-probe task with emotional pictures varying in content and time of exposure; and b) the Experiential Avoidance in Caregiving Questionnaire. Results: A mixed design ANOVA was carried out with one between-subjects factor (EAC: high, low) and three within-subjects factors (picture valence: distressing, positive; picture content: general, caregiving-related; and time: 100 and 500 ms). A significant four-way interaction was found. High-EAC participants showed avoidant attentional biases or not attention to emotional pictures. Low-EAC participants showed an attentional bias for positive general information and an avoidant bias for distressing general information, and the opposite pattern for caregiving-related stimuli. Conclusion: High EAC levels were associated with general avoidant attentional biases, whereas low EAC levels were related to a more selective and adaptive attentional pattern.

• A Prospective Examination of Processes Influencing the Relationship between Borderline Personality Features and Aggression: Experiential Avoidance and Anger Rumination as Mediators
John J. Donahue, Psy.D., University of Baltimore
Rebecca Thompson, Ph.D., University of Baltimore

Borderline Personality Disorder (BPD) features have been associated with increased aggression toward others. Under the Emotional Cascade Model (ECM; Selby & Joiner, 2009), rumination is proposed to intensify negative emotionality and attention toward emotional stimuli, resulting in behavioral dysregulation such as aggression. While not explicitly included within the ECM, experiential avoidance (EA) is a process that is considered to play a key role in BPD (Iverson et al., 2012), is a proxy risk factor for rumination (Spinhoven et al., 2016), and is associated with aggression (Reddy et al., 2011). The present study therefore seeks to longitudinally examine the role of EA and anger rumination in explaining the relationship between BPD features and aggression in a community sample of participants high in emotion dysregulation. One hundred and seven participants (51% women, mean age = 30.94, SD = 7.33) were recruited to participate in a six-month prospective study with three assessment points. Data collection is ongoing and the second assessment point has recently completed. Preliminary results support a serial mediation model with a significant indirect effect of time 1 BPD features on time 2 aggression through EA and anger rumination. Specifically, a bias-corrected bootstrap confidence interval for the indirect effect (B = .07) based on 5,000 bootstrap samples did not include zero (.01, .20). The final presentation will report analyses based on all three time points and discussion will emphasize the interplay between EA and rumination on aggression among those with BPD features.

• Psychological flexibility: an investigation in mental health staff at the individual, leadership, and team level, and its impact on service user outcomes
Danielle Lamb, University College London
Professor Sonia Johnson, University College London

This research investigates one of the key elements of Acceptance and Commitment Therapy (ACT), psychological flexibility. This paper reports the findings of a longitudinal study with NHS staff (n=445) working in Crisis Resolution Teams (24/7 mental health teams in the UK providing care at home to those in mental health crisis, with the aim of avoiding hospital admission). Psychological flexibility has been investigated at three levels: 1) the individual level, where results support previous research, that higher levels of psychological flexibility predict better wellbeing outcomes (measured via burnout, work engagement, and general psychological health); 2) the leadership level, where results indicate some support for the hypothesis that higher manager psychological flexibility is associated with better wellbeing outcomes in their staff; and 3) the team level, where data will be presented on whether higher team-level psychological flexibility is associated with better service user outcomes. This research aims to provide both guidance to service planners and managers, and a conceptual account of complex psychological constructs and their impact in an occupational context.

• Could experiential avoidance mediate the relationship between stress and tobacco smoking?
Vasiliki Christodoulou, Mental Health Services, Cyprus
Maria Karekla, University of Cyprus
Georgia Frangou, University of Cyprus

Notable scholarly attention has been given to the existence of a significant association between stress and tobacco smoking. However, few studies have investigated the mechanisms underpinning this relation. The present study aims to reinforce current evidence indicating that experiential avoidance may be a viable underlying mechanism underpinning the relation between stress and smoking, as well as being a predictor of low motivation to quit and poor quit outcomes. Participants will complete demographics and smoking history questionnaires, a motivation to quit assessment, a Carbon Monoxide measurement, a Fagerström Test for Nicotine Dependence (FTND), a stress scale and an Avoidance and Inflexibility Scale (AIS). We predict that experiential avoidance will act as a mediating mechanism between stress and level of nicotine dependence. In addition, it is expected that a higher level of experiential avoidance will be predictive of lower motivation to quit smoking as well as of a history of failed quit attempts. The role of experiential avoidance as a mechanism affecting smoking behavior may be an important variable in terms of designing more effective smoking cessation programs.

128. Applying and Adapting ACT with Adults with Intellectual Disabilities
Symposium (15:15-16:45)
Components: Original data, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Professional Development, Intellectual Disabilities
Target Audience: Beg.
Location: Lebrija

Nick Gore, DClinPsy, Tizard Centre, University of Kent
Nick Gore, DClinPsy, Tizard Centre, University of Kent

This symposium presents some recent work applying ACT with an intellectual disabilities population, a population that traditionally requires careful adaptation to talking therapies. The first paper defines this client group and covers some of the lessons learned when working with ACT; including the need to consider deficits in relational framing ability when trying to work with thoughts and feelings, and the need to develop an appropriately accessible measure of psychological flexibility. The second paper presents the work of a mindfulness group delivered to people with intellectual disability and features videotaped testimony of the participants’ reactions. The final paper reports on a six-session ACT group intervention for adults with intellectual disabilities. It presents data showing symptom reduction despite its brief duration, and even though symptom reduction was not pursued. Adaptations made and lessons learned will be discussed throughout the symposium.

• Working with ACT with people with intellectual disabilities - Lessons learned and areas for development.
Mark Oliver, DClinPsy, Northumberland, Tyne and Wear NHS Foundation Trust

There is every reason to expect that the same verbal processes that contribute to psychological distress in the typically developing population also apply to people with intellectual disability (PWID). Unfortunately, the cognitive and developmental deficits presented by this population present a challenge to many ACT interventions, particularly those that use verbally sophisticated metaphors, orienting to metacognitions, and the targeting of deictic frames. In addition, the freedom to engage in value-guided activities is frequently constrained by the lived experience of being supported by paid and unpaid carers. The challenge for clinicians is to identify ways of adapting ACT to meet the needs of PWID while remaining true to the processes considered to be responsible for therapeutic change. This paper outlines examples of lessons learned through adapting ACT for an ID population, highlighting a number of directions where more clinical development is needed to mediate the cognitive limitations of this client group.

• Using ACT to enhance a mindfulness based intervention for adults with intellectual disabilities
Steve Noone, Ph.D, Northumberland, Tyne and Wear NHS Foundation Trust

Given the vulnerability of people with intellectual disabilities, it is important to help promote resilience to anxiety and depression. Mindfulness Based Interventions, delivered in groups, have a strong evidence base. Some studies have shown that these approaches can be adapted for this population. It remains unclear how best to do this. This paper describes adaptations that include using core ACT principles and collaborating with a self-advocacy group to promote practice and values clarification

• The Resilience Group: An Acceptance and Commitment Therapy based Group for People with Intellectual Disabilities
Matthew Selman, DClinPsy, Northumberland, Tyne and Wear NHS Foundation Trust
Kay Rooney, Northumberland, Tyne and Wear NHS Foundation Trust
Kelly Cocallis, Tees, Esk and Wear Valley NHS Foundation Trust
Mark Oliver, DClinPsy

This presentation reports on the use of an ACT group intervention for people with mild intellectual disabilities who were experiencing mild/moderate levels of psychological distress (anxiety and depression). This is the first reported use of a group ACT intervention for this client population. Two groups were run parallel to each other over six sessions – each session focussing on an element of the Hexaflex. Pre and post measures of psychological distress were administered along with measures of values. A focus group was held to gain the participants experience and ideas for improvement. Feedback was positive about the group experience and engaging in values. While not the aim, significant symptom reduction was experienced across both groups. Participants described wanting more sessions. Discussion around adaptations and the need for a measure of psychological flexibility are included. Difficulties in conveying some of the concepts used within ACT for this client group are also noted.

129. Gender and Acceptance-Based Treatment Approaches in Punishing Contexts
Symposium (15:15-16:45)
Components: Conceptual analysis, Literature review, Original data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Gender Differences, Treatment Outcomes, Acceptance-Based Treatments, Aggression
Target Audience: Beg., Interm., Adv.
Location: Utera

Robyn L. Gobin, Ph.D., University of Illinois at Urbana Champaign
Thomas Szabo, Ph.D., Florida Institute of Technology

Gender influences how people understand themselves and their risk for certain experiences (e.g., aggression in intimate relationships). Iverson et al., (2013) found gender differences in risk for several forms of interpersonal aggression. The negative consequences of physical and nonphysical forms of aggression have been documented (Arriaga & Schkeryantz, 2015; Iverson et al., 2013), yet little research has examined the impact of gender and contextual factors on one’s experience of aggression and treatment outcomes. Acceptance-based treatment approaches differ from traditional therapies in their focus on functional processes that maintain ineffective behaviors rather than symptom characteristics (McClean & Follette, 2016). Featuring conceptual and research-based talks, the proposed symposium will explore associations between gender and aggression and gender differences in response to acceptance-based treatment approaches. Context will be emphasized with specific attention to the contexts of the military, chronic pain, and intimate partner violence. Future research directions and clinical implications will be discussed.

