The state mindfulness scale for physical activity: further psychometrics properties / Escala de estado de mindfulness para atividade física: novas propriedades psicométricas / Escala de mindfulness en la actividad física: nuevas propiedades psicométricas

Mindfulness has been defined as attention and awareness to the present with an attitude of openness, non-judgment, and acceptance. It is suggested that mindfulness can positively influence experiences in sports and physical activity, increasing adherence to these activities. This study aimed to examine new psychometric properties of the State Mindfulness Scale for Physical Activity (SMS-PA) using classical and modern testing theories among Brazilian sport and exercise practitioners. Two studies were conducted. In the first, with 617 Brazilian sports practitioners, confirmatory factor analysis supported the bifactor structure of the SMS-PA composed of two specific (mental and body mindfulness) and one general factor (state mindfulness), which did not vary among genders. The Rasch Rating Scale Model (RSM) supported essential one-dimensionality indicated by the general factor with good item fit statistics (infit/outfit 0.62-1.27). The model presented a good level of Rasch reliability (0.85), and the items difficulty estimation provided an understanding of the continuum represented by their content. In the second study, with 249 Brazilian exercise practitioners, the structural equation modeling showed that Body Mindfulness was associated with positive outcomes (positive affect and satisfaction with practice). The mediation analysis showed that people with higher levels of Body mindfulness tend to experience greater levels of Positive Affect and, consequently, greater Satisfaction with exercises. The results suggest that the Brazilian version of the SMS-PA is an appropriate measure of the state of mindfulness.(AU)

Mindfulness pode ser definido como atenção e consciência no momento presente com uma atitude de abertura, não julgamento e aceitação. A literatura sugere que o mindfulness pode influenciar positivamente experiências no esporte e atividade física e pode exercer um papel na adesão a essas atividades. Este estudo teve como objetivo investigar novas propriedades psicométricas da State Mindulness Sacale for Physical Activity (SMS-PA) utilizando as teorias clássicas e modernas dos testes em praticantes de exercício físico e esporte brasileiros. Dois estudos foram conduzidos. No primeiro, com 617 brasileiros praticantes de esporte, a Análise Fatorial Confirmatória (AFC) demonstrou adequação à estrutura bifatorial da SMS-PA composta por dois fatores específicos (mindfulness mental e físico) e um fator geral (estado de mindfulness), que apresentou invariância entre sexos. A Rasch Rating Scale Model (RSM) corroborou a unidimensionalidade essencial indicada pelo fator geral com bons índices de ajustes (infit/outfit 0.62 -1.27). O modelo apresentou bom nível de precisão Rasch (.85), e a estimação de dificuldade dos itens possibilitou compreensão do continuum representado pelo conteúdo dos itens. No segundo estudo, com 249 brasileiros praticantes de esporte, a Modelagem de Equações Estruturais demonstrou que o mindfulness físico esteve associado a afetos positivos e satisfação com a prática. A análise de mediação mostrou que pessoas com níveis altos de mindfulness físico tendem a apresentar níveis mais elevados de afeto positivo e, consequentemente, níveis mais elevados de satisfação com a prática. Os resultados sugerem que a versão brasileira do SMS-PA é uma medida apropriada do estado de mindfulness para atividades físicas.(AU)

La atención plena puede definirse como la atención y la conciencia en el momento presente con una actitud de apertura, no juicio y aceptación. La literatura sugiere que el mindfulness puede influir positivamente en las experiencias en el deporte y en la actividad física, además de desempeñar un papel en la adherencia a estas actividades. Este estudio tuvo como objetivo investigar nuevas propiedades psicométricas de la State Mindfulness Scale for Physical Activity (SMS-PA) utilizando las teorías clásicas y modernas de las pruebas en practicantes de ejercicio físico y de deporte en Brasil. Para ello, se realizaron dos estudios. En el primer, participaron 617 practicantes de deporte brasileños, y el análisis factorial confirmatorio (AFC) demostró adecuación en la estructura bifactorial de la SMS-PA, compuesta por dos factores específicos (mindfulness mental y físico) y un factor general (estado de mindfulness), que mostró invarianza entre sexos. El Rasch Rating Scale Model (RSM) corroboró la unidimensionalidad esencial indicada por el factor general con buenos índices de ajuste (infit/outfit 0,62-1,27). El modelo mostró un buen nivel de precisión de Rasch (.85), y la estimación de la dificultad de los ítems permitió comprender el continuo representado por el contenido de estos. En el segundo estudio, con 249 practicantes de deporte, el modelo de ecuaciones estructurales mostró que el mindfulness físico estaba asociado a resultados positivos (afecto positivo y satisfacción con la práctica). El análisis de mediación reveló que las personas con altos niveles de mindfulness físico tendían a tener mayores niveles de afecto positivo y, en consecuencia, mayores niveles de satisfacción con la práctica. Los resultados sugieren que la versión brasileña de la SMS-PA es una medida adecuada de mindfulness.(AU)

Percepções de familiares sobre uma rede de cuidados de saúde mental infantojuvenil / Family perceptions about a children's mental health network / Percepciones familiares sobre una red de atención de salud mental infantojuvenil

Este artigo pretende conhecer como a rede de cuidados em saúde tem se operacionalizado a partir da percepção de familiares de crianças com demanda de cuidado em saúde mental (SM). Foram realizados dois grupos focais, um com familiares da Atenção Básica (AB) e outro com familiares do Centro de Atenção Psicossocial Infantojuvenil (CAPSij), totalizando 15 participantes. Seguiu-se com a análise lexical do tipo classificação hierárquica descendente, com o auxílio do software R Interface, a fim de análises multidimensionais de textos e questionários (IRaMuTeQ), resultando em cinco classes: A Pílula Mágica; Forças e Fraquezas dos serviços; Procurando por ajuda; Aceitando o diagnóstico da criança e Onde procurei ajuda. Os resultados apontam para dificuldades presentes na AB em identificar e manejar situações de Saúde Mental Infantojuvenil (SMIJ), por meio de uma lógica ainda medicalizante. Ressalta-se que a escola é apresentada como lugar de destaque na produção da demanda por cuidado e a família ainda é pouco convocada à construção das ações. Conclui-se, então, que avanços ainda são necessários para operacionalização de um cuidado pautado nas diretrizes da política de SMIJ.(AU)

