Investigating Determinants of Client Psychotherapy Preference: An Analog Study.

Increased emphasis has been placed on elucidating the contribution of client variables, such as treatment preference, to optimize evidence-based practice. This analog study sought to better understand variables associated with treatment preference using a convenience sample of college students (n = 54) who read brief descriptions of three interventions for negative thoughts-defusion, noticing, and restructuring. They rated each on acceptability and practicality and completed measures of cognitive fusion, emotional distress, and experiential avoidance as possible moderating variables. Restructuring was overwhelmingly preferred and rated as more acceptable than the two alternatives by both the overall sample and a distressed subsample. Preference for defusion or noticing was not predicted by ratings of acceptability or practicality but by elevated levels of cognitive fusion and emotional distress consistent with a compensation model. Limitations of the study and its implications for further research on psychotherapy preference and its integration within evidence-based practice are discussed.

Corrigendum: Acceptance and commitment therapy preceded by attention bias modification on residual symptoms in depression: a 12-month follow-up.

[This corrects the article DOI: 10.3389/fpsyg.2019.01995.].

The Contribution of Psychological Inflexibility and Metacognitive Processes to Emotional Distress.

Process-based cognitive behavior therapy (PB-CBT) may be informed by identifying shared mechanisms of disorder linked to shared processes of therapeutic change. Repetitive negative thinking (RNT) is a molar pathogenic process common to both generalized anxiety disorder and depression. Acceptance and commitment therapy (ACT) and metacognitive therapy (MCT) offer separate models of the relationship between RNT and emotional distress. In a pair of related studies, the relative degree to which processes specific to the two models accounted for variability in levels of generalized anxiety and depression in college student samples was evaluated. Across both studies, processes of cognitive fusion and obstructed valued living within the ACT model and beliefs about the negative consequences of RNT within the MCT model were most predictive of variability in levels of emotional distress. Limitations of this project as well as implications for further research and practice of PB-CBT for disorders of emotional distress are discussed.

Inducing Amusement in the Laboratory and Its Moderation by Experiential Approach.

The relative ability of four comedic sketches to induce amusement in the laboratory and its moderation by dispositional differences in experiential approach as a form of positive emotion regulation were investigated. College student participants reported significant and equivalent diminished levels of negative affect relative to baseline following each sketch, while the level of positive affect induced by The Office exceeded that elicited by two of the three other sketches as well as by a top-ranked French comedic film clip. Regression models indicated that the two subscales of the Experiential Approach Scale and their interaction accounted for significant variability in negative mood reductions following the sketches. Unexpectedly, college student participants who enjoyed the greatest decrement in negative affect reported a regulation style in which anxiously clinging to positive emotions dominates over sustaining and savoring them. The limitations of this project and implications of its findings for laboratory inductions of amusement, as well as further investigations of its possible moderation by experiential approach as form of positive emotion regulation are discussed.

Psychological Flexibility in Depression Relapse Prevention: Processes of Change and Positive Mental Health in Group-Based ACT for Residual Symptoms.

Relapse rates following a depressive episode are high, with limited treatments available aimed at reducing such risk. Acceptance and commitment therapy (ACT) is a cognitive-behavioral approach that has gained increased empirical support in treatment of depression, and thus represents an alternative in relapse prevention. Psychological flexibility (PF) plays an important role in mental health according to the model on which ACT is based. This study aimed to investigate the role of PF and its subprocesses in reducing residual symptoms of depression and in improving positive mental health following an 8-week group-based ACT treatment. Adult participants (75.7% female) with a history of depression, but currently exhibiting residual symptoms (N = 106) completed measures before and after intervention, and at 6 and 12-month follow-up. A growth curve model showed that positive mental health increased over 12-months. Multilevel mediation modeling revealed that PF significantly mediated these changes as well as the reduction of depressive symptoms, and that processes of acceptance, cognitive defusion, values and committed action, in turn, mediated increased PF.

Acceptance and Commitment Therapy Preceded by Attention Bias Modification on Residual Symptoms in Depression: A 12-Month Follow-Up.

Depression is a highly recurrent disorder with limited treatment alternatives for reducing risk of subsequent episodes. Acceptance and commitment therapy (ACT) and attention bias modification (ABM) separately have shown some promise in reducing depressive symptoms. This study investigates (a) if group-based ACT had a greater impact in reducing residual symptoms of depression over a 12-month follow-up than a control condition, and (b) if preceding ACT with ABM produced added benefits. This multisite study consisted of two phases. In phase 1, participants with a history of depression, currently in remission (N = 244), were randomized to either receive 14 days of ABM or a control condition. In phase 2, a quasi- experimental design was adopted, and only phase-1 participants from the Sørlandet site (N = 124) next received an 8-week group-based ACT intervention. Self-reported and clinician-rated depression symptoms were assessed at baseline, immediately after phase 1 and at 1, 2, 6, and 12 months after the conclusion of phase 1. At 12-month follow-up, participants who received ACT exhibited fewer self-reported and clinician-rated depressive symptoms. There were no significant differences between ACT groups preceded by ABM or a control condition. There were no significant differences between ACT groups preceded by ABM or a control condition. Group-based ACT successfully decreased residual symptoms in depression over 12 months, suggesting some promise in preventing relapse.

