Acceptance & Action Questionnaire (AAQ) and Variations

Acceptance and Action Questionnaire - II (AAQ-II)

The AAQ-II was developed in order to establish an internally consistent measure of ACT’s model of mental health and behavioral effectiveness. Although the original AAQ (Hayes, Luoma, Bond, Masuda and Lillis, 2006), obtaining sufficient alpha levels for it has at times been a problem. It appears that there are several reasons for this (e.g., scale brevity, item wording, item selection procedures), and they were addressed in developing the AAQ-II. As a result, it is recommended that researchers and practitioners use this newer scale instead of the original AAQ (which from here forward will be termed the AAQ-I).

The AAQ-II was designed to assess the same construct as the AAQ-I and, indeed, the two scales correlate at .82. Thus, the AAQ-I can still be used, and findings based on it are still relevant, but it is perhaps psychometrically safer to use the AAQ-II. The reference for the AAQ-II is: Bond, F.W., Hayes, S.C., Baer, R.A., Carpenter, K.M., Orcutt, H.K., Waltz, T. & Zettle, R.D. (Submitted).

Preliminary psychometric properties of the Acceptance and Action Questionnaire – II: A revised measure of psychological flexibility and acceptance. (Note that authorship order was alphabetically determined for Carpenter, Orcutt, Waltz, and Zettle.)

What do we call ACT's model of mental health and behavioral effectiveness? (Or, what does the AAQ-I and -II measure?)

[Taken from Bond et al. (Submitted)]

When ACT was originally developed, the overarching term for its underlying model was experiential avoidance – the attempt to alter the form, frequency, or situational sensitivity of negative private events (e.g., thoughts, feelings, and physiological sensations), even when doing so leads to behavioral difficulties (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). Acceptance was the term used to positively describe this model; thus, it is defined as the willingness to experience (i.e., not alter the form, frequency, or sensitivity of) unwanted private events, in the pursuit of one’s values and goals.

The ACT model has matured over the years, with more emphasis on the dynamic and flexible fit between context, private experiences and valued action, which have always been inherent in the model. Such flexibility is seen when ACT therapists note that sometimes persisting in behavior is helpful, while at other times changing it is helpful: it depends upon the value- and goal-related opportunities that are available in a given context. Furthermore, as other parts of the ACT model are now given emphasis (e.g., cognitive defusion, contacting the present moment, mindfulness, and perspective-taking), experiential avoidance and, hence, acceptance are taking on a narrower meaning and are being used less often as terms for the overarching model (Hayes et al., 2006). Instead, the term psychological flexibility (or flexibility) is now being used to describe this model. It is defined as the ability to fully contact the present moment and the thoughts and feelings it contains without needless defense, and, depending upon what the situation affords, persisting or changing in behavior in the pursuit of goals and values (Hayes et al., 2006). While experiential avoidance and acceptance are still useful and acceptable ways to describe this construct, psychological flexibility is the more current and overarching term. In addition, it needs to be acknowledged that in some contexts (e.g., industrial-organizational psychology) it is important to speak of this domain positively (acceptance or flexibility) and in other contexts (e.g., psychopathology) it is easier to speak of it negatively (experiential avoidance or psychological inflexibility). These differences are terminological, not substantive.

The AAQ-II and key psychometric findings for the scale can be found below. Older versions of the AAQ (i.e., AAQ-9, AAQ-16 and AAQ-49) are also listed below.

There are more specific acceptance and defusion measures available. A good measure has been developed in the area of smoking (contact Elizabeth Gifford for more information: elizgifford@earthlink.net); a pain measure developed from the earliest versions of the AAQ called the Chronic Pain Acceptance Questionnaire (CPAQ; see attachments below) has been published and worked very well in this area (contact Lance McCracken for more information: Lance.McCracken@rnhrd-tr.swest.nhs.uk).

Several AAQ measures for specific problems and populations are posted under Disease and disorder specific AAQ variations.

There are also a variety of translated versions of the AAQ and AAQ-II posted under ACT measures in Languages Other than English.

Values Measures

Other values measures are under development.

Kelly Wilson (kwilson@olemiss.edu) or Matthew Smout (matthew.smout@saugov.sa.gov.au) are working on other approaches, and you may want to contact them.

ACT Daily Diary & Weekly Report

The ACT daily diary and weekly report (see attachments below) can be clinically useful in monitoring progress.

ACT measures in Languages Other than English

This page includes a list of translated ACT measures. As a courtesy, if you use these versions in research it is common to contact the translator and let them know of the study -- certainly before publishing it.

Automatic Thoughts Questionnaire - ATQ (F&B)

The Automatic Thoughts Questionnaire (ATQ; Hollon & Kendall, 1980). The ATQ measures depressogenic thought frequency. This measure is commonly used in depression studies examining the impact of cognitive therapy. However, the ATQ-B is a revision to this measure by Jacobson and colleagues (ATQ-B, Addis & Jacobson, 1996) aimed at assessing the believability of these depressive thoughts if they occur and it has been used as a proxy measure for defusion in the ACT community. We recommend that you use both subscales; the ATQ-F for frequency of automatic/depressive thoughts and the ATQ-B for believability of (or fusion with) these thoughts.

Scoring for the measure is typically a simple sum score for the F sub scale and the B sub scale. The F and B scores can be used in analyses as separate entities and have been shown to be differentially related to outcomes (e.g., frequency of thoughts was not reduced at post treatment but believability of them was reduced) in studies of depression using behavioral interventions.

Reference: Zettle, R. D. & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: The context
of reason giving. The Analysis of Verbal Behavior, 4, 30 38.

Behavioral Measures for Lab-Based Studies

This page includes behavioral measures used in laboratory-based studies.

Child and Adolescent Specific ACT-Related Measures

This page contains a working list of child and adolescent specific measures related to ACT processes.

Computerized measures

In this page I have uploaded a series of computerized measures that I have written in Visual Basic for Applications and used in a few studies. One of these measures, the Deictic Relational Task is a deictic framing measure that captures both deictic accuracy and fluency. We have been developing this measure over the last years with Michael Levin, Steven C. Hayes, Colin Stromberg and others.

There are many advantages to use Microsoft PowerPoint to write your computerized questionnaires and tasks. First of all, it is a highly disseminated software that I think most of you have. Secondly, it can potentially reduce acquiescence bias since you can change the background and format of each measure and you will be more likely to keep the participant's attention throughout.

The code of these slides (which you can find if you add the developer tab under options and click "visual basic") is freely available for modification and improvement as long as your intent is to benefit your clients, research and/or for enhancing the work of other scientist practitioners and researchers. Please, feel free to contact me if you find ways to improve the visual basic code or for questions about it. If you have questions about how to score the Deictic Relational Task or about how to compile all the measures together in a single PowerPoint document, let me know as well.

Note: make sure you enable macro before you try the measure (ex: Powerpoint Options/Trust Center/Trust Center Settings/Macro Settings/Enable all macros).

Disease and disorder specific AAQ variations

There are many measures of ACT concepts that have been developed for specific disorders, syndromes, and types of chronic disease.

Fusion Measures

Partial list of fusion measures.

Mindfulness Measures

Partial list of available mindfulness measures.

Other ACT-Related Measures

This page is a working list of other measures related to ACT processes.

Process measures packet (Ciarrochi & Bilich, 2006)

Ciarrochi, J. & Bilich, L. (2006). Process measures of potential relevance to ACT. Unpublished manuscript, University of Wollongong, Australia.

This document contains a large collection of ACT-relevant measures

Ciarrochi & Bilich, 2006

Self-Care Monitoring Forms

Attached, please find a copy of self-monitoring forms I use with a wide range of patients. I direct patients to monitor those self-care behaviors relevant to their treatment (hygiene, eating, going to sleep at reasonable hour, exercise, meditation/centering, alcohol use). There is ample room for adding other behaviors or to permit some journaling/notes. *I recently replaced the GIF formatted forms with forms converted to PDF format (using free PDF writer at www.gohtm.com).

ACT for addictions: Studies and publications

 

Below is summarized existing ACT empirical articles and references related to substance abuse, gambling, and recovery. Please contribute by adding to it if you see that references are missing.

Gambling related references:

Dymond & Whelan (2007). Verbal relations and the behavior analysis of gambling. Analysis of Gambling Behavior, 1, 19-20

Non empirical publications on substance abuse

Batten, S. V., DeViva, J. C., Santanello, A. P., Morris, L. J., Benson, P. R., & Mann, M. A. (2009). Acceptance and Commitment Therapy for comorbid PTSD and substance use disorders. In J. Blackledge, J. Ciarrochi, & F. Dean (Eds.), Acceptance and Commitment Therapy: Current Directions (pp. 311-328). Queensland, Australia: Australian Academic Press.

Heffner, M. & Eifert, G. (2003). Valued directions: Acceptance & Commitment Therapy in the treatment of alcohol dependence. Cognitive and Behavioral Practice, 10, 378-383.

Smout, M. (2008). Psychotherapy for Methamphetamine Dependence. Drug and Alcohol Services South Australia 2008: 429.http://www.dassa.sa.gov.au/webdata/resources/files/Methamphetamine_Treatment_Manual_FINAL.pdf

Wilson, K. G. & Byrd, M. R. (2004). Acceptance and Commitment Therapy for Substance Abuse and Dependence. In S. C. Hayes & K. Strosahl, (Eds.)A Practical Guide to Acceptance and Commitment Therapy (pp. 153-184). New York: Springer Press. (preprint available from 1st author -- click on his name above.)

Wilson, K. G. & Hayes, S. C. (2000). Why it is crucial to understand thinking and feeling: an analysis and application to drug abuse. The Behavior Analyst, 23, 25-43.

Wilson, K. G., Hayes, S. C., & Byrd, M. (2000). Exploring compatibilities between Acceptance and Commitment Therapy and 12-Step treatment for substance abuse. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 18, 209-234.

Substance abuse research

Batten, S. V., & Hayes, S. C. (2005). Acceptance and Commitment Therapy in the Treatment of Comorbid Substance Abuse and Post-Traumatic Stress Disorder: A Case Study. Clinical Case Studies, 4(3), 246-262.

Brown, R. A., Palm, K. M., Strong, D. R., Lejuez, C. W., Kahler, C. W. Zvolensky, M. J., Hayes, S. C., Wilson, K. G., Gifford, E. V. (2008). Development of an exposure- and ACT-based distress tolerance treatment for early lapse smokers: Rationale, program description, and preliminary findings. Behavior Modification, 32, 302-332.

Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M.., Rasmussen-Hall, M. L., & Palm, K. M. (2004). Acceptance theory-based treatment for smoking cessation: An initial trial of Acceptance and Commitment Therapy. Behavior Therapy, 35, 689-705.

Hayes, S. C., Wilson, K.G., Gifford, E.V., Bissett, R., Piasecki, M., Batten, S.V., Byrd, M., & Gregg, J. (2004). A preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance-abusing methadone-maintained opiate addicts. Behavior Therapy, 35, 667-688.

Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K. & Rye, A. K. (2008). Reducing the self stigma of substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes. Addiction Research & Therapy, 16, 149-165.

Stotts, A. L., Masuda, A., & Wilson, K. G. (in press). Using Acceptance and Commitment Therapy in methadone dose reduction: Rationale, treatment description, and preliminary cases. Cognitive and Behavioral Practice.

Twohig, M. P., Shoenberger, D., & Hayes, S. C. (2007). A preliminary investigation of Acceptance and Commitment Therapy as a treatment for marijuana dependence in adults. Journal of Applied Behavior Analysis, 40,619-632.

Tull, M., Schulzinger, D., Schmidt, N.B., Zvolensky, M.J., Lejuez, C. W. (2007). Development and initial examination of a brief intervention for heightened anxiety sensitivity among heroin users. Behavior Modification, 31, 220-242.

How to Do ACT Micro-Component Studies

This is a modified list of features that Dermot Barnes-Holmes presented at the first ACT Summer Institute in Reno in 2003. I (SCH) have added a few things as well

A List of Features that ACT Micro-Component Studies and Experimental Analogs of ACT Processes Should Contain

Here is a list of features that we consider to be essential for conducting top quality experimental research that is designed to model and test ACT processes in analog or micro-component research. There are almost certainly others and the relative emphasis that is placed on each one will vary as a function of the research question and overall design of the study.

1. The experimenter should be blind to the intervention applied to each participant (or the procedure automated; see below).

2. The experimental conditions must balance as much as possible for all relevant attribute variables (e.g., gender, psychopathology, unless the attribute(s) is the target of the analysis).

3. The experimenter should not be personally familiar with the participants and if they are, familiarity should be balanced across conditions.

4. The different interventions should be balanced in all possible ways, except for the critical difference you are seeking to manipulate (e.g., they should be the same length; they require similar levels of engagement with the material; if exercises are used that are appropriate for both conditions, they should be used in both; working should be matched where possible; method of delivery should be identical; etc).

5. The interventions should connect directly to the experimental challenge. In a pain tolerance study, for example, each of the interventions should focus on pain not anxiety or anger etc. (unless different foci are the target of the study).

6. Points 4 and 5 should be checked and supported by independent raters.

7. Where possible and appropriate, the procedure should involve requiring participants to articulate in their own words the intervention strategy that is being provided. Ideally this should be done at regular points throughout the intervention.

8. The verbal material produced under point 7 should be checked by independent raters to determine that participant “understanding” did not differ significantly across conditions, and to ensure that the manipulation successfully altered the intended behavioral process.

9. Participants should be reminded briefly of the relevant intervention strategy before the presentation of each physical or psychological challenge (e.g., CO2 inhalation, electric shock delivery, emotionally aversive pictures or video clips, spider BAT, etc).

10. Ideally, the entire procedure, including pre-intervention baseline, intervention, and post-intervention tasks should be automated. For example, the intervention could be presented via audio or video clips and these can then be checked by independent raters. Moreover, others can then take your automated procedure and attempt to replicate in a different lab. If automation is not possible, then every session should be videotaped to check for fidelity. If only some sessions are videotaped, then the experimenter should not know which ones are being taped.

11. All participants should be asked to summarize at the very end of the experiment the strategy they employed during the study so that these can be checked by independent raters.

12. Other questions of relevance should also be asked that might alter the interpretation of results. For example the participant might be asked to rate the likability or believability of the experimenter (including any video- or audio-based material), expectations for performance on the task, relevance of intervention to "real life", etc.

13. Ideally, some form of standardized self-report or other instrument should be developed to measure the extent to which participants understand and apply specific strategies.

14. For ACT / RFT studies the design of the protocols should be tied clearly to RFT concepts. Studies should not just grab a metaphor or exercise without working through how the metaphor/exercise is predicted, theoretically, to influence the participants’ responses in your study.

15. If the study is a group design it should be adequately powered to test the key hypotheses, especially if null results are to be meaningful. For example, if an interaction is possible, each individual cell size must have a large enough N to test that interaction at an adequate level (say, power of .8 assuming a sensible effect size)

16. If mediational analyses are important, the study must be powered to test these analyses.

17. Especially if null results are predicted, make sure the actual measurement characteristics, outliers, and similar
issues do not undermine the calculated power.

18. Meta-analyses of ACT micro-component studies show that in general, rationale-alone interventions are weak (and without the controls specified above they are often difficult to interpret because it is not known what participants actually did in response to the rationale). If the purpose is to examine ACT components, consider including more active and experiential elements.

19. If testing multiple ACT components, consider how to assess for changes in multiple ACT processes and whether comparison conditions should tease apart the impact of individual components.

Example Component Study Files

Attached you will find a series of components (e.g., video, visual basic programs, instructions, etc.) used in ACT micro studies examining the role of values in performance during a cold-pressor pain tolerance task. The study from which these components come is not yet published but many similar studies have used these components in the Barnes-Holmes laboratory at NUI-Maynooth. We hope that they will prove useful to you in developing your own studies. They have been uploaded to the site as compressed zip files but they should be able to be opened easily as their individual files once downloaded.

