Education Commons^™

Reach, Adoption, And Maintenance Of Online Acceptance And Commitment Therapy At A University: An Implementation Case Study, Carter H. Davis, Korena Klimczak, Ty B. Aller, Michael P. Twohig, Michael E. Levin

Psychology Faculty Publications

College students are undergoing a mental health crisis and existing clinical resources at universities may be inadequate to meet their needs. One solution to this problem could be the use of self-guided, online programs for mental health that can be easily distributed to students. A persistent issue, however, is the transition from program development to implementation of a self-guided program at campus-wide scale. We describe, in a self-narrative format, the steps taken to translate an online program we developed based in acceptance and commitment therapy (ACT), called ACT Guide, from a research context to a campus-wide service at our university. …

Choosing Act Or Cbt: A Preliminary Test Of Incorporating Client Preferences For Depression Treatment With College Students, Carter H. Davis, Michael P. Twohig, Michael Levin

Psychology Faculty Publications

Background

Depression is a significant concern among college students, who suffer at higher rates and with greater severity than the general population. Online self-help could reduce the burden currently placed on college counseling centers, and programs based in cognitive behavioral therapies (CBTs) have a strong evidence base. However, online CBTs for depression often suffer from low adherence rates. An understudied method for improving adherence in this population is offering students a choice between various CBTs.

Methods

We conducted a randomized trial with 142 students with high levels of depression, with a subset of participants randomly receiving either traditional cognitive behavioral …

Experiential Avoidance In Depression, Anxiety, Obsessive-Compulsive Related, And Posttraumatic Stress Disorders: A Comprehensive Systematic Review And Meta-Analysis, Mehdi Akbari, Mohammad Seydavi, Zahra S. Hosseini, Jennifer Krafft, Michael E. Levin

Psychology Faculty Publications

Although numerous studies on experiential avoidance and its relationship to psychopathology have been conducted, systematic summaries of this research are lacking. The current systematic review and meta-analysis evaluated the transdiagnostic role of experiential avoidance across depression, anxiety and related disorders (obsessive-compulsive and related disorders [OCRDs] and post-traumatic stress disorder [PTSD]) as well as potential moderators of these relations. A total of 441 eligible studies including 135,347 participants (66.16% female, mean age = 31.53) and 899 effect-sizes were summarized. Results indicated a moderate-to-large association of experiential avoidance with anxiety (r = .506) and depressive symptoms (r = .562), major …

An Open Trial Of Acceptance And Commitment Therapy With Exposure And Response Prevention In An Intensive Outpatient Setting For Adults With Ocd, L. K. Capel, P. Zurita-Ona, C. Muller, Michael P. Twohig

Psychology Faculty Publications

Intensive outpatient (IOP) treatment settings for adults with obsessive-compulsive disorder (OCD) are common, but data on their effectiveness is limited. The effectiveness of IOP treatment for adults with OCD using combined Acceptance and Commitment Therapy (ACT) and Exposure and Response Prevention (ERP) was studied with eight adults. The intervention was 15 hours per week for three weeks. Measures were collected at pre-treatment, one-week, two-weeks, post-treatment, and at one-month follow-up. At the end of treatment, all participants were in the mild range of OCD symptom severity with a mean symptom decrease of 58%. Psychological inflexibility, depression, anxiety and stress significantly decreased …

Study Protocol For A Randomized Controlled Trial Comparing Two Low-Intensity Weight Loss Maintenance Interventions Based On Acceptance And Commitment Therapy Or Self-Regulation, Jason Lillis, Leah Schumacher, J. Graham Thomas, Michael E. Levin, Shira Dunsiger, Jessica L. Unick, Erin Evans, Jacqueline F. Hayes, Rena R. Wing

Psychology Faculty Publications

Background: Weight regain is common following behavioral obesity treatment and attenuates many of the benefits of initial weight loss. This paper describes a randomized controlled trial that will evaluate the efficacy of two low-contact weight loss maintenance interventions based on Acceptance and Commitment Therapy (ACT) and self-regulation (SR). Potential mechanisms of action and moderators of treatment effects will also be evaluated.