This article aims to know how the healthcare network has been operationalized from the perception of family members of children with demand for mental health care (MH). Two focus groups were held, one with family members from Primary Care (PC) and the other with family members from the Child Psychosocial Care Center (CAPSij), totaling 15 participants. A lexical analysis of the descending hierarchical classification type was performed with the help of the software R Interface for multidimensional analyzes of texts and questionnaires (IRAMUTEQ), resulting in five classes: The Magic Pill; Strengths and Weaknesses of services; Looking for help; Accepting the child's diagnosis; and Where did I look for help. The results point to difficulties present in PC in identifying and managing situations of mental health in children and adolescents (MHCA), with a medicalization logic. Note that the school is presented as a prominent place in producing the demand for care, and the family is still not very much involved in the actions. It is, thus, concluded that advances are still needed for operationalization of care guided by MHCA policy guidelines.(AU)

Este artículo tuvo por objetivo conocer cómo opera una red asistencial a partir de la percepción de familiares de niños con demanda de atención en salud mental (SM). Se realizaron dos grupos focales, uno con familiares de Atención Primaria (AP) y otro con familiares del Centro de Atención Psicosocial Infantojuvenil (CAPSij), totalizando 15 participantes. Se realizó análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), lo que resultó en cinco clases: "La píldora mágica"; "Fortalezas y debilidades de los servicios"; "En busca de ayuda"; "Aceptar el diagnóstico del niño" y "¿Dónde busqué ayuda?". Los resultados apuntan las dificultades presentes en AP para identificar y manejar situaciones de salud mental infantojuvenil (SMIJ) mediante una lógica aún medicalizante. La escuela tiene un lugar destacado en la producción de la demanda de cuidados y la familia aún no está muy involucrada en la construcción de acciones. Se concluye que se necesitan avances para ofertar una atención guiada por lineamientos de la política del SMIJ.(AU)

Acceptance and commitment therapy for chronic pain: a quasiexperimental study / Terapia de aceitação e compromisso em grupo para dor crônica: estudo quase-experimental

Objective Chronic pain is an important health problem and affects both quality of life and mental health. This study assessed psychological inflexibility, pain intensity, quality of life, anxiety and depression symptoms, self-efficacy, and social support among patients with chronic pain. Method A quasiexperimental design was used to assess six adult participants pre- and post-group intervention (eight sessions) based on acceptance and commitment therapy. Results After the intervention, the patients experienced a reduction in psychological inflexibility, pain, and depression and anxiety symptoms and improvements in quality of life and self-efficacy. The quality of life and depression symptoms and the domains of quality of life and psychological inflexibility were negatively correlated. Conclusion Acceptance and commitment therapy is a promising treatment for the interdisciplinary treatment of the Pain Clinic.

Objetivo Dor crônica é um problema de saúde prevalente que acarreta prejuízos para qualidade de vida e saúde mental. Este estudo avaliou inflexibilidade psicológica, intensidade da dor, qualidade de vida, sintomas de ansiedade e de depressão, autoeficácia e suporte social em pacientes com dor crônica. Método Utilizou delineamento quase-experimental e os seis participantes adultos foram avaliados por meio de instrumentos no pré e pós-intervenção em grupo (oito sessões) com Terapia de Aceitação e Compromisso. Resultados Após a intervenção houve redução da inflexibilidade psicológica e da dor, melhora da qualidade de vida, redução dos sintomas de ansiedade e de depressão e aumento da autoeficácia. Houve correlação inversa entre qualidade de vida e sintomas de depressão e entre domínios da qualidade de vida e inflexibilidade psicológica. Conclusão Conclui-se que a Terapia de Aceitação e Compromisso é um tratamento promissor a ser integrado no atendimento interdisciplinar da Clínica de dor.

Cuidadores familiares de pessoas com demência: um estudo exploratório randomizado utilizando a Terapia de Aceitação e Compromisso em grupo / Family caregivers of people with dementia: an exploratory randomized study using Group Acceptance and Commitment Therapy