(unpublished) Self as Context Intervention for Task Persistence

We are in the process of testing the effects of a self-as-context intervention on two measures of task persistence (breath holding and a difficult math task). We used an active control condition involving the same metaphor and exercise, but emphasizing self-as-content and emotion control strategies throughout. The results of the intervention will be analyzed soon and included on this page.

We would really appreciate any feedback regarding the intervention scripts. If you have any comments or suggestions please contact Mike Levin at levinm2@gmail.com.

Data to be presented at
Levin, M., Waltz, T.J., Yadavaia, J.E. & Hayes, S.C. (2008). Examining the effect of a self as context intervention on multiple measures of task persistence. Paper presented at the 34th Annual Convention of the Association for Behavior Analysis International, Chicago, IL.

(unpublished) Values Intervention for Study Behavior

We are currently testing the effects of a brief values intervention on study behavior with college students. The intervention includes a week of self monitoring and is being compared to self monitoring alone without the values intervention. The study is being conducted by Jennifer Plumb, Michael Levin, Kate Morrison and Steven Hayes.

The values condition protocol script is included below. We would really appreciate any feedback regarding the intervention scripts. If you have any comments or suggestions please contact Jen Plumb at jcplumb@gmail.com.

Campbell-Sills et al., 2006

 Campell-Sills, L., Barlow, B.H., Brown, T.A. & Hofmann, S.G. (2006). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy, 44, 1251-1263.

Abstract

The present investigation compared the subjective and physiological effects of emotional suppression and acceptance in a sample of individuals with anxiety and mood disorders. Sixty participants diagnosed with anxiety and mood disorders were randomly assigned to one of two groups. One group listened to a rationale for suppressing emotions, and the other group listened to a rationale for accepting emotions. Participants then watched an emotion-provoking film and applied the instructions. Subjective distress, heart rate, skin conductance level, and respiratory sinus arrhythmia were measured before, during, and after the film. Although both groups reported similar levels of subjective distress during the film, the acceptance group displayed less negative affect during the post-film recovery period. Furthermore, the suppression group showed increased heart rate and the acceptance group decreased heart rate in response to the film. There were no differences between the two groups in skin conductance or respiratory sinus arrhythmia. These findings are discussed in the context of the existing body of research on emotion regulation and current treatment approaches for anxiety and mood disorders.

Protocol included below

Eifert & Heffner, 2003

Eifert, G. H. & Heffner, M. (2003). The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 34, 293-312.

Abstract

The present study compared the effects of creating an acceptance versus a control treatment context on the avoidance of aversive interoceptive stimulation. Sixty high anxiety sensitive females were exposed to two 10-min periods of 10% carbon dioxide enriched air, an anxiogenic stimulus. Before each inhalation period, participants underwent a training procedure aimed at encouraging them either to mindfully observe (acceptance context) or to control symptoms via diaphragmatic breathing (control context). A third group was given no particular training or instructions. We hypothesized that an acceptance rather than control context would be more useful in the reduction of anxious avoidance. Compared to control context and no-instruction participants, acceptance context participants were less avoidant behaviorally and reported less intense fear and cognitive symptoms and fewer catastrophic thoughts during the CO2 inhalations. We discuss the implications of our findings for an acceptance-focused vs. control-focused context when conducting clinical interventions for panic and other anxiety disorders.

The intervention protocol is included below quoted from Heffner (2000).

Feldner et al., 2003

Feldner, M. T., Zvolensky, M. J., Eifert, G. H., & Spira, A. P. (2003). Emotional avoidance: An experimental tests of individual differences and response suppression during biological challenge. Behaviour Research and Therapy, 41, 403-411.

Abstract

The present study examined the affective consequences of response inhibition during a state of anxietyrelated physical stress. Forty-eight non-clinical participants were selected on the basis of pre-experimental differences in emotional avoidance (high versus low) and subjected to four inhalations of 20% carbon dioxide-enriched air. Half of the participants were instructed to inhibit the challenge-induced aversive emotional state, whereas the other half was instructed to simply observe their emotional response. Participants high in emotional avoidance compared to those low in emotional avoidance responded with greater levels of anxiety and affective distress but not physiological arousal. Individuals high in emotional avoidance also reported greater levels of anxiety relative to the low emotional avoidance group when suppressing compared to observing bodily sensations. These findings are discussed in terms of the significance of emotional avoidance processes during physical stress, with implications for better understanding the nature of panic disorder.

The intervention protocol is included below quoted from Feldner (2003).

Forman et al., 2007

Forman, E.M., Hoffman, K.L., McGrath, K.B., Herbert, J.D., Brandsma, L.L. & Lowe, M.R. (2007). A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study. Behaviour Research and Therapy, 45, 2372-2386.

Abstract

The present study utilized an analog paradigm to investigate the effectiveness of two strategies for coping with food cravings, which was theorized to be critical to the maintenance of weight loss. Ninety-eight undergraduate students were given transparent boxes of chocolate Hershey’s Kisses and instructed to keep the chocolates with them, but not to eat them, for 48 h. Before receiving the Kisses, participants were randomized to receive either (a) no intervention, (b) instruction in control-based coping strategies such as distraction and cognitive restructuring, or (c) instruction in acceptance-based strategies such as experiential acceptance and defusion techniques. Measures included the Power of Food Scale (PFS; a measure of psychological sensitivity to the food environment), self-report ratings of chocolate cravings and surreptitiously recorded chocolate consumption. Results suggested that the effect of the intervention depended on baseline PFS levels, such that acceptance-based strategies were associated with better outcomes (cravings, consumption) among those reporting the highest susceptibility to the presence of food, but greater cravings among those who scored lowest on the PFS. It was observed that craving self-report measures predicted chocolate consumption, and baseline PFS levels predicted both cravings and consumption. Results are discussed in terms of the implications for weight loss maintenance strategies.

Protocol included below

Gutierrez et al., 2004

Gutierrez, O., Luciano, M. C., Rodríguez. M., & Fink. B. (2004). Comparison between an Acceptance-based and a Cognitive-Control-Based Protocol for coping with pain. Behavior Therapy, 35, 767-783.

Abstract

This study compares specific acceptance-based strategies and cognitive-control-based strategies for coping with experimentally induced pain. Forty participants were randomly assigned to an acceptance-based protocol (ACT), the goal of which was to disconnect pain-related thoughts and feelings from literal actions, or to a control-based protocol (CONT) that focused on changing or controlling pain-related thoughts and feelings. Participants took part in a nonsense-syllables-matching task that involved successive exposures to increasingly painful shocks. In both conditions, the task involved an overall value-oriented context that encouraged the participants to continue with the task despite the exposure to pain. At times throughout the task, participants were asked to choose to continue with the task and be shocked or stop the task and avoid being shocked. Each choice had specific costs and benefits. Participants performed the task twice, both before and after receiving the assigned experimental protocol. Two measures were obtained at pre- and post-intervention: tolerance of the shocks and self-reports of pain. ACT participants showed significantly higher tolerance to pain and lower believability of experienced pain compared to the CONT condition. Conceptual and clinical implications are discussed.

Protocol included below

Kehoe et al., 2007

Kehoe, A., Barnes-Holmes, Y., Barnes-Holmes, D., Cochrane, A. & Stewart, I. (2007). Breaking the pain barrier: Understanding and treating human suffering. The Irish Psychologist, 33(11), 288-297.

This article (see link above to download) describes the intervention components in detail starting on page 292.

Keogh et al., 2005

Keogh, E., Bond, F. W., Hanmer, R. & Tilston, J. (2005). Comparing acceptance and control-based coping instructions on the cold-pressor pain experiences of healthy men and women. European Journal of Pain, 9, 591-598.

Abstract

The current study reflects recent developments in psychotherapy by examining the effect of acceptance-based coping instructions, when compared to the opposite, more control/distraction-based instructions, on cold-pressor pain. Since previous research indicates gender differences in how people cope with pain, we also sought to determine whether differences would be found between healthy men and women. As predicted, results indicated that women reported lower pain threshold and tolerance level than did men. Furthermore, the acceptance-based instruction resulted in lower sensory pain reports when compared to the opposite instructions. Finally, for affective pain, acceptance instructions only benefited women. These results suggest that acceptance-based coping may be particular useful in moderating the way in which individuals, especially women, cope with pain.

The intervention protocol is included below quoted from Keogh et al. (2005).

Levitt et al., 2004

Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35, 747-766.

Abstract

The effects of acceptance versus suppression of emotion were examined in 60 patients with panic disorder. Prior to undergoing a 15-minute 5.5% carbon dioxide challenge, participants were randomly assigned to 1 of 3 conditions: a 10-minute audiotape describing 1 of 2 emotion-regulation strategies (acceptance or suppression) or a neutral narrative (control group). The acceptance group was significantly less anxious and less avoidant than the suppression or control groups in terms of subjective anxiety and willingness to participate in a second challenge, but not in terms of self-report panic symptoms or physiological measures. No differences were found between suppression and control groups on any measures. Use of suppression was related to more subjective anxiety during the challenge, and use of acceptance was related to more willingness to participate in a second challenge. The results suggest that acceptance may be a useful intervention for reducing subjective anxiety and avoidance in patients with panic disorder.

Protocol included below

Masedo & Esteve, 2007

Masedo, A.I. & Esteve, M.R. (2007). Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress. Behaviour Research and Therapy, 45, 199-209.

Abstract
Wegner’s Theory of Ironic Processes has been applied to study the effects of cognitive strategies to control pain. Research suggests that suppression contributes to a more distressing pain experience. Recently, the acceptance-based approach has been proposed as an alternative to cognitive control. This study assessed the tolerance time, the distress and the perceived pain intensity in three groups (suppression, acceptance and spontaneous coping groups) when the participants were exposed to a cold pressor procedure. Two hundred and nineteen undergraduates volunteered to participate. The suppression group showed the shortest tolerance time and the acceptance group showed the longest tolerance time. The acceptance group showed pain and distress immersion ratings that were significantly lower than in the other two groups, between which the differences were not significant. In the first recovery period, the suppression group showed pain and distress ratings that were higher than in the other two groups. In the second recovery period, although the acceptance group showed pain and distress ratings that were significantly lower than in the other two groups, the suppression and the spontaneous coping groups did not differ. The presence of a ‘rebound’ of physical discomfort and the effects of suppression on behavioural avoidance are discussed. These results support the acceptance approach in the management of pain.

The full intervention protocol is included below in Spanish as well as a quoted section from the article describing the intervention in English.

Páez-Blarrina et al., 2008

Páez-Blarrina M., Luciano C., Gutiérrez-Martínez O, Valdivia S., Ortega J. and Rodríguez-Valverde M. (2008). The role of values with personal examples in altering the functions of pain: Comparison between acceptance-based and cognitive-control-based protocols. Behaviour Research and Therapy, 46 , 84-97.

Abstract

The purpose of the present study was twofold. First, to compare the effect of establishing a motivational context of values on pain tolerance, believability, and reported pain, with three experimental conditions: pain acceptance (ACT condition), pain control (CONT condition), or no values (untrained condition). Second, the study aimed to isolate the impact of adding the corresponding coping strategies to both the ACT and the CONT conditions. Thirty adults were randomly assigned to one of the three experimental conditions. The participants went through the pain task in two occasions (Test I and Test II). In Test I, the effects of the ACT-values protocol (which established pain as part of valued action), the CONT-values protocol (which established high pain as opposed to valued action), and the no-values protocol, were compared. In Test II, the effect of adding the corresponding coping strategy to each condition (defusion for ACT vs. suppression for CONT) was examined. Test I showed a clear superiority of the ACT-values protocol in increasing tolerance and lowering pain believability. In Test II, the superiority of the ACT protocol was replicated, while the CONT protocol proved useful to reduce reported pain, in accordance with previous studies.

Protocol included below

Roche et al., 2007

Roche, B., Forsyth, J.P. & Maher, E. (2007). The impact of demand characteristics on brief acceptance- and control-based interventions for pain tolerance. Cognitive and Behavioral Practice, 14, 381-393.

Abstract

The present analog study compared the effectiveness of an acceptance- and control-based intervention on pain tolerance using a cold pressor task, and is a partial replication and extension of the Hayes, Bissett et al. (Hayes, S. C., Bissett, R.T., Korn, Z., Zettle, R. D., Rosenfarb, I. S., Cooper, L. D., & Grundt, A. M. (1999). The impact of acceptance versus control rationales on pain tolerance. The Psychological Record, 49, 33-47) study. Our aim was to test the effects of a nonspecific source of therapeutic change within the context of ACT therapy. Otherwise healthy undergraduates (N=20) were exposed to a cold pressor task before, immediately after, and 10 min following one of the two interventions. Half of the participants also were assigned to a high demand characteristic condition in which the experimenter maintained close physical proximity, eye contact, and placed subtle social pressure on participants to please the experimenter. The results showed that the most important factor influencing latency to withstand the cold pressor task was social pressure. The acceptance-based intervention was more subject to demand than the control strategy. Evaluative ratings of pain were unaffected by the demand manipulation. The current data suggest that demand characteristics can exert a significant positive impact on the outcome of therapeutic protocols. The implications of this view for acceptance- and control-based psychosocial interventions are discussed.

Intervention script quoted from article below

Vowles et al., 2007

Vowles, K., McNeil, D.W., Bates, M., Gallimore, P. & McCall, C. (2007). Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain. Behavior Therapy, 38, 412-425.

Abstract
Psychosocial treatments for chronic pain are effective. There is a need, however, to understand the processes involved in determining how these treatments contribute to behavior change. Control and acceptance strategies represent two potentially important processes involved in treatment, although they differ significantly in approach. Results from laboratory-based studies suggest that acceptance-oriented strategies significantly enhance pain tolerance and behavioral persistence, compared with control-oriented strategies. There is a need, however, to investigate processes of acceptance and control directly in clinical settings. The present study investigated the effects of three brief instructional sets (pain control, pain acceptance, continued practice) on demonstrated physical impairment in 74 individuals with chronic low back pain using an analogue experimental design. After controlling for baseline performance, the pain acceptance group demonstrated greater overall functioning on a set of 7 standardized physical tasks relative to the other two groups, which did not differ from one another. Further, the acceptance group exhibited a 16.3% improvement in impairment, whereas the pain control group worsened by 8.3% and the continued practice group improved by 2.5%. These results suggest that acceptance may be a key process involved in behavior change in individuals with chronic pain.

Protocol included below

ACT for Weight Control

A number of researchers are working on weight control issues from an ACT/ RFT perspective. Here is where you will find the relevant research and conceptual issues.

ACT-Related Research on Health Problems

The pages below list published ACT-related research studies for specific health problems that are available on the website as of July 2008. Empirical studies listed include ACT outcome studies, case studies, correlational research and micro/component studies. The literature is moving quickly and it takes a while to update pages like this. For a more detailed list of outcome studies and other empirical research you can download the "ACT Handout" and/or check the research summaries posted on the website, which are updated more regularly.

ACT vs. PRT for OCD: Adherence Manuals

Here are the adherence manuals used in the NIMH-funded randomized trial of ACT vs. PRT (Progressive Relaxation Training) for the treatment of Obsessive Compulsive Disorder (Investigators: Michael Twohig & Steven Hayes).

Twohig, M.P., Hayes, S.C., Plumb, J.C., Pruitt, L.D., Collins, A.B., Hazlett-Stevens, H., & Woidneck, M.R. (2010). A randomized clinical trial of acceptance and commitment therapy vs progressive relaxation training in the treatment of obsessive compulsive disorder. Manuscript under review.

For questions about the use of the ACT manual, please contact Jen Plumb. For questions regarding the use of the PRT manual, please contact Holly Hazlett-Stevens at the University of Nevada Reno.

ACT with Bupropion Smoking Cessation Treatment Study: Adherence Manual

Below you will find the manual used in the NIDA-funded smoking cessation study conducted at the University of Nevada Reno.

Please contact Heather Pierson for additional information about this manual.

Habit Reversal and ACT for Tic Disorders: Adherence Manual

This manual was adapted by Stephanie H. Best, MA from a line of adherence manuals used in various ACT and other studies.

