Examining Processes of Change for Acceptance and Commitment Therapy and Cognitive Behavioral Therapy Self-Help Books With Depressed College Students

Given the prevalence of depression, it is worthwhile to consider a variety of treatment approaches to reach as many sufferers as possible, including highly accessible formats such as self-help books. Books based in acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) propose to treat depression through distinct processes of change, though the degree to which these treatments are distinguishable in this format is unclear. Furthermore, it is possible that some individuals may respond better to therapeutic processes from one approach over the other based on personal preferences. We tested the effects of ACT and CBT self-help books on processes of change in a sample of 139 depressed college students in which some participants were given a choice of treatment and others were randomized. Cognitive fusion, which improved better in the ACT group, was the only process of change that distinguished the two treatments. Additionally, early improvements in cognitive fusion were associated with less depression-related stigma at posttreatment. Lastly, randomization, instead of choosing a treatment, led to greater improvements in almost all processes of change. We discuss how these findings inform personalized care, tangible differences between ACT and CBT, and effective practices for treating depression at large scale

Evaluating Acceptance and Commitment Therapy and Mindfulness-Based Stress Reduction Self-Help Books for College Student Mental Health

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 demonstrated equivalent medium to large effect sizes for improvements over time on outcomes (psychological distress, positive mental health, academic distress) and processes of change (psychological inflexibility, mindfulness, cognitive fusion). However, the ACT condition produced improvements on obstruction with valued action more quickly than MBSR. Across conditions, baseline to midtreatment improvements in psychological inflexibility, valued action, cognitive fusion, and mindfulness all predicted baseline to posttreatment improvements in psychological distress. Improvements in psychological inflexibility more strongly predicted improvements in positive mental health in the MBSR condition. Conclusions: Overall, results suggest the potential benefits of both ACT and MBSR self-help books for improving student mental health and the potential promise of delivering these books through online university library systems

Acceptance and commitment therapy for women diagnosed with binge eating disorder: A case-series study.

Binge eating disorder (BED) is an eating disorder marked by a recurrence of eating unusually large amounts of food in one sitting along with feeling a loss of control over eating and experiencing marked distress. Outcomes from two adult women with BED who voluntarily participated in 10 weekly sessions of Acceptance and Commitment Therapy are presented. Binge eating was self-monitored daily prior to and throughout treatment. The average frequency of weekly binge eating across both participants at pre-treatment was 5.7 times, which decreased to 2.5 per week at post-treatment, and 1.0 per week at follow-up. The improvements were particularly significant for Participant 1, who no longer met criteria for BED at post-treatment and follow-up. Similarly, both participants demonstrated improvements in body image flexibility throughout the course of study. A discussion of the results is presented along with implications for clinical practice and future directions in research

Preliminary test of group acceptance and commitment therapy on obsessive-compulsive disorder for patients on optimal dose of selective serotonin reuptake inhibitors

The aim of this study was to investigate the effects of adding group acceptance and commitment therapy (ACT) to adults diagnosed with obsessive compulsive disorder (OCD) who were already on an optimal dose of selective serotonin reuptake inhibitors (SSRIs). Forty-six Iranian women, on SSRIs, were randomized to group ACT + SSRI or continued SSRI conditions. SSRI dosages stayed stable during the study. Assessments included the Structured Clinical Interview (SCID-I), Yale-Brown Obsessive-Compulsive Scale Self report (Y-BOCS-SR), Beck Depression Inventory-II (BDI-II), Ruminative Response Scale (RRS), and Acceptance and Action Questionnaire (AAQ-II). The results showed significant reductions on the Y-BOCS-SR and BDI-II in both conditions at posttreatment with significantly greater reductions in the ACT + SSRI condition at follow-up. The RRS and AAQ-II saw significant improvements in the ACT + SSRI condition at posttreatment and follow-up compared to the SSRI condition. Results provide cross-cultural support for group ACT as a treatment for OCD and as a successful adjunct to SSRI treatment. © 201

Reach, Adoption, and Maintenance of Online Acceptance and Commitment Therapy at a University: An Implementation Case Study

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. We also present demographic, previous treatment, and referral data of over 1,500 student sign-ups to describe the reach of our program, how it was adopted into existing university services and systems, and how we maintained the program long term. Findings from these implementation efforts are discussed in the context of suggestions for using self-guided programs for students to fill gaps in mental health service provision in university settings

Response to diagnosis of pre-diabetes in socioeconomically deprived areas : a qualitative study

Background: Diabetes prevention is a key priority for the NHS, with a particular focus on populations at highest risk. The NHS Diabetes Prevention Programme (NHS DPP) has been introduced, offering a course of dietary and lifestyle education to individuals with pre-diabetes. However, concerns about the NHS DPP include: (1) the possible unintended consequences of labelling more people with a ‘pre-condition’; (2) the possibility of worsening health inequalities as people in socioeconomically deprived areas tend to access behaviour-change programmes less readily; (3) the appropriateness of an intervention focused on individuals versus population-wide public health policy interventions. Aim: To explore the experience of diagnosis of pre-diabetes, and understand the barriers and facilitators to uptake of the NHS DPP for people living in socioeconomically deprived areas. Design & setting: A qualitative study was undertaken. Participants with pre-diabetes were recruited from practices serving socioeconomically deprived areas of Sheffield, UK. Method: Semi-structured interviews were conducted and continued until data saturation (23 participants). Thematic analysis of data was undertaken. Results: Both healthcare context and an individual’s personal and community context shaped response to diagnosis and likelihood of engaging with the NHS DPP. Patient activation was a useful concept in understanding response. Whether or not people participated in the NHS DPP, being diagnosed with pre-diabetes tended to provoke some degree of dietary change and did not cause significant anxiety for most. However, there were multiple barriers to engaging with the NHS DPP for this patient group. Conclusion: Diagnosing pre-diabetes can provoke an individual positive response, but the sociocultural environment often limits an individual’s ability to engage with the NHS DPP or make lifestyle change

Development and psychometric evaluation of the PMR-Impact Scale: a new patient reported outcome measure for polymyalgia rheumatica.

