Mechanisms of Change in Acceptance-Based Mechanisms of Change in Acceptance-Based Interventions Interventions Chair: Evan M. Forman, Drexel University Chair: Evan M. Forman, Drexel University Discussant: Steven C. Hayes, University of Nevada, Reno Discussant: Steven C. Hayes, University of Nevada, Reno Mindfulness and Behavior Change Processes in Acceptance and Mindfulness and Behavior Change Processes in Acceptance and Commitment Therapy Commitment Therapy Akihiko Masuda & Steven C. Hayes, University of Nevada, Reno Akihiko Masuda & Steven C. Hayes, University of Nevada, Reno The Relationship of Three Self-report Measures of Mindfulness to The Relationship of Three Self-report Measures of Mindfulness to Each Other and to Measures of Emotion, Cognition, and Each Other and to Measures of Emotion, Cognition, and Psychopathology Psychopathology Emily A. Haigh, Shane A. Mares, Candace Croft, Michael T. Moore, & David Emily A. Haigh, Shane A. Mares, Candace Croft, Michael T. Moore, & David M. Fresco, Kent State University M. Fresco, Kent State University Differential Strategies in Coping with Induced Pain as a Function Differential Strategies in Coping with Induced Pain as a Function of Experiential Avoidance of Experiential Avoidance Robert D. Zettle, Tanya R. Hocker, Katherine A. Mick, Brett E. Robert D. Zettle, Tanya R. Hocker, Katherine A. Mick, Brett E. Scofield, Connie L. Petersen, Scofield, Connie L. Petersen, Hyunsung Song & Ratna P. Sudarijanto, Wichita State University Hyunsung Song & Ratna P. Sudarijanto, Wichita State University Learning is a Mechanism Through Which Psychological Acceptance Learning is a Mechanism Through Which Psychological Acceptance Affects Mental Health and Job Performance Affects Mental Health and Job Performance Frank W. Bond, Goldsmiths College, University of London, United Kingdom Frank W. Bond, Goldsmiths College, University of London, United Kingdom Comparing Outcome and Mechanisms of Action in Cognitive Comparing Outcome and Mechanisms of Action in Cognitive Behavioral and Acceptance and Commitment Therapies Behavioral and Acceptance and Commitment Therapies Evan M. Forman, James D. Herbert, Peter D. Yeomans, Katie McGrath, Ethan Evan M. Forman, James D. Herbert, Peter D. Yeomans, Katie McGrath, Ethan Moitre & Pamela A. Geller, Drexel University Moitre & Pamela A. Geller, Drexel University
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Mindfulness and Behavior Change Processes in Acceptance and Commitment Therapy
Mechanisms of Change in Acceptance-Based Interventions Chair: Evan M. Forman, Drexel University Discussant: Steven C. Hayes, University of Nevada, Reno. Mindfulness and Behavior Change Processes in Acceptance and Commitment Therapy Akihiko Masuda & Steven C. Hayes, University of Nevada, Reno - PowerPoint PPT Presentation
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Mechanisms of Change in Acceptance-Based Mechanisms of Change in Acceptance-Based InterventionsInterventions
Chair: Evan M. Forman, Drexel UniversityChair: Evan M. Forman, Drexel UniversityDiscussant: Steven C. Hayes, University of Nevada, RenoDiscussant: Steven C. Hayes, University of Nevada, Reno
Mindfulness and Behavior Change Processes in Acceptance and Mindfulness and Behavior Change Processes in Acceptance and Commitment TherapyCommitment Therapy
Akihiko Masuda & Steven C. Hayes, University of Nevada, RenoAkihiko Masuda & Steven C. Hayes, University of Nevada, Reno
The Relationship of Three Self-report Measures of Mindfulness to The Relationship of Three Self-report Measures of Mindfulness to Each Other and to Measures of Emotion, Cognition, and Each Other and to Measures of Emotion, Cognition, and
PsychopathologyPsychopathologyEmily A. Haigh, Shane A. Mares, Candace Croft, Michael T. Moore, & David M. Fresco, Emily A. Haigh, Shane A. Mares, Candace Croft, Michael T. Moore, & David M. Fresco,
Kent State UniversityKent State University
Differential Strategies in Coping with Induced Pain as a Function of Differential Strategies in Coping with Induced Pain as a Function of Experiential AvoidanceExperiential Avoidance
Robert D. Zettle, Tanya R. Hocker, Katherine A. Mick, Brett E. Scofield, Connie L. Robert D. Zettle, Tanya R. Hocker, Katherine A. Mick, Brett E. Scofield, Connie L. Petersen, Petersen,
Hyunsung Song & Ratna P. Sudarijanto, Wichita State UniversityHyunsung Song & Ratna P. Sudarijanto, Wichita State University
Learning is a Mechanism Through Which Psychological Acceptance Learning is a Mechanism Through Which Psychological Acceptance Affects Mental Health and Job PerformanceAffects Mental Health and Job Performance
Frank W. Bond, Goldsmiths College, University of London, United KingdomFrank W. Bond, Goldsmiths College, University of London, United Kingdom
Comparing Outcome and Mechanisms of Action in Cognitive Comparing Outcome and Mechanisms of Action in Cognitive Behavioral and Acceptance and Commitment TherapiesBehavioral and Acceptance and Commitment Therapies
Evan M. Forman, James D. Herbert, Peter D. Yeomans, Katie McGrath, Ethan Moitre & Evan M. Forman, James D. Herbert, Peter D. Yeomans, Katie McGrath, Ethan Moitre & Pamela A. Geller, Drexel UniversityPamela A. Geller, Drexel University