Prevention Trial: ACT Adherence Manual

The manual below is being used in a NIMH-funded study to prevent mental health issues in college students.

It was modified by Steve Hayes.

ACT/ RFT and Prejudice

Despite decades of social concern, racial, ethnic, and religious prejudice persists. Few cultural issues seem more important than figuring out why people hate and how to reduce discriminatory and violent behavior due to prejudice. It seems our survival may depend on our ability as human beings to solve this issue. ACT/ RFT is relevant not just to the needs of the victims of prejudice, discrimination, and terrorism, but also to the understanding and modification of psychological processes that lead to the perpetration of hateful and discriminatory acts.

From an ACT/ RFT perspective, prejudice can be defined as theobjectification and dehumanization of human beings because of their participation in verbal evaluative categories. Prejudice, defined this way, is a kind of verbal entanglement. It is difficult to avoid because some of the same cognitive processes that permit problem-solving also seem to foster prejudice. In addition, may of the things humans do to try and change or eliminate prejudice are either inert or prone to making these processes more resistant to change. Indeed, validated methods for reducing prejudice are very limited.

In this section are links to various ACT and RFT papers related to this topic.

Conceptual papers discussing prejudice/terrorism from an ACT/RFT perspective.

• Dixon, M. R., Dymond, S., Rehfeldt, R. A., Roche, B., & Zlomke, K. R. (2003). Terrorism and relational frame theory. Behavior and Social Issues, 12, 129-147.

• Hayes, S. C., Niccolls, R., Masuda, A., & Rye, A. K. (2002). Prejudice, terrorism, and behavior therapy. Cognitive and Behavioral Practice, 9, 296-301.

RFT studies related to prejudice and stereotyping

• Kohlenberg, B. K., Hayes, S. C., & Hayes, L. J. (1991). The transfer of contextual control over equivalence classes through equivalence classes: A possible model of social stereotyping. Journal of the Experimental Analysis of Behavior, 56, 505-518.

• Dixon, M. R., Zlomke, K. M., & Rehfeldt, R. A. (2006). Restoring Americans’ Nonequivalent Frames of Terror: An Application of Relational Frame Theory. The Behavior Analyst Today, 7(3), 275-289.

• Weinstein, J. H., Wilson, K. G., Drake, C. E., & Kellum, K. K. (2008). A Relational Frame Theory Contribution to Social Categorization. Behavior and Social Issues, 17, 39-64.

Empirical papers examining the impact of ACT on prejudice and stigma.

• Self related stigma regarding weight: Lillis, J. (2008). Acceptance and Commitment Therapy for the treatment of obesity-related stigma and sustained weight loss. Unpublished doctoral dissertation. University of Nevada, Reno.

• Self-stigma in substance abusing populations: Luoma, J.B., Kohlenberg, B.S., Hayes, S.C., Bunting, K. & Rye, A.K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes. Addiction Research & Theory, 16, 149-165.

• Prejudice towards ethnic minorities: Lillis, J., & Hayes, S. C. (2007). Applying acceptance, mindfulness, and values to the reduction of prejudice: A pilot study. Behavior Modification, 31(4), 389-411.

  Undergraduates enrolled in two separate classes on racial differences were exposed Acceptance and Commitment Therapy and an educational lecture drawn from a textbook on the psychology of racial differences in a counterbalanced order. Results indicate that only the ACT intervention was effective in increasing positive behavioral intentions at post and a 1-week follow-up. These changes were associated with other self-reported changes that fit with the ACT model.

• Stigma towards mental health problems: Masuda, A., Hayes, S. C., Fletcher, L. B., Seignourel, P. J., Bunting, K., Herbst, S. A., Twohig, M. P., & Lillis, J. (2007). The impact of Acceptance and Commitment Therapy versus education on stigma toward people with psychological disorders. Behaviour Research and Therapy, 45(11), 2764-2772.

  An RCT comparing ACT and education in 95 college students. ACT reduced mental health stigma significantly regardless of participants’ pre-treatment levels of psychological flexibility, but education reduced stigma only among participants who were relatively flexible and non-avoidant to begin with.

• Stigma towards substance abusers in drug counselors: Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., Masuda, A., Pistorello, J., Rye, A. K., Berry, K. & Niccolls, R. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35, 821-835.

  A medium sized randomized controlled trial that found that a one day ACT workshop produces greater decreases in stigmatization of clients by therapists and greater decreases in therapist burnout than an educational control and (or some comparisons) than multicultural training. Mediational analyses fit the model.

Case Studies

 

Case Studies by Year (Controlled Time Series Studies are covered in the RCT page)

In Press

• Twohig, M. P. & Whittal, M. L. (In Press). A Case of Obsessive-Compulsive Disorder. Cognitive and Behavioral Practice.

• Twohig, M. P. (In Press). Acceptance and Commitment Therapy for Treatment-Resistant Posttraumatic Stress Disorder: A Case Study.Cognitive and Behavioral Practice.

2008

• Veiga-Martínez, C., Pérez-Álvarez, M. & García-Montes, J.M. (2008). Acceptance and commitment therapy applied to treatment of auditory hallucinations. Clinical Case Studies, (2), 118-135.

2007

• Kleen, M., & Jaspers, J. P. C. (2007). Women should not be allowed to run. Acceptance and commitment therapy (ACT) with a pain disorder. Translated from: Vrouwen horen niet hard te lopen. Acceptance and commitment therapy (ACT) bij een pijnstoornis. Gedragstherapie, 40, 7-26.

2006

• García-Montes, J.M., Pérez-Álvarez, M. & Cangas-Díaz, A. (2006). Aproximación al abordaje clínico de los síntomas psicóticos desde la Aceptación. = Approaching clinical intervention for psychotic symptoms from an acceptance perspective . Apuntes de Psicología, 24(1-3), 293-307.

• Ruiz-Jiménez, F. J. (2006). Aplicación de la Terapia de Aceptación y Compromiso (ACT) Para el Incremento del Rendimiento Ajedrecí¬stico. Un Estudio de Caso [Application of Acceptance and Commitment Therapy (ACT) to Improve Chess-players Performance. A Case Study.International Journal of Psychology and Psychological Therapy, 6, 77-97.

2005

• Batten, S. V., & Hayes, S. C. (2005). Acceptance and Commitment Therapy in the Treatment of Comorbid Substance Abuse and Post-Traumatic Stress Disorder: A Case Study. Clinical Case Studies, 4(3), 246-262.

  Case study. Shows improvement with a dually diagnosed patient.

• Olivencia, J. J., & Díaz, A. J. C. (2005). Tratamiento psicológico del trastorno esquizotípico de la personalidad. Un estudio de caso. (Psychological treatment of schizotypal personality disorder. A case study). Psicothema, 17, 412-417.

  A case study that examines a combination of ACT and FAP in the successful treatment of a case of Schizotypal Personality Disorder.

• Orsillo SM, Batten SV. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29, 95-129.

  Discussion article and case study showing how to apply ACT to the treatment of PTSD.

• Wicksell, R. K., Dahl, J., Magnusson, B., & Olsson, G. L. (2005). Using Acceptance and Commitment Therapy in the rehabilitation of an adolescent female with chronic pain: A case example. Cognitive and Behavioral Practice, 12, 415-423. Shows dramatic improvement with a 14 year old chronic pain patient using a values focused ACT protocol.

2004

• García Montes, J. M., Luciano Soriano, C. M., Hernández López, M., & Zaldívar Basurto, F. (2004). Aplicación de la terapia de aceptación y Compromiso (ACT) a sintomatología delirante: un estudio de caso. [Application of Acceptance and Commitment Therapy (ACT) in delusional symptomathology: a case study]. Psicothema, 6(1), 117-124.

• Gardner, F. L. & Moore, Z.E. (2004). A mindfulness-acceptance-commitment based approach to athletic performance enhancement: Theoretical considerations. Behavior Therapy, 35, 707-724.

  Case study. An ACT protocol with an emphasis on mindfulness helps with sports outcomes.

2003

• Heffner, M., Eifert, G. H., Parker, B. T., Hernandez, D. H. and Sperry, J. A. (2003). Valued directions: Acceptance and Commitment Therapy in the treatment of alcohol dependence. Cognitive and Behavioral Practice, 10, 378-38.

  This case study describes a heavily values focused ACT treatment of a case of alcohol dependence within an Acceptance and Commitment Therapy model. Identifying valued directions seemed to help the client achieve sobriety and put a plan into action to "start living."

• Montesinos, F. (2003). ACT, sexual desire orientation and erectile dysfunction. A case study. Analisis y Modificación de Conducta, 29, 291-320.

  A successful application of ACT to a 30-year-old male with difficulties in accepting his bisexual orientation and with an erectile dysfunction is presented.

• Pankey, J. & Hayes, S. C. (2003). Acceptance and Commitment Therapy for psychosis. International Journal of Psychology and Psychological Therapy, 3, 311-328.

  Case study with a retarded psychotic person experiencing command hallucinations and multiple delusions. Believability drops dramatically over treatment but not frequency. Good functional improvement.

2002

• Heffner, M., Sperry, J., Eifert, G. H. & Detweiler, M. (2002). Acceptance and Commitment Therapy in the treatment of an adolescent female with anorexia nervosa: A case example. Cognitive and Behavioral Practice, 9, 232-236.

  Describes the use of ACT in anorexia and shows resulting data. Case study. The case study is followed by discussion articles:

   

  • Wilson, K. G. & Roberts, M. (2002). Core principles in Acceptance and Commitment Therapy: An application to anorexia. Cognitive and Behavioral Practice, 9, 237-243.

     

  • Hayes, S. C. & Pankey, J. (2002). Experiential avoidance, cognitive fusion, and an ACT approach to anorexia nervosa. Cognitive and Behavioral Practice, 9, 243-247.
  • Orsillo, S. M. & Batten, S. J. (2002). ACT as treatment of a disorder of excessive control: Anorexia. Cognitive and Behavioral Practice, 9, 253-259.
  • There is also a cognitive paper that is nominally a response to the case, but it mentions ACT only in passing, focusing instead on the traditional CBT model.

• López, S. & Arco, J.L. (2002). ACT como alternativa terapéutica a pacientes que no responden a tratamientos tradicionales: un estudio de caso [ACT as an alternative for patients that do not respond to traditional treatments: A case study]. Análisis y Modificación de Conducta, 120, 585-616.

  Presents data on ACT with a patient who failed a course of cognitive therapy.

2001

• García, J.M. & Pérez, M. (2001). ACT as a treatment for psychotic symptoms. The case of auditory hallucinations. Análisis y Modificación de Conducta, 27, 113, 455-472.

  Describes the use of ACT in the treatment of psychotic disorders and shows resulting data. Case study.

• Luciano, C. (2001). On the Experiential Avoidance Disorder and Acceptance and Commitment Therapy (ACT). Análisis y Modificación de Conducta, 27, 113, 317-332. A case study on ACT.

• Luciano, C. (2001) (Ed.), Terapia de Aceptación y Compromiso (ACT) y el Traastorno de Evitación Experiencial. Un síntesis de casos clínicos. (Ed.) Valencia: Promolibro.

• Luciano, C. & Cabello, F. (2001). Bereavement and Acceptance and Commitment Therapy (ACT). Análisis y Modificación de Conducta, 27, 113, 399-424.

  Describes the use of ACT in the treatment of complicated bereavement and shows resulting data. Case study.

• Luciano, C., Gómez, S., Hernández, M., & Cabello, F. (2001). Alcoholism, Experiential Avoidance, and Acceptance and Commitment Therapy (ACT). Análisis y Modificación de Conducta, 27, 113, 333-372.

  Describes the use of ACT in the treatment of alcoholism and shows resulting data. Case study.

• Luciano, C., & Gutierrez, O. (2001). Anxiety and Acceptance and Commitment Therapy (ACT). Análisis y Modificación de Conducta, 27, 113, 373-398.

  Describes the use of ACT in the treatment of anxiety problems and shows resulting data. Case study.

• Luciano, C., Visdómine, J.C., Gutiérrez, O., & Montesinos, F. (2001). ACT (Acceptance and Commitment Therapy) and chronic pain. Análisis y Modificación de Conducta, 27, 113, 473-502.

  Describes the use of ACT in the treatment of chronic pain and shows resulting data. Case study.

• Montesinos, F., Hernández, B., & Luciano, C. (2001). Application of Acceptance and Commitment Therapy (ACT) in cancer patients. Análisis y Modificación de Conducta, 27, 113, 503-524.

• Zaldívar, F. & Hernández, M. (2001). Acceptance and Commitment Therapy (ACT): Application to an experiential avoidance with agoraphobic form. Análisis y Modificación de Conducta, 27, 113, 425-454.

  Describes the use of ACT in the treatment of agoraphobia and shows resulting data. Case study.

2000

• Carrascoso López, F. J. (2000). Acceptance and Commitment Therapy (ACT) in Panic Disorder with Agoraphobia: A Case Study. Psychology in Spain, 4(1), 120-128.

• Garcia, R. F. (2000). Application of acceptance and commitment therapy in an example of experiential avoidance. Psicothema, 12, 445-450.

1999 and Earlier (First ACT Book Appears in 1999)

• Paul, R. H., Marx, B. P. & Orsillo, S. M. (1999). Acceptance-based psychotherapy in the treatment of an adjudicated exhibitionist: A case example. Behavior Therapy, 30, 149-162.

• Huerta, F.R., Gomez, S., Molina, A.M. & Luciano, C. (1998). Generalized anxiety: A case study. Analisis y Modificacion de Conducta, 24, 751-766.

• Dougher, M. J. & Hackbert, L. (1994). A behavior-analytic account of depression and a case report using acceptance-based procedures.The Behavior Analyst, 17, 321-334.

• Biglan, A. (1989). A contextual approach to the clinical treatment of parental distress. In G. H. S. Singer & L. K. Irvin (Eds.), Support for caregiving families: Enabling positive adaptation to disability (pp. 299-311). Baltimore, MD: Brookes.

  Uncontrolled. Presents case data on the use of ACT components with families.

• Hayes, S. C. (1987). A contextual approach to therapeutic change. In N. Jacobson (Ed.), Psychotherapists in clinical practice: Cognitive and behavioral perspectives (pp. 327-387). New York: Guilford Press.

  Shows a series of uncontrolled case evaluations on ACT with anxiety problems.

Correlational studies

Correlational studies on ACT-Related Processes by Year

See also the experimental psychopathology page

In Press

• Cheron, D.M., Ehrenreich, J.T. & Pincus, D.B. (In Press). Assessment of parental experiential avoidance in a clinical sample of children with anxiety disorders. Child Psychiatry and Human Development.

• Kashdan, T.B., Morina, N., & Priebe, S. (in press). Post-traumatic stress disorder, social anxiety disorder, and depression in survivors of the Kosovo War: Experiential avoidance as a contributor to distress and quality of life. Journal of Anxiety Disorders.

• Kelly, M. M. & Forsyth, J. P. (In Press). Associations between emotional avoidance, anxiety sensitivity, and reactions to an observational fear challenge procedure. Behaviour Research and Therapy

• Kollman, D. M., Brown, T. A. & Barlow, D. H. (In Press). The construct validity of acceptance: A multitrait-multimethod investigation. Behavior Therapy.

• Merwin, R.M., Rosenthal, M.Z. & Coffey, K.A. (In Press). Experiential avoidance mediates the relationship between sexual victimization and psychological symptoms: Replicating findings with an ethnically diverse sample. Cognitive Therapy and Research

• Vowles, K. E., McCracken, L. M., McLeod, C., & Eccleston, C. (in press). The Chronic Pain Acceptance Questionnaire: Confirmatory factor analysis and identification of patient subgroups. Pain.

• Westin, V., Hayes, S. C., & Andersson, G. (in press). Is it the sound or your relationship to it? The role of acceptance in predicting tinnitus impact. Behaviour Research and Therapy.

2009

• Abramowitz, J.S., Lackey, G.R. & Wheaton, M.G. (2009). Obsessive–compulsive symptoms: The contribution of obsessional beliefs and experiential avoidance. Journal of Anxiety Disorders, 23, 160–166.

