Thursday, July 26
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Thursday, July 26

9. Using ACT in the Treatment of More Complex Forms of Depression: Examples in Three Clinical Settings
Symposium (10:35am-12:05pm)
Components: Original Data
Categories: Clinical Interventions and Interests, Depression
Target Audience: Beg., Interm., Adv.
Location: Rue Sainte-Catherine

Chair: Kristy Dalrymple, Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University
Discussant: Robert Zettle, Ph.D., Wichita State University

ACT has demonstrated efficacy for the treatment of depression and is listed as an empirically supported treatment. However, additional research is needed to examine the application of ACT in routine psychiatric settings in which clients present with more severe/complex forms of depression. ACT may be particularly helpful for those who experience more severe and functionally impairing depression, given its emphasis on improving quality of life (e.g., Berk et al., 2012; Bohlmeijer et al., 2011). The first presentation will review findings from a pilot randomized trial examining ACT for depression with comorbid social anxiety in clients recruited from an outpatient psychiatry practice. The second presentation will discuss outcomes and predictors of outcomes from an ongoing study of ACT for clients with depression at a partial hospital program. The third presentation will describe findings from a randomized controlled trial comparing ACT to CBT for depression in an outpatient practice. Finally, these findings will be reviewed in the context of the existing ACT for depression literature and suggestions will be provided for future research directions.

• Acceptance and Commitment Therapy for Depression with Comorbid Social Anxiety: Results From a Pilot Randomized Trial
Kristy Dalrymple, Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University
Emily Walsh, B.A., Columbia University
Lia Rosenstein, B.A., Pennsylvania State University
Mark Zimmerman, M.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University

Depression often is complicated by comorbid social anxiety, resulting in greater functional impairment and poorer treatment outcomes. Given the transdiagnostic focus of ACT, it may be particularly helpful for this population. A prior open trial of ACT for depression and social anxiety showed significant improvement following 16 individual sessions (Dalrymple et al., 2014). The present study aimed to further examine its feasibility and acceptability in a pilot randomized controlled trial. Patients (n=26) with depression and social anxiety at a hospital-based outpatient psychiatry practice were recruited between July 2012 and January 2016. They were randomly assigned to medication as usual (MAU) or MAU plus ACT (MAU+ACT); patients in MAU+ACT received 16 weekly, individual sessions of ACT. Assessments were completed at pre-treatment, 8 weeks, and 16 weeks. Results showed medium between-groups Cohen’s d effect sizes at 16 weeks on depression symptoms (0.55), and medium-to-large effect size differences for social anxiety avoidance (0.69) and quality of life (0.67) favoring MAU+ACT. Additional results will be presented on outcome and process measures, such as psychological flexibility and behavioral activation.

• Treating Complex Presentations of Depression using Acceptance and Commitment Therapy
Theresa A. Morgan, Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University
Lauren Harris B.A., Rhode Island Hospital
Catherine D’Avanzato Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University
Sarah Zimage M.A., Rhode Island Hospital
Brian Pilecki Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University
Rawya Aljabari Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University
Olga Obraztsova Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University
Douglas Long Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University
Savannah McSheffrey, Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University
Adriana Hyams, Ph.D., Rhode Island Hospital/Warren Alpert Medical School of Brown University
Cerena Reid-Maynard, LICSW, Rhode Island Hospital/Warren Alpert Medical School of Brown University

In treatment settings, comorbidity in depression is the norm rather than the exception. It is also predictive of poorer outcomes, including symptom intensity/persistence, functional impairment, treatment utilization, and suicidality. Transdiagnostic therapies like ACT provide flexible models for treating complex patients with high acuity. The current study reports effectiveness of using ACT to treat depressed patients in acute crisis. Participants include 1035 partial hospital patients, 549 of whom met criteria for current MDD. Most common comorbid diagnoses included GAD (56%), social phobia (39%) and PTSD (34%). Results showed a 45% decrease in depression from intake to discharge (Cohen’s d =1.47). Functioning and quality of life improved by 23% and 22%, respectively. Changes to ACT processes were large (Cohen’s d from 0.94 to 1.24 for mindfulness, valuing, and flexibility). Best predictors of symptom change were number of comorbid diagnoses, SI at intake, education level, and presence of PTSD or BPD. In contrast, ACT process change was most related to age, current PTSD diagnosis, and education level. Discussion will include clinical issues when adapting ACT for this sample.

• ACT for Major Depressive Disorder: can it compare to evidence-based treatment and how does it work?
Jacqueline A-Tjak, Ph.D., PsyQ, Zaandam, the Netherlands and the University of Amsterdam, Amsterdam, the Netherlands

Worldwide, more than 300 million people are affected by depression. There has not yet been much research regarding if and how ACT can help improve the lives of those suffering from depressive disorders (although there is important research showing ACT can help cope with depressive symptoms). In this talk, we will share design and results from a Randomized Controlled Trial performed in the Netherlands in an outpatient facility with patients formally diagnosed with Major Depressive Disorder. We included 82 patients who received either ACT or CBT (both protocolized). We measured the impact on depressive symptoms, diagnosis and quality of life, from pre- to posttreatment, and at 6 and 12 months follow up. We also measured depressive symptoms and process measures at several time points during treatment, post treatment and at follow up. In this talk we will address how to understand the results from this RCT within the context of research on depression and depressive symptoms, focusing on ACT and CBT.

Educational Objectives:
1. Describe the feasibility, acceptability, and preliminary results from a pilot randomized trial examining the addition of ACT to medication as usual for patients experiencing depression and comorbid social anxiety in a routine outpatient psychiatry practice. 2. Describe outcomes, predictors of outcomes, and changes in processes for patients with depression and other comorbidities receiving ACT within a partial hospital program. 3. Explain the meaning of the results found in an RCT comparing ACT to CBT for patients with MDD, regarding both outcomes and processes.

 

11. Recent theoretical and methodological advances in Relational Frame Theory (RFT)
Symposium (10:35am-12:05pm)
Components: Conceptual analysis, Original data, Didactic presentation
Categories: Relational Frame Theory, Clinical Interventions and Interests, Educational settings, Functional contextual approaches in related disciplines, RFT, Coherence, Mental Health, Perspective Taking, IRAP, Children
Target Audience: Beg., Interm., Adv.
Location: Rue Crescent

Chair: Michael Bordieri, Ph.D., Murray State University

This symposium explores recent findings supporting the Relational Frame Theory (RFT) framework in the study of the self. The first paper reviews the concept of coherence from RFT and presents a paradigm that assesses coherence in a social context. The second paper empirically assesses the role of self-as-distinction and self-as-hierarchy on depression, stress, and anxiety. The third paper presents data supporting the relational triangulation framework of RFT in derived perspective taking and observational learning through social modeling. Finally, the fourth paper studies the influential role of negative and positive affect on verbal processes associated with wanting more or less based on the RFT perspective.

• Relational Coherence in a Social Context
Michael Bordieri, Ph.D., Murray State University
Jeremy Vargas, Murray State Univeristy

Recent theoretical advances in Relational Frame Theory (RFT) have placed increasing emphasis on coherence as a core dimension of relational responding (Barnes-Holmes, Barnes-Holmes, Luciano, & McEnteggart, 2017). This paper will briefly review empirical work that explores the appetitive properties of coherence before focusing on a paradigm that assesses coherence in a social context. The paradigm superimposes a conformity manipulation typically employed in social psychology (Asch, 1956; Smiowitz, Campton, & Flint, 1988) onto an established coherence reinforcer assessment (Bordieri, Kellum, Wilson, & Whiteman, 2016; Hughes & Bordieri, 2016). Results from 51 participants suggest that the reinforcing value of coherence can be manipulated by contextual factors such as social approval, but only to a limited extent. The obtained findings highlight the interaction of relational coherence with a competing source of reinforcement and highlight important limitations regarding the study of relational coherence in a convenience sample of undergraduate students. Implications for future research will be discussed, with particular attention placed on stimulus design and controlling for sequence effects.

• Distinction vs. Hierarchical Deictic Relating: Implications for Young People’s Mental Health
Orla Moran, Ph.D., University College Dublin
Louise McHugh, Ph.D., University College Dublin

Recent evidence from Contextual Behavioral Science indicates that 2 types of relating facilitate the experience of self-as-context- self-as-distinction and self-as-hierarchy. While the latter has been associated with better mental health outcomes relative to distinction, to date these types of relating have not been examined directly before any manipulation has occurred. The present study examined the relative contribution of each of these two types of self-as-context on depression, stress, and anxiety, while controlling for deictic ability and gender, using regression analyses in a sample of 102 young people. Mediation analysis was also used to examine the role of psychological flexibility. While self-as-hierarchy was significantly predictive of lower stress and depression, psychological flexibility was not found to mediate this relationship. Self-as-distinction did not emerge as a significant predictor of any outcome variable. Suggestions for future research on the basis of these findings are discussed.

• Social Modeling as Derived Perspective Taking via Relational Triangulation
Paul Guinther, Ph.D., Western Psychological and Counseling Services

The relational triangulation framework (Guinther, 2017) of Relational Frame Theory (Hayes, Barnes-Holmes, & Roche, 2001) posits that observational learning through social modeling (Bandura, 1977) is an instance of derived perspective taking. Empirical data supporting this contention has been collected using an operant match-to-sample relational triangulation perspective taking protocol (RT-PTP; Guinther, 2017). Participants were first directly trained to make deictic pointing responses to target locations relative to pointing origins of the self (A1) versus two others (A2 and A3) under the respective control of three contextual stimuli (i.e., X1:A1, X2:A2, X3:A3). Participants were then trained across trials to report the other-relative deictic orientations of a target (i.e., discriminating which varying side of the target was facing A2 versus A3, under the respective contextual control of X2 and X3). During a subsequent test for derived relational responding, participants spontaneously reported the self-relative deictic orientations of the target under X1, even though X1, A1, and A1's spatial position had never been directly conditioned to exert control over those responses. Thus, participants spontaneously transposed others' perspectives onto the self.

• An Examination of Generalised Implicit Biases Towards 'Wanting More' as a Proxy of Materialism: A Relational Frame Theory (RFT) Perspective
Brian Pennie, Trinity College Dublin, Ireland
Michelle Kelly, Ph.D., National College of Ireland

The research investigated the contextual effects of mood on implicit measures of ‘wanting more’ as a proxy of materialism and investigated the basic verbal processes underpinning this behaviour. Participants (n=60) were exposed to either a positive (n=21), negative (n=20) or neutral (n=19) mood induction procedure; an Implicit Relational Assessment Procedure (IRAP) examining biases towards wanting more or less; and questionnaires assessing life satisfaction, materialism, and positive and negative affect. On the IRAP, shorter mean response latencies across consistent (more-good/less-bad) compared to inconsistent (more-bad/less-good) trial-blocks were interpreted as an implicit bias towards ‘wanting more’. Compared to the neutral mood condition, participants in the positive mood condition demonstrated an increased bias towards ‘wanting less’ (p=.028). Several predicted associations were also observed. Of note, reduced levels of materialism were significantly correlated with an implicit bias towards wanting less (r=.579, p=.006). The findings provide preliminary support for the IRAP as a generalised implicit measure of ‘wanting more’ as a proxy of materialism; and suggest that changes in mood may influence this effect. Findings are discussed from an RFT perspective.

• Relational Framing in the Classroom. The Effects of Derived Relational Responding and Trained Augmentals on Instructional Control
Shari Daisy, Ed.S., The Chicago School of Professional Psychology, Los Angeles
Leslie Morrison, Ph.D., The Chicago School of Professional Psychology, Los Angeles
Eric Carlson, Ph.D., The Chicago School of Professional Psychology, Los Angeles
Jonathan Tarbox, Ph.D., University of Southern California

Instructional control is an important issue in education, impacting both teaching and learning. Although instructional control has been defined from several perspectives (Baron & Galizio, 1983; Glenn, 1987; Schlinger, 1993; Schlinger & Blakely, 1987; Skinner, 1969), Relational Frame Theory provides an explanation for how instructional control is established through the process of arbitrarily applicable relational responding, or derived relational responding (O'Hara & Barnes-Holmes, 2004). The current paper reviewed the literature in regards to instructional control and evaluated whether instructional control over student behavior could be established and reversed through the use of trained augmentals in a general education kindergarten classroom. First, coordination relations for a network of arbitrary stimuli were trained. Tests for derived frames of coordination then occurred. Next, augmental values for two arbitrary items - one of high value and one of minimal value - were established through training. Finally, reversal tests for instructional control over student behavior were conducted during group classroom activities with trained augmentals in place.

Educational Objectives:
1. Describe recent theoretical and empirical advances in the study of relational coherence. 2. Describe the relational triangulation framework 3. Discuss how augmentals establish and maintain instructional control over desired behaviors in the classroom setting.

 

13. Awareness, courage, and love: Clinical measurement, clinical analogue and clinical findings: FAP SIG Sponsored
Symposium (10:35am-12:05pm)
Components: Original Data
Categories: Clinical Interventions and Interests, Theoretical and philosophical foundations, Awareness, courage and love
Target Audience: Beg.
Location: Rue Saint-Paul

Chair: Jonathan W. Kanter, University of Washington
Discussant: Fabián O. Olaz, Centro Integral de Psicoterapias Contexuales

Although the terms awareness, courage, and love (ACL) were first introduced to describe qualities of therapist behavior while conducting Functional Analytic Psychotherapy (FAP), they have become frequent descriptions of therapy targets, especially when a client presents with problems related to intimacy. With the need for a functional and empirical basis for talking about client behavior in terms of ACL in mind, a contextual-behavioral, clinical model of ACL has been developed. This symposium presents important new empirical findings on this model with clinical-analogue and clinical samples. First, Katherine Manbeck presents results from a randomized lab-based clinical analogue experiment, in which the model was evaluated with a high fear-of-intimacy (FOI) participants, including measurement of heart-rate-variability (a marker of emotion regulation). Second, Adam Kuczynski presents results from a longitudinal study documenting relationships between ACL, quality of life, and psychopathology in therapy clients over the course of several months of ongoing therapy. Finally, Chad Wetterneck presents results documenting changes in ACL over the course of treatment for clients with PTSD, including the prediction of premature treatment termination.

• The intricacies of connecting with individuals who fear intimacy
Katherine E. Manbeck, University of Washington
Savannah M. Miller, University of Washington
Natalia M. Montes, University of Washington
Jonathan W. Kanter, University of Washington

In a lab-based, clinical analogue randomized experiment, 146 undergraduates oversampled for high fear of intimacy (FOI) engaged in "fast friends" interactions with research assistants trained to respond to participants' vulnerable disclosures with high responsiveness. Participant vulnerability is conceptualized as "courage" in the Awareness, Courage, and Love (ACL) model, while research assistant responsiveness is considered "love." Unlike previous experiments with undergraduates documenting that high responsiveness predicts closeness with the researcher up to two weeks later, the current results found an immediate effect which was not sustained over time (high responsiveness no longer predicted closeness after 48 hours). Furthermore, measurement of physiology before and after the interaction using heart rate (associated with anxiety) indicated that high responsiveness decreased anxiety for those in the normal range of fear of intimacy, but low responsiveness was more effective at decreasing anxiety in participants with highest FOI; high responsiveness did not decrease physiological arousal in high FOI participants. These data suggest important modifications to provision of therapeutic ACL that may need to occur in clinical interactions with certain client populations.

• Predictive Validity of Awareness, Courage, and Responsiveness (ACR) in a General Psychiatric Sample and Non-psychiatric Dyads
Adam Kuczynski, University of Washington
Jonathan W. Kanter, University of Washington

Social functioning deficits, including deficits in intimacy, are strong risk factors for psychological distress in general, physical health problems, and various psychopathologies in particular. Given that social functioning deficits, by definition, occur in a particular context, contextual-behavioral therapies are particularly equipped to target such deficits. The current study examines the predictive validity of a new measure of ACR - The Awareness, Courage, and Responsiveness Scale (ACRS) - using data from a longitudinal (followed over five months) general psychiatric sample (N = 50) and a non-clinical sample of romantic and non-romantic dyads (N = 70) taking part in a randomized controlled trial. Results indicated that the ACRS has strong internal reliability and is characterized by similarity in scores among dyads. The ACRS was a significant predictor of general psychiatric symptomatology and quality of life, however this relationship disappeared when loneliness was entered into the model. Treatment implications of these findings are discussed.

• Awareness, Courage, and Responding (ACR) in PTSD: Psychometrics, Predictive Validity, and Sensitivity to Change During Treatment
Chad T. Wetterneck, Rogers Memorial Hospital
Peter Grau, Marquette University
Sonia Singh, Bowling Green State University

PTSD has a pervasive impact on interpersonal intimacy, values-based behavior, and self-compassion. Most treatment models suggest cultivating interpersonal skills and emotion regulation to address avoidance and reduce trauma symptoms. Third-wave therapies fit with other evidence-based treatments to address these issues. However, validated instruments are needed to assess whether ACR constructs are reliable and valid, and if they impact outcomes. The current study examines a new ACR measure using data from 225 PTSD patients receiving third-wave enhanced exposure-based treatment in a PTSD specialty program. Results indicated that the ACR had good internal consistency, and convergent and divergent validity with admission measures. Machine learning analyses were used to predict treatment dropouts from admissions variables including psychological symptoms, therapeutic change processes, ACR, and interpersonal variables; the Courage scale was the top predictor of dropout. Individual ACR subscales demonstrated significant change over the course of treatment. A final machine learning analysis, yet to be completed, will determine whether ACR helps to predict treatment outcome. Future directions, including the use of the ACR in treatment planning, will be discussed.

Educational Objectives:
1. Demonstrate how to engage the awareness, courage, love model for use in clinical work and research. 2. List specific ACL measurement strategies. 3. Discuss how ACL predicts therapy progress and dropout for general and PTSD-specific samples.

 

15. Efficacy of brief RNT-focused ACT protocols in different settings
Symposium (10:35am-12:05pm)
Components: Original Data
Categories: Clinical Interventions and Interests, RFT, ACT, emotional disorders
Target Audience: Beg., Interm., Adv.
Location: Exclamation

Chair: Daniela Salazar-Torres, Fundación Universitaria Konrad Lorenz
Discussant: Carmen Luciano, Universidad de Almería, Madrid Institute of Contextual Psychology

Recent research on clinical RFT has identified repetitive negative thinking (RNT) as an especially counterproductive form of experiential avoidance because of its pervasiveness. RNT is usually the first response to aversive private events and some recent empirical analyses are showing that triggers of RNT are hierarchically related. This analysis has some clinical implications: (a) focusing the intervention on disrupting counterproductive patterns of RNT might be especially powerful and might produce rapid therapeutic gains; and (b) focusing therapeutic work on the triggers at the top of the hierarchy might promote greater generalization of the therapeutic outcomes due to how transformation of functions through hierarchical relations works. Some studies have been developed RNT-focused ACT protocols that have shown very promising outcomes. The current symposium will present new studies that are applying this type of protocols in different settings.

• Effect of a 2-session RNT-focused ACT protocol in emotional disorders: A randomized clinical trial
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
María B. García-Martín, Fundación Universitaria Konrad Lorenz
Diana M. García-Beltrán, Fundación Universitaria Konrad Lorenz
Ángela Henao, Fundación Universitaria Konrad Lorenz
Andrea Monroy-Cifuentes, Fundación Universitaria Konrad Lorenz
Andrés Peña-Vargas, Fundación Universitaria Konrad Lorenz
Eduar S. Ramírez, Fundación Universitaria Konrad Lorenz

Previous preliminary studies with N=1 methodology have shown that very brief ACT interventions focused on disrupting repetitive negative thinking (RNT) can be very effective in treating emotional disorders such as depression and generalized anxiety disorder (GAD). The aim of the current study is to test the efficacy of a 2-session RNT-focused ACT protocol versus a waiting-list control in treating depression and/or GAD. The study is currently collecting data. One-hundred participants suffering from depression and/or GAD will be randomly allocated to one of the two experimental conditions. Outcome variables are emotional symptoms, whereas process outcomes are measures of experiential avoidance, cognitive fusion, values, and RNT. Pre-treatment level of symptoms and scores on other measures will be explored as potential moderator variables of the effect of the intervention. Results will be discussed in terms of the viability of this very brief ACT protocol in applied settings.

• Effect of an online RNT-focused ACT intervention on emotional disorders
Marco A. Sierra, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Daniela Salazar-Torres, Fundación Universitaria Konrad Lorenz

Online psychological intervention is an emerging field that consists of the delivery of therapeutic assessment and treatment through information and communication technologies. Evidence suggests this might be a promising alternative to traditional psychotherapy. Online applications of third wave psychotherapy approaches have successfully decreased emotional symptomatology. The present study aims to analyze the efficacy of an online psychological intervention based on Acceptance and Commitment Therapy (ACT), which focused on undermining repetitive negative thinking (RNT) patterns. The treatment consisted of 3 modules that were delivered through one month of intervention and was based on previous protocols that showed the promising effect of RNT-focused ACT intervention. A multiple-baseline design was implemented in 30 participants suffering from moderate depression and/or generalized anxiety disorder. Data collection is currently in process. The results will be compared with the efficacy of brief RNT-focused ACT protocols.

• Effect of a brief RNT-focused ACT protocol in improving school adjustment of exceptionally gifted children
Yury A. Larrea-Rivera, Fundación Universitaria Konrad Lorenz
María B. García-Martín, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz

An exceptionally gifted child stand out in general intelligence, easily learns contents of any domain, and demonstrate behavior more sophisticated than his/her reference group. However, a good number of exceptionally gifted children presents school maladjustment due to experiencing school tasks as low-demanding and boring. This usually leads to emotional difficulties and scholar failure. The current study describes the effect of a brief ACT intervention focused on disrupting rumination and procrastination, and increase valued actions in exceptionally gifted children. A multiple-baseline design across participants was used with 9 children experiencing significant levels of school maladjustment. All children were identified as exceptionally gifted by means of intelligence quotient and learning potential tests. Results are discussed in terms of how psychological flexibility can enhance the use of high-level cognitive abilities and put them at the service of valued behavioral directions.

Educational Objectives:
1. List three clinical applications of an RFT analysis of repetitive negative thinking. 2. Discuss the potential of RNT-focused ACT protocols. 3. Describe the efficacy of RNT-focused ACT protocols in different settings.

 

16. Optimizing Well-being among Individuals with Appearance Concerns
Symposium (10:35am-12:05pm)
Components: Literature review, Original Data, Case presentation
Categories: Clinical Interventions and Interests, Behavioral medicine, Appearance Concerns
Target Audience: Beg., Interm., Adv.
Location: Multiplication

Chair: Staci Martin, Ph.D., National Institutes of Health
Discussant: Joanna Dudek, Ph.D., SWPS University of Social Sciences and Humanities

Individuals with a broad array of appearance-related concerns, such as those associated with chronic illness, injury, or other body dissatisfaction, often report diminished well-being. In this symposium, three presenters engaged in research and clinical work on this diverse topic will discuss how ACT processes may be leveraged to optimize well-being among individuals with appearance concerns. The first presenter will provide an empirical background and theoretical application of ACT to the problem of appearance concerns/visible differences with case examples. The second presenter will present data on body image flexibility that support the use of the ACT model to address these issues in women with visible differences. The third presenter will present a specific application of ACT to appearance concerns, describing a novel ACT-based intervention for individuals with type 1 diabetes whose weight concerns impact management of their chronic illness. Finally, the discussant will offer thoughts on ways to move this work forward. This symposium is applicable to anyone who has a client struggling with appearance concerns or is interested in clinical research in this area.

• Context, Connection, and Compassion: Theoretical Applications of ACT for People with Appearance Concerns
Staci Martin, Ph.D., National Institutes of Health

Individuals with health 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 impair quality of life and prevent valued living. This presentation will explore how mental health professionals can employ ACT techniques to target the anxiety, depression, and low self-esteem that often accompany these visible signs of illness. We will show how people with visible differences can practice defusion from thoughts about how they “should” look along with acceptance of their appearance. We will present concrete techniques that practitioners can use to change the contextual cues, strengthen patients’ connections to others, and foster self-compassion among these individuals. Finally, connecting (or re-connecting) with values is of pivotal importance to guide patients away from a conceptual self that focuses exclusively on their illness or appearance. Through these objectives along with case examples, we aim to show how ACT can promote optimum functioning in people with appearance changes due to health conditions.

• Body image inflexibility, body appreciation and affect in women with a visible difference
Fabio Zucchelli, M.Sc., University of the West of England, Bristol, UK
P. White, Ph.D., University of the West of England, Bristol, UK
E Halliwell, DPhil, University of the West of England, Bristol, UK
H Jarman, M.Sc., University of the West of England, Bristol, UK
A Slater, Ph.D., University of the West of England, Bristol, UK
D Harcourt, Ph.D., University of the West of England, Bristol, UK

Background: The emotional experience of women with a visibly different appearance varies from anxiety and low self-esteem in some, to more positive descriptions in others. Affect in this population is likely influenced by individuals’ body image, but may also be determined by psychological flexibility towards one’s body image. Drawing from a larger cross-sectional study, this sub-study sought to test whether body image inflexibility predicts positive/negative affect beyond body image alone. Methods: 148 women aged 18-74, who self-identified as having a visible difference, completed measures of body image inflexibility, body appreciation (positive body image), and positive and negative affect. Results: Controlling for perceived noticeability of one’s visible difference, body image inflexibility statistically predicted negative affect over and beyond body appreciation. Although body image inflexibility significantly correlated with positive affect, only body appreciation uniquely predicted positive affect. Conclusion: Body image flexibility may protect against negative affect in women with visible difference, suggesting potential utility of Acceptance and Commitment Therapy for this group. The positive valence of body appreciation may account for its greater influence on positive affect.

• Dying to Control Weight (An ACT Intervention to Help Individuals Thrive with Type 1 Diabetes)
Rhonda Merwin, Ph.D., Duke University Medical Center
Ashley A. Moskovich, Ph.D., Duke University Medical Center
Lisa K. Honeycutt, MA, Duke University Medical Center

Many young women with type 1 diabetes (T1D) report taking less insulin than they should to lose weight(1,2) tripling their risk for early complications and premature death(3). Attempts to understand and treat this problem have focused on the way in which diabetes increases attention to food and body dissatisfaction(3,4). However, conventional eating disorder (ED) treatments that target these factors are less effective with T1D patients than their nondiabetic counterparts(5,6), and even when attitudes about eating/weight change, behavior may not(5). Our data suggest that EDs in T1D might be better understood by considering how confusion and distress related to T1D might turn individuals away from T1D management and toward the clear and concrete goal of weight loss. We will outline a functional-contextualistic model of EDs in T1D based on our research (5R01DK089329-03; PI: Merwin) and describe a novel, ACT-based intervention (1R21 DK106603-01; PI: Merwin). Key intervention strategies will be described as well as preliminary outcomes (n=16). Discussion will be relevant to other chronic illnesses that impact appearance, interoception or require arduous daily management.

Educational Objectives:
1. Describe three ACT-consistent techniques for helping people with appearance concerns. 2. Discuss the meaning of the term 'visible difference' and the role of body image and body image flexibility in determining positive and negative affect in people with a visible difference. 3. Describe a functional perspective to T1D patients focus on appearance, and the outcomes for a novel ACT intervention based on this formulation.

 

24. Conceptual, empirical and pragmatic innovations in the contextual behavioural science of thriving with a long-term health condition
Symposium (1:20-2:50pm)
Components: Conceptual analysis, Original Data, Case presentation
Categories: Clinical Interventions and Interests, Behavioral medicine, Persistent Health Conditions
Target Audience: Beg., Interm., Adv.
Location: Rue Sainte-Catherine

Chair: David Gillanders, DClinPsy, University of Edinburgh
Discussant: Graciela Rovner, Ph.D., Karolinska Institutet, Angered's Hospital & ACT Institute Gothenburg, Sweden.

One of the remarkable things about contextual behavioural science is the breadth of application of a small number of concepts to very diverse areas. This symposium brings together researchers and clinicians from the UK, Canada and Australia. The three presenters will outline innovative approaches to understanding and intervening in three different populations of people with health conditions: cancer survivors, people with cystic fibrosis and workers who have a long-term health problem. Two of the papers are primarily data driven, one of which is cross sectional and the other an intervention study. The third will present a novel conceptual framework with illustrative case examples. Together the papers illustrate novel data, new applications of theory and pragmatic innovations that help people to thrive within these challenging health contexts.

• Exploring the Impact of Psychological Flexibility on the Relationship between Fear of Cancer Recurrence and Adjustment in Cancer Survivors
Kate Randell, DClinPsychol, NHS Forth Valley
David Gillanders, DClinPsy, University of Edinburgh
Susie Porteous, DClinPsy, NHS Forth Valley

Fear of cancer recurrence (FOR) has been repeatedly identified as a concern for many cancer survivors. Consensus over conceptualisation and measurement of FOR is still emerging, and few interventions to reduce its impact have been tested. The current study explored the potential for psychological flexibility to mediate the relationship between severity of FOR and distress and quality of life (QOL). In a cross-sectional design, 75 post-treatment cancer survivors completed a battery of assessment measures. Relationships between predictor variables of FOR and psychological flexibility, and outcome variables of distress and QOL were explored, using multiple linear regression and Conditional Process Analysis. Severity of FOR was predictive of adjustment outcomes, and psychological flexibility mediated this relationship. Exploration of each distinct flexibility process highlighted valued living as the strongest predictor of QOL and depression, while fusion with thoughts was most predictive of levels of anxiety. Psychological flexibility and ACT may be useful in both the identification of patients at risk of poorer adjustment, and in guiding the development of interventions to reduce the impact of FOR.

• Why don't people do their treatments? A conceptual exploration of non-adherence in chronic illness using a contextual behavioural approach
Jennifer Kemp MPsych (Clinical), Royal Adelaide Hospital, Adelaide, Australia

Non-adherence to treatment is a significant problem across all areas of medicine, with estimates suggesting a non-adherence rate of about 50% for prescribed treatments (e.g. Sabaté, 2003). As a result, millions of people with chronic illness may be missing out on the potential benefits of adequate treatment. Research into adherence is scarce and inconsistent. Education alone is not sufficient, and despite the addition of motivational interviewing, on-line interventions, and various interpersonal strategies, reliable treatment adherence remains elusive. Contextual Behavioural Science opens up new opportunities for addressing treatment adherence and adds precision and richness to addressing individual barriers to adherence. By exploring the functions of non-adherence, the specific issues that undermine adherence can be identified, and treatment can be placed in a values-based context. In this conceptual paper, the presenter will provide a conceptual behavioural model for non-adherence. Using illustrative case studies of her own clients with Cystic Fibrosis, she will explore contextual behavioural approaches to address non-adherence that can help patients overcome barriers to treatment adherence, improve their health and achieve a fulfilling life.

• Helping workers with chronic health conditions: Results from an ACT based telephone coaching intervention
Dayna Lee-Baggley, Ph.D., R. Psych., Nova Scotia Health Authority
Area Day, Ph.D., St Mary's University, Halifax
Nicolle Vincent, Ph.D., R. Psych, Nova Scotia Health Authority

Many workers face personal health and wellbeing demands that create additional challenges in remaining healthy and productive at work. The negative work outcomes linked to chronic conditions are well established and include increased absences/disability (Pizzi et al., 2005), psychological symptoms (e.g., Velly & Mohit, 2017) and productivity loss (e.g., Gilmour, 2017). Yet, for many, including those with chronic conditions, working has positive effects, including social contact, structure, and meaning (e.g., Saunders & Nedelec, 2014). ACTion (Awareness & Commitment Training In Organizational Networks) is a 10-week phone-based, individual-focused coaching program that uses ACT interventions to support individuals with chronic conditions in the workplace. In particular the program focuses on providing ACT-based tools to deal with "what gets in the way" of engaging in self-care and making use of workplace resources. Aspects of the program including the participant manual and coaching techniques will be presented. In addition, results from a randomized (waitlist control) clinical trial will be presented including measures of functioning, wellbeing, engagement, and strain at pre-, post-, and 3 months post.

Educational Objectives:
1. Describe an empirically based psychological flexibility oriented approach to conceptualising fears of recurrence in cancer patients. 2. Describe a conceptual model for non-adherence to treatment and approaches to treatment using a functional contextual behavioural framework. 3. Describe an empirically based adaptation to ACT for long term health conditions for telephone delivery in organisational settings.

 

26. Exploring a past, present and future of broadening of behavioral horizons
Symposium (1:20-2:50pm)
Components: Conceptual analysis, Original Data, Didactic presentation
Categories: Theoretical and philosophical foundations, Statistical Methodology, Clinical Interventions and Interests, Educational settings, Functional contextual approaches in related disciplines, Behavioral Science, Mainstream, Data-analytic methodology
Target Audience: Beg., Interm.
Location: Rue Crescent

Chair: Michael Vriesman, M.S., Eastern Michigan University
Discussant: Michael Levin, Ph.D., Utah State University

Early behavior analysts had targets and interests that were ambitious and reflected a broad scope of practice with diverse populations and problems—often with relative success. However, a recent focus on validating tools and technologies, the rapid expansion of professionals, and current credentialing practices have presented the field of behavior analysis with challenges. Furthermore, the application of behavior analytic principles has become more limited to very specific populations. With the emergence (or re-emergence) of process-oriented assessments and interventions and expansions in the utility of behavioral health interventions, behavior analysis may again find itself poised as experts in many complex and important areas of human service and interest. This symposium will identify current barriers in the field and the potential for growth beyond scope of current mainstream practices.

• “Can someone tell me the four functions of behavior? I lost my white book.” Revisiting the Technical Drift in Applied Behavior Analysis
Stuart Law, M.A., University of Nevada, Reno

Current practices in ABA have been dominated by a focus on the standard functional analysis and the validation of evidence-based technologies. In their 1980 article, Hayes, Rincover, and Solnick attempted to capture this by applying a scoring system to articles in the JABA with respect to four dimensions of the field. The results indicated that behavior analysis was moving towards a science of validating and comparing technical efforts, in lieu of the application of conceptual principles. Today, this drift has continued and may be preventing BCBAs from being effective in the search for new and complex operants and their application. Behavioral constructs are at the heart of many important and broadly applicable ideas like Process-Based Interventions and mindfulness. However, training in understanding philosophical assumptions, and foundational concepts may be necessary to ensure behavioral professionals are able of being effective in areas outside of (and arguably even within) working with individuals with limited verbal repertoires. This discussion will revisit the idea technical drift in ABA, and explore the implications and potential future directions.

