Journal of Contextual Behavioral Science最新文献

Introduction

Over 80% of patients with Chiari Malformation (CM) struggle with moderate to severe disability due to neck pain and headaches. Self-guided online Acceptance and Commitment Therapy (ACT) is efficacious in addressing chronic pain. However, it is unclear whether adjunctive weekly phone coaching (a cost- and labor-intensive component of the intervention) contributes to, or provides additional benefit to, ACT's success.

Method

This study randomized 112 participants with CM to ACT + Coaching, ACT-Only, or WC (WC) groups. Participants completed a baseline survey, weekly assessments, a self-guided online ACT intervention, and a one-month follow-up survey. Primary outcomes were psychological flexibility (PF) and chronic pain acceptance; secondary outcomes included pain intensity, pain interference, depression, and anxiety.

Results

There were no differences between the ACT + Coaching and ACT-Only groups on chronic pain acceptance, pain interference, or anxiety; however, there was a small but statistically significant effect favoring ACT + Coaching for depression and PF. Compared to the WC group, both the ACT + Coaching and ACT-Only groups significantly improved in chronic pain acceptance, and anxiety. Adherence was high (91% completed all sessions) and equivalent between conditions. Participants reported coaching was helpful and important, but there were no group differences in intervention satisfaction.

Discussion

There were no differences between treatment groups on most outcomes, intervention satisfaction, engagement, or adherence. Online ACT without adjunctive phone coaching may be a cost- and time-efficient option to address chronic pain acceptance and anxiety, but additional research is needed to establish and improve efficacy for other outcomes.

Clinical Trials Registration

NCT05581472

This trial aimed to assess the effect of an acceptance and commitment therapy (ACT) and mindfulness-based intervention on the various psychological and physical issues associated with obesity. A parallel group randomized controlled trial was conducted with 142 adults with body mass indexes in the overweight or obesity range seeking treatment. Participants were assigned either to the ACT and mindfulness-based group intervention (Mind&Life intervention) plus treatment as usual (TAU) or the TAU-only condition. Individuals receiving the Mind&Life intervention with TAU showed more adherence to the Mediterranean diet, and greater decrease in external eating, weight, and visceral fat both at posttreatment and at 6-month follow-up. Moreover, they displayed a greater reduction in total protein and animal protein intake and GPT enzymes level. By 6-month follow-up, the Mind&Life group experienced a lower impact of weight on quality of life than TAU participants. However, Mind&Life intervention completers showed greater restrained eating levels at follow-up. Overall, this study suggests that an ACT and mindfulness-based group intervention could produce improvements in the impact of weight on quality of life, some eating behaviors, dietary habits, and weight and body composition parameters of people facing weight-related challenges.

This scoping review examines 29 experimental studies on behavioral interventions aimed at teaching perspective-taking (PT) skills, identified through a comprehensive search strategy (PROSPERO: CRD42021252722) and adhering to the PRISMA-ScR guidelines. The review aimed to (1) identify PT enhancement protocols and their components, (2) assess behavioral measures of protocol efficacy, and (3) describe demographic, bibliometric, and ethical study characteristics. Key findings include a diversity in PT conceptualization aligned with two main theoretical approaches, the Non-Derived and the Derived Response approach, which can hinder comparability. Despite methodological differences, common teaching strategies such as prompting, modeling, and differential reinforcement are prevalent. The results indicate a notable shift from the Non-Derived to the Derived Response approach over time. Most participants were boys under ten with autism or other neurodivergences, and Single-Subject Designs were predominant. Additionally, many studies did not report the geographical origins of participants, which is crucial for understanding the cultural context in perspective-taking research. There were also notable shortcomings in some methodological and ethical aspects, including the lack of participant diversity, insufficient assent from minors, and inadequate reporting of social validity and conflict of interest. The review underscores the need for improved methodological rigor and ethical standards to enhance study comparability and replicability. Future research should calculate effect sizes to provide quantitative measures of intervention effectiveness, thereby advancing the field's understanding of the practical implications of behavioral interventions for PT skills.