• Gold, S.D., Dickstein, B.D., Marx, B.P. & Lexington, J.M. (2009). Psychological outcomes among lesbian sexual assault survivors: An examination of the roles of internalized homophobia and experiential avoidance. Psychology of Women Quarterly, 33, 54–66.

• Mitmansgruber, H., Beck, T. N., & Schüßler, G. (2009). "Mindful helpers": Experiential avoidance, meta-emotions, and emotion regulation in paramedics. Journal of Research in Personality, 42, 1358-1363.

2008

• Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15, 329-342.

• Boelen, P.A. & Reijntjes, A. (2008). Measuring experiential avoidance: Reliability and validity of the Dutch 9-item acceptance and action questionnaire (AAQ). Journal of Psychopathology and Behavioral Assessment, 30, 241-251.

• Bond, F.W., Flaxman, P.E., & Bunce, D. (2008). The influence of psychological flexibility on work redesign: Mediated moderation of a work reorganization intervention. Journal of Applied Psychology, 93, 645-654.

• Farach, F. J., Mennin, D. S., Smith, R. L. & Mandelbaum, M. (2008). The impact of pretrauma analogue GAD and posttraumatic emotional reactivity following exposure to the september 11 terrorist attacks: A longitudinal study. Behavior Therapy, 39, 262–276.

• Gratz, K.L., Tull, M.T. & Gunderson, J.G. (2008). Preliminary data on the relationship between anxiety sensitivity and borderline personality disorder: The role of experiential avoidance. Journal of Psychiatric Research, 42(7), 550-559.

• Greco, L. A., Lambert, W., & Baer, R. A. (2008). Psychological inflexibility in childhood and adolescence: Development and evaluation of the Avoidance and Fusion Questionnaire for Youth. Psychological Assessment. 20(2), 93-102.

• Kashdan, T. B., & Breen, W. E. (2008). Social anxiety and positive emotions: A prospective examination of a self-regulatory model with tendencies to suppress or express emotions as a moderating variable. Behavior Therapy, 39, 1-12.

• Leonard, L. M., Iverson, K. M. & Follette, V. M. (2008). Sexual functioning and sexual satisfaction among women who report a history of childhood and/or adolescent sexual abuse. Journal of Sex & Marital Therapy, 34, 375-384.

• McCracken, L. M., & Vowles, K. E. (2008). A prospective analysis of acceptance and values in patients with chronic pain. Health Psychology, 27, 215-220.

• McCracken, L. M. & Yang, S. (2008). A Contextual Cognitive-Behavioral Analysis of Rehabilitation Workers’ Health and Well-Being: Influences of Acceptance, Mindfulness, and Values-Based Action. Rehabilitation Psychology, 53(4), 479-485.

• Ning, M. C., Ming, T. W. C., Mae, J. Y C., & Ping, C. P. (2008). Validation of the chronic pain acceptance questionnaire (CPAQ) in cantonese-speaking chinese patients. The Journal of Pain, 9(9), 823-832.

• Ostafin, B. D. & Marlatt, G. A. (2008). Surfing the urge: Experiential acceptance moderates the relation between automatic alcohol motivation and hazardous drinking. Journal of Social and Clinical Psychology, 27(4), 404-418.

• Tull, M.T. & Gratz, K.L. (2008). Further examination of the relationship between anxiety sensitivity and depression: The mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. Journal of Anxiety Disorders, 22(2), 199-210.

• Tull, M.T., Rodman, S.A. & Roemer, L. (2008). An examination of the fear of bodily sensations and body hypervigilance as predictors of emotion regulation difficulties among individuals with a recent history of uncued panic attacks. Journal of Anxiety Disorders, 22(4), 750-760.

• Vowles, K. E., McCracken, L. M., & Eccleston, C. (2008). Patient functioning and catastrophizing in chronic pain: The mediating effects of acceptance. Health Psychology, 27, S136-S143.

• Wicksell, R. K., Renofalt, J., Olsson, G. L., Bond, F. W., & Melin, L. (2008). Avoidance and cognitive fusion - Central components in pain related disability? Development and preliminary validation of the Psychological Inflexibility in Pain Scale (PIPS). European Journal of Pain, 12, 491-500.

2007

• Andrew, D.H. & Dulin, P.L. (2007). The relationship between self-reported health and mental health problems among older adults in New Zealand: Experiential avoidance as a moderator. Aging and mental health, 11(5), 596-603.

• Butler, J., & Ciarrochi, J. (2007). Psychological Acceptance and Quality of Life in the Elderly. Quality of Life Research, 16, 607-615.

  In a sample of 187 elderly those higher in psychological acceptance had higher quality of life in the areas of health, safety, community participation and emotional well-being; and had less adverse psychological reactions to decreasing productivity.

• Chapman, A. L. & Cellucci, T. (2007). The role of antisocial and borderline personality features in substance dependence among incarcerated females. Addictive Behaviors, 32, 1131-1145.

• Esteve, R., Ramirez-Maestre, C., & Lopez-Martinez, A. E. (2007). Adjustment to chronic pain: The role of pain acceptance, coping strategies, and pain-related cognitions. Annals of Behavioral Medicine, 33(2), 179-188.

• Gold, S.D., Marx, B.P. & Lexington, J.M. (2007). Gay male sexual assault survivors: The relations among internalized homophobia, experiential avoidance, and psychological symptom severity. Behaviour Research and Therapy, 45(3), 549-562.

• Kashdan, T. B., & Breen, W. E. (2007). Materialism and diminished well-being: Experiential avoidance as a mediating mechanism. Journal of Social and Clinical Psychology, 26, 521-539.

  This correlational study examined the hypothesis that experiential avoidance mediates associations between excessively materialistic values and diminished emotional well-being, meaning in life, self-determination, and gratitude. Results indicated that people with high materialistic values reported more negative emotions and less relatedness, autonomy, competence, gratitude, positive emotions, and sense of meaning – all of these relations were mediated by experiential avoidance mediated all of these relations. Emotional disturbances such as social anxiety and depressive symptoms failed to account for these findings after accounting for shared variance with experiential avoidance.

• Kratz, A. L., Davis, M. C., & Zautra, A. J. (2007). Pain acceptance moderates the relation Between pain and negative affect in female osteoarthritis and fibromyalgia patients. Annals of Behavioral Medicine, 33(3), 291–301.

• McCracken, L. M., Gauntlett-Gilbert, J., & Vowles, K. E. (2007). The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain, 131, 63-69.

• McCracken, L. M., & Vowles, K. E. (2007). Psychological flexibility and traditional pain management strategies in relation to patient functioning with chronic pain: An examination of a revised instrument. Journal of Pain, 8, 339-349.

• McCracken, L. M., Vowles, K. E., & Gauntlett-Gilbert, J. (2007). A prospective investigation of acceptance and control-oriented coping with chronic pain. Journal of Behavioral Medicine, 30, 339-349.

• Morina, N. (2007). The role of experiential avoidance in psychological functioning after war-related stress in Kosovar civilians. Journal of Nervous and Mental Disease, 195(8), 697-700.

• Norberg, M. M., Wetterneck, C. T., Woods, D. W., & Conelea, C. A. (2007). Examination of the mediating role of psychological acceptance in relationships between cognitions and severity of chronic hairpulling. Behavior Modification, 31, 367 – 381.

  Correlational study with 730+ folks suffering from trichotillomania. Experiential avoidance as measured by the AAQ fully mediated the rela¬tionship between hair-pulling and both fears of negative evaluation and feelings of shame and partially mediated the relationship between hair-pulling severity and dysfunctional beliefs about appearance.

• Santanello, A.W. & Gardner, F.L. (2007). The role of experiential avoidance in the relationship between maladaptive perfectionism and worry. Cognitive Therapy and Research, 31(3), 319-332.

• Shawyer, F., Ratcliff, K., Mackinnon, A., Farhall, J., Hayes, S. C., & Copolov, D. (2007). The voices acceptance and action scale (VAAS): Pilot data. Journal of Clinical Psychology, 63(6), 593–606.

• Spira, A.P., Beaudreau, S.A., Jimenez, D., Kierod, K., Cusing, M.M., Gray, H.L. & Gallagher-Thompson, D. (2007). Experiential avoidance, acceptance, and depression in dementia family caregivers. Clinical Gerontologist, 30(4), 55-64.

• Tull, M.T., Jakupcak, M. & Paulson, A. (2007). The role of emotional inexpressivity and experiential avoidance in the relationship between posttraumatic stress disorder symptom severity and aggressive behavior among men exposed to interpersonal violence. Anxiety, Stress & Coping: An International Journal, 20(4), 337-351.

• Tull, M. T., & Roemer, L. (2007). Emotion regulation difficulties associated with the experience of uncued panic attacks: Evidence of experiential avoidance, emotional nonacceptance, and decreased emotional clarity. Behavior Therapy, 38(4), 378-391.

• Vowles, K. E., McCracken, L. M., & Eccleston, C. (2007). Processes of behavior change in interdisciplinary treatment of chronic pain: Contributions of pain intensity, catastrophizing, and acceptance. European Journal of Pain, 11, 779-787.

2006

• Bond, F. W., & Flaxman, P. E. (2006). The Ability of Psychological Flexibility and Job Control to Predict Learning, Job Performance, and Mental Health. Journal of Organizational Behavior Management, 26, 113-130.

• Cribb, G., Moulds, M.L. & Carter, S. (2006). Rumination and Experiential Avoidance in Depression. Behaviour Change, 23(3), 165-176.

• Flessner, D. A., & Woods, D. W. (2006). Phenomenological characteristics, social problems, and the economic impact associated with chronic skin picking. Behavior Modification, 30, 944-963.

  Found that the impact of skin picking on depression and anxiety was partially mediated by the AAQ in a non-referred sample of chronic skin pickers.

• Gaudiano, B. A., & Herbert, J. D. (2006). Believability of hallucinations as a potential mediator of their frequency and associated distress in psychotic inpatients. Behavioural and Cognitive Psychotherapy, 34, 497–502.

• Kashdan, T.B., Barrios, V., Forsyth, J.P., & Steger, M.F. (2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44, 1301-1320.

  two studies, one correlational and one longitudinal, show that experiential avoidance as measured by the AAQ fully or partially mediated the relationships between coping and emotion regulation strategies on anxiety-related pathology, (Sutdy 1) and psychological distress and hedonic functioning over the course of a 21-day monitoring period (Study 2). The variables examined included maladaptive coping, emotional responses styles, and uncontrollability on anxiety-related distress (e.g., anxiety sensitivity, trait anxiety, suffocation fears, and body sensation fears), and suppression and cognitive reappraisal on daily negative and positive experiences. The data showed that cognitive reappraisal, a primary process of traditional cognitive-behavior therapy, was much less predictive of the quality of psychological experiences and events in everyday life compared with EA.

• Kashdan, T. B., & Steger, M. (2006). Expanding the topography of social anxiety: An experience sampling assessment of positive emotions and events, and emotion suppression. Psychological Science, 17, 120-128.

  In a 21-day experience sampling study, dispositional social anxiety, emotional suppression, and cognitive reappraisal was compared daily measures of social anxiety. Socially anxious individuals reported the lowest rate of positive events on days when they were more socially anxious and tended to suppress emotions, and the highest rate of positive events on days when they were less socially anxious and more accepting of emotional experiences. Irrespective of dispositional social anxiety, participants reported the most intense positive emotions on days when they were less socially anxious and more accepting of emotional experiences.

• McCracken, L. M. (2006). Toward a fully functional, flexible, and defused approach to pain in young people. Cognitive and Behavioral Practice, 13, 182-184.

• McCracken, L. M., & Eccleston, C. (2006). A comparison of the relative utility of coping and acceptance-based measures in a sample of chronic pain sufferers. European Journal of Pain, 10(1), 23-29.

• McCracken, L. M., & Yang, S. (2006). The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain, 123, 137-145.

• Nicholas, M. K. & Asghari, A. (2006). Investigating acceptance in adjustment to chronic pain: Is acceptance broader than we thought? Pain, 124, 269-279.

• Reddy, M.K., Pickett, S.M. & Orcutt, H.K. (2006). Experiential avoidance as a mediator in the relationship between childhood psychological abuse and current mental health symptoms in college students. Journal of Emotional Abuse, 6(1), 67-85.

• Rosenthal, Z.M., Polusny, M.A. & Follette, V.M. (2006). Avoidance mediates the relationship between perceived criticism in the family of origin and psychological distress in adulthood. Journal of Emotional Abuse, 6(1), 87-102.

• Tull, M.T., Gratz, K.L., & Lacroce, D.M. (2006). The role of anxiety sensitivity and lack of emotional approach coping in depressive symptom severity among a non-clinical sample of uncued panickers. Cognitive Behaviour Therapy, 35(2), 74-87.

• Zvolensky, M. J., Solomon, S. E., McLeish, A. C., Cassidy, D., Bernstein, A., Bowman, C. J., et al. (2006). Incremental validity of mindfulness-based attention in relation to the concurrent prediction of anxiety and depressive symptomatology and perceptions of health. Cognitive Behaviour Therapy, 35(3), 148–158.

2005

• Chapman, A. L., Specht, M. W., & Cellucci, T. (2005). Borderline personality disorder and selfharm: Does experiential avoidance play a role? Suicide and Life Threatening Behavior, 35, 388–399.

• Greco, L. A., Heffner, M., Ritchie, S., Polak, M., Poe, S., & Lynch, S. K., (2005). Maternal adjustment following preterm birth: Contributions of experiential avoidance. Behavior Therapy, 36, 177-184.

  Experiential avoidance as measured by the AAQ correlated positively with post-discharge parental stress and traumatic stress symptoms surrounding preterm birth. Moreover, it partially mediated the association between stress during delivery and later traumatic stress symptoms. This process was not moderated by parent reports of child temperament or perceived social support, suggesting that experiential avoidance plays a mediating role irrespective of child characteristics or perceived support from family members and close friends.

• Marx, B.P. & Sloan, D.M. (2005). Experiential avoidance, peritraumatic dissociation, and post-traumatic stress disorder. Behaviour Research and Therapy, 43, 569-583.

  185 trauma survivors were assessed for peritraumatic dissociation, experiential avoidance (using the AAQ), and PTSD symptom severity. Both peritraumatic dissociation and experiential avoidance were significantly related to PTSD symptoms at baseline. After the initial levels of PTSD was taken into account, only experiential avoidance was related to PTSD symptoms both 4- and 8-weeks later.

• McCracken, L. M. (2005). Social context and acceptance of chronic pain: The role of solicitous and punishing responses. Pain, 113, 155-159.

• McCracken, L. M., & Eccleston, C. (2005). A prospective study of acceptance of pain and patient functioning with chronic pain. Pain, 118, 164-169.

• Orcutt, H. K., Pickett, S., & Pope, E. (2005). Experiential avoidance and forgiveness as mediators in the relation between traumatic life events and PTSD symptoms. Journal of Social and Clinical Psychology, 24, 1003–1029.

• Roemer, L., Salters, K., Raffa, S. D., & Orsillo, S. M. (2005). Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research, 29, 71-88.

  Correlational study. Shows that the AAQ is associated with GAD symptoms in both clinical and non-clinical populations.

• Rosenthal, Z.M., Hall, M.L.R., Palm, K.M., Batten, S.V. & Follette, V.M. (2005). Chronic avoidance helps explain the relationship between severity of childhood sexual abuse and psychological distress in adulthood. Journal of Child Sexual Abuse, 14(4), 25-41.

2004

• Begotka, A. M., Woods, D. W., & Wetterneck, C. T. (2004). The relationship between experiential avoidance and the severity of trichotillomania in a nonreferred sample. Journal of Behavior Therapy and Experimental Psychiatry, 35, 17-24.

  In a large sample of adults suffering from trichotillomania, experiential avoidance as measured by the 9 item AAQ correlated with more frequent and intense urges to pull, less ability to control urges, and more pulling-related distress than persons who were not experientially avoidant. Actual pulling did not differ.

