Pub Date : 2024-10-01DOI: 10.1016/j.jcbs.2024.100850
Brooke M. Smith, Jennifer L. Barney, Clarissa W. Ong, Tyson S. Barrett, Michael E. Levin, Michael P. Twohig
Leading theories regarding the mechanisms of exposure for OCD focus on Pavlovian fear reduction more than operant processes. Acceptance-based exposure directly targets operant behavior. Integrating these perspectives could lead to a more robust understanding of mechanisms of change in exposure and more effective and enduring treatments. The current study investigated acceptance and regulation of distress during exposure. Participants with intrusive thoughts were randomized into three groups, Acceptance (n = 23), Regulation (n = 20), and Control (n = 21), and completed two behavioral avoidance tests (BATs) 1 week apart. Active conditions completed a 30-min exposure plus 6 days of 10-min exposures at home; Control participants watched videos of the same durations. Self-report measures were collected at both sessions, and behavioral, subjective, and physiological repeated measures data were collected during both BATs. Compared to Control, active conditions decreased OCD symptom severity, rituals, and skin conductance levels, while Acceptance showed lower skin conductance levels than Regulation and Control. Acceptance showed greater willingness and psychological flexibility than Control, while Regulation did not. Results support theorized mechanisms of change in acceptance-based exposure and suggest willingness to experience distress may paradoxically lead to decreased physiological arousal, which has important implications for treatment and future research.
{"title":"Physiological, behavioral, and self-report outcomes of acceptance- and regulation-based exposure for intrusive thoughts","authors":"Brooke M. Smith, Jennifer L. Barney, Clarissa W. Ong, Tyson S. Barrett, Michael E. Levin, Michael P. Twohig","doi":"10.1016/j.jcbs.2024.100850","DOIUrl":"10.1016/j.jcbs.2024.100850","url":null,"abstract":"<div><div>Leading theories regarding the mechanisms of exposure for OCD focus on Pavlovian fear reduction more than operant processes. Acceptance-based exposure directly targets operant behavior. Integrating these perspectives could lead to a more robust understanding of mechanisms of change in exposure and more effective and enduring treatments. The current study investigated acceptance and regulation of distress during exposure. Participants with intrusive thoughts were randomized into three groups, Acceptance (<em>n</em> = 23), Regulation (<em>n</em> = 20), and Control (<em>n</em> = 21), and completed two behavioral avoidance tests (BATs) 1 week apart. Active conditions completed a 30-min exposure plus 6 days of 10-min exposures at home; Control participants watched videos of the same durations. Self-report measures were collected at both sessions, and behavioral, subjective, and physiological repeated measures data were collected during both BATs. Compared to Control, active conditions decreased OCD symptom severity, rituals, and skin conductance levels, while Acceptance showed lower skin conductance levels than Regulation and Control. Acceptance showed greater willingness and psychological flexibility than Control, while Regulation did not. Results support theorized mechanisms of change in acceptance-based exposure and suggest willingness to experience distress may paradoxically lead to decreased physiological arousal, which has important implications for treatment and future research.</div></div>","PeriodicalId":47544,"journal":{"name":"Journal of Contextual Behavioral Science","volume":"34 ","pages":"Article 100850"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142661134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jcbs.2024.100844
Vasilis S. Vasiliou , Laoise Meany , Chiarra Belluci , Samantha Dockray , Conor Linehan , Samantha Dick , Martin P. Davoren , Michael Byrne
Drug use during college can have substantial harm on students' lives and impacts the institutions' functioning and local communities. Yet existing interventions for drug use at college poorly address the concurrent dynamic influences of the experiences in earlier developmental periods of young adults and the proximal contextual triggers of college life; both risk factors that can contribute to drug use. To address this, we leveraged system dynamic methods and contextual-behavioural science (CBS) approaches to support the development of interventions focusing at addressin these risk factors. Using Causal Loop Diagram methods (Vensim PLE), we collected qualitative data from college students to generate Network Feedback Loops (NFLs) (n = 24, Maged 22 years old), during the development phase of the MyUse: a contextual behavioural change intervention for harm reduction practices at college students. The findings underscored central nodes (determinants within an intervention) that support our previous identified three CBS-harm-reduction practices for college students (targeted edges: mindful drug-use decision making, value-based activities, context-sensitive personalized plan of harm reduction). Analyses revealed 4 NFLs for students with previous drug use, consisting of 13 edges (4 positive, 2 negative, and 4 balancing reinforcing relationships) and 3 NFLs for students with no previous drug use, consisting of 4 positives, one negative, and one balancing relationship. All the NFLs were nested with the three CBS-related targeted outcomes. College students who use drugs need drug-related knowledge about the unpredictable and adverse effects of drugs, presented in a compassionate way and distributed from credible resources (e.g., students’ unions/club). Students with no previous drug use need education about the effects of drugs and awareness of how drugs can devaluate value-based activities (e.g. sports, friendships, social life). These should be delivered via proxy cue reminders and mobile-text approaches conveying messages about drug use susceptibility, distributed in real-time. Idiosyncratic, dynamic, and contextual-bound factors of lapse risks or preventive practices should account for each person-specific vulnerabilities via personalized harm reduction plans.
