Psychology Commons^™

Telehealth Acceptance And Commitment Therapy For Adolescents With Transdiagnostic Health-Related Anxiety: A Randomized Controlled Trial, Julie M. Petersen

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Health-related anxiety is a growing issue to understand how to treat, particularly following the COVID-19 pandemic. Some studies show that a specific type of therapy, acceptance and commitment therapy (ACT), may be beneficial for health anxiety in adults, but this has not yet been tested with adolescents. The present study is a randomized, waitlist-controlled trial of ACT delivered via Zoom for adolescents struggling with health-related anxiety. A total of 30 adolescents (ages 12-17), plus one caretaker each (N = 60), living in Utah and currently struggling with health-related anxiety were enrolled. The majority of caretakers and adolescents were White, non- …

A Systematic Review And Meta-Analysis Of Self-Guided Online Acceptance And Commitment Therapy As A Transdiagnostic Self-Help Intervention, Korena S. Klimczak, Guadalupe G. San Miguel, Miriam N. Mukasa, Michael P. Twohig, Michael E. Levin

Psychology Student Research

Online Acceptance and Commitment Therapy (ACT) interventions use websites and smartphone apps to deliver ACT exercises and skills. The present meta-analysis provides a comprehensive review of online ACT self-help interventions, characterizing the programs that have been studied (e.g. platform, length, content) and analyzing their efficacy. A transdiagnostic approach was taken, including studies that addressed a range of targeted problems and populations. Multi-level meta-analyses were used to nest multiple measures of a single construct within their respective studies. A total of 53 randomized controlled trials were included (n = 10,730). Online ACT produced significantly greater outcomes than waitlist controls at …

Storytelling To Promote Mental Health: A Conceptual Analysis And Application With Acceptance And Commitment Therapy For Depression, Carter H. Davis

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Mental health treatments can be delivered in many ways. One approach is to use storytelling to communicate healthy practices. While societies across the world have engaged in storytelling for thousands of years, these practices have been used less in the mental health field. The aim of this project was to study the overlap between the areas of mental health and storytelling. We also tested how a storytelling-based mental health treatment could help solve a particular clinical problem. In this case, the problem of people who receive inadequate help for managing depression through medication alone.

We examined one particular mental health …

Acceptance And Commitment Therapy For A Child With Misophonia: A Case Study, Julie M. Petersen, Michael P. Twohig

Psychology Faculty Publications

Misophonia, a condition involving hypersensitivity, anger, and/or disgust in response to specific noises (e.g., chewing, tapping), is highly underresearched in children. Several case studies point towards the utility of cognitive behavioral therapy and related treatments (e.g., acceptance and commitment therapy [ACT]). ACT presents a particularly promising option, as it focuses on building psychological flexibility in response to difficult internal experiences, rather than trying to remove or change them (e.g., responding effectively to irritation provoked by chewing). The present case study describes “Kelly” (pseudonym), a 12-year-old girl with moderately severe misophonia symptoms, who received a 16-session course of ACT for misophonia. …

School-Based Acceptance And Commitment Therapy For Adolescents With Anxiety: A Pilot Trial, Julie M. Petersen, Carter H. Davis, Tyler L. Renshaw, Michael E. Levin, Michael P. Twohig

Psychology Student Research

Anxiety disorders are one of the most prevalent diagnoses in youth, often resulting in impaired social and school functioning. Research on treatments for youth anxiety is primarily based in traditional clinical settings. However, integrating youth psychotherapies into the school environment improves access to evidence-based care. The present study is a pilot, randomized waitlist-controlled trial of a school-based, group acceptance and commitment therapy-based (ACT) intervention for adolescents with anxiety. Students at two separate schools (N = 26) with elevated anxiety were randomized to a 12-week waitlist or to immediate treatment. Participants in the immediate treatment condition reported statistically significant decreases …

School-Based Acceptance And Commitment Therapy For Adolescents With Anxiety, Julie M. Petersen

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Mental health problems, particularly anxiety, are a growing problem in adolescents. Some treatments (e.g., cognitive behavioral therapy) have been shown effective for youth anxiety, but do not help all adolescents. Acceptance and commitment therapy (ACT), a treatment supported for anxiety in adults, has yet to be fully researched in adolescents. ACT is a flexible therapy that is understood to be appropriate, if not ideal, for younger populations and schools. The present study compares a school-based, group ACT for adolescents with anxiety to a waitlist.

