This part of the site maintains a summary of publications (journal articles, chapters, theses, dissertations, books) but for an more complete indexed list also click on the publications link in the Features menu on the left side of the screen, or the books & tapes there. The file at the bottom of the page (the ACT handout) lists most ACT publications as of March 2008.
The subsections divide the empirical ACT literature into several categories. If you have a study that should be added you can upload the actual publication into the publications section (click on the word "publications" at the top of any page of the site and then go to "create content" on the left and say it is a publication you want to add). You can't add the reference to the publication here directly ... you have to email that information to the site editor and we will add it ... but if the publication itself is already uploaded we can link the reference here to that file so that people can find it and download it.
Case Studies by Year (Controlled Time Series Studies are covered in the RCT page)
2008
2007
2006
2005
Case study. Shows improvement with a dually diagnosed patient.
A case study that examines a combination of ACT and FAP in the successful treatment of a case of Schizotypal Personality Disorder.
Discussion article and case study showing how to apply ACT to the treatment of PTSD.
2004
Case study. An ACT protocol with an emphasis on mindfulness helps with sports outcomes.
2003
This case study describes a heavily values focused ACT treatment of a case of alcohol dependence within an Acceptance and Commitment Therapy model. Identifying valued directions seemed to help the client achieve sobriety and put a plan into action to "start living."
A successful application of ACT to a 30-year-old male with difficulties in accepting his bisexual orientation and with an erectile dysfunction is presented.
Case study with a retarded psychotic person experiencing command hallucinations and multiple delusions. Believability drops dramatically over treatment but not frequency. Good functional improvement.
2002
Describes the use of ACT in anorexia and shows resulting data. Case study. The case study is followed by discussion articles:
- Wilson, K. G. & Roberts, M. (2002). Core principles in Acceptance and Commitment Therapy: An application to anorexia. Cognitive and Behavioral Practice, 9, 237-243.
- Hayes, S. C. & Pankey, J. (2002). Experiential avoidance, cognitive fusion, and an ACT approach to anorexia nervosa. Cognitive and Behavioral Practice, 9, 243-247.
- Orsillo, S. M. & Batten, S. J. (2002). ACT as treatment of a disorder of excessive control: Anorexia. Cognitive and Behavioral Practice, 9, 253-259.
- There is also a cognitive paper that is nominally a response to the case, but it mentions ACT only in passing, focusing instead on the traditional CBT model.
Presents data on ACT with a patient who failed a course of cognitive therapy.
2001
Describes the use of ACT in the treatment of psychotic disorders and shows resulting data. Case study.
Describes the use of ACT in the treatment of complicated bereavement and shows resulting data. Case study.
Describes the use of ACT in the treatment of alcoholism and shows resulting data. Case study.
Describes the use of ACT in the treatment of anxiety problems and shows resulting data. Case study.
Describes the use of ACT in the treatment of chronic pain and shows resulting data. Case study.
Describes the use of ACT in the treatment of agoraphobia and shows resulting data. Case study.
2000
1999 and Earlier (First ACT Book Appears in 1999)
Uncontrolled. Presents case data on the use of ACT components with families.
Shows a series of uncontrolled case evaluations on ACT with anxiety problems.
Correlational studies on ACT-Related Processes by Year
See also the experimental psychopathology page
In Press
2008
2007
In a sample of 187 elderly those higher in psychological acceptance had higher quality of life in the areas of health, safety, community participation and emotional well-being; and had less adverse psychological reactions to decreasing productivity.
This correlational study examined the hypothesis that experiential avoidance mediates associations between excessively materialistic values and diminished emotional well-being, meaning in life, self-determination, and gratitude. Results indicated that people with high materialistic values reported more negative emotions and less relatedness, autonomy, competence, gratitude, positive emotions, and sense of meaning – all of these relations were mediated by experiential avoidance mediated all of these relations. Emotional disturbances such as social anxiety and depressive symptoms failed to account for these findings after accounting for shared variance with experiential avoidance.
Correlational study with 730+ folks suffering from trichotillomania. Experiential avoidance as measured by the AAQ fully mediated the rela¬tionship between hair-pulling and both fears of negative evaluation and feelings of shame and partially mediated the relationship between hair-pulling severity and dysfunctional beliefs about appearance.