{"title":"Capturing the context of drug use for college students: A contextual behavioural science informed qualitative analysis of harm reduction practices using network feedback loops simulation modelling","authors":"Vasilis S. Vasiliou , Laoise Meany , Chiarra Belluci , Samantha Dockray , Conor Linehan , Samantha Dick , Martin P. Davoren , Michael Byrne","doi":"10.1016/j.jcbs.2024.100844","DOIUrl":"10.1016/j.jcbs.2024.100844","url":null,"abstract":"<div><div>Drug use during college can have substantial harm on students' lives and impacts the institutions' functioning and local communities. Yet existing interventions for drug use at college poorly address the concurrent dynamic influences of the experiences in earlier developmental periods of young adults and the proximal contextual triggers of college life; both risk factors that can contribute to drug use. To address this, we leveraged system dynamic methods and contextual-behavioural science (CBS) approaches to support the development of interventions focusing at addressin these risk factors. Using Causal Loop Diagram methods (Vensim PLE), we collected qualitative data from college students to generate Network Feedback Loops (NFLs) (<em>n</em> = 24, Maged 22 years old), during the development phase of the MyUse: a contextual behavioural change intervention for harm reduction practices at college students. The findings underscored central nodes (determinants within an intervention) that support our previous identified three CBS-harm-reduction practices for college students (targeted edges: mindful drug-use decision making, value-based activities, context-sensitive personalized plan of harm reduction). Analyses revealed 4 NFLs for students with previous drug use, consisting of 13 edges (4 positive, 2 negative, and 4 balancing reinforcing relationships) and 3 NFLs for students with no previous drug use, consisting of 4 positives, one negative, and one balancing relationship. All the NFLs were nested with the three CBS-related targeted outcomes. College students who use drugs need drug-related knowledge about the unpredictable and adverse effects of drugs, presented in a compassionate way and distributed from credible resources (e.g., students’ unions/club). Students with no previous drug use need education about the effects of drugs and awareness of how drugs can devaluate value-based activities (e.g. sports, friendships, social life). These should be delivered via proxy cue reminders and mobile-text approaches conveying messages about drug use susceptibility, distributed in real-time. Idiosyncratic, dynamic, and contextual-bound factors of lapse risks or preventive practices should account for each person-specific vulnerabilities via personalized harm reduction plans.</div></div>","PeriodicalId":47544,"journal":{"name":"Journal of Contextual Behavioral Science","volume":"34 ","pages":"Article 100844"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jcbs.2024.100847
Tara Gudarzi , Matti Cervin
Emotion dysregulation and psychological inflexibility are widely regarded as key contributors to a range of mental health issues and are integral to several treatment models in the mental health field. However, no study has examined whether the two constructs reflect distinct aspects of psychological functioning or whether they can be clearly differentiated from mental health symptoms and associated impairment. Adolescence is a key period for the onset of mental health problems, making a better understanding of psychological processes involved in mental health in this age group important. The Difficulties in Emotion Regulation Scale (DERS-16, emotion dysregulation) and the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8, psychological inflexibility) are widely used assessment tools of emotion dysregulation and psychological inflexibility, but critical evaluations of their validity are sparse. Using exploratory and confirmatory factor analysis, we examined the discriminant validity of emotion dysregulation and psychological inflexibility as measured via the DERS-16 and the AFQ-Y8 in a sample of 633 adolescents (Mage = 16.6 [1.98]). Emotion dysregulation and psychological inflexibility did not demonstrate discriminant validity. Instead, four strongly correlated factors emerged, each comprising a combination of items from both assessment tools: (1) interference stemming from distressing thoughts and emotions, (2) negative self-evaluation, (3) loss of control when emotional, and (4) confusion about one's emotions. These factors were strongly correlated and adequately captured by an overarching factor, which we termed the X factor, which in turn was very strongly correlated with core symptoms of anxiety and depression and functional impairment stemming from mental health issues. In conclusion, the constructs of emotion dysregulation and psychological inflexibility, as assessed by the DERS-16 and AFQ-Y8, do not show discriminant validity in adolescents. Furthermore, the constructs measured by these tools are almost empirically indistinguishable from anxiety, depression, and functional impairment.