Adolescents (N = 26) with anxiety were randomized to a 12 week waitlist or to participate …

Testing An Acceptance And Commitment Therapy Website For Hoarding: A Randomized Waitlist-Controlled Trial, Jennifer Krafft

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Hoarding disorder is relatively common and seriously affects those who experience it. However, it is difficult to access hoarding treatment, due to barriers such as availability and stigma. Moreover, only one treatment is well-established for hoarding (CBT), and it does not directly address important processes such as mindfulness and acceptance. Therefore, in order to make treatment more useful and easy to access, this study tested a self-help program that focused on teaching mindfulness and acceptance as related to hoarding. The self-help program was compared to a waitlist condition; participants were randomly assigned to use the website or wait 12 weeks. …

Bibliotherapy For Depression: Evaluating Cognitive Behavioral Therapy And Acceptance And Commitment Therapy Approaches And Examining The Role Of Client Choice, Carter H. Davis

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

An alarming number of college students suffer from depression, which is often accompanied by struggles with anxiety and feeling inadequate compared to others (i.e., stigma). Seeing a counselor in person is challenging for many students due to wait times or feeling embarrassed or shameful. Using self-help books may be a helpful alternative for depressed students, but these books are not often tested in formal studies, and getting students to use self-help books over time is also difficult. Therefore, this study examined whether self-help books accessed online could help students with depression. We tested two books which use different approaches to …

Preliminary Findings On Processes Of Change And Moderators For Cognitive Defusion And Restructuring Delivered Through Mobile Apps, Michael E. Levin, Jennifer Krafft, Woolee An, Clarissa W. Ong, Michael P. Twohig

Psychology Student Research

A process-based therapy approach emphasizes examining how and for whom specific therapeutic components linked to specific processes of change function. This preliminary study explored the processes of change for cognitive defusion and restructuring with daily ratings of self-criticism from a larger component trial as well as self-compassion as a moderator of these daily effects. A sample of 51 adults high in self-criticism (M age = 22.69, 78% female, 88% non-Hispanic White) were randomized to a cognitive defusion or restructuring mobile app for two weeks and completed daily assessments. Both conditions improved over time on daily frequency, defused noticing, challenging, …

Examining The Feasibility And Effectiveness Of Online Acceptance And Commitment Therapy Self-Help In A Quasi-Stepped Care Model: A Pilot Study, Clarissa W. Ong, Carina L. Terry, Michael Levin, Michael P. Twohig

Psychology Student Research

The global burden of mental illness and limited resources make increasing the efficiency of available mental healthcare resources especially crucial. One way this can be done is a stepped care approach to treatment. To test the viability of using internet-based self-help in a stepped care model, we examined the feasibility, acceptability, and effectiveness of an online self-help acceptance and commitment (ACT) program prior to starting in-person therapy at a university community clinic (N = 51). Online program acceptability was at least moderate. There was clinically significant change in 75.9 to 79.3% and reliable change in 31.0 to 100% of …

Does The Cognitive Fusion Questionnaire Measure More Than Frequency Of Negative Thoughts?, Jennifer Krafft, Michael E. Levin

Psychology Student Research

Cognitive fusion is a psychopathological process that appears to be relevant to a wide range of disorders. This process is frequently measured with the Cognitive Fusion Questionnaire (CFQ). However, the construct validity of similar measures has been criticized for substantial overlap with distress. It is possible the CFQ may excessively measure the presence of unwanted thoughts, rather than fusion per se. Therefore, this study examined the discriminant validity of the CFQ relative to a measure of automatic negative thoughts (the Automatic Thoughts Questionnaire) in a college student sample (n = 389). While the two measures were highly correlated (ρ …

A Systematic Review And Meta-Analysis Of Acceptance And Commitment Therapy In South Korea, Woolee An

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Although psychologists have emphasized the importance of considering clients’ various cultural backgrounds and researching various populations, research is still overly focused on participants from English-speaking countries like the United States and Western countries. Numerous studies evaluating Acceptance and Commitment Therapy (ACT) have been published in South Korea. However, most of the studies are still unknown to English-speaking research communities because of language differences. In order to promote cross-cultural communication of study findings, the current study reviewed treatment research from South Korea.