2006
Found that the impact of skin picking on depression and anxiety was partially mediated by the AAQ in a non-referred sample of chronic skin pickers.
two studies, one correlational and one longitudinal, show that experiential avoidance as measured by the AAQ fully or partially mediated the relationships between coping and emotion regulation strategies on anxiety-related pathology, (Sutdy 1) and psychological distress and hedonic functioning over the course of a 21-day monitoring period (Study 2). The variables examined included maladaptive coping, emotional responses styles, and uncontrollability on anxiety-related distress (e.g., anxiety sensitivity, trait anxiety, suffocation fears, and body sensation fears), and suppression and cognitive reappraisal on daily negative and positive experiences. The data showed that cognitive reappraisal, a primary process of traditional cognitive-behavior therapy, was much less predictive of the quality of psychological experiences and events in everyday life compared with EA.
In a 21-day experience sampling study, dispositional social anxiety, emotional suppression, and cognitive reappraisal was compared daily measures of social anxiety. Socially anxious individuals reported the lowest rate of positive events on days when they were more socially anxious and tended to suppress emotions, and the highest rate of positive events on days when they were less socially anxious and more accepting of emotional experiences. Irrespective of dispositional social anxiety, participants reported the most intense positive emotions on days when they were less socially anxious and more accepting of emotional experiences.
2005
Experiential avoidance as measured by the AAQ correlated positively with post-discharge parental stress and traumatic stress symptoms surrounding preterm birth. Moreover, it partially mediated the association between stress during delivery and later traumatic stress symptoms. This process was not moderated by parent reports of child temperament or perceived social support, suggesting that experiential avoidance plays a mediating role irrespective of child characteristics or perceived support from family members and close friends.
185 trauma survivors were assessed for peritraumatic dissociation, experiential avoidance (using the AAQ), and PTSD symptom severity. Both peritraumatic dissociation and experiential avoidance were significantly related to PTSD symptoms at baseline. After the initial levels of PTSD was taken into account, only experiential avoidance was related to PTSD symptoms both 4- and 8-weeks later.
Correlational study. Shows that the AAQ is associated with GAD symptoms in both clinical and non-clinical populations.
2004
In a large sample of adults suffering from trichotillomania, experiential avoidance as measured by the 9 item AAQ correlated with more frequent and intense urges to pull, less ability to control urges, and more pulling-related distress than persons who were not experientially avoidant. Actual pulling did not differ.
Study compared experiential avoidance (as measures by the AAQ) and emotional intelligence in terms of their ability to predict general mental health, physical well-being, and job satisfaction in workers (controlling for the effects of job control since this work organisation variable is consistently associated with occupational health and performance). Results from 290 United Kingdom workers showed that emotional intelligence did not significantly predict any of the well-being outcomes, after accounting for acceptance and job control. Acceptance predicted general mental health and physical well-being but not job satisfaction, Job control was associated with job satisfaction, only. Not controlling one’s thoughts and feelings (as advocated by acceptance) may have greater benefits for mental well-being than attempting consciously to regulate them (as emotional intelligence suggests).
Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553-578. The AAQ validation study. Over 2000 subjects. Validates both a 9 and 16 item version, both single factor.
See McCracken 1998
Correlational study. Showed that experiential avoidance was correlated with post-traumatic symptomatology over and above other measures of psychological functioning.
Correlational study. Among a sample of individuals exposed to multiple potentially traumatic events, general experiential avoidance (but not thought suppression in particular), predicted symptoms of depression, anxiety, and somatization when controlling for posttraumatic stress symptom severity. Thought suppression (but not experiential avoidance) was associated with severity of posttraumatic stress symptoms when controlling for their shared relationship with general psychiatric symptom severity.
2003
Shows that AAQ predicts positive work outcomes (mental health, satisfaction, performance) even one year later, especially in combination with job control. Re-factors the AAQ and shows that a two factor solution can work on a slightly different 16 item version.
2002
Correlational study showing that childhood sexual abuse (CSA), experiential avoidance and emotional expressivity were significantly related to psychological distress. However, only experiential avoidance mediated the relationship between CSA and current distress.
2001
This is a correlational study (N = 283) showing that generalized experiential avoidance accounted for 67% of the variance in distress in a sexually abused population.
1999 and earlier
This study is based on a pain related early version of the AAQ. Greater acceptance of pain was associated with reports of lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily uptime, and better work status. A relatively low correlation between acceptance and pain intensity showed that acceptance is not simply a function of having a low level of pain. Regression analyses showed that acceptance of pain predicted better adjustment on all other measures of patient function, independent of perceived pain intensity. This work is replicated, refined and extended in McCracken, L. M. & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain. Pain, 105, 197-204. and McCracken, L. M. , Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159-166.