{"title":"Emotion dysregulation and psychological inflexibility in adolescents: Discriminant validity and associations with internalizing symptoms and functional impairment","authors":"Tara Gudarzi , Matti Cervin","doi":"10.1016/j.jcbs.2024.100847","DOIUrl":"10.1016/j.jcbs.2024.100847","url":null,"abstract":"<div><div>Emotion dysregulation and psychological inflexibility are widely regarded as key contributors to a range of mental health issues and are integral to several treatment models in the mental health field. However, no study has examined whether the two constructs reflect distinct aspects of psychological functioning or whether they can be clearly differentiated from mental health symptoms and associated impairment. Adolescence is a key period for the onset of mental health problems, making a better understanding of psychological processes involved in mental health in this age group important. The Difficulties in Emotion Regulation Scale (DERS-16, emotion dysregulation) and the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8, psychological inflexibility) are widely used assessment tools of emotion dysregulation and psychological inflexibility, but critical evaluations of their validity are sparse. Using exploratory and confirmatory factor analysis, we examined the discriminant validity of emotion dysregulation and psychological inflexibility as measured via the DERS-16 and the AFQ-Y8 in a sample of 633 adolescents (M<sub>age</sub> = 16.6 [1.98]). Emotion dysregulation and psychological inflexibility did not demonstrate discriminant validity. Instead, four strongly correlated factors emerged, each comprising a combination of items from both assessment tools: (1) interference stemming from distressing thoughts and emotions, (2) negative self-evaluation, (3) loss of control when emotional, and (4) confusion about one's emotions. These factors were strongly correlated and adequately captured by an overarching factor, which we termed the X factor, which in turn was very strongly correlated with core symptoms of anxiety and depression and functional impairment stemming from mental health issues. In conclusion, the constructs of emotion dysregulation and psychological inflexibility, as assessed by the DERS-16 and AFQ-Y8, do not show discriminant validity in adolescents. Furthermore, the constructs measured by these tools are almost empirically indistinguishable from anxiety, depression, and functional impairment.</div></div>","PeriodicalId":47544,"journal":{"name":"Journal of Contextual Behavioral Science","volume":"34 ","pages":"Article 100847"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jcbs.2024.100845
Kristiina Räihä, Henna Asikainen, Nina Katajavuori
Previous research in higher education has shown that Acceptance and Commitment Therapy (ACT) -based interventions have beneficial effects on students’ well-being. However, not much is known about the range of behaviour changes behind these outcomes.
In this mixed methods study, we explored the variety of the changes ACT-based course participating university students (N = 101) describe in their reflective learning reports. We did so by applying the Extended Evolutionary Meta Model (EEMM) in abductive content analysis, and by applying network visualisation of the various study burnout risk change groups.
The results showed that the largest proportion of students described changes in the EEMM dimension of overt behaviour (75%), especially time and effort management. Vitality, and decreased distress were the most described outcomes related to behaviour changes.
Study burnout risk decreased significantly at the course level. When observing the interrelations of behaviour changes in the networks of burnout risk change groups, alongside time and effort management, attentional and affective dimensions representing present moment awareness and acceptance were central changes in the group that had the greatest reduction in burnout risk. These findings contribute to the need to map out the variety of beneficial mechanisms and serve further idiographic research about changes during study-integrated ACT-based interventions.
