Acceptance and Commitment Therapy as a Transdiagnostic Approach to Treatment of Behavioral Health Concerns: A Concurrent Multiple Baseline Design Across Participants

Abstract

The current study examined the effects of an individual acceptance and commitment therapy (ACT) protocol in three young adults with topographically different, but functionally similar, behavioral health concerns. Using a concurrent multiple baseline design across participants (N = 3), clinically relevant target behaviors were collected daily as primary outcome measures. In addition, weekly self-report assessment of potential process variables and an assessment package at pretreatment, midpoint, posttreatment, and 3-month follow-up were used to evaluate process and outcomes of treatment. Results provided tentative support for ACT’s efficacy, with effects being most pronounced in Participants 2 and 3 with slight improvements in clinically relevant target behaviors. This study adds to the literature concerning process-based approaches to treatment by highlighting how ACT can be tailored to the needs of individuals with diverse behavioral health concerns.

Keywords

acceptance and commitment therapy process-based CBT transdiagnostic experiential avoidance multiple baseline design

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.

Atkins

P. W.

Ciarrochi

Gaudiano

B. A.

Bricker

J. B.

Donald

Rovner

. . . Hayes

S. C.

(2017). Departing from the essential features of a high quality systematic review of psychotherapy: A response to Öst (2014) and recommendations for improvement. Behaviour Research and Therapy, 97, 259–272.

Barlow

D. H.

Allen

L. B.

Choate

M. L.

(2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35(2), 205–230.

Barlow

D. H.

Ellard

K. K.

Fairholme

Farchione

T. J.

Boisseau

C. L.

Ehrenreich-May

J. T.

Allen

L. B.

(2010). Treatments that work: Unified protocol for transdiagnostic treatment of emotional disorders. Oxford University Press.

Beck

A. T.

Steer

R. A.

(1993). Beck Anxiety Inventory manual. Psychological Corporation.

Beck

A. T.

Steer

R. A.

Brown

G. K.

(1996). Manual for the Beck Depression Inventory-II. Psychological Corporation.

Bloy

Olivers

J. E.

Morris

(2011). Using acceptance and commitment therapy with people with psychosis: A case study. Clinical Case Studies, 10(5), 347–359.

Bogusch

L. M.

Moeller

M. T.

O’Brien

W. H.

(2018). Case study of acceptance and commitment therapy and functional analysis for emetophobia. Clinical Case Studies, 17(2), 77–90. https://doi.org/10.1177/1534650118754304

Bond

F. W.

Hayes

S. C.

Baer

R. A.

Carpenter

K. M.

Guenole

Orcutt

H. K.

. . . Zettle

R. D.

(2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/10.1016/j.beth.2011.03.007

10.

Boynton-Wheeler

C. H.

(2017). Acceptance and commitment therapy-specific processes in the psychotherapeutic treatment of obsessive compulsive disorder: A single case study. Clinical Case Studies, 16(4), 313–327. https://doi.org/10.1177/1534650117694269

11.

Deacon

B. J.

(2013). The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review, 33, 846–861.

12.

Eifert

G. H.

Forsyth

J. P.

(2013). Acceptance and commitment therapy for anxiety disorders: A practitioner’s treatment guide to using mindfulness, acceptance, and values-based behavior change. New Harbinger.

13.

First

M. B.

Gibbon

Spitzer

R. L.

Williams

J. B. W.

Benjamin

L. S.

(1997). Structured Clinical Interview for DSM-IV Axis II personality disorders, research version. American Psychiatric Association Press.

14.

First

M. B.

Spitzer

R. L.

Gibbon

Williams

J. B. W.

(2002). Structured Clinical Interview for DSM-IV-TR Axis I disorders, research version. American Psychiatric Association Press.

15.

Follette

W. C.

Houts

A. C.

(1996). Models of scientific progress and the role of theory in taxonomy development: A case study of the DSM. Journal of Consulting and Clinical Psychology, 64(6), 1120–1132.

16.

Gamez

Chmielewski

Kotov

Ruggero

Suzuki

Watson

(2014). The Brief Experiential Avoidance Questionnaire: Development and initial validation. Psychological Assessment, 26, 35–45.

17.