• Gender Differences in Response to Acceptance and Commitment Therapy among U.S. military veterans
Robyn L. Gobin, Ph.D., University of Illinois at Urbana Champaign
Ariel J. Lang, Ph.D., MPH, VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health
Shahrokh Golshan, Ph.D., VA San Diego Healthcare System
Carolyn Allard, Ph.D., VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health
Jessica Bomyea, Ph.D., VA San Diego Healthcare System, Center of Excellence for Stress and Mental Health
Paula P. Schnurr, Ph.D., National Center for PTSD, White River Junction
Jennifer L. Strauss, Ph.D., Duke University Medical Center; Department of Veterans Affairs, Washington, DC

Little is known about the impact of gender on treatment response. The majority of our knowledge base regarding treatment response among veterans comes from predominantly male samples. However, the extant literature suggests that women and men use different coping strategies, which may impact how effective specific treatments are across genders. The purpose of this investigation was to examine gender differences in response to Acceptance and Commitment Therapy (ACT), an empirically-supported transdiagnostic psychotherapy. A secondary data analysis of a multi-site randomized controlled trial of ACT as compared to a psychotherapy control, Present Centered Therapy (PCT), was used. One hundred sixty Veterans (32 women and 128 men) of OEF/OIF/OND participated. In the larger trial, no significant differences were found between treatment conditions in reducing the primary outcome, general distress, or most secondary outcomes (Lang et al., 2016). In this study of gender differences, women who received ACT reported greater reductions in PTSD and anxiety symptoms relative to those who received PCT, p<.01. There were no differences between ACT and PCT among men. These preliminary results suggest that ACT may be a promising treatment for psychologically-distressed women veterans. Clinical implications with be discussed.

• Women and Intimate Partner Violence: A Contextual Behavioural Science Perspective
Lene Forrester, Ph.D., BMI Healthcare
Jennifer L. Strauss, Ph.D., Duke University Medical Center; Department of Veterans Affairs, Washington, DC

Intimate Partner Violence (IPV) is recognised as a significant societal problem, in terms of its high frequency and the detrimental impact upon the predominantly female survivors (World Health Organisation 2012). Despite this knowledge, there is a relative paucity in the Contextual Behavioural Science (CBS) literature attempting to: (1) enhance our understanding of the complex gender and cultural dynamics underlying IPV, and (2) develop evidence-based interventions aimed at empowering women to leave these destructive relationships (Larson 2011). This paper will present a comprehensive review of the literature on this topic within the perspective of Relational Frame Theory (RFT). The impact of current and historical context will be addressed, and the relevance of gender as a factor in the aetiology, maintenance and impact of IPV will be emphasized. A targeted Acceptance and Commitment Therapy (ACT) intervention for women subjected to IPV contacting Women’s Aid, currently under development, will be presented for discussion.

• Punishing responses from significant others - important to address in acceptance-based pain management programs?
Marie Blom, M.S., Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
Björn Gerdle, PhD, Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

Social context is widely known to influence the experience of longstanding pain (Edwards et al, 2016). Diary studies have shown pain ratings to increase after being criticized by a significant other (Burns et al, 2013). The aim of this ongoing project, is to apply a contextual behavioral perspective in studying the effects of self-reported punishing responses from significant others on pain expressions (e.g., anger, irritation). Respondents (n~300) participated in an 8-10 week acceptance-based multiprofessional pain management program (PMP) for longstanding pain at a Swedish outpatient pain clinic, between January 2014 and September 2016. Relationship issues are addressed only to some degree in the PMP. The main aim of this study is to investigate whether an increased focus on such issues would be likely to benefit patients. Results will be presented on Multidimensional Pain Inventory (MPI-S), pain characteristics, Chronic Pain Acceptance Questionnaire (CPAQ), Hospital Anxiety and Depression Scale (HADS) and Life Satisfaction questionnaire (LiSat-11); before, after and at 1-year follow up after the PMP. Possibilities and difficulties of involving significant others in pain rehabilitation will be discussed.

130. Analyses of Deictic Relations
Symposium (15:15-16:45)
Components: Original data
Categories: Relational Frame Theory, Clinical Interventions and Interests, New Evidence in Hierarchical Framing- RFT, RFT, Performance
Target Audience: Beg., Interm., Adv.
Location: Estepa

Deirdre Kavanagh, Ghent University
Dermot Barnes-Holmes, Ghent University

This second symposium that focuses on experimental analyses of the deitic relations highlights the view that this is critically important verbal behavior, with developmental and clinical significance. Paper 1 explores the relationship between what is traditionally defined as empathy and deictic relational responding. The study explores the use of a relational empathy training protocol delivered to 8 typically-developing children, as measured against standardized assessments of emotional responding and perspective-taking. The findings show positive benefits associated with the training protocol in terms of perspective-taking and related behaviors. In the study decsribed in Paper 2, undergraduates are introduced to a stress induction procedure that, accompanied by various analog interventions that manipulate deictic relational responding (Deictic; Deictic+Hierarchical1; Deictic+Hierarchical1+Augmental; and Deictic+Hierarchical1+Augmental+Hierarchical2). The results show the superiority of the latter two interventions that each contain an augmental function. This study and its outcomes shed further light on the potential processes involved when deictic relations are manipulated for clinical purposes. In another study of hierarchical relations, Paper 3 explores the transformation of functions in accordance with these relations. In two contrasting conditions, contextual cues for hierarchy are manipulated and the results highlight the importance of previous learning in this regard.

• Establishing empathy: An exploratory study
Beatriz Harana, Ph.D. Student, University of Almeria
Carmen Luciano, Ph.D., University of Almeria
Adrián Barbero-Rubio, Ph.D., University of Almeria

Empathy has been addressed mainly from a cognitive standpoint but the numerous efforts still have not isolated the conditions under which it is produced. There is some agreement that empathy involves perspective taking and, accordingly, it might be studied as relational behavior (Relational Frame Theory (RFT). The main aim of this study is to develop a training protocol to establish empathy and evaluate its influence in traditional measures of emotions and perspective taking. A n=1 design is used with eight typical developing children and the protocol was implemented successively across participants. Results show an increase in the degree the child used perspective taking and behaved accordingly.

• An experimental analysis of the components involved in framing the own behaviour.
Juan C. López, Ph.D., Universidad de Almería
Carmen Luciano, Ph.D., Universidad de Almería & MICPSY

The current study aimed to thoroughly investigate the transformation of function involved in interacting with the own behaviour, typically known as defusion interactions. Deictic and hierarchical framing with augmental function have previously been identified in such interactions however the present paper is a somehow molecular analysis of the elements involved in such framings. 52 undergraduated completed two high-demand tasks at pre-test (PASAT-C and IRAP-Stroop). Next, they were randomly distributed and received one of four experimental protocols: Deictic Framing (D), whose interactions were built of only deictic framings on the ongoing discomfort and thoughts; D+Hierarchical framing (D+H), whose interactions were built adding to D the hierarchical function; D+H+Augmental (D+H+A) which explicitly added the augmental function; and the final condition which added the hierarchical discrimination of the whole ongoing process (D+H+A+H). They completed the two high-demand tasks as did as pre-test. Data showed the superiority of the D+H+A and D+H+A+H (those which included the explicit augmental function). These findings are discussed to make more explicit the processes or transformation involved in promoting effecive behaviors when discomfort is experimentally induced.

• One more step in analyzing hierarchical framing
Lidia Budziszewska, MS, Universidad Europea de Madrid, Spain
Carmen Luciano, University of Almeria,Spain
Enrique Gil, University of Almeria,Spain
Zaida Callejón, University of Almeria, Spain

The published evidence concerning transformation of functions in accordance with the relational frame of hierarchy is still very scarce; Gil, Luciano, Ruiz and Valdivia (2011) Gil, Luciano, Ruiz, Valdivia (2014) and Slattery & Stewart (2014).The aim of this study is to advance in such a track to provide more precise learning procedures. Participants were given two types of experimental histories prior to testing transformation of function according to hierarchical framing. The two conditions differed in the way the relational hierarchical cues were trained. In one case, participants received instructions to improve learning. In the other conditions, they did not. Participants followed several steps to learn to respond to arbitrary stimuli as coordination and relational hierarchical cues. Results show that participants reorganized stimuli according the previous learning especially when they received some specific instructions. Further research is discussed.

Sunday, 25 June

140. Investigación en Ciencia Conductual Contextual: Aportaciones Básicas y Aplicadas
Symposium (9:30-11:00)
Components: Datos originales
Categories: Intervenciones para mejorar el rendimiento
Target Audience: Beg., Interm., Adv.
Location: Buhaira

Este simposio presenta cuatro trabajos de diferentes procedencias que son una buena muestra del amplio abanico de posibilidades de investigación que permite abordar una perspectiva basada en la ciencia conductual contextual (contextual behavioral science: CBS), desde los aspectos más básicos al ámbito aplicado. El primer estudio se centra en la evaluación y el entrenamiento de la toma de perspectiva en niños desde la perspectiva de la RFT, esto es, como un tipo de comportamiento relacional deíctico. Este trabajo presenta una serie de modificaciones respecto a protocolos ya existentes de entrenamiento en marcos deícticos que parecen favorecer el desarrollo de este tipo de desempeño. El segundo trabajo presenta los resultados de un tratamiento ACT grupal para promover la adhesión al tratamiento antirretroviral (TAR) en pacientes infectados con VIH. La adhesión estricta al TAR es fundamental para que este tratamiento médico sea efectivo, y la intervención basada en ACT se muestra eficaz en la mejora de dicha adhesión. El tercer y cuarto trabajos que se incluyen en este simposio son estudios que han empleado el procedimiento de evaluación relacional implícita (IRAP) para explorar dos ámbitos de interés social. El tercer trabajo se centra en el análisis de las actitudes implícitas y explícitas hacia los alumnos con necesidades educativas especiales por parte de especialistas y profesores. El último trabajo presentado utiliza el IRAP para explorar las actitudes hacias las identidades catalana y española por parte de participantes catalanes y de otras partes de España. Ambos estudios muestran la utilidad del IRAP para detectar discrepancias entre actitudes implícitas y explícitas en sus respectivos ámbitos.

