Treatment of Clinical Perfectionism Using Acceptance and Commitment Therapy

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 the waitlist control group with respect to perfectionism severity, quality of life, and general symptom distress. The second study showed changes in psychological inflexibility and self-compassion explained improvements in quality of life and concern over mistakes, respectively. It also found a variable effect of baseline psychological inflexibility on response to treatment depending on the outcome tested. In contrast, average self-compassion was generally associated with better outcomes in ACT. Neurological results from the third study suggest receiving ACT was associated with greater cognitive efficiency while performing error-prone tasks and decreased responsivity to emotionally meaningful stimuli. In addition, changes in brain activation were not linked to changes in self-report outcomes. Collectively, this dissertation examined not only the efficacy of an intervention focused on a maladaptive behavioral pattern like clinical perfectionism but also how and for whom such a therapy works

Comparing the Efficacy of Defusion, Self-as-Context, and Distraction Strategies For Getting Rid of Possessions

Interventions for hoarding disorder need to target difficulty letting go of items to reduce clutter and improve functioning. The present studies were designed to test the efficacy of brief cognitive interventions for letting go of possessions and self-report outcomes. Participants (N = 67 in Study 1; N = 110 in Study 2) received training on defusion or distraction in Study 1 and defusion, self-as-context, or distraction in Study 2 and completed measures at pre- and postintervention. Study 1 found no differences between defusion and distraction on saving, self-rated discomfort with discarding, or perceived importance of the target belonging. In Study 2, participants provided most favorable feedback for self-as-context compared to defusion and distraction, indicating promise of this strategy. Nonetheless, findings from both studies overall provide minimal support for use of present procedures to reduce saving. Limitations include use of non-clinical samples and single-item variables to obtain participant feedback

Beyond Acceptance and Commitment Therapy: Process-Based Therapy

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 the logical next step for our field

Mindfulness and acceptance-based trainings for fostering self-care and reducing stress in mental health professionals: A systematic review

This review summarizes the effectiveness of Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), Mindful Self-Compassion (MSC), and Acceptance and Commitment Therapy (ACT) to foster self-care and reduce stress in mental health professionals. Twenty-four quantitative articles from PsycInfo and PubMed were identified that focused on mindfulness, self-compassion, psychological flexibility, stress, burnout, or psychological well-being. All MBSR and MBCT studies lacked active control conditions, but some of the ACT studies and one MSC study included an active control. Most studies support evidence that all training programs tend to improve mindfulness and some also self-compassion. In addition, psychological flexibility was measured in the ACT studies and tends to improve over time. Further, MBSR, MSC, and ACT tend to reduce stress or burnout. The results were less supportive for psychological well-being. The value of the various training adaptations as well as directions for future research are discussed

Examining the Feasibility and Effectiveness of Online Acceptance and Commitment Therapy Self-Help in a Quasi-Stepped Care Model: A Pilot Study

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 our sample on three of four outcomes of interest (e.g., symptom impairment) after the online program. In addition, 60 to 100% reliably improved from the online program as well as from subsequent treatment on three of four outcomes, indicating that most of our sample progressed through the steps of care effectively and benefited from the quasi-stepped care approach. Scores also indicated positive overall effects of the online program and in-person therapy. Our findings tentatively support the use of low-intensity resources like online self-help programs to reduce therapist burden in outpatient clinics by initiating client progress before intake. Limitation to this approach and the study are discussed

Comparing Effects of Acceptance Training and Psychoeducation on Hoarding Symptoms

Hoarding symptoms include difficulty letting go of possessions, excessive acquisition, and clutter that precludes use of active living spaces. The current study compared the effects of acceptance training to psychoeducation on hoarding severity in a sample of college students with elevated hoarding symptoms. Participants (N = 47) completed self-report measures at baseline, posttest, and one-week follow-up and an in vivo discarding behavioral task at posttest. There were no differences in self-reported outcomes between conditions over time, suggesting acceptance training was not more effective than psychoeducation. Significant and large effect sizes for hoarding severity and maladaptive hoarding cognitions were found from baseline to one-week follow-up, indicating both interventions improved hoarding symptoms in our sample. There was a medium and marginally significant effect favoring acceptance training for number of items discarded (p = .05). These findings tentatively support the utility of acceptance-based techniques and psychoeducation in the treatment of hoarding. In addition, brief early interventions may be effective for people who present with moderate hoarding severity. Limitations of the study include lack of a true control group to estimate placebo effects, lack of assessment of processes of change, and use of a nonclinical, demographically homogeneous sample

Hoarding Among Outpatients Seeking Treatment at a Psychiatric Hospital in Singapore

Hoarding symptoms commonly co-occur with other psychiatric disorders, such as major depressive disorder, and have been observed across cultures. Yet, few studies have examined hoarding in other disorders or in an Asian context. The present study aimed to determine: (1) the prevalence of clinically significant hoarding, (2) differences between participants with and without significant hoarding, and (3) predictors of hoarding severity in a Singaporean clinical sample. Five hundred outpatients with anxiety disorders, depressive disorders, schizophrenia, and pathological gambling completed a battery of questionnaires on hoarding, anxiety, depression, functional impairment due to clutter, and quality of life. Thirty percent of our sample reported significant hoarding. However, clutter levels in the hoarding group were low, and hoarding severity was not significantly linked to quality of life, after adjusting for anxiety and depression. In addition, depression - but not anxiety - predicted hoarding severity. Our results provide a cross-cultural perspective on hoarding symptoms, and replicate findings that support a link between depression and hoarding. The differential presentation of hoarding in our sample could be due to true cultural differences in hoarding pathology or to variant psychometric properties of the measures used. Further research evaluating hoarding in Asian contexts with different methodology is needed

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

Assessing Psychological Inflexibility in Hoarding: The Acceptance and Action Questionnaire for Hoarding (AAQH)

Psychological inflexibility is a psychopathological process referring to the tendency for behavior to be overly controlled by internal experiences to an extent that interferes with quality of life. Some studies indicate that psychological inflexibility is linked to hoarding, but findings have been mixed. This inconsistency may be due to reliance on general measures of psychological inflexibility in prior research as there was previously no validated measure to assess psychological inflexibility as it relates to hoarding. The present study developed and validated a measure of hoarding-related psychological inflexibility, the Acceptance and Action Questionnaire for Hoarding (AAQH) in a college student sample with elevated hoarding symptoms (n = 201). The AAQH demonstrated a two-factor structure and good internal consistency, construct validity, and incremental validity over a general measure of psychological inflexibility, the AAQ-II. The potential research and clinical utility of the AAQH as well as limitations of this preliminary validation study are discussed