Journal of Contextual Behavioral Science最新文献

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.

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.

Young adult sexual minority men are at heightened risk for psychological distress (i.e., depression and anxiety). Mounting evidence suggests the adverse consequences of distal stigma, and existing frameworks (the Minority Stress Theory and Psychological Mediation Framework) posit that distal minority stress may impact psychological distress through minority stress-specific processes, such as internalized homonegativity, as well as general psychological vulnerability factors, such as emotion dysregulation. There is a lack of research examining this process integrating both frameworks and understanding potential resilience factors such as mindfulness and self-compassion and where they may assert impact. Using structural equation modeling, the current study investigated the relationship between distal minority stress, measured by heterosexist discrimination, and psychological distress (i.e., depression and anxiety) through a serial indirect effect via internalized homonegativity and emotion dysregulation, while including internalized homonegativity and emotion dysregulation for their unique indirect effects separately, among young adult sexual minority men (n = 307). Further, the study explored mindfulness and self-compassion as potential moderators in subsequent models. Results indicate that two significant paths explain the association between heterosexist discrimination and psychological distress, including through internalized homonegativity and emotion dysregulation as a serial indirect path, as well as through internalized homonegativity alone. Both mindfulness and self-compassion emerged as protective factors in the “upstream” part of the model, particularly in the effect of heterosexist discrimination on internalized homonegativity. Contrary to expectation, both mindfulness and self-compassion had a strengthening impact on the positive association between internalized homonegativity and emotion dysregulation. Findings support the conceptualization of emotion dysregulation as a “downstream” effect of minority stress, as well as adapting and utilizing mindfulness and self-compassion to alleviate the impact of distal minority stress. Additional longitudinal research, particularly rigorously designed clinical trials, is needed to further evaluate such intervention programs.

This paper delves into the examination of cognitive behavioral therapy (CBT), a therapeutic modality reliant on both longitudinal and cross-sectional biopsychosocial data regarding the client, through the lens of evolutionary language within a process-based therapy (PBT) framework. The exposition commences with an elucidation and delineation of pivotal features and assumptions underpinning CBT, encompassing its philosophical foundations, postulated change processes, and the empirical research substantiating these processes. We posit ideas for clinicians to enhance their case formulation by incorporating process-based principles into CBT, invoking concepts such as variation, selection, retention, and contextual fit. Furthermore, we offer a case illustration and a treatment plan utilizing a network-based approach. In conclusion, we explore potential strengths, barriers, and future trajectories for PBT. Although CBT has predominantly undergone scrutiny as a treatment protocol in group-level outcome studies, we assert that CBT inherently operates as a process-driven model, as evidenced by established metrics assessing therapist competence in its implementation. Specifically, we illustrate how the judicious selection and utilization of specific procedures (techniques) targeting change processes emanate from an individualized and integrative case formulation. This formulation is rooted in the evidence supporting the chosen procedure, aligned with the client's preferences and goals, and embedded within the in-session process of selecting, planning, and reviewing between-session homework. CBT, therefore, emerges as a model for clinical practice and training characterized by inherent pragmatism, integrativeness, and transtheoreticism. It aligns seamlessly with the emphasis on process-informed, person-centered, evidence-based treatment within the PBT framework.

Introduction

The psychological inflexibility model proposes several transdiagnostic processes maintaining psychological distress and is one of the models forming the basis of Acceptance and Commitment Therapy (ACT). ACT has been used as an intervention for psychosis but prior to the present review and meta-analysis (PROSPERO ID: CRD42022369048) the relationship between psychological inflexibility and other ACT processes in the context of psychosis or psychosis-like symptoms has not been investigated.

Method

A Literature search of PsychINFO, Medline, PsychArticles, Web of Science and Embase was conducted, and methodological quality assessed. 655 titles were screened and were included if they explored the relationship between psychological inflexibility (experiential avoidance, cognitive fusion, values clarity, committed action) and psychosis or psychosis-like symptoms in the general population.

Results

A total of 35 studies were included in this review. Most studies were cross sectional and rated moderate in their methodological quality. Meta-analyses revealed a large effect of psychological inflexibility on paranoia, medium effect on delusions, small effect on auditory hallucinations. A medium effect of cognitive fusion on paranoia was found and medium effect size when comparing group differences (psychosis vs controls) in psychological flexibility. Additional findings (mostly mediation and moderation effects) not included in the meta-analyses are reported.

Discussion

The overall evidence suggests that there is a significant relationship between psychological flexibility and psychotic symptoms, particularly paranoia. This provides evidence supporting the use of interventions which target these processes in the context of psychosis. Limitations and future directions are discussed.

Acceptance is an important construct in various psychological models seeking to describe psychological distress and emotion regulation. Existing measures either focus on broader constructs like psychological flexibility or lack proper validation. There are no established tools which measure acceptance as a general process, as defined within Acceptance and Commitment Therapy (ACT). The absence of valid and reliable measures impedes research on acceptance processes in clinical change. To address this, we developed the Southampton Experiential Avoidance and Acceptance Scale (SEAAS). Across four studies an item pool was generated, evaluated, and refined into an 18-item scale with a theoretically coherent two-factor structure. The SEASS demonstrates strong psychometric properties, including excellent internal consistency, convergent, concurrent, and discriminant validity, and test-retest reliability. This scale is a promising new tool for assessing acceptance and experiential avoidance.