101 heterogeneous outpatients reporting moderate to severe levels of anxiety or depression were randomly assigned either to traditional CT or to ACT. 23 junior therapists were used. Participants receiving CT and ACT evidenced large and equivalent improvements in depression, anxiety, functioning difficulties, quality of life, life satisfaction and clinician-rated functioning. “Observing” and “describing” one’s experiences mediated outcomes for those in the CT group relative to those in the ACT group, whereas “experiential avoidance,” “acting with awareness” and “acceptance” mediated outcomes for those in the ACT group.
Randomized controlled study in which 14 student therapists treat one client each from an ACT model or a traditional CBT model for 6-8 sessions following a 2 session functional analysis. Participants with any normal outpatient problem were included. At post and at the 6 month follow up ACT clients are more improved on the SCL-90 and several other measures. Greater acceptance for ACT patients; great self-confidence for CBT patients. Both correlated with outcomes, but when partial correlations are calculated, only acceptance still relates to outcome.
108 chronic pain patients with a long history of treatment are followed through an ACT-based 3-4 week residential treatment program. Measures improved from initial assessment to pre-treatment on average only 3% (average of 3.9 month wait), but improved on average 34% following treatment. 81% of these gains were retained through a 3 month follow up. Changes in acceptance predicted positive changes in depression, pain related anxiety, physical disability, psychosocial disability, and the ability to stand. Positive outcomes were also seen in a timed walk, decreased medical visits, daily rest due to pain, pain intensity, and decreased pain medication use.
Controlled effectiveness trial. Not randomized. Shows that training in ACT produces generally more effective clinicians, as measured by client outcomes.
Experimental Psychopathology and Component Studies by Year
Below is a list of experimental psychopathology and analogue studies testing components of ACT. Intervention scripts for several of the studies are available here.
In Press
2008
2007
Two experiments. In Experiment 1, participants high (n = 15) or low in avoidance (n = 14), as measured by the Acceptance and Action Questionnaire, completed a simple matching task that required them to choose whether or not to look at an aversive visual image. Only the high-avoidance participants took longer to emit a correct response that produced an aversive rather than a neutral picture. Additionally, the high-avoiders reported greater levels of anxiety following the experiment even though they rated the aversive images as less unpleasant and less emotionally arousing than their low-avoidant counterparts. In Experiment 2, three groups, representing high- mid- and low-avoidance (n = 6 in each) repeated the matching task with the additional recording of event related potentials (ERPs). The findings replicated Experiment 1 but also showed that high-EA subjects had significantly greater negativity for electrodes over the left hemisphere relative to the midline suggesting that the high-EA group engaged in verbal strategies to regulate their emotional responses.
98 participants with chocolate cravings were exposed to a CBT-based protocol and an ACT-based protocol or no instructions and required to carry chocolate with them of for two days. Those more impacted by food related cues ate less and had fewer cravings in the ACT condition.
examined the impact of acceptance and defusion with a radiant heat induction.
A large and well-controlled randomized study that replicated Hayes, Bissett, Korn, Zettle, Rosenfarb, Cooper, & Grundt, 1999. Acceptance methods drawn from the 1999 ACT book and from the Hayes et al. 1999 pain study (the methods used included an acceptance rationale, practicing awareness of experience, the “Passengers on the Bus” exercise, and the ‘Two Scales Metaphor’) increased pain tolerance and decreased pain ratings in a cold pressor task as compared both to suppression methods (based on thought stopping) and to participants preferred method of coping (which tended to include distraction, relaxation, and keeping the hand still). The latter two conditions did not differ from each other in the main analysis.
2006
Similar to the study above, brief acceptance methods led to lower heart rate during exposure to an aversive film and less negative affect during the post-film recovery period that did control strategies in individuals with anxiety and mood disorders.
This study compared the responses of participants from a clinical and non-clinical sample to an emotion provoking film. The study found that participants from the clinical group spontaneously used suppression to a greater degree than non-clinical participants and that attempts at suppression were associated with greater distress.
2005
Simple acceptance-based coping instructions improved affective pain more than distraction but only for women.
Two studies. Correlational study shows suppressing personally relevant intrusive thoughts is associated with more thoughts, more distress, greater urge to do something. Those who accept are less obsessional, depressed and anxious. Experimental study shows that instructions to suppress does not work and leads to increased level of distress; instructions of accept (using a couple of short metaphors drawn from the ACT book) decreases discomfort but not thought frequency.
Correlational. High versus low EA participants show differences in pain tolerance and in pain coping.
