Journal of Contextual Behavioral Science最新文献

Background

Given the high prevalence of depression worldwide, there is a pressing need for increasing treatment accessibility and identifying treatment modalities that can sustainably address depression. The present study aims to test the feasibility, acceptability, outcomes and mechanisms of a brief online self-help program for depressive symptoms in adults (nCompass), based on Contextual Schema Therapy principles.

Method

102 participants scoring above 14 on the Beck Depression Inventory – Second Version were recruited online and randomly allocated to either the 15-day nCompass intervention or a self-administered online psychoeducation group. Participants filled in self-report measures of depression, schema coping and psychological flexibility at baseline, immediately following the intervention and at a two-week follow-up. Additionally, nCompass participants were administered an instrument measuring the acceptability of the program.

Results

The nCompass intervention was overall feasible and acceptable, with most participants completing the intervention and assessing it as easy to use, satisfactory and useful. Furthermore, results indicate higher decreases in depression and schema coping in the nCompass group by follow-up, compared to the control group. Changes in depressive symptoms from pre-test to post-test and follow-up in the nCompass group were explained by changes in surrender coping. There were no significant differences in psychological flexibility between the groups at either post-test or follow-up.

Discussion

Our results highlight the nCompass program as a promising option for treating depressive symptoms in the general population.

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.

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.

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 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.

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 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.