School-based Acceptance and Commitment Therapy for Adolescents with Anxiety

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 in a school-based, group ACT for anxiety. The groups took place during the school day, ranging from .5-1 hours for 1-2 times a week, depending on the school. Over the course of the study, the adolescents completed four surveys of anxiety, other mental health variables, and class absences. Adolescents in the ACT groups reported less anxiety and fewer class absences after receiving treatment as compared to the waitlist group. No differences were found for other mental health variables. Participants reported that the ACT groups were acceptable and enjoyable. These findings demonstrate that ACT groups may be beneficial to integrate within school settings. They also support the use of ACT with younger populations with anxiety more broadly

Telehealth Acceptance and Commitment Therapy for Adolescents With Transdiagnostic Health-Related Anxiety: A Randomized Controlled Trial

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- Hispanic/Latine, and female. Participants in the treatment condition received ten weekly, 50-minute sessions of ACT delivered via Zoom. Overall, adolescents who received ACT reported small, significant decreases in health-related anxiety as compared to the waitlist. No differences were found between groups for adolescent-rated general anxiety, depression, psychological inflexibility, or anxiety sensitivity. Caretakers reported decreases in child general anxiety and improvements in parental psychological inflexibility. No significant differences were found between groups for caretaker-rated familial accommodation and accommodation-related child distress. Overall, adolescents and caretakers rated the treatment positively. Future studies should test ACT with more diverse groups of adolescents as well as compare it to other available therapy options. However, this study is the first to examine ACT as a potential treatment for health-related anxiety in adolescents, and thereby adds to the growing literature supporting the use of ACT as a potential treatment option for youth

Acceptance and Commitment Therapy for a Child With Misophonia: A Case Study

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. At post-treatment, Kelly reported a decline to the mild range of misophonia, as well as re-engagement in activities that were important to her and clinically significant reductions in depressive symptoms. These results suggest that ACT may be an appropriate treatment for children with misophonia; however, much more research is warranted

Sexual Orientation Intrusive Thoughts and Well-Being: The Mediating Role of Psychological Inflexibility

Sexual orientation intrusive thoughts are a debilitating form of obsessive compulsive disorder (OCD). The present study aimed to elucidate how psychological inflexibility and dysfunctional beliefs may impact the relationships of sexual orientation intrusive thoughts and obsessive-compulsive (OC) symptoms with well-being. A total of 181 undergraduate students completed measures of sexual orientation intrusive thoughts, OC symptoms, psychological inflexibility, dysfunctional beliefs, and well-being. Results indicated positive correlations between psychological inflexibility, sexual orientation intrusive thoughts, dysfunctional beliefs, and OC symptoms, along with negative correlations between well-being and sexual orientation intrusive thoughts, OC symptoms, dysfunctional beliefs and psychological inflexibility. Psychological inflexibility acted as a mediator between sexual orientation intrusive thoughts and well-being, and between OC symptoms and well-being. Dysfunctional beliefs were not a significant mediator. These results suggest that psychological inflexibility may partially explain the association between OC symptoms and well-being, pointing towards the need for future research on the impact of psychological inflexibility on well-being in the context of OC symptoms

Weight-Related Psychological Inflexibility as a Mediator Between Weight Self-Stigma and Health-Related Outcomes

Weight self-stigma, the internalization of negative societal stereotypes, is a problem amongst populations with high weight. Weight self-stigma is associated with psychological inflexibility and maladaptive health-related behaviors. In this study, we explore how weight-related psychological inflexibility may influence weight self-stigma and health-related outcomes in 79 adults with high weight. Participants were primarily white (92.4%) and female (82.3%), with an average age of 39.56 and average body mass index of 33.78. The present study uses baseline, self-report data from a larger trial. Results indicate that weight self-stigma was negatively correlated with maladaptive eating behaviors, weight, and mental health. Weight-related psychological inflexibility was found as a significant mediator for the relationship between weight self-stigma and emotional eating, sedentary behavior, and mental health. Weight-related psychological inflexibility did not mediate the relationships between weight self-stigma and other eating measures and physical activity. These results support targeting weight-related psychological inflexibility and weight self-stigma in interventions