• Improving Integrated Behavioral Health Services: Capitalizing on the Similarities between Quality Improvement and Behavioral Science
Alexandros Maragakis, Ph.D., Eastern Michigan University

With the potential to improve access to behavioral health services, reduce healthcare costs, and improve overall health outcomes, the integration of behavioral and somatic healthcare services has gained much attention worldwide over the last decade. While integrated care systems are generally supported by both medical and behavioral providers, the method to integrate these services in the most efficient and effective manner remains an empirical question. The use of group designs, like randomly controlled trials, have the potential to provide insight on the overall impact of integrated care systems, but they provide minimal information on how specific processes within the system (e.g., scheduling same day appointments, utility of behavioral health screens) impact overall care. However, the use of quality improvement methods, which have become mandated in many healthcare settings, allow the clinical scientist to investigate the impact of specific processes on outcomes in a cost-efficient manner. This presentation will highlight the similarities between quality improvement and traditional behavioral methodologies, and present data-based and conceptual approaches on how behavioral science could rapidly improve integrated care services.

• Modeling ongoing acts-in-context from a contextual behavioral perspective: A network analysis approach
Adam M. Kuczynski, M.S., University of Washington
Jonathan W. Kanter, Ph.D., University of Washington

At the core of Contextual Behavioral Science (CBS) is the goal of predicting-and-influencing ongoing actions of individuals in context. Multiple methodological principles drive this goal, including the notion that research is a multi-dimensional, multi-level enterprise with precision, scope, and depth. Few data analytic techniques, however, converge at the intersection of these principles and as such, researchers are often forced to sacrifice one principle in exchange for another. In this talk, we discuss the limitations of current data analytic approaches to innovation within the CBS community and introduce network analysis as a solution to some of these issues. Network analysis is a statistical approach that allows for examination of probabilistic relations in a reticulated framework, and can be used to model the transactional relationship between environment and behavior both nomothetically and idiographically. Clinical and research implications are discussed, and practical instruction is provided.

Educational Objectives:
1. Describe the meaning of "technical drift" and how it has impacted the field of behavior analysis. 2. Apply behavior science to integrated care settings through quality improvement programs. 3. Expalin the utility of behavior science and RFT to early education.

 

28. Ecological Momentary Assessment as a CBS Tool: Empirical Applications of Ecological Momentary Assessment to Questions of Contextual Behavioral Science
Symposium (1:20-2:50pm)
Components: Original Data
Categories: Clinical Interventions and Interests, Clinical Interventions and Interests, Contextual Behavioral Methodology, Ecological Momentary Assessment
Target Audience: Interm., Adv.
Location: Rue Saint-Paul

Chair: Benjamin Pierce, M.S., Utah State University
Discussant: Andrew Gloster, Universität Basel

This symposium covers a range of applications of ecological momentary assessment (EMA) methods to various questions within Contextual Behavioral Science (CBS). We aim to demonstrate through this collection of papers the advantages of using EMA and associated analytic techniques to more deeply understand patterns of behavior in-context. The research questions cover a range of topics including the emergence and stimulus control of maladaptive eating behavior, the naturalistic effectiveness of coping responses to difficult thoughts, and the use of affective information to guide momentary behavior. Within each talk, we hope to illustrate the versatility of EMA to address the research questions as well as provide valuable information to inform the development and refinement of intervention techniques. We will therefore include a balance of methodological, theoretical, and applied implications for each topic, and hope to reach a breadth of audiences who may be interested in this exciting methodological approach.

• An ecological momentary assessment (EMA) investigation of cognitive processes for responding to difficult thoughts
Jennifer Krafft, M.S., Utah State University
Michael E. Levin, Utah State University

Research on the naturalistic use of cognitive processes for responding to difficult thoughts (i.e., defusion, reappraisal, and restructuring) in daily life has the potential to clarify theoretical questions on the consequences of these strategies and identify contextual factors that alter their effectiveness. We will report the results of an EMA study on cognitive processes in a sample of college students (expected n = 100). This presentation will provide answers to the following research questions: 1) Does momentary use of cognitive defusion, cognitive reappraisal, and/or cognitive restructuring predict momentary positive affect and values progress? 2) Are the effects of these strategies dependent upon characteristics of the thoughts targeted, such as self-relevance, importance, believability, and willingness? These results will help to provide clarity on whether these theoretically distinct processes have differential effects on well-being and values progress in the moment, and if their effects vary depending on characteristics of the thoughts addressed. Implications for clinical decision-making will be discussed, such as types of thoughts or outcomes for which specific cognitive strategies may be more effective.

• A Momentary Approach to Assessing and Treating Maladaptive Eating and Weight Control among Individuals with Type 1 Diabetes
Rhonda M. Merwin, Ph.D., Duke University Medical Center
Adhley A. Moskovich, Duke University Medical Center
Lisa K. Honeycutt, Duke University Medical Center

Individuals with type 1 diabetes (T1D) who intentionally omit insulin are at high risk for early and severe diabetes-related medical complications and premature death. Studies show 30-40% of young women with T1D omit insulin they know they need to manipulate their weight. Individuals with T1D do not fare as well in conventional eating disorder (ED) treatments, highlighting the need for innovative interventions. Studying ED behavior among individuals with T1D in the natural environment may elucidate the context in which these behaviors emerge and inform a momentary intervention strategy. We conducted an ecological momentary assessment study of individuals with T1D (5R01DK089329-03; PI: Merwin). We will present findings on the temporal patterns, situational factors and real-time precursors to ED behaviors among individuals with T1D, and describe how these data have informed the development of a novel ACT intervention that leverages mobile technology for momentary skill development (1R21 DK106603-01; PI: Merwin). Discussion will have broader implications for ecologically valid approaches to assessment and intervention of intractable behavior problems.

• Does momentary affect matter? An investigation of momentary affective discrimination and its relation to psychological flexibility processes
Benjamin Pierce, M.S., Utah State University
Michael E. Levin, Utah State University

Flexible responses to antecedent emotional states may be crucial for adaptive functioning in daily life. Past research suggests the ability to discriminate among a variety of emotional responses is important when using affective information to guide behavior and to cope with distress. However, little research has investigated the momentary associations between affective discrimination, experiential avoidance, and adaptive behavioral responses. Therefore, this paper examines the use of momentary affective information as predicted by experiential avoidance and as a predictor of adaptive behavior in a sample of 71 college students sampled over two weeks using Ecological Momentary Assessment (EMA) methods. A unique methodological strategy for studying momentary affective discrimination is described within a hierarchical linear modeling framework that distinguishes trait (between-persons) and state (within-persons) variability in this construct. The implications of the findings are discussed in relation to theoretical developments within contextual behavioral science (CBS) and to strategies for training effective discrimination of affective states in CBS-informed interventions.

Educational Objectives:
1. List ways that ecological momentary assessment strategies can address specific research questions within a contextual behavioral science perspective. 2. Describe some of the variety of statistical and analytic approaches available to interpret data from ecological momentary assessment research. 3. Explain how the findings of ecological momentary assessment research can be used to advance contextual behavior intervention practices and theory to address psychological problems.

 

30. Thriving with Medical Illness: Novel Acceptance and Mindfulness Interventions to Promote Psychological Flexibility in Adolescents and Adults
Symposium (1:20-2:50pm)
Components: Literature review, Original Data, Experiential exercises, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Adolescents, Physical illness, Mindfulness
Target Audience: Beg., Interm.
Location: Exclamation

Chair: Kathryn Birnie, Hospital for Sick Children
Discussant: Lilian Dindo, Baylor College of Medicine

This symposium will review three novel interventions for individuals living with chronic or recurrent pain (chronic pain, inflammatory bowel disease, opioid misuse disorder). First, an in-person 8 week mindfulness based group intervention for adolescents with chronic pain and inflammatory bowel disease will be reviewed and data presented on both child and parent outcomes. A comparison will be made with respect to adaptations needed between chronic vs relapsing pain conditions. Next, data from an ongoing pilot study of an online acceptance and mindfulness based intervention for adolescents with inflammatory bowel disease will be presented. This will include lessons learned from providing group therapy online. Lastly, a new ACT protocol for opioid weaning in adults with concurrent chronic pain and opioid misuse disorder will be presented. A clinical case series will be presented to demonstrate how ACT promotes opioid tapering in this population.

• From Development to Implementation: Adapting Mindfulness Programs for Adolescents with Chronic Pain and Adolescents with Inflammatory Bowel Disease – does one size fit all?
Danielle Ruskin, Hospital for Sick Children and York University

Research on the impact of mindfulness programs for adolescents has mainly focused on mindfulness in the schools, where mindfulness programs are delivered primarily to healthy children. Few studies document outcomes of mindfulness programs for adolescents with health conditions. Dr. Ruskin will report on a research program examining the development, effectiveness and implementation of a mindfulness program adapted for adolescents with health conditions (MBI-A). A review of the existent literature on mindfulness and acceptance approaches for adolescents with health conditions will be provided, followed by description of the MBI-A highlighting specific adaptations for youth with chronic disease. Quantitative data and findings from focus groups with adolescents will then be presented detailing feasibility, acceptability, and initial outcomes of delivery of the MBI-to two different populations: 1) Adolescents with chronic pain and 2) Adolescents with Inflammatory Bowel Disease. Discussion will include whether adolescents with chronic conditions (e.g., pain) versus relapsing/remitting conditions (e.g., IBD) respond differently to mindfulness programming. Initial findings from a concurrent parent workshop provided to parents of the adolescents in the MBI-A will be provided.

• The nuts and bolts of online mindfulness and ACT based treatment for youth with inflammatory bowel disease
Sara Ahola Kohut, Hospital for Sick Children and University of Toronto
Danielle Ruskin, Hospital for Sick Children and York University
Jennifer Stinson, Hospital for Sick Children and University of Toronto

The Internet has emerged as one of the top health information resources and modes of social communication for adolescents and is, therefore, ideally suited to the provision of online health care services. However, little research exists on online mindfulness and ACT based interventions for youth with chronic health conditions. In this talk, we will provide an overview of the literature on online mindfulness and ACT based interventions for young people with chronic health conditions. This will be followed by a description of a new online group therapy for adolescents with inflammatory bowel disease. Next, feasibility, acceptability and initial effectiveness outcomes of a pilot study of this online group will be presented. We will also show audio and video mindfulness and ACT based content that was developed in partnership with adolescents living with chronic pain, arthritis, and inflammatory bowel disease. Future directions for online mindfulness and ACT interventions in pediatric chronic disease populations will be discussed.

• ACT for Opioid Misuse and Opioid Tapering in Patients Living with Pain
Aliza Weinrib, Toronto General Hospital and York University
Philip Desormeau, University Health Network

Opioid overuse is an urgent public health crisis. Some people living with pain end up on long-term, high dose opioid therapy with elevated risk of side effects, addiction, and overdose. In more extreme cases, pain patients can develop opioid misuse disorder, and their clinical presentation includes pain and addiction components. ACT is an empirically supported treatment for both chronic pain and substance misuse, with an appropriately transdiagnostic approach. We will report on a pilot project to treat pain patients with opioid misuse disorder with a combination of ACT and buprenorphine/naloxone medication maintenance therapy. We will outline a series of case reports describing how we used ACT with these patients. A hexaflex model specifying how the key ACT processes are targeted in this population will be reviewed. We will present our published case study, as well as preliminary data from our outpatient clinic showing that ACT promotes opioid tapering. The patient perspective will be shared through patient videos. Finally, we will outline key features of our novel ACT protocol for opioid tapering in patients with pain.

Educational Objectives:
1. Describe a mindfulness program adapted for youth with chronic pain and IBD and identify differences in the wants and needs of teens from each of these populations. 2. Describe the benefits and challenges of providing mindfulness and ACT based interventions online to young people with chronic health conditions. 3. Describe how the transdiagnostic ACT approach can be applied with patients with comorbid pain and opioid abuse.

 

31. Advances in Relational Frame Theory Research of Applied Relevance
Symposium (1:20-2:50pm)
Components: Original Data, Experiential exercises
Categories: Relational Frame Theory, Clinical Interventions and Interests, Relating relations, children analogy, transference of function, avoidance, defusion, self-forgiveness, IRAP
Target Audience: Adv.
Location: Multiplication

Chair: Diana Bast, Federal University of São Carlos
Discussant: Ian Stewart, National University of Ireland Galway

The current symposium will include a number of talks in which RFT research of applied relevance will be presented. The first paper presents the effects of a commonly used ACT defusion exercise on transformation of functions through arbitrarily related stimuli. The second paper explores the effects of a hierarchy-defusion intervention on participants’ implicit (as assessed by the Implicit Relational Assessment Procedure; IRAP) and explicit self-forgiveness following perceived failure. The third paper presents a novel protocol for assessing and training the relating of relations (i.e., analogical relations) in young (3-7 year old) children. The fourth and final paper presents data on the relating of complex relational networks (i.e., analogical relations) based on same/opposite and bigger- than/smaller-than contextual cues in adults, interpreted via the Multi-Dimensional Multi-Level (MDML) model of relational framing.

• A preliminary measure of the effects of ACT metaphors on the transformation of function of arbitrarily related stimuli
Roberta Kovac, M.D., São Paulo University
William Perez, Nucleo Paradigma
Carmen Luciano, University of Almeria
Sonia Meyer, São Paulo University

This study aimed to measure the effects of an ACT metaphor delivered as a meditation exercise on the transformation of stimulus functions. After establishing two equivalence classes (A1B1C1D1, A2B2C2D2), one stimulus from each class was paired with distressing images and dissonant sound (A1) whereas another (A2) was paired with earning points. After pairing, participants also learned to produce avoidance and approach responses to these respective stimuli. Transfer of functions to equivalent stimuli (C1 and C2) was tested on the approach/avoidance task and by means of evaluative self-report measures (VAS, US Expectancy, Valence, Semantic Differential). The ACT metaphor “Leaves on the stream” was then delivered by earplug. Transfer of function tests were repeated after the intervention. Most participants emitted avoidance and approach responses to directly trained and derived stimuli. Pre/posttests results indicate no changes regarding avoidance responses and a slight reduction in the aversive function related to self-report measures.

• The Effect of Hierarchy-Defusion Intervention versus Control-Distraction on Implicit and Explicit Self-Forgiveness Following Perceived Failure
Diana Bast, Federal University of São Carlos
Jane Fitzpatrick, National University of Ireland Galway
Ian Stewart, National University of Ireland Galway

This study compared an hierarchy-defusion intervention and a control-distraction condition on participants’ implicit and explicit levels of self-forgiveness following perceived failure on an insoluble task. Participants (n=29) were first assessed for implicit and explicit self-forgiveness using the Implicit Relational Assessment Procedure (IRAP) and an explicit IRAP analogue measure respectively. They were then exposed to the insoluble task, after which they were asked to report their positive and negative feelings. They were subsequently assigned to hear either a defusion (n=14) or control-distraction (N=15) audio recording and were re-exposed to the implicit and explicit measures. Results showed a significantly positive change after the intervention on all IRAP trial-types for both groups, but a significant reduction of the negative bias for failure in the defusion condition. The (explicit) IRAP analogue measure showed no changes but there was an increase in both positive and negative feelings post-intervention for both groups. The results and the implications will be discussed.

• Assessing and Training Analogical Responding in Young Children
Elle Kirsten, National University of Ireland Galway
Ian Stewart, National University of Ireland Galway

Analogical (A:B::C:D) relational responding is a key repertoire in the development of verbal and intellectual repertoires. This paper will discuss the development and testing of a Relational Frame Theory based assessment of analogical relations in 3-7 year old children. The four stage protocol allows assessment/training of (i) non-arbitrary (physical) relations (ii) non-arbitrary analogy (relations between physical relations) (iii) arbitrary (abstract) relations and (iv) arbitrary analogical relations (relations between abstract relations). Correlational data on the performance in the analogical sections and the overall protocol, and performance on a standardized measure of language and cognition (Stanford-Binet 5) will be presented and discussed. The extent to which basic relational patterns provide the needed foundation for analogy, and training protocols to train weak or missing basic and analogical relations as identified by the assessment will also be discussed.

• Developing AARR: Relating relational networks
Cainã Gomes, Pontificia Universidade Católica de São Paulo
Dermot Barnes-Holmes, Gent University
Maria Eliza Mazzilli, Pontificia Universidade Catolica de São Paulo
William Perez, Nucleo Paradigma

This study aimed to extend previous research in relational responding. The main objective was to produce, in a bottom-up approach, relating complex relational networks based on same/opposite and bigger-than/smaller-than contextual cues. After the non-arbitrary pretraining of the aforementioned contextual cues, two four-member nonsense stimulus classes were established based on comparative (bigger-than/smaller-than) relations. Participants were trained to select stimuli on an array of eight options (all stimuli of both networks) based on a symbolic rule that established a relation (same or opposite) between two stimuli: one of network 1 and one of network 2. Training was done by relating the network 1 to network 2; and testing by relating network 2 to network 1. All participants reached the mastery criterion in the training stages and produced the predicted performances in the test. In a final stage, reinforcing and punishing consequences were varied systematically in the presence of two novel antecedent stimuli and antecedent control was observed for all seven participants. Results will be discussed in the light of the MDML framework and analogical responding.

Educational Objectives:
1. Describe recent RFT research of applied relevance. 2. Discuss RFT research on analogical networks in adults and children. 3. Discuss RFT research of clinical relevance (i.e., to ACT, self-forgiveness).

 

37. Open, aware, and engaged: ACTing and adapting across the video platform
Symposium (3:10-4:25pm)
Components: Conceptual analysis, Original Data, Experiential exercises
Categories: Clinical Interventions and Interests, Supervision, Training and Dissemination, Telehealth
Target Audience: Beg., Interm.
Location: Rue Sainte-Catherine

Chair: Erika M. Shearer, Ph.D., VA Puget Sound Health Care System
Discussant: Michael E. Levin, Ph.D., Utah State University

Clinical Video Telehealth (CVT) is a synchronous, internet-based, video teleconferencing technology to facilitate communication between providers and their patients. CVT appears to be an effective, well-accepted, and cost-effective modality to deliver evidence-based treatment to patients that may experience difficulties accessing such treatment. Despite the fact that CVT has been found to be feasible, effective, and satisfactory to both patients and providers, the overall adoption of CVT by providers has been slow. Providers, who act as gatekeepers of this modality, have an essential role in implementing CVT. The papers in this symposium seek to explore potential complexities specific to provision of Acceptance and Commitment Therapy (ACT) via CVT. The first paper in the symposium presents findings from a survey of Veterans Affairs (VA) providers related to barriers to ACT implementation via CVT. The second paper presents lessons learned from the implementation of “hybrid” ACT groups – groups that are facilitated both in-person and via CVT. The third paper presents qualitative data from the survey of VA providers as well as a process-oriented approach to ACT training.

• Taking ACTion across the computer screen: examining the clinician context
Erika M. Shearer, Ph.D., VA Puget Sound Health Care System
Alycia Zink, Ph.D., VA Puget Sound Health Care System
Lauren Hollrah, Psy.D., VA Puget Sound Health Care System

Despite research suggesting that Clinical Video Telehealth (CVT) produces results comparable to in-person mental health care with respect to assessment, treatment outcomes, therapeutic relationship, retention, and patient and provider satisfaction; this innovative modality of care remains underutilized. The current project sought to better understand barriers to providing ACT via CVT. Veterans Affairs providers who successfully completed ACT-D training were invited to complete an anonymous survey on their use of CVT and delivery of ACT via CVT. A total of 84 mental health staff completed the questionnaire. Roughly 42% of the sample endorsed using CVT; however, of that sample, less than half endorsed providing ACT via CVT. These findings point to an added layer of complexity related to provision of ACT via CVT. Potential barriers to CVT use were surveyed and challenges in implementing experiential work via CVT was the most frequently endorsed barrier followed by administrative burden and lack of training in CVT. This study extends the existing literature by determining barriers to CVT adoption with particular emphasis on the provision of ACT via CVT.

• The experience of facilitating a hybrid group: lessons learned
Lauren Hollrah, Psy.D., VA Puget Sound Health Care System
Kate L. Morrison, Ph.D., VA Puget Sound Health Care System
Lisa Glynn, Ph.D., VA Puget Sound Health Care System
Stacey M. Cherup-Leslie, Ph.D., VA Southern Nevada Health Care System
Sheeva Mostoufi, Ph.D., Behavior Therapy Center of Greater Washington
Erika M. Shearer, Ph.D., VA Puget Sound Health Care System

Acceptance and Commitment Therapy (ACT) has been well studied as an effective treatment to improve the lives of those with chronic pain. Chronic pain is a common health and mental health concern for Veterans seeking care in the Veteran Health Administration (VHA). While many Veterans suffering from chronic pain could benefit from ACT, they are often unable to access treatment due to rural locality, physical limitations, financial limitations, and conflicts with their schedule. Clinical video teleconferencing (CVT) is a modality that has been used to address these barriers. However, ACT may not be initially considered as an option to provide via CVT because of the experiential nature of the therapy. This presentation will describe the implementation of ACT groups for chronic pain using CVT through the chronic pain and primary care clinics in the VHA. The groups were offered in two formats: hybrid (in-person and CVT) and CVT alone. This presentation will summarize lessons learned from these groups and how to maintain fidelity to the ACT model through a novel platform.

• We are ACTing in a technology world: committing to a technology informed process
Alycia Zink, Ph.D., VA Puget Sound Health Care System
Erika M. Shearer, Ph.D., VA Puget Sound Health Care System
Lauren Hollrah, Psy.D., VA Puget Sound Health Care System

With a growing emphasis on video delivery for psychotherapy to increase access to mental health treatment (e.g. Telehealth or Clinical Video Telehealth) within the Veteran’s Hospital Administration (VHA), providers will likely need to develop a number of adaptations to existing evidence based treatments for use with this technology. In a recent poll, VHA clinicians who participated in the VHA’s Training and Dissemination Program for Acceptance and Commitment Therapy (ACT) reported limited use of this treatment via Telehealth and specifically identified difficulty adapting some of the techniques for use with video based platforms as a perceived barrier to implementation. Barriers identified included clinicians’ perception that the exercises would be too difficult to adapt to telehealth, while others opted for more visualization-based exercises. In rare instances, a few clinicians suggested theoretically sound modifications. This presentation will discuss the qualitative data obtained from this clinician poll as a basis for encouraging a “drop-down menu” approach, e.g., a process oriented approach, to implementation of ACT that would be more readily adaptable to video or web-based platforms.

Educational Objectives:
1. Describe provider-identified perceptions related to implementing ACT via video-based platforms. 2. Discuss considerations for adapting ACT to the telehealth modality. 3. List theoretically-driven adaptations to ACT for video-based platforms.

 

39. The Value of Health: Utilizing ACT to Promote Flexibility and Well-Being in Primary Care and Health-related Settings: ACT for Health SIG Sponsored
Symposium (3:10-4:25pm)
Components: Original Data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Behavioral medicine, Health, Primary Care Mental Health, Work Stress
Target Audience: Beg., Interm., Adv.
Location: Rue Crescent

Chair: R. Sonia singh, M.A., Bowling Green State University
Discussant: Dayna Lee-Baggley, Ph.D., Dalhousie University

Acceptance and Commitment Therapy (ACT) is a contextual behavioral therapy that utilizes several processes to promote psychological flexibility (Hayes et al., 1999). Four aspects of psychological flexibility are highly relevant to health including: (1) adapting to situational demands, (2) changing or shifting of perspective related to personal and social functioning, (c) finding balance when needs, desires, and demands of conflicts with life and (d) bold and meaningful committed action towards personal values (Kashdan & Rottenberg, 2010). ACT has been used to address health concerns, such as pain, chronic illness, and work stress (e.g., Flaxman & Bond, 2010, Luciano et al., 2014, Vowles et al., 2007). The current symposium builds upon this literature and synthesizes intervention research that evaluated the effects of ACT in pediatric primary care, women with breast cancer, and nurses and nurse aides in long-term care.

• Developing an Acceptance and Commitment Therapy (ACT)-Informed Evidence-Based Assessment Model to Guide Brief ACT-Intervention in an Integrated Pediatric Healthcare Clinic
Kimberly L. Gushanas, M.A., University of Texas

Brief ACT interventions have been utilized throughout integrated healthcare settings to address a wide array of medical and psychological needs (Strosahl, Robinson, & Gustavsson, 2012). As rates of chronic and co-occurring medical conditions continue to increase (Wu & Green, 2000), the need for flexible yet effective pediatric care models are becoming increasingly important (Dindo, Van Liew, & Arch, 2017). Although independent models exist for empirically-based screening, assessment, and intervention in integrated settings, literature is limited with regards to utilizing a comprehensive acceptance-based approach, especially within pediatric populations. This presentation will describe and outline the pilot implementation of an evidence-based screening and assessment protocol utilized within a specialized, integrated pediatric health clinic and designed to guide appropriate ACT-informed brief interventions. Two case examples will be reviewed, one highlighting the use of the protocol for an inpatient consultation, and another from outpatient tertiary care. Considerations for dissemination in pediatric settings will be discussed, as well as implications for research. Preliminary data regarding the outcomes of pilot implementation may be available at the time of presentation.

• Group ACT for breast cancer women: the usefulness of the Matrix method and Compassion based strategy
Giuseppe Deledda, Psy.D., “Sacro Cuore-Don Calabria” Hospital of Negrar

Introduce ACT protocol group intervention for women with breast cancer, with the Matrix method and Compassion based strategy. The intervention consisted of eight sessions every two weeks and two monthly follow-up sessions. In the group, patients have reflected on the suffering linked to oncological disease, the side effects of therapy, the pain and suffering in live it with the wig, and the bodily changes. The Matrix was used, in order to move patients to explore their thoughts and feelings, the behaviour strategies, the cognitive entanglement, attachment to a conceptualized self, loss of contact with the present (I-there-then), and the resulting failure in taking action related to values. The work of continuous discrimination on the I-here-now has been very useful to bring back and reinforce the work on values, even in the presence of recognized thoughts, emotions and sensations. Through the compassionate writing method, patients have had the opportunity to open up to their suffering, share the suffering of other women, and treat it with gentleness, respect, gratitude, admiration, and compassion.

• ACT for Nurses and Nurse Aides Experiencing Work Stress
Mary Moeller, M.A., Bowling Green State University
R. Sonia Singh, M.A., Bowling Green State University
Kristin A. Horan, M.A., University of Central Florida
Rachel S. Wasson, B.A., Bowling Green State University
Steve Jex, Ph.D., University of Central Florida
Clare Barratt, Ph.D., Bowling Green State University
Russell Matthews, Ph.D., University of Alabama
William H. O'Brien, Ph.D., Bowling Green State University

Nurses and nurse aides experience high rates of stress and burnout relative to other workplace populations (Levin, Hewitt, Misner, & Reynolds, 2003). Acceptance and Commitment Therapy (ACT) and other mindfulness-based therapies are becoming more widely researched as interventions for the negative appraisals and cognitive fusion that can lead to work stress and avoidance-based behaviors (Bond & Bruce, 2000; Brinkborg, Michanek, Hesser, & Berglund, 2011). The present study is a randomized controlled trial in which nurses and aides were randomly assigned to receive an ACT intervention or be put on a waiting list. The ACT intervention involved 2, two-hour sessions. The first session taught mindfulness, creative hopelessness, and that control strategies are often ineffective as a coping mechanism. The second session focused on cognitive defusion, letting go of the struggle, and values-based committed action. Intervention participants improved significantly in injury count and mindfulness. Mindfulness and acceptance mediated the effects of workplace stressors on aggression from residents, work-related frustration, and burnout. The results suggest that ACT may be an effective intervention for high-stress employees.

Educational Objectives:
1. Evaluate adaptive components and applications of an ACT-informed model of evidence-based assessment and intervention designed for specialized pediatric health settings. 2. Explain the value of a group-based ACT intervention for women living with breast cancer. 3. Describe a group-based ACT approach for work stress for nurses and nurse aides in long-term care settings.

 

40. Bringing ACT for Psychosis into the “Real World”: Recent Developments in Dissemination and Implementation: Psychosis SIG Sponsored
Symposium (3:10-4:25pm)
Components: Conceptual analysis, Literature review, Original Data, Didactic presentation
Categories: Clinical Interventions and Interests, Supervision, Training and Dissemination, Inpatient Hospitalization, Psychosis, Severe Mental Illness
Target Audience: Beg., Interm., Adv.
Location: Rue Mansfield / Rue Sherbrooke

Chair: Brandon A. Gaudiano, Ph.D., Alpert Medical School of Brown University & Butler Hospital
Discussant: Louise Johns, Oxford Health NHS Foundation Trust

ACT for psychosis (ACTp) is supported research showing that the treatment is effective at helping individuals cope with symptoms to decrease impairment and rehospitalizations. However, the dissemination of ACTp in typical community settings has lagged behind these efforts, and further work is needed to establish feasible and effective models of care for those being treated in real world settings. This symposium brings together three different research groups studying complementary ways of disseminating and implementing ACTp in inpatient and outpatient settings across different countries. The first paper will report results from a project to train routine hospital staff to integrate ACTp into the system of care in an acute-care psychiatric inpatient unit in the U.S. The second paper will describe effects on staff and patients when implementing a brief ACTp model on an inpatient unit in Sweden. The third paper will report on efforts to evaluate a group-based ACTp program for outpatients in Australia. Our discussant, Dr. Louise Johns, will comment on the current state of ACTp implementation efforts and crucial next steps.

• Researching the Effectiveness of Acceptance-based Coping during Hospitalization: Initial Results from the REACH Project
Brandon A. Gaudiano, Ph.D., Alpert Medical School of Brown University & Butler Hospital
Carter Davis, BFA, Butler Hospital
Gary Epstein-Lubow, M.D., Alpert Medical School of Brown University
Ivan W. Miller, Ph.D., Alpert Medical School of Brown University & Butler Hospital

ACT for psychosis (ACTp) has shown initial efficacy in randomized controlled trials for improving acute and post-discharge outcomes in patients with psychosis when studied in inpatient psychiatric hospitals in the U.S. However, the intervention has not been widely adopted in its current form because of its reliance on an individual-only format and delivery by doctoral-level research therapists with extensive prior experience using ACTp. The aim of the Researching the Effectiveness of Acceptance-based Coping during Hospitalization (REACH) Project is to adapt a promising acute-care psychosocial treatment for inpatients with psychosis, and to pilot test its effectiveness in a routine inpatient setting. More specifically, we describe initial results gained from: (a) modifying the ACTp treatment protocol for integration into the typical inpatient milieu; (b) completing an initial open trial to train staff and further refine the intervention based on stakeholder feedback; and (c) conducting a pilot randomized controlled trial to examine the effects of ACTp versus supportive therapy on rehospitalization rates and other clinical outcomes.

• Affecting the psychiatric ward milieu using a combination of individual treatment and staff behavior change
Mårten Tyrberg, Stockholm University & Hospital of Västmanland Västerås
Per Carlbring, Stockholm University
Tobias Lundgren, Stockholm University & Karolinska Institutet

Changing the context surrounding patients treated in psychiatric wards is a great challenge, with barriers in terms of the organization, work culture and clinical skill. We propose a model to influence the ward context by adding psychological treatment in both individual form and by teaching inpatient staff how to use a simplified ACT model to inform their daily interactions with patients. We further discuss difficulties in the implementation of psychological treatment in inpatient milieus. Results from three empirical studies in a naturalistic setting in Sweden form the basis of a model describing how access to evidence-based psychological treatment might be increased using limited extra resources. Data suggest that 1) an average of two individual ACT sessions might lessen the need for future inpatient care for psychosis patients, 2) inpatients as well as staff members themselves might benefit from staff learning and using a simplified ACT model, and 3) staff find the ACT model useful both in terms of helping patients handle psychiatric symptoms and in terms of handling their own work-related stress.

• Promoting recovery from psychosis using ACT groups in community mental health: Feasibility, acceptability and outcomes
Eric Morris, La Trobe University
John Farhall, La Trobe University & NorthWestern Mental Health
Jesse Gates, Melbourne Health
Jacinta Clemente, Melbourne Health
Eliot Goldstone, NorthWestern Mental Health

This paper will describe the ongoing evaluation of community-based Acceptance and Commitment Therapy groups for people recovering from psychosis at NorthWestern Mental Health in Melbourne, Australia. This 8-session group program has been adapted from the protocol described by O’Donoghue et al (2018), using the principles described by Butler et al (2015), and previously evaluated in the National Health Service in the United Kingdom. We will present preliminary findings of the effectiveness group ACT in helping consumers to recover, achieve improved wellbeing, and greater quality of life. Alongside these outcomes we will discuss the feasibility of running these groups in community health settings, and the qualitative feedback from participants of their group experiences. Group ACT shows promise as a low-intensity intervention to support the wellbeing and quality of life of people recovering from psychosis.

Educational Objectives:
1. Describe how routine hospital staff can be trained to adapt ACT for psychosis during inpatient care. 2. Apply the ACT model in simplified form to inpatient care. 3. Learn how to conduct feedback processes in ACT for psychosis groups and measure outcomes.

 

43. ACT processes and outcomes among high risk populations
Symposium (3:10-4:25pm)
Components: Literature review, Original Data, Didactic presentation
Categories: Clinical Interventions and Interests, Performance-enhancing interventions, Prevention and Community-Based Interventions, Supervision, Training and Dissemination, Suicide, Psychological flexibility, Youth, Inpatient care, Adolescent depression, Adolescent anxiety, Psychosis
Target Audience: Beg., Interm., Adv.
Location: Exclamation

Chair: John Donahue, Psy.D., University of Baltimore

This symposium explores ACT processes as well as ACT outcomes with high risk populations. This first presentation describes the results of two studies in which the relation between psychological flexibility and suicidal ideation (SI) was examined. In the first study, psychological flexibility predicted SI in a high risk population (i.e., individuals with Borderline Personality Disorder) over and above symptom severity. Findings of the second study are expected to reveal psychological flexibility longitudinally predicts SI in a general sample, even after controlling for relevant covariates. The second presentation provides outcome data from a randomized controlled trial of ACT for patients with psychosis conducted in Buenos Aires, Argentina. To date, ACT for patients with psychosis, an often high risk and difficult to treat population, has been ben implemented and found successful in several international settings. This current study will present the first outcome data from this region.