• Evaluación y entrenamiento de toma de perspectiva en niños: Reflexiones a partir de tres trabajos experimentales.
Luis Alberto Quiroga-Baquero, Fundación Universitaria Konrad Lorenz
María Isabel Rendón-Arango, Universidad Santo Tomás
Daniel Camilo Salas-Cuervo, Fundación Universitaria Konrad-Lorenz

Desde una perspectiva contextual-funcional, la Teoría de los Marcos Relacionales ha abordado teórica y empíricamente los fenómenos psicológicos relacionados con la toma de perspectiva, asumiéndolos como un tipo de responder relacional deíctico. La investigación empírica se ha centrado principalmente en el diseño de protocolos de evaluación y entrenamiento de marcos deícticos, así como en la replicación sistemática con el fin de aumentar su aplicabilidad y validez. El objetivo de esta serie experimental, fue implementar tres modificaciones a los protocolos formulados por McHugh, Barnes-Holmes y Barnes-Holmes (2004) y Davlin, Rehfeldt y Lovett (2011): (a) Entrenamiento previo en marcos de condicionalidad; (b) entrenamiento y evaluación de marcos deícticos en situaciones de interacción y manipulación directa; y (c) reducción de ensayos por fase e implementación de un diseño de líneas de base y pruebas múltiples a través de participantes y condiciones. Los resultados muestran que: (a) un entrenamiento previo en marcos de condicionalidad, promueve ejecuciones efectivas en las fases de evaluación y entrenamiento; (b) la evaluación y entrenamiento de relaciones deícticas en situaciones de interacción y manipulación directa de objetos favorece el desempeño en todas las fases del protocolo, en comparación con la utilización de situaciones hipotéticas; y (c) el uso de diseños de líneas de base y pruebas múltiples, permite identificar de forma más detallada los cambios en el responder relacional y promueve porcentajes de aciertos altos en cada fase. Estos hallazgos se discuten en términos de las dinámicas conductuales implicadas en el responder relacional deíctico, los supuestos de la investigación traslacional y los criterios de aplicabilidad, validez y eficiencia en la utilización de este tipo de protocolos.

• Efectos de la Terapia de Aceptación y Compromiso en la Adherencia al Tratamiento de Pacientes VIH de Bucaramanga
Cristian Leonardo Santamaria Galeano, Candidato a Magister, Universidad Pontificia Bolivariana, Seccional Bucaramanga
Ana Fernanda Uribe Rodriguez, Universidad Pontificia Bolivariana, Seccional Bucaramanga

El VIH es considerado una enfermedad crónica que implica mínimo un 95% de adherencia para garantizar el control viral y fortalecimiento inmunológico. Sólo una tercera parte de quienes acceden al tratamiento antirretroviral se adhieren a éste. Se aplicaron 8 sesiones de intervención a grupal a 17 pacientes VIH otros 28 fueron control, entre 18 y 50 años, en una institución de salud especializada en VIH. Se tomaron mediciones post-intervención y seguimiento con el cuestionario de adherencia al tratamiento (CAT-VIH), la escala de ansiedad y depresión (HAD) y el cuestionario de aceptación y acción (AAQ). Se encontraron diferencias estadísticamente significativas entre grupos en la medición del CAT-VIH en la post-intervención (p=.000) y el seguimiento p=.000. Al realizar el análisis de correlación, esta es negativa entre el CAT-VIH y el AAQ en la post-intervención (r=-.4) y el seguimiento (r=-.593). Se encontró correlación negativa entre la sintomatología depresiva y la adherencia al TAR en la post intervención (r=-.403); en el seguimiento se evidencia relación negativa entre la adherencia con la ansiedad (r=-.486) y la depresión (r=.510). Y correlación positiva entre el AAQ y la ansiedad (r=.542) y depresión (r=.372) en el seguimiento. Se evidencia la efectividad de un protocolo ACT en la adherencia al TAR. La relación inversamente proporcional entre las puntuaciones del AAQ y el CAT-VIH, ponen de manifiesto que a mayo evitación experiencial, los pacientes son menos adherentes al TAR.

• Usando el Procedimiento de Evaluación Relacional Implícita (IRAP) para Evaluar la Actitud del Profesorado hacia los Alumnos con Necesidades Educativas Especiales
Aurembiaix Llobera Cascalló, M. Sc., Universidad de Almería
Eduardo Miguel Blasco Delgado, Universidad de Almería

El presente estudio examina las actitudes implícitas y explícitas hacia el alumnado con Necesidades Educativas Especiales (NEE) en profesores de infantil-primaria (N= 11) y en profesores especializados en NEE (N= 12). Las actitudes implícitas se evaluaron a través de un Procedimiento de Evaluación Relacional Implícita (IRAP), mientras que las explícitas lo fueron a través de un cuestionario análogo al IRAP y el MBI-ED. Los resultados muestran diferencias entre las medidas implícitas y explícitas en ambos grupos. Así mismo, a nivel implícito, se ha encontrado un sesgo positivo hacia el alumnado con NEE en el grupo de especialistas y un sesgo negativo hacia el alumnado con NEE en el grupo de profesorado.

• Usando el Procedimiento de Evaluación Relacional Implícita (IRAP) para Evaluar las Actitudes hacia las Identidades Catalana y Española
Eduardo Miguel Blasco Delgado, M. Sc., Universidad Almería
Aurembiaix Llobera Cascalló, Universidad Almería

Un estudio basado en el Procedimiento de Evaluación Relacional Implícita (IRAP) fue diseñado para examinar las actitudes implícitas hacia la identidad catalana y hacia la identidad española en un grupo de catalanes (n = 17) y un grupo de personas del resto de España (n =16). Los participantes también completaron una medida explícita con ítems análogos al IRAP y el Cuestionario de Deseabilidad Social de Marlowe-Crowne. Los resultados muestran que ambos grupos presentan un sesgo más favorable hacia su grupo que hacia el otro grupo. También que el grupo Cataluña ha evaluado de forma menos favorable a los españoles que éstos a los catalanes. Finalmente, se ha confirmado que los participantes que han puntuado alto en la Escala Deseabilidad Social de Marlowe-Crowne, muestran discrepancias importantes entre lo contestado en el cuestionario explícito y el IRAP.

141. Assessing and Training Relational Framing in Children and Adults
Symposium (9:30-11:00)
Components: Original data
Categories: Relational Frame Theory, Educational settings, Children
Target Audience: Interm.
Location: San Bernardo

Ian Stewart, National University of Ireland Galway
Carmen Luciano, University of Almeria Spain

Relational frame theory (RFT) affords new insight into human language and cognition as arbitrarily applicable relational responding or relational framing. One key insight of RFT that derives directly from its operant roots is that relational framing can be targeted for training. This insight has most obvious application in the educational domain and this symposium presents a number of empirical studies centred on this theme and in particular on relational framing assessment and training with children. The first talk presents data showing the training of containment and hierarchical relational framing, the second provides data showing the training of same-difference relations, while the third discusses development of a tool for assessing operant fluency in relational framing in both children and adults and discusses measurement and training of relational operant behaviour in children and adults in light of their data.

• Facilitating Containment and Hierarchical Relational Responding Repertoires in Young Children
Teresa Mulhern, National University of Ireland Galway
Ian Stewart, National University of Ireland Galway

Relational Frame Theory (RFT) sees containment (A is in B; B contains A) and hierarchical (A is a type of B; B is a class containing A) relational responding as core repertoires for categorization. The current studies aimed to systematically train these repertoires including component skills of mutual and combinatorial entailment and transformation of function in young typically developing children. Study 1 focused on training arbitrary containment relational responding in three 5-year-olds using a combined multiple baseline (across both components and participants) design while Study 2 employed a combined multiple baseline design to facilitate arbitrary hierarchical relational responding in three 6-year-olds. In both cases, results showed the effectiveness of training for increasing responding in accordance with arbitrary containment and generalization was also observed. Results, including impact of training on standardized outcomes measures of intelligence broadly as well as categorization skill specifically, are discussed.

• Training children with autism in patterns of derived same and different relations
Siri Ming, National University of Ireland Galway
Ian Stewart, National University of Ireland Galway

The ability to identify similarities and differences between stimuli or concepts is a key skill in terms of development and academic success. In this study, two children with autism were trained to derive arbitrary relations of same/different using an iPad-based teaching protocol involving animals and their preferred foods. At baseline, neither child could derive arbitrary same/different relations either within the iPad game or based on a short text-based story. Following multiple exemplar training, both children could derive the relations with novel stimulus sets in both contexts. Implications for further research on same/different relations, curriculum development, and relevance for reading comprehension are discussed.

• Testing the predictive validity of an online relational responding fluency assessment
Shane McLoughlin, University of Chichester, UK
Sam Ashcroft, University of Chester, UK
Ian Tyndall, University of Chichester, UK
Antonina Pereira, University of Chichester, UK

This study aimed to develop an online tool for measurement of relational operant fluency. We administered a novel 72-trial derived relational responding (DRR) assessment to 50 people online (ages 8-59). This measured DRR accuracy and response latency for SAME / OPPOSITE and MORE / LESS relations at four levels of difficulty. From these accuracy / latency data, a fluency outcome variable was computed for each of four levels of both types of DRR. We then used correlation / regression analyses to investigate the relationship between relational operant behaviour (accuracy, latency, fluency) and several other outcome variables: (i) AAQ-2 performance, (ii) a novel response latency based measure of psychological flexibility, (iii) well-being (WHO Well-Being Index), (iv) self-efficacy in learning (e.g., Myself as a Learner Scale), (vi) attention and memory (immediate and delayed). Implications for measurement and training of relational framing in children and adults are discussed.