2004
Shows in a series of time-series designs and a group study, that the “milk, milk, milk” defusion technique reduces distress and believability of negative self-referential thoughts
Randomized study with analogue pain task showing greater tolerance for pain in the defusion and acceptance-based condition drawn from ACT as compared to a closely parallel cognitive-control based condition.
Normal participants high or low on the AAQ were exposed to a CO2 challenge. High emotional avoiders reported more panic symptoms than low avoiders. No difference physiologically.
Acceptance methods (drawn directly from the ACT book) did a better job than control strategies in promoting successful exposure in panic disordered patients
Examined the relationship between emotional reactivity (self-report and physiological reactivity) to pleasant, unpleasant, and neutral emotion-eliciting stimuli and experiential avoidance as measured by the AAQ. Sixty-two participants were separated into high and low experiential avoiders. Results indicated that high EA participants reported greater emotional experience to both unpleasant and pleasant stimuli compared to low EA participants. In contrast to their heightened reports of emotion, high EA participants displayed attenuated heart rate reactivity to the unpleasant stimuli relative to the low EA participants. Findings were interpreted as reflecting an emotion regulation attempt by high EA participants when confronted with unpleasant emotion-evocative stimuli.
2003
Randomized study comparing control versus acceptance during a CO2 challenge with anxious subjects. Acceptance oriented exercise (the finger trap) reduced avoidance, anxiety symptoms, and anxious cognitions as compared to breathing training.
High emotional avoidance subjects showed more anxiety in response to CO2, particularly when instructed to suppress their emotions.
2002
Small randomized trial that replicated Hayes, Bissett, Korn, Zettle, Rosenfarb, Cooper, & Grundt, 1999. An acceptance rationale plus two ACT defusion exercises (leaves on the stream and physicalizing) did significantly better than a match control focused intervention on pain tolerance, or a lecture on pain.
1999 or Before
Analog study. Shows that an acceptance rationale drawn from the ACT protocol produces more pain tolerance than a pain control rationale drawn from a CBT pain management package.
Randomized Controlled Trials, Controlled Time Series Designs, and Within Group Designs by Year
Under Review
In Press
Included people (adults) with longstanding pain due to whiplash (WAD). A 10-session protocol was compared with a wait list control group, and found significant improvements following treatment in functioning and life satisfaction, as well as in psychological flexibility (as measured with PIPS).
2008
2007
RCT showing that ACT + patient education is significantly better than patient education alone in producing good self-management and better blood glucose levels in lower SES patients with Type II diabetes. Effects at follow up are mediated by changes in self-management and greater psychological flexibility with regard to diabetes related thoughts and feelings.
Undergraduates enrolled in two separate classes on racial differences were exposed Acceptance and Commitment Therapy and an educational lecture drawn from a textbook on the psychology of racial differences in a counterbalanced order. Results indicate that only the ACT intervention was effective in increasing positive behavioral intentions at post and a 1-week follow-up. These changes were associated with other self-reported changes that fit with the ACT model.
Augmenting continuing education with psychologically-focused group consultation: Effects on adoption of Group Drug Counseling. Psychotherapy Theory, Research, Practice, Training. An ACT-based supervision group following training in Group Drug Counseling increased adoption in drug and alcohol counselors.
An RCT comparing ACT and education in 95 college students. ACT reduced mental health stigma significantly regardless of participants’ pre-treatment levels of psychological flexibility, but education reduced stigma only among participants who were relatively flexible and non-avoidant to begin with.
A multiple baseline showing ACT reducing the use of marijuana in 3 clients. 2 relapsed to a degree at follow up.
Open trial with 14 adolescents. Good outcomes that continue to improve through follow up.
2006
Pre – post study shows that ACT workshop helps parents cope with the stress of raising autistic children.
This study replicates the Bach and Hayes study with better measures and a better control condition. Good results esp. on measures of overt psychotic behavior (the BPRS). Mediational analyses fit the ACT model and are described in more detail in Gaudiano, B. A., & Herbert, J. D. (2006). Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: Pilot results. Behaviour Research & Therapy, 44(3), 415-437.
Randomized trial comparing and ACT / DBT combo to TAU. Very strong outcomes on self-harm and other measures. Follow-up is not in this manuscript -- will follow in another publication. The buzz is that outcomes continue to improve; along with acceptance scores.
RCT with 27 drug resistant epileptics comparing 9 hours of ACT – individual and group -- to supportive therapy. Reduction of seizures to near zero level; maintenance for a year. Quality of life improves continuously through the follow up. Mediational analyses fit the ACT model and are described in more detail in Lundgren, T., Dahl, J., & Hayes, S. C. (2008). Evaluation of mediators of change in the treatment of epilepsy with Acceptance and Commitment Therapy. Journal of Behavior Medicine.