• Longitudinal Associations between Psychological Flexibility Processes and Suicidal Ideation
John Donahue, Psy.D., University of Baltimore
Rebecca Thompson, Ph.D., University of Baltimore
Katie Callahan, B.A., University of Baltimore

Suicide is the tenth leading cause of death in the US and the cross-national lifetime prevalence of suicidal ideation (SI) is 9.2% (Nock et al., 2008). While the psychological flexibility (PF) model of psychopathology has been examined across a range of problem domains, research in relation to SI is in its nascency (Bryan et al., 2015). We will report on two longitudinal studies examining PF processes as predictors of later SI. In a sample of 63 participants endorsing elevated Borderline Personality Disorder symptomology (study 1), the closed response style, measured using the Cognitive Fusion Questionnaire and Brief Experiential Avoidance Questionnaire, was significantly associated with SI nine months later (β = .35, p < .05), over and above baseline negative affect, depressive rumination, and suicidal desire (ΔR2 = .07). In study 2, 150 online participants will complete measures of PF (CompACT), anxious/depressive symptomology (DASS-21), and SI at baseline and three months later. We hypothesize PF will longitudinally predict SI after controlling for relevant covariates. The utility of the PF model in understanding SI will be discussed.

• Randomized controlled trial of acceptance and commitment therapy applied for psychotic patients in a public mental health hospital in Buenos Aires
Germán Teti, M.D., CATC - Hospital "Braulio Moyano"
Juan Pablo Coletti, CATC

Until now, several randomized clinical trials (RCTs) have shown that ACT is an effective treatment for the management of schizophrenias and other psychotic disorders. Bach and Hayes, applied 4 sessions of ACT to 40 psychotic patients, finding a decrease in the rehospitalization rates in the group that received the intervention. Gaudiano and Herbert, applied 3 sessions of ACT to a group of 20 psychotic patients, finding significant differences with respect to the group that received the usual treatment in relation to the discomfort caused by hallucinations. Finally, a recent RCT, published in 2017 in the British Journal of Psychiatry, randomized 53 patients to 8 sessions of ACT and 53 patients to 8 sessions of befriending, resulted in a significant difference in the ACT group in relation to the discomfort caused by the voices. The present study aims to evaluate the efficacy of ACT applied to this population of patients in a context not yet explored. The present study has been approved by the ethics and research committe of the “Braulio Moyano” hospital in Buenos Aires.

Educational Objectives:
1. Describe suicidal ideation and suicide within the context of the psychological flexibility model of psychopathology. 2. Assess the relationship between psychological flexibility processes and later suicidal ideation in comparison to other known risk factors. 3. Describe the protocol for the RCT using ACT in this study.

 

44. Metaphor Co-Creation: ACT as Practiced in Japan: Japan Chapter Sponsored
Symposium (3:10-4:25pm)
Components: Case presentation
Categories: Clinical Interventions and Interests, Clinical Interventions and Interests, co-creation of metaphor, The way of case presentation, ACT practice in various cultures, CARE Guideline, creating a metaphor
Target Audience: Interm.
Location: Multiplication

Chair: Takashi, Mitamura, Ph.D., Ritsumeikan University
Discussant: Shinji Tani, Ph.D., Ritsumeikan University

We show how ACT is practiced in Japan by focusing on metaphor co-creation and case presentation. Case research is very important for scientific progress. It helps clinicians find techniques and findings that have never been reported in a research design. An elaborate and well-designed case research consists of case formulation, the use of a single case design and an ongoing form of measurement. Case research can contribute to a strong research base (according to the CARE Guideline). The main objective of this presentation is to highlight how case research can translate to stronger evidence. The second objective is to give some examples of metaphor co-creation in Japanese and discuss cultural differences. Japanese language is said to be a contextually dependent language. A clinical conversation using a metaphor and an ACT exercise differs from English. All three speakers will: a) Give a case presentation respecting the CARE Guideline; b) Outline an intervention using a single case design; c) Give examples of metaphor co-creation; d) Demonstrate exercises which fit within Japanese culture.

• Co-creation of metaphor to observe and describe sufferings with curiosity - A case of a woman with fear of incontinence
Atsushi Seguchi, Inuyama hospital

This case report describes an intervention based on ACT for a 39-year-old woman who was unable to drive her car because of fear of incontinence, To verify the effectiveness of the intervention, AAQ-Ⅱwas administered, and the frequency of driving, the duration of driving, the number of palaces she could go to by car, and response latency until she came out of a bathroom were measured repeatedly. In the intervention phase, the client and therapist co-created a metaphor for her thoughts as “Bibili-Chan” which looks like a traditional Japanese ghost. A defusion exercise was practiced using the “ Bibili-Chan” metaphor to observe and describe the client’s thoughts with curiosity, and she underwent the exercise while driving. The therapist encouraged her to use the metaphor in difficult situations. The client then spontaneously created another metaphor for the sensation she felt in her urinary bladder and used it for accepting the unpleasant sensation. This intervention led to improvements in AAQ-Ⅱscores (from 32 to 16) and in every behavioral measurement.

• Co-creating metaphor for exploring lost values and activities: A case of a woman who had major depression due to marital troubles
Yusuke Shudo, Hiroshima International University

This case report details the treatment of a woman in her 30s who had major depression due to marital problems. A functional assessment revealed that the woman’s depressive behavior of staying in bed was maintained by avoidance of her husband or stimulus that was reminiscent of her husband. Therefore, it was necessary (1) to clarify her values and increase the frequency of behavior based on those values to make her commit to them and (2) to establish acceptance of unpleasant experiences. The first intervention was to clarify her values and schedule activities based on those values. In this phase, “exploring lost values and behavior cards” exercise was used to help her understand that having uncertain values can cause depression and that value-based activities are important in the treatment of depression. Subsequently, acceptance-based interventions were introduced. These interventions helped enforce her value-based behavior, which was not influenced by mood. Their effectiveness was confirmed through repeated measurements using standardized scales; her BDI score improved from 32 to 7 and AAQ-Ⅱ score improved from 46 to 26.

• Co-creating a metaphor for evoke curiosity about fear: A case of a woman with emetophobia
Takashi Mitamura, Ritsumeikan University

This is a case study of a woman with emetophobia or fear of vomiting. Clinical behavior analytic intervention was conducted, which consisted of 9 sessions (including some follow-up sessions). The STAI, Emetophobia-Scale, AAQ-II, and BADS were administered repeatedly to the client. The therapist conducted exposure-based intervention. Then, the therapist and the client, who is a swimming instructor, created the metaphor “searching for goldfishes in the pool” to willingly experience anxiety. This intervention proved to be effective and reduced the client’s phobia. Additionally, behavior activation-based interventions were carried out in the next phase. As the result, not only did her anxiety (STAI-State: from 64 to 24, STAI-Trait: from 63-30, and Emetophobia-Scale: from 266 to 155) and experiential avoidance (AAQ-II: from 41 to 18) reduce, but her activity levels also increased (BADS: from 18 to 49). In addition, her depression was alleviated (BDI-II: from 25 to 7) and her daily life showed improvement.

Educational Objectives:
1. Describe the checklist of the CARE Guidelines 2. Explain the important points to create a metaphor and exercise. 3. Discuss the way of ACT practice in various cultures.

 

Friday, July 27

56. Examining the Impact on ACT Processes of ACT and Exposure-Based Treatments for OCD and PTSD
Symposium (10:35am-12:05pm)
Components: Original Data, Didactic presentation
Categories: Clinical Interventions and Interests, Theoretical and philosophical foundations, OCD, PTSD, ACT, The Matrix, IBA
Target Audience: Interm.
Location: Rue Sainte-Catherine

Chair: Chad Wetterneck, Ph.D., Rogers Memorial Hospital, Marquette University
Discussant: John Forsyth, Ph.D., University at Albany, SUNY

Consistent with recent calls to move away from treatment protocols towards understanding broader, transdiagnostic processes of change (Hayes & Hofmann, 2017), the papers presented in this symposium discuss studies exploring the impact of ACT and exposure-based treatments on ACT processes. ACT has been called an exposure-based treatment, and it has been suggested that exposure may be used to strengthen any of the core ACT processes. (e.g., Luoma, Hayes, & Walser, 2017). The studies presented here offer novel methods for examining ACT-related mechanisms of change in applied settings, and they clarify the impact of ACT and exposure-based treatments for OCD and PTSD on ACT processes.

• Valued Living and Psychological Flexibility in an Exposure-based PTSD Program: Considerations for Treatment
Peter Grau, M.S., Marquette University, Rogers Memorial Hospital
Chad Wetterneck, Ph.D., Rogers Memorial Hospital, Marquette University
Michael Clark, M.Ed., University of Wisconsin-Milwaukee, Rogers Memorial Hospital

Exposure therapy for PTSD is efficient (Foa & Mclean, 2016) and effective (Eftekhari et al., 2013). However, evidence suggests holistic treatment for PTSD benefits from incorporating the pursuit of meaning and values (Bean et al., 2017; Donahue, Huggins, & Marrow, 2017; Orsillo & Batten, 2005). This study explores the impact of incorporating a focus on valued living and psychological flexibility in an exposure-based partial hospitalization PTSD treatment program. Participants (n=150) were in treatment and were mainly White (87%), heterosexual (80%), and female (80%), with an average age of 35.7 (SD=10.8). Valued Living was measured using the Valued Living Questionnaire, psychological inflexibility was measured using the Acceptance and Action Questionnaire, and PTSD symptomology was measured using the PTSD checklist for DSM-5. Initial results show that over the course of treatment, PTSD symptomology decreases while valued living and psychological flexibility increases. Secondary analyses will be conducted to see whether changes in valued living and psychological flexibility interact with changes in PTSD symptoms. This provides evidence supporting use of ACT and exposure therapy for PTSD.

• The Impact of ERP and ACT for OCD on ACT Processes: A Single Case Design Study
Brian Thompson, Ph.D., Portland Psychotherapy Clinic, Research, & Training Center

Recent research suggests ACT and ERP may work through a broader range of processes than predicted by the theories underlying each (Twohig et al., 2010). In a multiple baseline across participants single case design study, ACT processes were tracked across a combined ERP and ACT for OCD treatment protocol delivered in 45-sessions. All participants (N = 4) began with ERP. At a randomized point in treatment, ERP was suspended, and participants received 4 ACT sessions before returning to ERP. At treatment completion, changes in Y-BOCS scores indicated 3 of 4 participants were treatment responders (>35%), and 2 of 4 participants achieved symptom remission (<14; Farris et al., 2013). Visual inspection of graphed data indicated ERP effected shifts from change-focused strategies towards acceptance-based strategies (defusion; willingness), even before one participant began the ACT phase. Findings suggest exposure effects changes in ACT processes.

• Preliminary data of an ACT vs IBA RCT for OCD
Benjamin Schoendorff, M.A., M.Sc., Contextual Psychology Institute

The data of an RCT (N = 46) comparing ACT with the Inference Based Approach for OCD (IBA, O’Connor et al. 2005) will be presented. In addition to pre-post and 6-month follow-up data, an innovative analysis of mechanisms of change specific to ACT, IBA, Cognitive Therapy (CT) and Exposure with Response Prevention (ERP) will be described. The results of an analysis of the temporal evolution of the postulated mechanisms of change for each condition will be presented, evidencing the specificity or otherwise of the postulated mechanisms of change for ACT and IBA as compared with those postulated for CT and ERP.

Educational Objectives:
1. Describe the potential value in integrating ACT concepts into exposure therapy for PTSD. 2. Demonstrate how ACT and exposure may effect change in ACT processes in OCD treatment. 3. Describe the method of analyzing the temporal evolution of postulated mechanisms of change of both ACT and IBA.

 

58. A functional contextual approach to moral injury: Conceptualization, treatment, and implementation considerations
Symposium (10:35am-12:05pm)
Components: Conceptual analysis, Literature review, Original Data, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Theoretical and philosophical foundations, Moral Injury
Target Audience: Beg., Interm., Adv.
Location: Rue Crescent

Chair: Lauren M. Borges, Ph.D., Rocky Mountain MIRECC
Discussant: Sean M. Barnes, Ph.D., Rocky Mountain MIRECC

Exposure to morally injurious events (MIEs) is a transdiagnostic risk factor for the development and maintenance of a range of psychological symptoms and syndromes including PTSD, substance use, suicidal behavior, and depression. Relationship disconnection, spiritual disengagement, workplace difficulties, and self-care neglect often result as impaired facets of functioning. Given the prevalence of exposure to MIEs (Wisco et al., 2017) and its transdiagnostic consequences, models of conceptualization, treatment, and implementation that target the function of these symptoms over form are imperative. Three presenters will approach moral injury from a functional contextual perspective. First, Lauren Borges will present a conceptual model of moral injury and data from a qualitative study examining veterans’ perspectives about addressing moral injury in treatment. Consistent with this model, Robyn Walser will present Acceptance and Commitment Therapy for Moral Injury (ACT-MI) and will provide data supporting this intervention. Finally, Jason Nieuwsma will present data on chaplains’ engagement with moral injury and ACT. Each talk describes how in approaching moral pain, individuals can move towards finding meaning in their lives again.

• A conceptual model of moral injury and a qualitative exploration of standard moral injury treatment
Lauren M. Borges, Ph.D., Rocky Mountain MIRECC
Brooke Dorsey Holliman, Ph.D., Rocky Mountain MIRECC
Sean M. Barnes, Ph.D., Rocky Mountain MIRECC

Experiencing morally injurious events (MIEs) is increasingly recognized as a risk factor for psychopathology. Following exposure to MIEs, moral pain often results where dysphoric emotions and cognitions are experienced (Farnsworth et al., 2017). Moral pain can include both self-conscious emotions and cognitions (e.g., shame) and other-condemning emotions and cognitions (e.g., contempt). Moral injury arises when attempts to manage, control, or cope with moral pain leads to social, psychological and spiritual suffering. This conceptualization of moral injury will be presented, as will qualitative data from veterans identifying lifetime difficulties in functioning related to moral injury. Standard approaches to treating moral injury will be identified and barriers to discussing moral injury in therapy will be explored. Persistence of moral injury following standard care (often evidence based psychotherapies for PTSD) will be described. Data surrounding the perceived utility of standard interventions in treating moral injury will be presented, as will veterans’ perceptions about the importance of moral injury treatment. These data support the exploration of interventions explicitly targeting the moral pain that maintains moral injury.

• Thriving in the midst of moral pain: A presentation of pilot data supporting Acceptance and Commitment Therapy for Moral Injury (ACT-MI)
Robyn Walser, Ph.D., National Center for PTSD
Jacob Farnsworth, Ph.D., Denver VA Medical Center
Lauren M. Borges, Ph.D., Rocky Mountain MIRECC
Wyatt Evans, Ph.D., Strong Star PTSD Consortium
Kent Drescher, Ph.D., VA Palo Alto Health Care System

Acceptance and Commitment Therapy for Moral Injury (ACT-MI), was developed as a transdiagnostic psychotherapy to improve psychological functioning following exposure to morally injurious events by utilizing the social functions of moral emotions (Nieuwsma et al., 2015). Using group psychotherapy, moral pain is targeted in ACT-MI via social functionalism and functional contextualism. During ACT-MI, clients learn that moral emotions are indicators of important values; to observe their thoughts, emotions, and urges; and to practice engaging in values-consistent behavior even in the presence of moral pain. Using this conceptual model, ACT-MI will be discussed as an intervention that explicitly builds psychological flexibility related to moral pain. Data from ACT-MI pilot groups provide preliminary support for increased engagement in the present moment, improved observation of internal experiences, and increased values-consistent behavior. ACT-MI was found to be acceptable among warzone Veterans (Farnsworth et al., 2017). Data will be presented supporting the feasibility of ACT-MI. Treatment considerations for connecting individuals to meaning and purpose in their lives to promote thriving in the midst of moral pain will be explored.

• Utilizing Acceptance and Commitment Therapy to aid chaplains in addressing moral injury
Jason Nieuwsma, Ph.D., Duke University
Jennifer Wortmann, Ph.D., Visn 6 MIRECC, Durham VA Medical Center
Rebecca Morris, MDiv, Portland VA Medical Center
Jaimie Lusk, Ph.D., Portland VA Medical Center
Janet Hanson, Rev., Portland VA Medical Center
Keith Meador, M.D., Vanderbilt University

Moral injury inherently invites therapeutic attention from perceived moral authority figures, such as clinical chaplains, with prominent definitions of moral injury explicitly noting its characteristic “spiritual” impact (Litz et al., 2009). Aspects of moral injury may be particularly responsive to intervention with Acceptance and Commitment Therapy (ACT; Nieuwsma et al., 2015), a therapeutic modality that is especially synergistic with core commitments in clinical chaplaincy (Nieuwsma, Walser, & Hayes, 2016). To evidence the unique therapeutic potential for chaplains to utilize ACT in addressing moral injury, this presentation will draw on multiple data sources collected by the authors: a) a representative survey of 2,163 Veterans Affairs (VA) and military chaplains (62% response rate); b) longitudinal training outcomes from approximately 120 chaplains intensively trained and supervised in the application of ACT; and c) a two-part survey of VA chaplains’ moral injury practices (N = 109; N = 367). The presentation will also include an example from one site where chaplains are conducting an ACT for moral injury group. Clinical, research, and interdisciplinary implications will be discussed.

Educational Objectives:
1. Describe moral injury and moral pain from a functional contextual perspective and identify barriers to approaching moral injury in treatment. 2. Discuss the components of Acceptance and Commitment Therapy for Moral Injury and how these facets of treatment can empower individuals to move towards their values even in the presence of moral pain. 3) List the strengths of engaging chaplains in utilizing ACT to address moral injury.

 

59. Barriers and innovations in self-guided ACT interventions: ACTing with Technology SIG Sponsored
Symposium (10:35am-12:05pm)
Components: Original Data
Categories: Clinical Interventions and Interests, Behavioral medicine, Technology, Self-Help
Target Audience: Beg., Interm., Adv.
Location: Rue Mansfield / Rue Sherbrooke

Chair: Jennifer Krafft, Utah State University
Discussant: Ben Johnson, Ph.D., RICBT

One of the core therapist competencies required in face-to-face ACT is the ability to elicit, identify, and target psychological inflexibility processes flexibly, as they appear in the moment (i.e., dancing around the hexaflex; Luoma, Hayes, & Walser, 2007). This flexible, functional approach to behavior change is challenging to translate to self-guided interventions, which may by necessity be limited in their flexibility, if not completely static. The tension between the clinical emphasis on flexible delivery of ACT and the limitations of self-guided interventions raises major questions, such as: How do more static vs. dynamic interventions impact treatment outcomes, acceptability, and engagement? How are self-help treatment developers innovating to make self-help experiential and personally relevant? How can clinicians use self-help most effectively given its unique limitations and advantages? What should clinicians think about when integrating self-help with their practice? This symposium will present results from recent, innovative self-guided ACT interventions, with a focus on exploring these questions.

• Flexibly targeting ACT and integrating a web-delivered intervention for tobacco cessation into your practice: The WebQuit intervention
Jonathan Bricker, Ph.D., Fred Hutchinson Cancer Research Center

Up to 70% of people with mental health problems smoke cigarettes—which contributes their dying ten years sooner than those with mental health problems who don’t smoke (Tam et al., 2016). However, less than a third of mental health practitioners with clients who smoke assist with them with stopping smoking (Sharma et al., 2018). Common barriers include practitioners’ lack of skill, knowledge, time, and mechanisms for reimbursement. Fortunately, my research team has developed a free web-delivered intervention that any mental health practitioner can easily integrate into their practice without special training. WebQuit is a cigarette smoking cessation that flexibly applies the ACT model into simple four step process: 1. Make a Plan, 2. Be Aware, 3. Be Willing, and 4. Be Inspired. The largest randomized trial of ACT (N= 2637) recently showed that WebQuit has 24% quit smoking rates at 12-month follow-up—much more effective than the typical 9% found in web-delivered interventions (Bricker et al., 2018). I will demonstrate WebQuit.org and show how to flexibly integrate it into practice.

• Using mobile apps to tailor ACT skill training in-the-moment: Results from the ACT Daily app
Michael E. Levin, Ph.D., Utah State University
Jack Haeger, M.S., Utah State University
Cynthia Navarro, M.A., Utah State University
Rick Cruz, Ph.D., Utah State University

Mobile apps offer unique advantages in providing high frequency, low intensity interventions throughout people’s day, and to tailor interventions based on in-the-moment variables. This presentation will report the results of a series of trials evaluating the ACT Daily mobile app, which delivers check-in assessments throughout people's day and provides tailored skill suggestions based on responses. We will focus on results from a recently completed trial comparing 69 adults randomized to receive the tailored ACT daily app, a non-tailored version, or an assessment only version of the app (without skill coaching). This trial found the tailored app outperforms a non-tailored or assessment only version of the app on post intervention outcomes as well as in-the-moment app assessment data. We will also briefly review two other trials of ACT Daily, which found positive results when the app was used adjunctively with face-to-face therapy and as a support for clients on a therapy waiting list. We will discuss how these results may inform clinical decision making in therapy and the use of mobile apps with clients.

• Development and pilot-testing of storytelling video self-help program based on Acceptance and Commitment Therapy for depression
Lisa A. Uebelacker, Ph.D., Brown University, Butler Hospital
Brandon Gaudiano, Ph.D., Brown University, Butler Hospital
Carter H. Davis, Butler Hospital
Ivan W. Miller, Brown University, Butler Hospital

This study involved development and testing of a 4-episode video self-help intervention called LifeStories, which features real patients describing their use of coping strategies for depression based on Acceptance and Commitment Therapy. In the development process, we interviewed people with experiences of depression and ultimately selected twelve to be featured as storytellers in LifeStories. Once we created a working version and an accompanying workbook, we conducted a baseline-controlled open trial (AB design) with 11 depressed individuals. Participants reported high levels of satisfaction and transportation (i.e., engagement) after watching LifeStories. We did not observe significant changes during the 4-week baseline period in interviewer-rated depression severity (primary outcome), but we observed a significant and large effect at Week 8 post-intervention. Most participants (54.5%) showed a reliable and clinically significant posttreatment response. During the intervention period only, we observed significant improvements for self-reported depressive symptoms and aspects of mindfulness (nonreactivity). Based on participant interviews, we identified additional areas for intervention refinement. We used feedback to further refine Lifestories and are currently conducting a pilot randomized controlled trial.

Educational Objectives:
1. Demonstrate the integration of a smoking cessation app into clinical practice flexibly and effectively. 2. Explain the effects of tailoring in mobile app interventions and how tailoring is linked to clinical decision-making. 3. Describe the rationale for and impact of incorporating story-telling into a self-help intervention.

 

63. Social intimacy: A transdiagnostic target for CBS therapists
Symposium (10:35am-12:05pm)
Components: Original Data
Categories: Clinical Interventions and Interests, Clinical Interventions and Interests, psychophysiological, Functional Analytic Psychotherapy, Social relating, Heart Rate Variability
Target Audience: Interm.
Location: Multiplication

Chair: Lindsey Knott, Ph.D., Michael E. DeBakey VA Medical Center
Discussant: Michel A. Reyes Ortega, Ph.D., National Autonomus University of Mexico Faculty of Medicine

In recent years, social intimacy (intimacy) has become a key factor in research related to Functional Analytic Psychotherapy (FAP, Wetterneck & Hart, 2012; Maitland et al., 2017). While there is an emerging literature base exploring the theoretical role of intimacy in psychological distress and implementation of FAP, there continues to be a dearth of empirical investigations on the subject. In this symposium, researchers will present data-driven investigations of the role of fear of intimacy in mental and physical health, how fear of intimacy impacts committed action and behavioral activation, and how intimacy with client’s therapists affects the timing and magnitude of treatment outcomes in FAP. In these studies, intimacy will be assessed at different levels including behavioral observations, questionnaires, and physiological responses. At the conclusion of the talks, an expert in the field will discuss the larger implications of the finding and how this data can facilitate therapist, client, and treatment growth and development.

• Intimacy as a clinically relevant target: The role of intimacy in mental and physical health
Katherine E. Manbeck, M.S., University of Washington
Jonathan Kanter, Ph.D., University of Washington
Savannah Miller, University of Washington

Fear of intimacy is associated with briefer relationships and more loneliness. Lack of social support is a risk factor for a variety of physical and mental illnesses, including mortality, but the direct relationship between fear of intimacy and outcomes of interest has not been evaluated. In study 1, participants completed a battery of assessments in our research lab, and a researcher assessed their BMI and heart rate variability at baseline and during social stress (sharing vulnerably with a researcher). We examined the association between self-reported fear of intimacy and physical health, assessed using the World Health Organization self-report measure and physiological markers of health (BMI and heart rate variability). In study 2, participants completed an online battery of tests designed to capture mental health and social adjustment variables. We explored the relationship between self-reported fear of intimacy and self-reported mental health. We further examined relationship closeness as a mediator of the relationship between fear of intimacy and health outcomes. We found that fear of intimacy is a clinically relevant target that tangibly affects health.

• When relationships are the intersection of values and committed action: The role of intimacy in behavioral activation
Emily Munoz, Texas A&M University Corpus Christi
Daniel W. M. Maitland, Ph.D., Texas A&M University Corpus Christi

Committed action is sometimes defined as taking effective action guided by our values (Harris, 2009). One values domain frequently targeted in clinical practice and research is interpersonal relationships. While relationships, broadly defined, hold much importance to individuals, the exact reason that interpersonal connection or social support impacts subjective distress is not fully understood. Researchers have theorized that social intimacy may be a key variable in understanding the role of relationships in transdiagnostic distress (Wetterneck, 2012) and studies have found that intervening upon intimacy have led to significant improvement in subjective well-being (Maitland et al., 2016). Based on these and other similar findings, modalities of therapy such as Functional Analytic Psychotherapy have developed treatment models that focus primarily on interpersonal intimacy (The Awareness, Courage, and Love Model; Maitland, Kanter, Manbeck, & Kuczysnki, 2017). The current research investigates the role of approach behavior in interpersonal interactions that involve engaging in vulnerable self-disclosure (intimacy) and the impact that engaging in these behaviors has on creating an enriched environment and increased committed action that can help an individual thrive.

• Intimacy as a mechanism of change in Functional Analytic Psychotherapy
Daniel W. M. Maitland, Ph.D., Texas A&M University Corpus Christi
Amanda Murray, Texas A&M University Corpus Christi
Emily Munoz, Texas A&M University Corpus Christi

Functional Analytic Psychotherapy has shown promising initial findings as a treatment for enhancing social functioning (social intimacy) and reducing distress. However, no study has comprehensively assessed FAP’s proposed model. In FAP’s model of behavior change, first, a strong in-session relationship is developed, followed by enhanced social functioning outside of session, which finally results in decreased psychological distress. Despite the lack of a comprehensive evaluation of FAP’s mechanism, researchers have developed the tools and provided data supportive of FAP’s theoretical mechanism of change (e.g. Maitland & Gaynor, 2016, Maitland et al., 2016). This talk will present a study conducted using a multiple baseline design with individuals struggling with social functioning, that comprehensively evaluates FAP’s proposed model of change testing the following hypothesis: adherent and competent application of FAP increases client therapist intimacy and increased client therapist intimacy, in turn, increases out of session intimacy, which leads to reduced psychiatric distress.

Educational Objectives:
1. Discuss the role of intimacy in psychological distress. 2. List measurement techniques for social intimacy across a number of behavioral levels. 3. Explain the role of intimacy in Functional Analytic Psychotherapy.

 

64. Delivery of Brief, Group-Based ACT Interventions in Diverse Settings: Outcomes and Lessons Learned in Implementation
Symposium (10:35am-12:05pm)
Components: Literature review, Original Data
Categories: Clinical Interventions and Interests, Supervision, Training and Dissemination, Group Acceptance and Commitment Therapy
Target Audience: Beg., Interm., Adv.
Location: Arobase

Chair: Emily B. Kroska, M.A., University of Iowa; University of Kansas Medical Center
Discussant: Darrah Westrup, Ph.D., Indepedent Practice

The demand for psychotherapy services far exceeds the number of available therapists. Thus, group interventions have the potential to offer increased access and efficiency to care. Acceptance and Commitment Therapy (ACT) research has supported the efficacy of brief group interventions in the treatment of anxiety, depression, and health behaviors. At the same time, research examining the application of brief group ACT interventions in diverse settings and populations is growing. Because ACT is transdiagnostic, integration into medical and educational settings is not only possible, but also beneficial in reaching patients who may be unable to pursue traditional weekly psychotherapy (e.g., rural inhabitants, patients with physical disability). This symposium will discuss dissemination and implementation of brief group ACT interventions in in the context of medical centers, educational settings, and a residential treatment facility. Preliminary outcomes and lessons learned regarding implementation will be offered. The findings suggest that brief ACT is feasible and acceptable, applicable with a variety of populations, and potentially effective in predicting behavior or symptom change.

• Responding to Traumatic Stress Post Hurricane María in Puerto Rico: Brief ACT-Informed Group Intervention with School Personnel
Rosaura Orengo-Aguayo, Ph.D., Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
Regan W. Stewart, Ph.D., Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
Freddie A. Pastrana, M.A., Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
Bianca Villalobos, Ph.D., Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
Michael de Arellano, Ph.D., Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences
Joy Lynn Suárez-Kindy, Psy.D., Puerto Rico Department of Education; Carlos Albizu University
Julia Keleher, Ed.D., Puerto Rico Department of Education

Natural disasters can adversely impact children and adolescents’ emotional, behavioral, and social functioning. Schools provide an ideal setting in which to implement wide-reach interventions that can bolster resiliency and promote psychological wellness after a potentially traumatic event. Our team has established a partnership with the Puerto Rico Department of Education (PR-DE) to implement the Puerto Rico Psychological Relief Program (PRPRP). This is a multi-phase, trauma-focused intervention model designed to respond to the needs of PR-DE students, teachers, and staff at each phase of the post-disaster recovery process. This presentation will provide: 1) an overview of the PRPRP Project and its incorporation of ACT Core Processes in post disaster recovery; 2) results of Phase 1 group trainings [Psychological First Aid + ACT-informed exercises] conducted with over 500 PR-DE staff three weeks after Hurricane María devastated the island; and 3) lessons learned, including recommendations for how to incorporate brief ACT-informed interventions to aid in the post disaster recovery process.

• One-Day Behavioral Intervention for Patients with Inflammatory Bowel Disease and Co-Occurring Psychological Distress—A Pilot Study
Lilian Dindo, Ph.D., Michael Debakey Veterans Administration Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas; Baylor College of Medicine, Houston, Texas
Jason K. Hou, M.D., Michael Debakey Veterans Administration Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas; Baylor College of Medicine, Houston, Texas
Elyse R. Thakur, Ph.D., Michael Debakey Veterans Administration Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas; Baylor College of Medicine, Houston, Texas

Background: Depression and anxiety are common among patients with inflammatory bowel disease (IBD) and are associated with poor health related quality of life (HRQoL); however treatments targeting depression and anxiety for patients with IBD are lacking. In this study, we developed and tested a 1-day Acceptance and Commitment Training (ACT) plus IBD education workshop (ACT4IBD) for patients with IBD and comorbid depression and/or anxiety. Twenty patients with IBD and concomitant anxiety and/or depression attended the ACT4IBD workshop. Assessments of disease activity, HRQoL, mental health, and psychological flexibility, were completed at baseline and 3-months post-treatment. At the 3-month follow-up, patients exhibited improvements in disease activity, psychological flexibility, and distress. Qualitative feedback indicated that the intervention was valuable. This pilot study provides preliminary evidence that a 1-day workshop for patients with distress and IBD is feasible and potentially efficacious for the enhancement of quality of life and improvement in distress symptoms. A larger randomized controlled trial will provide the power needed to better assess the effects of the workshop.

• How Much is Enough in Brief Acceptance and Commitment Therapy in Treating Depressive Symptoms?
Emily B. Kroska, University of Iowa; University of Kansas Medical Center
Michael W. O'Hara, University of Iowa

The present study sought to answer how much ACT is enough to make an impact on depressive symptoms by comparing three single-session group ACT interventions that varied in length (90 minutes, 3 hours, or 6 hours). Participants completed measures of depression, social satisfaction, and key ACT processes before and after the intervention (1- and 3-months). Results indicated that depressive symptoms decreased between baseline and follow-up, and there were no differences between conditions. Expected change in avoidance and social satisfaction was observed over time, but there were no between-condition differences. Mindfulness did not change over time across groups, but differences in mindfulness were observed at 3-month follow-up between the 90-minute group and the 3- and 6-hour groups. The findings are important to consider in light of public health initiatives to increase access to mental health services. Several aspects of the current study are promising from a public health perspective: the single-session time commitment, delivery in groups, and brevity. Future research should examine the acceptability and feasibility of brief interventions compared to traditional courses of psychotherapy.

Educational Objectives:
1. Describe implementation of a brief, ACT-based group intervention, within an educational setting, after Hurricane María devastated Puerto Rico. 2. Apply ACT among patients with comorbid medical an psychological conditions. 3. Discuss the delivery of brief ACT groups in treating depressive symptoms.

 

71. Cultivating Self-Compassion and Its Relation to ACT Intervention Processes
Symposium (1:20-2:50pm)
Components: Conceptual analysis, Literature review, Original Data, Didactic presentation
Categories: Clinical Interventions and Interests, Supervision, Training and Dissemination, Self-compassion
Target Audience: Beg., Interm., Adv.
Location: Rue Sainte-Catherine

Chair: John P. Forsyth, Ph.D., University at Albany, SUNY
Discussant: Dennis Tirch, Ph.D., Director, The Center for Compassion Focused Therapy

Self-compassion (Gilbert, 2009; Neff, 2003) is increasingly making its way into evidence-based practice, both as transdiagnostic process and as an important intervention outcome (Neff & Tirch, 2013). How core ACT intervention processes, including psychological flexibility, interface with self-compassion is not well understood. Each of the data-based papers in this symposium highlights relations among core ACT intervention processes and self-compassion. The methods span experimental psychopathology work, exploring the acute impact of a brief mindfulness and self-compassion intervention on mood, to intervention studies evaluating mediational relations among self-compassion and ACT intervention processes (e.g., defusion, mindfulness, and psychological flexibility) and research exploring relations among self-compassion and psychological flexibility in the treatment of persons suffering with PTSD. Each of the studies offers novel insights into the unique and synergistic contribution of self-compassion on ACT change processes, along with practical insights and recommendations for future research and clinical practice.

• Love Yourself or Just Breathe?: The Acute Effects of Loving-Kindness Meditation vs. Traditional Mindfulness on Mood
Jamie R. Forsyth, Ph.D., Union College

A vast body of literature supports the notion that meditation can have important impacts on suffering and psychopathology; however, few studies have evaluated differential effects between various forms of meditation. This presentation will describe a study that aimed to: 1) determine if a brief meditation can have immediate effects on mood, 2) determine the validity of two different types of meditation (i.e., mindfulness and loving-kindness) and 3) evaluate the differential efficacy of the two types of meditation, specifically, whether one is more effective than the other. Undergraduate students (N = 179), who were mostly novice meditators, participated in the current study. Results demonstrated that both meditation practices were equally effective at decreasing anxiety and depressive cognitions after only one 15-minute meditation session. Additionally, both forms of meditation produced increases in self-reported self-compassion and mindfulness. Finally, it seems that breathing meditation may be more beneficial for novice meditators and that loving-kindness meditation may have the largest impact when taught after one has been introduced to a simple mindfulness practice.

