Evaluation of mediators of change in the treatment of epilepsy with acceptance and commitment therapy

Abstract

The present study examined the mediators of change accounting for outcomes of a previously published study on acceptance and commitment therapy for the self-management of epilepsy and its life restricting impact. Conducted with 27 poor South Africans, a 9-h ACT protocol that included seizure management methods was shown to greatly reduce epileptic seizures and to increase quality of life over the next year as compared to an attention placebo control. A series of bootstrapped non-parametric multiple mediator tests showed that pre to follow-up changes in: seizures, quality of life, and well-being outcomes were mediated to a degree by ACT process measures of epilepsy-related acceptance or defusion, values attainment, persistence in the face of barriers, or their combination. The results of this study contribute to the understanding of the contextual conditioning mechanisms at work for those suffering from epilepsy and may show that helping people live vital lives may also help to reduce seizures.

Acceptance and Commitment Therapy: A Meta-Analytic Review

“…Finally, this meta-analysis did not include an analysis of the putative treatment mediators. However, the proposed mediators are supported in the literature [6, 51]. For example, Forman et al [6] found that changes in ‘observing’ and ‘describing’ mediated outcome for CT but ‘experiential avoidance’, ‘acting with awareness’, and ‘acceptance’ mediated outcomes for ACT.…”

In search of meaning: Values in modern clinical behavior analysis

“…Further, participants' level of values attainment and persistence in the face of barriers (as measured by the BullsEye) mediated improvements in frequency of seizures, overall well-being, and quality of life at a 1-year followup (Lundgren, Dahl, & Hayes, 2008).…”

“…This has primarily been used in clinical settings to aid in values clarification and committed action. A second measure is the Bull's-Eye, which assesses values attainment, discrepancy between stated values and behavior, perceived barriers to valued living, and behavioral persistence (Lundgren, Dahl, Melin, & Strosahl, 2008) and has been shown to function well as an outcome measure and a process measure and as a tool for educating clients about values in a clinical context (Lundgren, Dahl, & Hayes, 2008;Lundgren, Dahl, Kies, & Melin, 2006;Lundgren, Dahl, Yardi, & Melin, 2008). The Personal Values Questionnaire (Blackledge & Ciarrochi, 2006) is an ACT-consistent modification of Sheldon et al's (2002) Measures of values-consistent behavior have thus far been assessed by self-report in the clinical domain, through the use of values homework sheets, the consistency portion of the Valued Living Questionnaire, or the Bulls-Eye diary.…”

Preliminary Psychometric Properties of the Acceptance and Action Questionnaire–II: A Revised Measure of Psychological Inflexibility and Experiential Avoidance

“…, smoking (Gifford, Kohlenberg, Hayes, Antonuccio, Piasecki, RasmussenHall, & Palm, 2004), diabetes management (Gregg, Callaghan, Hayes, & Glenn-Lawson, 2007), tinnitus (Westin, Andersson, & Hayes, 2008), weight (Lillis & Hayes, 2008), coping with epilepsy (Lundgren, Dahl, & Hayes, 2008), and coping with psychotic symptoms (Shawyer, Ratcliff, Mackinnon, Farhall, Hayes, & Copolov, 2007), among several others. So far, all of these specific versions work well in predicting outcomes within their respective areas and have been particularly effective as mediators of ACT interventions that target these specific problems (e.g., Gifford et al, 2004;Gregg et al, 2007;Lundgren et al, 2008;Lillis & Hayes, 2008).…”

“…So far, all of these specific versions work well in predicting outcomes within their respective areas and have been particularly effective as mediators of ACT interventions that target these specific problems (e.g., Gifford et al, 2004;Gregg et al, 2007;Lundgren et al, 2008;Lillis & Hayes, 2008). However, a more general AAQ that can be used in a wide variety of contexts remains important for studying this theoretical model and the processes that underlie therapeutic and behavioral change.…”