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U nderstanding the Clinical Processes in ACT. Yvonne Barnes-Holmes & Dermot Barnes-Holmes. Co-Authors. Ian Stewart Louise McHugh Kelly Wilson Barbara Johnson Brandy Fink Andy Cochrane Anne Kehoe Hilary-Anne Healy Claire Keogh Jenny McMullen. Carmen Luciano

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Yvonne barnes holmes dermot barnes holmes

Understanding the Clinical Processes in ACT

Yvonne Barnes-Holmes &

Dermot Barnes-Holmes


Co authors

Co-Authors

  • Ian Stewart

  • Louise McHugh

  • Kelly Wilson

  • Barbara Johnson

  • Brandy Fink

  • Andy Cochrane

  • Anne Kehoe

  • Hilary-Anne Healy

  • Claire Keogh

  • Jenny McMullen

  • Carmen Luciano

  • Francisco J. Molina Cobos

  • Olga Gutiérrez

  • Sonsoles Valdivia

  • Marisa Páez

  • Miguel Rodríguez

  • Francisco Cabello

  • Carmelo Visdómine

  • José Ortega

  • Francisco Montesinos

  • Mónica Hernández

  • Laura Sánchez


Introduction

Introduction

  • There is no theory behind therapy, the former is a coherent set of theoretical constructs that hang together and make predictions, the latter is a coherent set of techniques that make a different set of predictions

  • Almost never in the history of psychology have they come together in a manner that was both theoretically consistent and technologically effective

  • ACT is no different, but as the field develops, there is growing reason to believe that there is considerable overlap between Relational Frame Theory (RFT) and ACT and that the former can make sound predictions about why the latter works, and to some extent about what the latter should look like


Overview

Overview

  • The current talk will review some of the predictions and empirical evidence that support processes and techniques identified in ACT

  • For the sake of simplicity, and in order to be consistent with the evidence, we will divide ACT into the following:

    • Acceptance vs. Avoidance

    • Acceptance vs. Cognitive Control

    • Values

    • Defusion


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Acceptance vs.

Avoidance


Acceptance vs avoidance

Acceptance vs. Avoidance

  • Our first place to start looking at ACT (Study 1) was to analyse the distinction between acceptance and avoidance – if this was not clear-cut, then the basic terminology might need to be reconsidered

  • ACT’s emphasis on the dichotomy between acceptance and avoidance and the development of the AAQ suggested that we might be able to functionally differentiate individuals in terms of their propensity towards acceptance or avoidance

  • We took 15 undergraduates who were low in acceptance (at least 1 SD below the mean on the AAQ) and 14 high in acceptance (at least 1 SD above the mean)


Acceptance vs avoidance1

Acceptance vs. Avoidance

  • Participants were exposed to a simple automated task that required them to match nonsense syllables

  • During the task, however, matching on some trials resulted in the presentation of a horrible aversive image (e.g. mutilated bodies) for 6 seconds

  • Participants were required to rate each aversive picture

  • But, primarily we wanted to determine how long it took them to do the task when they had discriminated which type of picture would come next

  • Our prediction was that low accepters/high avoiders would take longer to complete tasks, which they had learned would be followed by an aversive picture

  • This, for us, was a type of avoidance


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Median Reaction Times

3

  • During the task, High Acceptance produced similar reaction times whether they expected to see either an aversive or a neutral image next, so anticipation or avoidance was limited

  • But, Low Acceptance exhibited significantly longer reaction times when they expected to see an aversive image (p = 0.015)

2.5

High

Low

2

1.5

1

0.5

0

A N A N

But could this be simply because the Low Acceptance

Group perceived the neutral pictures to be more unpleasant and

thus legitimtely more avoidable than the High Acceptance group?