142. Using Different Methods to Study Clinical Applications II
Symposium (9:30-11:00)
Components: Didactic presentation
Categories: Relational Frame Theory, Clinical Interventions and Interests, Theoretical and philosophical foundations, Fear and Avoidance, Rule-governed Behavior
Target Audience: Beg., Interm., Adv.
Location: Lebrija

Dermot Barnes-Holmes, Ghent University

The current symposium is the second to explore and discuss different methodologies for studying clinical applications of RFT, covering fear of public speaking, spider phobia, and rule persistence. Paper 1 systematically compares analog interventions based on hierarchical-self and distinction-self in the context of public speaking as distress tolerance measured via self-report, skin conductance, and heart rate. The results show superiority of the hierarchical-self intervention and discusses the implications of this effect for clinical practice. Paper 2 compares two verbal rehearsal tasks (fear reduction vs. fear acceptance) on a spider-Fear IRAP and a spider-Avoid IRAP, as well as on a behavioral approach task with a live spider. Both IRAPs predict actual approach, with some evidence of differential moderating effects of the verbal rehearsal task similar to defusion. Paper 3 contains two studies that explore rule persistence in terms of levels of derivation (e.g., direct or derived rule) using an MTS task. The results show greater rule persistence with direct than derived rules, but only with extensive rule practice.

• Spider Fear and Avoidance: An Exploratory Study of the Impact of Two Verbal Rehearsal Tasks on a Behavior-Behavior Relation and its Implications for an Experimental Analysis of Defusion.
Aileen Leech, Ghent University
Dermot Barnes-Holmes, Ghent University

The current research sought to replicate and extend the findings reported by Leech, Barnes-Holmes, and Madden (2016) by examining the impact of a brief ‘verbal rehearsal’ task on performance on two Implicit Relational Assessment Procedures (IRAPs), actual approach behavior towards a live spider (a Behavioral Approach Task, BAT), and the relationship between the IRAPs and the BAT. The research comprised two verbal rehearsal conditions, one that focused on fear-acceptance, the other on fear-reduction, as ways of coping with fear. One IRAP targeted fear (Fear-IRAP), while the other targeted avoidance (Avoidance-IRAP). The Fear of Spider Questionnaire (FSQ) was also employed. The IRAP data broadly supported the previous findings where the Fear- and Avoidance- IRAPs predicted approach behaviors. There were no significant differences between the two verbal rehearsal conditions. However, correlations between performances on the IRAPs and the BAT were concentrated almost exclusively in the fear-reduction condition, rather than the fear-acceptance condition. This pattern suggests that the verbal rehearsal task impacted upon a behavior-behavior relation that may be relevant to the concept of defusion, as employed in the ACT literature.

• Persistent rule-following in the face of reversed reinforcement contingencies: Exploring the dynamics of levels of derivation, relational coherence, and relational flexibility
The importance of the effects of rules and instructions is well-established in the psychological literature. For Relational Frame Theory (RFT), analyses of levels of derivation may be critical to an understanding of rules. However, basic experimental research in this regard is extremely limited. Study1 comprised two experiments, in which participants received either a direct rule or a derived rule (i.e., involving a novel derived relational response). The results showed that the direct rule resulted in more persistent rule-following in the face of competing contingencies than the derived rule, but only when the opportunity to follow the reinforced rule beforehand was relatively protracted. This performance also showed significant correlations with stress. Study 2 explored different levels of derivation on rule-following, and preliminary findings already suggest differential patterns of rule-persistence. Overall, the findings have conceptual implications for an RFT-based account of rule-following., Ghent University
Yvonne Barnes-Holmes, Ghent University
Dermot Barnes-Holmes, Ghent University
Ciara McEnteggart, Ghent University

• An RFT analysis of self-based interventions for public speaking
Ana Belén Gallego Alonso, University of Jyväskylä. Finland
Raimo Lappalainen, University of Jyväskylä. Finland
Matthieu Villatte, Evidence-Based Practice Institute of Seattle

Research in the area of Relational Frame Theory has suggested the importance of emphasising the hierarchical dimension of self and not just the distinction between one's self and one's experiences in self as context exercises. The present study aimed to analyze the comparative effect of two self-based interventions (“Hierarchical Self” and “Distinction Self”). Using a between-subjects design, the participants were randomly assigned to one of the three groups: Group 1 (Hierarchical Self), Group 2 (Distinction Self), Group 3 (Control group). The primary outcome dependent variable was distress tolerance that was measured by the engagement in the behavioral task (i.e., giving a speech in front of a camera). An additional dependent variable was discomfort measured by self-reported questionnaires and physiological measures (skin conductance and heart beat). The independent variable was the intervention to which participants were assigned after the pre-experimental task. The findings indicated that participants´ assessments of their perceived speech performance, and also distress towards giving a speech were reduced in the Hierarchical Self condition compared to the Distinction Self condition. The implications of the findings for clinical practice are discussed.

143. Components that Maximize the Metaphor Effect II: Multiple Exemplars, Common Physical Properties and Nonarbitrary Causal Relations
Symposium (9:30-11:00)
Components: Conceptual analysis, Original data
Categories: Relational Frame Theory, Clinical Interventions and Interests, Metaphor
Target Audience: Beg., Interm., Adv.
Location: Utera

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

Acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is a contextual model of psychological intervention that aims to promote psychological flexibility. To accomplish this aim, metaphors are profusely used in ACT. One of the areas of human cognition most studied by relational frame theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001) is analogical reasoning. The link between ACT and RFT is becoming closer as a theoretical and empirical line of research is emerging that analyzes the components of metaphors that maximize the promotion of psychological flexibility. This symposium presents three empirical studies that extends previous research in this regard by analyzing the effect of common physical properties in the context of multiple examples of metaphors, the role of salience and hierarchical relations in the transformation of functions that occurs in metaphors, and the role of causal and hierarchical relations in metaphor effect.

• The effect of common physical properties and multiple exemplars in metaphor effect
José Simón, Fundación Universitaria Konrad Lorenz
Bibiana Criollo, Fundación Universitaria Konrad Lorenz
María B. García-Martín, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Marco A. Sierra, Fundación Universitaria Konrad Lorenz
Diana Riaño-Hernández, Fundación Universitaria Konrad Lorenz

This experimental analogue study aimed to analyze the effect of two variables in the metaphor effect on promoting psychological flexibility according to RFT: (a) the presence of common physical properties between the individual’s experience and the metaphor, and (b) the proposal of one or multiple examples of similar metaphors. A 2x2 factorial design was implemented. Eighty participants first responded to measures of experiential avoidance. Subsequently, they were exposed to a cold-pressor task at pretest. Afterwards, participants were randomly assigned to four experimental protocols consisting of: (a) a metaphor with common physical properties, (b) a metaphor without common physical properties, (c) three metaphors with common physical properties, and (d) three metaphors without common physical properties. Then, participants were re-exposed to the cold-pressor task (posttest). The results showed the presence of common physical properties increased the effect independently of the number of metaphors proposed.

• Analyzing the salience component in metaphors and hierarchical framing
Carmen Luciano, Universidad de Almería
Adrián Barbero-Rubio, Madrid Institute of Contextual Psychology
Bárbara Gil-Luciano, Madrid Institute of Contextual Psychology
Ángel Alonso, Madrid Institute of Contextual Psychology
Zaida Callejón, Universidad de Almería
L. Jorge Ruiz-Sánchez, Universidad de Almería

Metaphor is a special type of analogical behavior that has been –and still is- difficult to analyze experimentally. Most of the conceptual analysis coincides in the more salient component in the source than in the target to explain how it works. According to RFT, metaphor is a type of relating networks, however experimental analyses are still undone in regard to the conditions under which metaphors work. The present study is one step forward in exploring such specific component on the basis of manipulating the non-arbitrary functions. Thirty participants were divided in four conditions that differ in the type of training series to establish different networks. Then, participants were tested for relating networks. Results were discussed taking into account the characteristics of each protocol.

• Analyzing causality in clinical metaphors and hierarchical framing.
Bárbara Gil-Luciano, Madrid Institute of Contextual Psychology
Ángel Alonso, Madrid Institute of Contextual Psychology
Adrián Barbero-Rubio, Madrid Institute of Contextual Psychology
Carmen Luciano, Universidad de Almería
Zaida Callejón, Universidad de Almería

The present study is focused on the relational analysis of the client`s interactions with his own behaviors on the basis of the analysis done by Törneke et al. (2016). The aim is to isolate the effect of the metaphors components that are used for establishing the client’s discrimination of his behavior and the natural consequences achieved in the short and long terms. Forty participants ran the experiment following several phases. Firstly, they were involved in tasks where discomfort and negative thoughts emerged. Then, a metaphor was incorporated with four different components that were differentiated per condition. Finally, they went into the experimental tasks. Results are discussed in terms of the transformation of functions involved in the different conditions.

144. Current Research on Effects of Psychological Flexibility
Symposium (9:30-11:00)
Components: Conceptual analysis, Original data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Professional Development, Occupational Psychology, Disordered Eating, Paediatrics, Diabetes, Psychological Flexibility
Target Audience: Beg., Interm., Adv.
Location: Estepa

Psychological (in)flexibility is the key concept of Acceptance and Commitment Therapy (ACT). The analysis of the role of psychological flexibility in a variety of mental health and quality of life outcomes has been a traditional research area for Contextual Behavioral Science. This symposium presents four papers that advance in this direction. The first paper will analyze the relationship between psychological flexibility and service user outcomes in mental health staff. The second paper will present a tripartite influence of psychological inflexibility in disordered eating in women. The third presentation will show a study in which the predictive ability of psychological flexibility, mindfulness and parenting in health outcomes in adolescents with diabetes was analyzed. Lastly, the fourth presentation will analyze the relationship between psychological flexibility and subjective wellbeing in people attending mental health services. Taken together, these papers will show the relevance of investigating the relationship of psychological flexibility with mental health and quality of life outcomes.