After searching for Korean ACT studies using Korean electronic databases, 62 studies were selected, and each study’s treatment outcome …

A Brief Online Acceptance And Commitment Training For Enhancing Outcomes Of A Cultural Competence Intervention, Elizabeth Tish Hicks

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

In an increasingly diverse and multicultural society, there is a pressing and practical need for interventions to help professionals improve their cultural competence. Cultural competence trainings that target psychological flexibility in addition to knowledge, awareness, and skills may produce more efficacious results. The current study will examined the utility of targeting psychological flexibility (the ability to maintain contact the present moment and current internal experiences and to choose contextually appropriate, values-consistent behaviors, regardless of what one’s internal experiences are) as a process to enhance the impact of a cultural competence intervention with an Acceptance and Commitment Training (ACT)-enhanced cultural competence …

A Randomized Controlled Trial Of Online Acceptance And Commitment Therapy To Improve Diet And Physical Activity Among Adults Who Are Overweight/Obese, Michael E. Levin, Julie M. Petersen, Carrie Durward, Brittany Bingeman, Elizabeth Davis, Cindy Nelson, Shannon Cromwell

Psychology Student Research

Background: Acceptance and commitment therapy (ACT) has shown benefit for improving diet, physical activity, and weight among adults who are overweight and obese. However, research to date in this area has primarily evaluated ACT delivered through in-person interventions, which has more limited access relative to online formats. Purpose: The present study evaluated an online guided self-help program that integrated ACT with nutrition education to improve healthy eating and physical activity. Methods: A sample of 79 adults who were overweight/obese were randomized to receive the 8-week ACT on Health program plus weekly phone coaching or to a waitlist. Results: Participants completed …

Evaluating The Effects Of Guided Coaching Calls On Engagement And Outcomes For Online Acceptance And Commitment Therapy, Michael E. Levin, Jennifer Krafft, Carter Davis, Michael P. Twohig

Psychology Student Research

Previous research indicates mixed results for guided support with interventions. The current secondary analysis evaluated the effects of phone coaching from a dismantling trial of online acceptance and commitment therapy (ACT) in a sample of 136 distressed college students randomized to one of three versions of an ACT website. Participants were randomized to receive email prompts alone (non-coaching condition) or email plus phone coaching (coaching condition). Results indicated no differences between the coaching and non-coaching conditions on program engagement, program satisfaction, mental health outcomes, and almost all psychological flexibility processes. However, participants in the coaching condition reported stronger pre- to …

A Pilot Randomized Controlled Trial Of Acceptance And Commitment Therapy Guided Self-Help For Overweight And Obese Adults High In Weight Self-Stigma, Sarah Ann Potts, Jennifer Krafft, Michael E. Levin

Psychology Student Research

Weight self-stigma, in which individuals internalize stigmatizing messages about weight, is a prevalent problem that contributes to poor quality of life and health. This pilot randomized controlled trial evaluated acceptance and commitment therapy (ACT) guided self-help using The Diet Trap (Lillis, Dahl, & Weineland, 2014) for 55 overweight/obese adults high in weight self-stigma. Participants were randomized to the ACT self-help book plus phone coaching (GSH-P; n=17), self-help book plus email prompts only (GSH-E; n=20), or a waitlist condition (n=18), with online self-report assessments at baseline and posttreatment (8 weeks later). Participants reported high satisfaction ratings and engagement with the ACT …

Psychological Flexibility As Shared Process Of Change In Acceptance And Commitment Therapy And Exposure And Response Prevention For Obsessive-Compulsive Disorder: A Singe Case Design Study, Brian L. Thompson, Michael P. Twohig, Jason B. Luoma