• Donaldson, E. & Bond, F.W. (2004). Psychological acceptance and emotional intelligence in relation to workplace well-being. British Journal of Guidance and Counselling, 32, 187-203.

  Study compared experiential avoidance (as measures by the AAQ) and emotional intelligence in terms of their ability to predict general mental health, physical well-being, and job satisfaction in workers (controlling for the effects of job control since this work organisation variable is consistently associated with occupational health and performance). Results from 290 United Kingdom workers showed that emotional intelligence did not significantly predict any of the well-being outcomes, after accounting for acceptance and job control. Acceptance predicted general mental health and physical well-being but not job satisfaction, Job control was associated with job satisfaction, only. Not controlling one’s thoughts and feelings (as advocated by acceptance) may have greater benefits for mental well-being than attempting consciously to regulate them (as emotional intelligence suggests).

• Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M., A., Dykstra, T. A., Batten, S. V., Bergan, J., Stewart, S. H., Zvolensky, M. J., Eifert, G. H., Bond, F. W., Forsyth J. P., Karekla, M., & McCurry, S. M. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553-578.

The AAQ validation study. Over 2000 subjects. Validates both a 9 and 16 item version, both single factor.

• Mairal, J. B. (2004). Spanish Adaptation of the Acceptance and Action Questionnaire (AAQ). International Journal of Psychology and Psychological Therapy, 4, 505-515.

• McCracken, L. M. , Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159-166.

  See McCracken 1998

• Plumb, J. C., Orsillo, S. M., & Luterek, J. A. (2004). A preliminary test of the role of experiential avoidance in post-event functioning. Journal of Behavior Therapy and Experimental Psychiatry, 35, 245-257.

  Correlational study. Showed that experiential avoidance was correlated with post-traumatic symptomatology over and above other measures of psychological functioning.

• Tull, M. T., Gratz, K. L., Salters, K., & Roemer, L. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. Journal of Nervous & Mental Disease, 192(11), 754-761.

  Correlational study. Among a sample of individuals exposed to multiple potentially traumatic events, general experiential avoidance (but not thought suppression in particular), predicted symptoms of depression, anxiety, and somatization when controlling for posttraumatic stress symptom severity. Thought suppression (but not experiential avoidance) was associated with severity of posttraumatic stress symptoms when controlling for their shared relationship with general psychiatric symptom severity.

2003

• Bond, F. W. & Bunce, D. (2003). The role of acceptance and job control in mental health, job satisfaction, and work performance. Journal of Applied Psychology, 88, 1057-1067.

  Shows that AAQ predicts positive work outcomes (mental health, satisfaction, performance) even one year later, especially in combination with job control. Re-factors the AAQ and shows that a two factor solution can work on a slightly different 16 item version.

• Forsyth, J. P., Parker, J. D., & Finlay, C. G. (2003). Anxiety sensitivity, controllability, and experiential avoidance and their relation to drug of choice and addiction severity in a residential sample of substance-abusing veterans. Addictive Behaviors, 28(5), 851-870.

• McCracken, L. M. & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain. Pain, 105, 197-204.

• Tull, M.T., & Roemer, L. (2003). Alternative explanations for emotional numbing of posttraumatic stress disorder: An examination of hyperarousal and experiential avoidance. Journal of Psychopathology and Behavioral Assessment, 25, 147-154.

• Viane, I., Crombez, G., Eccleston, C., Poppe, C., Devulder, J., Van Houdenhove, B., & De Corte, W.(2003). Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal. Pain, 106(1/2), 65-73.

2002

• Marx, B. P. & Sloan, D. M. (2002). The role of emotion in the psychological functioning of adult survivors of childhood sexual abuse. Behavior Therapy, 33, 563-577.

  Correlational study showing that childhood sexual abuse (CSA), experiential avoidance and emotional expressivity were significantly related to psychological distress. However, only experiential avoidance mediated the relationship between CSA and current distress.

• Stewart, S. H., Zvolensky, M. J., & Eifert, G. H. (2002). The relations of anxiety sensitivity, experiential avoidance, and alexithymic coping to young adults’ motivations for drinking. Behavior Modification, 26, 274–296.

• Zvolensky, M. J., & Forsyth, J. P. (2002). Anxiety sensitivity dimensions in the prediction of body vigilance and emotional avoidance. Cognitive Therapy and Research, 26, 449-460.

2001

• Batten, S. V., Follette, V.M., & Aban, I (2001). Experiential Avoidance and high risk sexual behavior in survivors of child sexual abuse. Journal of Child Sexual Abuse, 10(2), 101-120.

  This is a correlational study (N = 283) showing that generalized experiential avoidance accounted for 67% of the variance in distress in a sexually abused population.

• Boeshen, L. E., Koss, M. P., Figueredo, A. J., & Coan, J. A. (2001). Experiential avoidance and post-traumatic stress disorder: A cognitive mediational model of rape recovery. Journal of Aggression, Maltreatment and Trauma, 4, 211–245.

1999 and earlier

• McCracken, L. M., Spertus, I. L. , Janeck, A. S., Sinclair, D., & Wetzel, F. T. (1999). Behavioral dimensions of adjustment in persons with chronic pain: Pain-related anxiety and acceptance. Pain, 80, 283-289.

• McCracken, L. M. (1999). Behavioral constituents of chronic pain acceptance: Results from factor analysis of the Chronic Pain Acceptance Questionnaire. Journal of Back & Musculoskeletal Rehabilitation, 13, 93-100.

• McCracken, L. M. (1998). Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain, 74, 21-27.

  This study is based on a pain related early version of the AAQ. Greater acceptance of pain was associated with reports of lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily uptime, and better work status. A relatively low correlation between acceptance and pain intensity showed that acceptance is not simply a function of having a low level of pain. Regression analyses showed that acceptance of pain predicted better adjustment on all other measures of patient function, independent of perceived pain intensity. This work is replicated, refined and extended in McCracken, L. M. & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain. Pain, 105, 197-204. and McCracken, L. M. , Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159-166.

• Batten, S. V., Follette, V. M., & Hayes, S. C. (1997). Experiential avoidance as a model for understanding psychological correlates of HIV and AIDS: Review, theory, and treatment implications. The Behavior Therapist, 20, 99-103.

• Wulfert, E., Greenway, D. E., Farkas, P., Hayes, S. C., & Dougher, M. J. (1994). Correlation between a personality test for rigidity and rule-governed insensitivity to operant contingencies. Journal of Applied Behavior Analysis, 27, 659-671.

Effectiveness Articles

• Vowles, K. E., & McCracken, L. M. (in press). Acceptance and values-based action in chronic pain: A study of effectiveness and treatment process. Journal of Consulting and Clinical Psychology.

• Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D. & Geller, P. A. (2007). A randomized controlled effectiveness trial of Acceptance and Commitment Therapy and Cognitive Therapy for anxiety and depression. Behavior Modification. 31(6), 1-28.

  101 heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned either to traditional CT or to ACT. 23 junior therapists were used. Participants receiving CT and ACT evidenced large and equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction and clinician-rated functioning. “Observing” and “describing” one’s experiences mediated outcomes for those in the CT group relative to those in the ACT group, whereas “experiential avoidance,” “acting with awareness” and “acceptance” mediated outcomes for those in the ACT group.

• Lappalainen, R., Lehtonen, T., Skarp, E., Taubert, E., Ojanen, M., & Hayes, S. C. (2007). The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial. Behavior Modification. 31(4), 488-511.

  Randomized controlled study in which 14 student therapists treat one client each from an ACT model or a traditional CBT model for 6-8 sessions following a 2 session functional analysis. Participants with any normal outpatient problem were included. At post and at the 6 month follow up ACT clients are more improved on the SCL-90 and several other measures. Greater acceptance for ACT patients; great self-confidence for CBT patients. Both correlated with outcomes, but when partial correlations are calculated, only acceptance still relates to outcome.

• McCracken, L. M., Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43, 1335-1346.

  108 chronic pain patients with a long history of treatment are followed through an ACT-based 3-4 week residential treatment program. Measures improved from initial assessment to pre-treatment on average only 3% (average of 3.9 month wait), but improved on average 34% following treatment. 81% of these gains were retained through a 3 month follow up. Changes in acceptance predicted positive changes in depression, pain related anxiety, physical disability, psychosocial disability, and the ability to stand. Positive outcomes were also seen in a timed walk, decreased medical visits, daily rest due to pain, pain intensity, and decreased pain medication use.

• Strosahl, K. D., Hayes, S. C., Bergan, J., & Romano, P. (1998). Does field based training in behavior therapy improve clinical effectiveness? Evidence from the Acceptance and Commitment Therapy training project. Behavior Therapy, 29, 35-64.

  Controlled effectiveness trial. Not randomized. Shows that training in ACT produces generally more effective clinicians, as measured by client outcomes.

Experimental Psychopathology and Component Studies

Experimental Psychopathology and Component Studies by Year

Below is a list of experimental psychopathology and analogue studies testing components of ACT. Intervention scripts for several of the studies are available here.

In Press

• Masuda, A., Hayes, S. C., Twohig, M. P., Drossel, C., Lillis, J. & Washio, Y. (In Press). A parametric study of cognitive defusion and the believability and discomfort of negative self-relevant thoughts.Behavior Modification.

• Liverant, G. I., Brown, T. A., Barlow, D.H., & Roemer, L. (in press). Emotion regulation in unipolar depression: The effects of acceptance and suppression of subjective emotional experience on the intensity and duration of sadness and negative affect. Behaviour Research and Therapy.

2008

• Crocker, J., Niiya, Y., & Mischkowski, D. (2008). Why does writing about important values reduce defensiveness? Self-affirmation and the role of positive other-directed feelings. Psychological Science, 19, 740-747.

• Degen, L.M. (2008). Acceptance-based emotion regulation, perceptions of control, state mindfulness, anxiety sensitivity, and experiential avoidance: Predicting response to hyperventilation. Unpublished doctoral dissertation. American University.

• Healy, H. A., Barnes-Holmes, Y., Barnes-Holmes, D., Keogh, C., Luciano, C. & Wilson, K. (2008). An experimental test of a cognitive defusion exercise: Coping with negative and positive self-statements.The Psychological Record, 58, 623-640.

• Hutcherson, C. A., Seppala, E. M. & Gross, J. J. (2008). Loving-kindness meditation increases social connectedness. Emotion, 8, 720-724.

• Low, C.A., Stanton, A.L. & Bower, J.E. (2008). Effects of acceptance-oriented versus evaluative emotional processing on heart rate recovery and habituation. Emotion, 8(3), 419–424.

• McMullen, J., Barnes-Holmes, D., Barnes-Holmes, Y., Stewart, I., Luciano, C. & Cochrane, A. (2008). Acceptance versus distraction: Brief instructions, metaphors, and exercises in increasing tolerance for self-delivered electric shocks. Behaviour Research and Therapy, 46, 122–129.

• Páez-Blarrina, M., Luciano, C., Gutierrez-Martinez, O., Valdivia, S., Ortega, J. & Valverde, M. (2008). The role of values with personal examples in altering the functions of pain: Comparison between acceptance-based and cognitive-control-based protocols. Behaviour Research and Therapy, 46, 84–97.

• Páez-Blarrina, M. B., Luciano M.C., Gutiérrez-Martínez, O., Valdivia, S., Rodriguez, M. & Ortega, J. (2008). Coping with pain in the motivational context of values: Comparison between an acceptance- based and a cognitive-control-based protocol. Behavior Modification, 32(3), 403-422.

2007

• Baruch, D.E., Kanter, J.W., Busch, A.M., Richardson, J.V. & Barnes-Holmes, D. (2007). The differential effect of instructions on dysphoric and nondysphoric persons. Psychological Record, 57(4), 543-554.

• Cochrane, A., Barnes-Holmes, D., Barnes-Holmes, Y., Stewart, I., & Luciano, C. (2007). Experiential avoidance and aversive visual images: Response delays and event related potentials on a simple matching task. Behavior Research and Therapy, 45, 1379-1388.

  Two experiments. In Experiment 1, participants high (n = 15) or low in avoidance (n = 14), as measured by the Acceptance and Action Questionnaire, completed a simple matching task that required them to choose whether or not to look at an aversive visual image. Only the high-avoidance participants took longer to emit a correct response that produced an aversive rather than a neutral picture. Additionally, the high-avoiders reported greater levels of anxiety following the experiment even though they rated the aversive images as less unpleasant and less emotionally arousing than their low-avoidant counterparts. In Experiment 2, three groups, representing high- mid- and low-avoidance (n = 6 in each) repeated the matching task with the additional recording of event related potentials (ERPs). The findings replicated Experiment 1 but also showed that high-EA subjects had significantly greater negativity for electrodes over the left hemisphere relative to the midline suggesting that the high-EA group engaged in verbal strategies to regulate their emotional responses.

• Forman, E.M., Hoffman, K.L., McGrath, K.B., Herbert, J.D., Brandsma, L.L. & Lowe, M.R. (2007). A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study.Behaviour Research and Therapy, 45, 2372-2386.

  98 participants with chocolate cravings were exposed to a CBT-based protocol and an ACT-based protocol or no instructions and required to carry chocolate with them of for two days. Those more impacted by food related cues ate less and had fewer cravings in the ACT condition.

• Gratz, K.L., Bornovalova, M.A., Delany-Brumsey, A., Bettina, N. & Lejuez, C.W. (2007). A laboratory-based study of the relationship between childhood abuse and experiential avoidance among inner-city substance users: The role of emotional nonacceptance. Behavior Therapy, 38(3), 256-268.

• Kehoe, A., Barnes-Holmes, Y., Barnes-Holmes, D., Cochrane, A. & Stewart, I. (2007). Breaking the pain barrier: Understanding and treating human suffering. The Irish Psychologist, 33(11), 288-297

  examined the impact of acceptance and defusion with a radiant heat induction.

• Kingston, J., Chadwick, P., Meron, D. & Skinner, T.C. (2007). A pilot randomized control trial investigating the effect of mindfulness practice on pain tolerance, psychological well-being, and physiological activity.Journal of Psychosomatic Research, 62, 297-300.

• Marcks, B.A. & Woods, D.W. (2007). Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: An analog to obsessive-compulsive disorder. Behaviour Research and Therapy, 45, 2640–2651.

• Masedo, A.I. & Esteve, M.R. (2007). Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress. Behaviour Research and Therapy, 45, 199-209.

  A large and well-controlled randomized study that replicated Hayes, Bissett, Korn, Zettle, Rosenfarb, Cooper, & Grundt, 1999. Acceptance methods drawn from the 1999 ACT book and from the Hayes et al. 1999 pain study (the methods used included an acceptance rationale, practicing awareness of experience, the “Passengers on the Bus” exercise, and the ‘Two Scales Metaphor’) increased pain tolerance and decreased pain ratings in a cold pressor task as compared both to suppression methods (based on thought stopping) and to participants preferred method of coping (which tended to include distraction, relaxation, and keeping the hand still). The latter two conditions did not differ from each other in the main analysis.

• Roche, B., Forsyth, J.P. & Maher, E. (2007). The impact of demand characteristics on brief acceptance- and control-based interventions for pain tolerance. Cognitive and Behavioral Practice, 14, 381-393.

• Salters-Pedneault, K., Gentes, E., & Roemer, L. (2007). The role of fear of emotion in distress, arousal, and cognitive interference following an emotional stimulus. Cognitive Behaviour Therapy 36, 12–22.

• Tull, M.T. & Roemer, L. (2007). Emotion regulation difficulties associated with the experience of uncued panic attacks: Evidence of experiential avoidance, emotional nonacceptance, and decreased emotional clarity. Behavior Therapy, 38(4), 378-391.

• Vowles, K., McNeil, D.W., Bates, M., Gallimore, P. & McCall, C. (2007). Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain. Behavior Therapy, 38, 412-425.

• Zettle, R.D., Petersen, C.L., Hocker, T.R. & Provines, J.L. (2007). Responding to a challenging perceptual-motor task as a function of level of experiential avoidance. The Psychology Record, 57, 49-62.

