This dismantling trial compared the effects of a full online Acceptance and Commitment Therapy (ACT) intervention to the isolated effects of the Open (i.e., acceptance, cognitive defusion) and Engaged (i.e., values, committed action) components of ACT. A sample of 181 distressed college students were randomized to one of four conditions: a 12-session full ACT website (Full), a version targeting the Open components (Open), a version targeting the Engaged components (Engaged), or waitlist. Participants in active conditions were also randomized to receive phone coaching or just email prompts to increase program adherence. All three ACT conditions significantly improved over time relative to the waitlist condition on the primary outcome of mental health symptoms. The Engaged and Full conditions had greater rates of reliable change on the primary outcome relative to waitlist, but not the Open condition. Similarly, only Engaged and Full conditions improved on positive mental health relative to waitlist. The Full condition had greater improvements on a few ACT process measures relative to Engaged and Open conditions, particularly cognitive fusion. Overall, results indicate targeting only the Open components of ACT was somewhat less effective, and that including both the Open and Engaged components led to greater decreases in cognitive fusion.
Objectives: College counseling centers face significant challenges meeting the mental health needs of their students and waitlists are common. Mobile apps offer a promising solution to increase access to resources while students wait for services. Methods: This pilot randomized controlled trial evaluated the feasibility and acceptability of a publicly available mindfulness app. Students on a counseling center waitlist (n=23) were randomized to use the app or not, with assessments completed over four weeks. Results: Recruitment over three semesters was slow, leading to an underpowered trial. Participants reported high satisfaction and moderate app usage. Very preliminary support was found for potential app efficacy relative to the control condition, particularly for depression, anxiety, and overall distress. Weaker, mixed effects were found for mindfulness and values processes. Conclusions: Overall, these results provide mixed findings suggesting the potential benefits, but also challenges in using a mindfulness app for students waiting to receive counseling services.
Clinical perfectionism is characterized by imposing excessively high standards on oneself and experiencing severe distress when standards are not met. It has been found to contribute to the development and maintenance of various clinical presentations including anxiety, obsessivecompulsive, and eating disorders. The present study tested the efficacy of ten weekly individual sessions of acceptance and commitment therapy (ACT) relative to a waitlist control on clinical perfectionism and global outcomes among 53 individuals with clinical perfectionism. ACT is a process-based therapy that targets maladaptive underlying processes (e.g., rigid adherence to unrealistic high standards) rather than symptom topography (e.g., anxiety, depression). Participants completed assessments at pretreatment, posttreatment, and one-month follow-up. Results indicated compared to the waitlist condition, the ACT condition led to greater improvements in clinical perfectionism as well as outcomes related to wellbeing, functional impairment, distress, and processes of change. Our study suggests targeting core dysfunctional processes (i.e., clinical perfectionism) rather than symptom topography with treatments like ACT is feasible and efficacious, supporting a shift from symptom-focused to process-based care. We also note potential weaknesses in our treatment protocol and study methodology that should be addressed in future research. Study limitations included a small sample size and high dropout rate (35.7%).
Mobile apps may be useful in teaching psychological skills in a high-frequency, low-intensity intervention. The acceptance and commitment therapy (ACT) matrix is a visual tool to help develop psychological flexibility by categorizing moment-to-moment experience and is well suited to a mobile app. This pilot study tested the effects of a simple and complex version of a novel app using the ACT matrix in two distinct samples: help-seeking individuals ( n = 35) and students receiving SONA credit ( n = 63). Findings indicated no differences between app conditions and a waitlist condition in the SONA credit sample. However, in the help-seeking sample, improvements were found on well-being and valued action in participants who used the app, with greater improvements and app adoption for those using a complex version with additional skills. A mobile app based on the ACT matrix has benefits for help-seeking individuals, but supplementary features may be necessary to support consistent use and benefits.
Stigma is known to have major impacts on the physical and psychological health of many groups. Psychological inflexibility is a psychological process that may help explain the impact of stigma on both self and others. Accordingly, acceptance and commitment therapy (ACT), which targets psychological inflexibility, has been researched as a potential treatment for stigma. In order to provide a comprehensive overview of these issues, this paper offers a systematic review and meta-analysis of the association between psychological inflexibility and stigma, as well as a systematic review of ACT interventions for stigma. The results of the meta-analysis showed a positive, medium-to-large association between psychological inflexibility and stigma measures aggregating across 16 studies. The systematic review of interventions identified 15 studies on ACT interventions for stigma. Initial findings indicate consistent reductions in stigma following ACT interventions, as well as improved outcomes relative to active controls. Data on mediation and moderation, as well as long-term outcomes, are also presented. Implications for conceptualizing and treating stigma, and limitations of the research, are discussed.
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