Methods: Adults (anticipated N=480)with overweight or obesity will complete an initial 3-monthonline weight loss program (Phase 1). Participants who achieve ≥4 kg weight loss (anticipated N=288) will then be randomized to an ACT or SR weight loss maintenance intervention. …

A Randomized Trial Of Brief Online Interventions To Facilitate Treatment Seeking For Social Anxiety, Margaret R. Tobias, Lauren N. Landy, Michael E. Levin, Joanna J. Arch

Psychology Faculty Publications

Objective: This study developed and evaluated a brief, single-session online intervention designed to facilitate treatment seeking among adults with clinically significant social anxiety (SA) symptoms, who generally seek treatment at exceptionally low rates.

Method: Adults (N= 267) reporting significant SA symptoms were recruited online and randomized to a brief, single-session online intervention: Education consisted of brief psychoeducation and treatment resources, or Education+Motivation which added treatment seeking-focused motivational content adapted from Motivational Interviewing and Acceptance and Commitment Therapy. Attitudes, intentions, perceived control, and treatment seeking were assessed at Pre, Post, and one-month follow-up (FU).

Results: Both interventions were feasible …

Acceptability, Feasibility, And Efficacy Potential Of A Multimodal Acceptance And Commitment Therapy Intervention To Address Psychosocial And Advance Care Planning Needs Among Anxious And Depressed Adults With Metastatic Cancer, Joanna J. Arch, Joel N. Fishbein, Michelle C. Ferris, Jill L. Mitchell, Michael E. Levin, Elizabeth T. Slivjak, David J. Andorsky, Jean S. Kutner

Psychology Faculty Publications

Background: Adults with metastatic cancer frequently report anxiety and depression symptoms, which may impact health behaviors such as advance care planning (ACP).

Objective: The study leveraged acceptance and commitment therapy (ACT), an evidence-based approach for reducing distress and improving health behaviors, and adapted it into a multimodal intervention (M-ACT) designed to address the psychosocial and ACP needs of anxious and depressed adults with metastatic cancer. The study evaluated M-ACT's acceptability, feasibility, and efficacy potential.

Design: The study was designed as a single-arm intervention development and pilot trial.

Setting/Subjects: The trial enrolled 35 anxious or depressed adults with stage IV cancer …

A Randomized Dismantling Trial Of The Open And Engaged Components Of Acceptance And Commitment Therapy In An Online Intervention For Distressed College Students, Michael E. Levin, Jennifer Krafft, Elizabeth T. Hicks, Michael P. Twohig, Benjamin G. Pierce

Psychology Faculty Publications

This dismantling trial compared the effects of a full online Acceptance and Commitment Therapy (ACT) intervention to the isolated effects of the Open (i.e., acceptance, cognitive defusion) and Engaged (i.e., values, committed action) components of ACT. A sample of 181 distressed college students were randomized to one of four conditions: a 12-session full ACT website (Full), a version targeting the Open components (Open), a version targeting the Engaged components (Engaged), or waitlist. Participants in active conditions were also randomized to receive phone coaching or just email prompts to increase program adherence. All three ACT conditions significantly improved over time relative …

Beyond Acceptance And Commitment Therapy: Process-Based Therapy, Clarissa W. Ong, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

This article describes process-based therapy (PBT) as a natural evolution toward more effective and efficient mental healthcare. Using acceptance and commitment therapy as an example of an early prototype of PBT, this paper explicates the broader features of PBT and the shift in mindset researchers and clinicians will need to take to fully embrace PBT with respect to assessment, conceptualization, and intervention. In addition, the paper enumerates challenges to implementing the PBT model and proposes recommendations for circumventing these challenges in the areas of theory development, research methodology, and clinical practice. Finally, we make the argument shifting to PBT is …

Moderators And Processes Of Change In Traditional Exposure And Response Prevention (Erp) Versus Acceptance And Commitment Therapy-Informed Erp For Obsessive-Compulsive Disorder, Clarissa W. Ong, Shannon M. Blakey, Brooke M. Smith, Kate L. Morrison, Ellen J. Bluett, Jonathan S. Abramowitz, Michael P. Twohig