Gamez

Chmielewski

Kotov

Ruggero

Watson

(2011). Development of a measure of experiential avoidance: The Multidimensional Experiential Avoidance Questionnaire. Psychological Assessment, 23(3), 692–713. https://doi.org/10.1037/a0023242

18.

Ghafoori

(2018). Prolonged exposure therapy for experiential avoidance: A case-series study. Clinical Case Studies, 17(3), 123–135. https://doi.org/10.1177/1534650118766660

19.

Gloster

A. T.

Klotsche

Ciarrochi

Eifert

Sonntag

Wittchen

Hoyer

(2017). Increasing valued behaviors precedes reduction in suffering: Findings from a randomized controlled trial using ACT. Behaviour Research and Therapy, 91, 64–71.

20.

Goldberg

D. P.

Williams

(1988). A user’s guide to the General Health Questionnaire. Nfer-Nelson.

21.

Hayes

S. C.

Barlow

D. H.

Nelson-Gray

R. O.

(1999). The scientist practitioner: Research and accountability in the age of managed care (2nd ed.). Allyn and Bacon.

22.

Hayes

S. C.

Hofmann

S. G.

(Eds.). (2018). Process-based CBT: The science and core clinical competencies of cognitive behavioral therapy. New Harbinger.

23.

Hayes

S. C.

Levin

M. E.

Plumb-Vilardaga

Villatte

J. L.

Pistorello

(2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44(2), 180–198. https://doi.org/10.1016/j.beth.2009.08.002

24.

Hayes

S. C.

Long

D. M.

Levin

M. E.

Follette

W. C.

(2013). Treatment development: Can we find a better way? Clinical Psychology Review, 33(7), 870–882.

25.

Hayes

S. C.

Strosahl

K. D.

Wilson

K. G.

(1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.

26.

Hayes

S. C.

Strosahl

K. D.

Wilson

K. G.

(2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

27.

Hayes

S. C.

Wilson

K. G.

Gifford

E. V.

Follette

V. M.

Strosahl

(1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168.

28.

Herzberg

K. N.

Sheppard

S. C.

Forsyth

J. P.

Crede

Earlywine

Eifert

G. H.

(2012). The Believability of Anxious Feelings and Thoughts Questionnaire (BAFT): A psychometric evaluation of cognitive fusion in a nonclinical and highly anxious community sample. Psychological Assessment, 24(4), 877–891.

29.

Hill

M. L.

Masuda

Makeda

Twohig

M. P.

(2014). Acceptance and commitment therapy for individuals with problematic emotional eating A case-series study. Clinical Case Studies, 14(2), 141–154. https://doi.org/10.1177/1534650114547429

30.

Kashdan

T. B.

Barrios

Forsyth

J. P.

Steger

M. F.

(2006). Experiential avoidance as a generalized psychological vulnerability: Comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44(9), 1301–1320.

31.

Knowlton

C. N.

Kryvanos

Poole

Christopher

Lafavor

(2019). Acceptance and commitment therapy for the treatment of chronic pain and coexisting depression: A single-case study. Clinical Case Studies, 18(4), 254–269. https://doi.org/10.1177/1534650119839156

32.

Levin

M. E.

Hildebrandt

M. J.

Lillis

Hayes

S. C.

(2012). The impact of treatment components suggested by the psychological flexibility model: A meta-analysis of laboratory-based component studies. Behavior Therapy, 43(4), 741–756.

33.

Mennin

D. S.

Ellard

K. K.

Fresco

D. M.

Gross

J. J.

(2013). United we stand: Emphasizing commonalities across cognitive-behavioral therapies. Behavior Therapy, 44(2), 234–248.

34.

Nathan

P. E.

Gorman

J. M.

(Eds.) (2015). A guide to treatments that work (4th ed.). Oxford University Press.

35.

Skevington

S. M.

Lotfy

O’Connell

K. A.

, & the WHOQOL Group. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of Life Research, 13, 299–310.

36.

Trompetter

H. R.

ten Klooster

P. M.

Schreurs

K. M. G.

Fledderus

Westerhof

Bohlmeijer

E. T.

(2013). Measuring values and committed action with the Engaged Living Scale (ELS): Psychometric evaluation in a nonclinical sample and a chronic pain sample. Psychological Assessment, 25, 1235–1246.

37.

Wegner

D. M.

Zanakos

(1994). Chronic thought suppression. Journal of Personality, 62, 615–640.