6 acceptance and mindfulness group sessions during 35 days including individual homework assignments. 8 of 10 participants completed the program. At 1 mo follow up 50 percent (of 8 completers) were non-smokers, and the rest showed a decrease in smoking at a rate between 45 and 75 percent. Increase of the acceptance aspect of mindfulness was correlated with non-smoking.
Multiple baseline showing very large reductions in OCD with an 8 session ACT protocol without in session exposure.
Multiple baseline. Good effects at post but less so at follow up.
A small randomized trial (25 completers) comparing ACT plus habit reversal to a wait list. Wait list subjects then receive ACT/HR. Solid hair pulling, anxiety, and depression outcomes, maintained at a 3 month follow up. Wait list participants also improve once they get ACT. AAQ moves and correlates well with outcomes.
2005
108 chronic pain patients with a long history of treatment are followed through an ACT-based 3-4 week residential treatment program. Measures improved from initial assessment to pre-treatment on average only 3% (average of 3.9 month wait), but improved on average 34% following treatment. 81% of these gains were retained through a 3 month follow up. Changes in acceptance predicted positive changes in depression, pain related anxiety, physical disability, psychosocial disability, and the ability to stand. Positive outcomes were also seen in a timed walk, decreased medical visits, daily rest due to pain, pain intensity, and decreased pain medication use.
2004
Large randomized trial showing that ACT is more helpful than traditional CBT in dealing with end stage cancer and works through a different process. Amazing data.
A small randomized controlled trial shows that a four hour ACT intervention reduced sick day usage by 91% over the next six months compared to treatment as usual in a group of chronic pain patients at risk for going on to permanent disability.
RCT showing that ACT significantly reduces depression among workers on sick leave.
Medium sized randomized controlled trial comparing ACT to nicotine replacement therapy (NRT) as a method of smoking cessation. Quit rates were similar at post but at a one-year follow-up the two groups differed significantly. The ACT group had maintained their gains (35% quit rates) while the NRT quit rates had fallen (less than 10%). Mediational analyses shows that ACT works through acceptance and response flexibility.
A medium sized randomized controlled trial that found that a one day ACT workshop produces greater decreases in stigmatization of clients by therapists and greater decreases in therapist burnout than an educational control and (or some comparisons) than multicultural training. Mediational analyses fit the model.
A large randomized controlled trial was conducted with polysubstance abusing opiate addicted individuals maintained on methadone. Participants (n=114) were randomly assigned to stay on methadone maintenance (n=38), or to add ACT (n=42), or Intensive Twelve Step Facilitation (ITSF; n=44) components. There were no differences immediately post-treatment. At the six-month follow-up participants in the ACT condition demonstrated a greater decrease in objectively measured (through monitored urinalysis) opiate use than those in the methadone maintenance condition (ITSF did not have this effect). Both the ACT and ITSF groups had lower levels of objectively measured total drug use than did methadone maintenance alone.
Two small RCTs (N = 18; and N = 28) comparing a three session ACT protocol (two individual; one group) to two other conditions. As compared to yoga, significantly reduced seizures in the ACT condition; as compared to attention control, significantly reduced seizures and experiential avoidance, and significantly increased quality of life in the ACT condition at a one year follow up.
A series of controlled single case designs show that ACT, and ACT combined with habit reversal helps with hair pulling.
2003
Small randomized controlled trial shows that ACT is about as good as systematic desensitization in reducing math anxiety, but works according to a different process. Systematic desensitization reduced trait anxiety more. ACT results were better for high emotional avoiders. This is the only study so far with a negative effect size for ACT -- in this case in comparison to systematic desensitization.
2002
Shows that a three-hour ACT intervention reduces rehospitalization by 50% over a 4 month follow-up as compared to treatment as usual in the seriously mentally ill.
2000
Small RCT on the treatment of social anxiety. Compared ACT to Cognitive Behavioral Group Therapy and to a no treatment control. Results indicated that ACT participants evidenced a significant increase in reported willingness to experience anxiety, a significant decrease in behavioral avoidance during public speaking, and a marginally decrease in anxiety during the exposure exercises as compared with the control group. Similar results were found for CBGT, but ACT found greater changes in behavioral avoidance.
Randomized controlled trial. Shows that ACT is more effective than a previously empirically supported behavioral approach to reducing worksite stress and anxiety, and that both are better than a wait list control.