{"title":"Changes in university students’ behaviour and study burnout risk during ACT-based online course intervention: A mixed methods study","authors":"Kristiina Räihä, Henna Asikainen, Nina Katajavuori","doi":"10.1016/j.jcbs.2024.100845","DOIUrl":"10.1016/j.jcbs.2024.100845","url":null,"abstract":"<div><div>Previous research in higher education has shown that Acceptance and Commitment Therapy (ACT) -based interventions have beneficial effects on students’ well-being. However, not much is known about the range of behaviour changes behind these outcomes.</div><div>In this mixed methods study, we explored the variety of the changes ACT-based course participating university students (N = 101) describe in their reflective learning reports. We did so by applying the Extended Evolutionary Meta Model (EEMM) in abductive content analysis, and by applying network visualisation of the various study burnout risk change groups.</div><div>The results showed that the largest proportion of students described changes in the EEMM dimension of overt behaviour (75%), especially time and effort management. Vitality, and decreased distress were the most described outcomes related to behaviour changes.</div><div>Study burnout risk decreased significantly at the course level. When observing the interrelations of behaviour changes in the networks of burnout risk change groups, alongside time and effort management, attentional and affective dimensions representing present moment awareness and acceptance were central changes in the group that had the greatest reduction in burnout risk. These findings contribute to the need to map out the variety of beneficial mechanisms and serve further idiographic research about changes during study-integrated ACT-based interventions.</div></div>","PeriodicalId":47544,"journal":{"name":"Journal of Contextual Behavioral Science","volume":"34 ","pages":"Article 100845"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jcbs.2024.100843
Wanting Zu , Fei Li , Xiaoxuan Ma , Shiyun Zhang , Wenbo Nie , Lisheng Wang
Background and objective
Anxiety, depression, and diabetes distress are three common psychological distresses among people with type 2 diabetes. Although previous research has explored factors associated with them, most studies have viewed these factors as independent constructs, overlooking the complex interactions between these factors, which can limit our understanding of psychological symptoms and associated factors from an integrated perspective. The purpose of this study was to explore the relationships between psychological distress outcomes and related psychological factors in people with diabetes from a network analysis perspective and further provide evidence for the selection of specific psychological intervention targets.
Design and setting
A cross-sectional study was conducted in person at diabetes centers of three tertiary hospitals in China.
Participants
481 adults with type 2 diabetes (62% male; mean age 51.91 ± 13.64 years; mean HbA1c 9.34 ± 2.23%) were recruited between December 2022 and April 2023.
Methods
Psychological distress outcomes and related factors analyzed included depression (PHQ-9), anxiety (GAD-7), diabetes distress (DDS), acceptance level (AADQ), cognitive fusion (CFQ), social support (PSSS), and self-efficacy (DMSES). Correlation analyses and network analyses were used to explore complex associations among these variables.
Results
The network included ten nodes, diabetes-related interpersonal distress, anxiety, and regimen-related distress were the most influential in the network. Significant relationships emerged in networks with five nodes, with both acceptance level and cognitive fusion associated with the general psychological distress and diabetes distress; social support demonstrated stable associations with all three psychological outcomes in each network.
Conclusion
After controlling for other factors, psychological flexibility and social support could still be significantly associated with psychological distress outcomes, indicating the potential to integrate them as transdiagnostic processes into psychological interventions for this population. However, the results of this study are based on the group level, and the dynamic networks of individuals need to be further explored in order to meet the needs of individuals in different contexts.