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Self-Report Ratings

  • No, because High Acceptance rated the aversive images as more unpleasant and more emotionally intense than Low Acceptance

  • But yet, Low Acceptance were less willing to look at either images than High Acceptance

Pleasant Unpleasant

Mild Intense

Willing Unwilling


D iscussion

Discussion

  • So, the outcomes were consistent with ACT predictions regarding acceptance and avoidance and their dichotomy

  • Individuals low in acceptance/high in avoidance showed greater anticipatory avoidance of the negative pictures than those high in acceptance/low in avoidance

  • This avoidance was consistent with their own ratings of willingness to look at the pictures

  • Furthermore, this avoidance occurred even though these individuals rated the pictures as less unpleasant and less intense than the other group

  • The high acceptance groups, therefore, showed less avoidance and greater experiential willingness in the face of adversity – outcomes that are consistent with ACT predictions


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ERP’s and Avoidance

  • Study 2 replicated Study 1, but incorporated Event Related Potentials (ERP’s) during the task with:

    • 6 High Acceptance

    • 6 Low Acceptance

    • 6 Mid-Range Acceptance

  • Once again, we predicted that level of avoidance would differentiate and we hoped it would be detected by the ERP’s


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Median Reaction Times

  • Identical to Study 1, High and Mid Acceptance produced similar reaction times for both aversive and neutral images, showing no anticipation or avoidance

  • But, Low Acceptanceagain emitted longer reaction times when they expected to see an aversive, rather than a neutral, image (p = 0.0431)

3.5

3

2.5

2

Low

1.5

High

Mid

1

0.5

0

A N A N A N


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Mid

Low

High

Pleasant Unpleasant

Mild Intense

Willing Unwilling

Self-Report Ratings

  • Again, this was not because the pictures were less unpleasant, because theHigh and Mid Acceptance rated the aversive images as more unpleasant and emotionally intense than Low Acceptance

  • But,Low and Mid Acceptancewere less willing to look at the images


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ERP’s Recordings

  • As expected, the ERP’s recordings discriminated between the two types of pictures, with the unpleasant pictures producing significantly more positive wave forms than the neutral pictures for all groups

  • And an interesting finding emerged with regard to the scalp locations . . .


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Low Acceptance

Area Dimensions (V • ms)

High Acceptance


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ERP’s Recordings

  • The fact that the Low Acceptance group showed greater negative activation for left hemisphere electrodescould suggest greater verbal activity for this group, which might indicate the use of verbal avoidance strategies (e.g. “This is not real, think of something else,” etc.)


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Discussion

  • So again, the avoidance groups could be distinguished from one another on several predictable counts -- Low Acceptance showed greater anticipation of the aversive images than the others and were less willing to look at them -- and yet, they rated the pictures as less unpleasant

  • Some willingness distinctions even emerged between mid and high range accepters

  • The unwillingness and tolerance avoidance for Low Acceptance was associated with greater negative activation for left hemisphere electrodes, suggesting the activation of verbal areas

  • Again, the former outcomes are consistent with ACT’s emphasis on acceptance, avoidance and willingness and the ERP’s data were consistent with RFT’s emphasis on verbal behaviour


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Acceptance vs.

Cognitive Control


Acceptance

Acceptance

  • Up until the mid-90’s, CBT was still insistent that explicit attempts to control cognitive events directly would reduce their frequency and impact, and thus be associated with positive clinical outcomes

  • ACT has always offered a counter-approach because of its contextualistic underpinnings that argues that the only way to change verbal events is to change the context in which they occur and acceptance is the term we use to describe this broader target

  • In this regard, though not intentionally, ACT is more in line with Eastern traditions that emphasise acceptance/mindfulness

  • But Eastern traditions are not sciences and thus cannot be relied upon to provide scientific argument or evidence


Acceptance1

Acceptance

  • Although in Eastern traditions and in ACT, we had reason to believe that acceptance was an active ingredient in positive clinical outcomes and psychological well-being generally, there was almost no empirical evidence to attest to this

  • Furthermore, positive empirical evidence for the impact of acceptance would to some extent undermine positivity for the main existing alternative that was cognitive control – which functionally may be seen as the opposite of acceptance

  • It should also be added that empirical evidence for cognitive control as an active ingredient in CBT is relatively scarce, in spite of its wide usage


Acceptance2

Acceptance

  • So, thus far, we had some comfort in the terminology that suggested a dichotomy between acceptance and avoidance

  • But, acceptance as a clinical tool was something else

  • In our first empirical analysis of acceptance as a mechanism of change, we set out with a very simple aim -- to see if we could construct a short, but potent, acceptance intervention that would be functionally similar to what is presented in therapy, but which might just work in an experimental context

  • This was demonstration research of the simplest kind


Study 3

Study 3

  • During Study 3, ‘normal’ participants were simply presented with a computerised task in which they were asked to match a lot of neutral pictures and a small number of horrible aversive pictures (e.g. mutilated bodies)