• Experiential Avoidance is Associated with Military Sexual Trauma Non-disclosure in Female Service Members/Veterans
Rebecca K. Blais, PhD, Utah State University
Emily Brignone, ABD, Utah State University
Michael E. Levin, PhD, Utah State University

Roughly 25% of female Veterans (FVs) do not disclose military sexual trauma (MST). Non-disclosure prevents the provision of mental health services that can reduce the sequelae of MST. Experiential avoidance, or actions that avoid reliving painful, traumatic memories, may be an important barrier to disclosure. This study sought to identify reasons for MST non-disclosure in 111 FVs. FVs provided reasons for non-disclosure using free text responses, which were analyzed using editing analysis style. Experiential avoidance was identified as a barrier to disclosure in 20% (n=22) of the sample. Sample responses included: “I didn’t want to relive it,” “brings up too many bad memories,” and “I just…wanted to forget and move on…” Other barriers included stigma (35%,n=39) and discomfort with screening setting (24%,n=27). Data collection is in progress to determine the association of experiential avoidance and MST non-disclosure in male veterans. ACT could help reduce experiential avoidance related to MST non-disclosure.

• The role of psychological inflexibility in the tripartite influence model for women: A single body image inflexibility pathway to disordered eating behaviours.
Catrin Griffiths, Doctorate in Health Psychology, University of the West of England, Bristol, UK
Tim Moss, PhD, University of the West of England, Bristol, UK
Nichola Rumsey, PhD, University of the West of England, Bristol, UK
Heidi Williamson, Doctorate in Health Psychology, University of the West of England, Bristol, UK
TracyTylka, Ohio State University

Sixty percent of women regularly engage in disordered eating, which is associated with the development of diagnosable eating disorders and obesity. In the current study latent structural equation modelling (SEM) tested an adapted version of the Tripartite Influence Model of body image and disordered eating with the inclusion of body image inflexibility, among 378 adult women. Body image inflexibility represented a single pathway which fully mediated the relationship between women’s body image and their engagement in disordered eating. Body image inflexibility also fully mediated the relationships between internalisation of the thin ideal and disordered eating, and between pressure from friends and disordered eating. Perceived pressure to be thin from friends, partners, family and the media also had distinct relationships within the model. The results highlight the importance of including body image inflexibility as a mediating variable in theoretical models of disordered eating and as a construct treatment interventions can target.

• An exploration of the role of psychological flexibility, mindfulness and parenting in predicting health outcomes in adolescents with type 1 diabetes
Lorraine Lockhart, DClin, University of Edinburgh, NHS Forth Valley
Nuno Ferreira, PhD, University of Edinburgh

Purpose: The current study was designed as an initial exploration of the associations between psychological flexibility and mindfulness, parenting behaviours and diabetes-related outcomes, specifically quality of life and treatment adherence. Methodology: A cross-sectional quantitative design was used. Forty five dyads of adolescents (aged 12-18) diagnosed with Type I diabetes and their parents responded to a survey comprised of the following measures - Adolescents: AAQ-Y , CAMM, DAAS, PBI , DQoLY , Self-Care inventory ; Parents: FFMQ , AAQ-II. Results: Higher levels of mindfulness and Psychological Flexibility in young people were associated with better self-care behaviours (r=.49; r=.54) and Quality of Life (r=.62; r=.42). Parental variables were not related to any of the outcomes. Higher levels of Psychological Flexibility in parents were associated with better self-care behaviours (r=.43) and QoL (r=.33), whilst parental mindfulness was only associated with better QoL (r=.35). Preliminary regression models seems to suggest that Adolescent diabetes acceptance and parental psychological flexibility are significant predictors of self-care whilst Adolescent mindfulness and type of Insulin administration are significant predictors of QoL. Conclusions: Psychological flexibility and mindfulness are useful constructs for understanding health outcomes in adolescents with type 1 diabetes suggesting acceptance and commitment and mindfulness-based therapies may be beneficial for improving outcomes in this population.

• Subjective Wellbeing and Psychological Flexibility in People Attending Mental Health Services
Ross White Ph.D, DClinPsy, University of Liverpool
Judith McCluskey, NHS Greater Glasgow and Clyde

Background: Subjective wellbeing has been recognised as an important outcome for those experiencing mental health difficulties. This study investigated associations between psychological flexibility and subjective wellbeing in people attending mental health services in the UK. Method: A total of 132 individuals attending mental health services in the UK participated in this study. Participants completed a battery of assessments including the Mental Health Continuum-Short Form (MHC-SF), Hospital Anxiety and Depression Scale (HADS), and Acceptance and Action Questionnaire (AAQ-II). A cross-sectional design was used. Results: Participants were divided into three groups according to their levels of subjective wellbeing assessed by the MHC-SF: "Languishing” (n=61), "Flourishing" (n=13) and "Moderately Mentally Healthy" (n=58). A statistically significant difference was found in the AAQ-II scores between the 3 groups (F (2, 129) = 28.80, p < .0001, η2=0.56) and this difference remained significant when depression (F (2, 128) = 4.26, p < .05) and anxiety (F (2, 128) = 14.45, p < .0001) scores were controlled for. Conclusion: The findings highlight the potentially important contribution that Acceptance and Commitment Therapy interventions may offer for improving levels of subjective wellbeing in people experiencing mental health difficulties.

152. Psychological Flexibility and Acceptance and Mindfulness-Based Treatments for Chronic Health Conditions
Symposium (11:15-12:30)
Components: Original data
Categories: Clinical Interventions and Interests, Behavioral medicine, ACT, Mindfulness, HIV, Health Psychology, Parents and Children with Chronic Illness
Target Audience: Beg., Interm., Adv.
Location: Buhaira

There is increasing evidence that psychological flexibility (PF) is a key variable in the adaptive adjustment to chronic health conditions. Also, acceptance and mindfulness-based treatments aimed at increasing PF have proven useful in improving the management of health and chronic illness. The present symposium includes four papers that address different aspects of the relationship between PF and health management in chronic disease. The first paper will present data on the efficacy and cost-effectiveness of a group-based ACT treatment for fibromyalgia from a randomized controlled trial conducted in Spain (EFFIGACT study). The group-ACT (GACT) treatment was more clinically effective than recommended pharmacological treatment (pregabalin + duloxetine) and a wait-list condition, with clinical improvements maintained at 6 months with medium effect sizes in most measures. Also, GACT was related to significantly less direct costs over the 6 months study period compared to both control arms. The second paper will present an analysis of the long-term outcomes of the Mindfulness Based Program for Infertility (MBPI) for a sample of 55 infertile women. Results show that in the seven-year period after treatment, there were sustained improvements in emotion regulation and psychopathological symptoms for participants in the program. The third paper in the symposium will present a randomized controlled trial conducted in Spain of a brief ACT intervention for newly diagnosed HIV patients. HIV diagnosis entails social stigma, fear of rejection, and chronicity, and is associated to impaired quality of life. The analysis will focus on identifying what patients may benefit most from the intervention and to which extent ACT could play a preventive role in comprehensive care for HIV patients. The last paper in this symposium explores the relationships between PF, asthma knowledge, and asthma management self-efficacy in parents of children with asthma and their children’s asthma morbidity. Parents of children aged 3-12 years with asthma completed a cross-sectional survey assessing their PF, asthma knowledge, asthma management self-efficacy, their children’s asthma symptoms and their use of inhaled bronchodilators. Results show that parental PF is positively associated to asthma knowledge, asthma management self-efficacy, and less asthma morbidity in children.

• Effectiveness and cost-utility of Group Acceptance and Commitment Therapy for Fibromyalgia versus recommended drugs: Results from a 6-month randomised controlled trial conducted in Spain (EFFIGACT study)
Albert Feliu-Soler, Ph.D, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
Francesco D’Amico, Ph.D, Personal Social Services Research Unit, London School of Economics and Political Science, London
Adrián Pérez-Aranda, MSc, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
Laura Andrés-Rodríguez, MSc, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
Javier García-Campayo, Ph.D, Miguel Servet University Hospital, University of Zaragoza, Spain
Juan V. Luciano, Ph.D, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain

In the last decade, there has been burgeoning interest in the effectiveness of third-generation psychological therapies for managing fibromyalgia (FM) symptoms and there is also a need for studies evaluating the cost-effectiveness of pharmacological and non-pharmacological interventions in FM. The present work examined the clinical effectiveness and cost-utility of a group-based form of acceptance and commitment therapy (GACT) compared to recommended pharmacological treatment (RPT) or waiting list (WL). A total of 156 patients with FM were enrolled at primary health care centers in Zaragoza (Spain) and were randomly assigned to a group-based form of ACT (GACT; N=51), recommended pharmacological treatment (RPT = pregabalin + duloxetine; N=52), or wait list (WL; N=53). The primary clinical end point was functional status (measured with the Fibromyalgia Impact Questionnaire) and the secondary clinical end points included pain catastrophizing, pain acceptance, pain, anxiety, depression, and health-related quality of life. All clinical measures were assessed at baseline, after treatment and at 6-month follow-up. Health economic outcomes included health-related quality of life and healthcare use at baseline and at 6-month follow-up using the EuroQol (EQ-5D-3L) and the Client Service Receipt Inventory (CSRI), respectively. The differences between groups regarding clinical data were calculated by linear mixed-effects (intention-to-treat approach). Cost-utility analyses included Quality-Adjusted Life Years (QALYs), direct and indirect cost differences, and incremental costeffectiveness ratios (ICERs). Patients allocated to GACT showed superior improvement regarding functional impairment (d= 1.43), pain catastrophising (d= 0.69), pain (d= 0.47), anxiety (d= 0.39), depression (d= 0.37), pain acceptance (d= 1.01) and health-related quality of life (d= 0.66) compared to both RPT and WL immediately after treatment. Clinical improvements were maintained at 6 months with medium effect sizes in most cases. GACT was related to significantly less direct costs over the 6 months study period compared to both control arms (GACT €824.2 ± 1,062.7 vs. RPT €1,730.7 ± 1,656.8 vs WL €2,462.7 ± 2,822.0). Lower direct costs for GACT in comparison to RPT were due to lower costs from primary care visits and FM-related medications. The ICERs were dominant in the completers' analysis and remained robust in the sensitivity analyses. In conclusion, ACT appears to be an effective and cost-effective treatment in comparison to RPT in patients with FM.