• Clarifying Relations Among Self-Compassion and ACT Processes in the Treatment of Anxiety Disorders: A Test of Several Mediational Models
Eric D. Tifft, B.A., University at Albany, SUNY
Timothy R. Ritzert, Ph.D., Longwood University
John P. Forsyth, Ph.D., University at Albany, SUNY

Two RCTs, one face-to-face (Arch et al., 2012) and the other purely self-help (Ritzert et al., 2016), demonstrate that ACT is an efficacious and effective transdiagnostic intervention for anxiety disorders. Both protocols, in turn, target core ACT intervention processes and self-compassion (Neff, 2003). The purpose of this paper is to elucidate relations among self-compassion and ACT processes (i.e., mindfulness, psychological flexibility, and defusion) when each is evaluated as a mediator and as an outcome within a self-help RCT for anxiety disorders (N = 503). ACT processes and self-compassion were assessed pre and post intervention, and at 3 and 6 month follow-up. Using simple and multiple meditational models (Hayes, 2012), we will report on the relative contributions of ACT-relevant process as mediators of changes in self-compassion post-intervention, and conversely whether self-compassion mediated positive changes in ACT processes as outcomes. As will be seen, self-compassion and ACT processes are intimately intertwined. Discussion will highlight theoretical and practical considerations regarding the role of self-compassion, both as process and outcome, in relation to the ACT model of therapeutic change.

• An Analysis of the Relationship Between Self-Compassion, Psychological Inflexibility, and PTSD Severity in a Partial Hospitalization Program
Peter Grau, M.S., Marquette University, Rogers Memorial Hospital
Chad Wetterneck, Ph.D., Rogers Memorial Hospital, Marquette University

Seligowski, Miron, and Orcutt (2015) found that psychological inflexibility has a mediating effect on the impact of self-compassion of trauma symptom severity in a sample of trauma-exposed undergraduates. This study attempts to replicate and extend those results in a PTSD treatment program while using the two-factor model for the Self-Compassion Scale (Neff, 2003) and ACT-consistent measures of psychological well being (valued living and quality of life). Participants (N =147) were mainly White (87%), heterosexual (80%), and female (80%), with an average age of 35.7 (SD =10.8). Psychological inflexibility was measured using the Acceptance and Action Questionnaire and PTSD symptomology was measured using the PTSD checklist for DSM-5. Contrary to the previous findings, SEM results show that self-compassion predicts both PTSD symptoms and psychological wellbeing in the presence of psychological inflexibility. Additionally, psychological inflexibility predicts psychological health and PTSD symptom severity. This study provides evidence in support of targeting self-compassion and psychological inflexibility in PTSD treatment.

Educational Objectives:
1. Describe the importance of a single session meditation for novice meditators and the clinical implications for selecting an optimal mindfulness exercise when targeting self-compassion. 2. Describe empirical relations between self-compassion and ACT processes and the practical implications of this work for mental health practice. 3. Explain the potential benefits of cultivating self-compassion and targeting psychological inflexibility in PTSD treatment.

 

73. Importance of Values in Therapy: Empirical Evidence: Greek-Cypriot Chapter Sponsored
Symposium (1:20-2:50pm)
Components: Conceptual analysis, Literature review, Original Data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Values
Target Audience: Beg., Interm., Adv.
Location: Rue Crescent

Chair: Andrew Gloster, University of Basel
Discussant: Megan Kelly, Edith Nourse Rogers Memorial Veterans Hospital and University of Massachusetts Medical School

Values and valued action are a crucial aspect of the ACT model. Working on values during interventions can facilitate and enhance work on other components of the model. Clarifying values and building up patterns of reinforcing action can be emotionally intense, for both the client and therapist/trainer. Arguably, values are one of the key reasons the ACT model resonates with practitioners and leads to meaningful change in the clients we serve. Empirical verification of some these theoretical positions are lacking, however. This symposium will empirically examine how and in what way values impact interventions and in turn are changed during interventions. The presentations in this symposium will present data from studies that both do and do not directly target values (i.e., ACT & CBT) as well data from studies that assessed values during technological interventions. Data will be discussed with respect to possible theoretical and clinical refinements.

• Values, value conflicts, and change
Juergen Hoyer, Technische Universitaet Dresden, Institute for Clinical Psychology and Psychotherapy
Jasmin Čolić, Technische Universitaet Dresden, Institute for Clinical Psychology and Psychotherapy
Gerd Gruebler, Technische Universitaet Dresden, Institute for Philosophy
Andrew Gloster, University of Basel, Clinical Psychology and Epidemiology

We investigated a) which domains of living psychotherapy patients value and b) to what extent valued action changes during psychotherapy. Furthermore, we examined the degree to which valued domains were experienced as compatible (“conflicted”) with one another. In Study 1, we applied the Valued Living Questionnaire (VLQ; German version) pre- and post-treatment and at 6 month follow-up in over 500 patients at a university CBT outpatient clinic, all reliably diagnosed with standardized interviews. In Study 2, a study with N = 104 philosophy students, we explored how values included in the VLQ (e.g., family, friendship, work, physical self-care) interrelate and form consonant vs dissonant relationships. Data show that value-oriented action increased through therapy, but only in the magnitude of a small effect. Study 2 demonstrated that while some values are well in harmony (e.g., family and physical self-care) others are not (e.g., parenting and work). Integrating these findings we will emphasize the idea that an increase in valued action in some areas can either be helpful or bring about new challenges in other areas.

• How Daily Engagement in Values Impacts Outcomes and Prosocial Activities
Andrew Gloster, Ph.D., University of Basel
Marcia Rinner, University of Basel
Andrea Meyer, University of Basel

Values are behaviors and as such are constantly changing in response to numerous contextual factors. Retrospective recall of non-static behaviors is susceptible to numerous biases. Research on values needs to account for their dynamic nature in part by collecting data in the environment (ESM) and more frequently than pre-post treatment. In this presentation, we will present data from two studies with repeated measures data that inform on how values function. In study one, weekly assessments collected from n = 51 treatment-resistant patients will be presented. Analyses will examine the temporal progression of change for values in relation to other variables (e.g., symptoms, avoidance). In study two, daily assessments (i.e., every three hours) collected from n = 118 participants with Major Depression, n = 47 participants with social phobia, and n = 119 controls will be presented. Analyses will test whether participants’ daily engagement in personally defined valued actions is associated with increased mood and prosocial behaviors. Together, these studies will provide information about the conditions that increase and decrease the impact of daily valued behaviors.

• Valued living: How an ACT intervention for chronic pain affects chronic pain patients' values-consistent living?
Michaela Paraskeva-Siamata, University of Cyprus
Maria Karekla, University of Cyprus
Vasilis Vasileiou, University of Cyprus
Evaggelos Karademas, University of Crete
Savvas Papacostas, Cyprus Institute of Neurology and Genetics

Chronic pain is a health condition, related to numerous negative consequences for the life of patients, their families and the health care system. Acceptance and Commitment Therapy (ACT) is considered an effective intervention to deal with chronic pain. As values-consistent living is one of the main targets of ACT, the present study aims to examine the effectiveness of an 8-week group ACT intervention for chronic pain on valued-living. Specifically, it will examine session by session changes in values-consistent living, associating it with changes in other ACT model components and changes. Fifty-eight Greek and Greek-Cypriot chronic pain patients (80.80% women, age M=52) received the group intervention and completed a set of questionnaires including the Bull's Eye measure of values-consistent living in every session. Statistical analyses will help us understand how the specific intervention affected participants' values-consistent living through the intervention and afterwards, and which ACT components produced the maximum change in valued-living.

Educational Objectives:
1. Explain how and in what way values impact interventions and in turn are changed during interventions. 2. Describe session by session changes in values-consistent living, associating it with changes in other ACT model components and changes. 3. Evaluate possible theoretical and clinical refinements in values work.

 

77. Using ACT to enhance performance and well-being
Symposium (1:20-2:50pm)
Components: Conceptual analysis, Original Data, Didactic presentation, Case presentation
Categories: Performance-enhancing interventions, Clinical Interventions and Interests, Clinical Interventions and Interests, Prevention and Community-Based Interventions, Performance-enhancing interventions, Educational settings, Organizational behavior management, Functional contextual approaches in related disciplines, Applied psychology, space psychology, mindfulness, ACT, perormance psychology, group cohesion, stress, isolation, music performance anxiety, performance enhancement, imposter syndrome
Target Audience: Beg., Interm., Adv.
Location: Exclamation

Chair: David Juncos, Psy.D., Horstein, Platt & Associates (private practice in Philadelphia, PA)

This symposium presents the utility of ACT to help enhance performance and well-being in various contexts. The first paper explores the psychological human factors involved in human space exploration, describes findings from Mars analogue mission simulations and discusses how contextual behavioural science may be beneficial in this context. The second paper presents results of a study comparing efficacy of an ACT intervention and a solutions problems skills protocol intervention for improving academic perormance in university students. The third paper presents results of three studies in which ACT was used to treat music performance anxiety and discusses how the results relate to larger discussions on ACT’s proposed mechanisms of change. Finally, the fourth paper describes the relationship between Impostor Phenomemon and Burnout, and how these relate to experiential avoidance, while presenting study results assessing these variables among psychology students.

• Contextual Behavioural Science for Building Cohesive Groups and Maintaining the Productivity and Well-being of Astronauts and the Mission Support for Long-duration Space Missions
Karoly Schlosser, Ph.D. researcher in psychology, Institute of management Studies, Goldsmiths, University of London
Frank Bond, Director, Institute of Mangement Studies, Goldsmiths, University of London

Applied psychology in space exploration is becoming vital (Vakoch, 2011) as humans are preparing to take the next leap to explore space and establish colonies on the Moon and Mars. The endeavours of becoming inter-planetary species will require significantly longer missions and so it is crucial for astronauts and mission support to perform outstandingly, whilst maintaining their psychological well-being and performance in situations that have not yet been fully examined. In order to successfully accomplish mission outcome in such extreme and isolated environments astronauts and their team need to remain psychologically flexible in supporting each other and addressing unexpected issues. We believe that contextual behavioural science underpinned by over two decades of empirical research, is well placed to improve the psychological and behavioural skills needed for such demanding missions; research clearly shows that acceptance and commitment based trainings improve mental health, productivity, prosocial behaviour and innovation by increasing people’s psychological flexibility, even among high performance groups.

• Comparison of a Solutions Problems Skills protocol vs Psychological Flexibility protocol in improving academic performance in university students
María Belén García-Martín, Fundación Universitaria Konrad Lorenz
Cindy Bermúdez, Fundación Universitaria Konrad Lorenz
Diana C. Riaño, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz

The academic performance has been widely studied, explaining it as the quantity and quality of knowledge reflected in the grades obtained by a student. There are multiple factors that can influence this performance, as sociocultural, economic, contextual and psychological factors. Recent investigations show that emotional intelligence is a component that has relation in the academic results, even more than the intellectual quotient than the students. There are also some studies that show that psychological flexibility has a relevant role in academic performance and intervention that promote them can have an effect on it. The aim of the present study is to compare the effect of two interventions for improving academic performance: one intervention based on increasing problem solving skills and one intervention based on acceptance and commitment therapy. An experimental design with a waiting-list control group was implemented. The results will be discussed according to the differences found in the efficacy of both interventions.

• Acceptance and Commitment Therapy as a clinical performance anxiety treatment and enhancement program for musicians
David Juncos, Psy.D., Horstein, Platt & Associates (private practice in Philadelphia, PA)

Acceptance and commitment therapy shows promise as a treatment for music performance anxiety (MPA) and as a potential performance enhancement (PE) program for musicians with MPA. In this paper the results of three studies in which ACT was used to treat MPA will be discussed: 1) a single-case design with a professional rock/pop drummer (Juncos et al., 2014), 2) a single-case design with a student violinist (Juncos & Markman, 2015), 3) and a pilot study with seven vocal students (Juncos et al., 2017). How the results of these studies relate to larger discussions of ACT's proposed mechanisms of change (e.g., Ciarrochi et al., 2010) will also be discussed, namely, that increases in psychological flexibility are thought to be due to acceptance of unwanted symptoms, increased cognitive defusion, reduction of experientially avoidant behaviors, and increased valued action. Future directions for this line of research will be mentioned.

• ”I don’t want to be an impostor and it’s burning me out!”
Andreas Larsson, Ph.D., Stockholm University
Tord Ohlsson, Stockholm University

Burnout is work-related sudden loss of energy, to the point where work is often no longer possible. Oftentimes family and personal life suffering greatly and individual suffering is huge. This a rising problem in the western world. Mental health providers are amongst the most at risk. A common stressor for burnout is impostor phenomenon (IP) - the experience of not being good enough, knowledgeable enough or productive enough despite evidence of the contrary. In this study it was hypothesized that Experiential avoidance (EA) could be seen as a contender for describing the relationship between the two or even behind both of them. Psychology students were asked to complete measures of IP, Burnout and EA and results provided supported the hypothesis that IP predicted Burnout but when including EA it is a better predictor of both. This paper will describe the research and give implication for treatment.

Educational Objectives:
1. Describe our findings in Mars analogue mission simulations and discuss how contextual behavioural science may be benefitial in this extraordinary context. 2. Describe two interventions to promote academic performance 3. Explain possible mechanisms by which ACT may effectively treat music performance anxiety and possibly enhance performance skills.

 

78. Shame, Stigma, and Stress: Barriers to Thriving for Gender and Sexual Minorities: Gender and Sexual Diversity SIG Sponsored
Symposium (1:20-2:50pm)
Components: Original Data
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Barriers to treatment, gender and sexual minorities
Target Audience: Beg., Interm., Adv.
Location: Multiplication

Chair: R. Sonia Singh, M.A., Bowling Green State University
Discussant: Matthew Skinta, Ph.D., Palo Alto University

Minority stress is defined as the model of psychological stressors experienced by people who identify as a part of marginalized and stigmatized groups (Meyers, 1995). Gender and sexual minorities are defined as individuals experiencing minority stress due to living in a heterocentric, cisgender society. Minority stress studies have consistently and reliably found that sexual minority individuals experience higher rates of depression, anxiety, suicidal ideation, self-injurious behavior, substance abuse, and stigmatization than heterosexual individuals (as cited in Skinta & Curtin, 2016). Further, gender and sexual minority individuals are less likely to seek treatment due to their experiences of discrimination and minority stress. Given this experience of minority stress, there has recently been a push towards addressing and understanding contextual behavioral variables when working with gender and sexual minority clients (Skinta & Curtin, 2016). This symposium will synthesize basic research related to the impact of shame, stigma, and stress on gender and sexual minority individuals, as well as the importance of addressing these variables from a contextual behavioral perspective and implications for treatment.

• Thriving at the intersections: Minority stress and coping in sexual minority Latinxs in the U.S.A.
Néstor Noyola, B.S., Clark University
Esteban Cardemil, Ph.D., Clark University

Sexual minority Latinxs (SMLs) experience the intersections of multiple systems of oppression (e.g., racism and heterosexism), and thus face unique minority stress. Given the dearth in the literature, we conducted a qualitative study using an intersectionality framework to explore SMLs’ experiences of minority stress and coping responses. Semi-structured interviews were conducted with 17 self-identified sexual minority Latinx adults (Mdnage = 25) recruited online. There was diversity in sexual orientation (24% identified as lesbian, 29% as bisexual, 12% as pansexual, 29% as gay and 6% as queer), with most identifying as female (58%). Approximately half identified as immigrants. Preliminary thematic analyses suggest that anticipating family rejection, internalizing heterosexism and racism, and experiencing discrimination/microaggressions represent main areas of minority stress for SMLs. In the face of these stressors, coping entailed separating private life from public life, focusing on the future, and understanding the impermanence of the present. Implications for ACT processes (e.g., present-moment awareness, psychological openness, and values-based action) will be discussed.

• Substance Use and Fear of Stigma Among Gender and Sexual Minority Individuals
Madeline Benz, M.S., Clark University
Kathleen Palm Reed, Ph.D., Clark University

Experiences of everyday discrimination and stigma may influence substance use severity and treatment-seeking behaviors among gender/sexual minority (GSM) young adults. Fear of stigma, rather than the anticipation or experience of stigma, may predict these outcomes . Further, fear of stigma may be particularly relevant among individuals who experience intersecting marginalized identities. Thus, the present study used an anonymous online survey to examine these associations among a national sample of 67 individuals who identified as a GSM and endorsed substance use problems. There were significant linear correlations between severity of alcohol use problems and both anticipated and fear of minority-related stigma (ps<.05), as well as between fear of minority-related stigma and past help-seeking behavior (p=.02). Preliminary regression analyses indicate that fear of minority-related stigma predicts increased severity of alcohol use problems (β=.38, p<.01). Additionally, reported fear of minority-related stigma is associated with a higher likelihood of having received substance use treatment in the past (Expβ=1.08, p=.01). Additional analyses and implications regarding directions for prevention and intervention will be discussed from a contextual behavioral perspective.

• Sexual Minority Work Stress: Barriers and Potential Solutions
R. Sonia Singh, M.A., Bowling Green State University
William H. O'Brien, Ph.D., Bowling Green State University

Sexual minority individuals often experience harassment, incivility, and discrimination in the workplace (Sears & Mallory, 2011). Although it is important to fight discrimination, it is also important that sexual minorities have resiliency to live in a heterocentric world. Bond and Lloyd (2016) provided suggestions for developing psychological flexibility and related constructs at an individual level to build resilience. The authors discuss the importance of safe disclosure as being important to safety and resilience in the work place. Some potential barriers to disclosure may be intrapersonal (e.g., shame) or environmental (e.g., workplace climate). The current study (n = 312) examined variables that may act as barriers to resiliency. Regression analysis was used to test whether shame significantly predicted fear of disclosure at work when controlling for work place climate. The results of the regression with two predictors was significant, (R2 =0.55, F(2,263)=108.72, p<.001). It was also found that shame predicted fear of disclosure independent from LGBT workplace climate (β = .27, p<.001). Implications of these findings for intervention with sexual minority work stress will be discussed.

Educational Objectives:
1. Discuss how racism and heterosexism intersect to influence the minority stress that sexual minority Latinxs experience in their day-to-day lives. 2. Describe how the fear of stigma associated with everyday discrimination influences symptom severity and treatment-seeking among individuals who identify as a gender or sexual minority and endorse substance use problems. 3. Describe how shame can prevent disclosure and safety in the work place and discuss how this relates to psychological flexibility and work stress in sexual minorities.

 

84. It is time to discuss race and politics: Applying CBS to address social divisions
Symposium (3:10-4:25pm)
Components: Original Data
Categories: Educational settings, Clinical Interventions and Interests, Racism, politics
Target Audience: Beg.
Location: Rue Crescent

Chair: Mariah D. Corey, University of Washington
Discussant: Akihiko Masuda, University of Hawaii at Manoa

In today's challenging cultural and political context, it is more important than ever that CBS is actively engaged in generating solutions that reduce distress experienced by those who are exposed to discrimination and oppression, that we empower well-intentioned individuals to engage in values-guided committed actions, and that we improve empathy, facilitate rationale dialogues, and seek human connections across social divisions. This symposium presents results of 3 randomized studies documenting the benefits of contextual-behavioral science approaches to improve outcomes on these hot-button issues. In the first paper, results are presented from a randomized trial of a workshop-style intervention that improved White medical providers' empathy and emotional rapport towards Black patients in racially charged medical interactions. The second paper presents a randomized trial of a workshop-style intervention to reduce racial bias and improve connections among Black and White undergraduates on college campuses and the third paper presents an intervention to reduce political polarization and improve empathy among conservative and liberal undergraduates. Across these settings, results are encouraging and future work in these crucial areas is needed.

• A contextual-behavioral intervention to improve provider empathy and emotional rapport in racially charged interactions: A randomized trial
Daniel C. Rosen, Bastyr Univesity
Jonathan W. Kanter, University of Washington
Katherine Manbeck, University of Washington
Heather Branstetter, Bastyr University
Mariah D. Corey, University of Washington
Monnica T. Williams, University of Connecticut

This report presents results of a randomized controlled trial of a contextual-behavioral, workshop-style intervention that aimed to address racial biases that lead to disparities in health care and health outcomes by improving medical provider's empathy and emotional rapport towards Black patients in racially charged interactions. The intervention integrated experiential exercises from Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP) to help providers practice acceptance of aversive emotions and connecting with patients in moments of heightened emotion. The sample comprised 25 medical students and early professionals, an important population to study as medical biases and behaviors become increasingly entrenched over time. Using objective coding of provider behavior in interactions with standardized Black patients who specifically disclosed racially charged information and presented in ways that might trigger negative stereotypes to the provider, we found support for positive behavior changes in intervention providers compared to a control sample of providers. Limitations, future research directions, and clinical implications for helping providers overcome bias are discussed.

• Facilitating racial harmony on college campuses: A randomized trial
Jonathan W. Kanter, University of Washington
Monnica T. Williams, University of Connecticut

This paper presents results of a contextual-behavioral, workshop-style intervention that brought 44 Black and White undergraduate students together on a college campus to decrease White student's racial bias and tendencies to microaggress, strengthen Black student's ethnic identity, and increase closeness and connection among all participants. The workshop included a didactic/discussion component and experiential exercises from Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP) designed to increase acceptance and willingness in the presence of inter-racial anxiety and to facilitate closeness and connection. Compared to an active comparison condition, intervention participants demonstrated significant benefits including decreased tendencies to microaggress (White students), improved ethnic identity (Black students), and increased closeness and connection between workshop participants. Most results remained significant at a one-month follow-up. Limitations, future research directions, and pragmatic implications for improving diversity training are discussed.

• Improving relations and decreasing polarization between conservatives and liberals on a college campus: A preliminary trial
Katherine E. Manbeck, University of Washington
Adam Kuczynski, University of Washington
Daniel W. M. Maitland, Texas A&M University at Corpus Christi
Lauren Fine, University of Washington
Mariah D. Corey, University of Washington

The US has never been more divided politically. This limits consideration of alternatives, causes discord, and increases stress. This may be particularly problematic on college campuses, where conservative students are outnumbered and often feel marginalized. In this study, we examined the effectiveness of a half-day workshop to decrease polarization and improve closeness between conservatives and liberals. Informed by findings from political psychology, the intervention employed experiential exercises from Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP) to encourage identification of core values and engage in vulnerable discussions of deeper reasons for core political beliefs. We collected data from 2 groups: one group of conservatives and liberals, and one of all liberals (groups did not know political composition). We found improvements in general attitudes and hostility towards outgroup members from pre- to post-workshop in both groups, and improvements in attitudes toward outgroup workshop participants that were maintained at 1-month follow up. Participants also reported arguing less than expected. Results indicated that this workshop improves connectedness between workshop participants and is acceptable to participants.

Educational Objectives:
1. Demonstrate brief experiential exercises used in interventions to decrease racism and improve political dialogue. 2. Describe primary benefits of CBS approaches to racism and political dialogue. 3. Discuss obstacles to engaging in connections across racial and political differences from a contextual-behavioral lens.

 

88. ACT for People with Pain: What We Still Have to Learn: Pain SIG Sponsored
Symposium (3:10-4:25pm)
Components: Original Data, Didactic presentation
Categories: Behavioral medicine, Clinical Interventions and Interests, Chronic Pain
Target Audience: Beg., Interm., Adv.
Location: Exclamation

Chair: Steve Hull, M.D., Mercy Pain Center
Discussant: David Gillanders, DClinPsy, University of Edinburgh, School of Health in Social Science

Chronic pain is one of the areas where ACT interventions have had the most impact (e.g., Wicksell et al, 2013; Hughes et al., 2017). However, there is still much to learn about the best way to assess ACT-related processes, the most effective delivery format for interventions, and the factors that predict negative outcomes such as opioid misuse. This symposium brings together clinical researchers who aim to broaden our knowledge base in these areas. The first presenter will describe the development of the ACTiveAssessment algorithm as a means of grouping patients by pain acceptance levels and thus individualizing rehabilitation programs. The second presenter will describe results from a mixed-methods (in-person and online) ACT intervention for individuals with a genetic syndrome and chronic pain. Our third presenter will address factors predicting risk of opioid misuse in chronic pain patients and will describe the role of psychological flexibility in these individuals. Finally, our discussant will integrate these findings and discuss how they fill some of the existing knowledge gaps as well as the directions for future research.

• ACTiveAssessment: Profiling patients’ way to manage their pain and their responsiveness using CPAQ-8 (Chronic Pain Acceptance Questionnaire-8)
Graciela Rovner, Ph.D., ACT Institutet Sweden; Karolinska Institutet; Pain Services, Angered Hospital
Fredrik Johansson, Medical Library, Danderyd University Hospital
David Gillanders, DClinPsy, University of Edinburgh, School of Health in Social Science

ACT-based programs for chronic pain yield medium to low effect sizes, leading many to search for ways to identify who responds to what kinds of treatment. Grouping patients by their pain acceptance (using the CPAQ-8) offers an understanding of their shared behavioral patterns and rehabilitation needs, in turn guiding the modularization of the rehab program. This study describes the development of the ACTiveAssessment algorithm, a clinical cut off for pain acceptance clustering. LCA replication (N=1775) confirmed the four-cluster solution found in previous research. ROC analysis showed that clinical cluster membership could predict LCA cluster membership with excellent sensitivity (.87 to .97), and specificity (.01 - .08) (AUC between 89.3%- 96.6%). The ACTiveAssessment algorithm allows clinicians to use clustering in their assessment and triage decisions, enhancing the potential for further progress in principle-driven tailoring and modularizing rehabilitation programs in a stepped care model.

• A Mixed Methods ACT Intervention for Individuals with Chronic Pain from Neurofibromatosis Type 1 (NF1): Results from a Randomized Controlled Trial (RCT)
Staci Martin, Ph.D., National Institutes of Health
Taryn Allen, Ph.D., Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research Inc.
Kari Struemph, Ph.D., National Institutes of Health
Mary Anne Tamula, MA, Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research Inc.
Andrea Baldwin, CRNP, National Institutes of Health
Pamela Wolters, Ph.D., National Institutes of Health
Brigitte Widemann, MD, National Institutes of Health

NF1 is a genetic syndrome associated with painful symptoms, including plexiform neurofibroma (PN) tumors that grow along the nerves. We conducted a RCT to determine effects of a mixed-methods ACT intervention among individuals with NF1, PNs, and pain. Forty-one participants were randomized to the ACT intervention or a Wait List. The intervention involved two, 2-hour in-person sessions and 8 weeks of weekly email assignments and biweekly video chats. The trainer taught mindfulness, acceptance, and values-consistent coping strategies. Questionnaires assessed pain interference, pain intensity, pain acceptance, inflexibility, and emotional wellbeing. Twenty-one ACT participants (M age=27.6 years) and 20 Wait List participants (M age=27.8 years) were included. In the ACT group, mean pain interference and pain intensity scores decreased from baseline to post-intervention (ps<.01); Wait List differences were nonsignificant. Repeated measures analyses of these variables were not significant. However, the group X time interaction for pain acceptance (CPAQ) scores was significant (F=11.45, p<.01), suggesting that the ACT intervention increased pain acceptance after just four hours of in-person treatment. More research with larger samples is needed.

• Psychological Flexibility, Pain Characteristics, and Risk of Opioid Misuse in Noncancerous Chronic Pain Patients
Amanda Rhodes, M.A., Kean University
Donald Marks, Psy.D., Kean University
Jennifer Block-Lerner, Ph.D., Kean University
Timothy Lomauro, Ph.D., VA New Jersey Health Care System

Opioids are a leading prescription medication for persistent and recurrent pain, which affects 10% - 35% of the US population annually. To our knowledge, this is the first study exploring psychological flexibility and its association with pain severity, pain interference, early aversive histories and risk of opioid misuse in chronic pain patients. Data were collected at two outpatient pain clinics in the northeastern United States. Adults (N = 99) completed a cross-sectional survey with validated measures. Findings suggest that pain severity, pain interference and early aversive history each uniquely predict risk of opioid misuse. Psychological flexibility mediated the individual pathways between pain severity and pain interference, with risk of opioid misuse. Further, pain severity predicted pain interference, mediated by psychological flexibility. Implications of findings are discussed in terms of future psychological and medical assessments and interventions for chronic pain. One’s willingness to be open, centered and engaged with the world, psychological flexibility, appears to play a significant role in the experience of and coping strategies for physical pain.

Educational Objectives:
1. Describe how algorithms based on pain acceptance scores can be used to individualize rehabilitation programs. 2. List an example of how mixed-methods ACT interventions using online components can be used for treating patients with pain. 3. Demonstrate an understanding of the role of psychological flexibility in people with pain who mis-use opioids.

 

89. Empirically evaluating smartphone app technology effectiveness in delivering and evaluating ACT interventions
Symposium (3:10-4:25pm)
Components: Original Data
Categories: Clinical Interventions and Interests, Behavioral medicine, Contextual assessment, ACT, technology, mobile devices
Target Audience: Beg., Interm.
Location: Multiplication

Chair: Javier Rizo, B.A., Duke University, Psychiatry and Behavioral Sciences
Discussant: Michael Levin, Ph.D., Utah State University, Logan, UT

Smartphones, a mobile technology device with many computer functionalities, are a ubiquitous presence in many societies around the world. As people increasingly embed these devices in their daily lives for all sorts of purposes, clinicians and researchers are turning smartphones into a healthcare tool. Smartphones can remotely deliver contextual behavioral interventions such as ACT and evaluate their effects, or remotely evaluate the effects of in-person interventions. This symposium presents the varying uses for smartphones in ACT interventions and discusses how effective smartphones are as instruments of treatment delivery and treatment assessment.

• Analyzing longitudinal user engagement data of an ACT smoking cessation app for those with serious mental illness to examine outcomes of psychological flexibility and smoking behaviors
Javier Rizo, B.A., Duke University, Psychiatry and Behavioral Sciences
Paige Palenski, B.S., Duke University, Psychiatry and Behavioral Sciences
Roger Vilardaga, Ph.D., Duke University, Psychiatry and Behavioral Sciences

Cigarettes cause 1,300 worldwide deaths per day, with tobacco use being the top preventable cause of death amongst those with serious mental illness. Smartphone apps increasingly deliver treatments for nicotine addiction. Therefore understanding user engagement patterns with these apps and its effects on smoking outcomes is critical. We will present longitudinal background analytics data from 23 participants diagnosed with serious mental illness who enrolled in a randomized controlled trial, assigned to use a smoking cessation app for 4 months. In this ongoing trial, participants are being randomized to either Learn to Quit (n=10), an ACT app designed for people with serious mental illness, or NCI QuitGuide (n=13), an app designed for the general population. Participants provide measures of smoking abstinence, app usability, and experiential avoidance. We will conduct an exploratory analysis of longitudinal engagement patterns between the two apps, examining their association with smoking outcomes and self-reported levels of experiential avoidance. The results of this study may improve our understanding of users’ engagement with mobile health apps and inform future app development efforts.

• ACT for a transdiagnostic treatment-resistant patients: Evidence from event sampling methodology and process assessments
Andrew Gloster, Ph.D., University of Basel, Division of Clinical Psychology and Intervention Science
Charles Benoy, University Psychiatric Clinics of Basel
Veronika Kuhweide, University Psychiatric Clinics of Basel
Katrin Pinhard, University Psychiatric Clinics of Basel
Klaus Bader, University Psychiatric Clinics of Basel

Therapy non-response is a common occurrence in both clinical trials and with individual practitioners. Few studies have tested whether psychotherapy is a viable option for treatment-resistant patients in general and less information is known about the processes of change vs. continued non-response. This study examined whether Acceptance and Commitment Therapy (ACT) would be helpful for a transdiagnostic group of patients with non-response to previous treatments. ACT was administered in a specialized inpatient unit via a multidisciplinary team in which patients received both group and individual therapy. Patients were given smartphones for a one-week event sampling methodology (ESM) at the beginning and end of treatment. In addition, patients completed weekly process assessments. Pilot data showed large decrease in symptoms (d = 0.9) and medium increase in meaning in life (d = 0.5). Data will be presented on compliance with the ESM, weekly process, and discuss how these factors relate to treatment outcomes.

• Examining a prototype mobile app for self-critical thoughts: A clinical component test of cognitive defusion and cognitive restructuring
Jack Haeger, M.S., Utah State University, Logan, UT
Michael Levin, Ph.D., Utah State University, Logan, UT
Woolee An, M.S., Utah State University, Logan, UT
Michael Twohig, Ph.D., Utah State University

Cognitive behavioral therapies have continued to evolve since their inception, leading to a growing field of increasingly diverse treatment approaches and components. It is important to examine the differing active effects and processes of change among treatment components, as this will aid in fostering a more precise understanding of the therapeutic methods common in today’s evidence-based practices. Mobile apps offer a promising method for conducting such clinical component tests by providing greater experimental control and a higher dosage of treatment that can be deployed in-context. This study compared the components of cognitive restructuring and cognitive defusion delivered via a mobile app. A sample of 87 adults high in self-criticism were randomized to a defusion app, a restructuring app, or waitlist condition for two weeks. Overall, results indicated that although mobile apps providing defusion and restructuring strategies are equally effective at reducing self-criticism, they appear to work through distinct processes of change. Additional key findings will be presented including: secondary outcomes, mediators of change, consistency of effects, user engagement/satisfaction, and future implications.

Educational Objectives:
1. Describe how users with serious mental illness engage with smartphone app interventions and its effects on treatment outcomes. 2. Explain how ESM is used by patients and inform about treatment processes. 3. Describe the diverging clinical impact and processes of change associated with cognitive defusion and restructuring delivered via a mobile app.