Introdução: Estima-se que a prevalência de sintomas ansiosos em cuidadores familiares de pessoas com demência é igual ou maior do que a prevalência de sintomas depressivos, embora a ansiedade tenha sido pouco explorada na literatura voltada para este público. Estudos têm demonstrado que a Terapia de Aceitação e Compromisso (ACT) pode ser utilizada com cuidadores familiares, com efeitos positivos sobre sintomas ansiosos. Entretanto, a ACT ainda não foi avaliada no formato em grupo e tampouco em países em desenvolvimento para este público. Objetivos: O trabalho foi subdividido em dois estudos. O objetivo do Estudo 1 foi revisar a literatura através de uma meta-análise e avaliar quantitativamente a eficácia da ACT em grupo, presencialmente, nos sintomas de ansiedade e depressão de adultos com 18 anos ou mais. O objetivo do Estudo 2 foi adaptar e avaliar os efeitos da ACT, em grupo, nos sintomas de ansiedade de cuidadores familiares de pessoas com demência. Método: No Estudo 1, quatro bases de dados foram pesquisadas em agosto/2018 e uma busca atualizada foi realizada em novembro/2021. Foram incluídos 48 estudos clínicos randomizados (3292 participantes: ansiedade = 34 ECRs; depressão = 40 ECRs). O Estudo 2, é um estudo exploratório randomizado, realizado em um único centro, não-cego. Cinquenta e sete cuidadores familiares de pessoas com demência foram randomizados para o grupo intervenção (n = 29) ou lista de espera (n = 28). O grupo intervenção participou de oito sessões de ACT em grupo, realizadas por vídeo conferência, semanalmente. Os participantes responderam aos questionários de avaliação de ansiedade, depressão, flexibilidade psicológica, qualidade de vida e sobrecarga, em três momentos diferentes: semanas 0, 9 e 20. Análises de regressão múltipla foram realizadas para comparar os escores dos participantes do grupo intervenção e controle, na semana 9 e 20. Os escores da linha de base foram usados como controle nas análises de intenção de tratamento (ITT) e dos participantes que participaram em pelo menos seis sessões de intervenção. Resultados: No Estudo 1 o tamanho de efeito para sintomas ansiosos foi de médio a grande (g=0,52, p < 0,001; 95% IC=0,30 ­ 0,73), já o tamanho de efeito para sintomas depressivos foi de pequeno a médio (g=0,47, p < 0,001; 95% IC=0,31 ­ 0,64). A amostra do Estudo 2 foi composta em sua maioria mulheres, de baixo a médio nível socioeconômico, com uma idade média de 52 anos e mediana de escolaridade de 15 anos. Participantes do grupo intervenção apresentaram pontuações mais baixas para sintomas de ansiedade e depressão, comparados com participantes do grupo controle. Este resultado foi encontrado nas semanas 9 e 20, tanto na análise de ITT, quanto na análise daqueles que completaram seis sessões ou mais. Apenas os participantes que participaram de pelo menos seis sessões, apresentaram redução da sobrecarga nas semanas 9 e 20, além de apresentarem melhora na qualidade de vida na semana 9. Os resultados não indicaram efeitos da intervenção na flexibilidade psicológica. Conclusão: Este estudo oferece evidências a favor da utilização da ACT em grupo, com familiares de pessoas com demência, auxiliando na redução dos sintomas ansiosos e depressivos.

Background: The prevalence of anxiety symptoms is estimated to be equal to or higher than the prevalence of depressive symptoms in family carers of people with dementia. However, anxiety is currently somehow neglected in the carer literature. Previous studies demonstrated that Acceptance and Commitment Therapy (ACT) is effective for treating anxiety symptoms in family carers of people with dementia, but the vast majority of these studies were conducted in developed countries. Objectives: The thesis was divided into two studies. Study 1 was a meta-analysis which aimed to quantitatively examine the efficacy of group-based ACT, delivered face-to-face, on anxiety and depressive symptoms in adults aged 18 or older. The Study 2 adapted and investigated the effectiveness of an ACT group intervention on the anxiety symptoms in Brazilian family carers of people with dementia. Method: In Study 1, four electronic databases were searched in August, 2018 and an update search was conducted in November, 2021. Forty-eight randomised controlled trials (RCTs) were included in this review (3292 participants: anxiety = 34 RCTs, depression = 40 RCTs). Study 2 was a single-centre, unblinded, double-arm exploratory randomised trial. Fifty-seven family carers of people with dementia presenting with mild to severe anxiety symptoms were randomised to the intervention group (n = 29) or waiting list group (n = 28). The intervention group received eight weekly sessions of group ACT, delivered through videoconference. Participants completed the measure of anxiety and depressive symptoms, caregiver burden, psychological flexibility and quality of life at Weeks 0, 9 and 20. Multiple linear regression analyses were performed to evaluate whether there was a significant difference in scores between the intervention and control groups, at weeks 9 and 20, while controlling for the baseline scores using both intention-to-treat (ITT) and completers data analyses. Results: In Study 1 the overall effect size for anxiety symptoms was medium-to-large (g = 0.52, p < 0.001; 95% CI =0.30­0.73), while the overall effect size was small-to-medium for depressive symptoms (g = 0.47, p < 0.001; 95% CI = 0.31­0.64). In Study 2 Participants were mostly women, from low- to middle-income socioeconomic levels, with a mean age of 52 years and median education of 15 years. Participants in the intervention group had lower scores of anxiety and depression symptoms compared to participants in the control condition at weeks 9 and 20 in both the ITT and completer analyses. Only participants who attended six or more sessions (i.e., completer sample) demonstrated reduced caregiver burden at both follow-up points. The completer sample also showed improvement in quality of life at week 9. The results did not show any effect of the intervention on psychological flexibility. Conclusion: This study provides evidence supporting the use of group ACT, delivered through videoconference, with family carers of people with dementia to help them cope better with anxiety and depressive symptoms.

Terapia de aceitação e compromisso para redução do estresse em universitários: um estudo qualitativo / Acceptance and commitment therapy for university students: a qualitative study / Terapia de aceptación y compromiso para estudiantes universitarios: un estudio cualitativo

Este estudo teve como objetivo explorar a percepção de alunos de graduação em relação à sua participação em uma intervenção baseada na terapia de aceitação e compromisso (acceptance and commitment therapy[ACT]), para redução da inflexibilidade psicológica (IP) e do estresse em estudantes universitários. Parti­ciparam da pesquisa 21 alunos, de diferentes cursos de graduação, com idade média de 23,4 ± 5,61, sendo 71,4% do sexo feminino e 28,6% do sexo masculino. Os dados coletados nas entrevistas foram submetidos à análise de conteúdo e organizados em quatro categorias: experiência no programa, utilidade, viabilidade e sugestões e processos da ACT. Os resultados possibilitaram identificar que o programa foi uma experiên-cia positiva para os participantes. Além disso, constatou-se que a intervenção foi útil e viável, e possibili-tou que os estudantes desenvolvessem as habilidades necessárias para lidar melhor com as adversidades do dia a dia, sem que precisassem se afastar dos seus valores pessoais.

