Comparing Cognitive Fusion and Cognitive Reappraisal as Predictors of College Student Mental Health

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, hostility, academic distress, and student role problems 1 month later. Reappraisal predicted only student role problems longitudinally when controlling for fusion. These results suggest that cognitive fusion is a stronger predictor than reappraisal for a range of student mental health concerns and may be a particularly important target for improving student mental health

The Interaction of Mindful Awareness and Acceptance in Couples Satisfaction

Past studies indicate that the awareness and acceptance facets of trait mindfulness both independently predict relationship satisfaction. However, this study hypothesized that the combination of awareness and acceptance might be a stronger contributor to relationship functioning than either in isolation. Regression analyses were used to test whether mindful awareness and acceptance interact in predicting couples satisfaction in a sample of dating or married college students (n = 138). Acceptance was positively associated with couples satisfaction, while awareness was unrelated. These two mindfulness facets interacted such that greater awareness was related to poorer satisfaction when acceptance was low, but was unrelated when acceptance was high. Conversely, greater acceptance was only related to greater satisfaction when awareness was moderate or high. These results suggest the combination of high awareness and low acceptance can be problematic for relationships, while at least moderate mindful awareness is needed for acceptance to be beneficial

Utilizing ACT Daily as a Self-Guided App for Clients Waiting for Services at a College Counseling Center: A Pilot Study

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 depression and anxiety symptoms as well as psychological inflexibility processes over the 2 weeks. App data further indicated significant in-the-moment improvements on depression, anxiety and psychological inflexibility immediately following skill coaching, with these effects becoming larger over time. Conclusions: Mobile apps like ACT Daily could serve as an effective, pre-therapy tool for depressed/anxious students

Delivering Acceptance and Commitment Therapy for Weight Self-Stigma through Guided Self-Help: Results from an Open Pilot Trial

Weight self-stigma is a promising target for innovative interventions seeking to improve outcomes among overweight/obese individuals. Preliminary research suggests acceptance and commitment therapy (ACT) may be an effective approach for reducing weight self-stigma, but a guided self-help version of this intervention may improve broad dissemination. This pilot open trial sought to evaluate the potential acceptability and efficacy of a guided self-help ACT intervention, included coaching and a self-help book, with a sample of 13 overweight/obese individuals high in weight self-stigma. Results indicated a high degree of program engagement (77% completed the intervention) and satisfaction. Participants improved on outcomes over time including weight self-stigma, emotional eating, weight management behaviors, health-related quality of life, and depression. Although not a directly targeted outcome, participants improved on objectively measured weight, with an average of 4.18 pounds lost over 7 weeks, but did not improve on self-reported weight at 3-month follow-up. Processes of change improved over time, including psychological inflexibility, valued action and reasons to lose weight. Coaching effects indicated greater retention and improvements over time with one coach vs. the other, suggesting characteristics of coaching can affect outcomes. Overall, these results provide preliminary support for the acceptability and efficacy of a guided self-help ACT program for weight self-stigma. Implications of these results and how to address clinical challenges with guided self-help are discussed

Comparing In-The-Moment Skill Coaching Effects from Tailored Versus Non-Tailored Acceptance and Commitment Therapy Mobile Apps in a Non-Clinical Sample

Mobile apps are promising for teaching how to practice psychological skills in high-risk and in vivo momentary situations, but there has been minimal research on the immediate effects of app-based skill coaching on mental health in-the-moment. This study analyzed the mobile app data in a non-clinical sample of 39 adults participating in a larger randomized controlled trial, with participants randomized to an acceptance and commitment therapy (ACT) mobile app that tailors skill coaching based on in-the-moment variables (n = 17) or an app that provides randomly selected skill coaching (n = 22). Data was collected before and after each ACT skill coaching session on proximal outcome (depression, anxiety, engagement in meaningful activity) and ACT process variables. Multilevel models indicated significant immediate improvements on average following ACT skill coaching sessions on all proximal outcome and ACT process variables, although with relatively small effects ranging between .17 and .27 SD units change. Larger immediate pre-to- post effects from ACT coaching sessions were found for anxiety, experiential avoidance, and cognitive fusion in the tailored app versus random app condition. Overall, results suggest an ACT app can have immediate, in-the-moment effects on psychological functioning, which may be enhanced by tailoring skills to current context