{"title":"Exploring the interconnectedness of depression, anxiety, diabetes distress, and related psychosocial factors in adults with type 2 diabetes: A network analysis","authors":"Wanting Zu , Fei Li , Xiaoxuan Ma , Shiyun Zhang , Wenbo Nie , Lisheng Wang","doi":"10.1016/j.jcbs.2024.100843","DOIUrl":"10.1016/j.jcbs.2024.100843","url":null,"abstract":"<div><h3>Background and objective</h3><div>Anxiety, depression, and diabetes distress are three common psychological distresses among people with type 2 diabetes. Although previous research has explored factors associated with them, most studies have viewed these factors as independent constructs, overlooking the complex interactions between these factors, which can limit our understanding of psychological symptoms and associated factors from an integrated perspective. The purpose of this study was to explore the relationships between psychological distress outcomes and related psychological factors in people with diabetes from a network analysis perspective and further provide evidence for the selection of specific psychological intervention targets.</div></div><div><h3>Design and setting</h3><div>A cross-sectional study was conducted in person at diabetes centers of three tertiary hospitals in China.</div></div><div><h3>Participants</h3><div>481 adults with type 2 diabetes (62% male; mean age 51.91 ± 13.64 years; mean HbA1c 9.34 ± 2.23%) were recruited between December 2022 and April 2023.</div></div><div><h3>Methods</h3><div>Psychological distress outcomes and related factors analyzed included depression (PHQ-9), anxiety (GAD-7), diabetes distress (DDS), acceptance level (AADQ), cognitive fusion (CFQ), social support (PSSS), and self-efficacy (DMSES). Correlation analyses and network analyses were used to explore complex associations among these variables.</div></div><div><h3>Results</h3><div>The network included ten nodes, diabetes-related interpersonal distress, anxiety, and regimen-related distress were the most influential in the network. Significant relationships emerged in networks with five nodes, with both acceptance level and cognitive fusion associated with the general psychological distress and diabetes distress; social support demonstrated stable associations with all three psychological outcomes in each network.</div></div><div><h3>Conclusion</h3><div>After controlling for other factors, psychological flexibility and social support could still be significantly associated with psychological distress outcomes, indicating the potential to integrate them as transdiagnostic processes into psychological interventions for this population. However, the results of this study are based on the group level, and the dynamic networks of individuals need to be further explored in order to meet the needs of individuals in different contexts.</div></div>","PeriodicalId":47544,"journal":{"name":"Journal of Contextual Behavioral Science","volume":"34 ","pages":"Article 100843"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142416097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jcbs.2024.100842
Narae Jeong , Eunjung Kim , Jonghoon Chun
As social costs rise due to the increasing prevalence of depression, there is a growing emphasis on cost-effective and evidence-based psychotherapeutic methods. Acceptance and Commitment Therapy (ACT) for depression is an effective approach that reduces depressive symptoms and helps prevent recurrence by enhancing psychological flexibility. This study developed a mobile app-based ACT and tested its effectiveness for college students with depression. Eighty college students with depression were randomly assigned to either a treatment group (n = 41) or a control group (n = 39). The treatment group received mobile app-based ACT for 4 weeks, the control group waited without treatment. The scores from pre, post, and follow-up assessments were compared between the two groups. Significant interaction effects of time and group were found for depression and anxiety symptoms, as well as for treatment process variables such as acceptance, inflexibility, defusion, values, commitment, and mindfulness. Acceptance and cognitive defusion emerged as significant mediators in the impact of mobile app-based ACT on depression. The mobile app-based ACT effectively reduced depression and improved treatment process variables, demonstrating its cost-effectiveness. The study also discusses the implications, limitations, and directions for future research.
{"title":"Effects of a randomized controlled trial of mobile app-based Acceptance and Commitment Therapy on depressive symptoms and process variables in college students - Focusing on the mediating effects of acceptance and cognitive defusion-","authors":"Narae Jeong , Eunjung Kim , Jonghoon Chun","doi":"10.1016/j.jcbs.2024.100842","DOIUrl":"10.1016/j.jcbs.2024.100842","url":null,"abstract":"<div><div>As social costs rise due to the increasing prevalence of depression, there is a growing emphasis on cost-effective and evidence-based psychotherapeutic methods. Acceptance and Commitment Therapy (ACT) for depression is an effective approach that reduces depressive symptoms and helps prevent recurrence by enhancing psychological flexibility. This study developed a mobile app-based ACT and tested its effectiveness for college students with depression. Eighty college students with depression were randomly assigned to either a treatment group (<em>n</em> = 41) or a control group (<em>n</em> = 39). The treatment group received mobile app-based ACT for 4 weeks, the control group waited without treatment. The scores from pre, post, and follow-up assessments were compared between the two groups. Significant interaction effects of time and group were found for depression and anxiety symptoms, as well as for treatment process variables such as acceptance, inflexibility, defusion, values, commitment, and mindfulness. Acceptance and cognitive defusion emerged as significant mediators in the impact of mobile app-based ACT on depression. The mobile app-based ACT effectively reduced depression and improved treatment process variables, demonstrating its cost-effectiveness. The study also discusses the implications, limitations, and directions for future research.</div></div>","PeriodicalId":47544,"journal":{"name":"Journal of Contextual Behavioral Science","volume":"34 ","pages":"Article 100842"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142433546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jcbs.2024.100841