 

90. Recent Research on Verbal Processes Involved in Components of ACT and RFT
Symposium (3:10-4:25pm)
Components: Conceptual analysis, Original Data, Didactic presentation
Categories: Theoretical and philosophical foundations, Clinical Interventions and Interests, Prevention and Community-Based Interventions, RFT, Autism, perspective taking, adolescents, adults, defusion, theory of mind
Target Audience: Beg., Interm., Adv.
Location: Arobase

Chair: Natalia Baires, Southern Illinois University, Carbondale
Discussant: Jonathan Tarbox, Ph.D., BCBA-D, University of Southern California

During Acceptance and Commitment Therapy (ACT) and Relational Frame Theory (RFT), various verbal processes are observed, such as self-as-content and self-as-context statements. Furthermore, perspective taking (PT) plays a key role during said processes. In the current symposium, three studies utilizing ACT or RFT in conjunction with verbal processes are discussed. The first study, which evaluates the effects of a defusion exercise and PT interactions based on RFT, aims to alter negative statements about the self through training of deictic frames in adolescents with autism. The second study focuses on evaluating the efficacy of ACT with adolescents and adults with autism to increase self-as-context statements and decrease self-as-content statements. Moreover, data from physiological measures were obtained and subsequently stabilized while discussing negative thoughts after receiving ACT, suggesting that ACT has an effect on physiological responses. Finally, a third study will discuss how a RFT-based protocol assists in expanding PT skills in adults with autism. In combination, all three studies provide diverse insight into the role verbal processes play when components of ACT and RFT are included.

• Effects of Defusion and Deictic Frame Interactions on the Development of Self-As-Context in Individuals with Autism
Sebastián García-Zambrano, Southern Illinois University, Carbondale
Ruth Anne Rehfeldt, Ph.D., BCBA-D, Southern Illinois University, Carbondale
India Pauly Hertel, B.S., Southern Illinois University, Carbondale

The aim of this study is to evaluate the effects of a defusion exercise in combination with perspective-taking interactions protocol based on Relational Frame Theory (RFT). The protocol is designed to alter verbal statements about the self through training deictic frames (e.g., I-YOU, HERE-THERE, AND NOW-THEN) in conjunction with a defusion exercise. A pre-post design with a control group is implemented to evaluate the effects of the protocol on the probability of self-as-context and self-as-content statements. Adolescents with autism are assigned to each group based on the frequency of self-as-content statements. Each participant is interviewed individually through a structured interview aimed at identifying deictic frames and negative statements. Participants in the treatment group receive the protocol of defusion and deictic frames individually, and participants in the control group receive a Behavioral Skills Training session individually. Finally, participants are interviewed using an interview based on the identification of deictic relationships and negative statements about the self. Preliminary results showed an increase in the probability of occurrence of the self-as-context statements after the implementation of the protocol.

• Effects of Acceptance and Defusion on Verbal Self-Statements and Physiological Measures in Individuals with Autism Spectrum Disorder
Jessica Hinman, B.A., Southern Illinois University, Carbondale

The purpose of this study is to evaluate the efficacy of using Acceptance and Commitment Training (ACT) with adolescents and young adults with autism to change the function of verbal statements made about the self while talking about a negative thought. Throughout the study, participants will wear an Empatica wristband measuring physiological responses. Participants will determine a negative thought they have about themselves and discuss why they believe the thought is true, followed by a version of ACT to talk about the same negative thought. Verbal statements about the self and physiological measures before and after ACT will be compared. Preliminary anecdotal results for three typically developing adults suggest that ACT was effective in increasing self-as-context statements, and decreasing self-as-content and reason giving statements. Additionally, the physiological data show stabilization while discussing the negative thought after receiving ACT, suggesting that ACT can change the function of verbal statements and affect physiological responses. Preliminary and expected results suggest a clinical utility of ACT to improve the way individuals with autism interact with their thoughts.

• Perspective-Taking and Multiple Exemplars in Adults with Autism Spectrum Disorder
Natalia Baires, M.S., BCBA, Southern Illinois University, Carbondale
Jessica Hinman, B.A., Southern Illinois University, Carbondale
Ruth Anne Rehfeldt, Ph.D., BCBA-D, Southern Illinois University, Carbondale

Perspective-taking (PT) encompasses skills individuals require to take on perspectives of others. While this skill is frequently absent in repertoires of children with autism, adults with autism also lack key components for strong PT skills. The term "advanced theory of mind" was devised to account for the subtlety in social information and difficulty in interpreting such information, which is encountered on a daily basis. Existing literature on PT yields limited studies focusing on adults with autism, which indicates a need for such treatments. In the current study, participants, consisting of adults with autism, will complete five theory of mind (ToM) tasks. As part of exclusion criterion, participants possess an intelligence quotient of at least 90. Using a Relational Frame Theory and Acceptance and Commitment Therapy perspective, participants will expand their PT skills if low performance is demonstrated. Preliminary data obtained from typically developing adults demonstrate high scores. It is hypothesized that participants' scores on ToM tasks will improve in the post-test phase and their skills will generalize to a novel ToM task.

Educational Objectives:
1. Discuss the effectiveness of a defusion exercise and perspective taking interactions based on RFT to alter negative statements about the self. 2. Describe the efficacy of ACT on increasing self-as-context statements and decreasing self-as-content statements in conjunction with its effects on physiological responses. 3. Discuss how a protocol based on RFT can assist in increasing perspective taking skills in adults with autism.

 

Saturday, July 28

100. SMART (Strengthening Mental Abilities through Relational Training) interventions across the lifespan: Enhanced outcomes across a variety of valued indicators for school-aged children, adults with learning difficulties, and Alzheimer's patients
Symposium (10:35am-12:05pm)
Components: Conceptual analysis, Original Data
Categories: Performance-enhancing interventions, RFT, Education, Alzheimer's, Adult Learning Disability
Target Audience: Beg.
Location: Rue Sainte-Catherine

Chair: Ian Tyndall, Ph.D., University of Chichester, UK
Discussant: Robert Whelan, Ph.D., Trinity College Dublin, Ireland

This symposium showcases one of the most exciting and dynamic developments in the contextual behavioural science mission (Hayes, Barnes-Holmes, Wilson, 2012). Relational Frame Theory proposes that relational framing skills are at the core of what we understand by language and cognition, or intelligent behaviour more generally. More specifically, the symposium presents three papers that utilise the SMART (Strengthening Mental Abilities through Relational Training) online training programme to improve scores on standardised psychometric tests of intelligence, cognition, and aptitude, and also non-cognitive tests such as self-esteem and motivation to learn. Firstly, Dr. Ian Tyndall, University of Chichester, UK, presents research on the effects of SMART intervention in three schools in Ireland, one primary, and two secondary on educational attainment, self-efficacy, and motivation to learn. Secondly, Dr. Sarah Cassidy, Maynooth University, Ireland, will describe a study using SMART with adults with learning disabilities resulting in enhanced literacy and self-esteem. Thirdly, Dr. Nanni Presti, Kore University, Sicily, highlights fascinating findings of the application of SMART training with Alzheimer’s patients, with promising data that goes well beyond pharmacological treatment-as-usual.

• Critical tests of capacity of relational training to enhance educational attainment self-efficacy: Randomised control trials of the SMART (Strengthening Mental Abilities through Relational Training) online intervention program in three Irish schools
Shae McLoughlin, University of Chichester, UK
Ian Tyndall, Ph.D., University of Chichester, UK
Antonina Pereira, Ph.D., University of Chichester, UK
Teresa Mulhern, University of Chester
Sue Bentham, University of Chichester, UK

The general factor of intelligence is the best predictor of academic outcomes offered by the field of psychology. We sought to provide the first randomized controlled trials (RCTs) to test the efficacy of relational frame training for improving cognitive ability and the scholastic outcomes they predict. Study 1: Using a crossover RCT design, we assessed the effects of relational frame training on young children’s (n = 40; age 7-9) IQ, attitudes to learning, and standardised tests of their national curriculum. Study 2: Using a stepped-wedge RCT design, we assessed the effects of relational frame training on secondary school students’ (n = 170; age 13-14) IQ and summer examination results across six subject areas, controlling for baseline personality factors. Study 3: Using a crossover RCT design, we assessed the effects of relational frame training on secondary school students’ (n = 195; age 13-14) IQ, perceptual speed/attention, and summer exam results across six subject areas, controlling for baseline personality factors and gender. This paper will report on the progress of these studies to date.

• Testing the Impact of a Derived Relational Responding Intervention on Relational Skills, Full Scale IQ, literacy, attention and self esteem in adults returning to education
Sarah Cassidy, Ph.D., Maynooth University, Ireland
Bryan Roche, Ph.D., Maynooth University, Ireland
Steve Gannon, Ph.D., Maynooth University, Ireland

The current research aimed to replicate and extend a previous finding that “Relational Skills” training can lead to improvement in the general intelligence of children by testing its efficacy with adults with learning challenges, while also assessing its impact on attention and self-esteem. 12 adults returning to education at an adult literacy training initiative were first administered the Wechsler Adult Intelligence Scale, the Wechsler Individual Attainment Test, Rosenberg’s self-esteeM.Sc.ale, and the Achenbach attention scale. Group 1 participants (n=5) then began supervised online relational skills training in their adult training environment for several 30-60 minute sessions per week for several months while Group 2 (n=7) formed the waiting control group. Data trends show significant improvements in relational ability, literacy skills, attention skills and levels of self-esteem for Group 1, but not for Group 2. This research points the way towards on line educational interventions that can target not just cognitive ability, but also other skills that are critical in learning environments such as literacy, attention and self-esteem in adults with long standing learning difficulties.

• Does SMART training improve cognitive skills in Alzheimer’s patients undergoing AChI treatment? A 9-month follow-up clinical trial as an add-on intervention
Giovambattista 'Nanni' Presti, Ph.D., Kore University, Sicily
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
Annalisa Oppo, Sigmund Freud University, Milan, Italy
Bryan Roche, Maynooth University, Ireland

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 RFT training, as an add-on non-pharmacological intervention to cholinesterase inhibitors (ChEIs) to increase cognitive skills. Participants were exposed to SMART (Strengthening Mental Abilities with Relational Training) via 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 a 3- and 6-month follow-up (FU) using MODA (Milan Overall Dementia Assessment), Coloured Progressive (CPM) and attentive matrices, respectively. 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 at the end of training. Results were maintained at 3-month FU for MODA. 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.

Educational Objectives:
1. List key relational frames applied to enhance educational attainment. 2. Describe protocols for adapting relational frame theory to Alzheimer's patients. 3. Demonstrate utility of SMART training for adults with poor literacy skills.

 

102. Innovation and evaluation in ACT training: Steps towards a science of dissemination
Symposium (10:35am-12:05pm)
Components: Conceptual analysis, Original Data, Didactic presentation
Categories: Supervision, Training and Dissemination, Clinical Interventions and Interests, Supervision, Training and Dissemination, Professional Development, Training for trainers, Science of training, Novice therapists
Target Audience: Beg., Interm., Adv.
Location: Rue Crescent

Chair: David Gillanders, DClinPsy, University of Edinburgh
Discussant: Jacqueline A-Tjak, ACTCursus, Netherlands

The contextual behavioural science community is thriving. One of the practical engines of its growth is the availability of training, particularly in ACT. A great deal of international effort is focussed on delivering training, making training more accessible, and developing innovations in both the content of training and how to train people. In contrast to the vigorous and thriving activity in this area, very little is known about the actual impact of such efforts. Empirical evidence of the personal, professional and clinical impact of ACT training is limited to less than 15 peer reviewed articles. In this symposium, ACBS peer-reviewed ACT trainers present data from two novel studies, and give an overview of an innovative approach to 'training the trainers'. These papers will give delegates new data on the impact of online ACT training, new tools to evaluate ACT training, and new methods for enhancing the continuing professional development of those already giving trainings. The symposium will encourage delegates to reflect on the potential (and pitfalls) of further developing a science of training.

• The perceived impact of an online third wave CBT training among postgraduate students and mental health professionals
Frédérick Dionne, Ph.D., Université du Québec à Trois-Rivières
Luc Bourrassa, D.Ps. (c), Université du Québec à Trois-Rivières
Nadia L'Espérance, Ph.D., CIUSSS de la Mauricie-et-du-Centre-du-Québec, Université du Québec à Trois-Rivières

Despite the growing dissemination of the third-wave of cognitive and behavioral therapy (CBT) and the desire from mental health professionals and students to receive training in this approach, there are few studies evaluating its perceived benefits at a personal level. The main objective of this study is to better understand the perceived impact of a third wave CBT online university course. A Content analysis of 48 written assignments which reflect what students have learned from the course were analyzed with the use of a Nvivo software. The average age of participants is 36.6 years (σ: 11.1 years). The results are articulated around four general themes: 1) personal improvements on the therapeutic processes (e.g., acceptance, present moment); 2) the alleviation of symptoms (ex: stress, burnout); 3) increased positive experiences and quality of life (e.g, well-being, personal growth); 4) negative experiences lived through the course of the training (e.g, unpleasant emotions, difficulty with the software). The authors discuss the implications of this study as well as its limitations and suggest future research directions.

• Development and initial validation of the Mindful Healthcare Scale - a new measure of psychological flexibility for helping professionals
Gillian Kidney, DClinPsychol, NHS Grampian
David Gillanders, DClinPsy, University of Edinburgh
Lene Forrester, Ph.D., BMI Healthcare, UK

Research shows that psychological flexibility (PF) is useful to helping professionals, for both skill development, and personal wellbeing. Whilst studies have used general measures of PF, context specific measures are often more precise and sensitive to interventions. This paper describes the initial development of a new measure of PF in helping professionals: The Mindful Healthcare Scale (MHS). Exploratory and confirmatory factor analysis, plus reliability and convergent validity analyses, across two samples of helping professionals (n = 480 and n = 196) led to scale refinement. The final scale had 13 items and an excellent fitting factor structure, with 3 sub-factors corresponding to engagement, awareness, and defusion, and a higher order factor representing overall psychological flexibility in professional helping. Cronbach's alpha were .74 (engaged), .71 (awareness), .74 (defusion), and .79 (overall flexibility). The MHS correlated in the expected directions with measures of burnout (r=-.62), self-compassion (r=.58), negative reactions to other's distress (r=-.52) and general psychological flexibility (r=.68). The potential uses of the MHS for evaluating ACT training and recommendations for future research will be presented.

• ACT Training Lab - a blueprint for bespoke CPD events for ACT trainers and advanced practitioners
Graciela Rovner, Ph.D., Karolinska Institutet, Angered's Hospital & ACT Institute Gothenburg, Sweden.
Joseph Oliver, Ph.D., Contextual Consulting
Jacqueline A-Tjak, ACTcursus, Zaandam, Netherlands
Louise McHugh, Ph.D., University College Dublin, Ireland
David Gillanders, DClinPsychol, University of Edinburgh

Training for trainers is crucial to the growth of our CBS community. Delivering impactful training can be challenging, but can be made easier by working together to facilitate co-operation, connectivity and resource sharing. To this end, a small group of peer reviewed trainers met in January 2018 for a two-day retreat. This training took a skills-sharing and experimentation format, akin to a 'Training Lab'. Some outcomes of this retreat included: new developments in training people how to work with the 'self', methods to link clinical assessment and treatment decisions in more empirically based ways developing ways to incorporate movement and body awareness into trainings, new approaches for balancing the experiential and skills development elements of training consideration of ways to evaluate training. In this presentation we will share relevant materials, and you will hear an outline of the retreat format, the outcomes, impacts on trainer practice, potential uses and pitfalls encountered, in an effort to encourage other practitioners to use the Training Lab format as a model for life long education.

• Skills of Acceptance and Commitment Therapy (ACT) among novice therapists are associated with changes in depression symptoms in a brief ACT intervention
Katariina Keinonen, M.S., University of Jyväskylä
Heidi Kyllönen, M.S., University of Jyväskylä
Piia Astikainen, Ph.D., University of Jyväskylä
Raimo Lappalainen, Ph.D., University of Jyväskylä

Objective: The aim of this study was to explore whether early sudden gain (clinically significant change within two sessions) was associated with therapists’ skills of ACT when providing a brief six-session intervention for diagnosed depression. Method: A total of 37 novice therapists (students of psychology) were evaluated for process-specific skill level and global competence and adherence using the ACT Adherence Scale. Two randomly selected sessions were included in the sample (n = 74 sessions). The ratings were then analyzed in relation to the treatment results on the level of depressive symptoms. Results: Overall competence and adherence in ACT (r=0.36, p=0.030 and r=0.38, p=0.021, respectively) and especially process-specific skill levels (i.e. r=0.45, p=0.005 for defusion and r=0.48, p=0.003 for values based actions) were associated with change of depression symptoms. However, the competence level was not associated with early sudden gain. Conclusions: Our preliminary data suggested that among novice therapists, the basic skills of ACT were connected the outcome of the whole treatment, but not to early sudden gains observed after two sessions.

Educational Objectives:
1. Evaluate the perceived impact of a third wave online training on a personal level among university students and mental health professionals. 2. Critically evaluate approaches and tools for the empirical evaluation of ACT training and health staff well-being interventions. 3. Discuss the level of therapist competence and adherence in a brief ACT based intervention for diagnosed depression using novice therapists and the association between competence and outcome.

 

106. The impact of identity on thriving: Examining self-as-content in multiple contexts: Student SIG Sponsored
Symposium (10:35am-12:05pm)
Components: Original Data
Categories: Clinical Interventions and Interests, Behavioral medicine, Theoretical and philosophical foundations, RFT, Self-as-content, Identity, Psychopathology
Target Audience: Beg., Interm., Adv.
Location: Exclamation

Chair: Madeline B. Benz, M.S., Clark University
Discussant: Jason B. Luoma, Ph.D., Portland Psychotherapy Clinic, Research, & Training Center, PC

The ability to consider oneself in changing environmental contingencies without excessive attachment to experiences promotes psychological flexibility and general well-being. This concept, known as self-as-context, is associated with the processes of acceptance and mindfulness fostered in Acceptance and Commitment Therapy. In contrast, self-as-content, defined as a rigid over-identification with a personal label (e.g. “addict” or “victim”), can negatively impact psychological and behavioral functioning. Through a series of quantitative research presentations, this symposium will explore the impact of self-as-content on thriving and mental health across multiple domains. First, Madeline Benz will examine how identification with a stigmatized group impacts treatment-seeking behavior among individuals who report substance use problems. Second, Lia Bishop will determine the ways in which rigid identification with trauma-based identities impacts post-trauma functioning in a community sample. Third, Peter Grau will discuss the relationship between event centrality and psychopathology in a clinical sample of trauma survivors. Last, Douglas Gazarian will explore how rigid identification with masculine norms influences psychopathology and treatment-seeking behavior in college-aged men.

• What does it mean to consider yourself an “addict”?: The impact of identity on treatment-seeking behaviors among individuals with substance use problems
Madeline Benz, M.S., Clark University
Kathleen Palm Reed, Ph.D., Clark University
Lia Bishop, Clark University

Individuals who identify with marginalized groups experience unique stressors and stigma that shape how they are viewed and treated. Identifying as an “addict” caries a mainstream connotation that the individual is blameworthy, which is a stigmatizing perspective that may serve as a barrier to treatment-seeking for young adults. Other studies have found certain types of stigma may facilitate treatment. Given research suggesting fear of stigma may be more salient than the experience of stigma for some marginalized groups, we examined treatment-seeking behaviors in a national sample of 171 young adults with a history of problematic substance use. Correlations indicated fear of substance-related stigma was associated with previous help-seeking behavior and intentions to seek treatment (ps<.001). When controlling for severity of alcohol use problems, fear of substance-related stigma predicted intentions to seek help beyond the anticipation/experience of stigma (β=.48, p<.001). These preliminary analyses suggest fear of substance-related stigma may contribute to increased treatment-seeking behavior among young adults with a history of substance use problems. Implications will be discussed using an ACT framework.

• “I’m a survivor”: Exploring the relationship between conceptualized identities and post-trauma functioning
Lia Bishop, M.A., Clark University
Kathleen Palm Reed, Ph.D., Clark University

Research suggests that individuals who build their identity around traumatic experiences (e.g. “I am a victim”) may be more likely to develop post-trauma psychopathology. Psychological inflexibility may underlie this relationship, such that individuals who attempt to control their thoughts and feelings are more likely to develop a static (e.g. “conceptualized”) identity. In a community sample of 193 trauma survivors, path analyses confirmed that individuals who endorsed more conceptualized identities also reported greater posttraumatic stress disorder (PTSD) and depression symptoms, and that psychological inflexibility partially explained these relationships (p < .001; p < .001 respectively). Psychological inflexibility accounted for 47.62% of the variance between identity conceptualization and PTSD, and 64.16% of the variance between identity conceptualization and depression. Qualitative analyses revealed that individuals who endorsed more conceptualized identities also tended to (1) use definitive identity language (e.g. survivor, victim), (2) report external standards of “normalcy” (e.g. “I will never be normal again”) and (3) endorse stark breaks between their pre- and post-trauma identities (e.g. “who I was died that night”). Implications and limitations will be discussed.

• De-centralizing the context of trauma: Exploring the relationship between PTSD symptoms, posttraumatic cognitions, and centrality of events in PTSD treatment
Peter Grau, M.S., Marquette University, Rogers Memorial Hospital
Chad Wetterneck, Rogers Memorial Hospital, Marquette University

Boals and Murrell (2016) conducted a clinical trial that demonstrated PTSD symptom severity is predicted by the centrality of a traumatic event. Conceptually, they found that centrality of a traumatic event is linked to rigid self-identification with that traumatic event, mapping onto the concept of self-as-context. Additionally, da Silva et al. (2016) found that centrality of events is related to both increased PTSD symptom severity and negative posttraumatic cognitions. Taken together, these studies provide evidence in favor of incorporating Acceptance and Commitment Therapy (ACT) into treatment with the intent of reducing event centrality and, as a result, PTSD symptom severity and negative posttraumatic cognitions. This study replicates and extends these results in a PTSD partial hospitalization program (PHP) that integrates ACT principles into an exposure-based model. Participants (n=150) were in treatment and mainly White, heterosexual, and female (mean age=35.7). Structural Equation Modeling will examine how centrality of events and posttraumatic cognitions affect PTSD symptom severity in treatment. Implications for clinical practice and PTSD conceptualization will be discussed.

• Masculine Self-Concept Rigidity and Psychological Distress
Douglas Gazarian, B.A., Clark University
Michael E. Addis, Ph.D., Clark University

Inflexible adherence to male gender expectations (e.g., emotional control) predicts depressive symptoms, aggressive behaviors, and reduced help-seeking. To our knowledge, no study has used the psychological flexibility model to conceptualize masculinity as a rigid self-process in some men. Further, how this changes by context is unknown. The present study investigates whether men with stronger self-attachments to traditional expectations about manhood show increased psychological distress, and whether receiving psychoeducational information changes this process. Undergraduate males completed a Masculine-Self Implicit Association Test alongside a self-report measure of masculinity-adherence. Participants in the experimental condition watched a video deconstructing male gender roles as emotionally restrictive. Participants in the control condition watched an unrelated video. Masculine self-concept was measured before and after the video manipulation, and again after a one-week interval. Data collection is ongoing; however, initial analyses reveal moderate effect sizes linking self-attachment to masculine norms and psychological distress (r = .40 - .60). Upcoming analyses will test the manipulation’s effect on self-concept malleability across time.

Educational Objectives:
1. Describe how the fear of stigma associated with identifying as an “addict” influences treatment-seeking among a national sample of young adults with a history of substance use problems. 2. List and explain how conceptualized identities manifest among trauma survivors, and influence post-trauma mental health; understand the functional impact of integrating a traumatic event into one’s identity on negative posttraumatic cognitions and PTSD symptom severity in a clinical sample. 3. Demonstrate recognition of masculine gender as relevant to many men’s conceptualized selves.

 

107. Understanding and targeting fear and rumination with RFT
Symposium (10:35am-12:05pm)
Components: Conceptual analysis, Original Data
Categories: RFT, Clinical Interventions and Interests, Fear, anxiety, generalization, conditioning, ACT, emotional disorders
Target Audience: Beg., Interm., Adv.
Location: Multiplication

Chair: Miguel Rodriguez-Valverde, University of Jaen, Spain

This symposium presents studies using experimental designs in the study of conditioned fear and the hierarchical organization of triggers of rumination. The first paper investigates the use of eye-blink startle as a psychophysiological measure on the derived transfer of fear. The second paper uses an aversive conditioning procedure to study the potentiation and attenuation of fear reactions to neutral stimuli. The third paper explores the effectiveness of defusion protocols to reduce rumination and worry strategies. The fourth paper study the role of hierarchical organizations of triggers of rumination and the impact of hierarchical framing to promote psychological flexibility.

• Transfer of conditioned fear-potentiated startle across equivalence classes
Miguel Rodriguez-Valverde, University of Jaen, Spain
Monica Hernandez-Lopez, University of Jaen, Spain
Miguel Angel Lopez-Medina, M.Sc.,, University of Jaen, Spain

Although research on the transfer of fear is key to understanding human fear and anxiety, there is a paucity of evidence about this phenomenon with physiological measures of arousal. The few published studies are based on skin conductance responses (SCRs) as the measure of fear. Current recommendations in psychophysiology research point to fear-potentiated blink startle as a more adequate measure of fear conditioning. However, all previous research from our lab has failed to find clear transfer-of-fear effects with this measure. The present study attempts to overcome the limitations of previous research by using task parameters that have proved useful in obtaining solid transfer effects with SCRs (Rodríguez-Valverde, Luciano, & Barnes-Holmes, 2009). Participants underwent an MTS procedure for the formation of two five-member equivalence classes. Two elements from each class were used in a differential aversive conditioning procedure (CS+1: B1; CS+2: C1; CS-1: B2; CS-2) with electric shock as the UCS. Transfer tests were presented with the remaining class elements. Acoustic eye-blink startle (EMG activity of the orbicularis oculi muscle) was the main dependent variable.

• Transformation of conditioned fear-potentiated startle in accordance with a relational frame of comparison
Miguel Rodriguez-Valverde, Ph.D., University of Jaen, Spain
Monica Hernandez-Lopez, University of Jaen, Spain
Maria Fontiverio-Maldonado, M.Sc., University of Jaén

This study analyzed the experimental interactions that are responsible for the potentiation and attenuation of fear reactions (fear-potentiated acoustic startle) to stimuli with no direct history of aversive conditioning. After establishing a series of symbolic (arbitrary) comparative relations (larger-than, smaller-than) between different visual stimuli, the "intermediate size" stimulus in the relational network was repeatedly paired with mild shock in an aversive conditioning procedure. Once conditioning was acquired, two other elements in the relational network were tested to see if they produced a modulation of acoustic startle reactions in accordance with the previously established arbitrary relations. A stimulus that was previously trained to be symbolically “smaller than” the CS should produce an attenuation of the startle reflex, while a stimulus previously trained to be symbolically “larger than” the CS should produce a potentiation of the startle reflex. Results were obtained in the absence of direct conditioning contingencies with either the “smaller-than” or the “larger-than” stimuli. Although symbolically different in “size”, the physical dimensions of all the stimuli in the experimental task were identical.

• Promoting Rumination and Analyzing the Differential Effect of Defusion Protocols on a Memory Task
Bárbara Gil-Luciano, Universidad de Almería, Madrid Institute of Contextual Psychology
Daniel S. Tovar, Fundación Universitaria Konrad Lorenz
Tatiana Calderón-Hurtado, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Beatriz Sebastián, Universidad de Almería
Eduar S. Ramírez, Fundación Universitaria Konrad Lorenz

Psychological inflexibility is made of distinct reactions that are oriented to lessen distress. In this sense, worry and rumination (RNT) are strategies that seem to be common denominators in many psychological disorders. This study had two parts. Firstly, we explored such a hierarchical organization of thoughts with two ruminative induction procedures, analyzing their impact on a memory task. Secondly, we examined the differential effect of two defusion protocols that aimed to alter the discriminative avoidant functions of triggers for RNT. Results suggest that inducting RNT with stronger triggers (thoughts at the top of the hierarchy, or “big ones”, that symbolically contain or are inclusive of weaker thoughts or triggers) showed a more negative effect in the task performance than inducting RNT with less stronger triggers. Results also indicate that participants that were intervened with the defusion protocol that specifically contained hierarchical cues to reduce the discriminative avoidant functions of triggers for RNT showed a better performance at post-test, in comparison with participants that received a defusion protocol that only contained deictic cues.

• An RFT approach of the Hierarchical Organization of Triggers for Rumination
Bárbara Gil-Luciano, Universidad de Almería, Madrid Institute of Contextual Psychology
Tatiana Calderón-Hurtado, Fundación Universitaria Konrad Lorenz
Daniel Tovar, Fundación Universitaria Konrad Lorenz
Francisco J. Ruiz, Fundación Universitaria Konrad Lorenz
Beatriz Sebastián, Universidad de Almería
Andrés Peña-Vargas, Fundación Universitaria Konrad Lorenz

The present study analyzed the relational networks between private events (thoughts) that typically trigger rumination. Among a sample of 100 undergraduate students, participants went through several evaluation phases. Firstly, all participants responded to several questionnaires that broadly measured their current emotional health state. Secondly, participants were presented a list of thoughts that typically serve as triggers for rumination, and were asked to select a number of thoughts that they frequently had and to what extent they get entangled in them. Consequently, they were presented and explained three different types of diagrams as examples of how those thoughts could be organized: coordination, comparison and hierarchy. Finally, participants were asked to select the diagram that best fitted for them. Results were that 79% of participants organized their triggers for rumination in relations of hierarchy, while 19% of participants organized them in relations of comparison, and only 2% in relations of coordination. Conceptual and clinical implications of these findings are discussed.

Educational Objectives:
1. List the main psychophysiological measures used in research on the derived transfer of fear. 2. esign experimental research about the transfer of fear. 3. Discuss the clinical implications of the hierarchical organization of triggers of rumination.

 

115. ACT in the workplace: Understanding how ACT interventions improve employees' mental health
Symposium (1:20-2:50pm)
Components: Original Data
Categories: Occupational health, Professional Development, Mindfulness
Target Audience: Beg., Interm.
Location: Rue Sainte-Catherine

Chair: Paul Flaxman, Ph.D., City, University of London
Discussant: Frank Bond, Goldsmiths, University of London

There is growing interest in the use of ACT to help improve mental health in workplace settings. Previous studies have shown that ACT is effective in improving workplace well-being, and the beneficial effects are often mediated via increases on general measures of psychological flexibility. However few studies have offered more in-depth explorations of how ACT improves employees’ functioning. This symposium reports three intervention studies seeking to address this issue. The first paper is a mixed methods study, evaluating the effects of a 4-session ACT training programme on teachers’ mental health; 34 of these participants were interviewed to understand how ACT-based processes are manifesting in employees’ daily life. The second study explored various potential processes of change, including increases in positive affect, behavioural activation and cognitive defusion. The findings indicate the defusion is an influential process of change in these brief interventions. Finally, study 3 directly compares ACT and mindfulness training in a workplace setting. The results suggest that ACT and mindfulness training improve employees’ mental health via similar processes of change.

• School teachers’ experiences of a workplace ACT intervention: A mixed methods study
Dr. Paul Flaxman, City, University of London
Ross McIntosh, City, University of London
Shannon Horan, City, University of London
Jeff Salter, Mind the Gap Transformations
Dr. Julia Yates, City, University of London

Previous investigations of ACT’s mechanisms of change in workplace settings have focused on general mediation effects. The present paper reports the findings a mixed methods study, in which 34 school teachers attended a 4-session ACT-based training program. Participants completed measures of mental health, valuing, and mindfulness skills at pre, post, and 2 month follow-up. The same teachers participated in semi-structured research interviews during which they discussed the effects of the ACT intervention on their work and home lives. Using template analysis, and focusing initially on exemplars of the 6 hexaflex processes, we extracted specific examples of how teachers had changed in response to the intervention. Thematic analysis revealed additional themes that captured teachers’ experiences of the process of the intervention (e.g., resistance, group process) and impact on cognitive-affective experiences (e.g., decreased tension and negative affect). This strategy of linking qualitative and quantitative data shows promise for understanding more specific processes of (and barriers to) change when ACT is delivered in the workplace.

• ACT in the workplace: Exploration of multiple processes of change
Dr. Paul Flaxman, City, University of London
Dr. Niguel Guenole, Goldsmiths, University of London
Dr. Joda Llloyd, Goldsmiths, University of London
Porfessor Frank Bond, Goldsmiths, University of London

This waitlist controlled study evaluated potential processes of change in an ACT-based training intervention delivered at two organisations in the United Kingdom. The intervention was delivered to groups of employees over three half-day sessions. A total of 243 participants completed baseline assessments and were allocated to the ACT condition (n = 112) or to a waiting list control group (n = 131). Study measures were administered at baseline, two months after two initial group sessions, and again another three months after the third session (a five month evaluation period in total). The primary outcome measures were general mental health (GHQ-12) and life satisfaction. The aim of the study was to examine whether increases in positive affect, a reduction in behavioural avoidance, or increased cognitive defusion operated as unique processes of change. Results of growth modelling indicated that improvements in employees’ well-being were associated particularly with a reduction in fusion (as measured with the cognitive fusion questionnaire). Study findings support the use of various defusion exercises in brief worksite ACT programs.

• A randomized controlled comparison of worksite applications of ACT and mindfulness training: Investigating attentional and attitudinal mediators of change
Paul Flaxman, City, University of London
Dr. Vasiliki Christodoulou, Cyprus, Mental Health Services
Dr. Joe Oliver, Contextual Consulting, UK
Dr. Eric Morris, La Trobe University, Australia
Dr. Nigel Guenole, Goldsmiths, University of London

Few studies have directly compared workplace applications of ACT with mindfulness training. In addition, some authors have questioned whether ACT is truly a “mindfulness-based” intervention (MBI) because of the reduced expectation around meditation practice. In this randomised controlled trial, 199 employees of a healthcare organisation in London, UK were allocated to a 4-session ACT-based training programme (n = 67), a 4-session mindfulness training program (based on MBSR; n = 63), or to waiting list control group (n = 69). Self-report measures of general mental health and three specific mindfulness skills (acting with awareness, non-judgement, and non-reactivity) were administered on 5 separate occasions spread over a six month evaluation period. Both ACT and MT resulted in significant (and broadly equivalent) improvements in employees’ mental health. Growth modelling and mediation analysis indicated that both interventions were working primarily via the cultivation of a non-judgemental attitude toward difficult inner experience (i.e., through the FFMQ’s non-judging subscale). Results suggest that ACT and MT are targeting similar processes, and that ACT warrants classification as an MBI.

Educational Objectives:
1. Describe how ACT processes manifest in employees’ daily lives. 2. Assess ACT’s processes of change when delivered in workplace settings. 3. Explain how ACT compares to a similar-length mindfulness training program in a workplace context.