The Development of In Vivo Measures to Assess the Impact of Sex-Drive Reducing Medications in an Offender with an Intellectual Disability.

The ability to adequately evaluate medications in the treatment of paraphilias has been limited by reliance upon self-report as a measure of effectiveness over periods of time that may be too short to detect reoffending. One solution to this shortcoming is the development of valid, long-term, stable assessment measures. The purpose of this case study was to analyze the effects of Prozac and Provera on an array of behaviors germane to the successful treatment of paraphilias, including: (a) sexual arousal in the laboratory and natural environment, (b) sexual thoughts (deviant and nondeviant) accompanied by arousal in the natural environment, and (c) overt actions in the community associated with increased risk of reoffending over a 31-month period for an exhibitionist with an intellectual disability. Despite the ineffectiveness of the medications, the measures demonstrated long-term, differentiated significant clinical responding; further underscored the importance of assessing deviant sexual arousal and adherence to relapse-prevention procedures in the natural environment; and provided a new methodology to assess sexual preoccupations and sexual arousal. Use of these in vivo measures raises questions regarding their potential to improve the predictability of risk assessments, and serve as an aide in the analysis of whether a treatment procedure is effective for an individual.

The Development of Novel Interoceptive Exposure Methods for Inducing Derealization and Depersonalization Symptoms.

Derealization and depersonalization and are commonly experienced by individuals with panic disorder. Although interoceptive exposure (IE) is a key therapeutic component in the treatment of panic disorder, there currently are few recognized ways to elicit reactions that successfully mimic dissociative symptoms commonly experienced during panic. We examined the ability of several novel methods that elicit anomalous and confusing perceptual experiences to induce at least moderately intense dissociative reactions in a college student sample (N = 34). Two of the novel procedures (i.e., stripes and hand) and a task previously identified as effectively eliciting dissociative symptoms, strobe light plus three-dimensional (3D) glasses reliably induced derealization/depersonalization reactions. The implications of these findings for further research and the clinical practice of IE in treatment of panic attacks are discussed.

Assessing the generalization of relapse-prevention behaviors of sexual offenders diagnosed with an intellectual disability.

The generalization of relapse-prevention skills of 10 males residing at a state facility for sexual offenders diagnosed with an intellectual disability was assessed in the community using three different experimental probes: (a) treatment staff (TS), (b) nontreatment staff (NTS), and (c) community adults (CAs). Results indicated a decrease in compliance from the TS to NTS and CAs, with the lowest levels of generalization displayed by offenders who were older and displayed a wider range of paraphilias. The degree of generalization also varied as a function of the contingencies for prevention-plan noncompliance, with higher rates of generalization occurring for violations that were more severely consequated. The implications of the findings for future research in promoting the generalization of relapse-prevention skills of sexual offenders, in general, and those who also exhibit intellectual disabilities, in particular, are discussed.

Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance.

The present research describes the development and psychometric evaluation of a second version of the Acceptance and Action Questionnaire (AAQ-II), which assesses the construct referred to as, variously, acceptance, experiential avoidance, and psychological inflexibility. Results from 2,816 participants across six samples indicate the satisfactory structure, reliability, and validity of this measure. For example, the mean alpha coefficient is .84 (.78-.88), and the 3- and 12-month test-retest reliability is .81 and .79, respectively. Results indicate that AAQ-II scores concurrently, longitudinally, and incrementally predict a range of outcomes, from mental health to work absence rates, that are consistent with its underlying theory. The AAQ-II also demonstrates appropriate discriminant validity. The AAQ-II appears to measure the same concept as the AAQ-I (r=.97) but with better psychometric consistency.

Processes of change in acceptance and commitment therapy and cognitive therapy for depression: a mediation reanalysis of Zettle and Rains.

Several articles have recently questioned the distinction between acceptance and commitment therapy (ACT) and traditional cognitive therapy (CT). This study presents a reanalysis of data from Zettle and Rains that compared 12 weeks of group CT with group ACT. For theoretical reasons, Zettle and Rains also included a modified form of CT that did not include distancing, and no intent-to-treat analysis was included. Particularly because that unusual third condition did somewhat better than the full CT package, it contaminated the direct comparison of ACT and CT, which has of late become theoretically interesting. In the present study, data from participants in the ACT and CT conditions were reanalyzed. ACT was shown to produce greater reductions in levels of self-reported depression using an intent-to-treat analysis. Posttreatment levels of cognitive defusion mediated this effect at follow-up. The occurrence of depressogenic thoughts and level of dysfunctional attitudes did not function as mediators. This study adds additional evidence that ACT works through distinct and theoretically specified processes that are not the same as CT.