OBJECTIVES: Polymyalgia rheumatica (PMR) causes pain, stiffness and disability in older adults. Measuring the impact of the condition from the patient's perspective is vital to high-quality research and patient-centred care, yet there are no validated patient-reported outcome measures (PROMs) for PMR. We set out to develop and psychometrically evaluate a PMR-specific PROM. METHODS: Two cross-sectional postal surveys of people with a confirmed diagnosis of PMR were used to provide data for field testing and psychometric evaluation. 256 participants completed the draft PROM. Distribution of item responses was examined and exploratory factor analysis and Rasch analysis were used to inform item reduction, formation of dimension structure and scoring system development. 179 participants completed the PROM at two-time points, along with comparator questionnaires and anchor questions. Test-retest reliability, construct validity and responsiveness were evaluated. RESULTS: Results from the field-testing study led to the formation of the PMR-Impact Scale (PMR-IS), comprising four domains (symptoms, function, psychological and emotional well-being, and steroid side effects). Construct validity and test-retest reliability met accepted quality-criteria for each domain. There was insufficient evidence from this study to determine its ability to detect flares/deterioration, but the PMR-IS was responsive to improvements in the condition. CONCLUSION: The PMR-IS offers researchers a new way to assess patient-reported outcomes in clinical studies of PMR. It has been developed robustly, with patient input at every stage. It has good construct validity and test re-test reliability. Further work is needed to fully establish its responsiveness and interpretability parameters and assess its real-world clinical utility

An Open Trial of Group Acceptance and Commitment Therapy (ACT) With an Adjunctive Mobile App for Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder (GAD) is a common and debilitating condition. Effective treatments exist, but they are time-and resource-intensive. This study tested the initial efficacy and acceptability of a novel treatment protocol designed to increase efficiency: acceptance and commitment therapy (ACT) taught in groups and through an adjunctive mobile app. Participants were 21 individuals with GAD who received six weeks of 2-hour group ACT sessions as well as access to an adjunctive ACT mobile app. Significant improvements occurred in worry, anxiety, social functioning, and depression as well as relevant processes (psychological inflexibility, anxiety-related cognitive fusion). In-the-moment improvements were also observed in symptoms and ACT processes immediately after completing mobile app sessions. Treatment was perceived as credible and acceptable overall. However, rates of reliable and clinically significant change were low, and app usage did not correlate with change in worry. Overall, this study suggests that an efficient, brief ACT group intervention combined with a mobile app may lead to improvements in GAD but may not be sufficient for clinically significant change. A detailed overview of the treatment is included, and guidance for clinicians interested in implementing this protocol is discussed

Response to diagnosis of pre-diabetes in socioeconomically deprived areas: a qualitative study

Background Diabetes prevention is a key priority for the NHS, with a particular focus on populations at highest risk. The NHS Diabetes Prevention Programme (NHS DPP) has been introduced, offering a course of dietary and lifestyle education to individuals with pre-diabetes. However, concerns about the NHS DPP include: (1) the possible unintended consequences of labelling more people with a ‘pre-condition’; (2) the possibility of worsening health inequalities as people in socioeconomically deprived areas tend to access behaviour-change programmes less readily; (3) the appropriateness of an intervention focused on individuals versus population-wide public health policy interventions. Aim To explore the experience of diagnosis of pre-diabetes, and understand the barriers and facilitators to uptake of the NHS DPP for people living in socioeconomically deprived areas. Design & setting A qualitative study was undertaken. Participants with pre-diabetes were recruited from practices serving socioeconomically deprived areas of Sheffield, UK. Method Semi-structured interviews were conducted and continued until data saturation (23 participants). Thematic analysis of data was undertaken. Results Both healthcare context and an individual’s personal and community context shaped response to diagnosis and likelihood of engaging with the NHS DPP. Patient activation was a useful concept in understanding response. Whether or not people participated in the NHS DPP, being diagnosed with pre-diabetes tended to provoke some degree of dietary change and did not cause significant anxiety for most. However, there were multiple barriers to engaging with the NHS DPP for this patient group. Conclusion Diagnosing pre-diabetes can provoke an individual positive response, but the sociocultural environment often limits an individual’s ability to engage with the NHS DPP or make lifestyle change

Hearing Care and Management Priority Among Parents of Children with Down Syndrome: A Grounded Theory

Objective: This study qualitatively explored the factors that influence how parents of children who are Deaf or hard-of-hearing with Down syndrome prioritize hearing care and management and developed an associated theory to explain that priority. Design: Grounded theory was used for the purposes of this qualitative study. Data were collected using in-depth interviews which were analyzed using a three-tiered qualitative coding process. Study Sample: Eighteen mothers of children who are Deaf or hard-of-hearing with Down syndrome participated in this study. Results: The higher the extent of engaged professional support, perception of benefit for child, parent activation, and family engagement, the higher the priority for hearing care and management will likely be among parents of children who are Deaf or hard-of-hearing with Down syndrome. Conclusions: Understanding how parents of children who are Deaf or hard-of-hearing with Down syndrome decide to prioritize hearing care and management has implications for how hearing health providers and others provide care to parents to enhance priority for hearing-related needs