Comparing Outcome and Mechanisms Comparing Outcome and Mechanisms of Action in Cognitive Behavioral and of Action in Cognitive Behavioral and
Acceptance and Commitment Acceptance and Commitment TherapiesTherapies
Evan M. Forman, James D. Herbert, Peter D. Yeomans, Evan M. Forman, James D. Herbert, Peter D. Yeomans, Katie McGrath, Ethan Moitre & Pamela A. Geller, Katie McGrath, Ethan Moitre & Pamela A. Geller,
Drexel UniversityDrexel University
Corresponding Author:Evan M. Forman, Ph.D.Department of PsychologyDrexel University245 N 15th Street, MS 515Phila., PA 19102(215) [email protected]
Paper presented at the AABT, New Orleans, November 19, 2004Paper presented at the AABT, New Orleans, November 19, 2004
ACT vs CBTACT vs CBTCBTCBT ACTACT
FocusFocus reducing or eliminating reducing or eliminating distorted/unwanted distorted/unwanted thoughts, feelings, and thoughts, feelings, and bodily sensations bodily sensations
reducingreducing unwillingness unwillingness toto experience and experience and efforts to efforts to controlcontrol thoughts, feelings thoughts, feelings and sensationsand sensations
Study QuestionsStudy Questions Disseminability?Disseminability? Efficacy (RCT)?Efficacy (RCT)? Effectiveness in real-world setting (few Effectiveness in real-world setting (few
exclusion criteria, comorbidity, exclusion criteria, comorbidity, subthreshold diagnostically) subthreshold diagnostically) [Strosahl et al., [Strosahl et al., 1998]1998]
Mechanisms of action?Mechanisms of action?
… … of ACT relative to CBTof ACT relative to CBT
Study DesignStudy Design Setting: University counseling centerSetting: University counseling center Participants: health science students (nursing, Participants: health science students (nursing,
medicine, physical therapy, etc.)medicine, physical therapy, etc.) Therapists: Doctoral students (n = 13) in a Therapists: Doctoral students (n = 13) in a
CBT-oriented clinical psychology programCBT-oriented clinical psychology program Therapist Training/SupervisionTherapist Training/Supervision
Problem Checklist: Main Problem Checklist: Main ConcernsConcerns
– Worried about my grades or academic workWorried about my grades or academic work– Concerned about my primary relationshipsConcerned about my primary relationships– Feel easily irritated, frustrated, and/or angryFeel easily irritated, frustrated, and/or angry– Feeling depressed or unhappyFeeling depressed or unhappy– Not feeling close/connected to othersNot feeling close/connected to others– Worried about my physical healthWorried about my physical health– Concerned about my eating habits/nutritionConcerned about my eating habits/nutrition– Having fears/worries that occupy my mindHaving fears/worries that occupy my mind
Enrollment Slowdowns Enrollment Slowdowns 18 participants have 18 participants have reached time 2reached time 2– Effect sizes > p valuesEffect sizes > p values– Clinical SignificanceClinical Significance
Groups not equal at baseline (randomization Groups not equal at baseline (randomization failure)failure)– Repeated measures compares Repeated measures compares slopes slopes of change not of change not
simple differencesimple difference– Stratification by symptom (BDI, BAI, BHS, OQ) threshold; Stratification by symptom (BDI, BAI, BHS, OQ) threshold;
participants with minimal symptoms discardedparticipants with minimal symptoms discarded No midpoint assessment (No midpoint assessment (mediational analyses)mediational analyses)
TimeTime .023.023 .881.881 .001.001Time x Time x GroupGroup .001.001 .973.973 .000.000
BaselineBaseline 3 mo3 moCBTCBT 20.5720.57
(1.04)(1.04)20.720.7
11(.55)(.55)
ACTACT 20.6420.64(.83)(.83)
20.720.733
(.44)(.44)
10
15
20
25
Baseline 3 mo
CBT ACT
Mediational AnalysesMediational Analyses1.1. Does mediational variable decrease Does mediational variable decrease
as a function of treatment and as a function of treatment and differentially by treatment type (CBT differentially by treatment type (CBT vs ACT)?vs ACT)?
2.2. Does change in mediational variable Does change in mediational variable covary with change in outcome?covary with change in outcome?
3.3. Is treatment effect attenuated—Is treatment effect attenuated—differentially by treatment type—differentially by treatment type—when mediational variable is when mediational variable is statistically controlled?statistically controlled?
AwarenessAwareness NoNoAcceptanceAcceptance Yes Yes (ACT)(ACT) OQ OQ (ACT)(ACT) OQOQ (ACT) (ACT)
SummarySummary DisseminableDisseminable EffectiveEffective Efficacious relative to CBTEfficacious relative to CBT
– DepressionDepression– FunctioningFunctioning– Subjective Life SatisfactionSubjective Life Satisfaction
Mechanisms of ActionMechanisms of Action– BelievabilityBelievability, for ACT, not CBT, on , for ACT, not CBT, on depressiondepression– ObserveObserve, for ACT, not CBT, on , for ACT, not CBT, on anxietyanxiety– AcceptanceAcceptance, for ACT, not CBT, on , for ACT, not CBT, on functioningfunctioning
( CGI )
FutureFuture Increase nIncrease n Consider specific diagnosesConsider specific diagnoses Session-by-session data (BSQ)Session-by-session data (BSQ) Diffusion as a mechanism of actionDiffusion as a mechanism of action