  • The former pictures simply represented an experimental control, while the latter represented our core effort to provide participants with a clinical strategy they could use to deal with unpleasant psychological/visual content


Avoiding negative images

Avoiding Negative Images

  • Because the matching was too simple to function as a dependent variable, we targeted participants’ willingness to look at the aversive pictures by: (1) giving them the option to avoid the pictures altogether before the trial and counting how many they looked at and (2) observing how long they would endure them on screen


Acceptance or control

Acceptance or Control

  • Participants were exposed to the baseline matching task, the intervention, and then the task again

  • Both interventions involved the presentation of a vignette in which participants were asked to --imagine that they had witnessed a horrific car accident in which they had to rescue the badly injured and bloodied victims from the car and to imagine that they found the sight of blood extremely aversive

  • They were then given a coping strategy/intervention to help them deal with the vignette (and to influence their subsequent performances on the negative pictures)


Acceptance vs control

Acceptance vs. Control

  • Participants in CognitiveControlwere instructed to try to control their emotional reactions and to avoid feelings of discomfort (e.g. by imaging that the blood was just like tomato ketchup)

  • Participants in Acceptance were instructed to fully embrace their feelings of discomfort (i.e. to fully accept that trying to save the bloodied and mutilated victims would be the most horrific experience of their lives)


Experimenter influence

Experimenter Influence

  • Experimenter influence were also manipulated by altering the instructions and the extent to which the experimenter monitored the matching performances

  • DuringtheNo Instruction/No Monitoringconditions, participants were informed that it did not matter whether they looked at the negative pictures (i.e. no instruction) and the experimenter sat approximately 30 feet away and pretended to read a book (no monitoring)

  • During theInstruction/Monitoringconditions, participants were told that it wasvery important to look at the negative pictures (instruction) and the experimenter walked around actively monitoring performances (monitoring)


Results

Results

  • The results of the study failed to differentiate between the two groups on the number of aversives observed

  • However, they did differ in their mean response latencies while the aversives were on the screen (i.e. aversive tolerance time)


Mean response times neutral pictures

2200

2000

1800

Tolerance Time in ms.

1600

1400

1200

1000

Baseline

Post-Intervention

Mean Response Times: Neutral Pictures

On the neutral pictures, there were no changes at all between

Baseline and Post-intervention, as expected


Mean response times aversive pictures

Accept/Instruct

2200

2000

Accept/No Instruct

1800

1600

Control/No Instruct

1400

Control/Instruct

1200

Baseline

Post-Intervention

1000

Mean Response Times: Aversive Pictures

  • But, on the aversive pictures, Acceptance and Control differed significantly when combined with Instruction/Monitoring (p = 0.002)

  • Strategy and Experimenter Influence interacted significantly


D iscussion1

Discussion

  • The Acceptance strategy increased participants’ tolerance time in the presence of the aversive pictures (when combined with active experimenter influence)

  • Control did not and decreased tolerance in both cases

  • While both strategy outcomes appeared to be influenced by the social context, further analyses indicated that this primarily affected the extent to which participants applied the strategies, rather than affecting the strategies directly (i.e. the strategies were applied more when the experimenter attended)

  • This was our first empirical evidence that acceptance could be delivered as a brief therapeutic intervention in an experimental context and was associated with positive outcomes

  • Cognitive control was in fact counter-productive in terms of altering aversive tolerance when the images were present


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Acceptance vs. Control

with Pain

  • In Study 4, we were concerned that the data so far would not generalise to physical pain and the psychological content associated with that – perhaps different outcomes would emerge relative to coping with aversive visual imagery

  • So, we exposed participants to systematic electric shocks

  • This was based on a previous study by Gutierrez, Luciano, Rodriguez,and Fink who compared acceptance and control as coping interventions with electric shock with 40 undergraduates

  • They reported that Acceptance not only increased shock tolerance, but also reduced participants’ believability of their own subjective pain ratings


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Our Study

  • Although the original study was entirely consistent with our own findings thus far, there was increasing concern within the community about experimental precision – but this was hard to offset against external validity

  • So in Study 4, we tried to come up with a format that was fully automated (hence experimentally ‘clean’), but that would still allow the interventions to be impactful

  • We did some refinement of the Acceptance and Control exercises and metaphors to remove possible confounds

