Post on 27-Mar-2015
transcript
1
Understanding the Clinical Processes in ACT
Yvonne Barnes-Holmes &
Dermot Barnes-Holmes
2
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
3
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
4
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
5
Acceptance vs. Avoidance
6
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. Avoidance
7
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
Acceptance vs. Avoidance
8
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)
0
0.5
1
1.5
2
2.5
3
High Low
Median Reaction Times
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?
9
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
0 50 100
0 50 100
0 50 100
High
Low
Mild Intense
Willing Unwilling
Self-Report Ratings
10
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
11
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
ERP’s and Avoidance
12
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 Acceptance again emitted longer reaction times when they expected to see an aversive, rather than a neutral, image (p = 0.0431)
0
0.5
1
1.5
2
2.5
3
3.5
High Mid
Low
Median Reaction Times
A N A N A N
13
Again, this was not because the pictures were less unpleasant, because the High and Mid Acceptance rated the aversive images as more unpleasant and emotionally intense than Low Acceptance
But, Low and Mid Acceptance were less willing to look at the images
0 50 100
Pleasant Unpleasant
0 50 100
0 50 100
HighLow
Mid
Mild Intense
Willing Unwilling
Self-Report Ratings
14
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 . . .
15
Low Acceptance
-12500
-7500
-2500
2500
7500
12500
Left Middle Right
High Acceptance
-12500
-7500
-2500
2500
7500
12500
Left Middle Right
Are
a D
imen
sion
s (
V •
ms)
16
The fact that the Low Acceptance group showed greater negative activation for left hemisphere electrodes could 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.)
ERP’s Recordings
17
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
Discussion
18
Acceptance vs. Cognitive Control
19
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
20
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
21
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
Acceptance
22
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
Study 3
23
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
Avoiding Negative Images
24
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 or Control
25
Participants in Cognitive Control were 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)
Acceptance vs. Control
26
Experimenter influence were also manipulated by altering the instructions and the extent to which the experimenter monitored the matching performances
During the No Instruction/No Monitoring conditions, 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 the Instruction/Monitoring conditions, participants were told that it was very important to look at the negative pictures (instruction) and the experimenter walked around actively monitoring performances (monitoring)
Experimenter Influence
27
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)
Results
28
Mean Response Times: Neutral Pictures
On the neutral pictures, there were no changes at all between Baseline and Post-intervention, as expected
Baseline Post-Intervention
1000
1200
1400
1600
1800
2000
2200 T
oler
ance
Tim
e in
ms.
29
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
Accept/Instruct
Accept/No Instruct
Control/No Instruct
Control/Instruct
1000
1200
1400
1600
1800
2000
2200
Baseline Post-Intervention
30
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
31
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
Acceptance vs. Control with Pain
32
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
Our Study
33
40 ‘normal’ participants were assigned to four conditions
Design
Intervention Values Context
Pre-Intervention
Post-Intervention
Acceptance High
Low
Control High
Low
34
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
35
Delivery
36
A Participants were 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 Participants were 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
LV Participants were told that the aim of the experiment was to contribute to research on the relation between voltage level and perception of shock
37
C Participants 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 Participants were 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
LV Participants were told that the aim of the experiment was to contribute to research on the relation between voltage level and perception of shock
38
Shock Tolerance Data
The Acceptance participants significantly increased their shock tolerance from pre- to post-intervention
Control produced no change
0
3
6
9
12
15
Pre-Intervention Post-Intervention
Control
Acceptance
No.
of
Sh
ock
s T
aken
39
Self-Report Data
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
40
50
60
70
80
90
100
Pre-Intervention Post-Intervention
Low Value
High Value
High Pain
Low Pain
40
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)
41
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 that participants 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)
Discussion
42
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 an Acceptance Rule and a Control Rule -- a brief and simple rule for accepting or distracting
In this study, we also employed a Placebo Condition
Study 5: Simple Rules
43
Acceptance Rule
Acceptance Rule,
Metaphor & Exercise
Control
Rule
Control Rule, Metaphor &
Exercise
Placebo
Experimental Conditions
44
Only Full Acceptance increased tolerance significantly from Pre- to Post-Intervention, but none of the other four
Distraction-Rule actually decreased tolerance significantly
Tolerance Data
0123456789
10
Pre-Intervention Post-Intervention
Rule DistractionRule AcceptancePlaceboDistractionAcceptance
Se
lf-D
eli
ve
red
Sh
oc
ks
(p < .002)
(p < .03)
45
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
0
20
40
60
80
100
Acceptance Distraction Placebo RuleAcceptance
RuleDistraction
Per
cen
tag
e o
f P
arti
cip
an
ts
More Pain & More Shocks
46
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
Discussion
47
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 ControlPlacebo
And were exposed to the radiant heat pad in a fully automated procedure
Different Pain Same Outcome
48
Heat Apparatus
49
Results
At baseline, the groups did not differ on a series of psychological measures
And the amount of heat tolerance was tightly controlled
50
Tolerance Data
0 1 2 3 4 5 6 7 8 9
Baseline Post-Intervention Reminder
Hea
t T
ime
Tol
eran
ce (
Sec
ond
s)
P = .005
Placebo Control Acceptance
Both Acceptance and Control increased pain tolerance, but only Acceptance was significant
51
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, a range 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 RFT and added legitimacy to the outcomes and methodologies
Discussion
52
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
One Query?