Components from ACT were included as component of a successful program to reduce high risk sexual behavior in adolescents.
1999 and earlier(First ACT Book Appears in 1999)
Small controlled trial. Shows that ACT is as effective as cognitive therapy for depression when presented in a group format, and that it works by a different process. The effect sizes in favor of ACT are about .6
RCT on the distress felt by families of disabled children. Good outcomes. ACT included as a treatment for depression.
Small controlled trial focusing on process differences between ACT and CT. Only the Hamilton outcome is mentioned in this manuscript. Shows that ACT is more effective that cognitive therapy for depression when presented in an individual format, and that it works by a different process
Empirical Reviews of ACT Data
2006
Meta-analysis of ACT process evidence and ACT outcomes, current through Summer 2005.
2004
Tutorial review of the ACT literature current through late 2003.
Projects underway or recently completed that we know about
A large RCT on smoking using Zyban or Zyban plus ACT plus FAP is just finishing the follow up phase. Funded by NIDA. Better outcomes for Zyban plus ACT plus FAP. Liz Gifford and Steve Hayes are the investigators.
Liz Roemer, Sue Orsillo, and Dave Barlow are testing an ACT-related package with GAD. Funded by NIMH
Frank Bond has completed and is writing up two replications and extensions of the Bond and Bunce 2000 study
Fredrick Livheim (livheim@hotmail.com) has conducted a randomized prevention trial with ACT in a school setting. Sigificantly better stress outcomes including at a 6 month follow up
Heather Nash who was at University of Alaska, has relocated to Las Vegas. She has a study of ACT with eating disorders using a multiple baseline
John Forsyth and Maria Karekla (University of Albany) ran a small RCT comparing an Acceptance Framed version of Panic Control Therapy vs. a "treatment as usual" version of Panic Control Therapy for persons suffering from panic disorder. The results are being written up. Persons in the ACT Framed condition were far less likely to drop out of treatment just prior to interoceptive exposure compared with the TAU condition.
John Forsyth and Sean Sheppard (University at Albany) are about to launch a large RCT comparing the effectiveness of The Mindfulness & Acceptance Workbook for Anxiety in a National and International sample of people who view their anxiety and fear as a significant problem for them. The study website is not up yet, but the URL will be www.ACTforAnxiety.com. Stay tuned.
John Forsyth, Ed Hickling, Dan Silverman have finished the first arm of an effectiveness study evaluating a half day ACT workshop for people suffering from Multiple Sclerosis (MS). The study includes pre-workshop assessment and a 3 month follow-up, plus a treatment seeking MS control group that did not get the workshop. The second wave of data collection will be happening in Fall 08. Preliminary data (just workshop participants) show that the workshop significantly reduced depression (from moderate-to-severe range to mild range), thought suppression, and pain interference on quality of life. The sample is small at the moment. So, take these findings as preliminary.
Similar ACT-based anxiety protocols are being tested by Jill Levitt, and by Eifert, Forsyth, & Craske
Branstetter, A., Wilson, K. G., & Mutch, D. G. (August 2003). ACT and the treatment of psychological distress among cancer patients. Paper given at the World Conference on ACT, RFT, and the New Behavioral Psychology, Linköping, Sweden. Large randomized trial showing that ACT is more helpful than traditional CBT in dealing with end stage cancer and works through a different process. Amazing data. (Write it up Ann!)
There is a large trial of ACT for methamphetamine abuse underway under the direction of Matthew Stout in Australia
Randomized trial underway on ACT for command hallucinations in Australia. Under the direction of Fran Shawyer at the Mental Health Research Institute of Victoria. email: fshawyer@mhri.edu.au
Aki Masuda has replicated and extended his “milk, milk, milk” study showing that 3 seconds of repetition does as well as 20 s in reducing distress, compared to the rationale alone; but the 20 s version does best in reducing believability.
Julieann Pankey has found that the AAQ is highly correlated with complicated grieving.
Dosheen Cook has found that the AAQ-heath relationship is the same in Asian as in Caucasian populations
Meyer, B., & Chow, L. (2003, June). Preference for experiential/mindfulness versus rational/cognitive Therapy: The role of information processing styles and sociopolitical attitudes. Poster presented at the annual convention of the Society for Psychotherapy Research. Weimar, Germany. Found that ACT was preferred by liberals … conservative preferred CBT. You can get this manuscript from b.meyer@roehampton.ac.uk
Greco, Dew, & Blomquist have a small uncontrolled pilot-feasibility study currently underway examining the impact of ACT for adolescents with chronic abdominal pain, anxiety, and depression (current enrollment = 10 teens/parents).