  • And we began to look at values as an active addition to acceptance


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Design

  • 40 ‘normal’ participants were assigned to four conditions


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Play Video 1

Play Video 2

Play Video 3

Play Video 4

Play Video 5

Play Video 6

Play Video 7

Play Video 8

Delivery

  • The entire procedure was automated through a program containing a series of video clips

  • Participants progressed through the clips at their own pace, individually and alone

  • Clips were rated first by independent observers, for consistency, adherence and empathy and were found to not differ in any capacity


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Delivery


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Acceptance: High/Low Values

A Participantswere provided with metaphors and experiential exercises indicating that the best way to deal with pain related thoughts and feelings was to accept them in the context of whatever action is being taken

HV Participantswere asked to imagine that they suffered from chronic pain and that the task involving shock was one which they must do in order to support their family

LVParticipantswere told that the aim of the experiment was to contribute to research on the relation between voltage level and perception of shock


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Control: High/Low Values

CParticipants were given metaphors and experiential exercises designed to teach them that the best way to deal with pain related thoughts and feelings was to distract themselves by imagining pleasant images

HV Participantswere asked to imagine that they suffer from chronic pain and that the task involving shock was one which they must do in order to support their family

LVParticipantswere told that the aim of the experiment was to contribute to research on the relation between voltage level and perception of shock


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15

12

9

Acceptance

No. of Shocks Taken

Control

6

3

0

Pre-Intervention

Post-Intervention

Shock Tolerance Data

  • The Acceptance participants significantly increased their shock tolerance from pre- to post-intervention

  • Control produced no change


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High Value

Low Value

High Pain

100

90

80

70

60

50

40

Pre-Intervention

Post-Intervention

Self-Report Data

Low Pain

  • There was an interesting effect for values – although there was no significant main effect, High Values participants rated the pain as greater across time, whereas Low Values rated it as less


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Tolerating High Pain

  • We wanted to check whether some of the effects were driven by people who had different perceptions of how much pain they were in -- so we examined only those reporting great pain more closely

  • 100% of participants in Acceptance who reported greater experienced pain Post-Intervention showed an increase in tolerance levels, compared to only 50% of the same sub-set of Control (significant: p = 0.0455)

  • We also analysed the number of trials for which participants continued in the Post-Intervention task after reporting high levels of pain (>= 80) and found that the median number of trials for Acceptance was 4, compared to 2 for Control (significant: p = 0.0069)


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Discussion

  • So as an intervention, Acceptance worked better than Control in the context of experimentally physical pain in the form of electric shock

  • Changes in tolerance were particularly strong for participants experiencing a lot of pain and using Acceptance

  • The effects were the same as those reported by other researchers even in a highly structured automated experimental environment

  • While the Values manipulation did not have a significant effect on shock tolerance, it did affect self-reports of pain, in thatparticipants in High Values reported more pain subsequent to the intervention (perhaps the values component oriented them more towards their pain, but not in an avoidant way)


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Study 5: Simple Rules

  • One issue that had been emerging across experiments was the possibility that participants were not really engaging with the various features of the interventions (i.e. the exercises and metaphors), but that they were simply generating or following simple rules

  • So, in Study 5, we compared the full Acceptance and Control interventions used before, but added two new interventions that simply comprised of anAcceptance Rule and a Control Rule-- a brief and simple rule for accepting or distracting

  • In this study, we alsoemployed a Placebo Condition


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Experimental Conditions


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Acceptance

Distraction

Placebo

Rule Acceptance

Rule Distraction

Self-Delivered Shocks

10

9

8

(p < .002)

7

6

5

4

(p < .03)

3

2

1

0

Pre-Intervention

Post-Intervention

Tolerance Data

  • Only Full Acceptanceincreased tolerance significantly from Pre- to Post-Intervention, but none of the other four

  • Distraction-Rule actually decreased tolerance significantly


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Percentage of Participants

More Pain & More Shocks

  • Again, we looked at those participants who reported more pain and still took more shocks and found that these were mostly in the Acceptance Conditions


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Discussion

  • So, the positive acceptance outcomes thus far could not be explained in terms of simple rule following – the metaphors and exercises were essential

  • When these were absent, the moderate improvement in pain tolerance for an acceptance rule was non-significant