This study aims to explore undergraduate students' perception of their participation in an intervention, based on acceptance and commitment therapy (ACT), to reduce psychological inflexibility (PI) and stress in undergraduate students. Twenty­one students from different undergraduate programs participated in the research, with an average age of 23.4 ± 5.61, of whom 71.4% were female and 28.6% were male. The data collected in the interviews were submitted to content analysis and organized into four categories: experience in the program, utility, feasibility, and ACT suggestions and processes. The results made it possible to identify that the program was a positive experience for the participants, the intervention was useful and feasible and enabled students to develop the requirements to better deal with the adversities of daily life without departing from their personal values.

Este estudio tiene como objetivo explorar la percepción de los estudiantes de pregrado sobre su participa-ción en una intervención, basada en la terapia de aceptación y compromiso (acceptance and commitment therapy [ACT]), para reducir la inflexibilidad psicológica (IP) y el estrés en los estudiantes de pregrado. En la investigación participaron 21 estudiantes de diferentes carreras, con una edad promedio de 23,4 ± 5,61, de los cuales el 71,4% eran mujeres y el 28,6% hombres. Los datos recolectados en las entrevistas fueron sometidos a análisis de contenido y organizados en cuatro categorías: experiencia en el programa, utilidad, factibilidad y sugerencias y procesos de ACT. Los resultados permitieron identificar que el programa fue una experiencia positiva para los participantes, la intervención fue útil y factible y permitió a los estudian-tes desarrollar los requisitos necesarios para enfrentar mejor las adversidades de la vida diaria, sin apar-tarse de sus valores personales.

The Iranian form of psychometric properties of the Multidimensional Psychological Flexibility Inventory

The Multidimensional Psychological Flexibility Inventory (MPFI) is a new 60-item self-report scale developed to assess the specific components of psychological flexibility and inflexibility proposed in the Hexaflex model of Acceptance and Commitment Therapy (ACT). The present study sought to examine the psychometric properties of the Persian version of the MPFI-60 in a community sample of 307 Iranian adults. The original study supported a 12-factor second-order structure consisting of 6 dimensions for psychological flexibility and 6 dimensions for psychological inflexibility. The Persian MPFI-60 demonstrated acceptable semantic and test content, internal structure, correlations with other variables, and internal consistency. It also evidenced in relation to anxiety, stress, depression, and self-compassion. Overall, the results indicate that the Persian MPFI-60 is a psychometrically sound measure in the Iranian context that enables researchers and clinicians to comprehensively assess the components of psychological flexibility and inflexibility within the Hexaflex model. (AU)

ACT em grupo para manejo de ansiedade entre universitários: ensaio clínico randomizado / Group therapy based on act for anxiety management among university students: randomized clinical trial / Terapia grupal basada en ACT para el manejo de la ansiedad entre estudiantes universitarios: ensayo clínico aleatorizado

Estima-se que um a cada cinco estudantes universitários ao redor do mundo apresenta algum tipo de transtorno psicológico, dentre os quais os transtornos de ansiedade são os mais prevalentes. Este estudo consiste em um ensaio clínico randomizado com o objetivo de avaliar a eficácia e efetividade de um protocolo semiestruturado de psicoterapia em grupo baseado nos princípios da Terapia de Aceitação e Compromisso (ACT) para o tratamento de ansiedade entre estudantes universitários. Os participantes foram alocados aleatoriamente entre os grupos intervenção e controle. Os níveis de ansiedade pré e pós-intervenção foram avaliados por meio do instrumento General Anxiety Disorders-7 (GAD-7). A amostra final do estudo foi composta por 15 pessoas, dentre as quais 10 foram alocadas no grupo intervenção e 5, no grupo controle. Os resultados foram analisados de duas formas: a) por protocolo (Per-protocol analysis); e b) por intenção de tratar (Intention-to-treat Analysis). Este tratamento reduziu a sintomatologia ansiosa em 39,7% entre os pacientes que completaram o tratamento (por protocolo, p=0,030) e em 30,8% entre todos alocados para o grupo intervenção (i.e., por intenção de tratar, incluindo os dropouts, p=0,035), enquanto os controles não tiveram redução significativa no mesmo período. Portanto, recomenda-se a utilização deste protocolo dentro do contexto universitário como uma alternativa viável ao acompanhamento individual em situações de transtornos de ansiedade. Pesquisas futuras com amostras maiores podem contribuir na consolidação deste protocolo.

One in every five university students around the world is estimated to have some type of psychological disorder, considering anxiety disorders as the most prevalent. This study consists in a randomized clinical trial aimed to evaluate efficacy and effectiveness of a semi-structured group psychotherapy protocol based on the principles of Acceptance and Commitment Therapy (ACT) for the treatment of anxiety among university students. Participants were randomly allocated in the intervention and control groups. Pre- and post-intervention anxiety levels were measured using the General Anxiety Disorders-7 (GAD-7) questionnaire. The study sample was composed of 15 people, 10 of whom were allocated to the intervention group and 5 to the control group. Results were analyzed in two ways: 1) Per protocol analysis; and 2) Intention-to-treat analysis. This treatment reduced anxiety symptoms by 39.7% among patients who completed treatment (Per protocol, p=0.003) and by 30.8% among all those allocated to the intervention group (i.e., by Intention-to-treat, including dropouts, p=0.035), whereas controls showed no significant reduction in same period. Therefore, we recommend the use of this protocol within the university context as a viable alternative to individual counselling in situations of anxiety disorders. Future research with larger samples may contribute to consolidate this protocol.

