A Preliminary Examination of an Acceptance and Commitment Therapy-Based Program for Incarcerated Domestic Violence Offenders.

Batterers intervention programs (BIPs) have only a marginal impact on domestic violence (DV) recidivism, in part because treatment attrition is high. The current study evaluates a new BIP based on Acceptance and Commitment Therapy (called ACTV, Achieving Change Through Values-Based Behavior) in a sample of incarcerated DV offenders who failed to complete community-based BIP (N = 23). The current study examined participants' risk factors and assessed criminal justice outcomes in the 1 year following treatment completion. The men exhibited high levels of experiential avoidance, adverse childhood experiences, psychopathy, and attachment when compared to clinical and forensic samples from past research. Consistent with the theory underlying ACTV, experiential avoidance decreased significantly over the course of treatment. In addition, 1 out of 22 (4.5%) had a domestic assault charge in the 1-year follow-up period. Overall, the current study offers preliminary support for the use of ACTV with noncompliant, incarcerated offenders.

Online acceptance and commitment therapy as treatment for loneliness among older adults: Report of a pilot study.

BACKGROUND: Loneliness has been linked to cognitive decline, cardiovascular risk, and risk of mortality among older adults. Creative approaches are needed to increase access for older adults to evidence-based intervention programs. One possible approach is acceptance and commitment therapy (ACT). The aim of this study was to pilot test a novel ACT-based online intervention to decrease loneliness in older adults living in the community. METHODS: A self-paced online ACT program consisting of eight interactive modules designed to teach participants skills to address common contributors to loneliness was evaluated. It was delivered to a sample of 529 men and women, aged 65 or over, who were assessed pre-intervention, postintervention, and at a one-month follow-up, with a short 10-item version of the UCLA Loneliness Scale. RESULTS: For participants who completed all eight modules of the intervention, average levels of loneliness significantly decreased from pre- to posttreatment, b = -0.013, t (385) = -4.69, p < 0.001 (Cohen's d = 0.30). The improvement in loneliness was maintained at the one-month follow-up assessment. These improvements were particularly robust for individuals who were lonely at outset (Cohen's d = 0.73). The change in loneliness among these individuals was significantly greater than that observed in members of a "hold-out" group of lonely individuals that did not participate in the intervention (Cohen's d = 0.24). CONCLUSIONS: This pilot investigation suggests the feasibility of this program for decreasing loneliness in older adults. Future controlled investigations with long-term follow-up assessments are needed to confirm the effectiveness and sustained benefits of the program.

Therapist use of cognitive behavior therapy and eye movement desensitization and reprocessing components for the treatment of posttraumatic stress disorder in practice settings.

Introduction: Treatment practice guidelines for posttraumatic stress disorder (PTSD) recommend both Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavior Therapy (CBT); however, implementation in practice setting remains challenging. Here we aim to foster implementation efforts for PTSD by identifying the relative use of the various components of empirically supported treatments by therapists and the characteristics that predict their use. Methods: Surveyed 346 therapists (84.07% female) of whom 272 participants (78.61%) were trained primarily in CBT and 135 participants (39.02%) were trained in primarily in EMDR. Assessed relative use of various EMDR and CBT components as well as several training and personality factors. Results: Psychoeducation about trauma was the most common element used. "Off label" use of components was also identified with application of EMDR techniques to other diagnoses. Findings also suggest underutilization of in vivo exposure techniques across therapists. EMDR therapists reported relatively high use of core EMDR techniques (i.e., greater use of EMDR core techniques). Big five personality factors, therapy efficacy, and anxiety were associated with differential component use. Discussion: Results identify trends in empirically supported component use and therapist characteristics that are associated with the use of various techniques for PTSD. The findings suggest implementation efforts could foster training in underused techniques, address barriers to their utilization and develop knowledge of effective packages of components.

A Technology-Enhanced Intervention for Violence and Substance Use Prevention Among Young Black Men: Protocol for Adaptation and Pilot Testing.