  • Although Distraction effects are again negligible

  • Distraction actually makes you worse when it comes in the form of a simple rule


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The next study (Study 6) was also concerned acceptance, but attempted to broaden the generality of the work by employing a new type of pain induction, that might circumvent criticisms that electric shock is not a good analogue of clinical pain

So, three groups of participants were assigned to:

Acceptance

Control

Placebo

And were exposed to the radiant heat pad in a fully automated procedure

Different Pain

Same Outcome


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Heat Apparatus


R esults

Results

  • At baseline, the groups did not differ on a series of psychological measures

  • And the amount of heat tolerance was tightly controlled


Tolerance data

9

HeatTimeTolerance (Seconds)

8

7

6

5

4

3

Acceptance

P = .005

Control

2

Placebo

1

0

Baseline

Post-Intervention

Reminder

Tolerance Data

  • Both Acceptance and Control increased pain tolerance, but only Acceptance was significant


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Discussion

  • So, positive outcomes again for acceptance – now a total of six experiments

  • Acceptance is always significantly better than Control, which had negligible effects

  • Outcomes so far have included tightly controlled experimental environments, arange of populations and numerous experimental methodologies and types of pain

  • The data overall are highly consistent with ACT’s centrality for acceptance and its predictions on avoidance

  • The ERP’s data were consistent with both ACT and RFTand added legitimacy to the outcomes and methodologies


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One Query?

  • But one thing troubled us and we had seen it in research by other labs

  • In some studies, there had been positive (albeit limited and never significant) outcomes for Cognitive Control

  • So, in the radiant heat research, we began to look more closely at our interventions and those used in other studies

  • In the heat study, in particular, we noticed that part of the Control intervention involved saying a pain-related thought aloud before participants tried to distract themselves from it


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Revisions

  • So, we thought that it might just be possible that this feature offered a type of defusion, or at least cognitive distancing, that may have attributed to the outcomes

  • And we set about modifying the Control intervention so as to eliminate this potential confound (Study 7)

  • Our new condition was called Control Revised

  • And we were amazed at what we found . . .


Tolerance data1

9

HeatTimeTolerance (Seconds)

8

Acceptance

7

Control Revised

6

5

4

3

P = .005

2

1

0

Baseline

Post-Intervention

Reminder

Tolerance Data

  • The effects for Acceptance were exactly the same

  • But, Control had no effect at all, and in fact increased pain tolerance was decreasing


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Discussion

  • So, even the small improvements that had been previously recorded for Cognitive Control may not have functioned in the way that was intended

  • Some of the experimental interventions had spurious features that enabled aspects of defusion to creep into the Control protocols

  • In our latter heat experiment in which this feature was addressed directly, the effects for Control could not be differentiated from Placebo


Values

Values


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Investigating Values

  • But, of course,there is more to ACT than acceptance and much of what we do in the therapy depends upon the combination of active ingredients rather than simply a series of incoherent or unintegrated steps

  • However, as much as possible, we try to isolate the components individually for experimental purposes to get a better understanding of outcomes and processes

  • So, we turned our attention next to Values

  • But note, that where we had looked at values before, the outcomes were mixed and it would be very difficult to deliver values as a solitary intervention


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Values

  • We have done only one study (Study 8) to date looking specifically at values

  • This study was conducted in Spain and attempted primarily to assess the influence of a values clarification exercise

  • Although two types of exposure to painful private events were also compared (writing down versus experiential exercise) across three conditions


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Barriers

Valued Living

10

9

8

7

6

REPORT

5

4

3

2

1

0

1

2

3

4

VALUES CLARIF F/U

Values

  • 10 participants were assessed on personal barriers, valuable actions and areas of valued living affected by problems and barriers

Subject 2

Values Clarification

  • Values Clarification alone quickly and steadily reduced barriers and improved reports of valued living and effect enhanced across time


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Barriers

Valued Living

S.7

S.8

10

9

8

7

6

REPORT

5

4

3

2

1

0

1

2

3

4

5

6

VC WRITING F/U

VC EXERCISE F/U

Values Clarification + Writing

  • Values Clarification + Writing alone showed a similar outcome, but the decrease in barriers was less

  • Values Clarification + Exercise alone was similar

  • Overall, the type of exposure to private events did not matter greatly, and these even softened the effects relative to Values Clarification alone