Se estima que uno de cada cinco estudiantes universitarios en todo el mundo tiene algún tipo de trastorno psicológico, entre los cuales los trastornos de ansiedad son los más frecuentes. Este estudio consiste en un ensayo clínico aleatorizado cuyo objetivo fue evaluar la eficacia y efectividad de un protocolo de psicoterapia grupal semiestructurada basado en los principios de la Terapia de Aceptación y Compromiso (ACT) para el tratamiento de la ansiedad en estudiantes universitarios. Se asignaron aleatoriamente a los participantes en los grupos de intervención y control. Los niveles de ansiedad antes y después de la intervención se midieron utilizando el instrumento General Anxiety Disorders-7 (GAD-7). La muestra final del estudio estuvo compuesta por 15 personas, de las cuales 10 fueron asignadas al grupo de intervención y 5 al grupo de control. Los resultados se analizaron de dos maneras: 1) por protocolo (Per protocol analysis); y 2) por intención de tratar (Intention-to-treat Analysis). Con este tratamiento los síntomas de ansiedad se redujeron en un 39,7% entre los pacientes que completaron el tratamiento (por protocolo, p=0,030) y en un 30,8% entre todos los asignados al grupo de intervención (es decir, por intención de tratar, incluidos los dropouts, p=0,035), mientras que los controles no tuvieron una reducción significativa en el mismo periodo. Por lo tanto, se recomienda utilizar este protocolo dentro del contexto universitario como una alternativa viable a lo asesoramiento individual en situaciones de trastornos de ansiedad. La investigación futura con muestras más grandes puede contribuir a la consolidación de esta modalidad.

Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial

Objective: To evaluate a protocol for acceptance and commitment therapy-based behavioral intervention for insomnia (ACT-BBI-I) in adults compared to cognitive behavioral therapy for insomnia (CBT-I). Methods: Forty-five adults with chronic insomnia were randomized to ACT-BBI-I or CBT-I. Both interventions were performed in six weekly group sessions. The common treatment elements in both protocols included stimulus control and sleep restriction. CBT-I is focused on the cognitive restructuring of maladaptive beliefs about sleep and the daytime effects of insomnia. ACT-BBI-I focuses on therapeutic processes of acceptance, availability, values, defusion, and commitment. The results were evaluated through the following instruments: a sleep diary, the Insomnia Severity Index, the Epworth Sleepiness Scale, the Hospital Anxiety and Depression Scale, the Acceptance and Action Questionnaire-II, and the Dysfunctional Beliefs and Attitudes about Sleep scale. Results: Both interventions had a significant positive impact on sleep patterns, insomnia, anxiety, beliefs about sleep, and psychological flexibility. All improvement was maintained at the 6-month follow-up. Conclusion: The results suggest that integrating principles of ACT with behavioral techniques may be useful for treating insomnia. Further research should identify whether the principles of ACT result in added effectiveness compared to behavioral components alone. Clinical trial registration: RBR-7nc5wq

The safety and efficacy of acceptance and commitment therapy against psychotic symptomatology: a systematic review and meta-analysis

Objective: Acceptance and commitment therapy (ACT) is a third-wave psychological intervention that has attracted considerable clinical and research attention. A previous meta-analysis of ACT trials in psychosis reported a large effect size of ACT against overall psychotic symptomatology. However, there were critical methodological issues in the review that justify replication. Methods: Systematic review and meta-analysis of randomized controlled trials (RCTs) testing ACT vs. any comparator condition in a sample of adults with psychosis. The outcome of interest was overall psychotic symptomatology. Results: The search identified seven published and eight unpublished trials (of which we were able to obtain data from one). Data on symptomatology were extracted from six trials that involved 274 participants. The summary effect size (Hedge's G) for overall symptomatology was small and not significant (-0.21, 95%CI -0.60-0.18). Trials were generally rated as having a high risk of bias. Safety reporting was inadequate across included trials. Conclusions: Our observed effect size contrasted with that reported in a previous meta-analysis; differences were likely explained by errors in data extraction. The findings of this review suggest that there is currently inadequate evidence to conclude that ACT is a safe and effective treatment against psychotic symptomatology. Systematic review registration: CRD42018097200

Viabilidade da terapia de aceitação e compromisso para dependentes de drogas / Feasibility of acceptance and commitment therapy for drug addicts

A dependência de substâncias é uma das condições de saúde mais estigmatizadas no mundo, contribuindo para o seu agravamento, exclusão social e discriminação. Conscientes da percepção negativa da sociedade em relação à sua condição, essas pessoas podem internalizar o estigma, a partir de crenças, sentimentos e comportamentos negativos sobre si. Uma das intervenções com evidências iniciais positivas para reduzir o estigma internalizado é a Terapia de Aceitação e Compromisso (ACT). Este estudo avaliou a viabilidade de uma intervenção baseada em ACT para reduzir o estigma internalizado entre dependentes de substâncias. Os participantes receberam o tratamento convencional do serviço, além da intervenção composta por seis sessões com periodicidade semanal, conduzidas por uma dupla de terapeutas previamente treinadas. Implementar estratégias para a redução do estigma internalizado pode contribuir para manter os benefícios obtidos ao longo do tempo, aumentando a adesão ao tratamento e a qualidade dos cuidados fornecidos.

Substance dependence is one of the most stigmatized health conditions in the world, contributing to its worsening, social exclusion and discrimination. Aware of society's negative perception of their condition, these people can internalize stigma from negative beliefs, feelings and behaviors about themselves. One of the interventions with positive initial evidence to reduce internalized stigma is the Acceptance and Commitment Therapy (ACT). This study evaluated the feasibility of an ACT-based intervention to reduce internalized stigma among substance addicts. The participants received the conventional treatment of the service, in addition to the intervention consisting of six weekly sessions, conducted by a pair of previously trained therapists. Implementing strategies to reduce internalized stigma can contribute to maintaining the benefits obtained over time, increasing adherence to treatment and the quality of care provided.