2006

• Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy, 44, 1251-1263.

  Similar to the study above, brief acceptance methods led to lower heart rate during exposure to an aversive film and less negative affect during the post-film recovery period that did control strategies in individuals with anxiety and mood disorders.

• Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6(4), 587–595.

  This study compared the responses of participants from a clinical and non-clinical sample to an emotion provoking film. The study found that participants from the clinical group spontaneously used suppression to a greater degree than non-clinical participants and that attempts at suppression were associated with greater distress.

• Cohen, G.L., Garcia, J., Apfel, N. & Master, A. (2006). Reducing the racial achievement gap: A social-psychological intervention. Science, 313, 1307-1310.

• Feldner, M.T., Hekmat, H., Zvolensky, M.J., Vowles, K.E., Secrist, Z. & Leen-Feldner, E.W. (2006). The role of experiential avoidance in acute pain tolerance: A laboratory test. Behaviour Research and Therapy, 41(4), 403-411.

• Gratz, K.L., Rosenthal, M.Z., Tull, M.T., Lejuez, C.W. & Gunderson, J.G. (2006). An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of Abnormal Psychology, 115(4), 850-855.

• Keogh, E., Barlow, C., Mounce, C., & Bond, F. W. (2006). Assessing the relationship between cold pressor pain responses and dimensions of the anxiety sensitivity profile in healthy men and women. Cognitive Behaviour Therapy 35(4), 198–206.

• Williams, L.M. (2006). Acceptance and commitment therapy: An example of third-wave therapy as a treatment for Australian Vietnam War veterans with posttraumatic stress disorder: Unpublished dissertation, Charles Sturt University, Bathurst, New South Wales.

2005

• Creswell, J.D., Welch, W.T., Taylor, S.E., Sherman, D.K., Gruenewald, T.L. & Mann, T. (2005). Affirmation of personal values buffers neuroendocrine and psychological stress responses. Psychological Science, 16(11), 846-851.

• Keogh, E., Bond, F. W., Hanmer, R. & Tilston, J. (2005). Comparing acceptance and control-based coping instructions on the cold-pressor pain experiences of healthy men and women. European Journal of Pain, 9, 591-598.

  Simple acceptance-based coping instructions improved affective pain more than distraction but only for women.

  Tested acceptance- and control-based instructions in a cold pressor task. The result showed that the acceptance-based coping strategy could reduce self-reported pain, and that males and females reacted to the coping strategies differently. Females produced lower pain level following the acceptance-based strategy than males

• Marcks, B. A. & Woods, D. W. (2005). A comparison of thought suppression to an acceptance-based technique in the management of personal intrusive thoughts: A controlled evaluation. Behaviour Research and Therapy, 43, 433-445.

  Two studies. Correlational study shows suppressing personally relevant intrusive thoughts is associated with more thoughts, more distress, greater urge to do something. Those who accept are less obsessional, depressed and anxious. Experimental study shows that instructions to suppress does not work and leads to increased level of distress; instructions of accept (using a couple of short metaphors drawn from the ACT book) decreases discomfort but not thought frequency.

• Zettle, R. D., Hocker, T. R., Mick, K. A., Scofield, B. E., Petersen, C. L., Hyunsung S., & Sudarijanto, R. P. (2005). Differential strategies in coping with pain as a function of level of experiential avoidance. The Psychological Record, 55(4), 511-524.

  Correlational. High versus low EA participants show differences in pain tolerance and in pain coping.

2004

• Masuda, A., Hayes, S. C., Sackett, C. F., & Twohig, M. P. (2004). Cognitive defusion and self-relevant negative thoughts: Examining the impact of a ninety year old technique. Behaviour Research and Therapy, 42, 477-485.

  Shows in a series of time-series designs and a group study, that the “milk, milk, milk” defusion technique reduces distress and believability of negative self-referential thoughts

• Gutiérrez, O., Luciano, C., Rodríguez, M., & Fink, B. C. (2004). Comparison between an acceptance-based and a cognitive-control-based protocol for coping with pain. Behavior Therapy, 35, 767-784.

  Randomized study with analogue pain task showing greater tolerance for pain in the defusion and acceptance-based condition drawn from ACT as compared to a closely parallel cognitive-control based condition.

• Karekla, M., Forsyth, J. P., & Kelly, M. M. (2004). Emotional avoidance and panicogenic responding to a biological challenge procedure.Behavior Therapy, 35, 725-746.

  Normal participants high or low on the AAQ were exposed to a CO2 challenge. High emotional avoiders reported more panic symptoms than low avoiders. No difference physiologically.

• Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35, 747-766.

  Acceptance methods (drawn directly from the ACT book) did a better job than control strategies in promoting successful exposure in panic disordered patients

• Sloan, D. M. (2004). Emotion regulation in action: Emotional reactivity in experiential avoidance. Behaviour Research and Therapy, 42, 1257-1270.

  Examined the relationship between emotional reactivity (self-report and physiological reactivity) to pleasant, unpleasant, and neutral emotion-eliciting stimuli and experiential avoidance as measured by the AAQ. Sixty-two participants were separated into high and low experiential avoiders. Results indicated that high EA participants reported greater emotional experience to both unpleasant and pleasant stimuli compared to low EA participants. In contrast to their heightened reports of emotion, high EA participants displayed attenuated heart rate reactivity to the unpleasant stimuli relative to the low EA participants. Findings were interpreted as reflecting an emotion regulation attempt by high EA participants when confronted with unpleasant emotion-evocative stimuli.

• Spira, A. P., Zvolensky, M. J., Eifert, G. H., & Feldner, M. T. (2004). Avoidance-oriented coping as a predictor of anxiety-based physical stress: A test using biological challenge. Journal of Anxiety Disorders, 18, 309–323.

2003

• Butler, E. A., Egloff, B., Wilhelm, F. H., Smith, N. C., Erickson, E. A., & Gross, J. J. (2003). The social consequences of expressive suppression. Emotion, 3, 48–67.

• Eifert, G. H. & Heffner, M. (2003). The effects of acceptance versus control contexts on avoidance of panic-related symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 34, 293-312.

  Randomized study comparing control versus acceptance during a CO2 challenge with anxious subjects. Acceptance oriented exercise (the finger trap) reduced avoidance, anxiety symptoms, and anxious cognitions as compared to breathing training.

• Feldner, M. T., Zvolensky, M. J., Eifert, G. H., & Spira, A. P. (2003). Emotional avoidance: An experimental tests of individual differences and response suppression during biological challenge. Behaviour Research and Therapy, 41, 403-411.

  High emotional avoidance subjects showed more anxiety in response to CO2, particularly when instructed to suppress their emotions.

• Hopkinson, J. & Neuringer, A. (2003). Modifying behavioral variability in moderately depressed students. Behavior Modification, 27(2), 251-264.

2002

• Takahashi, M., Muto, T., Tada, M., & Sugiyama, M. (2002). Acceptance rationale and increasing pain tolerance: Acceptance-based and FEAR-based practice. Japanese Journal of Behavior Therapy, 28, 35-46.

  Small randomized trial that replicated Hayes, Bissett, Korn, Zettle, Rosenfarb, Cooper, & Grundt, 1999. An acceptance rationale plus two ACT defusion exercises (leaves on the stream and physicalizing) did significantly better than a match control focused intervention on pain tolerance, or a lecture on pain.

1999 or Before

• Hayes, S.C., Bissett, R., Korn, Z., Zettle, R. D., Rosenfarb, I., Cooper, L., & Grundt, A. (1999). The impact of acceptance versus control rationales on pain tolerance. The Psychological Record, 49, 33-47.

  Analog study. Shows that an acceptance rationale drawn from the ACT protocol produces more pain tolerance than a pain control rationale drawn from a CBT pain management package.

Outcome Studies

Randomized Controlled Trials, Controlled Time Series Designs, and Within Group Designs by Year

Under Review

• Greco, L. A., Blomquist, K. K., Acra, S., & Moulton, D. (Under Review). Acceptance and Commitment Therapy for Adolescents with Functional Abdominal Pain: Results of a Pilot Investigation. Manuscript submitted for publication.

In Press

• Hesser, H., Westin, V., Hayes, S.C. & Andersson, G. (2009). Clients’ in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress. Behaviour Research and Therapy.

• Ruiz, F. J. & Luciano, C. (In Press). Eficacia de la terapia de aceptación y compromiso (ACT) en la mejora del rendimiento ajedrecístico de jóvenes promesas. Acceptance and commitment therapy (ACT) and improving performance in bright youth hopes chess-players. Psicothema.

• Vowles, K. E., Loebach-Wetherell, J., & Sorrell, J. T. (in press). Targeting acceptance, mindfulness, and values-based action in chronic pain: Findings of two preliminary trials of an outpatient group-based intervention. Cognitive and Behavioral Practice.

• Wicksell, R.K., Melin, L., Lekander, M. & Olsson, G.L. (In Press). Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain – A randomized controlled trial. Pain

2009

• Lillis, J., Hayes, S. C., Bunting, K., & Masuda, A. (2009). Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model. Annals of Behavioral Medicine, 37, 58-69.
• Tapper K., Shaw, C., Ilsley, J., Hill, A.J., Bond, F.W. & Moore, L. (2009). Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women. Appetite, 52, 396–404.

2008

• Brown, R. A., Palm, K. M., Strong, D. R., Lejuez, C. W., Kahler, C. W., Zvolensky, M. J., Hayes, S. C., Wilson, K. G., & Gifford, E. V. (2008). Distress tolerance treatment for early-lapse smokers: Rationale, program description, and preliminary findings. Behavior Modification, 32(3), 302-332.

• Lillis, J. (2008). Acceptance and Commitment Therapy for the treatment of obesity-related stigma and sustained weight loss. Unpublished doctoral dissertation. University of Nevada, Reno.

• Lundgren, T., Dahl, J., Yardi, N., & Melin, J. (2008). Acceptance and Commitment Therapy and Yoga for drug refractory: A randomized controlled trial. Epilepsy and Behavior.

• Luoma, J.B., Kohlenberg, B.S., Hayes, S.C., Bunting, K. & Rye, A.K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes. Addiction Research & Theory, 16, 149-165

• Varra, A. A., Hayes, S. C., Roget, N., & Fisher, G. (2008). A randomized control trial examining the effect of acceptance and commitment training on clinician willingness to Use evidence-based pharmacotherapy. Journal of Consulting and Clinical Psychology, 76(3), 449-458.

• Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: A study of effectiveness and treatment process. Journal of Consulting and Clinical Psychology, 76(3), 397-407.

• Wicksell, R.K., Ahlqvist, J., Bring, A., Melin, L. & Olsson, G.L. (2008). Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD)? A randomized controlled trial. Cognitive Behaviour Therapy, 37(3), 1-14.

  Included people (adults) with longstanding pain due to whiplash (WAD). A 10-session protocol was compared with a wait list control group, and found significant improvements following treatment in functioning and life satisfaction, as well as in psychological flexibility (as measured with PIPS).

2007

• Braekkan, K.C. (2007). An acceptance and commitment therapy intervention for combat veterans with posttraumatic stress disorder: Preliminary outcomes of a controlled group comparison. Unpublished doctoral dissertation. Spalding University.

• Dalrymple, K.L. & Herbert, J.D. (2007). Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder: A pilot study. Behavior Modification, 31, 543-568.

• Gaudiano, B. A., Miller, I. W., & Herbert, J. D. (2007). The treatment of psychotic major depression: Is there a role for adjunctive psychotherapy? Psychotherapy and Psychosomatics, 76, 271-277.

• Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(2), 336-343.

  RCT showing that ACT + patient education is significantly better than patient education alone in producing good self-management and better blood glucose levels in lower SES patients with Type II diabetes. Effects at follow up are mediated by changes in self-management and greater psychological flexibility with regard to diabetes related thoughts and feelings.

• Lillis, J., & Hayes, S. C. (2007). Applying acceptance, mindfulness, and values to the reduction of prejudice: A pilot study. Behavior Modification, 31(4), 389-411.

  Undergraduates enrolled in two separate classes on racial differences were exposed Acceptance and Commitment Therapy and an educational lecture drawn from a textbook on the psychology of racial differences in a counterbalanced order. Results indicate that only the ACT intervention was effective in increasing positive behavioral intentions at post and a 1-week follow-up. These changes were associated with other self-reported changes that fit with the ACT model.

• Luoma, J. B., Hayes, S. C., Twohig, M. P., Roget, N., Fisher, G., Padilla, M., Bissett, R., & Kohlenberg, B. (2007). Augmenting continuing education with psychologically focused group consultation: Effects on adoption of group drug counseling. Psychotherapy: Theory, Research, Practice, Training, 44(4), 463–469.

  Augmenting continuing education with psychologically-focused group consultation: Effects on adoption of Group Drug Counseling. Psychotherapy Theory, Research, Practice, Training. An ACT-based supervision group following training in Group Drug Counseling increased adoption in drug and alcohol counselors.

• Masuda, A., Hayes, S. C., Fletcher, L. B., Seignourel, P. J., Bunting, K., Herbst, S. A., Twohig, M. P., & Lillis, J. (2007). The impact of Acceptance and Commitment Therapy versus education on stigma toward people with psychological disorders. Behaviour Research and Therapy, 45(11), 2764-2772.

  An RCT comparing ACT and education in 95 college students. ACT reduced mental health stigma significantly regardless of participants’ pre-treatment levels of psychological flexibility, but education reduced stigma only among participants who were relatively flexible and non-avoidant to begin with.

• McCracken, L. M., MacKichan, F., & Eccleston, C. (2007). Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: Effectiveness and clinically significant change. European Journal of Pain, 11, 314-322.

• Páez, M., Luciano, M. C., & Gutiérrez, O. (2007). Tratamiento psicológico para el afrontamiento del cáncer de mama. Estudio comparativo entre estrategias de aceptación y de control cognitivo. [Psychological treatment for breast cancer. Comparison between acceptance based and cognitive control based strategies] Psicooncología, 4, 75–95.

• Pellowe, M.E. (2007). Acceptance and commitment therapy as a treatment for dysphoria . Unpublished doctoral dissertation. University of Wyoming.

• Twohig, M. P., Shoenberger, D., & Hayes, S. C. (2007). A preliminary investigation of acceptance and commitment therapy as a treatment for marijuana dependence in adults. Journal of Applied Behavior Analysis, 40, 619-632.

  A multiple baseline showing ACT reducing the use of marijuana in 3 clients. 2 relapsed to a degree at follow up.

• Wicksell R.K, Melin, L. & Olsson, G.L. (2007). Exposure and acceptance in the rehabilitation of children and adolescents with chronic pain. European Journal of Pain, 11, 267-274.

  Open trial with 14 adolescents. Good outcomes that continue to improve through follow up.

2006

• Blackledge, J. T., & Hayes, S. C. (2006). Using Acceptance and Commitment Training in the Support of Parents of Children Diagnosed with Autism. Child & Family Behavior Therapy, 28(1), 1-18.

  Pre – post study shows that ACT workshop helps parents cope with the stress of raising autistic children.

• Gaudiano, B. A., & Herbert, J. D. (2006). Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: Pilot results. Behaviour Research & Therapy, 44(3), 415-437.

• Gratz, K. L., & Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with Borderline Personality Disorder. Behavior Therapy, 37(1), 25-35.

  Randomized trial comparing and ACT / DBT combo to TAU. Very strong outcomes on self-harm and other measures. Follow-up is not in this manuscript -- will follow in another publication. The buzz is that outcomes continue to improve; along with acceptance scores.

• Lundgren, T., Dahl, J., & Hayes, S. C. (2008). Evaluation of mediators of change in the treatment of epilepsy with Acceptance and Commitment Therapy. Journal of Behavior Medicine.

• Ossman, W. A., Wilson, K. G., Storaasli, R. D., & McNeill, J. W. (2006). A Preliminary Investigation of the Use of Acceptance and Commitment Therapy in Group Treatment for Social Phobia. International Journal of Psychology and Psychological Therapy, 6, 397-416.

• Rosenqvist, D. & Sand, J. (2006). Mindfulness based smoking cessation for groups - an explorative study. Thesis at the Lund University, Sweden.