Paul Sandery, John Baranoff, Diana Dorstyn
Third wave interventions have demonstrated efficacy as a treatment option to promote wellbeing in adolescents. Evidence of their effectiveness for chronic mental health disorders remains unclear. The PubMed, PsycINFO, ProQuest, Embase, and CINAHL databases were searched from inception until March 2024 for five established interventions: acceptance and commitment therapy (ACT), compassion focused therapy, dialectical behaviour therapy (DBT), mindfulness-based cognitive therapy, and mindfulness-based stress reduction (MBSR). Risk of bias was assessed (QualSyst tool), and standardized mean group differences (Hedges’ g) with associated p-values, 95% confidence intervals, and prediction intervals calculated. Three randomized controlled trials and 10 single-group designs, all assessing DBT and representing 700 adolescents (most with subthreshold or full syndrome borderline personality disorder), were included. All studies were of sound methodological quality. DBT was associated with large and significant reductions in mental health symptoms (depression, anxiety, emotional regulation, suicidal ideation, self-harm, and BPD symptoms; g range = 0.69 to 1.05) – although individual variability in treatment response was noted. Symptom improvements were maintained at follow-up (g range = 0.70 to 1.71), although based on limited data. Neither DBT intensity nor duration significantly moderated treatment effects. DBT is the most assessed intervention for adolescents with severe emotional or behavioral problems. Additional controlled studies with diverse samples are needed to confirm the unique effects of DBT relative to other promising third wave interventions. Protocol registration: Open Science Framework [https://osf.io/fgd2j/].
{"title":"Third wave interventions for adolescents with mental health disorders: A systematic review with meta-analysis","authors":"Paul Sandery, John Baranoff, Diana Dorstyn","doi":"10.1016/j.jcbs.2024.100841","DOIUrl":"10.1016/j.jcbs.2024.100841","url":null,"abstract":"<div><div>Third wave interventions have demonstrated efficacy as a treatment option to promote wellbeing in adolescents. Evidence of their effectiveness for chronic mental health disorders remains unclear. The PubMed, PsycINFO, ProQuest, Embase, and CINAHL databases were searched from inception until March 2024 for five established interventions: acceptance and commitment therapy (ACT), compassion focused therapy, dialectical behaviour therapy (DBT), mindfulness-based cognitive therapy, and mindfulness-based stress reduction (MBSR). Risk of bias was assessed (QualSyst tool), and standardized mean group differences (Hedges’ <em>g</em>) with associated <em>p</em>-values, 95% confidence intervals, and prediction intervals calculated. Three randomized controlled trials and 10 single-group designs, all assessing DBT and representing 700 adolescents (most with subthreshold or full syndrome borderline personality disorder), were included. All studies were of sound methodological quality. DBT was associated with large and significant reductions in mental health symptoms (depression, anxiety, emotional regulation, suicidal ideation, self-harm, and BPD symptoms; <em>g</em> range = 0.69 to 1.05) – although individual variability in treatment response was noted. Symptom improvements were maintained at follow-up (<em>g</em> range = 0.70 to 1.71), although based on limited data. Neither DBT intensity nor duration significantly moderated treatment effects. DBT is the most assessed intervention for adolescents with severe emotional or behavioral problems. Additional controlled studies with diverse samples are needed to confirm the unique effects of DBT relative to other promising third wave interventions. Protocol registration: Open Science Framework [<span><span>https://osf.io/fgd2j/</span><svg><path></path></svg></span>].</div></div>","PeriodicalId":47544,"journal":{"name":"Journal of Contextual Behavioral Science","volume":"34 ","pages":"Article 100841"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jcbs.2024.100846
Elisabet Casellas-Pujol , Joaquim Soler , Carlos Schmidt , Anna Soria-Madrid , Matilde Elices , Juan Carlos Pascual
Long-term follow-up studies have shown that the symptoms of borderline personality disorder (BPD) tend to remit over time. However, many patients present long lasting symptoms (LLS), including low mood, emptiness, and persistent impairment in psychosocial adjustment. Given the high rate of LLS in BPD patients, new treatment strategies are needed. We conducted a randomized clinical trial (RCT) to evaluate the efficacy of a novel intervention that combines self-compassion and contextual-based skills for patients with persistent symptoms. Sixty BPD individuals with LLS who had received dialectical behavior therapy skills training (DBT-ST) in the previous six months were recruited and randomized to receive the experimental intervention or treatment as usual (TAU) for 12 weeks. All participants were evaluated pre- and post-intervention and at 3-months follow-up. The primary outcome measure was self-reported well-being. Other clinical variables were also evaluated, including depressive symptoms, BPD symptoms, functionality, self-compassion, and self-criticism. Participants in the experimental arm showed a significant increase in indicators of well-being (e.g., happiness and quality of life) and a significant decrease in depressive symptoms. These results were sustained—and even continued to improve—at the three-month follow-up. No significant changes were observed in BPD severity, self-criticism, or self-compassion. More RCTs are needed to test the efficacy of new interventions targeting this population with persistent symptoms, not only to reduce symptoms but also to promote well-being and personal recovery.
