Psychological inflexibility as a predictor associated with insomnia.

Psychological flexibility has recently attracted the attention of researchers in the field of sleep disorders; therefore, in the study, psychological flexibility was evaluated as a predictor or factor related to the presence/severity of insomnia. We included 2218 individuals selected from the randomized-control trial for behavioural therapy for insomnia and cross-sectional studies, including 1797 individuals with insomnia and 421 controls without insomnia. All participants completed the DSM-5-based insomnia diagnosis interview, Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Acceptance Action Questionnaire-II. Linear regression and multinomial logistic regression models were used. Sex, education, occupation, marital status, anxiety, depression and psychological inflexibility were possible predictors or factors associated with the severity of insomnia. Multivariate linear regression analysis demonstrated that sex (𝛽 = 0.88; t = 2.80; p = 0.005), depression (𝛽 = 0.41; t = 10.7; p < 0.001), anxiety (𝛽 = 0.58; t = 14.1; p < 0.001) and psychological inflexibility (𝛽 = 0.09; t = 5.07; p < 0.001) were predictors of insomnia. The results of the multinomial logistic regression demonstrate that, in comparison to the absence of insomnia, insomnia at all levels (mild, moderate and severe) was associated with sex, anxiety and depression. Psychological inflexibility was only associated with severe insomnia (odds ratio = 1.04). These findings are important from a public health perspective because behavioural strategies designed to treat insomnia with a focus on psychological flexibility are low-cost and may help improve sleep quality in adults with insomnia, which also influences mental health.

Promoção à saúde mental de trabalhadores do agronegócio: um estudo reflexivo / Promoting the mental health of agribusiness workers: a reflective study / Promoción de la salud mental de los trabajadores del agronegorio: un estudio reflexivo

Introdução: Os trabalhadores do setor administrativo do agronegócio estão susceptíveis a riscos ocupacionais em seu processo de trabalho, como: físicos, químicos, de acidentes e ergonômicos, biológicos e psicossociais como fadiga, tensão e pressão no trabalho. Essas condições influenciam na saúde física e mental desses trabalhadores interferindo no desempenho das atividades laborais e na qualidade de vida no trabalho. Em decorrência destes fatores, nota-se a importância de encontrar meios para proporcionar uma melhor qualidade de vida e satisfação no ambiente ocupacional bem como, promover uma saúde mental entre os trabalhadores do agronegócio. Objetivo: Refletir as estratégias organizacionais do enfermeiro do trabalho para a promoção da saúde mental no ambiente laboral de trabalhadores do agronegócio. Método: Estudo reflexivo, do tipo descritivo, que reflete as experiências no desenvolvimento de ações de uma equipe multidisciplinar de uma empresa de agronegócio localizada em mais de três estados brasileiros e conta com 1200 trabalhadores. A ideia do cuidado com a saúde mental dos trabalhadores do agronegócio surgiu a partir da observação da enfermeira do trabalho na busca recorrente dos trabalhadores ao departamento de gente e gestão, com relatos de problemas vivenciados dentro e fora da empresa. Frente a essa problemática surgiu a necessidade de disponibilizar para os trabalhadores um cuidado com foco na saúde mental, por meio de acolhimento e direcionamento para atendimento especializado dentro da própria empresa. Diante disso, foi estruturado dentro do Programa de Qualidade de Vida no Trabalho, já existente na empresa, um pilar denominado cuidado com a saúde emocional, com modalidades de atendimentos individuais, grupos de rodas de conversa e no formato on-line. Resultados: Com a divulgação do programa os trabalhadores estavam mais à vontade para buscar atendimentos com a psicóloga do programa e mostram-se interessados pelos grupos de rodas de conversas. Durante um ano, 238 trabalhadores buscaram pelo atendimento. A partir de então, a promoção do cuidado com a saúde mental dos trabalhadores ocorreu por meio da manutenção dos grupos de atendimentos individuais. Conclusão: O cuidado com a saúde mental no contexto corporativo é essencial para promover a integridade física e psicológica do trabalhador. Contudo, é necessário que a empresa invista mais em campanhas informativas com cuidado com a saúde mental, pois durante um ano, apenas 19,83% dos trabalhadores buscaram pelos atendimentos propostos pela empresa, além de que, a implementação de um programa para a saúde dos trabalhadores, valoriza a profissão do enfermeiro do trabalho e lhe traz subsídios para a continuidade e qualidade de assistências àqueles que o mesmo assiste.