Addressing mental health needs among parents of children with Special Health Care Needs (SHCN) requires improved access to effective interventions. This study assessed the satisfaction, skills implementation intention, and psychological flexibility of frontline paraprofessionals providing family and child rehabilitation services for families of children with SHCN in Hong Kong following participation in a Focused Acceptance and Commitment Therapy Skills Training (FACT-ST) program. The training program comprised two phases: an initial foundation training stage (i.e., the FT group), which provided theoretical instruction on ACT, and a subsequent supervised practice stage (i.e., the FT + SP group), during which participants were required to conduct at least three video-conferencing FACT sessions with parents of children with SHCN under supervision. A diverse sample of 317 paraprofessionals participated, with 246 completing the foundation training and an additional 71 completing both training phases. The FACT-ST program was positively received, as indicated by high average client satisfaction questionnaire scores. In the FT + SP group, paired sample t-test indicated that the mean total skills implementation intention score remained consistent at the 3-month follow-up (M = 36.65, SD = 7.56) when compared to the 2-week follow-up (M = 36.00, SD = 8.28, P = 0.063). Repeated measures analysis of covariance showed significant improvements in psychological flexibility from baseline to the 3-month follow-up in both the FT (F = 57.57, P = < 0.001, ηp² = 0.20) and the FT + SP groups (F = 19.06, P = < 0.001, ηp² = 0.24). Qualitative feedback highlighted the utility of live demonstrations, experiential exercises, and collaborative interactions during training. Our findings are one of the first affirming both the feasibility and acceptability of the FACT-ST program for paraprofessionals working with parents of children with SHCN. The findings underscore the potential of paraprofessionals to become crucial contributors to the mental health care system, addressing service gaps within the community.

Experiential avoidance and cognitive fusion, the two interrelated processes central to psychological inflexibility according to Acceptance and Commitment Therapy, were theoretically and empirically related to adolescent suicidal ideation. However, the longitudinal interaction among experiential avoidance, cognitive fusion, and adolescent suicidal ideation has yet to be empirically examined. As such, our study aims to examine the longitudinal reciprocal relationships among these variables using the cross-lagged panel model (CLPM) and random intercept cross-lagged panel model (RI-CLPM). A total of 1720 Chinese adolescents (54.6% females; M_age = 14.44, SD_age = 1.35) completed self-reported questionnaires regarding experiential avoidance, cognitive fusion, and suicidal ideation on three occasions, using 6-month intervals. The results showed that in CLPM, experiential avoidance, cognitive fusion, and suicidal ideation positively predicted each other. However, RI-CLPM only provided support for the longitudinal interaction between experiential avoidance and cognitive fusion as well as the role of suicidal ideation in exacerbating experiential avoidance and cognitive fusion. The findings highlight that suicidal ideation may lead to increased levels of experiential avoidance and cognitive fusion in adolescents and the need to distinguish between within-person and between-person effects when studying the relationship between psychological inflexibility and adolescent suicidal ideation.

The field of psychotherapy research increasingly recognizes the need for idiographic studies linking process of change to outcomes. However, investigations have typically focused on successful outcomes alone, neglecting the analysis of specific behaviors connected to treatment failure. This study aims to link process to both effective and ineffective outcomes. By examining 80 psychotherapy sessions across 13 cases with a mixed-method approach, a turn-by-turn conversational analysis was carried out. After detecting different levels of effectiveness following a multiple baseline design, sequential analysis and intra- and inter-case comparisons were performed. The results indicated that while differential reinforcement of target behavior was found to be related to both successful and unsuccessful outcomes, the defining characteristics of effective sessions were the preciseness of specific strategies and the predominance of appetitive over aversive stimulation throughout the intervention. These findings revealed that splitting units into linear relations to analyze psychotherapeutic interaction might be insufficient. Instead, addressing not only the presence but also the absence and concurrence of covariation associated with the events of interest could be a determining factor in unveiling the processes leading to different outcomes in psychotherapy.