The effectiveness of acceptance and commitment therapy for social anxiety disorder: a randomized clinical trial

Abstract Objective Acceptance and commitment therapy has been used to treat anxiety disorders recently. The purpose of this study was to investigate the effectiveness of acceptance and commitment therapy for psychological symptoms in students with social anxiety disorder, including difficulty in emotion regulation, psychological flexibility based on experiential avoidance, self-compassion, and external shame. Methods This study was a semi-experimental clinical trial. Twenty four students with social anxiety disorder were randomly divided into two groups after initial evaluations: an experimental group (12 subjects) and a control group (12 subjects). The experimental group received 12 treatment sessions based on a protocol of acceptance and commitment therapy for anxiety disorders, and the control group was put on a waiting list. Self-Compassion (SCS), Difficulty in Emotion Regulation (DERS), External Shame (ESS), Social Anxiety (SPIN), and Acceptance and Action (AAQ-II) questionnaires were used to assess participants. Data were analyzed using SPSS. Results Acceptance and commitment therapy was shown to be effective at the post-test and follow up stages for reducing external shame, social anxiety, and difficulty in emotion regulation and its components, and for increasing psychological flexibility and self-compassion (p < 0.05). The largest effect size of treatment was for increase of psychological flexibility and the lowest efficacy was for the components "difficulty in impulse control" and "limited access to emotional strategies" at the post-test and follow-up stages, respectively. Conclusion Acceptance and commitment therapy may be an appropriate psychological intervention for reducing the symptoms of students with social anxiety disorder and helping them to improve psychological flexibility. Emotion and related problems can be identified as one of the main targets of this treatment. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT20180421039369N1.

Evaluación de la espiritualidad en pacientes con duelo utilizando la terapia de aceptación y compromiso en la Clínica de Duelo por Suicidio del Centro Universitario de Ciencias de la Salud de la Universidad de Guadalajara, México / Evaluation of complicated spiritual grief in patients with loss of results in acceptance and commitment therapy at the suicide clinic of the CUCS / Avaliação da espiritualidade em pacientes enlutados em processo terapéutico de aceitação e compromisso na Clínica de luto por suicídio do Centro Universitário de Ciências da Saúde da Universidade de Guadalajara

Introducción. El apego se define como aquel vínculo significativo que se establece entre personas. Cuando este se rompe, ocurre lo que se denomi-na una pérdida significativa seguida de un proceso de duelo, el cual con-siste en una reacción de dolor natural ante el desprendimiento de algo o de alguien. Durante este proceso, la espiritualidad es una estrategia central para sobreponerse a una experiencia dolorosa; sin embargo, esta también puede verse afectada por los significados que se le atribuyen. La terapia de aceptación y compromiso se emplea en distintos desórdenes psicológicos que involucran la evitación experiencial, incluyendo el duelo.Objetivo. Evaluar el duelo complicado espiritual en pacientes tratados con terapia de aceptación y compromiso, antes y después de la intervención.Materiales y métodos. Se aplicó el cuestionario Inventory of Complicated Spiritual Grief a pacientes con duelo antes y después de ser tratados con terapia de aceptación y compromiso en la Clínica del Duelo del Cen-tro Universitario de Ciencias de la Salud de la Universidad de Guadalaja-ra, México.Resultados y conclusiones. La terapia de aceptación y compromiso ha de-mostrado ser útil en el proceso del duelo, así como en el restablecimiento de la espiritualidad, toda vez que esta es resignificada y da sentido a las experiencias dolorosas.Palabras clave: Duelo; Apego; Espiritualidad; Terapia de aceptación y compromiso.

Introduction: Attachment refers to the significant bond we establish with a person, when this is broken, what we call a significant loss occurs, followed by a grieving process: natural pain reaction to the detachment of something or someone who had a It was worth it During this, spirituality appears as a cen-tral strategy to overcome painful experiences, but it can also be affected by the meanings attributed to it. Acceptance and commitment therapy has been used in different psychological disorders that involve experiential avoidance, including grief.Objectives: The central objective of the study is to evaluate the complicated spiritual duel. Material and methods: The Inven-tory of Complicated Spiritual Grief (ICSG) was applied in pa-tients with grief, before and after being treated with Acceptance and Commitment Therapy in the grief clinic of the University Center of Health Sciences.Results and Conclusions: Acceptance Therapy and commitment has proven to be useful in facilitating the elaboration of grief, as well as in restoring spirituality since it is resignified and gives meaning to painful experiences.

Introdução. O apego refere-se ao vínculo significativo estabe-lecido entre pessoas, se vier a quebrar acontece uma perda significativa, seguida de um processo de luto que envolve uma reação natural de dor ao desapego. Durante esse processo, a espiritualidade é uma estratégia central para superar uma expe-riência dolorosa, no entanto, esteja afetada pelos significados atribuídos a ela. A Terapia de aceitação e comprometimento é usada em várias circunsatâncias que envolvem evasão expe-riencial, incluindo luto.Objetivo. O principal objetivo do estudo é avaliar o luto com-plicado espiritual.Materiais e métodos. O questionário Inventory of Complicated Spiritual Grief foi aplicado em pacientes com perdas significa-tivas, antes e depois de serem tratados com a Terapia de acei-tação e compromisso na clínica de luto do Centro Universidade de Ciências da Saúde da Universidade de Guadalajara.Resultados e conclusões. Terapia de aceitação e compromisso mostrou ser útil no processo de luto, bem como na restauração da espiritualidade, uma vez que é ressignificada e dá sentido à experiências dolorosas

Grupo de Apoio Psicológico a Mulheres em Situação de Infertilidade / Psychological Support Group for Women in Situation of Infertility / Grupo de Apoyo Psicológico a Mujeres en Situación de Infertilidad