BACKGROUND: Black boys and men from disinvested communities are disproportionately survivors and perpetrators of youth violence. Those presenting to emergency departments with firearm-related injuries also report recent substance use. However, young Black men face several critical individual and systemic barriers to accessing trauma-focused prevention programs. These barriers contribute to service avoidance, the exacerbation of violence recidivism, substance use relapse, and a revolving-door approach to prevention. In addition, young Black men are known to be digital natives. Therefore, technology-enhanced interventions offer a pragmatic and promising opportunity to mitigate these barriers, provide vital life skills for self-led behavior change, and boost service engagement with vital community resources. OBJECTIVE: The study aims to systematically adapt and pilot-test Boosting Violence-Related Outcomes Using Technology for Empowerment, Risk Reduction, and Life Skills Preparation in Youth Based on Acceptance and Commitment Therapy (BrotherlyACT), a culturally congruent, trauma-focused digital psychoeducational and service-engagement tool tailored to young Black men aged 15-24 years. BrotherlyACT will incorporate microlearning modules, interactive safety planning tools for risk assessment, goal-setting, mindfulness practice, and a service-engagement conversational agent or chatbot to connect young Black men to relevant services. METHODS: The development of BrotherlyACT will occur in 3 phases. In phase 1, we will qualitatively investigate barriers and facilitators influencing young Black men's willingness to use violence and substance use prevention services with 15-30 young Black men (aged 15-24 years) who report perpetrating violence and substance use in the past year and 10 service providers (aged >18 years; any gender; including health care providers, street outreach workers, social workers, violence interrupters, community advocates, and school staff). Both groups will be recruited from community and pediatric emergency settings. In phase 2, a steering group of topic experts (n=3-5) and a youth and community advisory board comprising young Black men (n=8-12) and service providers (n=5-10) will be involved in participatory design, alpha testing, and beta testing sessions to develop, refine, and adapt BrotherlyACT based on an existing skills-based program (Achieving Change Through Values-Based Behavior). We will use user-centered design principles and the Assessment, Decision, Administration, Production, Topical, Experts, Integration, Training, and Testing framework to guide this adaptation process (phase 2). In phase 3, a total of 60 young Black men will pilot-test the adapted BrotherlyACT over 10 weeks in a single-group, pretest-posttest design to determine its feasibility and implementation outcomes. RESULTS: Phase 1 data collection began in September 2021. Phases 2 and 3 are scheduled to start in June 2023 and end in September 2024. CONCLUSIONS: The development and testing of BrotherlyACT is a crucial first step in expanding an evidence-based psychoeducational and service-mediating intervention for young Black men involved in violence. This colocation of services shifts the current prevention strategy from telling them why to change to teaching them how. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/43842.

Older Adults' Experiences in a Web-Based Intervention for Loneliness.

Background: Older adults may be vulnerable to loneliness due to natural and age-related transitions. Lonely older adults are at an increased risk of adverse health outcomes due to their loneliness, including cognitive decline, cardiovascular disease, and mortality. Objective: The purpose of this study was to explore the experiences of vulnerable older adults in a web-based loneliness intervention. Methods: Older adult participants in a web-based loneliness intervention (n = 24) participated in semi-structured interviews eliciting feedback about their experience in the program and perceived outcomes. Participants' responses were analyzed using qualitative content analysis. Results: Participants reported fewer negative perceptions of their social skills and future social interactions, gaining new social skills, improved relationships, and increased confidence to initiate and maintain social contact. Conclusions: Findings suggest the efficacy of combining a web-based loneliness intervention with cognitive behavioral therapy, and provide implications for future web-based interventions for older adult populations.

A randomized clinical trial of acceptance and commitment therapy and the Duluth Model classes for men court-mandated to a domestic violence program.

OBJECTIVE: This is the first randomized controlled trial to compare Acceptance and Commitment Therapy (ACT) with the Duluth Model curriculum, which took place in community-based corrections for the treatment of men convicted of domestic violence. ACT is a third-wave cognitive-behavioral approach that utilizes experiential methods to foster psychological flexibility. The Duluth Model curriculum is an educational approach grounded in feminist theory that focuses on changing attitudes toward women and unlearning power and control motivations. This trial was preregistered at ClinicalTrials.gov (registration number: NCT03609801). METHOD: This study included 338 men who were court-mandated to complete a domestic violence program after being convicted of assault against a female partner. Participants were randomized to complete the 24 sessions of the ACT program or the Duluth Model Men's Nonviolence Classes. Outcomes included criminal justice data (domestic violence charges, other violent charges, and nonviolent charges) incurred during the 1 year following program dropout or completion, and victim reports of intimate partner violence (IPV; aggression, controlling behaviors, and stalking/harassment). RESULTS: In intent-to-treat comparisons to Duluth, ACT participants did not show a difference in domestic assault charges at 1 year posttreatment (p = .44). ACT participants acquired significantly fewer violent charges (p = .04) and nonviolent charges (p = .02) compared to Duluth participants. Data from victims indicated that victims of ACT participants reported significantly fewer IPV behaviors than victims of Duluth participants on the Conflict Tactics Scale (d = .78), the Controlling Behaviors Scale (d = .66) and the Stalking Behavior Checklist (d = .71) at 1 year posttreatment. CONCLUSIONS: An ACT-based group intervention delivered in community corrections reduced violent and nonviolent criminal charges compared to the Duluth classes. Domestic violence charges did not differ between groups but victim reports indicated that ACT participants engaged in fewer IPV behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Strategic Plan for Strengthening America's Families: A Brief from the Coalition of Behavioral Science Organizations.