Psychology Faculty Publications

The present study evaluated moderators and processes of change in a randomized controlled trial comparing exposure and response prevention (ERP) delivered from a traditional framework versus ERP from an acceptance and commitment therapy framework (ACT+ERP) for obsessive-compulsive disorder (OCD). This paper presents baseline, weekly session, posttreatment, and follow-up data from the study. We examined (a) moderation effects of anxiety, depression, psychological inflexibility, and interpretation of intrusions and (b) the role of psychological inflexibility and interpretation of intrusions respectively as processes of change. Participants with less dysfunctional appraisals at pretreatment performed consistently better in ERP relative to ACT+ERP. In process analyses, …

Evaluating Acceptance And Commitment Therapy And Mindfulness-Based Stress Reduction Self-Help Books For College Student Mental Health, Michael E. Levin, Woolee An, Carter H. Davis, Michael P. Twohig

Psychology Faculty Publications

Objectives: Self-help has the potential to improve access to mental health resources for college students. However, solutions are needed to improve sustainable delivery, cost- effectiveness, and to know which resources are most useful. Methods: A sample of 109 college students were randomly assigned to read either an Acceptance and Commitment Therapy (ACT) or Mindfulness-Based Stress Reduction (MBSR) self-help book through the University library website over 8 weeks with assessments at baseline, midtreatment (4-weeks), and posttreatment (8-weeks). Results: The majority of participants reported reading over half of their assigned book and high satisfaction ratings were given for both books. Both conditions …

Utilizing Act Daily As A Self-Guided App For Clients Waiting For Services At A College Counseling Center: A Pilot Study, Jack Haegar, Carter H. Davis, Michael E. Levin

Psychology Faculty Publications

Objective: Considering increasing demands for mental health services at college counseling centers (CCCs), there is a need for cost-effective solutions that avoid depleting stressed CCC resources. This study examined if ACT Daily, a mobile application based on acceptance and commitment therapy (ACT), could serve as an effective self-guided intervention.

Participants: 11 individuals on a CCC waitlist suffering from anxiety/depression participated in the study over 2 weeks.

Methods: This study implemented a pre-post, open trial design of ACT Daily. Assessments were completed at baseline and 2-week post assessment.

Results: Results indicated that ACT Daily was acceptable and that participants improved on …

Examining Processes Of Change In An Online Acceptance And Commitment Therapy Dismantling Trial With Distressed College Students, Michael E. Levin, Jennifer Krafft, Michael P. Twohig

Psychology Faculty Publications

This secondary analysis examined the processes of change from a randomized dismantling trial evaluating the Open (i.e., cognitive defusion, acceptance) and Engaged (i.e., values, committed action) components of acceptance and commitment therapy (ACT). Analyses were conducted with 161 distressed college students randomly assigned to a full online ACT program (Full n=40), online ACT targeting the Open components (Open n=41) or targeting the Engaged components (Engaged n=39), or a waitlist condition (Waitlist n=41). The intervention occurred over six weeks followed by a post-treatment assessment with mental health symptoms as the primary outcome. Consistent with predictions, pre- to …

An Examination Of The Relationship Between Perfectionism And Neurological Functioning, Julie M. Petersen, Clarissa W. Ong, Allison S. Hancock, Ronald B. Gillam, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Clinical perfectionism is the rigid pursuit of high standards, interfering with functioning. Little research has explored neural patterns in clinical perfectionism. The present study explores neural correlates of clinical perfectionism, before and after receiving ten 50-minute, weekly sessions of acceptance and commitment therapy (ACT), as compared to low-perfectionist controls, in specific cortical structures: the dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex (MPFC), right inferior parietal lobule (IPL). Participants in the perfectionist condition (n = 43) were from a randomized controlled trial evaluating ACT for clinical perfectionism and low-perfectionist controls were undergraduate students (n = 12). Participants completed three tasks (editing …

A Preliminary Investigation Of The Effect Of Acceptance And Commitment Therapy On Neural Activation In Clinical Perfectionism, Clarissa W. Ong, Allison S. Hancock, Tyson S. Barrett, Eric B. Lee, Nicholas Wan, Ronald B. Gillam, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Clinical perfectionism is associated with various cognitive processes including performance monitoring and emotion regulation. This exploratory study analyzed neurological data from a randomized controlled trial for clinical perfectionism that compared acceptance and commitment therapy (ACT) to a waitlist control. The objective was to assess the effect of ACT on neural activation. Twenty-nine participants underwent a functional near-infrared spectroscopy assessment during which they completed behavioral tasks designed to elicit error detection and error generation at pre- and posttreatment. The hemodynamic response function (HRF) in the dorsolateral prefrontal cortex, dorsomedial prefrontal cortex, and right inferior parietal lobe was analyzed using mixed effects …