Introduction

This study illustrates how mindfulness and acceptance-based intervention (MABI) can change metacognitions and executive functions among individuals with anxiety disorders.

Methods

Forty-five Iranian individuals (mean [SD] age, 24.60 [4.94] years; 51.1 % female) with comorbid anxiety disorders participated in a randomized, waitlist-controlled trial of weekly group sessions of either MABI or waitlist control (WLC). Primary and process of change outcomes were assessed at baseline, post-intervention, and 1-month follow-up.

Results

Significant changes were observed over time on anxiety symptoms (Cohen d = 1.04, 95% CI [0.40 ± 1.65]), as well as on metacognitive beliefs (Cohen d = 1.04, 95% CI [0.40 ± 1.64]), executive functions (Cohen d = 0.91, 95% CI [0.28 ± 1.51]), and mindfulness facets (Cohen d = 0.97, 95% CI [0.34 ± 1.58]), in favor of MABI over WLC.

Conclusions

Overall, findings add to the knowledge in the field and provide cross-cultural evidence in support of MABIs as interventions that target anxiety symptoms, metacognitive beliefs and executive functions in a non-Western culture.

Psychological flexibility and resilience represent adaptive functioning and the pursuit of values in the presence of adversity such as during the COVID-19 pandemic. Understanding the conceptual and functional differences between these constructs is essential given their overlapping roles as key protective factors. This study involved 1059 participants from a Korean community sample who completed self-reported surveys measuring psychological flexibility, resilience, and mental health outcomes. Network analysis was used to create a sparse network comprising six nodes for psychological flexibility and ten nodes for resilience. Bridge strength centrality was estimated to identify the nodes connecting the two constructs. In addition, we employed a relative weights analysis to evaluate the relative significance of each psychological flexibility process on mental health outcomes while accounting for the composite resilience score. Within the psychological flexibility cluster, “Leaving thoughts be,” “Steady self,” “Awareness of value,” and “Being engaged” emerged as bridge elements, with “Steady self” exhibiting the highest bridge strength. Additionally, different patterns were observed in the unique contribution of each psychological flexibility process to positive and negative mental health outcomes. These findings suggest the potential role of “Steady self” as a catalyst for the transfer of skills and coping mechanisms between the different dimensions of psychological flexibility and resilience. The influential processes identified in this study had predictive value in their association with mental health outcomes. Future directions and implications are discussed.

This pilot study evaluates the feasibility and efficacy of a brief (four-week) predominantly self-help acceptance and commitment therapy (ACT) intervention (“Full Palliative Living”) in improving palliative patient primary outcomes (death attitudes, distress, pain, and quality of life) and a secondary outcome psychological flexibility (PF) within a palliative care (PC) setting. A quasi-experimental non-equivalent group design was used with pre- and post-intervention assessments with two groups: intervention (n = 52) and comparison (n = 54). Across three sets of analyses (mixed within/between ANCOVAs, intervention group t-tests and reliable change index), results demonstrated beneficial intervention effects for distress and PF at post-intervention. Mediation analyses showed that increases in PF mediated improvements in distress. Feasibility of delivering the intervention in a frontline PC service was supported by intervention acceptability and adherence ratings, intervention engagement, and participants’ perceptions of intervention helpfulness. The intervention effects on distress are noteworthy given the high prevalence of distress and the self-reported prioritisation of help-seeking for distress among PC patients. The Full Palliative Living program has the potential to make a significant contribution to a holistic approach to PC.

Background

Refugees, particularly unaccompanied refugee minors (URM), often report poor mental health. Psychological Flexibility (PF), derived from Acceptance and Commitment Therapy (ACT), appears to positively impact mental health in various populations, including adolescents and refugees.

Objectives

This study aimed to examine the structure of the PF model and the connections among its core processes, as well as the structure and connections between mental health constructs (i.e., post-traumatic stress, depression, anxiety, stress, quality of life) and PF in URM.

Methods

100 URM aged 13–18 years living in shelters in the Republic of Cyprus completed four self-reports, assessing depression, anxiety, and stress (DASS-21), PF (Psy-Flex), PTSD (CRIES-13), and HRQL (KIDSCREEN-10). Network Analysis was used to examine the structure and connections of the constructs.

Results

Most core PF processes showed positive connections amongst each other, with the strongest edge between committed action and values. Together with self as context, these core processes exhibited the highest expected influence. The strongest positive connections in the mental health network were found among stress, anxiety, and depression. Stress had the highest expected influence, whereas PF had the lowest. A post hoc Johnson-Neyman analysis suggested a buffering effect of PF on the impact of PTSD on anxiety and stress.

Conclusions

Proposed areas of focus for clinicians working with URM include incorporating strategies that address stress symptoms and facilitate individuals in pursuing value-based behavior. It is equally important to encourage critical reflection on values and the conceptualized self in the context of culture.