Greco has examined willingness and experiential avoidance among children who experience chronic abdominal pain and persistent headaches. Unpublished as of yet. After controlling for gender, age, and pain frequency, duration, and severity, higher levels of acceptance predicted life quality (Beta = .38), and experiential avoidance/fusion predicted greater use of school medical services and school restrooms during class time (Betas = .24 and .23, respectively), lower quality of life (Beta = -.49), higher anxiety (Beta = .64), and lower teacher-rated academic competence (Beta = -.29).
Greco, Dew, & Baer have a manuscript underway that presents psychometric properties of the Willingness and Action Measure (WAM), Avoidance and Fusion Questionnaire (AFQ), and Child Acceptance and Mindfulness Measure (CAMM). Findings suggest that the WAM and CAMM correlate positively with positive functioning, whereas scores on the AFQ correlate positively with physical and emotional symptoms and school disability.
Greco & Russell (2004) evaluated the short-term effects of participating in a summer camp for diabetic youth and investigated the extent to which psychological acceptance moderated children’s response to camp. Psychological acceptance (using the WAM) moderated the relation between pre- and post-camp diabetes self-care behavior, with self-care ratings increasing most when psychological acceptance was high (Beta = .24, p < .05).
Laurie Greco is testing out ACT with eating disorders
Heather Murray, James Herbert, and Evan Forman have a group ACT vs group CBT RCT for Smoking Cessation underway
Laura Ely and Kelly Wilson have a small (n = 10) open trial with college students at risk for drop out. Showed improvements on grades and on many of the subscales of the LASSI (study skills inventory) such as time management and using study aids which were never directly addressed
Debra Moore and Kelly Wilson have a small (n = 20) RCT on teens at risk for highschool drop out. Data being entered
Irish ACT studies (all at NUI Maynooth and all involving the Barnes-Holmes team):
Claire Keogh is working on an extension of the Masuda
study on defusion. So far the data are consistent with the original.
Claire Keogh, Hilary-Anne Healy have completed a study on the utility of a defusion statement ("I am having the thought that" when presented in the context of positively and negatively evaluated self-referential statements in an automated procedure. Good data
Anne Keogh is comparing acceptance and control as interventions with experimentally induced radiant heat pain. Data is looking good for acceptance. May be a gender diff
Andy Cochrane, is looking at acceptance and a behavioral approach task relevant to spider phobia. All interventions fully automated. No data yet.
Geraldine Scanlon is working with a sample of ADHD kids on self-esteem, trying to replicate the recent study of me-good and me-bad relations published in the Record by Rhonda and Kelly.
Claire Campbell is investigating the PASAT and mirror tracing procedures for stress tolerance and applying ACT interventions to them.
Fodhla Coogan and Loretto Cunningham are looking at experimental analogues of experiential avoidance in the context of equivalence relations and aversive versus positive pictures.
Kevin Vowles and John Sorrell have been piloting a group treatment for chronic pain patients integrating the traditional educational stuff that is often part of psychological treatments for pain (e.g., meds, exercise, nutrition, sleep, communication) with ACT. The treatment consists of eight 90-minute sessions. Data so far look good
Frank Gardner at La Salle has a study being written up that shows that
1. Individuals who score high on measures of anger (STAXI) also score high on experiential avoidance and low on emotion regulation.
2. Individuals who score high on anger AND demonstrate behavioral dysregulation are likely to have a significant aversiove early life history (across multiple domains) unlike those patients with behavior dysregulation with minimal anger. These same patients score much lower on QOLI and a values assessment that we have bveen using as well.-
3. The AAQ predicts early termination from treatment (explaining 51% of the variance)... when directly targeted with a a 10 minute "psychoeducation" about experiential avoidance premature termination (69% of which occurs between intake and session 1) is reduced by 50%.
Jason Luoma at University of Nevada, Reno is conducting a randomized trial comparison an introductory 2-day workshop on ACT to the same workshop plus six sessions of phone consultation on learning ACT.
Brandon Gaudiano is conducting a pilot study of a novel psychosocial treatment integrating behavioral activation and ACT for patients with Major Depressive Disorder, severe with psychotic features.
Jen Plumb and Steven Hayes examined the relationship between personal values and depression using the PVQ (Blackledge & Ciarrochi). Found that depressed individuals were more likely to report low success at living consistently with values across domains than non-depressed individuals, and the discrepancy between values success and importance was related more strongly to psychological functioning in depressed individuals than non-depressed individuals. When depressed individuals were low on success at living consistently with their values they were more likely to endorse pliant and avoidance based reasons for choosing those values than non-depressed controls.