Evaluating an adjunctive mobile app to enhance psychological flexibility in acceptance and commitment therapy

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 ACT Daily skill coaching on in-the-moment measures of inflexibility and symptoms, with unique effects found for acceptance and mindfulness. Adjunctive ACT mobile apps appear promising in enhancing therapy effects on psychological inflexibility and outcomes. A tailored skill coaching approach like ACT Daily based on randomly prompted assessments may be especially promising

An Examination of The Transdiagnostic Role of Delay Discounting in Psychological Inflexibility and Mental Health Problems

Delay discounting is a basic behavioral process that has been found to predict addictive behaviors, and more recently, other mental health problems. Acceptance and Commitment Therapy (ACT), is a transdiagnostic treatment that appears to alter delay discounting, possibly through reducing psychological inflexibility. The current study sought to further bridge research on delay discounting and ACT by examining the relation of delay discounting to a broad range of selfreported mental health problems and measures of psychological inflexibility. A cross sectional online survey was conducted with 389 college students. Small negative correlations ranging between .09 and .15 were statistically significant between delay discounting and self-reported depression, anxiety, eating concerns, hostility, academic distress, and student functioning (only general social functioning and social anxiety were non-significant). Similar negative correlations were also found between delay discounting and measures of psychological inflexibility. Psychological inflexibility statistically mediated all of the relations between delay discounting and mental health problems such that delay discounting was no longer related to mental health problems when including the mediator. Overall, these results suggest that delay discounting is a transdiagnostic process relevant to a range of mental health problems, potentially through its impact on psychological inflexibility

Comparing Cognitive Defusion and Cognitive Restructuring Delivered Through a Mobile App for Individuals High in Self-Criticism

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 defusion relative to waitlist. These mediators were inconsistent for cognitive restructuring. Improvements in self-compassion and cognitive decentering correlated with improvements in outcomes in the defusion condition, but not the restructuring condition. Overall, these results suggest mobile apps providing cognitive defusion and cognitive restructuring strategies are equally effective, but work through distinct processes of change

Tailoring Acceptance and Commitment Therapy Skill Coaching In-The-Moment Through Smartphones: Results from a Randomized Controlled Trial

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 conditions and used the app for the following four weeks. Results indicated equivalently high user satisfaction with the tailored versus random apps. Participants used the EMA-only app the most and the tailored app the least, but overall adherence was adequate. Participants in the tailored app improved significantly more on psychological distress and positive mental health relative to the random app and EMA-only conditions. However, no differences were found between the random app and EMA-only conditions on outcomes. Between group differences over time were also found on psychological inflexibility, but this appeared to be primarily due to a lower rate of improvement in the random app condition relative to both tailored and EMA-only. Overall, these results suggest that tailoring ACT skill coaching based on in-the-moment variables leads to greater efficacy

Web-based Acceptance and Commitment Therapy for Mental Health Problems in College Students: A Randomized Controlled Trial

There are significant challenges in addressing the mental health needs of college students. The current study tested an acceptance and commitment therapy (ACT) web-based self-help program to treat a broad range of psychological problems students struggle with. A sample of 79 college students were randomized to web-based ACT or a waitlist condition, with assessments at baseline and posttreatment. Results indicated adequate acceptability and program engagement for the ACT website. Relative to waitlist, participants receiving ACT improved on overall distress, general anxiety, social anxiety, depression, academic concerns, and positive mental health. There were no between group effects on eating concerns, alcohol use, or hostility or on some key ACT process of change measures. ACT participants improved more on mindful acceptance and obstruction to valued living, both of which mediated treatment outcomes. Results are discussed in the context of lessons learned with the website prototype, and areas for further research are presented