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| Acceptance and Commitment Therapy for Clinical Conditions: Randomized Controlled Trial Outcomes |
| Monday, May 26, 2008 |
| 1:30 PM–2:50 PM |
| Boulevard C |
| Area: CBM; Domain: Service Delivery |
| Chair: Jesse M. Crosby (Utah State University) |
| Abstract: This symposium will include four presentations of the effectiveness of Acceptance and Commitment Therapy (ACT) in randomized controlled trial research. The first presentation will describe the results of an ACT group psychotherapy intervention targeting the self-stigma of individuals with substance use disorders. The second presentation is an evaluation of an integrated health model comparing ACT to Yoga for the treatment of refractory seizures. The third presentation will report on two trials comparing ACT with wait list or multidisciplinary controls (including psychopharmacology) for the treatment of chronic pain. Finally, the fourth presentation will compare ACT to Progressive Relaxation Training for the treatment of obsessive compulsive disorder. |
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| Acceptance and Commitment Therapy for Self-Stigma in a Residential Substance Abusing Population: Results of a Randomized Trial. |
| JASON BRIAN LUOMA (Portland Psychotherapy Clinic, Research, & Training Center, PC), Barbara S. Kohlenberg (University of Nevada School of Medicine), Steven C. Hayes (University of Nevada, Reno), Lindsay B. Fletcher (University of Nevada, Reno), Alyssa Rye (University of Nevada, Reno) |
| Abstract: As part of a NIDA-funded project, we have developed a six hour group psychotherapy intervention targeting the self-stigma of individuals with substance abuse disorders. The intervention development process was informed by basic research on a theory of language and cognition called Relational Frame Theory that examined the nature of stereotyping, judgment, and evaluation. Using a version of Acceptance and Commitment Therapy (ACT) that was specifically modified to target self stigma, we went through a two year manual development process, followed by a randomized controlled trial conducted in a residential treatment setting that (N=134) compared ACT plus treatment as usual to treatment as usual. Assessments were taken pre intervention, one week later, and at a four month follow up. Initial outcomes are moderately supportive of an ACT approach to self-stigma with towards positive effects on some outcome variables at follow up, including improved attendance of therapy after discharge and improved substance use outcomes. Findings on process variables measuring change in shame and ACT-related variables were mixed. |
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| Evaluation of an Integrated Health Model for the Treatment of Refractory Epilepsy in India and South Africa. |
| TOBIAS LUNDGREN (University of Uppsala, Sweden), JoAnne Dahl (University of Uppsala, Sweden), Nandan Balkrishna Yardi (Yardi Epilepsy Clinic), Lennart Melin (University of Uppsala, Sweden) |
| Abstract: Epileptic seizures can be traumatic, stigmatizing and disabling for the persons who have a tendency to seize. The aim of this study was to evaluate an integrated health model for the treatment of refractory seizures in India. The design of the study was a RCT ABC group design (n=18) with two conditions; ACT and Yoga. The inclusion criterion for participation was: at least 4 seizures the last three months, age 15 or older, no other ongoing illness, able and willing to participate in the study. Each condition consisted of one individual session, two group sessions, and one more individual session. The ACT condition consisted of the treatment principles: Values identification, cognitive diffusion, exposure, commitment and behaviour modification. The Yoga was based on 5 positions that stimulated the vagus nerve, which has documented effect on decreasing seizures. Treatment effects were measured by means of looking at life quality, experiential avoidance, seizure Index, Bulls-eye and EEG. The result of the posttreatment, 6 month, and 1 year follow up showed a significant difference between the groups in seizure index in favour of the ACT condition as compared to Yoga. There was a significant increase in life quality and life function for both conditions. |
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| Exposure and Acceptance to Increase Functioning in People with Chronic Pain. |
| RIKARD K. WICKSELL (Astrid Lindgren Children's Hospital, Karolinska Un), Gunnar Olsson (Astrid Lindgren Children's Hospital, Karolinska University Hospital, Sweden) |
| Abstract: Despite recent advances, chronic pain still results in debilitating effects for many patients. Traditional pharmacological and psychological strategies are often insufficient in reducing symptoms and facilitating recovery. In developing a behaviour medicine treatment based on Acceptance and Commitment Therapy for people with chronic pain, avoidance of pain-related stimuli is considered central to disability. Rather than focusing on alleviation of pain and distress by using control-oriented techniques, acceptance of pain and distress and defusion strategies are emphasized as a means to facilitate values-oriented exposure. In the current presentation, two randomized controlled trials will be presented. In the first study (n=20), adults with chronic pain due to whiplash injuries were treated with a 10-session protocol, and compared with a wait-list control group. In the second study (n=32), adolescents with longstanding pain syndromes were treated with either a 10-12 session ACT-approach or a multidisciplinary approach including amitriptyline. Results from both studies supporting the clinical model will be presented. In addition, core components of the treatment and clinical experiences will be addressed. Psychological flexibility as the possible mechanism of change as well as implications for future research and development will be discussed. |
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| A Randomized Clinical Trial of Acceptance and Commitment Therapy for OCD. |
| JENNIFER PLUMB (University of Nevada, Reno), Michael P. Twohig (Utah State University), Steven C. Hayes (University of Nevada, Reno), Larry Pruitt (University of Nevada, Reno), Angie Sailer (University of Nevada, Reno), Holly Hazlett-Stevens (University of Nevada, Reno), Michael Levin (University of Nevada, Reno), Dahlia Mukherjee (University of Nevada, Reno) |
| Abstract: This study compared ACT for OCD to Progressive Relaxation Training (N=34). Results showed that ACT for OCD produced significantly greater decreases in OCD severity at post and follow up than PRT as measured by the Y-BOCS. These results were also clinically significant because a statistically greater number of participants in the ACT group had clinical improvement at post and follow up than the PRT condition.
There were statistically significant changes on measures of thought action fusion, the amount one attempts to control one’s thoughts, and experiential avoidance at post and follow up for the ACT group compared to the PRT group. These findings are consistent with the purported mechanisms of change in ACT for OCD and not in PRT. Weekly changes in OCD severity and purported ACT processes were measured at the beginning of each therapy session, and it was found that changes in ACT processes decreased more quickly than OCD severity, and that changes in ACT processes predicted changes in OCD severity better than vice versa. The participants found the presentations of the two treatments to be equally credible; the two treatments were also rated as equally acceptable at posttreatment; and there was not a significant difference in withdrawal rates. |
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