{"title":"Contextual-compassion training for borderline personality disorder with long lasting symptoms: A randomized clinical trial","authors":"Elisabet Casellas-Pujol , Joaquim Soler , Carlos Schmidt , Anna Soria-Madrid , Matilde Elices , Juan Carlos Pascual","doi":"10.1016/j.jcbs.2024.100846","DOIUrl":"10.1016/j.jcbs.2024.100846","url":null,"abstract":"<div><div>Long-term follow-up studies have shown that the symptoms of borderline personality disorder (BPD) tend to remit over time. However, many patients present long lasting symptoms (LLS), including low mood, emptiness, and persistent impairment in psychosocial adjustment. Given the high rate of LLS in BPD patients, new treatment strategies are needed. We conducted a randomized clinical trial (RCT) to evaluate the efficacy of a novel intervention that combines self-compassion and contextual-based skills for patients with persistent symptoms. Sixty BPD individuals with LLS who had received dialectical behavior therapy skills training (DBT-ST) in the previous six months were recruited and randomized to receive the experimental intervention or treatment as usual (TAU) for 12 weeks. All participants were evaluated pre- and post-intervention and at 3-months follow-up. The primary outcome measure was self-reported well-being. Other clinical variables were also evaluated, including depressive symptoms, BPD symptoms, functionality, self-compassion, and self-criticism. Participants in the experimental arm showed a significant increase in indicators of well-being (e.g., happiness and quality of life) and a significant decrease in depressive symptoms. These results were sustained—and even continued to improve—at the three-month follow-up. No significant changes were observed in BPD severity, self-criticism, or self-compassion. More RCTs are needed to test the efficacy of new interventions targeting this population with persistent symptoms, not only to reduce symptoms but also to promote well-being and personal recovery.</div></div>","PeriodicalId":47544,"journal":{"name":"Journal of Contextual Behavioral Science","volume":"34 ","pages":"Article 100846"},"PeriodicalIF":3.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.1016/j.jcbs.2024.100840
Ross G. Menzies , Rachel E. Menzies
This article reviews the central theoretical claims found in the various psychotherapeutic approaches broadly referred to as the existential therapies. Despite substantial differences across existential packages, these therapies broadly arise from the theoretical position that the pain and suffering common to our species arises, not from illnesses hypothesized in traditional medical and psychiatric accounts, but rather from a set of existential concerns that all humans must face. These ‘givens’ of existence include death, identity, isolation, meaning, and freedom. From this theoretical perspective, all branches and brands of psychotherapy need to include some procedures to address these issues. Evidence for the importance of these constructs in human experience is presented, followed by evidence for existential therapies themselves. A dearth of quality research trials establishing a strong evidence base for this branch of therapy was noted. Further, process-based research in this area was shown to be weak. That is, few researchers have sought to show that the hypothesized processes are responsible for the changes observed in existential therapy. We describe how viewing existential therapy through a Process-Based Therapy (PBT) framework and the Extended Evolutionary Meta-Model (EEMM) will encourage: (1) a greater examination of the processes of change occurring; (2) an expansion in the way in which existential therapies operate, enabling the inclusion of procedures drawn from other therapeutic modalities; and (3) more nuanced targeting of existential processes in any given case.