Este trabalho teve como objetivo descrever um relato de experiência a partir de um Programa de Intervenção com mulheres em situação de infertilidade. Tal Programa faz parte do Projeto de Extensão da UEL/PR, na área da Psicologia, com fundamento na Análise do Comportamento. Foram realizados dois grupos, compostos por sete mulheres cada, de Londrina e região, entre 31 e 42 anos, em situação de infertilidade conjugal. Realizou-se 10 sessões, de aproximadamente duas horas cada, semanalmente. Após dois meses do término, realizou-se sessões de followup. Os procedimentos utilizados foram técnicas de dinâmica de grupo, técnicas da Análise do Comportamento, como modelagem e modelação, Terapia de Aceitação e Compromisso (ACT) e Psicoterapia Analítica funcional (FAP). Realizou-se avaliações qualitativas por meio de dados obtidos com os relatos das participantes. A partir da fala das participantes, puderam ser percebidas mudanças em seus comportamentos, tanto dentro das sessões quanto em seu ambiente natural, de acordo com seus relatos verbais. A intervenção grupal tem o potencial de promover a aprendizagem de um repertório de enfrentamento das dificuldades relacionadas à infertilidade, o fortalecimento de aspectos positivos no relacionamento conjugal e social, além da aceitação emocional e seu manejo. Durante as sessões de follow-up, quatro participantes relataram estar dando início ao processo de adoção e, cinco participantes conseguiram atingir a gravidez. Sugere-se a replicação deste Programa com este tipo de população, bem como estudos com controle de variáveis....(AU)

This study aimed to report a clinical intervention, based on the principles of Behavior Analysis, in two groups of women in infertility situation. This program is part of the Extension Project of UEL/PR, in the field of Psychology, based on Behavior Analysis. Each group assisted seven women, between 31 and 42 years, in situation of conjugal infertility. Eleven sessions were held, approximately two hours each, once a week. After two months of the end of the groups, follow-up sessions were realized to monitor the changes observed. The procedures were group dynamics, problem solving and decision making techniques, Social Skills Training, Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP). To this end, it was sought to do Functional Analysis of the behaviors of each participant. Quantitative and qualitative evaluation, from data obtained with the session reports was realized. The group intervention led to the learning of a behavioral repertoire of coping with the difficulties related to infertility, the strengthening of positive aspects in the marital and social relationship, besides the emotional acceptance and its handling. During and after the follow-up sessions, four participants reported being starting the process of adoption and five participants were able to achieve pregnancy. It is suggested that further studies with wider control variables should be conducted to test the effectiveness of the procedures used....(AU)

El objetivo de este trabajo fue describir un relato de experiencia proveniente del programa de intervención con mujeres en situación de infertilidad. El programa forma parte de un Proyecto de Extensión, de la Universidad Estatal de Londrina (UEL), Provincia de Paraná, en el área de la Psicología, con base en el Análisis del Comportamiento. Se formaron dos grupos con siete mujeres, entre 31 y 42 años, en situación de infertilidad. Se llevaron a cabo 10 sesiones de aproximadamente dos horas semanales. Dos meses después del término, se realizaron sesiones de follow-up. Los procedimientos utilizados fueron técnicas de dinámica de grupo, técnicas de Análisis de Comportamiento tales como el modelado y modelado, Terapia de Aceptación y Compromiso (ACT) y Psicoterapia Analítica Funcional (FAP). Se realizaron evaluaciones cualitativas por medio de datos obtenidos con los relatos de las participantes. A partir del habla de las participantes, se pudieron percibir cambios en sus comportamientos, tanto dentro de las sesiones y en su ambiente natural, de acuerdo con sus relatos verbales. La intervención grupal tiene el potencial de promover el aprendizaje de un repertorio de enfrentamiento de las dificultades relacionadas a la infertilidad, el fortalecimiento de aspectos positivos en la relación conyugal y social, además de la aceptación emocional y su manejo. Durante las sesiones de follow up, cuatro participantes relataron que estaban dando inicio al proceso de adopción y cinco participantes lograron el embarazo. Se sugiere la replicación de este Programa con este tipo de población, así como estudios con control de variables....(AU)

Effectiveness of Acceptance and Commitment Therapy for Chronic Pain Patients: A Systematic Review and Meta-Analysis / 정신간호학회지

PURPOSE: The aims of this study was to evaluate the effects of acceptance and commitment therapy (ACT) for chronic pain patients. METHODS: Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses, we searched the Cochrane Library, CINAHL, EMBASE, OVID, PubMed and Korean databases to identify randomized controlled trials published through May 2019. To estimate the effect size, a meta-analysis of the studies was performed using the R program, and the risk of bias was assessed using the Cochrane's Risk of Bias tool for randomized studies. RESULTS: A total of 11 studies were included in this study. Studies were heterogeneous, and random effects models were used in the analyses. ACT was effective for improving pain (g=−0.40, 95%CI:−0.69~−1.12, p<.001, I2=80%), pain acceptance (g=1.24, 95% CI:0.41~2.05, p<.001, I²=95%), anxiety (g=−0.47, 95% CI:−0.81~−0.13, p<.001, I²=84%), depression (g=−0.52, 95% CI:−0.85~−0.19, p<.001, I²=85%), and quality of life (g=1.14, 95% CI:0.11~2.17, p<.001, I²=95%). CONCLUSION: Our study findings of the ACT seems to be effective for improving pain, pain acceptance, anxiety, depression, and quality of life in patients with chronic pain. Additionally, ACT may be useful for reducing barriers to therapy, and various studies should be attempted.