There is growing interest in the role of psychological flexibility as a potential resilience factor in workplace settings for protecting employees against the risk of job burnout. This field study contributes to the literature by investigating the utility of delivering brief ACT-informed training to the entire regional workforce of an innovation and manufacturing organization. A total of 504 employees attended the training, 281 of whom completed study measures prior to the training and three months later. Across the 3-month timeframe, participants reported a statistically small and significant increase in work-related psychological flexibility. Increased psychological flexibility was associated with improved stress resilience, reduced exhaustion, and increased personal accomplishment. No change was observed on the depersonalization component of burnout or task performance. Moderation analyses revealed that residual change associations between work-related psychological flexibility and both exhaustion and resilience were stronger among participants with higher baseline exhaustion. By contrast, work-related psychological flexibility trended toward a stronger residual change relationship with personal accomplishment among participants with lower baseline exhaustion. We interpret these findings from the perspective of resource-based theories of workplace functioning, and highlight the potential of cultivating psychological flexibility as part of organization-wide personnel development initiatives.

The present study compared multi-methodically and multi-dimensionally the effects of acceptance and avoidance coping with emotional pain, both between and within-group. Convenience sampling was used, with 88 participants included (81.8% females; Mage = 21.75 years) and being randomly assigned to one of two instructed groups: (a) Acceptance followed by avoidance of pain sensations and thoughts, and (b) Avoidance followed by acceptance. All participants underwent an emotional pain induction procedure three times involving negative autobiographical recall and an emotional-pain standardized script. In the first emotion induction, no instructions were given whereas in the other two, participants were instructed to use the techniques they were trained in. On both autobiographical and emotional-pain script tasks, participants who used firstly avoidance and secondly acceptance exhibited significantly lower mean heart rate and higher mean heart rate variability RR index across time. Also, in the last emotional pain induction, on both tasks, acceptance resulted in lower physiological activation than avoidance. No significant differences were found for the self-report of negative affect. Overall, acceptance vs. avoidance differences were mostly found in the physiological outcomes, suggesting the importance of including objective measures when examining coping techniques. Our findings suggest that ACT's concept of creative hopelessness is supported, as participants may have to use firstly use ineffective coping strategies to better understand what methods are most effective for managing pain. To our knowledge, this study is the first study to compare acceptance vs. avoidance coping with emotional pain both between and within-group, using a multi-method and multi-dimensional approach.

Objectives

The present study examined the feasibility and acceptability of a brief transdiagnostic group-based Acceptance and Commitment Therapy (ACT; Valued Living Program, VLP) versus an active social control condition (Social Discussion Group, SDG) for inpatients admitted for acute mental health conditions.

Method

Participants were group randomised to three sessions of the VLP (n = 17) or the SDG (n = 19) plus treatment-as-usual (TAU). The primary outcomes were service use data (emergency department presentations and inpatient admissions). Participants were assessed at pre-treatment, post-treatment, and at 4 and 12-months post-discharge on quantitative and qualitative secondary outcomes of psychological and behavioural functioning.

Results

Both interventions were rated as acceptable and useful. Primary and secondary outcomes demonstrated a longitudinal pattern of improvement for the VLP condition relative to the SDG condition. Longitudinal drop-out was high, which reduced the reliability of quantitative secondary outcomes.

Conclusions

The VLP appears acceptable to inpatients experiencing acute mental health conditions. Positive initial outcomes support further investigation into the VLP's effectiveness. However, the feasibility of evaluating the VLP via RCT was limited by poor participant retention which might be improved with additional study resources. Further investigation into protocol engagement is also warranted prior to proceeding with a larger RCT.

Women who have obesity engage in healthcare avoidance at a higher rate than women in the normal weight range. Body mass index (BMI) and weight stigma are positively correlated and women who have obesity report weight-related concerns as reasons for healthcare avoidance. The current study examined whether body-image related psychological inflexibility and cognitive fusion moderate the relationship between weight-related stigma and healthcare avoidance. Female participants with obesity (n = 261) were recruited on Prolific and completed surveys online. Results showed that inflexibility and cognitive fusion moderated the relationship between stigma and healthcare avoidance. Future studies could examine the effectiveness of interventions targeting psychological inflexibility and fusion to decrease healthcare avoidance. There is also a clear need to target weight bias within society, healthcare systems, and healthcare providers.