The Role Of Psychological Inflexibility And Self-Compassion In Acceptance And Commitment Therapy For Clinical Perfectionism, Clarissa W. Ong, Jennifer L. Barney, Tyson S. Barrett, Eric B. Lee, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

The current study examined psychological inflexibility and self-compassion as theoretically relevant mediators and moderators of outcomes following acceptance and commitment therapy (ACT) for clinical perfectionism. Fifty-three participants with clinical perfectionism were randomized to either a 10-session ACT condition or a 14-week waitlist control condition (only 39 completed the post treatment assessment). Outcomes tested include concern over mistakes, doubting of actions, personal standards, quality of life, symptom distress and functional impairment, and valued action. Multilevel modeling analyses showed reduced psychological inflexibility mediated the relationship between condition and higher quality of life and increased self-compassion mediated the relationship between condition and decreased …

A Web-Based Self-Guided Program To Promote Valued-Living In College Students: A Pilot Study, Jacob Firestone, Leeann Cardaciotto, Michael E. Levin, Edie Goldbacher, Peter Vernig, Laura Eubanks Gambrell

Psychology Faculty Publications

Web-based programs that focus on values, a core process within acceptance and commitment therapy (ACT), may be a promising approach to cultivate positive psychosocial adjustment among undergraduates. The current study tested the usability, acceptability, and receptivity of the Living Your Values (LYV) program, a single-session, web-delivered, self-guided values intervention for undergraduates and its utility to promote valued-living and psychological wellbeing. In an undergraduate sample (N = 133), while the LVY program was deemed moderately usable, acceptability and receptivity findings were more attenuated. At follow-up (n = 98), a significant pre-intervention to follow-up increase in valued-living was evidenced both overall and …

A Review Of Aaq Variants And Other Context-Specific Measures Of Psychological Flexibility, Clarissa W. Ong, Eric B. Lee, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Psychological flexibility refers to a way of interacting with internal experiences and the external environment that advances one toward chosen values whereas psychological inflexibility reflects rigid adherence to ineffective responses such that valued living is compromised. Psychological flexibility is a critical variable of interest in acceptance and commitment therapy, thus, accurate assessment of this construct is pertinent to professionals in the field. Numerous measures of psychological flexibility for specific conditions exist and the psychometric validation of each of these measures varies in breadth and depth. To orient professionals to the scope of available measures as well as their psychometric properties, …

A Randomized Controlled Trial Of Acceptance And Commitment Therapy For Clinical Perfectionism, Clarissa W. Ong, Eric B. Lee, Jennifer Krafft, Carina L. Terry, Tyson S. Barrett, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Clinical perfectionism is characterized by imposing excessively high standards on oneself and experiencing severe distress when standards are not met. It has been found to contribute to the development and maintenance of various clinical presentations including anxiety, obsessive-compulsive, and eating disorders. The present study tested the efficacy of ten weekly individual sessions of acceptance and commitment therapy (ACT) relative to a waitlist control on clinical perfectionism and global outcomes among 53 individuals with clinical perfectionism. ACT is a process-based therapy that targets maladaptive underlying processes (e.g., rigid adherence to unrealistic high standards) rather than symptom topography (e.g., anxiety, depression). Participants …

Comparing Cognitive Fusion And Cognitive Reappraisal As Predictors Of College Student Mental Health, Jennifer Krafft, Jack Haegar, Michael E. Levin

Psychology Faculty Publications

Transdiagnostic cognitive behavioral interventions target different cognitive processes to promote mental health, including cognitive fusion and cognitive reappraisal. Determining the relative impact of cognitive fusion and reappraisal on a range of student mental health concerns could help interventions target psychopathological cognitive processes more effectively. Therefore, this study examined the longitudinal impact of cognitive fusion and reappraisal on mental health and functioning outcomes. A series of hierarchical regression models tested the effects of cognitive fusion and reappraisal in a sample of college students (n = 339). When controlling for reappraisal and baseline symptoms, fusion predicted distress, depression, generalized anxiety, social anxiety, …