  6 acceptance and mindfulness group sessions during 35 days including individual homework assignments. 8 of 10 participants completed the program. At 1 mo follow up 50 percent (of 8 completers) were non-smokers, and the rest showed a decrease in smoking at a rate between 45 and 75 percent. Increase of the acceptance aspect of mindfulness was correlated with non-smoking.

• Twohig, M. P.; Hayes, S. C., & Masuda, A. (2006). Increasing Willingness to Experience Obsessions: Acceptance and Commitment Therapy as a Treatment for Obsessive-Compulsive Disorder. Behavior Therapy, 37(1), 3-13.

  Multiple baseline showing very large reductions in OCD with an 8 session ACT protocol without in session exposure.

• Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). A preliminary investigation of acceptance and commitment therapy as a treatment for chronic skin picking. Behaviour Research and Therapy, 44, 1513-1522.

  Multiple baseline. Good effects at post but less so at follow up.

• Woods, D. W., Wetterneck, C. T., & Flessner, C. A. (2006). A controlled evaluation of Acceptance and Commitment Therapy plus habit reversal for trichotillomania. Behaviour Research and Therapy.

  A small randomized trial (25 completers) comparing ACT plus habit reversal to a wait list. Wait list subjects then receive ACT/HR. Solid hair pulling, anxiety, and depression outcomes, maintained at a 3 month follow up. Wait list participants also improve once they get ACT. AAQ moves and correlates well with outcomes.

• Williams, L.M. (2006). Acceptance and commitment therapy: An example of third-wave therapy as a treatment for Australian Vietnam War veterans with posttraumatic stress disorder: Unpublished dissertation, Charles Sturt University, Bathurst, New South Wales.

2005

• McCracken, L. M., Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43, 1335-1346.

  108 chronic pain patients with a long history of treatment are followed through an ACT-based 3-4 week residential treatment program. Measures improved from initial assessment to pre-treatment on average only 3% (average of 3.9 month wait), but improved on average 34% following treatment. 81% of these gains were retained through a 3 month follow up. Changes in acceptance predicted positive changes in depression, pain related anxiety, physical disability, psychosocial disability, and the ability to stand. Positive outcomes were also seen in a timed walk, decreased medical visits, daily rest due to pain, pain intensity, and decreased pain medication use.

2004

• Branstetter, A. D., Wilson, K. G., Hildebrandt, M., & Mutch, D. (2004). Improving psychological adjustment among cancer patients: ACT and CBT. Paper presented at the Association for Advancement of Behavior Therapy, New Orleans.

  Large randomized trial showing that ACT is more helpful than traditional CBT in dealing with end stage cancer and works through a different process. Amazing data.

• Dahl, J., Wilson, K. G., & Nilsson, A. (2004). Acceptance and Commitment Therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785-802.

  A small randomized controlled trial shows that a four hour ACT intervention reduced sick day usage by 91% over the next six months compared to treatment as usual in a group of chronic pain patients at risk for going on to permanent disability.

• Folke F., & Parling, T. (2004). Acceptance and Commitment Therapy in group format for individuals who are unemployed and on sick leave suffering from depression: A randomized controlled trial. Unpublished thesis, University of Uppsala, Uppsala, Sweden.

  RCT showing that ACT significantly reduces depression among workers on sick leave.

• García, R. F., Villa, R. S., & Cepeda, N. T. (2004). Effect of hypnosis and Acceptance and Commitment Therapy (ACT) on physical performance in canoeists. International Journal of Clinical and Health Psychology, 4(3), 481-493.

• Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M.., Rasmussen-Hall, M. L., & Palm, K. M. (2004). Acceptance theory-based treatment for smoking cessation: An initial trial of Acceptance and Commitment Therapy. Behavior Therapy, 35, 689-705.

  Medium sized randomized controlled trial comparing ACT to nicotine replacement therapy (NRT) as a method of smoking cessation. Quit rates were similar at post but at a one-year follow-up the two groups differed significantly. The ACT group had maintained their gains (35% quit rates) while the NRT quit rates had fallen (less than 10%). Mediational analyses shows that ACT works through acceptance and response flexibility.

• Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., Masuda, A., Pistorello, J., Rye, A. K., Berry, K. & Niccolls, R. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35, 821-835.

  A medium sized randomized controlled trial that found that a one day ACT workshop produces greater decreases in stigmatization of clients by therapists and greater decreases in therapist burnout than an educational control and (or some comparisons) than multicultural training. Mediational analyses fit the model.

• Hayes, S. C., Wilson, K. G., Gifford, E. V., Bissett, R., Piasecki, M., Batten, S. V., Byrd, M., & Gregg, J. (2004). A randomized controlled trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance abusing methadone maintained opiate addicts. Behavior Therapy, 35, 667-688.

  A large randomized controlled trial was conducted with polysubstance abusing opiate addicted individuals maintained on methadone. Participants (n=114) were randomly assigned to stay on methadone maintenance (n=38), or to add ACT (n=42), or Intensive Twelve Step Facilitation (ITSF; n=44) components. There were no differences immediately post-treatment. At the six-month follow-up participants in the ACT condition demonstrated a greater decrease in objectively measured (through monitored urinalysis) opiate use than those in the methadone maintenance condition (ITSF did not have this effect). Both the ACT and ITSF groups had lower levels of objectively measured total drug use than did methadone maintenance alone.

• Livheim, F. Acceptance and Commitment Therapy i skolan - att hantera stress: En randomiserad, kontrollerad studie. Unpublished doctoral dissertation, University of Uppsala, Sweden. 2004.

• Lundgren, A. T. (2004). Development and evaluation of an integrative health model in the treatment of epilepsy: Two randomized controlled trials investigating the effects of a short term ACT intervention, yoga, and attention control therapy in India and South Africa. Unpublished thesis, University of Uppsala, Uppsala, Sweden.

  Two small RCTs (N = 18; and N = 28) comparing a three session ACT protocol (two individual; one group) to two other conditions. As compared to yoga, significantly reduced seizures in the ACT condition; as compared to attention control, significantly reduced seizures and experiential avoidance, and significantly increased quality of life in the ACT condition at a one year follow up.

• Twohig, M. & Woods, D. (2004). A preliminary investigation of acceptance and commitment therapy and habit reversal as a treatment for trichotillomania. Behavior Therapy, 35, 803-820.

  A series of controlled single case designs show that ACT, and ACT combined with habit reversal helps with hair pulling.

2003

• Zettle, R. D. (2003). Acceptance and commitment therapy (ACT) versus systematic desensitization in treatment of mathematics anxiety. The Psychological Record, 53(2), 197-215.

  Small randomized controlled trial shows that ACT is about as good as systematic desensitization in reducing math anxiety, but works according to a different process. Systematic desensitization reduced trait anxiety more. ACT results were better for high emotional avoiders. This is the only study so far with a negative effect size for ACT -- in this case in comparison to systematic desensitization.

2002

• Bach, P. & Hayes, S. C. (2002). The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70 (5), 1129-1139.

  Shows that a three-hour ACT intervention reduces rehospitalization by 50% over a 4 month follow-up as compared to treatment as usual in the seriously mentally ill.

2000

• Block, J.A. & Wulfert, E. (2000). Acceptance or change: Treating socially anxious college students with ACT or CBGT. The Behavior Analyst Today, 1(2), 3-10.

  Small RCT on the treatment of social anxiety. Compared ACT to Cognitive Behavioral Group Therapy and to a no treatment control. Results indicated that ACT participants evidenced a significant increase in reported willingness to experience anxiety, a significant decrease in behavioral avoidance during public speaking, and a marginally decrease in anxiety during the exposure exercises as compared with the control group. Similar results were found for CBGT, but ACT found greater changes in behavioral avoidance.

• Bond, F. W. & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156-163.

  Randomized controlled trial. Shows that ACT is more effective than a previously empirically supported behavioral approach to reducing worksite stress and anxiety, and that both are better than a wait list control.

• Metzler, C. W., Biglan, A., Noell, J., Ary, D., & Ochs, L. (2000). A randomized controlled trial of a behavioral intervention to reduce high-risk sexual behavior among adolescents in STD clinics. Behavior Therapy, 31, 27-54.

  Components from ACT were included as component of a successful program to reduce high risk sexual behavior in adolescents.

1999 and earlier(First ACT Book Appears in 1999)

• Zettle, R. D., & Raines, J. C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45, 438-445.

  Small controlled trial. Shows that ACT is as effective as cognitive therapy for depression when presented in a group format, and that it works by a different process. The effect sizes in favor of ACT are about .6

• Singer, G. H., Irvine, A. B., & Irvin, L. K. (1989). Expanding the focus of behavioral parent training. In G. Irvin (Ed.), Support for caregiving families: Enabling positive adaptation to disability (pp. 85-102). Baltimore, MD, Paul H. Brookes.

  RCT on the distress felt by families of disabled children. Good outcomes. ACT included as a treatment for depression.

• Zettle, R. D. & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: The context of reason giving. The Analysis of Verbal Behavior, 4, 30-38.

  Small controlled trial focusing on process differences between ACT and CT. Only the Hamilton outcome is mentioned in this manuscript. Shows that ACT is more effective that cognitive therapy for depression when presented in an individual format, and that it works by a different process

Reviews of the Empirical Literature

Empirical Reviews of ACT Data

2010

• Ruiz, F. J. (2010). A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10, 125-162.

2008

• Öst, L. G. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy, 46(3), 296-321

2006

• Hayes, S. C., Luoma, J., Bond, F., Masuda, A., and Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44, 1-25.

Meta-analysis of ACT process evidence and ACT outcomes, current through Summer 2005.

2004

• Hayes, S. C., Masuda, A., Bissett, R., Luoma, J. & Guerrero, L. F. (2004). DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies? Behavior Therapy, 35, 35-54.

Tutorial review of the ACT literature current through late 2003.

Studies Underway that We Know About

Projects underway or recently completed that we know about

A large RCT on smoking using Zyban or Zyban plus ACT plus FAP is just finishing the follow up phase. Funded by NIDA. Better outcomes for Zyban plus ACT plus FAP. Liz Gifford and Steve Hayes are the investigators.

Liz Roemer, Sue Orsillo, and Dave Barlow are testing an ACT-related package with GAD. Funded by NIMH

Frank Bond has completed and is writing up two replications and extensions of the Bond and Bunce 2000 study

Fredrick Livheim (livheim@hotmail.com) has conducted a randomized prevention trial with ACT in a school setting. Sigificantly better stress outcomes including at a 6 month follow up

Heather Nash who was at University of Alaska, has relocated to Las Vegas. She has a study of ACT with eating disorders using a multiple baseline

John Forsyth and Maria Karekla (University of Albany) ran a small RCT comparing an Acceptance Framed version of Panic Control Therapy vs. a "treatment as usual" version of Panic Control Therapy for persons suffering from panic disorder. The results are being written up. Persons in the ACT Framed condition were far less likely to drop out of treatment just prior to interoceptive exposure compared with the TAU condition.

John Forsyth and Sean Sheppard (University at Albany) are about to launch a large RCT comparing the effectiveness of The Mindfulness & Acceptance Workbook for Anxiety in a National and International sample of people who view their anxiety and fear as a significant problem for them. The study website is not up yet, but the URL will be www.ACTforAnxiety.com. Stay tuned.

John Forsyth, Ed Hickling, Dan Silverman have finished the first arm of an effectiveness study evaluating a half day ACT workshop for people suffering from Multiple Sclerosis (MS). The study includes pre-workshop assessment and a 3 month follow-up, plus a treatment seeking MS control group that did not get the workshop. The second wave of data collection will be happening in Fall 08. Preliminary data (just workshop participants) show that the workshop significantly reduced depression (from moderate-to-severe range to mild range), thought suppression, and pain interference on quality of life. The sample is small at the moment. So, take these findings as preliminary.

Similar ACT-based anxiety protocols are being tested by Jill Levitt, and by Eifert, Forsyth, & Craske

Branstetter, A., Wilson, K. G., & Mutch, D. G. (August 2003). ACT and the treatment of psychological distress among cancer patients. Paper given at the World Conference on ACT, RFT, and the New Behavioral Psychology, Linköping, Sweden. Large randomized trial showing that ACT is more helpful than traditional CBT in dealing with end stage cancer and works through a different process. Amazing data. (Write it up Ann!)

There is a large trial of ACT for methamphetamine abuse underway under the direction of Matthew Stout in Australia

Randomized trial underway on ACT for command hallucinations in Australia. Under the direction of Fran Shawyer at the Mental Health Research Institute of Victoria. email: fshawyer@mhri.edu.au

Aki Masuda has replicated and extended his “milk, milk, milk” study showing that 3 seconds of repetition does as well as 20 s in reducing distress, compared to the rationale alone; but the 20 s version does best in reducing believability.

Julieann Pankey has found that the AAQ is highly correlated with complicated grieving.
Dosheen Cook has found that the AAQ-heath relationship is the same in Asian as in Caucasian populations

Meyer, B., & Chow, L. (2003, June). Preference for experiential/mindfulness versus rational/cognitive Therapy: The role of information processing styles and sociopolitical attitudes. Poster presented at the annual convention of the Society for Psychotherapy Research. Weimar, Germany. Found that ACT was preferred by liberals … conservative preferred CBT. You can get this manuscript from b.meyer@roehampton.ac.uk

Greco, Dew, & Blomquist have a small uncontrolled pilot-feasibility study currently underway examining the impact of ACT for adolescents with chronic abdominal pain, anxiety, and depression (current enrollment = 10 teens/parents).

Greco has examined willingness and experiential avoidance among children who experience chronic abdominal pain and persistent headaches. Unpublished as of yet. After controlling for gender, age, and pain frequency, duration, and severity, higher levels of acceptance predicted life quality (Beta = .38), and experiential avoidance/fusion predicted greater use of school medical services and school restrooms during class time (Betas = .24 and .23, respectively), lower quality of life (Beta = -.49), higher anxiety (Beta = .64), and lower teacher-rated academic competence (Beta = -.29).

Greco, Dew, & Baer have a manuscript underway that presents psychometric properties of the Willingness and Action Measure (WAM), Avoidance and Fusion Questionnaire (AFQ), and Child Acceptance and Mindfulness Measure (CAMM). Findings suggest that the WAM and CAMM correlate positively with positive functioning, whereas scores on the AFQ correlate positively with physical and emotional symptoms and school disability.

Greco & Russell (2004) evaluated the short-term effects of participating in a summer camp for diabetic youth and investigated the extent to which psychological acceptance moderated children’s response to camp. Psychological acceptance (using the WAM) moderated the relation between pre- and post-camp diabetes self-care behavior, with self-care ratings increasing most when psychological acceptance was high (Beta = .24, p < .05).

Laurie Greco is testing out ACT with eating disorders

Heather Murray, James Herbert, and Evan Forman have a group ACT vs group CBT RCT for Smoking Cessation underway

Laura Ely and Kelly Wilson have a small (n = 10) open trial with college students at risk for drop out. Showed improvements on grades and on many of the subscales of the LASSI (study skills inventory) such as time management and using study aids which were never directly addressed

Debra Moore and Kelly Wilson have a small (n = 20) RCT on teens at risk for highschool drop out. Data being entered

Irish ACT studies (all at NUI Maynooth and all involving the Barnes-Holmes team):

Claire Keogh is working on an extension of the Masuda
study on defusion. So far the data are consistent with the original.

Claire Keogh, Hilary-Anne Healy have completed a study on the utility of a defusion statement ("I am having the thought that" when presented in the context of positively and negatively evaluated self-referential statements in an automated procedure. Good data

Anne Keogh is comparing acceptance and control as interventions with experimentally induced radiant heat pain. Data is looking good for acceptance. May be a gender diff

Andy Cochrane, is looking at acceptance and a behavioral approach task relevant to spider phobia. All interventions fully automated. No data yet.

Geraldine Scanlon is working with a sample of ADHD kids on self-esteem, trying to replicate the recent study of me-good and me-bad relations published in the Record by Rhonda and Kelly.