Psychology Faculty Publications

Changes in psychological flexibility were tracked in a combined protocol of exposure and response prevention (ERP) and acceptance and commitment therapy (ACT) for adults with OCD to assess if changes in psychological flexibility processes were unique to ACT intervention (e.g., not impacted by ERP). Using a non-concurrent multiple baseline design, four participants received sessions of ERP and ACT while data was collected on psychological flexibility processes of change and OCD symptom severity. Results indicate treatment response for three of four participants based on OCD scores. Contrary to predictions, data suggest both ERP and ACT have positive effects on psychological flexibility. …

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 …

Treatment Of Clinical Perfectionism Using Acceptance And Commitment Therapy, Clarissa W. Ong

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Clinical perfectionism is characterized by rigidly pursuing unrealistically high standards on which self-worth is contingent and experiencing distress when these standards are not met. Because clinical perfectionism is associated with many psychological diagnoses, understanding how to treat it may help streamline available treatments. The aim of this dissertation was to test the effect of acceptance and commitment therapy (ACT), a cognitive-behavioral therapy, on 53 individuals with clinical perfectionism. Participants in the ACT group received 10 therapy sessions and those in the control group were on a waitlist for 14 weeks. The first study supported the effectiveness of ACT relative to …

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 …

Telepsychotherapy For The Treatment Of Trichotillomania: A Randomized Controlled Trial, Eric B. Lee

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Trichotillomania is defined as recurrent pulling of one’s hair that results in distress and negative effects on general functioning and quality of life. Estimates of trichotillomania lifetime prevalence generally range from approximately 1% to 3% and it is likely as common as disorders such as obsessive-compulsive disorder and agoraphobia. Yet, quality treatment for trichotillomania is often difficult to find as many mental health professionals are uninformed about the disorder and its treatment. Moreover, mental health services in general are inaccessible to many with estimates suggesting that 96.5 million people do not have access to adequate services. The use of telepsychology …

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 …

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.

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 …

A Randomized Controlled Trial Of Multiple Versions Of An Acceptance And Commitment Therapy Matrix App For Well-Being, Jennifer Krafft, Sarah Potts, Benjamin Schoendorff, Michael E. Levin

Psychology Faculty Publications

Mobile apps may be useful in teaching psychological skills in a high-frequency, low-intensity intervention. The Acceptance and Commitment Therapy (ACT) matrix is a visual tool to help develop psychological flexibility by categorizing moment-to-moment experience and is well suited to a mobile app. This pilot study tested the effects of a simple and complex version of a novel app using the ACT matrix in two distinct samples: help-seeking individuals (n = 35) and students receiving SONA credit (n = 63). Findings indicated no differences between app conditions and a waitlist condition in the SONA credit sample. However, in the …

Evaluating An Adjunctive Mobile App To Enhance Psychological Flexibility In Acceptance And Commitment Therapy, Michael E. Levin, Jack Haegar, Benjamin G. Pierce, Rick A. Cruz

Psychology Faculty Publications

The primary aims of this study were to evaluate the feasibility and potential efficacy of a novel adjunctive mobile app designed to enhance the acquisition, strengthening, and generalization of acceptance and commitment therapy (ACT) skills being taught in therapy. A sample of 14 depressed/anxious clients receiving ACT used the ACT Daily app for two weeks in a pre-post, open trial design. Participants reported a high degree of program satisfaction. Clients significantly improved over the two-week period on depression and anxiety symptoms as well as a range of psychological inflexibility measures. Analyses of mobile app data indicated effects of …

Effects Of Acceptance And Commitment Therapy On Impulsive Decision Making, Kate L. Morrison

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

For some people, decision making is more often influenced by immediate gratification, rather than what is best for them in the long term. This study intended to change how those people made decisions, in order to help them live meaningful lives. This was done through eight sessions of a treatment called Acceptance and Commitment Therapy (ACT; in comparison to no treatment). Forty adults were randomly assigned to either treatment or a no treatment control. The treatment did not change the way people responded on the decision making measures, although the treatment reduced problematic behaviors and obstacles to living a meaningful …