Evaluating the Open and Engaged Components of Acceptance and Commitment Therapy in an Online Self-Guided Website: Results From a Pilot Trial

Online acceptance and commitment therapy (ACT) is promising for treating a range of psychological problems. Component research can further clarify which components are needed for optimal outcomes in what contexts. Online platforms provide a highly controlled format for such research. In this pilot trial, 55 adults were randomized to: ACT-Open (i.e., acceptance, defusion components), ACT-Engaged (i.e., values, committed action), or ACT-Combined (i.e., acceptance, defusion, values, committed action). Each condition was 12 sessions over six weeks, with assessments at baseline, posttreatment, and four-week follow-up. ACT-Open, ACT-Engaged, and ACT-Combined all significantly improved from pre- to post-treatment on mental health, psychosocial functioning, and components of psychological flexibility. Compared to ACT-Combined, ACT-Open improved less on psychosocial functioning at posttreatment, and ACT-Engaged worsened on functioning at follow-up. The platform was acceptable with high satisfaction ratings. Results support the feasibility of conducting online ACT component research, which will be tested in a fully powered non-inferiority trial

Intensive Outpatient Acceptance and Commitment Therapy with Exposure and Response Prevention for Adolescents

Intensive treatments for youth obsessive-compulsive disorder (OCD) are important and underresearched. This study used three adolescent cases to assess the preliminary efficacy of an intensive treatment combining acceptance and commitment therapy (ACT) with exposure and response prevention (ERP) for OCD. Participants received intensive treatment for 15 hours per week for three weeks. Assessments were collected at pre-treatment, weekly during treatment, and at posttreatment. All participants ended treatment in the mild range of OCD severity with 32-60% reductions in symptoms. Participants also reported notable improvements in psychological flexibility and ended treatment in the non-clinical range of depression, anxiety, and stress. These results indicate promise and preliminary support for the use of ACT+ERP in intensive settings for adolescents with OCD. This paper focuses on the clinical application of these techniques

Is Perfectionism Always Unhealthy? Examining the Moderating Effects of Psychological Flexibility and Self-Compassion

Objectives: Perfectionism is generally associated with worse mental health outcomes, though evidence suggests elements of it might be helpful. In light of these findings, we examined whether psychological skills like psychological flexibility and self-compassion moderated the relationship between perfectionism and wellbeing (i.e., quality of life, symptom impairment, and psychological distress). Methods: Undergraduate students (N= 677) completed self-report measures. Results: A latent profile analysis identified three perfectionism groups (low, average, high) based on four perfectionism subscales: concern over mistakes, need for approval, rumination, and striving for excellence. Generally, we found that psychological flexibility and/or self-compassion buffered the impact of average and high perfectionism on quality of life and symptom impairment. Conclusion: Our results support the utility of practicing psychological flexibility and/or self-compassion for people with average and high levels of perfectionism. Limitations include using a cross-sectional design and non-clinical sample

A Randomized Controlled Trial of Online Acceptance and Commitment Therapy to Improve Diet and Physical Activity Among Adults Who Are Overweight/Obese

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 5.5 ACT sessions on average (out of 8) and reported moderately high program satisfaction. Participants in the ACT condition improved significantly more than the waitlist at posttreatment on the primary outcome of healthy eating index (HEI; based on 24-hour recall assessments) and almost all secondary outcomes assessing self-reported eating behaviors, weight, mental health, weight self-stigma, and psychological inflexibility. However, no intervention effects were found for self-reported physical activity. At 8-week follow-up, improvements were maintained for most outcomes in the ACT condition, but not for the HEI. Improvements in psychological inflexibility mediated treatment effects on some outcomes, but not HEI or weight. Conclusions: Overall, delivering ACT through online guided self-help combined with nutrition education appears promising for improving healthy eating, weight, and self-stigma, but results for physical activity and long-term behavior change are unclear, possibly due to limitations in the ACT on Health program