• The Mindfulness Based Program for Infertility (MBPI): A seven-year follow-up study
Ana Galhardo, Ph.D., Instituto Superior Miguel Torga: CINEICC-Faculty of Psychology and Educational Sciences of the University of Coimbra
Marina Cunha, Ph.D., Instituto Superior Miguel Torga: CINEICC-Faculty of Psychology and Educational Sciences of the University of Coimbra
José Pinto-Gouveia, M.D., Ph.D., CINEICC-Faculty of Psychology and Educational Sciences of the University of Coimbra

This study examines whether there are long-term effects of the MBPI encompassing four moments: pre-MBPI (T1), post-MBPI (T2), six-months follow-up (T3) and seven-year follow-up (T4). Fifty-five women completed the MBPI and questionnaires assessing depressive and anxiety symptoms, experiential avoidance and mindfulness at T1, T2 and T3. Seven years later, participants completed the self-report measures online [response rate 73% (n = 40)]. Repeated measures ANOVAs showed significant direct effects of time with medium effect sizes in mindfulness (F = 7.16; p < .001; Ƞ2p = .24), experiential avoidance (F = 10.75; p < .001; Ƞ2p = .22), depressive symptoms (F = 11.68; p < .001; Ƞ2p = .23), and anxiety symptoms (F = 7.31; p < .001; Ƞ2p = .16). In the seven-year period there were sustained improvements in emotion regulation and psychopathological symptoms. Although further research is needed to replicate these findings, the MBPI gains seem to persist over time.

• Can ACT help patients to cope with HIV diagnosis? A randomized controlled trial in newly diagnosed HIV patients
Francisco Montesinos, Ph.D., European University of Madrid
Federico Pulido, Ph.D., Hospital Universitario 12 de Octubre, Madrid
Federico Pulido, Hospital Universitario 12 de Octubre, Madrid
M.Asunción Hernando, European University of Madrid
M.Asunción Hernando, European University of Madrid
Marisa Páez, Instituto ACT, Madrid
Alicia González , Hospital Universitario La Paz, Madrid
Ignacio Perez-Valero, Hospital Universitario La Paz, Madrid

Learning to live with uncertainty and risk of social rejection is not easy. Despite the medical advances, even today HIV diagnosis involves chronicity and stigma. This context can imply a noteworthy emotional impact and significant decrease in quality of life. 54 newly diagnosed HIV patients were recruited in two hospitals in Madrid and randomly assigned to control or ACT condition. The aim of our study was to determine the efficacy of an ACT-based abridged intervention. A protocol was designed and applied through 3 intensive individual sessions. Measures related with quality of life, anxiety, depression, psychological flexibility, cognitive fusion, CD4 and viral load levels at pre-intervention and 3, 6 and 12 months later were collected. Preliminary analysis comparing pre and post treatment measures will be presented. Analysis will be aimed at identifying which patients may benefit most from the intervention and what extent ACT could play a preventive role in in comprehensive care for HIV patients.

• The Relationships Between Psychological Flexibility, Asthma Knowledge, and Asthma Management Self-Efficacy Among Parents of Children with Asthma and Their Children’s Asthma Morbidity
Yuen Yu CHONG, PhD student, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
Yim Wah MAK, Ph.D, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
Alice Yuen LOKE, Ph.D., School of Nursing, The Hong Kong Polytechnic University, Hong Kong

Psychological flexibility (PF) refers to an individual’s capacity to draw on personal experiences to either persist in or change their behaviors for the purpose of valued living. Parental PF may have dual effects on parents in choosing appropriate strategies to manage childhood health problems and on their children’s health outcomes. This study was to examine the role of parental PF in the parental learning about childhood asthma management (such as parental knowledge and self-efficacy) and the asthma morbidity of their children (such as asthma symptoms or the use of symptom-relieving medications). Three hundred and twenty-four parents of children aged 3-12 years with asthma completed a cross-sectional survey assessing their PF, asthma knowledge, asthma management self-efficacy, their children’s asthma symptoms and their use of inhaled bronchodilators. The results from the structural equation modeling showed that more PF in parents was significantly associated with better asthma knowledge and asthma management self-efficacy. Furthermore, the parents’ PF was the only latent construct that was significantly associated with their children’s asthma morbidity (β = .34, p = .001). Fostering the PF of parents in the childhood asthma care might reduce their children’s asthma symptoms.

153. Exploring RFT Implications for Education
Symposium (11:15-12:30)
Components: Original data
Categories: Relational Frame Theory, Clinical Interventions and Interests, Educational settings, Children, Education
Target Audience: Beg., Interm., Adv.
Location: San Bernardo

Yvonne Barnes-Holmes, Ghent University
Dr. Ciara McEnteggart, Department of Experimental Clinical and Health Psychology, Ghent University, Belgium

ACBS has focused much of its energy and interest on clinical understanding, assessment, and application. While this is an important area of ongoing development for our community, educational focus significantly lags behind and yet remains an important area for futher exploration and expansion in a CBS field. This symposium on education contains two papers, thus leaves room for further discussion of why this area of our field stuggles to draw the enthisuaism of researchers and practitioners, relative to clinical interests. Paper 1 has two aims. 1. It contains data pertaining to a protocol of training repertoires of derived relational responding. 2. It explores the challenges commonly encountered in doing this type od developmental/educational research. Paper 2 is part of the same RFT-based educational research program underway in Poland. This paper focuses particularly on prerequisities to repertoires of, and competencies in, deictic relational responding. Consistent with previous research, the work also explores the potential relationship between deictic competence and traditional theory of mind tasks.

• Exploring challenges in the assessment of relational responding in typically-developing children.
Krystyna Pomorska, MSc, University of Social Sciences and Humanities, Warsaw
Yvonne Barnes-Holmes Ph.D., University of Gent
prof. Paweł Ostaszewski, University of Social Sciences and Humanities, Warsaw

In spite of the substantive body of research on RFT, work on its potential application to education and remedial education lag behind other areas. Assessing relational repertoires in children is far from easy, given that these repertoires form the basis of language itself. Existing protocols for testing and training derivation are usually adopted from experimental protocols and seem odd and boring when presented even to typically-developing children. For children, referred to as atypical, it is often difficult to even determine what they are being asked, hence making it more difficult for assessors to determine whether the target skills are partially present. Finding the balance between presenting the task clearly (often requiring non-arbitrary examples), and at the same time assessing arbitrary applicable relational responding (AARR) is critical to the integration of RFT concepts into remedial education. The purpose of this presentation is to highlight obstacles we have recently observed in testing frames of coordination, distinction, comparison, opposition as well as deictic frames in typically-developing children aged 6-8 (N=30).

• Do we know everything about Theory of Mind? What a functional analysis of language brings to our understanding of perspective-taking skills in typical and atypical development.
Krystyna Pomorska, MSc, University of Social Sciences and Humanities, Warsaw
Yvonne Barnes-Holmes, Ph.D., University of Gent
prof. Paweł Ostaszewski, University of Social Sciences and Humanities, Warsaw

In mainstream psychology, perspective-taking skills have primarily been studied under the rubric of the Theory of Mind. While widely accepted, many questions remain to be answered by this approach and its potential application to remedial education. In contrast, behavioral researchers, working under the rubric of Relational Frame Theory, have defined perspective-taking in terms of repertoires of deictic relational responding. There is already a substantive body of evidence in support of this definition, as well as a number of studies to support its educational applicability. The purpose of this presentation is to illustrate the potential overlap and differences between deictic relational responding and theory of mind abilities (first- and second-order beliefs) at different stages of development (sample has N = 30) and different levels of verbal behavior. The data highlights the effectiveness of an intervention, based on training deictic relational responding, on theory of mind skills in typically-developing children and children with autism.