When Is Experiential Avoidance Harmful In The Moment? Examining Global Experiential Avoidance As A Moderator, Michael E. Levin, Jennifer Krafft, Benjamin G. Pierce, Sarah Potts

Psychology Faculty Publications

Background and Objectives: Although experiential avoidance has been shown to predict a wide range of mental health problems, there has been minimal research to-date on the more immediate effects of engaging in experiential avoidance in the moment or the moderators that predict when it is more or less harmful.

Methods: An ecological momentary assessment (EMA) study was conducted with 70 undergraduate students who completed assessments three times a day, over seven days as well as a baseline assessment of global questionnaires.

Results: Both greater global experiential avoidance and momentary experiential avoidance independently predicted greater momentary negative affect, lower positive affect, …

Adding Acceptance And Commitment Therapy To Exposure And Response Prevention For Obsessive-Compulsive Disorder: A Randomized Controlled Trial, Michael P. Twohig, Jonathan S. Abramowitz, Brooke M. Smith, Laura E. Fabricant, Ryan J. Jacoby, Kate L. Morrison, Ellen J. Bluett, Lillian Reuman, Shannon M. Blakey, Thomas Ledermann

Psychology Faculty Publications

The objective of this study was to test whether treatment acceptability, exposure engagement, and completion rates could be increased by integrating acceptance and commitment therapy (ACT) with traditional exposure and response prevention (ERP). 58 adults (68% female) diagnosed with obsessive-compulsive disorder (OCD; M age = 27, 80% white) engaged in a multisite randomized controlled trial of 16 individual twice-weekly sessions of either ERP or ACT + ERP. Assessors unaware of treatment condition administered assessments of OCD, depression, psychological flexibility, and obsessional beliefs at pretreatment, posttreatment, and six-month follow-up. Treatment acceptability, credibility/expectancy, and exposure engagement were also assessed. Exposure engagement was …

The Influence Of A Personal Values Intervention On Cold Pressor-Induced Distress Tolerance, Brooke M. Smith, Jennifer L. Villatte, Clarissa W. Ong, Grayson M. Butcher, Michael P. Twohig, Michael E. Levin, Steven C. Hayes

Psychology Faculty Publications

Research has demonstrated that values and acceptance interventions can increase distress tolerance, but the individual contribution of each remains unclear. The current study examined the isolated effect of a values intervention on immersion time in a cold pressor. Participants randomized to Values (n = 18) and Control (n = 14) conditions completed two cold pressor tasks, separated by a 30-minute values or control intervention. Immersion time increased 51.06 seconds for participants in the Values condition and decreased by 10.79 seconds for those in the Control condition. Increases in self-reported pain and distress predicted decreases in immersion time for Control, but …

The Role Of Experiential Avoidance In Problematic Pornography Viewing, Michael E. Levin, Eric B. Lee, Michael P. Twohig

Psychology Faculty Publications

Research suggests that online pornography use can have harmful consequences for some individuals, but the psychological processes that contribute to problematic viewing are unclear. This study sought to evaluate the role of experiential avoidance in the negative consequences of online pornography viewing in a small cross sectional survey sample of 91 male college students who reported viewing. Results indicated that viewing pornography for experientially avoidant motivations was related to more frequent viewing and predicted self-reported negative consequences of viewing over and above other motivations (e.g., sexual pleasure, curiosity, excitement seeking). Although more frequent viewing was related to more self-reported negative …

Comparing Cognitive Defusion And Cognitive Restructuring Delivered Through A Mobile App For Individuals High In Self-Criticism, Michael E. Levin, Jack Haegar, Woolee An, Michael P. Twohig

Psychology Faculty Publications

There are ongoing questions regarding the similarities and differences in the clinical impact and processes of change for cognitive restructuring and cognitive defusion. This clinical component test compared 87 adults high in self-criticism randomized to a cognitive defusion mobile app, restructuring app, or waitlist condition for two weeks. Equivalent improvements were found from the defusion and restructuring apps relative to the waitlist in self-criticism and distress as well as decentering, self-compassion, and dysfunctional attitudes. However, the defusion condition had a more consistent pattern of improvements relative to waitlist. Improvements in cognitive decentering, self-compassion, and dysfunctional attitudes mediated effects for cognitive …