 

117. Empirical investigations of experiential avoidance and psychological well-being
Symposium (1:20-2:50pm)
Components: Original Data
Categories: Theoretical and philosophical foundations, Theoretical and philosophical foundations, Experiential avoidance, Psychological flexibility, PTSD, Addiction, childhood trauma, AAQ-II, MEAQ
Target Audience: Interm.
Location: Rue Crescent

Chair: Robert Whelan, Trinity College Dublin, Ireland
Discussant: Louise McHugh, University College Dublin, Ireland

Experiential avoidance (EA), the tendency to avoid private experiences such as thoughts, feelings, and bodily sensations, has been identified as a potential risk factor in a range of disorders. The current symposium proposal includes data from studies that examined EA with respect to post-traumatic stress disorder, symptoms of anxiety, and addiction. The first presentation (Lewis & Naugle) will report the discriminant validity of two measures of EA in predicting symptoms for those with a likely post-traumatic stress disorder diagnosis. The second presentation (Tyndall et al.) will describe how EA relates to measures of psychological distress and wellbeing, highlighting the utility of this distinct profile for working with clients within the psychological flexibility framework. The third presentation (Pennie & Whelan) will focus on the function of alcohol dependency in adults who misuse alcohol, with preliminary data suggesting that alcohol is often used as a coping mechanism to avoid present-moment experiences in individuals who misuse alcohol. Data from these three studies can further refine our understanding of EA in a range of psychopathologies.

• Measuring experiential avoidance: Evidence toward multidimensional predictors of trauma sequelae
Meaghan Lewis, Western Michigan University
Amy Naugle, Western Michigan University

The current study sought to investigate measurement discrepancies in self-reported experiential avoidance (EA). Recent research indicates EA may be more appropriately conceptualized as a multidimensional construct, operationally defined in terms of specific avoidance strategies (Gámez et al., 2014). To test this notion, EA was measured using two self-report instruments, the Acceptance and Action Questionnaire-II (AAQ-II; Bond et al., 2011) and the Multidimensional Experiential Avoidance Questionnaire (MEAQ; Gámez et al., 2011) in a convenience sample of university students. Measurement differences and unique contributions to prediction of posttraumatic stress symptoms (PTSS) and engagement in problematic behaviors were evaluated. Both the AAQ-II and MEAQ were found to significantly mediate the effect of childhood trauma exposure on PTSS. However, when levels of PTSS were dummy coded into dichotomies of those with a likely PTSD diagnosis and those without, the MEAQ was a stronger predictor of symptoms for those with a likely PTSD diagnosis than the AAQ-II. These results provide initial support for the discriminant validity of the MEAQ, which appears to be a more specific predictor of trauma-related symptoms.

• Profiles of Psychological Flexibility: A Latent Class Analysis of the psychological flexibility model in terms of depression, anxiety, stress, and positive and negative emotions
Ian Tyndall, University of Chichester, UK
Dan Waldeck, Coventry University, UK
Luca Pancani, University of Milano-Biccoca, Italy
Rob Whelan, Trinity College Dublin, Ireland
Bryan Roche, Maynooth University, Ireland

Psychological flexibility is a core tenet of the Acceptance and Commitment Therapy (ACT) model of behaviour change and emotional well-being. There are six components to psychological flexibility, with varying theoretical positions as to whether each component functions alone, or whether they work in pairs, for example. There is an ongoing current debate as to whether key self-report measures of psychological flexibility and experiential avoidance (e.g., Acceptance and Action Questionnaire-II) actually measure these important constructs. The present paper will outline a study that aims to help elucidate how important components of the psychological flexibility model relate to measures of psychological distress and wellbeing. A Latent Class Analysis (LCA; n = 557) was conducted on measures of psychological flexibility, cognitive fusion, experiential avoidance, committed action, and present-moment mindfulness, with to regard to measures of depression, anxiety, stress, and positive and negative emotions. The LCA identified three clear statistically different profiles of psychological flexibility. This presentation will highlight the utility of these profiles for working with clients within psychological flexibility and ACT frameworks.

• A functional understanding of alcohol misuse: Quantifying the role of experiential avoidance, maladaptive coping and impulse control processes
Brian Pennie, Trinity College Dublin
Rob Whelan, Trinity College Dublin, Ireland

Contact with the present moment is a key component of emotional well-being. In contrast, individuals with addiction problems tend to demonstrate a range of behavioural deficiencies including experiential avoidance, psychological rigidity, and maladaptive impulse control. We adopted a novel online method that allowed us to collect both task and psychometric data from a large sample with the aim of determining the unique and shared contributions of experiential avoidance, present-moment mindfulness, impulse control, and drinking motives on adults who misuse alcohol. Preliminary data (n=159) revealed that problematic drinking was strongly associated with maladaptive coping (r = .566, p = <.001) and impulsivity (r = .232, p = .003). Although experiential avoidance was not directly related to alcohol misuse, coping and conformity as motives for drinking were associated with both experiential avoidance (r = -.215, p = .014) and present-moment mindfulness (r= -.195, p <.001). These preliminary data suggest that alcohol may be a coping mechanism to avoid present-moments experiences in individuals who misuse alcohol.

Educational Objectives:
1. Explain how the predictive validity of the AAQ-II and MEAQ relates to trauma symptoms and childhood trauma exposure. 2. Elucidate how experiential avoidance relates to measures of psychological distress and well-being. Highlight the utility of this distinct profile for working with clients within the psychological flexibility framework. 3. Describe the unique a shared contributions of experiential avoidance, maladaptive coping and impulsivity on alcohol misuse in an adult population. Outline the importance of experiential avoidance as a maladaptive process involved in alcohol misuse.

 

118. Discrimination and microaggressions: CBS research findings and a call to action
Symposium (1:20-2:50pm)
Components: Original Data
Categories: Functional contextual approaches in related disciplines, Microaggressions, Racism, Discrimination
Target Audience: Beg.
Location: Rue Mansfield / Rue Sherbrooke

Chair: Adam M. Kuczynski, M.S., University of Washington
Discussant: Jonathan W. Kanter, Ph.D., University of Washington

Consistent with our organization’s core values, CBS must increase its efforts to predict-and-influence acts of discrimination and oppression, including—in today’s cultural climate--microaggressions. This symposium presents important data documenting that experiences of discrimination and microaggressions have harmful and clinically significant effects, predicting increases in depression and anxiety for people of color. Then, we present new findings on a contextual-behavioral measure of White individuals’ likelihood of engaging in microaggressive behavior, and we present a reliable and valid system for objectively observing and measuring the severity of observed microaggressions. Overall, results converge on conclusions that microaggressions are not simply idiosyncratic or politically motivated hyper-sensitive overreactions. Microaggressions can be objectively studied with contextual-behavioral science methods, are harmful, and are related to other indices of racism in White individuals who commit them. Discussion will encourage other CBS professionals to enter the arena of microaggression research and intervention development using CBS principles.

• Identity, discrimination, and microaggressions: New evidence and therapeutic implications
Mariah D. Corey, B.S., University of Washington
Jutta Joormann, Ph.D., Yale University
Katherine E. Manbeck, M.S., University of Washington
Jonathan W. Kanter, Ph.D., University of Washington

This paper will review data on the relationship between experiences of discrimination and microaggressions among people of color and negative health and mental health outcomes, including new data from our lab. This new data suggests that, in the current cultural and political climate in which there has been a resurgence in White nationalism and clear increases in violence against Blacks, a strong Black ethnic identity is not necessarily protective against the depressogenic effects of experiences of discrimination and may in fact be a risk factor. We offer some suggestions for how contextual-behavioral practitioners and scientists may understand these findings and work therapeutically with people of color in this climate.

• Measuring microaggressions in White individuals I: Self-reported microaggressions predict prejudice and racism
Ryan Parigoris, University of Washington
Adam M. Kuczynski, M.S., University of Washington
Cathea M. Carey, University of Washington
Mariah D. Corey, B.S., University of Washington
Monnica T. Williams, Ph.D., University of Connecticut

Previous efforts to understand microaggressions have surveyed stigmatized group members’ experiences of receiving microaggressions but not attempted to measure White individual’s likelihood of engaging in such acts. Furthermore, previous research has not attempted to understand the construct of microaggressions from a contextual-behavioral perspective. This paper presents new data, from a cross-sectional survey of almost 1,000 White undergraduate students, on a contextual-behavioral measure of one’s self-reported likelihood of delivering microaggressions and explores the association between the likelihood of delivering microaggressions and racial prejudice. We found that White students’ self-reported likelihood of engaging in microaggressive acts was significantly related to all measures of racial prejudice, suggesting that the delivery of microaggressions by white students is not simply innocuous behavior and may be indicative of broad, complex, and negative racial attitudes and explicit underlying hostility and negative feelings toward blacks.

• Measuring microaggressions in White individuals II: Objectively identifying microaggressive behavior
Cathea M. Carey, University of Washington
Mariah D. Corey, B.S., University of Washington
Ryan Parigoris, University of Washington
Adam M. Kuczynski, M.S., University of Washington
Monnica T. Williams, Ph.D., University of Connecticut

Are microaggressions objectively, reliably observable by independent observers or are they simply idiosyncratic or hyper-sensitive overreactions by those who report experiencing them? For a contextual-behavioral understanding of microaggressions, the construct must be situated in observable human actions-in-context. In a lab-based study, we video-taped 45 White individuals having conversations about current events (such as police violence against Black people or the removal of a confederate monument from a Southern city), during which they might say something experienced as microaggressive (such as “all lives matter, not just black lives”), with a Black lab assistant listening. We trained 7 independent assistants (two White, two Black, and three Asian students) to observe the videotapes and identify how microaggressive the participants were in the interactions. Students were highly reliable across several categories of microaggressions, including tendencies to deny racism or bias in oneself and others, demonstratations of discomfort and avoidance when discussing race, and being unconcerned about social justice. We also report relationships between these objective findings and participants self-reported levels of prejudice and racism.

Educational Objectives:
1. Describe recent empirical findings on the relationship between microaggressions, ethnic identity, and overt racism. 2. Discuss the development of a contextual-behavioral self-report measure of microaggressions. 3. Discuss intervention techniques from a contextual-behavioral perspective.

 

119. Using the matrix to address psychological suffering across multiple disorders
Symposium (1:20-2:50pm)
Components: Original Data
Categories: Clinical Interventions and Interests, ACT Matrix
Target Audience: Beg., Interm.
Location: Rue Saint-Paul

Chair: Emily B Kroska, Ph.D., University of Iowa
Discussant: Benjamin Schoendorff, M.A., M.Sc., , CONTEXTUAL PSYCHOLOGY INSTITUTE, MONTRÉAL

This symposium will present studies from a number of different areas of the world and that used differing research designs but that all involved using the ACT matrix to address psychological suffering in the context of severe disorders and psychiatric problems (i.e., depression and tinnitus, suicidal ideation and high functioning autism).

• The use of the Matrix in a randomized controlled trial in suicidal patients
Veronique Brand-Arpon, Ph.D., Centre Hospitalier Régional Universitaire de Montpellier

The results of the first monocentric randomized controlled trial comparing the effectiveness of ACT vs. relaxation, for patients suffering from current suicidal behaviour disorder show that, as hypothesised, ACT was more effective than relaxation to reduce severity and intensity of suicidal ideation between pre- and post-therapy, with a maintain of the effect at 3 months follow-up. In addition, ACT was more effective than relaxation to reduce level of depressive symptomatology, anxiety, psychological pain, hopelessness and anger, known to be associated to suicidal risk. Finally, ACT improved global functioning and quality of life. Therefore, this trial confirms feasibility and utility of ACT group program among high risk suicidal patients.

• Using the ACT Matrix to Enhance Perspective Taking and Psychological Flexibility in Autism: A Pilot Study
Diana Bast, Ph.D., Federal University of São Carlos
Clodagh Murray, Ph.D., National University of Ireland, Galway
Ian Stewart, Ph.D., National University of Ireland, Galway
Giovanni Miselli, Ph.D., ISTITUTO FONDAZIONE OSPEDALIERO DI SOSPIRO ONLUS (CR)
Benjamin Schoendorff, M.A., M.Sc., , CONTEXTUAL PSYCHOLOGY INSTITUTE, MONTRÉAL
Shinji Tani, Ph.D., Ritsumeikan University, Japan

This pilot study examined the utility of the ACT Matrix as an intervention to increase psychological flexibility and well-being in adolescents and young adults diagnosed with high functioning autism. A key aim was to teach participants to cope with their emotions and increase their resilience and endurance in general as well as specifically in the task of seeking employment. Four clients of the Care Trade Institute in London took part; three had been diagnosed with high functioning autism while the fourth had been diagnosed with Aspergers Disorder. They were pre and post assessed with standardized scales (DASS, AAQ-II, CFQ, Valued Living Questionnaire and The Matrix Bridging Questionnaire Part B) and pts attended for 4 hour sessions on each of four days and received a specially adopted version of the protocol. They were also given several weeks’ access to a mobile application (the ‘ACT Matrix’ app) which asked them eight times a day whether their behavior was ‘towards’ or ‘away’ from their stated values. Participants showed differing levels of improvement. Results are discussed in detail.

• Using the matrix in a Japanese context to treat a client with depression and tinnitus: A single case design
Shinji Tani, Ph.D., Ritsumeikan University, Japan

This study investigated the use of the matrix with a Japanese client suffering from Tinnitus and Depression. The client showed strong levels of fusion concerning particular relationships - with a boss in a previous workplace, and also with her father. She thought that both of them had responsibility for her Tinnitus, and she felt strong anger towards them. Functional analysis was conducted using the Matrix. The therapist helped the client explore the workability of her behaviors. He also used defusion exercises, metaphors and verbal AIKIDO so as to help her to distance herself from her thoughts, to increase her sensitivity towards contingencies, and to identify important values. Results showed that particular relational responses were weakened, while her score on the BDI-II (16 points) and the Tinnitus Cognition Questionnaire (-8 points) decreased. A decrease in AAQ (-4 points) score was also found. The talk will discuss application of the Matrix and of verbal AIKIDO in a Japanese cultural context.

Educational Objectives:
1. Describe the ACT Matrix. 2. Discuss the Matrix as a potential methodology to treat severe disorders. 3. Discuss the utility of the ACT Matrix as a cross-cultural tool.

 

121. From individual to systemic behavior change: What Behavior Analysis and Pro-sociality can bring to ACT
Symposium (1:20-2:50pm)
Components: Conceptual analysis, Literature review, Original Data, Case presentation
Categories: Theoretical and philosophical foundations, Organizational behavior management, Clinical Interventions and Interests,, Prevention and Community-Based Interventions, Performance-enhancing interventions, Educational settings, Organizational behavior management, Theoretical and philosophical foundations, Applied Behavior Analysis, Neurodevelopmental disorders, Pro-Sociality, Multi-Level Selection, Intellectual Disability, Adolescents, Adults, Autism, Establishment of event functions
Target Audience: Beg., Interm., Adv.
Location: Exclamation

Chair: Jessica Hinman, B.A., Southern Illinois University, Carbondale

This symposium explores the use of Behavior Analysis and Community-based research to the study of clinically relevant processes. The first paper uses a radical behavioral conceptual analysis to study the process behind maladaptive delay discounting strategies. The second paper presents a new theory regarding care pathways for professionals working with children and adolescents with neurodevelopmental disorders. The third paper presents a a behavioral and ACT-based environmental intervention aimed at increasing social skills and value-consistent behaviors in individuals with intellectual disabilities.

• From the Skinner Box to Socially Meaningful Behavior Change: Synthesizing ACT and Delay Discounting in the Context of Applied Behavior Analysis
Jonathan Tarbox, Ph.D., BCBA-D, University of Southern California and FirstSteps for Kids
Elizabeth Meshes, Chicago School for Professional Psychology
Amy Odum, Ph.D., Utah State University

Acceptance and commitment therapy (ACT) was originally developed as a behavioral approach to psychotherapy for treating disorders traditionally treated by clinical psychology. However, the functional analyses that form the foundation of ACT are equally applicable to anyone who has rule-governed behavior that interacts with socially meaningful overt behavior. Most daily problems of behavior involve making difficult choices between smaller short term negative reinforcers (e.g., avoiding work) versus larger longer-term positive reinforcers (e.g., successful career). Delay discounting research demonstrates that unfavorable delays and proportions of reinforcement result in less favorable choices. ACT attempts to transform the function of verbal behavior such that choosing the harder choice in the short term in order to access the larger reinforcer later is more probable. This presentation will present the radical behavioral conceptual analysis behind this process and discuss applicability across work with individuals with autism, parents of children with autism, and behavioral supervision of staff. Potential for using this analysis for extending applied behavior analysis into other important areas of applied work will also be discussed.

• Developing Care Pathways for Neurodevelopmental Disorders: Seeing Common Problems as Problems of Commons
Gustaf Waxegard, M.Sc., Ph.D. candidate, Linnaeus University, Sweden; R&D-unit, Region of Kronoberg
Hans Thulesius, Lund University, Sweden; R&D-unit, Region of Kronoberg, Sweden

Welfare-type societies tend to encourage construction of care pathways to counter fragmentation of health care services caused by the well-documented trends of increased professionalization, decentralization, and specialization. Still, care pathways for mental health problems remain poorly conceptualized, academically as well as in practice. Implementation is fraught with difficulties, and the implied collaborative behavior between professional stakeholders often fails to develop to the detriment of patients. This paper aims to increase professional ability to integrate and develop care pathways for neurodevelopmental disorders (ND) in children and adolescents. Based on multilevel empirical data, it presents a new theory about ND care pathways as commons, holding a complex common pool resource (CPR) attractive to professionals. The paper a) sets ND care pathways on a more solid theoretical footing, b) points to the PROSOCIAL framework as promising alternative for ND care pathway development work, and c) provides a rationale for further CBS-relevant research on professional behavior in care pathways för mental health based on Ostromian commons theory, relational frame theory, and the Institutional Analysis and Development (IAD-) framework.

• Club '57: Applied Behavior Analysis and Acceptance and Commitment Therapy for Individuals With Autism Spectrum Disorder
Jessica Hinman, B.A., Southern Illinois University, Carbondale
India Pauly Hertel, B.S., Southern Illinois University, Carbondale
Sebastián García-Zambrano, B.A., Southern Illinois University, Carbondale
William Root, M.S., BCBA, Southern Illinois University, Carbondale
Natalia Baires, M.S., BCBA, Southern Illinois University, Carbondale
Daniel Grishman, B.A., Southern Illinois University, Carbondale
Victoria Hutchinson, B.S., Southern Illinois University, Carbondale
Molly Lamb, B.A., Southern Illinois University, Carbondale
Miranda Morton, B.A., Southern Illinois University, Carbondale
Ruth Anne Rehfeldt, Ph.D., BCBA-D, Southern Illinois University, Carbondale

Many adolescents and young adults with autism spectrum disorder (ASD) often engage in rigid behavioral routines, including rigid self-rules. These routines may make it difficult for them to effectively adapt and respond to unforeseen changes in life, which may result in ill-adaptive avoidance behaviors in the future, all characteristics of psychological inflexibility (Pahnke, Lundgren, Hursti & Hirvikoski, 2013). The purpose of Club 57 is to provide an environment where adolescents and young adults with ASD are able to socialize, develop friendships with peers, and acquire new social skills, all while receiving Acceptance and Commitment Training (ACT) services that promote engagement in behavioral repertoires consistent with valued living. Between February and May , Club 57 has served more than 30 individuals ranging in age from 13 to 28 years old. Pre- and post-test assessments were administered to 14 participants Assessments indirectly measured levels of psychological inflexibility, experiential avoidance, social anxiety, and cognitive fusion. Overall, analyses of the assessment results found a statistically significant difference responses for three of the four assessments, suggesting an overall improvement in psychological flexibility. Given the number of adolescents and young adults with ASD that experience anxiety, depression, and social isolation, programming that directly addresses these experiences will be discussed along with the clinical significance of the results.

Educational Objectives:
1. Describe how experiential avoidance involves a choice between a smaller sooner negative reinforcer versus a larger later positive reinforcer. 2. Utilize Acceptance and Commitment Therapy (ACT) metaphors and experiential activities with adolescents and young adults diagnosed with Autism Spectrum Disorder (ASD).  3. Evaluate the effects of ACT components on cognitive fusion, acceptance, and mindfulness in adolescents and young adults with ASD.

 

122. Why philosophy matters: Reconnecting with our roots and branching out: Contextual Philosophy of Science SIG Sponsored
Symposium (1:20-2:50pm)
Components: Conceptual analysis, Didactic presentation
Categories: Theoretical and philosophical foundations, Professional Development, Theoretical and philosophical foundations, Functional contextual approaches in related disciplines, Contextualism
Target Audience: Beg., Interm., Adv.
Location: Multiplication

Chair: Douglas M. Long, Ph.D., Warren Alpert Medical School of Brown University

Why does philosophy matter? What difference does it make in our lives? This symposium will shed light on the importance of philosophy from both personal and professional viewpoints. Paper 1 will discuss functional contextualism, the philosophy underlying the development of ACT, and explore how focusing on workability can have a profound impact. Paper 2 will discuss descriptive contextualism, a sister of functional contextualism, and examine how this viewpoint can also be fruitful. Paper 3 will confront the reality that most knowledge is not born of contextualist viewpoints, and offer practical suggestions for collaborating with professionals of different backgrounds. The symposium aims to stimulate conversation and will conclude with time for open discussion and questions from the audience.

• How I fell in love with a-ontology
Kelly G. Wilson, Ph.D., University of Mississippi

The philosophical roots of ACT can be found in a philosophy of science called functional contextualism. Among the noteworthy and sometimes controversial features of this position has been steadfast abstention from ontology. Instead of focusing on the “nature of reality”—what is—functional contextualism focuses on what works. In this talk, I will provide an argument in support of a focus on workability. In my own case, I came to embrace a-ontology as a very pragmatic matter well before I began a serious study of philosophy of science. My a-ontology came through personal practice. My a-ontology had roots within multiple areas of academic study, but also through entirely nonacademic investigations. At a very particular juncture in my own life, standing at the cusp of living and dying, the simplicity and freedom of letting go of ontology was lifesaving. In this paper, I will describe a deeply personal approach to this weighty philosophical topic that led from a near death experience to a way to do science.

• The Other Contextualism: Exploring the Value of Descriptive Contextualist Approaches in Research and Practice
Donald R. Marks, Ph.D., Kean University

In the contextual behavioral science community, descriptive contextualist approaches have received less attention and theoretical explication than functional contextualism. Investigational methods associated with descriptive contextualism include narrative, historical, ethnographic, and metaphorical accounts of the act in context. Workability and practical application may have less importance to the descriptive contextualist than the exploration of possible meanings and the development of “compelling,” though tentative, accounts of behavior in context. With its emphasis on the aesthetic and rhetorical functions of scientific discourse, descriptive contextualism offers a fruitful approach for examining the behavior of scientific investigators – providing richly detailed accounts of the contexts, including socioeconomic and political contingencies, that give rise to specific scientific endeavors and claims. Drawing on the behavioral hermeneutics of Willard Day (1992), the critical epistemology of Sandra Harding (2015), and the sociology of science of Law (2004) and Latour (1993), this paper considers the value of descriptive perspectives for researchers and practitioners working in the functional contextualist tradition, while also acknowledging the scientific limitations of descriptive methods.

• Collaborating Across Philosophical Worldviews
Sean P. Wright, Lutheran Community Services Northwest

The philosophical worldview of contextualism has usefully guided the development of a behavioral science that intentionally aims to change the world for the better given the challenges of the human condition. However, much of the extant knowledge of human behavior (and the ongoing research and applied interventions developed from this knowledge) is rooted in the assumptions of other philosophical worldviews, such as mechanism or organicism. It may be pragmatic for contextual behavioral scientists and practitioners to collaborate with others whose work is grounded in different philosophical assumptions for the purpose of increasing the depth of contextual analyses and to predict-and-influence the behavior of individuals who produce and consume scientific knowledge. This contribution describes guidelines for effective collaborations across worldviews that is informed by practical experience from recent collaborations among psychotherapists and an ongoing collaboration with legal scholars.

Educational Objectives:
1. Define functional contextualism as a philosophy of science and provide examples of how functional contextualism can inform personal and professional practices. 2. Define descriptive contextualism as a philosophy of science and provide examples of scientific projects informed by descriptive contextualist perspectives. 3. Name 3 guidelines for effective discussions of alternate philosophical worldviews.

 

123. Projets cliniques et de recherche novateurs en francophonie
Symposium (1:20-2:50pm)
Components: Analyse conceptuelle, Revue de la littérature, Données originales, Exercices pratiques, Présentation didactique, Étude de cas
Categories: Interventions cliniques, Approches contextuelles fonctionnelless dans des disciplines connexes, Interventions cliniques, Prévention et interventions communautaires, Interventions pour améliorer les performances, Développement professionnel, Fondements théoriques et philosophiques, Théorie des cadres relationnels, Trouble de la Personnalité Borderline, ACT TSA, Auto-compassion, Adultes - TAG, Coaching
Target Audience: Débutant, Intermédiaire, Avancé
Location: Arobase

Chair: Sylvie Rousseau M.Ps., Université de Sherbrooke

Ce symposium met en valeur des initiatives cliniques et de recherche en francophonie. D’abord, Dre Keltoum Belmihoub illustre une prise en charge du trouble de la personnalité limite sous l’angle de trois TCC de la troisième vague (schémas, ACT et DBT). Ensuite, les psychologues Lise Grond et Andrea Velez offriront une application clinique novatrice des principes de l’ACT auprès de personnes avec un trouble du spectre de l’autisme (TSA). Le Dr Ilios Kotsou, auteur et chercheur, présentera par la suite un essai aléatoire sur les effets d’un entraînement à l’auto-compassion en ligne. Enfin, Sylvie Rousseau, psychologue, décrira un protocole d’intervention basé sur l’ACT pour le trouble d’anxiété généralisée ainsi que des données sur son efficacité. Une période d’échanges permettra aux participants de poser leurs questions et de partager leurs expériences.

• Prise en charge Psychologique de la troisième vague des TCC du Trouble de la Personnalité Borderline
Keltoum Belmihoub, URNOP-Université d'Alger2.ALGERIE

Nous allons à travers une étude de cas clinique illustrer quelques concepts théoriques des trois modèles de la troisième vague de la théorie cognitivo-comportementale à savoir : 1-Le modèle de la théorie des schémas précoces inadaptés de J.Young. Qui mis l’accent sur le la relation thérapeutique pour compenser la négligence des parents, et incite le thérapeute à être un bon modèle pour le patient dans la façon d'exprimer ses émotions et ses besoins. 2-le modèle de la thérapie dialectale comportementale de M. Linhan.La dialectique met l'accent sur la valeur de la recherche de combinaisons naturelles afin de réaliser le changement chez le client, et cherche également à équilibrer, à se concentrer sur les stratégies de changement et d’acceptation. 3-le modèle de la théorie de l'engagement et de l'acceptation de S. Hayes. Qui vise à développer une flexibilité psychologique qui est la capacité d'être en contact avec les émotions et les pensées du moment présent tout en travaillant à réaliser ses objectifs selon ses valeurs et ce qui est important pour lui.

• Reflexions sur la thérapie d'acception et d'engagement chez les adultes présentant un trouble du spectre de l'autisme de haut niveau
Lise Grond, psychologue, CIUSSS de l'est-de-l'île-de-montréal (IUSMM)
Andrea Velez, psychologue, CIUSSS de l'est-de-l'île-de-montréal (CLSC de Rosemont)

La prévalence des personnes présentant un trouble du spectre de l’autisme (TSA) est en constante hausse dans le monde. Cette clientèle, qui est plus vulnérable à développer un trouble de santé mentale, représente donc inévitablement une partie des prises en charge des psychothérapeutes. Très souvent, ces professionnels se trouvent démunis face à ces patients ; des thérapies qui n’avancent plus ou sont abandonnées car le diagnostic est peu connu ou parfois même pas posé. Peu de littérature et de recherches cliniques concernant la thérapie ACT (acceptation et engagement) et le TSA existent, pourtant, ces personnes devraient obtenir la même qualité de service que la clientèle neurotypique. Dans cette présentation, les auteures partageront quelques réflexions sur l’utilisation de la thérapie ACT pour une clientèle présentant un TSA de haut niveau. Elles parleront des étapes ACT avec des pistes d’adaptation possibles. Ultimement, cette présentation vise à outiller les professionnels et à ouvrir leurs horizons pour rendre leurs services accessibles à une clientèle complexe. Finalement, elles font un appel a plus des recherches dans le domaine.

• Traiter le trouble d'anxiété généralisée par la thérapie d'acceptation et d'engagement
Sylvie Rousseau M.Ps., Université de Sherbrooke

Les recherches sur l’efficacité de l’ACT dans le traitement des troubles anxieux demeurent rares et très peu d’études cliniques utilisent un protocole standardisé basé sur l’ACT pour les traiter. Dans le cadre de mon doctorat en psychologie, que je compléterai sous peu, j'ai évalué l'efficacité de la thérapie d'acceptation et d'engagement pour le trouble d'anxiété généralisée. Les résultats de cette recherche confirment le lien existant entre le traitement ACT et l’amélioration de la qualité de vie chez les personnes qui sont atteintes du TAG. Lors de l'atelier de formation que j'aimerais présenter lors du congrès, je décrirai ce qui ressort de cette recherche. J'expliquerai le but et les principales composantes du traitement, selon le protocole élaboré par Eifert et Forsyth, soit: comprendre la nature et la fonction de l’anxiété; apprendre à mieux composer avec l’anxiété; déterminer des actions en direction de ce qui est important pour la personne comme une alternative à la gestion de l’anxiété afin d’améliorer la qualité de vie. Des métaphores et des exercices seront proposés pour intégrer les principes de l'ACT.

Educational Objectives:
1. Expliquer les concepts clés des trois modèles de la troisième vague des TCC. 2. Démontrer à travers un cas clinique l'efficacité pratique de ces concepts. 3. Comparer l'apport de chaque modèle par rapport aux autres.

 

128. Clinically relevant applications of the Implicit Relational Assessment Procedure (IRAP)
Symposium (3:10-4:25pm)
Components: Conceptual analysis, Original Data
Categories: Relational Frame Theory, Clinical Interventions and Interests, IRAP
Target Audience: Beg., Interm., Adv.
Location: Rue Sainte-Catherine

Chair: Miguel Rodriguez-Valverde, Ph.D., University of Jaen, Spain
Discussant: Louise McHugh, Ph.D., University College Dublin

Researchers in the domains of psychopathology and clinical psychology are increasingly using the Implicit Relational Assessment Procedure (IRAP) as a way of tapping into clinical phenomena that are difficult to analyze with more traditional measures. This symposium presents three papers that explore the use of the IRAP for the assessment of clinically relevant verbal relations in different areas of interest. The first paper explores the use of the IRAP as a measure of the discrepancy between perceived and desired body size that could complement existing explicit measures like silhouette scales. The second paper used the IRAP to assess automatic beliefs about the effects of cannabis use in both cannabis users and non-users, showing that implicit beliefs about the positive effects of cannabis seem to contribute differentially to the prediction of actual cannabis use. The third paper aimed to explore the common-humanity factor of self-compassion, and whether people tend to identify with this factor more in relation to their own experiences or to the experiences of others.

• Using the IRAP as a measure of discrepancy between actual and ideal body size
Monica Hernandez-Lopez, Ph.D., University of Jaen, Spain
Alberto Luis Blanco-Romero, B.A., University of Jaen, Spain
Lourdes Quiñones-Jimenez, B.A., University of Jaen, Spain
Miguel Rodriguez-Valverde, University of Jaen, Spain

The discrepancy between one's perceived and desired body size appears to be of key relevance for body dissatisfaction. Silhouette scales such as the Contour Drawing Rating Scale (CDRS: Thompson & Gray, 1995) are typically used as an explicit measure of this discrepancy. The present study explored whether it is possible to provide an implicit index of body size discrepancy based on the Implicit Relational Assessment Procedure (IRAP). Forty female and 40 male college students were presented with two different IRAP tasks each (and actual-body-size task, with the labels I am and I am not, and an ideal-body-size task, with the labels I want to be and I don't want to be). Both tasks used the same set of six drawings as targets: the three extremes of thinness and the three extremes of fatness from the nine-item CDRS (female pictures were used for female participants and male pictures were used for male participants). Participants also completed the CDRS. The differential contribution of implicit and explicit discrepancy to eating disorder symptoms and body dissatisfaction was analyzed.

• Implicit beliefs about the effects of cannabis consumption in cannabis users and non-users
Miguel Rodriguez-Valverde, Ph.D., University of Jaen, Spain
Vanesa Martinez-Reche, B.A., University of Jaen, Spain
Gloria Torres-Fernandez, M.Sc., University of Jaen, Spain
Monica Hernandez-Lopez, University of Jaen, Spain

Expectations about cannabis effects play an important role in predicting cannabis use. This study assessed both implicit and explicit beliefs about the effects of cannabis use in a sample of users and non-users. One hundred participants underwent an IRAP task with the labels With cannabis and Without cannabis, and six positive (e.g. I have fun) and six negative (e.g. I am paranoid) phrases as targets. Eighty-one of them (41 users and 40 non-users) completed the task and produced valid data. Participants also completed a visual analogue scale (VAS) with the same stimuli employed for the IRAP and questionnaires about cannabis use and severity of addiction. While both groups showed a clear implicit pro-cannabis bias it was significantly stronger for users than for non-users. There was a clear discrepancy between implicit and explicit measures for both groups, with IRAP scores showing better prediction of actual cannabis use. These results are discussed in terms of their clinical implications.

• “I Am Not Alone in My Suffering”: Implicitly Measuring the Common Humanity Factor of Self-Compassion
Eman Alasiri, Eastern Washington University
Diana Bast, Ph.D., Federal University of São Carlos, Brazil
Russel Kolts, Eastern Washington University

This study aimed to explore common humanity and whether people tend to identify with this factor more in relation to their own experiences or those experiences of others. Most of the previous research on self-compassion used explicit measures which can be scientifically limiting. The current study developed an implicit measure of common humanity using the Implicit Relational Assessment Procedure (IRAP). Stimuli in the IRAP were drawn from Neff’s (2003) sub-scales of common humanity and isolation. Participants completed the IRAP as well as two explicit measures; Neff’s Self-Compassion Scale and an IRAP analogue. Results suggest that, at an implicit level, participants expressed more common humanity toward the self. On the explicit measure, nevertheless, participants expressed less common humanity toward the self. Moreover, explicitly, participants denied feeling of isolation when they struggle in life, but did not show the same bias on the implicit measure. Finally, implicitly, participants denied that when others struggle they feel isolated, whereas, explicitly, they confirmed that. Limitations and implications of the study are elaborated in the discussion.

Educational Objectives:
1. Describe how the IRAP can be used for measuring clinically relevant verbal relations. 2. Explain the relationship between implicit verbal relations and clinically relevant measures (symptomatology, etc.). 3. List the clinical implications of IRAP research.