• Emergence of untrained verbal proficiency following an RFT based training on categories
Giovambattista Presti, Facoltà di Scienze dell’Uomo e della Società, Università “Kore” di Enna, Italy
Melissa Scagnelli, Istituto G. Fabris, Università IULM, Milano, Italy
Melissa Zecchin, Istituto scientifico “Eugenio Medea” Bosisio Parini, Lecco, Italy
Catia Rigoletto, Istituto scientifico “Eugenio Medea” Bosisio Parini, Lecco, Italy
Massimo Molteni, Istituto scientifico “Eugenio Medea” Bosisio Parini, Lecco, Italy
Paolo Moderato, Istituto G. Fabris, Università IULM, Milano, Italy

Much of our understanding of human cognition depends on our understanding of categorization. Behavior analysts have investigated taxonomical categorization for years without the need for relying on concepts as mental representations of categories. A categorical concept could be defined as a class stimuli (objects, actions, etc.) that control similar responses. Most of these concepts are acquired through formal or informal education, when the same response (e.g., saying ‘‘bird’’) is reinforced in the presence of several different stimuli (e.g., birds), but not in the presence of other animals or objects.Researchers in the field of Relational Frame Theory, a theory of language and human cognition have elaborate effective procedures to train categorization, however little is known on the more general effects of these training on special populations and on language skills in general. The aim of this study was to evaluate the efficacy of an RFT based procedure in teaching categories to children diagnosed with language disorders and its more general impact on language skills as measured with standardized testing. Twenty-two 3 to 7 years old children with a diagnosis of language disorder (F 80.1) according to ICD 10 criteria were first trained to respond to a “give me…” question (AB) and then to match groups of items (BC) and then tested in the derived relations over twelve categories. At the end of the testing phase an additional test was performed: Responding to “The X is a…?” and “Tell me the Y you know”, where X is an item in a category and Y are the categories. Data show a highly statistically significant increase not only with respect to the derived relational behaviors and in items spontaneously listed but also on standardized scoring with TVL (Test for assessment of the language) at baseline, after treatment and follow up in the following areas: Words comprehension (Wilcoxon test=2.748, p=0.006), Sentences comprehension (Wilcoxon test=3.080, p=0.002), Echoic of sentences (Wilcoxon test=3.348 p<0.001)labeling (Wilcoxon test=3,398, p<0.001).Preliminary data of a training based on a frane of coordination suggest that effects on language can go beyond the trained stimuli and categories.

154. Implementation and Empirical Support for Acceptance and Commitment-Therapy in Psychiatric Inpatient Settings
Symposium (11:15-12:30)
Components: Original data, Didactic presentation
Categories: Clinical Interventions and Interests, Clinical Interventions and Interests, Other, Clinical Psychiatric Inpatient Setting
Target Audience: Beg., Interm., Adv.
Location: Lebrija

Marcia Rinner, M.Sc., University of Basel, Switzerland
Andrew T. Gloster, Prof. Dr., University of Basel, Switzerland

To date, applications and research of ACT have concentrated predominantly on outpatient settings. However, ACT is increasingly applied in other clinical domains, such as inpatient settings. This symposium aims to present three different implementations of ACT in inpatient settings and the empirical testing of these settings via effectiveness studies.

• Influencing Factors of ACT compared to CBT in a naturalistic inpatient setting.
Mareike Pleger, M.Sc., Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
Prof. Albert Diefenbacher, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
Dr. Christoph Schade, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
Andrew T Gloster, Prof. Dr., Univeristät Basel, Switzerland
Prof. Thomas Fydrich, Humboldt-University, Berlin, Germany

The first talk presents data drawn from a quasi-randomized clinical trial, which conducts the effectiveness of ACT compared to CBT within a naturalistic setting. Results of our preliminary study indicate ACT and CBT to be equally effective treatments. In this symposium pilot results of our current study will be presented, which focuses on specific patient dispositions that might predict differing positive therapeutic outcomes according to each treatment approach. 170 transdiagnostic inpatients of a German psychiatric department were assigned to either ACT or CBT condition and assessed with respect to different symptom measures as well as ACT-specific outcomes.

• Implementing multi-professional ACT-treatment in a day-care setting
Inga-Marlen Pontow, M.Sc., Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
Ronald Burian, Dr. med., Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
Prof. Albert Diefenbacher, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany

The second talk will present the implementation of Acceptance and Committment Therapy (ACT) in a psychosomatic day-care clinic. It will emphasize the opportunities of working with ACT in a multi-professional team especially with patients that suffer not only from mental (such as somatization or other affective disorders) but comorbid from medical disorders (such as diabetes or coronary heart diseases). First pilot data will be presented that are based on pre to post-treatment assessments. Preliminary analyses indicate that patients benefit in terms of psychological flexibility and also in terms of symptom reduction even though this is not the core target of ACT.

• ACT –based inpatient setting for chronic and treatment resistant mental diseases
Charles Benoy, M.Sc., Psychiatric Hospital of the University of Basel, Switzerland
Isabell Schumann, lic. phil., Psychiatric Hospital of the University of Basel, Switzerland
Katrin Pinhard, med. pract., Psychiatric Hospital of the University of Basel, Switzerland
Veronika Kuhweide, Psychiatric Hospital of the University of Basel, Switzerland
Marc Walter, Prof. Dr. med., Psychiatric Hospital of the University of Basel, Switzerland
Andrew T. Gloster, Prof. Dr., Universität Basel, Switzerland

The third study presents pilot-data from a prospective effectiveness study analyzing an ACT-based inpatient setting for chronic and treatment resistant mental disorders. The analysis is based on a trans-diagnostic sample of N=79 patients and includes pre to post- treatment assessment battery and weekly process measures form three sources: patients, therapists, and nurses. Preliminary analyses show a moderate to large effect size in primary outcomes. Analyses will be presented that document change across numerous ACT and competing constructs as well as examining weekly-process patterns of change.

155. Contextual Behavioral Science Applications in Autism and Intellectual Disabilities
Symposium (11:15-12:30)
Components: Conceptual analysis, Literature review, Original data, Didactic Presentation,
Categories: Clinical Interventions and Interests, Behavioral medicine, Intellectual Disabilities, Autism
Target Audience: Interm., Adv.
Location: Utera

The most popular area of Applied Behavior Analysis is the intervention in autism and intellectual disabilities. As originated in Behavior Analysis, Contextual Behavioral Science (CBS) can contribute to improve these applications by providing a functional analysis of language and cognition. This symposium presents important advances in this direction. The first presentation will show the application of RFT-based training in a Child Psychiatry Unit conducted in Italy. The second presentation will address the possibilities of the Relational Evaluation Procedure (REP) for assessing and training children with autism. The third paper will show how to conduct a functional analysis and case conceptualization for people with intellectual disabilities. Lastly, the fourth paper will present the application of the Implicit Relational Assessment Procedure (IRAP) for measuring the effect of public messaging on attitudes towards autism. Overall, these presentations show the breadth of CBS applications to this applied area.

• Educational application of RFT based training in a Child Psychiatry Unit in the National Health System in Italy: A pilot study
Giovambattista Presti, IESCUM, Istituto Europeo per lo Studio del Comportamento Umano Università Kore
Antonella Costantino, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico
Melissa Scagnelli, IESCUM, Istituto Europeo per lo Studio del Comportamento Umano
Francesca Brasca, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico
Davide Carnevali, IESCUM, Istituto Europeo per lo Studio del Comportamento Umano
Martina Leuzzi, IESCUM, Istituto Europeo per lo Studio del Comportamento Umano
Concetta Messina, IESCUM, Istituto Europeo per lo Studio del Comportamento Umano
Paolo Moderato, IESCUM, Istituto Europeo per lo Studio del Comportamento Umano Libera Università di Lingue e Comunicazione IULM

A joint pilot project between IESCUM and UONPIA of Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico addressed clinically relevant repertoires of 11 children with a diagnosis of Language Disorder and Dyslexia ranging from 3 to 11 years old. Research involved the application of clinical procedures based on Relational Frame Theory (RFT) to address language and reading issues. Categorization and reading are considered fundamental skills to promote development of thought, action and speech and to allow better adaptation to the natural and social environment. Trainings based on its principles showed efficacy in promoting the development of complex skills. Data show that procedures based on the frame of coordination promoted the emergence of skills beyond the specific responses taught in the categorization and reading trainings. There was a highly statistically significant increase, between baseline and end of intervention, in both trained and untrained behaviors. Significant differences in standardized test performance for language and reading were also found.

• Assessing and training children with autism spectrum disorder using the Relational Evaluation Procedure (REP)
Orla Corbett, National University of Ireland Galway
Jennifer Hayes, National University of Ireland Galway
Ian Stewart, National University of Ireland Galway
John McElwee, Private Practitioner
Concetta Messina, IESCUM, Istituto Europeo per lo Studio del Comportamento Umano
Paolo Moderato, IESCUM, Istituto Europeo per lo Studio del Comportamento Umano Libera Università di Lingue e Comunicazione IULM

The relational evaluation procedure (REP) is seen by proponents of relational frame theory (RFT) as a useful means by which to assess and train relational responding. Most REP work so far has been conducted with typically developing adults; however, given the importance of relational responding as a repertoire and of the potential utility of the REP for assessing and training this repertoire, researchers need to investigate its use with other populations including children with autism and other developmental delay. The current study presents relevant data. Nine children were initially assessed using a simple REP-based multi-level protocol (the NSD-REP) and on a measure of linguistic ability (Pre-school Language Scale, 4th Edition; PLS4). Three children found to pass Level 1 (same and different relations) but not Level 2 (affirmation and disconfirmation of same and different relations) were subsequently given a training intervention in the latter using a multiple baseline design. These findings supplement previous data suggesting the utility of the REP for training relational responding in children with autism.