Jen Plumb, Mike Levin and Steven Hayes are examining the potentially motivative effects of values statements on studying behavior in college students. Two studies are underway (data collection phase). One examines self-monitoring of study behavior versus a simple values intervention in addition to self-monitoring. The other examines the differential effects of aversive values motivation (e.g., pliant, avoidant functions) as opposed to appetitive values motivation (e.g., choice, awareness of the reinforcement from living consistent with values) on studying behavior.
Ernst Bohlmeijer is in the process of pilot testing an intervention integrating ACT and mindfulness for clients experiencing various forms of psychological distress.
JoAnne Dahl and students have RCTs underway in smoking, OCD, and obesity.
Jason Lillis (Nevada) has an RCT just finish in obesity and weight maintenance with nice outcomes. ACT lead significantly lower weight and blood pressure outcomes, lower self-stigma, and higher quality of life. Changes were mediated by ACT processes.
JoAnne Dahl has an RCT underway with headache and one with social phobia
Mónica Hernández-López Jesús Gil Roales-Nieto & Carmen Luciano Soriano have a completed smoking RCT comparing ACT to CBT with good outcomes
Julie Wetherell at UCSD and the VA there (working with Niloo Afari, who recently joined their faculty) have a VA grant to compare ACT to CBT in 100 chronic pain patients.
Gerhard Andersson has found that tinnitus acceptance and action mediates the relationship between distress over tinnitus and depression, quality of life, and further distress over tinnitus seven months later. Being written up.
Nancy Kocovski, Jan Fleming, & Neil Rector (U of Toronto) have an ACT protocol (they call it Mindfulness and Acceptance-Based Group Therapy) for social anxiety that is working well and is headed toward a randomized controlled trial
Tobias Lundgren just finished an ACT RCT for adolescents diagnosed with Aspergers syndrome. The study involved a 12 week treatment program with a 2 months follow up. Significant interaction effects were found on depression, anxiety and stress scales in favor of the treatment group. Furthermore, significant interaction effects were found on attention ability and teacher ratings on troublesome behavior as compared to a waiting list.
Studies underway at the School of Psychology, University of Wollongong
1) Billich, Ciarrochi, & Deane have completed a wait-list control trial of ACT with the NSW police. The research suggests that ACT improves mental health, at least in the short run. We are writing this up for publication (This is funded by the Australian Research Council)
2) Fisher and Ciarrochi are conducting a cross-sectional study on personal values and quality of life amongst clients with Cancer. We are examining whether people have better adjustment and mental health when they tend to hold values for authentic reasons (e.g., vitality) rather than controlled reasons (e.g., external pressure), and when they tend to succeed at authentically held values.
3) Ciarrochi and Bailey (in press) have developed a new measure that is designed to aid values clarification. The measure is called the Survey of Life Principles (SLP), and is currently being evaluated in a number of studies. Stefanic and Ciarrochi are examining the psychometric properties of the SLP. Frearson & Ciarrochi are evaluating it in the context of couples satisfaction. Bayliss and Ciarrochi are evaluating it in the context of the police force.
4) Bayliss and Ciarrochi have done a small longitudinal study amongst NSW police recruits, following them from police recruit (Time 1) to one year in the police force (Time 2). Mindfulness, low experiential avoidance, and emotion identification skill were significant predictors of mental health at Time 2, even after controlling for mental health at Time 1. We are in the process of writing this up. (This is funded by the Australian Research Council)
5) We are now in the seventh year of a large longitudinal study of adolescents (now aged 17). Supavadeeprasit and Ciarrochi are preparing a manuscript that looks at experiential avoidance (in grade 8) predicting future social and emotional well-being. Jordan & Ciarrochi have also been looking at the measurement of mindfulness amongst adolescents and its ability to predict future levels of social and emotional well-being (The longitudinal study is been funded by the Australian Research Council and the National Health and Medical Research Council).
6) Ciarrochi, Lane, & Blackledge have developed an internet-based ACT intervention for people diagnosed with cancer. We are in the process of evaluating its efficacy. (This has been funded by the NSW Cancer Council).
Additional information about research being conducted in Australia and New Zealand can be found here.
The non-empirical literature on ACT / RFT (we are listing primarily ACT work here) is large. In order to make this list easy to update it is listed by year, but do note that this puts some of the important articles in the middle.
In Press
2007
2006
2005