 

132. Increasing psychological flexibility, resilience, and coping strategies for parents of children with medical conditions: ACT and Autism SIG Sponsored
Symposium (3:10-4:25pm)
Components: Conceptual analysis, Original Data, Didactic presentation
Categories: Clinical Interventions and Interests, Behavioral medicine, Clinical Interventions and Interests, Prevention and Community-Based Interventions, Behavioral medicine, Functional contextual approaches in related disciplines, Children, parents, asthma, randomized controlled trial, mediation analysis, depression, Autism Spectrum Disorder, caregiver
Target Audience: Beg., Interm., Adv.
Location: Rue Saint-Paul

Chair: Yolanda R. Villarreal, Ph.D., McGovern Medical School at University of Texas Health Science Center Houston

This symposium explores the effects of Acceptance and Commitment Therapy interventions among parents of children with medical conditions and the mediating role of ACT processes in clinical settings. The first paper presents the results from a randomized controlled trial investigating the effects of a group-based ACT intervention combined with asthma education for parents of children with asthma. The second paper investigates the mediating effect of psychological flexibility in the management of childhood asthma among parents. The third paper uses a longitudinal design to study the mediating role of psychological inflexibility on the relationship between early (1-2 weeks postpartum) and later (3 and 6-month postpartum) depressive postpartum symptoms among new mothers with medically fragile infants. The fourth paper investigates the effects of psychological acceptance to increase resilience and coping strategies among parents of children with Autism Spectrum Disorder.

• A randomized controlled trial of group-based Acceptance and Commitment Therapy in parents of children with asthma: Effects on the asthma outcomes of children
Yuen-yu Chong, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
Yim-wah MAK, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
Alice Yuen LOKE, School of Nursing, The Hong Kong Polytechnic University, Hong Kong

Childhood asthma imposes a heavy psychological burden on parents which could affect their child’s health. Fostering parental psychological flexibility through Acceptance and Commitment Therapy (ACT) may help parents to accept their psychological difficulties and to improve their childhood asthma management for their personally held values. A randomized controlled trial was conducted to examine the efficacy of a parental training program using group-based ACT plus asthma education (ACT), in comparison with an asthma educational talk (Control), on the utilization of acute healthcare services due to asthma exacerbations in children. One hundred and sixty-eight parents of children aged 3-12 years with asthma were consecutively recruited in a public hospital in Hong Kong. Generalized estimating equations analyses showed that children whose their parents in the ACT group had significantly fewer ED visits (adjusted IRR) = 0.20, 95%CI [0.08,0.53], p=.001) due to asthma exacerbations over a 6-month period, measured at 6 months post-intervention. Results of this study suggest that ACT as an adjunct to parental asthma education could improve the health outcomes of children with asthma.

• Exploring mediators of change in a parental training program using ACT for improving asthma outcomes in children: An analysis using structural equation model based on a clinical trial data
Yuen-yu Chong, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
Yim-wah MAK, School of Nursing, The Hong Kong Polytechnic University, Hong Kong
Alice Yuen LOKE, School of Nursing, The Hong Kong Polytechnic University, Hong Kong

Most of the psychological interventions for parents of children with asthma are based on cognitive behavioral models, suggesting that improvements of child’s health outcomes can occur through different processes, such as increasing parental self-efficacy or reducing psychological distress in asthma care. In this study, the mediators of change in a randomized controlled trial evaluating the effects of ACT in parents for improving their children’s asthma outcomes were explored. Data from 168 parent-child dyads who were randomly assigned to either a parental training program using group-based ACT plus asthma education; or an asthma educational talk were analyzed. Potential mediators in the structural equation models were tested: parental PF, parental psychological symptoms (anxiety, depression and stress) and parental self-efficacy in childhood asthma management. The results showed that only parental PF at post-intervention mediated the group effect on improving child’s asthma symptoms at six months post-intervention (indirect effect = 0.133, 95% CI [0.048, 0.287], p<.001). This study contributes to the body of evidence regarding the mediating role of parental PF in the management of childhood asthma.

• Psychological Flexibility and Depression in New Mothers of Medically Vulnerable Infants: A Mediational Analysis
Yolanda R. Villarreal, Ph.D., McGovern Medical School at University of Texas Health Science Center Houston
Michelle R. Klawans, MPH, McGovern Medical School at University of Texas Health Science Center Houston
Thomas F. Northrup, Ph.D., McGovern Medical School at University of Texas Health Science Center Houston
Mackenzie L. Spellman, McGovern Medical School at University of Texas Health Science Center Houston
Angela L. Stotts, McGovern Medical School at University of Texas Health Science Center Houston

Maternal postpartum depression is prevalent and associated with negative child outcomes, including behavior problems and cognitive delays. Mothers of children admitted directly after birth to the neonatal intensive care unit (NICU) are at even higher risk for depressive symptoms and infants born premature and/or at low birth weight may be more vulnerable to the adverse effects of maternal depression. Understanding mechanisms, particularly modifiable mechanisms, involved in development/persistence of depressive symptoms is critically important for developing effective treatments. This longitudinal, secondary analysis investigated the role of psychological inflexibility as a mediator of the relationship between early (1-2 weeks postpartum) and later (3 and 6-months postpartum) depressive postpartum symptoms among mothers (N = 360) with an infant in the NICU. Psychological inflexibility measured two weeks after infant discharge fully mediated the relationship between early and later depressive symptoms at 3-months postpartum, with partial mediation at 6-months, while controlling for factors previously found predictive of postpartum depression. Acceptance therapies specifically targeting psychological inflexibility may be promising in reducing depressive symptoms postpartum among new mothers with a NICU infant.

• Parents helping parents of children with Autism Spectrum Disorder through ACT
Kenneth Fung, University of Toronto
Johanna Lake, Centre for Addiction and Mental Health
Lee Steel, Extend-A-Family Toronto
Kelly Bryce, Surrey Place Centre
Yona Lunsky, Centre for Addiction and Mental Health

While there are many interventions targeted to help parents of children with Autism Spectrum Disorder (ASD) apply behavioral principles with their children, there are relatively fewer interventions developed to support parents’ resilience. Psychological acceptance is one of the many challenges parents face, making ACT an ideal intervention. This paper will share some of the experiences, observations, and quantitative data from ACT groups for parents of children with ASD to increase their resilience and coping. In particular, these groups were run by parents of children with ASD themselves, and this aspect will be highlighted in the discussion.

Educational Objectives:
1. Describe the intervention components of a parental training program using group-based ACT combined with asthma education conducted in a Hong Kong setting. 2. Lists ome of the challenges facing parents of children with ASD, and describe how ACT processes can be employed to help increase their resilience. 3. Describe the benefits and pitfalls to having parents of children with ASD lead ACT groups and the potential implications of this for sustainability and dissemination.

 

134. Using technology in creative ways to assess and improve ACT interventions
Symposium (3:10-4:25pm)
Components: Original data
Categories: Educational settings, Prevention and Community-Based Interventions, Clinical Interventions and Interests, Clinical Interventions and Interests, Prevention and Community-Based Interventions, Performance-enhancing interventions, Educational settings, Organizational behavior management, Higher Education, ACT, adults, online, e-mental health, workplace, college/university student mental health
Target Audience: Beg., Interm., Adv.
Location: Exclamation

Chair: Shelley Viskovich, University of Queensland, Australia

This symposium presents results of different studies using technology and Acceptance and Commitment Therapy (ACT)-based interventions. The first paper explores whether or not an ACT values-based approach using Ecological Momentary Intervention (EMI) impacts procrastination in an online educational environment. The second paper presents a co-designed, web-based ACT intervention developed to increase engagement in difficult to reach populations (i.e. farmers). Finally, the third paper discusses results obtained from 4-week web-based ACT intervention to promote mental health in university students. Results showed that the four ACT processes (cognitive fusion, valued living, acceptance and mindfulness) mediated changes on the primary outcomes depression, well-being, self-compassion, and life satisfaction.

• Acceptance and Commitment Therapy: A Values-based Approach to Reduce Procrastination Among Online University Students
Nelly A, Dixon, Ed.D., BCBA, LBA, Kaplan Universtiy
Edward Cumella, Ph.D., Kaplan University
Emily Sandoz, Ph.D., Univeristy of Louisiana, Lafayette

In online higher education environments, students present with diverse personal circumstances. Contextual factors present barriers that decrease students’ abilities to engage in timely coursework. There is limited research on Acceptance and Commitment Therapy (ACT) and procrastination within online educational settings. The present investigation explores whether or not an ACT values-based approach using Ecological Momentary Intervention (EMI) impacts procrastination in an online educational environment. Fifty students enrolled in a 10 semester online masters of psychology program will be randomly assigned to either an experimental or control group. Treatment consists of a short ACT-based presentation and values exploration. After viewing the presentation, participants will write for five minutes to define values and create a list of 10 keywords, which will be integrated into EMI prompts as augmentals. Participants will complete pre, post, and 5-week follow-up questionnaires, the Academic AAQ and Academic Procrastination Scale-Short Form. Outcome data from questionnaires, Discussion Board timeliness, and late assignments will be analyzed using repeated measures MANOVA covering the three time periods, contrasting experimental and control groups to determine if procrastination was reduced.

• Evaluation of an Acceptance and Commitment Therapy (ACT) web-based mental health promotion program for university students
Shelley Viskovich, University of Queensland, Australia
Kenneth I. Pakenham Ph.D., University of Queensland, Australia

This study evaluated a web-based Acceptance and Commitment Therapy (ACT) mental health promotion program called YOLO (You Only Live Once) for university students. YOLO is a 4-week 4-module program encompassing all six ACT processes with no face-to-face contact. A total of 134 participants were randomised to one of three intervention groups investigating varied program delivery methods. Primary outcomes assessed were depression, anxiety, stress, well-being, self-compassion, alcohol and drug use and life satisfaction. ACT processes assessed were acceptance, cognitive fusion, education values, valued living and mindfulness. Improvement on the primary outcomes and ACT processes did not differ among the three intervention groups. Program engagement was similar across groups with 25% completing all four modules. Analyses showed significant improvements on primary outcomes depression, anxiety, stress, well-being, self-compassion and life satisfaction, and ACT processes cognitive fusion, engaged living, and mindfulness. Four ACT processes (cognitive fusion, valued living, acceptance and mindfulness) mediated changes on the primary outcomes depression, well-being, self-compassion, and life satisfaction. These preliminary findings provide support for a web-based ACT mental health promotion program for university students.

Educational Objectives:
1. Describe how a values-based exploration using self-generated augmentals affects procrastination behaviors in online college students. 2.Explain the temporal effect the Ecological Momentary Intervention (EMI) has on the submission of student assignments in online courses. 3. Describe how consumers can be involved in the co-design of ACT-based interventions to increase engagement in difficult to reach populations.

 

135. Mindfulness and self-compassion as key processes in mediating life outcomes
Symposium (3:10-4:25pm)
Components: Conceptual analysis, Literature review, Original data
Categories: Research on the mechanisms of mindfulness, Theoretical and philosophical foundations, Evolution, Clinical Interventions and Interests, Performance-enhancing interventions, Theoretical and philosophical foundations, Child malttreatment, Adults survivors of trauma, Self capacity, Role of mindfulness, Mindfulness, Experiential avoidance
Target Audience: Beg., Interm.
Location: Multiplication

Chair: Éliane Dussault, B.A., University of Quebec in Montreal

This symposium presents results on the mediating role of mindfulness and self-compassion on different important life outcomes. The first paper studies the mediating role of mindfulness on the link between child neglect and relatedness (i.e., interpersonal relationships, idealization/disillusionment and fear of abandonment) in a sample of adults. Results revealed that mindfulness acts as a significant mediator between child neglect and relatedness. The second paper investigates the role of self-compassion in the relationship between meditation practice and overall life satisfaction. Results showed that self-compassion is a significant mediator of meditation practice and life satisfaction. Finally, the third paper studies self-compassion as a mediator of the relationship between psychological inflexibility and psychological resilience. Results revealed that self-compassion acts as a partial mediator in the model.

• Childhood neglect and adult relatedness: The indirect effect of being mindful
Éliane Dussault, B.A., University of Quebec in Montreal
Noémie Bigras, M.A., University of Quebec in Montreal
Natacha Godbout, Ph.D., University of Quebec in Montreal

While child maltreatment is related to negative long-term effects such as poorer health and intimate violence (Dugal et al., 2017), limited research has studied the link between childhood neglect (CN) and adult relatedness (i.e., interpersonal relationships, idealization/disillusionment and fear of abandonment). Trauma-based theory postulates that experiencing CN could affect the survivors' disposition towards mindfulness, which in turn may lead to impairments in adult relatedness (Godbout et al., 2016). More research is however necessary to support this postulate. The current study examined the role of mindfulness as mediator in the relationship between CN and adult relatedness. An online survey evaluating CN, mindfulness and relatedness, was conducted among a community sample of 480 adults. Path analyses revealed that mindfulness acts as a mediator of the link uniting CN and relatedness. More precisely, CN was indirectly associated with relatedness through three specific components of mindfulness: acting with awareness, nonreactivity and nonjudgment, explaining 42% of the variance. These results suggest that mindfulness-based interventions could help adult survivors of CN to form and maintain significant relationships.

• The Mediator Role of Self Compassion in the Relationship Between Psychological Inflexibility and Psychological Resilience
ENGİN BÜYÜKÖKSÜZ, OKAN UNIVERSITY
IŞIL TEKİN, İSTANBUL MEDENİYET UNIVERSITY

From the perspective of ACT, the reason of the pains and psychological problems people have originates from the narrowing of the behaviours occurring as a result of cognitive fusion and experiential avoidance. The aim of this study is to search the mediator role of self compassion in the relationship between experiential avoidance and psychological resilience. Participants of this study are undergraduate students (N=285: 61 males; 224 females).Measuring instruments of this study are acceptance and action questionnaire-II, self-compassion scale, and brief resilience scale. In order to mention the mediator effect of the mediator effect model, some conditions should be provided.The meaningfulness of the results were found via PROCESS, and then with the aim of calculating direct effects and indirect effects, regression based PROCESS was used in accordance with the suggestions. As a result of this study, it is seen that self compassion plays a partial mediatory role between experiential avoidance and psychological resilience.

Educational Objectives:
1. Explain the indirect role of mindfulness in the relationship between childhood neglect and adult relatedness. 2. Discuss theoretical considerations of adapting Buddhist philosophy to Western psychological theory. 3. Describe how the psychological resilience increase the mediator of self compassion.

 

136. Seeing through the eyes of others: How can ACT reduce prejudice and harmful behaviors?
Symposium (3:10-4:25pm)
Components: Conceptual analysis, Literature review, Original Data, Experiential exercises
Categories: Educational settings, Clinical Interventions and Interests, Prevention and Community-Based Interventions, Clinical Interventions and Interests, Organizational behavior management, Spirituality and Religion, Empathy health care workers, Spirituality and Religion, Sexual harassment training
Target Audience: Beg., Interm., Adv.
Location: Arobase

This symposium explores different contexts in which ACT can be helpful to reduce prejudice and harmful behaviors. The first paper presents a current research project investigating the effects of an intervention focused on perspective-taking skills aimed at reducing health care providers’ stereotypes and stigma. The second paper describes the psychospiritual constructs of demonization and desecration in the context of the 2016 U.S. presidential election and summarizes results of a cross-sectional study on the significance of negative spiritual appraisals regarding the 2016 U.S. presidential election on psychological adjustment. The third paper discusses sexual harrassment, critiques the existing sexual harassment trainings and describes how ACT and perspective-taking could be a helpful scientifically grounded alternative to reduce harassment behaviors.

• How can ACT prevent racism and prejudice?
JoAnne Dahl, Ph.D., Uppsala University

There is significant evidence that health care providers hold stereotypes based on race, class sex and other characteristics that, in fact, influence interpretations of behaviours, symptoms as well as clinical decisions and treatment. Health care workers are often unaware of these stereotypes or stigma which they carry. There is also evidence to show that heath care providers interact less effectively with clients from minority groups than with those from similar class, culture and race. So far, most programs for dealing with this problem have been to focus on improving health care providers with cross-cultural communication skills which have had only limited effects on these mostly unaware stigma that result in stereotyped conceptualisation and resulting action. The aim of the research we are presently doing is to investigate the effects of an intervention focused on perspective taking skills based on Relational Frame Theory.

• Demonization, desecration, and the 2016 U.S. presidential election: The role of negative spiritual appraisals on post-election psychological adjustment
Serena Wong, M.A., M.E., Bowling Green State University
Tabitha Waite, M.A., Bowling Green State University
Rachel Wasson, B.A., Bowling Green State University
Augustus Artschwager, B.A., Bowling Green State University
Kenneth I. Pargament, Ph.D., Bowling Green State University
William H. O'Brien, Ph.D., Bowling Green State University

Demonization and desecration are negative spiritual appraisals associated with psychological maladjustment across political and relational contexts (Krumrei, Pargament, & Mahoney, 2011; Mahoney et al., 2002; Pargament et al., 2005). To what extent do people perceive the election of President Trump as the work of evil forces or a violation of the sacred? Using a cross-sectional online sample of 252 Americans, the authors examined the prevalence and role of negative spiritual appraisals of the 2016 U.S. presidential election on psychological adjustment. Approximately one-third of participants endorsed some level of such appraisals. Desecration and demonization also predicted maladjustment above and beyond vote and voter demographics. Moreover, the interactive effect between vote and negative spiritual appraisals accounted for unique variance in maladjustment. At higher levels of demonization and desecration, those who voted for President Trump reported greater difficulties with emotion regulation than those who voted against President Trump. Negative spiritual appraisals also moderated the relationship between vote and thought suppression, antagonism, congeniality, and perceived negative impact of the election. Implications for mental health and psychospiritual interventions are discussed.

Educational Objectives:
1. Create a pro social action based on the perceived needs of the ‘other’. 2. Describe the psychospiritual constructs of demonization and desecration. 3. Describe how ACT could be used to develop a conceptually-sound, empirically-grounded training.

 

Sunday, July 29

143. Heart Rate Variability: A Potential Physiological Marker of Thriving
Symposium (9:00-10:15am)
Components: Original Data
Categories: Psychophysiology, Psychophysiology, Heart Rate Variability
Target Audience: Beg., Interm., Adv.
Location: Rue Sainte-Catherine

Chair: R. Sonia Singh, M.A., Bowling Green State University
Discussant: Jennifer McGrath, Ph.D., MPH, Concordia University

Mindfulness is defined as non-judgmental, focused present moment awareness (Kabat-Zinn, 1990) and is an important correlate of psychological flexibility. Additionally, mindfulness-based interventions are designed to promote outcomes that are closely aligned with psychological flexibility and related constructs. The Neurovisceral Integration Model posits that heart rate variability (HRV) is one index of neural structures that are critically important for the regulation and integration of cognitive, emotional, physiological, and behavioral responses (Thayer and Lane, 2000). These neural structures are collectively referred to as the central autonomic network. Multiple lines of research have demonstrated that processes in central autonomic network are associated with the capacity to flexibly respond to stressors and emotional experiences. Further, the central autonomic network has been associated with the capacity to generate flexible responses to address environmental demands. Given that both the central autonomic network and mindfulness are associated with psychological flexibility and related constructs, it stands to reason that they should also be significantly associated with each other. The current symposium synthesizes several research studies examining this association.

• The Role of Mindfulness in Cardiovascular Reactivity and Recovery from Laboratory-Induced Pain
Mariya Zaturenskaya, M.A., University of Texas Health Science Center at San Antonio/STRONG STAR Multidisciplinary PTSD Research Consortium – Fort Hood Site
William H. O'Brien, Bowling Green State University

Despite a growing number of mindfulness-based intervention studies, the mechanism through which mindfulness relates to positive health outcomes is poorly understood. Using Heart Rate Variability (HRV) as an index of autonomic function may be helpful in elucidating the relationship between mindfulness and positive outcomes. The current study examined the relationship between mindfulness (Five Facet Mindfulness Questionnaire; Baer at al, 2006) and HRV reactivity and recovery from a physiological stressor. HRV data of healthy university students (N = 49) were collected during three phases: a baseline period, a cold pressor task, and a recovery period. Differences in pain tolerance, distress, and heart rate variability between the high and low mindfulness groups were assessed across the three phases of the experiment. Participants were found to be reactive to the stressor, which supports the validity of our pain/stress induction. Individuals higher in mindfulness had better HRV recovery from the stressor, suggesting the high mindfulness group responded to, or recovered from, the stressor more adaptively.

• Greater Mindfulness Predicts Autonomic Recovery from Stressors Inducing both Parasympathetic activation and Withdrawal
Tanya Watford, M.S., Bowling Green State University
William H. O'Brien, Bowling Green State University

Both mindfulness and stress have garnered attention given their impact on autonomic functioning (Garland, 2011). However, the role of mindfulness in targeting the physiological mechanisms of stress is not well understood. The present study examined mindfulness (Mindful Attention Awareness Scale (MAAS); Brown & Ryan, 2003) of healthy participants (n = 57; mean age = 20; 61% Female; 75% Caucasian) before recording their high-frequency heart rate variability (HF-HRVn.u.) in response to two counterbalanced 3-minute stress inductions (i.e., math task and surgical video). The high mindfulness group (HM) demonstrated greater baseline HF-HRV compared to the low mindfulness group (LM), t(54) = -3.77, p < .001. All participants demonstrated expected HF-HRV increases during the math task and decreases during the video. However, only HM demonstrated significant autonomic recovery from both stressors, F(1,53) = 7.15, p = .01. Thus, mindfulness predicts recovery from stressful experiences that provoke both parasympathetic activation and withdrawal.

• Difficulties in Emotion Regulation Mediate the Relation Between Mindfulness and Heart Rate Variability
Alex H. Buhk, B.A., University of Toledo
Julia Richmond, M.A., University of Toledo
Jason C. Levine, Ph.D., University of Toledo
Matthew T. Tull, Ph.D., University of Toledo
Kim L. Gratz, Ph.D., University of Toledo

Despite the effectiveness of mindfulness-based interventions (MBIs) for psychological disorders, the underlying psychological and neurobiological mechanisms are unclear (Guendelman et al., 2017). Although research has found a negative relationship between mindfulness training and heart rate variability (HRV; Krygier et al., 2013) - a central modulator of emotion and self regulation (Appelhans & Luecken, 2006), research on explanatory psychological processes is needed. Given mindfulness is centered on focusing one’s attention using “non-elaborative, non-judgmental awareness” of present-moment experience (Kabat-Zinn, 2005), Gratz and colleagues’ (2010) model of emotion regulation which emphasizes “awareness, understanding, and acceptance” may explain the relationship between mindfulness and HRV. Participants completed the difficulties in emotion regulation scale (DERS; Gratz & Roemer, 2004) and mindfulness scale (MAAS; Brown & Ryan, 2003). HRV was measured over three hours. The current study employed mediation analysis (Preacher & Hayes, 2008). The results revealed an indirect effect suggesting that effects of mindfulness on HRV are mediated by DERS. This presentation will discuss the findings in the context of contemporary emotion regulation theory and purported acceptance and MBI processes.

Educational Objectives:
1. Describe the role and significance of mindfulness in recovering effectively from stress that results in both arousal and withdrawal. 2. Demonstrate the usefulness of heart rate variability as a measure of both stress reactivity and the effect of mindfulness on recovery, providing a physiological index of thriving. 3. Discuss the findings in the context of contemporary emotion regulation theory and purported acceptance and MBI processes.

 

145. Brief ACT Matrix Interventions for Medical Inpatients: Addressing Suffering and Promoting Workability
Symposium (9:00-10:15am)
Components: Conceptual analysis, Literature review, Original Data, Didactic presentation, Case presentation
Categories: Behavioral medicine, Clinical Interventions and Interests, Pain, opioid use, multi-problem patients, consult-liason psychiatry
Target Audience: Interm.
Location: Rue Crescent

Chair: Aliza Weinrib, Ph.D., Toronto General Hospital, University Health Network
Discussant: Benjamin Schoendorff, Contextual Psychology Institute & Institut Universitaire en Santé Mentale de Montréal

The ACT matrix – a visual diagram that can be used to succinctly communicate the ACT model – is a natural fit for brief interventions aimed at medical patients. This symposium will highlight the application of the ACT matrix in three independent hospital-based initiatives. First, a one-day ACT matrix workshop has been developed and tested for patients before major orthopedic surgery. Secondly, a brief one-on-one psychotherapy protocol utilizing the matrix has been applied after major surgery to support patients coping with complex post-surgical neuropathic pain, which often becomes chronic. We will share data regarding the efficacy of these ACT interventions in reducing opioid use after surgery. The third initiative presented is an ACT approach to consult-liaison psychiatry, which integrates the matrix into the behavioral assessment and brief treatment of acutely ill medical patients presenting with comorbid psychiatric disorders that can hamper medical treatment. This symposium includes both theoretical and data-driven components, along with clinical insights regarding applying the matrix in the medical setting in order to reduce suffering and promote workability.

• ACT for Prevention of Persistent Post-surgical Pain and Opioid Use in At-Risk Veteran Patients
Lilian Dindo, Ph.D., Baylor College of Medicine
Barbara Rakel, University of Iowa

High levels of pain, significant anxiety, and/or depressive symptoms prior to surgery put patients at elevated risk for persistent pain and prolonged opioid use following surgery. We examined the preliminary effects of a 1-day ACT workshop in “at-risk” patients for the prevention of prolonged pain and opioid use following orthopedic surgery. In a small randomized controlled trial, 60 at-risk Veterans undergoing orthopedic surgery completed a 1-day ACT workshop (N = 31) or Treatment as Usual (TAU; N =30). Pain levels and opioid use were assessed up to 3 months following surgery. Participants in the ACT condition reported greater reductions in average pain than the TAU group. Additionally, 23% of ACT group were still taking opioids at 7 weeks post-op vs. 45% of TAU group. These promising results merit further investigation. Providing an intervention prior to surgery for at-risk veterans has the potential to change clinical practice from a focus on management of postoperative pain to prevention of chronic pain in at-risk individuals.

• ACT for Complex Post-Surgical Pain: Theory, Application, and Clinical Outcome Data
Aliza Weinrib, Ph.D., Toronto General Hospital, University Health Network
Kathryn Birnie, Hospital for Sick Children & Toronto Western Hospital, University Health Network

Patients who undergo major surgeries (e.g., organ transplantation, removal of tumors) are often overwhelmed by pain and distress in the aftermath of the life-saving procedure. They are at risk of persistent neuropathic pain, long-term dysregulation of mood and functioning, and chronic high-dose opioid use. The world-first Transitional Pain Service (TPS) cares for patients experiencing persistent, neuropathic post-surgical pain who are no longer eligible for the hospital-based acute pain service, and are not yet appropriate for an outpatient chronic pain clinic. The TPS includes a behavioral component that is grounded in the ACT model and utilizes the matrix. Based on 4 years of clinical experience with this population, hexaflex models of psychological flexibility and psychological inflexibility after surgery have been formulated. These models take the ACT processes that we are familiar with in the domain of chronic pain, and explicate their applicability in the more novel domains of acute pain treatment. Clinical outcome data will be presented, showing improved outcomes in terms of post-surgical opioid tapering, depressed mood, and functioning for patients who received ACT.

• ACTIVE Consult-Liaison Psychiatry: A novel application of the ACT Matrix for assessment and intervention in acute medical settings
M. Brandon Goodman, M.D., University of North Carolina School of Medicine, Department of Psychiatry
Jonthan S. Gerkin, MD, University of North Carolina School of Medicine, Department of Psychiatry

Patients with serious mental illness -- including bipolar affective disorder, depressive disorders, and psychosis -- make up a significant portion of the American health care system. These patients are often referred to consult-liaison (CL) psychiatry, with the goal of removing behavioral obstacles to effective medical treatment. In order to address the needs of these patients in tertiary care, we have developed Acceptance and Commitment Therapy Integration for Value Elucidation (ACTIVE) - an ACT approach to CL assessment and treatment. ACTIVE fosters patient-centered, value-based and workable committed action by both the patient and their medical team. Using the ACT matrix, the consult-liaison psychiatrist works with the patient and medical team to identify medically-ineffective behaviors, as well as core values and shared behavioral goals for the patient’s hospitalization. Values serve as an anchor for developing goals that allow for pursuit of a rich, meaningful life and optimal medical care, including behavioral/psychiatric care. The resulting intervention aims to support the values of the patient, the primary medical team, the psychiatrist, and the broader health care system.

Educational Objectives:
1. Describe key elements of the ACT matrix as applied with medical patients. 2. Describe key ACT processes to target in medical patients using the ACT matrix, so that psychological flexibility and workable behaviors are increased. 3. List effects of ACT matrix interventions on opioid use in post-surgical populations.

 

146. Changes in Values as a Process of Posttraumatic Growth after Violent Trauma
Symposium (9:00-10:15am)
Components: Conceptual analysis, Literature review, Original Data
Categories: Clinical Interventions and Interests, Performance-enhancing interventions, Posttraumatic Growth
Target Audience: Interm.
Location: Rue Mansfield

Chair: Thea Comeau, Ph.D. candidate, McGill University
Discussant: Marilyn Fitzpatrick, Ph.D., McGill University

Values change is considered one of three ways in which Posttraumatic Growth (PTG) manifests after violent trauma (Tedeschi & Calhoun, 2004). In spite of its central role in models of PTG, there is a dearth of research exploring these positive values changes after trauma, as well as factors which may contribute to this specific form of growth. The current panel will present three papers. The first of these will review the research and provide a conceptual and empirical framework for the role of values in understanding PTG. The two subsequent papers will report on findings of an Interpretative Phenomenological Analysis of interviews with 12 survivors of the Troubles conflict in Northern Ireland. The second paper will review the intersection of values and spirituality in those individuals who report having experienced positive changes in their values following religious violence. The third paper will report on the role self-compassion plays in the experience of positive changes in values following injury or traumatic bereavement. Clinical implications of the findings will be discussed.

• Values Provide a New Lens for Examining Posttraumatic Growth
Thea Comeau, Ph.D. candidate, McGill University
Jiwon Lee, McGill University
Emma Cox, McGill University
Marilyn Fitzpatrick, McGill University

Posttraumatic growth manifests in three ways: changes in self, relationships, and in values (Tedeschi & Calhoun, 2004). Though growth after trauma has been frequently reported, methodological and conceptual concerns limit the utility of this concept (Coyne & Tennan, 2010; Jayawickreme & Blackie, 2016). Positive changes in values are an under explored component of growth after violent trauma (Comeau et al., in preparation). Following exposure to violence, individuals are more likely to participate in philanthropic and altruistic behaviors (Vazquez, Perez-Sales, & Hervas, 2008), which may indicate shifts in values and values congruent behavior. This paper will summarize the literature on positive values change after trauma, including the experience and process of these changes. It will demonstrate the potential role values change can play in both facilitating and tracking posttraumatic growth. It will also highlight ways in which the exploration of values change after trauma can strengthen our understanding of posttraumatic growth. Finally, this paper will suggest tools to assess values, both clinically and for research, to enable the identification of this specific type of posttraumatic growth.

• Spirituality and Positive Changes in Values in Northern Ireland Conflict Survivors
Emma Cox, McGill University
Jiwon Lee, McGill University
Thea Comeau, McGill University
Marilyn Fitzpatrick, McGill University

Both spirituality and values have been identified as essential components of posttraumatic growth (Calhoun & Tedeschi, 2013). Research has not explored the intersection of these two components. This paper reports the findings of an Interpretative Phenomenological Analysis, which investigated the experience of positive changes in values following victimization through religious violence in Northern Ireland. Participants who had experienced traumatic bereavement or injury engaged in one 1-3 hour semi-structured interview. Out of the 12 participants in the original study, 7 identified spirituality as an essential component in their growth. Findings of a sub-analysis of these 7 participants yielded five themes: after trauma, faith and spirituality provided comfort and healing; spirituality guides the clarification and enactment of values; spirituality strengthened the connection between the living and their deceased loved ones; trauma deepens spirituality, resulting in positive change; and faith in divine healing provided more healing than reliance on earthly justice. This research suggests that even in the context of religious violence, people can still thrive through refining and reflecting on their own spiritual beliefs and personal values.

• Self-Compassion in Survivors of Trauma with Positive Changes in Values
Jiwon Lee, McGill University
Emma Cox, McGill University
Thea Comeau, McGill University
Marilyn Fitzpatrick, McGill University

Research has shown that lower levels of self-compassion are associated with a higher degree of suffering post-trauma, and increases in self-compassion may mitigate some post-trauma symptoms (Bistricky et al., 2017). Further, cognitive processes associated with self-compassion may contribute to posttraumatic growth (Wong & Yeung, 2017). To date, however, the relationship between self-compassion and the values change associated with posttraumatic growth have not been analyzed. This study explored how the three components of self-compassion – self-kindness, mindfulness, recognition of common humanity – play a role for people who have experienced a positive change in values following violence. Interviews were conducted with 12 survivors of the Troubles conflict in Northern Ireland and were analyzed by using Interpretative Phenomenological Analysis. Results suggested that while different participants displayed different components of self-compassion, only the participants displaying self-kindness continued to demonstrate all of the other components of self-compassion. Therefore, self-kindness may act as a central component of self-compassion for individuals who have experienced positive changes in values after surviving violent trauma. Implications for research and theory will be discussed.

Educational Objectives:
1. Apply ACT conceptualizations of values to post traumatic growth theory in new ways. 2. Critique previous conceptualizations of post traumatic growth which do not adequately consider the role of values. 3. Design new values based interventions to use with clients struggling with traumatic experiences to facilitate posttraumatic growth.

 

147. When positive emotions function in unexpected ways: A transdiagnostic treatment consideration
Symposium (9:00-10:15am)
Components: Conceptual analysis, Literature review, Original Data, Didactic presentation
Categories: Clinical Interventions and Interests, Theoretical and philosophical foundations, Positive emotions, posttraumatic stress disorder, substance use disorders, borderline personality disorder
Target Audience: Beg., Interm.
Location: Rue Saint-Paul

Chair: Lia S. Bishop, M.A., Clark University, Worcester, MA, USA
Discussant: Kathleen M. Palm Reed, Clark University, Worcester, MA, USA

When positive emotions are considered within the context of clinical psychology, they are often viewed as putatively adaptive - serving as “buffers” against negative emotions. However, from a contextual behavioral framework the inflexible avoidance of, or attachment to any emotion regardless of valence could be related to decrements in mental health and well-being. The current symposium will provide theoretical and empirical presentations, informed by contextual behavioral science, that illustrate the importance of identifying both positive and negative emotions as transdiagnostic treatment considerations, and emphasize the clinical and empirical utility of doing so. Lia Bishop will begin the symposium with a literature review that compares and contrasts the function of positive emotions within both a mainstream psychology and a contextual behavioral perspective. Next, using longitudinal data, Dr. Hollie Granato will examine the relationships between experienced joy, emotion regulation, and risk behaviors in a treatment-seeking population of clients. Finally, Dr. Jessica Armstrong will present qualitative findings on the role of positive emotions in drug and alcohol relapse among individuals seeking inpatient treatment for substance use disorders.