• From ABA to ACT: functional analysis and case conceptualization for people with intellectual disabilities and psychopathology
Giovanni Miselli, PhD BCBA, Fondazione Istituto Ospedaliero di Sospiro Onlus (CR) Italy
Roberto Cavagnola, Psy D., Fondazione Istituto Ospedaliero di Sospiro Onlus (CR)
Mauro Leoni, PhD, Fondazione Istituto Ospedaliero di Sospiro Onlus (CR), University of Pavia
Serafino Corti, PhD, Fondazione Istituto Ospedaliero di Sospiro Onlus (CR), Università Cattolica Brescia Italy
Francesco Fioriti Ed.D, Fondazione Istituto Ospedaliero di Sospiro Onlus (CR)
Giuseppe Chiodelli, MD; Laura Galli, MD; Michela Uberti, MD, Fondazione Istituto Ospedaliero di Sospiro Onlus (CR)
Giovanni Michelini, PhD., Fondazione Istituto Ospedaliero di Sospiro Onlus (CR)

People diagnosed with intellectual disabilities and neurodevelopment disorders have a greater risk to develop a psychiatric disorder, despite this knowledge these conditions often and undiagnosed and untreated. The purpose of this talk is present a review on evidence -based intervention concerning the reduction of psychopatology and improvement of quality of life in people with intellectual disabilities and present procedure for functional analysis and case conceptualization field tested in a Department for Disabilities in Northern Italy. Theoretical models and literature are reviewed form ABA, Cognitive Behavior Therapy and Third Generation Cognitive Behavioral Therapies, with a specific focus on contextual behavioral science and ACT. Model and procedure for functional analysis and case conceptualization for this complex population will be presented theoretically and illustrated through single case intervention.

• Using the IRAP to investigate the effect of public messaging on attitudes towards autism
Diana Bast, PhD, National University of Ireland Galway
Christina Lyons, National University of Ireland Galway
Ian Stewart, PhD, National University of Ireland Galway

Although public awareness of autism has improved in recent times, there are still misunderstandings or judgmental attitudes based on misinformed stereotypes. This study investigated the effects on implicit (IRAP-based) and explicit (IRAP-analogue) attitudes of different types of messaging on autism. Undergraduates were randomly assigned such that Group 1 was shown a relatively negative video showing behavioral problems in autism, while Group 2 was shown an ostensibly positive video delivered by a successful adult diagnosed as autistic as a child. Analysis showed no between group difference on the explicit measure but a significant difference between the groups on the IRAP such that G2 (positive) showed significantly higher levels of anti-Autism/pro-Normal bias than G1 (negative) both within (d=.76, p<.001) and across IRAP (d=2.6, p=.0098) trial types. These apparently counter-intuitive data will be discussed in terms of subtleties of anti-prejudice messaging as well as issues of malleability and implicit-explicit divergence.

156. Contextual Behavioral Science and Mental Health
Symposium (11:15-12:30)
Components: Conceptual analysis, Literature review, Original data,
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Crisis Intervention, Global Mental Health, Third Wave Cognitive Behavioural Therapies, Psychosis
Target Audience: Beg., Interm., Adv.
Location: Estepa

Contextual Behavioral Science (CBS) is providing a wide range of applications to enhance mental health in a variety of contexts. This symposium will present some reflections and applications of CBS in this area. The first presentation will review the evidence supporting brief applications of Acceptance and Commitment Therapy (ACT) and highlight the relevance of research in this area, which could lead to effective and low-cost applications of ACT in several socially-relevant domains. The second paper will reflect on the contribution that CBS can make to global mental health due to the cross-cultural utility of ACT and its focus on enhancing wellbeing instead of focusing on reducing symptoms. The third paper will present a systematic review of the cost-effectiveness of third wave therapies in the treatment of patients with physical or mental conditions. Lastly, the fourth paper will present the data from a multiple baseline design that analyze the effect of a 10-session individual protocol of a combination of ACT and behavioral activation with patients with psychosis.

• ACT in crisis intervention. A critical review.
Lidia Budziszewska, Universidad Europea de Madrid, Spain
Pablo Ruisoto, Universidad Europea de Madrid & University of Salamanca

In recent decades, the number of lab-controlled studies in ACT have multiplied supporting the validity of the core therapeutic processes of ACT (A-Tjak, Davis, Morina, Powers, Smits, & Emmelkamp, 2015), but more naturalistic approaches such as brief interventions in crisis remains a challenge, although successful experiences keep building up (Stroshal, Robinson, Gustavsson, 2012). For example, brief interventions working with former child soldiers, street children and victims of violence (Dahl, 2011, 2012). Two main reasons justify this study: first, dose/effect studies have found that most change in therapy happens before session (Strosahl, 2010); second, some context, such as currents interventions with refugees. The aim of this paper is twofold: 1) to critically review studies focused on brief interventions for high distress situations outlining key principles of brief ACT intervention in crisis, and 2) to review the available data about its efficacy and effectiveness. Key concepts, such as suffering and change, and the relevance of developing value-based brief interventions in multicultural contexts with limited funds, instead of expensive pathology centered long-term therapy will be further discussed underlying differences with biomedical model (DSM) approach. Hopefully, this study will foster new efforts to increase public investment to address crisis.

• The Contribution that Contextual Behavioural Science can make to Global Mental Health
Ross White, University of Liverpool

Global Mental Health initiatives aim to address inequities in mental health provision across the world, and place particular emphasis on building mental health service capacity in low- and middle-income countries (LMIC) where over 80% of the global population is living. Consistent with this approach, concerted efforts are being made to globally disseminate psychological therapies. These efforts will need to negotiate the tensions that exist between making therapies sufficiently scalable, whilst retaining features of the psychotherapy that maximize both the acceptability and efficacy of the intervention. This paper reflects on the important contribution that Contextual Behavioral Science (CBS) can make to Global Mental Health (GMH). This includes consideration of the cross-cultural utility and validity of Acceptance and Commitment Therapy (ACT), and the way in which CBS approaches can help ensure that GMH initiatives do not narrowly focusing on symptoms of mental disorders rather than enhancing wellbeing. Knowledge from ACT and Functional Analytical Psychotherapy can help build sophistication in efforts to develop and deliver programmatic/’therapist-free’ forms of psychotherapy that will need to retain sensitivity to even subtle forms of emotional expression from clients. In addition, the PROSOCIAL approach provides opportunities for groups of people to cooperate effectively to achieve shared aspirations and build ‘communities of support’ that can serve to optimize peoples’ mental health and wellbeing. Examples of CBS-related work being undertaken in LMIC will be used to illustrate these possibilities.

• Cost-effectiveness of 'Third Wave' Cognitive and Behavioral Therapies: A Systematic Review and Quality Assessment of Economic Evaluations Alongside Randomized Controlled Trials
Juan V. Luciano, Ph.D, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
Albert Feliu-Soler, Ph.D, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
Laura Andrés-Rodriguez, MSc, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
Adrián Pérez-Aranda, MSc, Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
Francesco D’Amico, Ph.D, Personal Social Services Research Unit, London School of Economics and Political Science, London,
Lance M. McCracken, Ph.D, Institute of Psychiatry, Psychology & Neuroscience, King’s College London

The term “third wave” cognitive behavioural therapy (CBT) encompasses new forms of CBT that both extend and innovate within CBT. Most third-wave therapies have been subject to RCTs focused on clinical effectiveness, however the number and quality of economic evaluations alongside these RCTs has been unknown and may be few. Evidence about the cost-effectiveness of these therapies may help support decisions on efficient allocation of resources in health policies. The main aim of this study was to systematically review the cost-effectiveness of third wave therapies in the treatment of patients with physical or mental conditions. We conducted a systematic literature search in PubMed, PsycINFO, EMBASE, and CINALH to identify economic evaluations of third wave therapies. Quality and Risk of Bias (RoB) assessment of economic evaluations was also made using the Drummond 35-item checklist and the Cochrane Collaboration’s Risk of bias assessment tool, respectively. Ten RCTs were included in this systematic review. Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and extended Behaviour Activation (eBA) showed acceptable cost-effectiveness and cost-utility ratios. No study employed a time horizon of more than 3 years. Quality and RoB assessments highlight some limitations that temper the findings. There is some economic evidence that MBCT, MBSR, ACT, DBT, and eBA are cost-effective from a societal or a third-party payer perspective. For many third wave interventions, no single economic evaluation alongside RCTs was identified. More economic evaluations with high methodological quality are needed.

• Psychological treatment for inpatients with psychosis
Cornelia Larsson, licensed psychologist adn psychotherapist, doctoral student, Centre for psychiatry research, Stockholm County Council & Dep.of Clinical Neuroscience Karolinska institutet, Stockholm, Sweden
Thomas Parling, PhD, Centre for psychiatry research, Stockholm County Council & Dep.of Clinical Neuroscience Karolinska institutet, Stockholm, Sweden
Tobias Lundgren, PhD, Centre for psychiatry research, Stockholm County Council & Dep.of Clinical Neuroscience Karolinska institutet, Stockholm, Sweden
Helena Fatouros-Bergman, PhD, Centre for psychiatry research, Stockholm County Council & Dep.of Clinical Neuroscience Karolinska institutet, Stockholm, Sweden

National guidelines in Sweden recommend individual cognitive behavior therapy as a prioritized intervetnion for those suffering from schizophrenia. However, a majority of inpatient wards lack psychological / psychotherapeutic competence to deliver these interventions. Recent studies have shown that acceptance based therapies are acceptable for patients with psychosis (Cramer et al., 2016), reduce positive symptoms (Shawyer et al., 2012), and reduce negative symptoms (White et al., 2011). The feasibility and effectiveness of behavioral activation for inpatients with psychosis have been shown in a preliminary study (Mairs et al., 2011). The study protocol includes one introductory session followed by three sessions each adressing; behavioural activation, acceptance of voices/thoughts and acceptance of affects/emotions. Aims: is an acceptance based therapy (10 daily individual sessions) acceptable, does it increase experienced health status, valued activities, and does it decrease psychotic symptoms in a Swedish inpatient context. Method: Participants from two inpatient wards are invited to 10 daily sessions. The study is a multiple baseline design with consecutive patients, the goal is to include n=12 participants. The study is ongoing and therefore no results are available at this timepoint. We will discuss the suitability of the intervention in a Swedish context parallell to the outcome.