Despite significant progress in research on the treatment and prevention of psychological, behavioral, and health problems, the translation of this knowledge into population-wide benefit remains limited. This paper reviews the state of America's children and families, highlighting the influence of stressful contextual and social conditions on child and family well-being and the concentration of disadvantage in numerous neighborhoods and communities throughout the nation. It then briefly reviews the progress that has been made in pinpointing policies that can reduce stressful contextual conditions such as poverty, discrimination, and the marketing of unhealthful foods and substances. It also describes numerous family and school interventions that have proven benefit in preventing psychological and behavioral problems as diverse as tobacco, alcohol, and other drug use; depression; antisocial behavior; academic failure; obesity prevention; and early childbearing. We argue that progress in translating existing knowledge into widespread benefit will require a nationwide effort to intervene comprehensively in neighborhoods and communities of concentrated disadvantage. We present a strategic plan for how such an effort could be organized. The first step in this organizing would be the creation of a broad and diverse coalition of organizations concerned with advancing public health and well-being. Such a coalition could increase public support both for the policies needed to focus on these disadvantaged areas and the research needed to incrementally improve our ability to help these areas.

Reply to Lessons in Program Evaluation: The ACTV Batterer Program Study and Its Claims.

Gondolf, Bennett, and Mankowski raise many concerns about the ACTV batterers' intervention program (BIP) and the Zarling, Bannon, and Berta evaluation of ACTV, including (a) the researchers' and the Iowa Department of Corrections' promotion of ACTV; (b) research design, outcome measure, and results; (c) contextual issues; and (d) the effectiveness debate surrounding BIPs. The current commentary responds to each of these concerns, as well as identifies errors and corrects misinformation in their article. It is hoped that this response will also clarify the broader context of ACTV development and research and contribute to the ongoing discussion about BIPs.

A randomized controlled trial of acceptance and commitment therapy for aggressive behavior.

OBJECTIVE: The objective of the current research was to test the efficacy of a group-based Acceptance and Commitment Therapy (ACT) intervention for partner aggression, compared with a support and discussion control group, in a clinical sample of adults. METHOD: One hundred one participants (mean age = 31; 68% female; 18% minority) who endorsed recently engaging in at least 2 acts of partner aggression were randomly assigned to receive ACT or a support-and-discussion control condition. Both interventions consisted of 12 weekly 2-hr sessions. Assessments at pretreatment, during treatment, posttreatment, and 3 and 6 months after treatment measured psychological aggression (Multidimensional Measure Emotional Abuse Scale [MMEA]), physical aggression (Conflict Tactics Scales [CTS-2]), experiential avoidance (Avoidance and Action Questionnaire [AAQ]), and emotion dysregulation (Difficulties in Emotion Regulation Scale [DERS]). RESULTS: RESULTS of growth curve modeling analyses demonstrated that participants in the ACT group had significantly greater declines in psychological and physical aggression from pre- to posttreatment and from pretreatment to follow-up and that 6-month treatment outcomes were partially mediated by levels of experiential avoidance and emotion dysregulation at posttreatment. CONCLUSIONS: The results of this first trial of ACT for aggressive behavior indicate that the ACT group significantly reduced both physical and psychological aggression and that these changes were significantly greater than those of the control group, suggesting that an ACT approach to aggression may serve as an efficacious treatment for aggression.

Internalizing and externalizing symptoms in young children exposed to intimate partner violence: examining intervening processes.

Children's emotion dysregulation, children's appraisals, maternal psychological functioning, and harsh discipline were investigated as potential mediators in the putative link between exposure to intimate partner violence and poor child outcomes. Participants included 132 children ages 6-8 and their mothers who had been enrolled in a longitudinal study of parenting and children's social development. The mothers were receiving some form of government-based economic assistance or other social services, and were currently involved in a romantic relationship. Results of structural equation modeling indicated children's emotion dysregulation mediated the links between exposure to intimate partner violence (IPV) and both internalizing and externalizing problems. Harsh discipline mediated the link between exposure to IPV and externalizing, but not internalizing, symptoms. Child appraisals and maternal psychological functioning mediated the link between exposure to IPV and internalizing, but not externalizing, symptoms.