53
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 . . .
Revisions
54
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
0 1 2 3 4 5 6 7 8 9
Baseline Post-Intervention Reminder
Hea
t T
ime
Tol
eran
ce (
Sec
ond
s)
P = .005
Control Revised Acceptance
55
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
Discussion
56
Values
57
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
Investigating Values
58
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
Values
Values Clarification
Values Clarification
+ Writing
Values Clarification
+ Experiential Exercise
59
10 participants were assessed on personal barriers, valuable actions and areas of valued living affected by problems and barriers
Values
Subject 2
0123456789
10
1 2 3 4
RE
PO
RT
VALUES CLARIF F/U
Values Clarification
Barriers
Valued Living
Values Clarification alone quickly and steadily reduced barriers and improved reports of valued living and effect enhanced across time
60
0123456789
10
1 2 3 4 5 6
REPO
RT
S.8
VC EXERCISE F/U
0123456789
10
1 2 3 4 5 6
RE
PO
RT
VC WRITING F/U
S.7
Barriers
Valued LivingValues Clarification + Writing
Values Clarification + Exercise
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
61
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
Discussion
62
Defusion
63
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
Defusion
64
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
Defusion
65
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
Defusion
66
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
67
‘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 easier to deal with than
simply thinking or saying “I am an awful person”’
Defusion Instructions
68
(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
Defusion
69
Normal Negative Self-Statement
Deep down there is something wrong with meDeep down there is something wrong with me
70
Defusion Negative Self-Statement
I am having the thought that deep down there I am having the thought that deep down there is something wrong with meis something wrong with me
71
Abnormal Negative Self-Statement
I have a wooden chair and deep down there is I have a wooden chair and deep down there is something wrong with mesomething wrong with me
72
Results: Comfort
0
50
100
150
200
250
300
350
400
450
500
Normal Abnormal Defusion
Anti-Defusion Instruction
Defusion Instruction
Neutral Instruction
Uncomfortable
Comfortable
The (pro) defusion instructions were correlated with less discomfort than the other two types of instruction
As was the defusion presentation format
73
Results: Willingness
0
100
200
300
400
500
600
Normal Abnormal Defusion
Anti-Defusion Instruction
Defusion Instruction
Neutral Instruction
Unwilling
Willing
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
74
Results: Believability
0
100
200
300
400
500
600
700
800
900
Normal Abnormal Defusion
Anti-Defusion Instruction
Defusion Instruction
Neutral Instruction
Unbelievable
Believable
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
75
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
76
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
77
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
78
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
79
Rationale ExerciseDefusion Defusion
Thought Control Thought Control
Defusion Thought Control
Thought Control Defusion
Defusion Placebo
Thought Control Placebo
Placebo Defusion
Placebo Thought Control
Placebo Placebo
Experimental Conditions
80
Once again, the emotional impact of the negative self-referential statements was measured in terms of:
Discomfort
Believability
Willingness
Method
81
Results: Comfort
All interventions with a defusion component generated decreases in discomfort
But, the largest effects were DD and PD, suggesting activity in the defusion exercise
Condition
Uncomfortable
100
80
60
40
20
0
Pre-Intervention
Post-Intervention
DD TC/TC
D/TC
TC/D
D/P TC/P
P/D P/TC
P/PComfortable
82
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
83
Results: Believability
All effects were in the right direction of decreasing believability
But, D-D and TC-D showed largest decreases in believability
Believable
Condition
Pre-Intervention
Post-Intervention
Unbelievable
100
80
60
40
20
0DD TC/
TCD/TC
TC/D
D/P TC/P
P/D P/TC
P/P
84
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
85
Results: Willingness
All effects were in the right direction of decreasing unwillingess
But, D-TC was the only significant outcome
Unwilling
Condition
Pre-Intervention
Post-Intervention
Willing
100
80
60
40
20
0
DD TC/TC
D/TC
TC/D D/P
TC/P
P/D P/TC P/P
86
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
87
Concluding Comments
88
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 Comments
89
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 Comments
90
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 . . .
Concluding Comments