Effects of Acceptance Commitment Therapy Based Recovery Enhancement Program on Psychological Flexibility, Recovery Attitude, and Quality of Life for Inpatients with Mental Illness / 정신간호학회지

PURPOSE: The purpose of this study was to (1) develop an acceptance commitment therapy (ACT) based recovery enhancement program for inpatients with mental illness and (2) test the effects of the program on patients' psychological flexibility, recovery attitude, and quality of life. METHODS: A mixed methods design was used: a combination of a repeated-measure design with a non-equivalent control group and qualitative data collection. The participants were 41 inpatients with mental illness (experimental group: 20, control group: 21). The ACT based recovery enhancement program was conducted over four sessions for a total of two weeks. Data were collected from December 2018 to January 2019. RESULTS: Study results revealed that the ACT based recovery enhancement program was effective for psychological flexibility (F=150.71, p<.001), recovery attitude (F=60.22, p<.001), and quality of life (F=31.59, p<.001) for inpatients with mental illness. CONCLUSION: The results of this study suggest that the ACT based recovery enhancement program can be used as an effective mental health nursing intervention for psychological flexibility, recovery attitude, and quality of life of inpatients with mental illness.

Social validity of a contextual behavioral science-based intervention for retirement education

Abstract The literature shows that retirement can bring both positive and negative effects. However, there are few tested interventions for preparing workers for this transition and avoiding or minimizing its negative impacts. This paper presents a study with multiple groups that examined the social validity of an intervention for retirement education grounded in contextual behavioral science and acceptance and commitment therapy. Twenty-seven workers aged 29 to 65 divided into three intervention groups participated (group 1, N = 15; group 2, N = 9; group 3, N = 3). According to the participants' evaluations, the intervention provided socially valid goals, socially acceptable procedures, and socially important effects. However, some improvements are still needed, such as the use of more dynamic methods, better formatted printed material, and increased fidelity between the content's implementation and the prescribed activities. The positive results indicate that contextual behavioral science may bolster the development of interventions whose components possess evidence for their social validity. The further evaluation of the intervention via a clinical trial study will offer more robust evidence for its effectiveness. It is hoped that by increasing the availability of theory-based interventions in this area, the present study will promote valid strategies to facilitate better adjustment to retirement.

Establishment of the theory and operation of willing acceptance and commitment therapy / 中南大学学报(医学版)

Mindfulness-based psychotherapy, known as the third-wave cognitive behavior therapy, showed a multi-cultural integration trend. As part of it, willing acceptance and commitment therapy not only took root in the discoveries in the fields of evolutionary psychology and cognitive psychology, but also absorbed the concepts of psychotherapy from Chinese traditional culture. As a result, it regards truth and harmony as the essence of health, proposes a triangle model (health/pain-willing acceptance-striving) to elucidate the mechanism of psychopathology and psychotherapy in theory. Operationally, it contains four principles of psychotherapy, which are as follow: "knowing yourself and others, reaction but adequately, reality as well as harmony, willing acceptance and striving". Furthermore, it proposes eight therapeutic procedures including "understand yourself, recognize suffering, check coping style, keep openness and acceptance, mindfulness and flexibility, live in the moment, clarify the value, and commit action". With these principles and procedures, willing acceptance and commitment therapy aims to fade the neural trace of patients' painful memories, improve their psychological flexibility and rebuild their lifestyles consistent with their values.

The Effects of an Acceptance-Commitment Therapy Based Stress Management Program on Hospitalization Stress, Self-Efficacy and Psychological Well-Being of Inpatients with Schizophrenia

PURPOSE: The purpose of this study was to construct an acceptance-commitment therapy (ACT)-based stress management program for inpatients with schizophrenia and to examine its effects on hospitalization stress, self-efficacy, and psychological well-being. METHODS: A non-equivalent control group pretest-posttest design was used. Participants were 44 inpatients with a diagnosis of schizophrenia. The experimental group (n=22) received the ACT-based stress management program twice a week for a total of four weeks. The control group (n=22) received the usual care from their primary health care providers. The study was carried out from August 7 to September 1, 2017, and data were analyzed using IBM SPSS/WIN 22.0 with a Chi-square test, Fisher's exact test, and an independent t-test. RESULTS: The experimental group showed a significant decrease in hospitalization stress (t=5.09, p < .001) and an increase in self-efficacy (t=2.44, p=.019). However, there was no significant difference in psychological well-being between the two groups (t=0.13, p=.894). CONCLUSION: The results of this study suggest that the ACT-based stress management program can be used as an effective mental health nursing intervention for hospitalization stress and self-efficacy for inpatients with schizophrenia.

Improving Diabetes Self-Mangement and Mental Health through Acceptance and Commitment Therapy / 임상당뇨병

The purpose of this study was to introduce acceptance and commitment therapy (ACT) for diabetes educators and review its effectiveness on diabetes patient self-care and mental health. ACT can reduce disease burden by reducing cognitive fusion and experiential avoidance. Psychotherapy such as ACT may be a useful intervention for helping diabetes patients to improve self-care and mental health conditions. Diabetes educators should make continuous efforts to practice ACT for patients in clinical settings.

Development and Effects of an Acceptance Commitment-based Cognitive Behavioral Program for Patients with Schizophrenia / 정신간호학회지

PURPOSE: The purposes of this study were to develop an acceptance commitment-based cognitive behavioral program for patients with schizophrenia and to use it as an intervention tool for psychiatric mental health nursing and thereby confirm the program's effects on patients' psychological flexibility, psychological well-being, and treatment adherence including insight and attitude toward treatment. METHODS: This study consisted of a pretest, posttest 1, and posttest 2 for a nonequivalent control group design. The participants were 42 patients with schizophrenia (experimental group: 21, control group: 21). The acceptance commitment-based cognitive behavioral program was conducted in 10 sessions for 5 weeks. Data collected from February to April 2018 were analyzed using the SPSS/WIN 25.0 for χ2 test, Fisher's exact test, independent t-test, and repeated measurement ANOVA. RESULTS: The differences between experimental and control groups were statistically significant regarding psychological flexibility, psychological well-being, and insight. CONCLUSION: This study findings suggest that the acceptance commitment-based cognitive behavioral program can be used as an effective mental health nursing intervention for psychological flexibility, psychological well-being, and insight of patients with schizophrenia.