Values Clarification + Exercise


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Discussion

  • So, some positive effects for values clarification

  • No matter, how you do it, a simple values clarification exercise helps to increase the extent of actual valued living and decrease barriers to same

  • There were some minor differences in terms of how this can be done, but these were minimal

  • The data also identified what appeared to be a functional relationship between decreases in barriers and improvements in valued living

  • These are entirely consistent with ACT predictions regarding how private events can function as barriers and how these can be altered with values


Defusion

Defusion


Defusion1

Defusion

  • But, no-one would think for a second that ACT would be ACT without defusion

  • In fact, defusion, it seems is the gel that glues the active ingredients together

  • In fact, acceptance is often difficult when defusion is not in place

  • Also, for RFT the deliteralisation effects that underpin defusion techniques are central to ACT’s outcomes, so in ways studying defusion is perhaps the best test of the relationship between the theory and the therapy


Defusion2

Defusion

  • When we started looking at defusion, we had only one previous study by Masuda et al. (2004) to work from

  • They attempted to assess the impact of word repetition on believability and discomfort levels associated with negative self-relevant words (e.g. “anxious, anxious, anxious” etc.)

  • Their findings indicated that the use of a defusion rationale produced greater reductions in discomfort and believability about the words when compared to a thought suppression rationale or a distraction task


Defusion3

Defusion

  • In this study (Study 9) , we automated the presentation of 20 positive and 20 negative self-statements

  • This generated a total of 60 statements because there were three exposures to each statement

  • After the appearance in screen of each statement, participants were asked to provide ratings regarding their reactions to the statements in terms of:

    • Comfort

    • Believability

    • Willingness


Defusion4

Defusion

  • We manipulated defusion in two ways

  • (1) Defusion Instructions

  • The 80 undergraduates were randomly assigned to:

    • Defusion Condition (pro-defusion instructions)

    • Anti-Defusion Condition (anti-defusion instructions)

    • Neutral Condition (neutral-defusion instructions)


Defusion instructions

Defusion Instructions

‘In the current experiment, we are interested in the emotional impact of unusual self-statements. The scientific literature in this area shows that if you rephrase a self-statement like “I am an awful person” into “I am having the thought that I am an awful person”, then the emotional impact of the statement is reduced

In other words, thinking or saying words like “I am having the thought that I am an awful person” is easierto deal with than simply thinking or saying “I am an awful person”’


Defusion5

Defusion

  • (2) Defusion in Visual Format

  • We wanted to see the extent to which defusion within the visual presentation of the self-statements would give rise to defusion-predictable outcomes

  • To manipulate this, we employed three types of presentation format for each statement:

    • Normal

    • Defusion

    • Abnormal


Normal negative self statement

Normal Negative Self-Statement

Deep down there is something wrong with me


Defusion negative self statement

Defusion Negative Self-Statement

I am having the thought that deep down there is something wrong with me


Abnormal negative self statement

Abnormal Negative Self-Statement

I have a wooden chair and deep down there is something wrong with me


Results comfort

Uncomfortable

500

450

400

350

Neutral Instruction

300

Defusion Instruction

250

Anti-Defusion Instruction

200

150

100

50

0

Comfortable

Normal

Abnormal

Defusion

Results: Comfort

  • The (pro) defusion instructions were correlated with less discomfort than the other two types of instruction

  • As was the defusion presentation format


Results willingness

Unwilling

600

500

400

Neutral Instruction

Defusion Instruction

300

Anti-Defusion Instruction

200

100

0

Normal

Abnormal

Defusion

Willing

Results: Willingness

  • The (pro) defusion instructions were correlated with more willingness than the other two types of instruction

  • As was the defusion presentation format – very similar results to comfort ratings


Results believability

Unbelievable

900

800

700

600

Neutral Instruction

500

Defusion Instruction

400

Anti-Defusion Instruction

300

200

100

0

Believable

Normal

Abnormal

Defusion

Results: Believability

  • Contrary to predictions, the (pro) defusion instructions were correlated with more believability than the other two types of instruction

  • As was the defusion presentation format – very similar results to comfort and willingness ratings


Discussion

Discussion

  • Although they looked impactful in the ratings, the defusion instructions did not have a significant influence

  • However, the Defused presentation format significantly decreased discomfort, increased willingness, but unexpectedly increased believability