• State of the Research: Positive Emotions
Lia S. Bishop, M.A., Clark University, Worcester, MA, USA
Kathleen M. Palm Reed, Clark University, Worcester, MA, USA

Among western civilizations, the ideal of living free from physical or mental distress has led to the pursuit of ever-increasing happiness and comfort. In clinical psychology, this has been reified through clinical interventions that attempt to increase positive and decrease negative emotions. Yet increasing evidence suggests that positive emotions like joy, love, and happiness may not be putatively pleasurable, and may instead elicit responses of fear and/or avoidance for some individuals. A contextual behavioral science model suggests that rigid responses to any type of emotion (positive, negative, or neutral) could lead to poorer mental health. However, extant research has predominantly focused on negative emotions when validating this theory. This symposium will aggregate research on positive emotions and (1) identify how researchers have operationalized “positive emotions,” (2) contrast the function of positive emotions across mainstream psychology and contextual behavioral science, and (3) provide a clinical example of this construct by exploring fear of positive emotions among individuals with posttraumatic stress disorder (PTSD). Clinical utility, empirical import, and areas of future research will be discussed.

• Positive Emotions and Emotion Dysregulation: The Relationship between Positive Emotions and Urges to Use Substances among High-Risk Individual Diagnosed with Borderline Personality Disorder
Hollie F. Granato, Ph.D., Harbor – UCLA Medical Center, CA, USA

To date, most studies have focused on negative affect when evaluating emotion dysregulation among individuals diagnosed with Borderline Personality Disorder (BPD), and found that negative emotions increase risk for impulsive behavior (Linehan et al., 2015). However, research on substance use suggests that a link may also exist between positive affect and risk for impulsive behavior (Smith & Cyders, 2016). To explore the relationship between positive affect and emotion dysregulation among individuals diagnosed with BPD, this presentation will examine a path analysis model of emotion dysregulation's impact on the relationship between joy and substance use urges over the course of DBT treatment. This study will include approximately 50 clients who meet criteria for BPD and are enrolled in standard DBT in an outpatient community mental health clinic. Preliminary analyses suggest that joy mediates the relationship between emotion dysregulation and substance use urges longitudinally. Data will be evaluated at two time points, and a strength of this study is the use of longitudinal statistical modeling. Additional findings, clinical implications, and limitations will be discussed.

• Seeking Relief from Emotional Pleasure: Using Thematic Analysis to Explore the Role of Positive Emotions in Self-Reported Reasons for Relapsing to Drugs and Alcohol in Individuals with Substance Use Disorders
Jessica L. Armstrong, Ph.D., Veterans’ Administration – Connecticut Healthcare System, CT, USA

Substance use disorders (SUDs) are chronic, relapsing conditions (McLellan, 2002). Evidence supports the role of negative emotions in predicting substance use and relapse (Sinha, 2007). From a contextual behavioral framework, strong attachment to – or aversion of – any emotion should elicit similar behavioral responses. Yet there is limited research examining the role of positive emotions in self-reported reasons for relapsing to drugs/alcohol. The current study used qualitative methods to examine the role of positive emotions in relapse behaviors among individuals receiving inpatient SUD treatment. A total of 30 participants were interviewed for the purposes of this study, and approximately one third (n = 9) described positive emotions as contributing to their relapse experiences. Thematic analyses revealed two primary themes across these interviews, including (1) beliefs that positive emotions were not “deserved” and (2) desires to escape or avoid feeling good or “doing well” in recovery. Thus, substance use ultimately functioned to “relieve” participants of the discomfort associated with feeling good. Finding nuances, clinical implications, and study limitations will be discussed.

Educational Objectives:
1. List and operationalize “positive emotions” within a contextual behavioral framework, and clarify the clinical utility of this construct. 2. Discuss how positive emotions manifest across a range diagnoses in both intuitive and counter-intuitive ways. 3. Examine how strong avoidance of, or attachment to, positive emotions impacts treatment engagement and outcome among individuals with trauma histories, personality disorders, and substance use disorders.

 

149. Integrating ACT with other models
Symposium (9:00-10:15am)
Components: Conceptual analysis, Literature review, Original Data, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Theoretical and philosophical foundations, Functional contextual approaches in related disciplines, Social Anxiety Disorder, FAP, FACT, Sex Therapy, Depression, Parenting
Target Audience: Beg., Interm., Adv.
Location: Exclamation

Chair: Kate Morrissey Stahl, LCSW, Ph.D., CST, University of Georgia

This symposium explores the integration of Acceptance and Commitment Therapy (ACT) with familiar clinical frameworks. The first paper explores the integration of the Emotionally Focused Therapy with ACT for sex therapy. The second paper presents the development and preliminary results of a Mindfulness, ACT intervention for patients with depression in a group therapy setting.

• Acceptance and Commitment Therapy and Emotionally Focused Therapy: Integrating the Approaches for Sex Therapy
Kate Morrissey Stahl, LCSW, Ph.D., CST, University of Georgia

This paper explores how a systemic approach to therapy, Emotionally Focused Therapy (EFT), could be integrated with a behavior analytic functional contextual approach, Acceptance and Commitment Therapy (ACT), which has a strong evidence base for use with individuals, for sex therapy. This integrated approach could be used with couples in a way that is likely to be more efficacious than ACT alone, and possibly with individuals in a way that is more efficacious than EFT alone. The benefits of integration will be discussed as well as details about how the styles of therapy complement each other, implications for sex therapy practice with couples, and a case example.

• Mindfulness, Acceptance and Commitment combined in Cognitive Behavioral Group Therapy for patients with depression – First results of an ongoing study
Nina Schulze, Dipl. Psych., Neuropsychiatric Center Hamburg
Moritz, Steffen, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany
Silja C. Reuter, Neuropsychiatric Center Hamburg
Yvonne Nestoriuc, Department of Psychosomatik Medicine and Psychotherapy, University Medical Center Hamburg, Martinistr. 52, 20246 Hamburg, German
Peter Tonn, MD, Neuropsychiatric Center Hamburg

Background: CBT is constantly being developed further. Most recently, mindfulness-based and acceptance-based methods have been integrated. Practicing mindfulness improves self-awareness and self-care. The ability to accept unpleasant situations and emotions reduces suffering and emotional pain. Methods: Randomized controlled trial (RCT). The MAC group receives an intervention of eight sessions of group therapy, in which the aspects of Mindfulness, Acceptance and Commitment are taught. The control group will receive a training of progressive muscle relaxation. Measurement at several time points, pre-post analysis, mediation analysis, complementary measurement of negative therapy effects, session evaluations, follow-ups. Discussion: Due to a structural reform in the german health care system, it has become a lot easier for therapists to offer group therapy. Therefore the goal of our study was not only to create and evaluate a new group treatment, but also to develop a therapy manual in which the treatment is described in detail and which we can give to other therapists to spread the use of ACT based interventions in Germany.

Educational Objectives:
1. Discuss how to adapt FAP and ACT with molar perspective for treatment of Social Anxiety. 2. Apply ACT approach in a sex therapy context with couples.

 

151. How Do We ACT in Asia? - The Contextualization of ACT in Eastern Asian Culture: Asian Culture and CBS SIG Sponsored
Symposium (9:00-10:15am)
Components: Conceptual analysis, Literature review, Original Data, Didactic presentation, Case presentation
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, ACT in China, Hong Kong, South Korea
Target Audience: Beg., Interm.
Location: Arobase

Chair: Yan Li, Duke University
Discussant: Zhuohong Zhu, Chinese Academy of Sciences

CBS, by definition, should put a huge emphasis on understanding different contexts. There are 1.6 billion people, about 22% of the world’s population, living in East Asia. Their cultural contexts are underrepresented in CBS literature. The purpose of this symposium is to present how CBS research is done in East Asian cultures. We bring together scholars from China, Hong Kong and South Korea. In this symposium, we will discuss: a)The effects of a group-based ACT intervention for improving parental management of childhood asthma in Hong Kong. The researchers recruited 168 participants in their Randomized Controlled Trial (RCT), and the results are positive. We will also present how ACT was used with this population. b) The validation of the Chinese Psychological Flexibility Inventory and its application with over 30,000 public sector employees. This study paves the way for future empirical ACT studies in China. (c) A systematic review of ACT treatment research in South Korea. This review will identify novel and distinct findings in applying ACT among Korean participants.

• Using group-based Acceptance and Commitment Therapy for improving parental management of childhood asthma: Effects on parent and child outcomes
Yuen-yu Chong, The Hong Kong Polytechnic University
Yim-wah MAK, The Hong Kong Polytechnic University
Alice Yuen LOKE, The Hong Kong Polytechnic University

Fostering psychological flexibility of parents of children with asthma through Acceptance and Commitment Therapy (ACT) may help them to accept psychological difficulties, leading to eventual improvements of their psychological well-being, as well as their children’s health outcomes. A randomized controlled trial was conducted to examine the efficacy of a parental training program using group-based ACT combined with asthma education (ACT), in comparison with an asthma educational talk (Control), on the utilization of acute healthcare services due to asthma exacerbations in children. One hundred and sixty-eight parents of children aged 3-12 years with asthma were consecutively recruited. Generalized estimating equations analyses showed that when compared with the children in the Control group, children whose their parents in the ACT group had significantly fewer ED visits due to asthma exacerbations over a 6-month period. The parents who received the ACT training became more psychologically flexible; had less negative emotional experiences such as guilt and worry sorrow and anger, and attained a better quality of life.

• The Structural Validity of the Chinese Version of Psychological Flexibility Inventory and Its Use in Different Professional Groups
Shujuan Wang, Chinese Academy of Sciences
Zhuohong Zhu, Chinese Academy of Sciences
Min Lu, Chinese Academy of Sciences

The development of Chinese version of Psychological Flexibility Inventory (PFI) is discussed in this article. Psychological flexibility is the core concept within the Acceptance and Commitment Therapy(ACT). Extant comprehensive ACT process measures include the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (CompACT) and the Multidimensional Psychological Flexibility Inventory (MPFI). Based on the current work, we developed a Chinese version of comprehensive measure of ACT processes (PFI) and explored the measure’s factorial structure, validity and reliability in order to provide a psychometrically sound instrument in China. Psychological flexibility has been found to mediate important therapeutic outcomes. In order to provide evidence that psychological flexibility can serve as a functional diagnostic dimension, the study is then to further explore the effect of psychological flexibility on indicators of psychological status with job stress in different work environment. Now we have gathered more than 30,000 of investigation data in Chinese police officers, government employees and bank workers. Results of the investigation will be reported and some interesting results will be discussed in the article.

• A systematic review of ACT treatment research in South Korea
Woolee An, Utah State University
Eric Lee, Utah State University
Michael P. Twohig, Utah State University
Michael E. Levin, Utah State University

In the past decade, numerous studies using Acceptance and Commitment Therapy (ACT) have been published in South Korea. However, most of these studies were published in Korean and unknown to the broader ACBS community. In order to promote cross-cultural communication, this talk aims to systematically review ACT treatment research in South Korea. Electronic databases relevant to psychology in South Korea were searched for articles specifying the use of ‘수용전념치료’ and ‘acceptance and commitment therapy’ up to December 2017. Seventy-three relevant abstracts were yielded and analyzed. Fifty studies were identified as clinical trials, 30 of which were randomized control trials. Anxiety was the most frequently studies problem area. The majority of studies found positive results for effects of ACT on psychological, physiological, and life-style change outcomes. Common limitations within the research literature included small sample sizes, use of disparate multiple outcomes, and inadequate validation of questionnaires with Korean populations. This review identifies novel and distinct findings in applying ACT among Korean participant.

Educational Objectives:
1. Apply ACT in the parental management of childhood asthma with people from Hong Kong. 2. Describe the validation of Chinese Psychological Flexibility Inventory and its application. 3. Explain how to use ACT with people from South Korea.

 

157. ACT and CBS as solutions to problematic eating behaviors
Symposium (10:35am-12:05pm)
Components: Conceptual analysis, Literature review, Original data
Categories: Clinical Interventions and Interests, Behavioral Clinical Interventions and Interests, Behavioral medicine, Theoretical and philosophical foundations, Functional contextual approaches in related disciplines, Health, Obesity, Weight, Weight loss, Veterans, Measurement, Weight management, Problematic Health Behavior
Target Audience: Beg., Interm., Adv.
Location: Rue Crescent

Chair: Anne I. Roche, MA, University of Iowa

The symposium presents a diversity of approaches or studies addressing Acceptance and Commitment Therapy and Contextual Behaviorial Science as solutions to problematic eating behaviors. The first paper in the symposium describes the opportunity for developing new interventions based on integration of ACT, Molar Behaviorism and Wearable Technologies in order to create more lasting results in a rehabilitation program. The second paper presents a study that compared the psychometric properties of different questionnaires assessing experiential avoidance in obese and overweight veterans. The third paper presents a study examining the relationship between binge eating and depressive symptoms and the interactive effects of the latter and experiential avoidance. Findings suggest, among others, that depressive symptoms and experiential avoidance are independent risk factors for binge eating in individuals seeking weight loss treatment. The fourth and last paper of the symposium focuses on two studies that allow to gain a greater understanding of functional processes, such as avoidance and mindfulness, involved in the development and maintenance of problematic health behavior.

• ACTonFOOD: Address Obesity and Overweight Through an Extended Contextual Behavioral Approach
Giorgia Varallo, M.A., IRCCS Istituto Auxologico Italiano, Verbania, Italy - Catholic University of the Sacred Heart, Milan
Rob Cattivelli, Psy.D., Ph.D., IRCCS Istituto Auxologico Italiano, Verbania, Italy - Catholic University of the Sacred Heart, Milan
Anna Guerrini, Clinical Psychology Lab, San Giuseppe Hospital IRCCS Istituto Auxologico Italiano, Verbania, Italy
Nicola Maffini, MA, Private Practice
Francesco Vailati Riboni, Catholic University of the Sacred Heart, Milan
Alessandro Musetti, University of Parma, Italy
Chiara Spatola, IRCCS Istituto Auxologico Italiano, Verbania, Italy - Catholic University of the Sacred Heart, Milan
Emanuele Giusti, IRCCS Istituto Auxologico Italiano, Verbania, Italy - Catholic University of the Sacred Heart, Milan

Obesity and weight problems are growing steadily and becoming a global epidemic. Recent research reports 64% of the adult population as overweight. The social and economic impact is increasing and most of the rehabilitation programs, while effective in the short-term, do not produce long lasting results. From an extended behavioral perspective, integrating contextual behavioral science and multiscale approach, healthy habits are difficult to establish, due to a problematic balance between impulsive, ephemeral choice and global, long-term gains. To foster long-term, value-based decisions, individualized tech friendly feedbacks represents a new opportunity to set flexible and individual goals. The aim of this work is to combine Acceptance and Commitment Therapy, Molar Activities Analysis, and Wearable Technology to develop efficient and sustainable interventions, effective also at the end of structured rehabilitation programs, providing adequate contingencies of reinforcement and, integrating systematic measurements, continuous feedbacks and individualized, values-based objectives. We offer a comprehensive overview, from a conceptual to empirical viewpoint presenting novel, promising data in the obese population.

• Psychometric Properties of the Acceptance and Action Questionnaire for Weight-Related Difficulties (AAQW) in Overweight and Obese Veterans
Cara Dochat, B.A., San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology
Jessica Gundy Cuneo, Ph.D., Department of Psychiatry, University of California, San Diego
Kathryn M. Godfrey, Ph.D., Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University
Niloofar Afari, Ph.D., VA San Diego Healthcare System; VA Center of Excellence for Stress and Mental Health

Experiential avoidance (EA) contributes to psychopathology maintenance and poor health outcomes. The Acceptance and Action Questionnaire (AAQ) was developed to measure EA process change, however, condition-specific measures are needed to effectively assess EA in various populations. We compared the psychometric properties of the AAQ-II with those of the AAQ for Weight-Related Difficulties (AAQW) and its revised version (AAQW-R) in overweight and obese Veterans who recently completed a behavioral weight loss treatment (N=89). Overall, the AAQW-R showed adequate reliability and validity, and appears to measure weight-specific, rather than general EA. Only the AAQW-R, not the AAQW, was significantly correlated with BMI and showed stronger relationships with measures of related constructs. Exploratory factor analysis of AAQW-R items identified three factors which largely comport with the AAQW-R subscales. However, discrepancies highlight possible differences in the latent construct for this sample of mostly male Veterans. Administering these measures in larger samples to assess sensitivity to change and test-retest reliability is necessary to confirm the measure’s utility for assessing weight-related EA.

• Depressive symptoms and binge eating in individuals seeking behavioral weight loss treatment: the moderating role of experiential avoidance
Kathryn M. Godfrey, Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
Meghan Butryn, Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA.
Evan Forman, Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA.
Nancy E. Sherwood, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.

Depressive symptoms (DS) and binge eating (BE) are prevalent in weight management populations and limit treatment success. DS may trigger BE, and BE-related distress could increase DS. Elucidating the psychological processes, such as experiential avoidance (EA), within this relationship could inform theory and clinical practice. This study examined the relationship between DS and BE and hypothesized a moderating role of EA. Participants (N = 468, 76% female) initiating weight loss treatment completed self-report questionnaires of BE, DS, and EA. In regression models, DS (B = 0.72, p < 0.001) and EA (B = 0.22, p < 0.001) were significantly associated with BE. There was a significant DS by EA interaction (B = -0.03, p = 0.002), such that EA had a stronger association with BE in individuals with lower DS. Findings highlight that DS and EA are independent risk factors for BE and that individuals with lower DS are vulnerable to BE at higher levels of EA. EA is a mechanism to consider targeting for tailoring and enhancing efficacy of weight loss treatment.

• Problematic health behaviors: Experiential avoidance as a common function
Anne I. Roche, MA, University of Iowa
Emily B. Kroska, MA, University of Iowa

Although different problematic health behaviors are formally distinct, they may serve a common avoidant function. This presentation will focus on 2 studies: 1) an observational study examining the association between childhood trauma and problem behaviors in adulthood, and 2) two meta-analyses examining the efficacy of acceptance- and mindfulness-based interventions vs. controls for smoking cessation (N =11) and weight loss (N = 25). Study 1: Mediation analyses indicated that experiential avoidance significantly mediated the association between childhood trauma and problem behavior among college students (PM = .43). Multiple mediation analyses indicated that two mindfulness facets significantly mediated the same association. Study 2: Results indicated small but significant effect sizes favoring acceptance- and mindfulness-based interventions over controls for smoking cessation (OR = 1.562, p < .001) and weight loss (g = .301, p < .001). When converted to a common metric, effect sizes were comparable (smoking: d = .246; weight loss: d = .305). These findings provide insight into the potential effectiveness of targeting functional processes such as avoidance and mindfulness in health behavior change efforts.

Educational Objectives:
1. Describe the opportunity for developing new interventions based on integration of ACT, Molar Behaviorism and wereable technologies. 2. Discuss issues in measuring process change of acceptance-based constructs. 3. Discuss depressive symptoms and experiential avoidance as risk factors for binge eating in individuals seeking weight loss treatment.

 

159. Using Acceptance and Commitment Therapy to Help Parents Thrive in the Context of Child Struggles
Symposium (10:35am-12:05pm)
Components: Original Data, Experiential exercises, Case presentation
Categories: Clinical Interventions and Interests, Parenting, autism, anxiety, pilot study, feasibility study, group treatment
Target Audience: Interm.
Location: Rue Saint-Paul

Chair: Phoebe S. Moore, Ph.D., University of Massachusetts
Discussant: Lisa W. Coyne, Ph.D., McLean Hospital / Harvard Medical School

In this symposium, we will discuss the challenges for parents caring for children with significant struggles, such as anxiety disorders, OCD, and autism, and we focus on the promise of Acceptance and Commitment Therapy for helping parents and families thrive in this context. We will review three separate pilot studies of an ACT parenting protocol and discuss data on acceptability and feasibility of the parent treatment protocol as well as treatment outcomes. Guided by the findings of these feasibility trials, we recommend future directions for research and clinical adaptation of our ACT for Parents therapy model.

• Acceptance and Commitment Therapy for Parents of Anxious Children: Pilot Open Trial
Ashley Hart, Ph.D., University of Massachusetts
Jacqueline Raftery-Helmer, Ph.D., Worcester State University
Madeline Levitt, M.A., Clark University
Lisa W. Coyne, Ph.D., McLean Hospital / Harvard Medical School
Phoebe S. Moore, Ph.D., University of Massachusetts

We will present data from a pilot study of Acceptance and Commitment Therapy for Parents of Anxious Children (ACT-PAC), a six-week group intervention that aims to alleviate psychological distress in parents, reduce stigma surrounding pediatric anxiety disorders, and ultimately improve outcomes for youth with these common and impairing conditions. Twenty-three parents (3 males, mean age = 45) of children with a primary anxiety disorder diagnosis (9 males; mean age = 13) reported subjectively (during qualitative feedback interviews) and objectively (mean total score on Client Satisfaction Questionnaire = 25.4, SD = 4.8) that they found ACT-PAC helpful. Pre- and post-group assessment data suggest that ACT-PAC may increase parents’ psychological flexibility (e.g., decrease mean Cognitive Fusion Questionnaire scores, t = -2.32, p = .03) and improve children’s anxiety symptoms (e.g., decrease mean scores on the GAD subscale of the parent-report version of the SCARED, t(22) = -2.53, and on the anxiety/depression subscale of the Child Behavior Checklist, t(22) = -2.05, p = .02). We will discuss our experiences with, ways to enhance, and future directions for ACT-PAC.

• Acceptance and Commitment Therapy (ACT) for Parents of Children with ASD: A Pilot Study Turned Case Study
Kirstin B. Birtwell, Ph.D., Massachusetts General Hospital / Harvard Medical School
Lisa W. Coyne, Ph.D., McLean Hospital / Harvard Medical School

Parents of children with autism spectrum disorder (ASD) play an integral role in their children's treatment. These parents experience more depression, stress, and poorer quality of life relative to parents of typically developing children and are even more vulnerable if they rely on avoidance to cope with the challenges that arise from intense caregiver demands. To address this risk, an ACT-focused parenting group was initiated at a multidisciplinary autism clinic. As a pilot, 3 parents completed a 5-session ACT-based parenting support group. While qualitative data on satisfaction, experiential avoidance, wellness, and quality of life will be presented (including increased self-compassion, decreased depression, and improved life satisfaction from pre- to post-treatment), the current presentation will focus specifically on an in-depth discussion regarding group-format feasibility, the importance of initiating therapeutic contact, and the benefit of combining individual and group ACT treatment models for parents of children with ASD.

• Pilot Testing of ACT for Parents of Anxious Children in an Irish Clinic
Sarah Cassidy, Ph.D., Smithsfield Clinic and Maynooth University, Ireland
Steven Gannon, Ph.D., Smithsfield Clinic and Maynooth University, Ireland
Lisa W. Coyne, Ph.D., McLean Hospital / Harvard Medical Schol

Aims: ACT has a growing body of research evidence demonstrating its effectiveness with a variety of different populations with different presentations. The current study aimed to evaluate an ACT intervention for parents of anxious children, designed by Coyne and Moore, in an Irish context. Methods: The intervention was delivered once weekly, for 2 hours, 6 consecutive weeks. 7 families attended the training, comprised of 11 parents. All parents had children who had been assessed/treated at the clinic for anxiety. Demographic information was gathered prior to the intervention commencing. Numerous measures were administered pre and post intervention (e.g., DASS, PSI, Parenting Scale, PSOC, MBCRPR, SLS, CHAOS, Family Environment Scale, SDQ). Results: Data trends will be discussed but overall show improvements in parenting sense of competence and reduction in feelings of stress, anxiety and chaos in the home. Conclusion: This exploratory work has shown training parents in using ACT therapy is very effective at helping families to lessen the impact of anxiety on their lives.

Educational Objectives:
1. Describe data on the promise of ACT delivered to parents for supporting meaningful positive change in parent and family well-being. 2. Understand clinical challenges to implementing ACT in the populations of parents with anxiety or autistic children. 3. Develop strategies for addressing challenges to effective engagement of families affected by anxiety and autism in parenting treatment research on ACT.

 

161. Thriving in Community Settings: An Investigation into the Benefits of ACT and Self-Compassion for Adolescents: Children, Adolescents & Families SIG and Alberta Chapter Sponsored
Symposium (10:35am-12:05pm)
Components: Conceptual analysis, Literature review, Original Data, Didactic presentation, Case presentation
Categories: Prevention and Community-Based Interventions, Clinical Interventions and Interests, Performance-enhancing interventions, Self-compassion, DNAv, rural, adolescents, parents, groups, schools, community-based participatory research, using ACT models with parents as care-givers in Anxiety
Target Audience: Beg., Interm.
Location: Exclamation

Chair: Alisha Henson, McGill University
Discussant: Marilyn Fitzpatrick, Ph.D., McGill University

This symposium presents two projects based, developed and implemented in the context of rural Ontario. Accessibility to specialized mental health treatment for youths in rural areas is challenging and limited. Mental health practitioners must show creativity and innovation to reach these youth. ACT and self-compassion interventions can be considered innovative in themselves as they involve challenging societal norms regarding how internal experiences and challenges are perceived and treated. Both proposed models go beyond intervening with youth and include working within the context of their environment, one in a school setting and the other by involving the family environment (parent), which can widen the impact of such interventions. This presentation will demonstrate how two different approaches, one focusing on self-compassion and values and the other on ACT processes (using the DNA-v model), can help youth learn to regulate their emotions, increase well-being and decrease mental health symptoms while learning to connect with youth in their community.

• Benefits of a Group-Based Self-Compassion and Values Intervention for Youth in a Rural School Setting: A Feasibility Study
Alisha Henson, McGill University
Dr. Marilyn Fitzpatrick, McGIll University
Dr. Jessica Ruglis, McGill University
Dr. Dianna Lanteigne, Phoenix Centre for Children and Families
Abby Doner, Phoenix Centre for Children and Families

Green (2008) calls for the engagement of both practitioners and consumers in the research and development of evidence-informed practices (e.g., interventions and program evaluations) to increase validity, applicability, and expedite program development. This multi-step research project engaged youth with mental health experiences in a Community Based Participatory Research (Leung, Yen, & Minkler, 2004) process to evaluate and edit a Self-Compassion (Germer & Neff, 2013) program for rural youth. Subsequently, thirty rural adolescent girls participated in a self-compassion - values workshop as part of their physical education class. Data were analyzed using a mixed sequential design, utilizing quantitative measures, as well qualitative analysis of the student's program workbooks. Outcomes indicated that there was an increase of both hedonic and eudaimonic well-being and a decrease in mental health indicators. Overall, the youth reported positive qualitative experiences and an increase in awareness of the self, their values, and their relationship to others. The findings aid in the continued development of the program and help understand benefits of self-compassion-valued based programs for early intervention in schools.

• Thriving Together: A Joint Group-Based Intervention for Youths Struggling with Emotion Regulation and their Parent. A Case Study of Three Parent-Youth Dyads
Marie-Christine Bois, Université du Québec en Outaouais
Dr. Dave Blackburn, Université du Québec en Outaouais
Alisha Henson, McGill University

Parent-child communication and relational challenges are an ongoing concern for many families. An ACT group-based intervention was developed and implemented, targeting rural adolescents (14-16 years) experiencing psychological distress and emotion regulation problems and their parent(s). In this parent-adolescent DNA-v inspired group (Hayes, 2015), dyads developed skills to allow for more psychological flexibility, to form a common language to talk about challenging experiences, and to learn to communicate their internal struggles; with the goal of improving their relationship and increase openness to one another. Three dyads completed the full program. Data from their pre and post questionnaires and feedback from exercises completed during the intervention and qualitative surveys were analyzed and form of three case studies. Outcomes indicate a decrease in adolescent mental health symptoms and psychological flexibility, as well as an increase in positive behaviours and overall functioning. Attention was also given to the impact for the group on the parents, including changes in their parenting attitudes, parental stress regarding their youth and their confidence in their abilities as a parent.

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• A Structured Experience Group Model using ACT concepts and methods (from Thriving Teen, DNA-v and BOLD models) for Parents of Highly Anxious teens; a 10 year review and analysis
J Neil Mulholland, Ph.D., Glenrose Rehab. Hosp. & U of Alberta, Edmonton, Canada

In Murrell's and Scherber's state of the the research address on ACT with Children &/or Parents, they cover studies from 1989 - 2006. In that they note, in the summary chart, that only 2 studies, up until then focused on parents. Within this same address, Murrell, Coyne, Wilson (2006) note that "Evidence suggests that ACT can be useful to parents dealing with challenges children present" This presentation focuses on: A Group Model to assist parents of Highly Anxious Teenagers, using ACT (DNA-V) and Compassion Therapies; pre and posttests from 20 groups. This model also involves anxious teenagers who are in a parrel group or are integrated with the parent group.

Educational Objectives:
1. Describe the challenges of providing and accessing specialized mental health services in rural areas and small communities. 2. List the benefits of working with youths in the context of their environment when using ACT or self-compassion based interventions to help support an increase in well-being and decrease mental health symptoms. 3. Describe the development of two programs, the challenges of implementing them and the benefits of these programs for the youths participants.

 

163. Designing and evaluating the effectiveness of Acceptance and Commitment Therapy interventions for addictions
Symposium (10:35am-12:05pm)
Components: Original data, Case presentation
Categories: Clinical Interventions and Interests, Prevention and Community-Based Interventions, Behavioral medicine, Professional Development, Anxiety, Substance Abuse, Addiction, smoking cessation, Brief Acceptance and Commitment Therapy, primary health care setting, Chinese
Target Audience: Beg., Interm.
Location: Arobase

Chair: Danielle E. Ryals, Phoenix Programs, Inc

This symposium presents results on the clinical effectiveness of the Acceptance and Commitment Therapy (ACT) model for addiction. The first paper studies the effectiveness of the ACT model to decrease anxiety and increase well-being among adults with substance use disorders. The second paper investigates whether an ACT intervention is more effective than drug counseling on retention and cocaine abstinence. The third paper presents data regarding the effectiveness of an individual, brief ACT over treatment as usual for smoking cessation among adults.

• Acceptance and Commitment Therapy for the Treatment of Anxiety in Clients with Substance Use Disorders
Danielle E. Ryals, Phoenix Programs, Inc.
Laura Cameron, Phoenix Programs, Inc.
Heather Harlan, Phoenix Programs, Inc.

This project examined the effectiveness of the Acceptance and Commitment Therapy model and its impact on values-based living as well as the use of mindfulness practices in the acceptance of unwanted internal distress regarding anxiety in clients with substance use disorders. Data collected during the project was compared to previous treatment as usual consisting of intervention focused on symptom reduction. Participants in this program were adults who scored a 2 or higher on the Generalized Anxiety Disorder 7 (GAD7) assessment measure. Treatment consisted of individual counseling, and/or group therapy meeting weekly for 8-12 weeks. To achieve the primary aim a treatment fidelity measure was used to assure compliance with established treatment protocol by the counselors providing services as well as an assessment measure given to participants included the GAD7. Well-being and to assist in compiling data regarding movement toward values-based committed action and acceptance practices demonstrated toward the experience of anxiety was compared at intake, discharge, and 6-month follow-up using the results of the Acceptance and Action Questionnaire II, and the Quality of Life Index.

• How SMART is your trial? Preliminary data from a SMART design targeting cocaine use disorder with ACT and contingency management
Angela Stotts, Ph.D., University of Texas Health Science Center, McGovern Medical School
Charles Green, Ph.D., University of Texas Health Science Center, McGovern Medical School
Joy Schmitz, Ph.D., University of Texas Health Science Center, McGovern Medical School

A core principle of drug addiction treatment states that no single treatment is appropriate for everyone; rather, treatments need to be adjusted based on patient characteristics and response in order to be maximally effective. Ideally, clinicians would identify a sequence of interventions that works best across different stages of treatment, from abstinence initiation to relapse prevention. Development of effective adaptive interventions calls for a shift in how we conduct randomized clinical trials (RCTs). A sequential, multiple assignment, randomized trial (SMART) is being conducted to test multiple, sequential intervention strategies for cocaine use disorder. In Phase 1, Acceptance and Commitment Therapy (ACT) plus contingency management (CM) are being compared to Drug Counseling (DC) plus CM on retention and cocaine abstinence. Synergism of ACT+CM on primary treatment mechanisms of experiential avoidance and reward sensitivity is hypothesized. In Phase 2, based on Phase 1 cocaine treatment response, participants are re-randomized to additional pharmacotherapy. Initial Phase I data (N = 36) suggest that the ACT+CM is associated with superior retention and higher initial abstinence rates relative to DC+CM.

• Effectiveness of an individual, brief acceptance and commitment therapy for smoking cessation in adults recruited in primary health care settings: a randomized controlled trial
Yim Wah Mak, RN, RM, Ph.D., School of Nursing, The Hong Kong Polytechnic University
Alice Yuen LOKE, School of Nursing, The Hong Kong Polytechnic University

This is the first randomised control trial to adopt an individual, Acceptance and Commitment Therapy (ACT) for smoking cessation that was delivered in primary health care settings, with subsequent sessions delivered by telephone, using a proactive approach among the Chinese population. This study aimed to examine whether individual, brief ACT together with educational materials can help smokers to quit more effectively when compared with the usual care. Secondary outcomes such as psychological flexibility and smoking cessation self efficacy were also measured. Compared to the control group, participants who underwent 3 brief sessions of ACT and were given educational materials were more ready to quit smoking, perceived a greater importance in quitting, and had more psychological flexibility, a specific indicator of change through the ACT intervention. A proactive approach to recruiting participants for a smoking cessation trial was found to be feasible with the support of the staff of primary health care settings. Future research is needed to examine the optimal length and duration of the intervention.

Educational Objectives:
1. Implement Acceptance and Commitment Therapy Model for the treatment of anxiety in clients with substance use disorders. 2. Describe the role of the program manager, counselors, family team and financial officer in the implementation process of the ACT project. 3. Describe the role of SMART designs in developing and testing interventions based on patient characteristics and treatment response.