Effects Of Acceptance And Commitment Therapy On Impulsive Decision Making, Kate L. Morrison, Brooke M. Smith, Clarissa W. Ong, Eric B. Lee, Jonathan E. Friedel, Amy L. Odum, Gregory J. Madden, Thomas Ledermann, Jillian M. Rung, Michael P. Twohig

Psychology Faculty Publications

This study examined the transdiagnostic effect of acceptance and commitment therapy (ACT) on impulsive decision making in a community sample. Forty adults were randomized to eight individual sessions of ACT or an inactive control. Participants completed pre-, mid-, and post-assessments for psychological symptoms, overall behavior change, valued living, delay discounting, psychological flexibility, and distress tolerance. Data were analyzed with multilevel modeling of growth curves. Significant interaction effects of time and condition were observed for psychological flexibility, distress tolerance, psychological symptoms, and the obstruction subscale of valued living. No significant interaction effect was found for two delay discounting tasks nor the …

Acceptance And Commitment Therapy For A Case Of Scrupulosity-Related Obsessive-Compulsive Disorder, Eric B. Lee, Clarissa W. Ong, Woolee An, Michael P. Twohig

Psychology Faculty Publications

Acceptance and Commitment Therapy (ACT) is a modern form of Cognitive Behavior Therapy (CBT) with growing support for treating obsessive-compulsive disorder (OCD). We present a case wherein a client presented with scrupulosity-related OCD. We briefly review scrupulosity, explain the theory behind ACT, and present a case, the treatment process, and desired outcomes. Exposure and response prevention (ERP) is described from an ACT perspective and discussed as an option for people with OCD who may be reluctant to engage in more traditional forms of ERP.

Telepsychotherapy For Trichotillomania: A Randomized Controlled Trial Of Act-Enhanced Behavior Therapy, Eric B. Lee, Jack Haegar, Michael E. Levin, Clarissa W. Ong, Michael P. Twohig

Psychology Faculty Publications

Despite its prevalence, quality treatment for trichotillomania is often difficult to find. The use of telepsychology has been an effective method for disseminating treatment services for a variety of mental health conditions. However, no research has examined the use of telepsychology to treat trichotillomania. This randomized controlled trial used Acceptance and Commitment Therapy Enhanced Behavior Therapy delivered by way of telepsychology to treat trichotillomania in adults. The study compared an active treatment condition (n = 12) to a delayed treatment waitlist control condition (n = 10). Results showed significant reductions in hair pulling severity from pre- to post-treatment compared to …

Tailoring Acceptance And Commitment Therapy Skill Coaching In-The-Moment Through Smartphones: Results From A Randomized Controlled Trial, Michael E. Levin, Jack Haegar, Rick A. Cruz

Psychology Faculty Publications

There is growing evidence for the efficacy of acceptance and commitment therapy (ACT) interventions delivered through smartphones, but research has not yet focused on how to optimize such interventions. One benefit of mobile interventions is the ability to adapt content based on in-the-moment variables. The current randomized controlled trial evaluated whether an ACT app that tailored skill coaching based on in-the-moment ecological momentary assessments (EMAs) would be more efficacious than the same app where skill coaching was random or an EMA-only condition. A sample of 69 adults interested in using a self-help app were randomized to one of three app …

Psychological Inflexibility And Stigma: A Meta-Analytic Review, Jennifer Krafft, Jillian Ferrell, Michael E. Levin, Michael P. Twohig

Psychology Faculty Publications

Stigma is known to have major impacts on the physical and psychological health of many groups. Psychological inflexibility is a psychological process that may help explain the impact of stigma on both self and others. Accordingly, acceptance and commitment therapy (ACT), which targets psychological inflexibility, has been researched as a potential treatment for stigma. In order to provide a comprehensive overview of these issues, this paper offers a systematic review and meta-analysis of the association between psychological inflexibility and stigma, as well as a systematic review of ACT interventions for stigma. The results of the meta-analysis showed a positive, medium-to-large …