  • However, on closer inspection of the data and other information gathered from participants it may be the case that they were rating the believability of whole statements –”I am having the thought that . .” rather than the content itself – this is not unlike defusion


Discussion1

Discussion

  • So, increases in willingness to having negative self-referential content were consistent with ACT’s predictions regarding defusion

  • Believability ratings, upon closer inspection, suggested that the defused format decreased participants’ believability of the content directly

  • Decreases in discomfort were not directly predicted by ACT, but such outcomes are positive although they would not be targeted directly


Defusion interventions

Defusion Interventions

  • In the previous study, we had assessed simple impacts for defusion and found that it generated positive and largely ACT consistent outcomes even when defusion occurred within the visual presentation of the content

  • But, if we employed defusion as an intervention, as had been the case for Masuda et al., would we find similar outcomes?

  • Study 10 attempted to address this question


Study 10

Study 10

  • Participants generated a personalised negative self-relevant thought that represented a summary of several related personal statements

  • They were then given a written protocol that contained an instruction followed by an exercise

  • The three protocols were:

    • Defusion

    • Thought Control

    • Placebo


Experimental conditions

Experimental Conditions


Method

Method

  • Once again, the emotional impact of the negative self-referential statements was measured in terms of:

  • Discomfort

  • Believability

  • Willingness


Results comfort1

DD

TC/

TC

D/

TC

TC/

D

D/P

TC/

P

P/D

P/

TC

P/P

Results: Comfort

Uncomfortable

100

80

60

40

20

Pre-Intervention

0

Post-Intervention

Comfortable

Condition

  • All interventions with a defusion component generated decreases in discomfort

  • But, the largest effects were DD and PD, suggesting activity in the defusion exercise


Results comfort2

Results: Comfort

  • Interestingly, the only significant differences pre- and post-intervention emerged for the following conditions:

    • Placebo-Defusion

    • Defusion-Placebo

    • Defusion-Defusion

    • Thought Control-Thought Control


Results believability1

100

80

60

40

20

DD

TC/

TC

D/

TC

TC/

D

TC/

P

P/

TC

D/P

P/D

P/P

0

Results: Believability

Believable

Pre-Intervention

Post-Intervention

Unbelievable

Condition

  • All effects were in the right direction of decreasing believability

  • But, D-D and TC-D showed largest decreases in believability


Results believability2

Results: Believability

  • The only significant differences pre- and post-intervention emerged for the following conditions:

    • Placebo-Defusion

    • Placebo-Thought Control

    • Defusion-Placebo

    • Defusion-Defusion

    • Defusion-Thought Control

    • Thought Control-Defusion

    • Thought Control-Thought Control

  • So, a very mixed bag overall


Results willingness1

Unwilling

100

80

60

40

Pre-Intervention

20

Post-Intervention

DD

TC/

TC

D/

TC

TC/

D

TC/

P

P/D

P/

TC

Willing

D/P

P/P

0

Condition

Results: Willingness

  • All effects were in the right direction of decreasing unwillingess

  • But, D-TC was the only significant outcome


Discussion2

Discussion

  • Quite a mixed bag overall

  • But, generally most positive effects in predicted directions for packages containing defusion features

  • Defusion exercise appeared to be somewhat more effective than a simple rationale


Yvonne barnes holmes dermot barnes holmes

Concluding Comments


Concluding comments

Concluding Comments

  • There are many more analogue studies completed and underway than those reported here

  • The effects for ACT components across the board are predominantly as predicted and compare favourably with substantively weaker outcomes generated by target comparisons

  • The range of issues generated by the studies shows the complexity of the effects and the difficulty in conducting high quality research in this modality

  • As studies progress, the standard of experimental rigour is exceptional


Concluding comments1

Concluding Comments

  • Automated interventions

  • Balancing for gender

  • Balancing for heat tolerance, acceptance etc.

  • Pre-screening with relevant psychological assessments

  • Including self-report measures

  • Blind experimenter

  • Use of different types of physical and psychological stressors

  • Use of non-clinical populations

  • Very substantive N in some cases

  • Interventions are very closely matched, topographically and functionally

  • Range of ACT components tested


Concluding comments2

Concluding Comments

  • We are now in a place where these types of analyses can be done effectively and with high levels of precision

  • The evidence is overwhelmingly positive . . .


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