{"title":"Existential therapies and the extended evolutionary meta-model: Turning existential philosophy into process-based therapy","authors":"Ross G. Menzies , Rachel E. Menzies","doi":"10.1016/j.jcbs.2024.100840","DOIUrl":"10.1016/j.jcbs.2024.100840","url":null,"abstract":"<div><p>This article reviews the central theoretical claims found in the various psychotherapeutic approaches broadly referred to as the existential therapies. Despite substantial differences across existential packages, these therapies broadly arise from the theoretical position that the pain and suffering common to our species arises, not from illnesses hypothesized in traditional medical and psychiatric accounts, but rather from a set of existential concerns that all humans must face. These ‘givens’ of existence include death, identity, isolation, meaning, and freedom. From this theoretical perspective, all branches and brands of psychotherapy need to include some procedures to address these issues. Evidence for the importance of these constructs in human experience is presented, followed by evidence for existential therapies themselves. A dearth of quality research trials establishing a strong evidence base for this branch of therapy was noted. Further, process-based research in this area was shown to be weak. That is, few researchers have sought to show that the hypothesized processes are responsible for the changes observed in existential therapy. We describe how viewing existential therapy through a Process-Based Therapy (PBT) framework and the Extended Evolutionary Meta-Model (EEMM) will encourage: (1) a greater examination of the processes of change occurring; (2) an expansion in the way in which existential therapies operate, enabling the inclusion of procedures drawn from other therapeutic modalities; and (3) more nuanced targeting of existential processes in any given case.</p></div>","PeriodicalId":47544,"journal":{"name":"Journal of Contextual Behavioral Science","volume":"34 ","pages":"Article 100840"},"PeriodicalIF":3.4,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2212144724001200/pdfft?md5=63409ce5a89376292fe26f1b78d62ed2&pid=1-s2.0-S2212144724001200-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142241668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1016/j.jcbs.2024.100838
Sunkyung Yoon , Sooyeon Kim , Sinhae Cho , Hyewon Choi
Experiential avoidance, a central treatment target of Acceptance and Commitment Therapy (ACT), involves avoiding uncomfortable internal states and trying to control them. While some researchers suggest several components of ACT align with East Asian values, indicating the possibility of lower experiential avoidance among East Asians compared to Westerners, previous cross-cultural studies have challenged this notion. This study aimed to draw conclusions regarding cultural differences in experiential avoidance between East Asian and Western cultures through two studies. Using a meta-analysis in Study 1, we systematically reviewed previous cross-cultural studies that compared experiential avoidance between the two cultures. Six cross-cultural studies were included in the meta-analysis. In Study 2, we sought to replicate the findings using a large sample of college students. Across studies, East Asians reported greater experiential avoidance compared to Westerners, with significant heterogeneity in effect sizes observed (Study 1). Results from Study 2 showed that being an East Asian predicted greater experiential avoidance when accounting for distress and other covariates. Further, the correlation between experiential avoidance and distress was weaker among East Asian students relative to White students. Our results highlight that elevated levels of experiential avoidance in East Asians may need to be interpreted differently in clinical setting, while within-culture individual differences also need to be considered.
{"title":"Avoiding the unwanted: A cross-cultural comprehensive analysis of experiential avoidance and a meta-analysis","authors":"Sunkyung Yoon , Sooyeon Kim , Sinhae Cho , Hyewon Choi","doi":"10.1016/j.jcbs.2024.100838","DOIUrl":"10.1016/j.jcbs.2024.100838","url":null,"abstract":"<div><p>Experiential avoidance, a central treatment target of Acceptance and Commitment Therapy (ACT), involves avoiding uncomfortable internal states and trying to control them. While some researchers suggest several components of ACT align with East Asian values, indicating the possibility of lower experiential avoidance among East Asians compared to Westerners, previous cross-cultural studies have challenged this notion. This study aimed to draw conclusions regarding cultural differences in experiential avoidance between East Asian and Western cultures through two studies. Using a meta-analysis in Study 1, we systematically reviewed previous cross-cultural studies that compared experiential avoidance between the two cultures. Six cross-cultural studies were included in the meta-analysis. In Study 2, we sought to replicate the findings using a large sample of college students. Across studies, East Asians reported greater experiential avoidance compared to Westerners, with significant heterogeneity in effect sizes observed (Study 1). Results from Study 2 showed that being an East Asian predicted greater experiential avoidance when accounting for distress and other covariates. Further, the correlation between experiential avoidance and distress was weaker among East Asian students relative to White students. Our results highlight that elevated levels of experiential avoidance in East Asians may need to be interpreted differently in clinical setting, while within-culture individual differences also need to be considered.</p></div>","PeriodicalId":47544,"journal":{"name":"Journal of Contextual Behavioral Science","volume":"34 ","pages":"Article 100838"},"PeriodicalIF":3.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142169448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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