Claire Campbell is investigating the PASAT and mirror tracing procedures for stress tolerance and applying ACT interventions to them.

Fodhla Coogan and Loretto Cunningham are looking at experimental analogues of experiential avoidance in the context of equivalence relations and aversive versus positive pictures.

Kevin Vowles and John Sorrell have been piloting a group treatment for chronic pain patients integrating the traditional educational stuff that is often part of psychological treatments for pain (e.g., meds, exercise, nutrition, sleep, communication) with ACT. The treatment consists of eight 90-minute sessions. Data so far look good

Frank Gardner at La Salle has a study being written up that shows that
1. Individuals who score high on measures of anger (STAXI) also score high on experiential avoidance and low on emotion regulation.
2. Individuals who score high on anger AND demonstrate behavioral dysregulation are likely to have a significant aversiove early life history (across multiple domains) unlike those patients with behavior dysregulation with minimal anger. These same patients score much lower on QOLI and a values assessment that we have bveen using as well.-
3. The AAQ predicts early termination from treatment (explaining 51% of the variance)... when directly targeted with a a 10 minute "psychoeducation" about experiential avoidance premature termination (69% of which occurs between intake and session 1) is reduced by 50%.

Jason Luoma at University of Nevada, Reno is conducting a randomized trial comparison an introductory 2-day workshop on ACT to the same workshop plus six sessions of phone consultation on learning ACT.

Brandon Gaudiano is conducting a pilot study of a novel psychosocial treatment integrating behavioral activation and ACT for patients with Major Depressive Disorder, severe with psychotic features.

Jen Plumb and Steven Hayes examined the relationship between personal values and depression using the PVQ (Blackledge & Ciarrochi). Found that depressed individuals were more likely to report low success at living consistently with values across domains than non-depressed individuals, and the discrepancy between values success and importance was related more strongly to psychological functioning in depressed individuals than non-depressed individuals. When depressed individuals were low on success at living consistently with their values they were more likely to endorse pliant and avoidance based reasons for choosing those values than non-depressed controls.

Jen Plumb, Mike Levin and Steven Hayes are examining the potentially motivative effects of values statements on studying behavior in college students. Two studies are underway (data collection phase). One examines self-monitoring of study behavior versus a simple values intervention in addition to self-monitoring. The other examines the differential effects of aversive values motivation (e.g., pliant, avoidant functions) as opposed to appetitive values motivation (e.g., choice, awareness of the reinforcement from living consistent with values) on studying behavior.

Ernst Bohlmeijer is in the process of pilot testing an intervention integrating ACT and mindfulness for clients experiencing various forms of psychological distress.

JoAnne Dahl and students have RCTs underway in smoking, OCD, and obesity.

Jason Lillis (Nevada) has an RCT just finish in obesity and weight maintenance with nice outcomes. ACT lead significantly lower weight and blood pressure outcomes, lower self-stigma, and higher quality of life. Changes were mediated by ACT processes.

JoAnne Dahl has an RCT underway with headache and one with social phobia

Mónica Hernández-López Jesús Gil Roales-Nieto & Carmen Luciano Soriano have a completed smoking RCT comparing ACT to CBT with good outcomes

Julie Wetherell at UCSD and the VA there (working with Niloo Afari, who recently joined their faculty) have a VA grant to compare ACT to CBT in 100 chronic pain patients.

Gerhard Andersson has found that tinnitus acceptance and action mediates the relationship between distress over tinnitus and depression, quality of life, and further distress over tinnitus seven months later. Being written up.

Nancy Kocovski, Jan Fleming, & Neil Rector (U of Toronto) have an ACT protocol (they call it Mindfulness and Acceptance-Based Group Therapy) for social anxiety that is working well and is headed toward a randomized controlled trial

Tobias Lundgren just finished an ACT RCT for adolescents diagnosed with Aspergers syndrome. The study involved a 12 week treatment program with a 2 months follow up. Significant interaction effects were found on depression, anxiety and stress scales in favor of the treatment group. Furthermore, significant interaction effects were found on attention ability and teacher ratings on troublesome behavior as compared to a waiting list.

Study underway by Andrew Gloster and colleagues at the Institute of Clinical Psychology & Psychotherapy in Dresden, Germany, grant funded by the German government entitled: What Should We Do When CBT for Panic/Agoraphobia Fails: ACT! The goal is to test whether ACT can help those patients who are categorized as non-responders following an intense course of CBT.

Studies underway at the School of Psychology, University of Wollongong

1) Billich, Ciarrochi, & Deane have completed a wait-list control trial of ACT with the NSW police. The research suggests that ACT improves mental health, at least in the short run. We are writing this up for publication (This is funded by the Australian Research Council)

2) Fisher and Ciarrochi are conducting a cross-sectional study on personal values and quality of life amongst clients with Cancer. We are examining whether people have better adjustment and mental health when they tend to hold values for authentic reasons (e.g., vitality) rather than controlled reasons (e.g., external pressure), and when they tend to succeed at authentically held values.

3) Ciarrochi and Bailey (in press) have developed a new measure that is designed to aid values clarification. The measure is called the Survey of Life Principles (SLP), and is currently being evaluated in a number of studies. Stefanic and Ciarrochi are examining the psychometric properties of the SLP. Frearson & Ciarrochi are evaluating it in the context of couples satisfaction. Bayliss and Ciarrochi are evaluating it in the context of the police force.

4) Bayliss and Ciarrochi have done a small longitudinal study amongst NSW police recruits, following them from police recruit (Time 1) to one year in the police force (Time 2). Mindfulness, low experiential avoidance, and emotion identification skill were significant predictors of mental health at Time 2, even after controlling for mental health at Time 1. We are in the process of writing this up. (This is funded by the Australian Research Council)

5) We are now in the seventh year of a large longitudinal study of adolescents (now aged 17). Supavadeeprasit and Ciarrochi are preparing a manuscript that looks at experiential avoidance (in grade 8) predicting future social and emotional well-being. Jordan & Ciarrochi have also been looking at the measurement of mindfulness amongst adolescents and its ability to predict future levels of social and emotional well-being (The longitudinal study is been funded by the Australian Research Council and the National Health and Medical Research Council).

6) Ciarrochi, Lane, & Blackledge have developed an internet-based ACT intervention for people diagnosed with cancer. We are in the process of evaluating its efficacy. (This has been funded by the NSW Cancer Council).

Additional information about research being conducted in Australia and New Zealand can be found here.

Information About Grants and Grant Writing

This page includes a list of resources for learning about the grant application process and how to write successful grants.

• Power Point Slides

  There are several power point presentations by Steven Hayes and Jacqueline Pistorello posted at the bottom of this page. These slides were developed for a grant class taught at the University of Nevada - Reno and cover different aspects of grant writing and submission.

• Grant Mechanisms and Funding Opportunities

  Describes the different types of funding mechanisms (RO1, K, etc...) for NIH.

• Step by Step Outline of Applying for Grants

  Walks through the different steps for submitting a grant.

• NIH Advice on Writing Clinical Research Grants

  Provides useful suggestions on how to write and what to include in each of the grant sections for clinical research grant submitted to NIH.

• NIH Grant Review Process Video

  "The Center for Scientific Review has produced a video of a mock study section meeting to provide an inside look at how NIH grant applications are reviewed for scientific and technical merit. The video shows how outside experts assess applications and how review meetings are conducted to ensure fairness. The video also includes information on what applicants can do to improve the chances their applications will receive a positive review."

• Electronic Submission Information

  Provides information regarding how to submit your grant electronically, including common errors and required software

Ongoing ACT Grants

If you have an ongoing grant on ACT please add a child page and describe it!

Here are a few we know about:

Jacqueline Pistorello and Steven Hayes at the University of Nevada (with co-investigators Tony Biglan and John Seely at Oregon Institue) have been awarded a 5 year 2.6 million dollar grant from the National Institute on Mental Health (2008 - 2013) to examine the impact of ACT on the prevention of behavioral health problems in 18-20 year old college students.

National Institute on Drug Abuse, “Stigma and Burnout in Addiction Counselors,” R01 DAO17868, August 1, 2005- July 31, 2008, S. C. Hayes, Principal-investigator.

National Institute on Drug Abuse, “Reducing Felt Stigma in SUD,” $435,000, 2003-2006, Barbara S. Kohlenberg, Principle investigator.

National Institute on Drug Abuse, “Distress Tolerance Treatment for Early Smoking Lapsers,” $1,068,000, 2003-2006, Richard Brown, Principle investigator

National Institute on Drug Abuse, “Acceptance Therapy During Methadone Detoxification,” 2005-2008, Angela L. Stotts, University of Texas-Houston Medical School

If you are looking for resources to assist in applying for a grant, the Association for Behavioral and Cognitive Therapies has a useful list of links to learn more about grants and funding sources that can be accessed here.

Resources for Finding Funding Opportunities and Previously Funded Grants

This page includes a list of resources for finding funding opportunities (PAs, RFAs).

• CRISP (Computer Retrieval of Information on Scientific Projects)
  

  Searchable database that can be used to identify any previously funded grants.

• Searching for Funding Announcements - Grants.Gov
  

  Searchable database for funding announcements (RFAs and PAs).

• NIMH Newsletter
  

  Archived list of emails from the NIMH newsletter describing funding opportunities and other grant relevant information. Also, provides a link to join

ACT for Math Anxiety

There is only one study so far published with a negative effect size for ACT as compared to something else:

Zettle, R. D. (2003). Acceptance and commitment therapy (ACT) versus systematic desensitization in treatment of mathematics anxiety. The Psychological Record, 53, 197-215.

This study compared ACT to systematic desensitization. The recent meta-analysis of the ACT literature included it and you can download the study from this website. Rob found that ACT worked better than a control condition, as did desensitization. On measures of math anxiety, ACT and desensitization were not statistically significantly different, but the d was in the wrong direction, and on general levels of overall anxiety, desensitization was better.

In 1999 ACT book we said this about fitting a fairly challenging intervention like ACT to the problem: "Before ACT begins, the client must be prepared for it. It can be an intensive intervention and the clients should not be subjected to such interventions lightly." In line with that, it seems possible that Math Anxiety is too low level of a problem to warrant ACT. Interestingly, in Zettle's study highly experientially avoidant participants did better in ACT than those who were not avoidant -- while the same did not hold true for desensitization.

ACT for Pain

I have had many failures replicating the Hayes et al (1999) pain tolerance study. Over the years I have answered criticisms of reviewers in my attempt to have negative results published. As a result I have begun to video record my interventions for analysis by anyone who is interested. I now take a whole host of adherence measures and subjective reports. I have even examined acceptance over the long run in the lab. But still no effects on pain tolerance for ACT-derived protocols over placebos or alternative treatments (relaxation and education or supression). often no effects for acceptance-based interventions at all.

I would love to offer practical suggestions but as you will see from my list I have five years of research here - so I am trying! I am all out of suggestions. I also think that if the procedure has to be contrived so much that effects are only measureable on such measures as the AAQ (which measures what ACT teaches the client - ipso facto we will see changes in scores) or if the research requires a clincian as experimenter or highly elaborate and exhaustive subjective ratings and statistical techniques - its not a very powerful effect! So I hesitate to contrive procedures much mroe complex than what I have got. (The details of which I hope we will discuss as a community in reposne to these postings).

So here is my list of failures....

Failure 1
Examining the effectiveness of acceptance and control – based interventions on pain tolerance.

This study compared the effectiveness of an acceptance-based and control-based intervention on pain tolerance using a cold pressor task, and is a part-replication and extension of the Hayes et al., (1999) study. Twenty college students were exposed to the cold pressor task before, immediately after, and 20 minutes subsequent, to an 8 minute acceptance-based or control-based therapeutic intervention, including the use of physical and abstract metaphors. Half of the participants were also assigned to a high demand characteristic condition in which the experimenter purposely placed subtle social pressure on them to please the experimenter. The results showed that the most significant factor influencing performance on the cold pressor task was the effect of placing social pressure on participants, with no significant overall effect for Acceptance or Control interventions.

Failure 2
A Systematic Analysis of the Role of Demand Characteristics in an Acceptance Based Approach to Pain Tolerance.

This study compared the role of demand characteristics in an acceptance-based approach to pain tolerance and both the long and short-term effects of the acceptance-based versus the no therapy interventions. Forty participants were exposed to a cold pressor task before and immediately after a short intervention. Twenty-eight participants also completed a follow up task three months later. Half of the participants receiving each intervention were also subject to high levels of demand characteristics. In this high demand condition the experimenter placed subtle social pressure on the participants to perform well on the second cold pressor task. The findings showed that participants in the acceptance condition improved more, but not significantly more, than those in the no therapy condition. Participants in the high demand condition performed significantly better than those in the low demand condition. Interaction effects for therapy x demand were also found between the experimental groups.

Failure 3
Comparing the Effectiveness of Acceptance and Control Strategies for Pain Tolerance with a Sub-clinical Population

This study used an experienced psycho synthesis therapist and cognitive behavior therapy postgraduate as an experimenter who had studied ACT and taken the full ACT weekend workshop. This study was a part replication and extension of the Hayes, Bissett, Korn, Zettle, Rosenfarb, Cooper and Grunt (1999) study. Four sub-clinical volunteers (two smokers, one drinker and a tantrum thrower) were exposed to a cold pressor task before, immediately after, and several weeks subsequent to a 90 minute acceptance-based therapeutic intervention. Baseline rates of idiosyncratic problem behaviours were also recorded prior to, and for several weeks subsequent to, the initial intervention. The acceptance-based intervention was then administered weekly for up to 25 weeks by a qualified cognitive-behavior therapist to asses its impact on pain tolerance and target problem behaviour rates in the longer term. The acceptance-based intervention showed weak effects on pain tolerance during all phases of the study and no discernible effects on problem behaviors were observed (in fact they got worse!).

Failure 4
Examining the effectiveness of an acceptance and relaxation-based intervention on pain tolerance

This study attempted to compare the effectiveness of an acceptance and relaxation-based intervention on pain tolerance to a cold pressor task and is a partial replication and extension of the Hayes et al., (1999) study. Forty college students were exposed to a cold pressor task before and immediately after an eight minute acceptance-based and relaxation-based intervention. Half of the participants in each group were also assigned to a high demand condition, in which subtle social pressure was placed on the participants to please the experimenter and do well in the task. The results confirmed that the most significant factor influencing performance on the cold pressor task was placing social pressure on participants to do well. There was no significant overall effect for either the acceptance or relaxation-based intervention although both produced mild improvements in pain tolerance.

Failure 5
The effectiveness of an acceptance and control-based interventions on pain tolerance at two different levels of pain in a cold pressor task.

This study employed the now standard procedure of using 40 subjects – half get an acceptance protocol and half get a control-based protocol following a baseline cold pressor task and before a post-intervention cold pressor task. Half of each group get cold pressors at 0 degrees centigrade – the remainder at 3 degrees. Acceptance has a mild effect – not significant – and does not interact with temperature on an ANOVA. This dashed our hopes that maybe acceptance was more useful for intense pain over mild pain – no lab data to support that idea yet.

Failure 6
So maybe it’s the subject’s fault! Assessing the effectiveness of acceptance and control based interventions with anxious and non-anxious subjects.

We recruited 20 high and 20 low trait anxiety subjects by screening with the STAI. We defined high and low as one SD above and below the mean score as outlined in the standardized distribution scores. Half of each got a control intervention and half got acceptance. Anxious subjects did not benefit more than non anxious from either the acceptance or the control intervention on a cold pressor task. Overall no effect for acceptance. No effects were found on any subjective reports.

ACT for Stigma Against Mental Health Patients

Aki Masuda tested ACT versus education for reducing stigma against mental health patients in an RCT. The interventions were both very short (2.5 hours) and the sample was one of convenience (Intro Psych students). Both conditions reduced stigmatizing attitudes signficantly and gains were maintained at a 2 month follow up but there was no difference between them.

The study was Aki's dissertation at UNR. You should be able to get it at Dissertation Abstracts International late in 2006.

AC