Introduction: Workers in the agribusiness administrative sector are susceptible to occupational risks in their work process, such as: physical, chemical, accident and ergonomic, biological and psychosocial such as fatigue, tension and pressure at work. These conditions influence the physical and mental health of these workers, interfering with the performance of work activities and quality of life at work. As a result of these factors, it is important to find ways to provide a better quality of life and satisfaction in the occupational environment, as well as promoting mental health among agribusiness workers. Objective: To reflect the organizational strategies of occupational nurses to promote mental health in the work environment of agribusiness workers. Method: Reflective, descriptive study, which reflects the experiences in developing actions of a multidisciplinary team from an agribusiness company located in more than three Brazilian states and has 1200 workers. The idea of caring for the mental health of agribusiness workers arose from the observation of the occupational nurse in the workers' recurring search for the people and management department, with reports of problems experienced inside and outside the company. Faced with this problem, the need arose to provide workers with care focused on mental health, through welcoming and directing them to specialized care within the company itself. In view of this, a pillar called care for emotional health was structured within the Quality of Life at Work Program, already existing in the company, with individual assistance modalities, conversation groups and in an online format. Results: With the publicity of the program, workers were more comfortable seeking assistance from the program's psychologist and were interested in conversation groups. During one year, 238 workers sought assistance. From then on, the promotion of care for workers' mental health occurred through the maintenance of individual care groups. Conclusion: Mental health care in the corporate context is essential to promote the physical and psychological integrity of workers. However, it is necessary for the company to invest more in informative campaigns with care for mental health, as during one year, only 19.83% of workers sought the services proposed by the company, in addition to the implementation of a health program of workers, values the profession of occupational nurses and provides support for the continuity and quality of care for those they assist.

Introducción: Los trabajadores del sector administrativo agroindustrial son susceptibles a riesgos laborales en su proceso de trabajo, tales como: físicos, químicos, accidentalidad y ergonómicos, biológicos y psicosociales como fatiga, tensión y presión en el trabajo. Estas condiciones influyen en la salud física y mental de estos trabajadores, interfiriendo en el desempeño de las actividades laborales y la calidad de vida en el trabajo. Como resultado de estos factores, es importante encontrar formas de brindar una mejor calidad de vida y satisfacción en el entorno ocupacional, así como promover la salud mental entre los trabajadores de la agroindustria. Objetivo: Reflejar las estrategias organizacionales de las enfermeras ocupacionales para promover la salud mental en el ambiente laboral de los trabajadores de la agroindustria. Método: Estudio reflexivo, descriptivo, que refleja las experiencias en el desarrollo de acciones de un equipo multidisciplinario de una empresa agroindustrial ubicada en más de tres estados brasileños y que cuenta con 1200 trabajadores. La idea de cuidar la salud mental de los trabajadores del agronegocio surgió a partir de la observación de la enfermera ocupacional en la búsqueda recurrente de los trabajadores por el departamento de personas y gestión, con relatos de problemas vividos dentro y fuera de la empresa. Ante esta problemática surgió la necesidad de brindar a los trabajadores una atención enfocada a la salud mental, a través de su acogida y orientación a atención especializada dentro de la propia empresa. Ante esto, se estructuró un pilar denominado atención a la salud emocional dentro del Programa Calidad de Vida en el Trabajo, ya existente en la empresa, con modalidades de atención individual, grupos de conversación y en formato online. Resultados: Con la publicidad del programa, los trabajadores se sintieron más cómodos buscando ayuda del psicólogo del programa y se interesaron por los grupos de conversación. Durante un año, 238 trabajadores buscaron ayuda. A partir de entonces, la promoción del cuidado de la salud mental de los trabajadores se dio a través del mantenimiento de grupos de atención individuales. Conclusión: El cuidado de la salud mental en el contexto empresarial es fundamental para promover la integridad física y psicológica de los trabajadores. Sin embargo, es necesario que la empresa invierta más en campañas informativas con cuidado de la salud mental, ya que durante un año, sólo el 19,83% de los trabajadores buscó los servicios propuestos por la empresa, además de la implementación de un programa de salud de los trabajadores. valora la profesión de enfermeras ocupacionales y brinda apoyo para la continuidad y calidad de la atención a quienes asisten.

Effectiveness of acceptance and commitment therapy upon distress, emotion regulation, and self-compassion in patients with cardiovascular disease: a randomized clinical trial.

INTRODUCTION: Cardiovascular patients experience various psychological problems due to the conditions caused by their disease, which make it worse if left untreated. OBJECTIVE: The purpose of the current study was to evaluate the effects of acceptance and commitment therapy on distress, emotion regulation, and self-compassion in patients with cardiovascular disease. METHODS: This study was a randomized clinical trial with pre-test, post-test and two-month and four-month follow-up periods accompanying a control group. At four stages, patients filled out questionnaires on depression, anxiety, stress (DASS-21), emotion regulation (ERQ), and self-compassion (SCS). The experimental group underwent a treatment protocol based on acceptance and commitment therapy. Data were then analyzed using SPSS-25 with repeated measures analysis of variance. RESULTS: Act significantly reduced depression, anxiety, and stress, enhanced self-compassion, and improved emotion regulation in cardiac patients. Between-subjects (Group) partial etas for depression, anxiety, stress, reappraisal, suppression, and self-compassion were 0.61, 0.64, 0.66, 0.62, 0.66, and 0.65, respectively. Treatment efficacy was maintained during the 2- and 6-month follow-up visits. CONCLUSION: The results of this study suggest that treating cardiac patients' psychological problems in a way focused on acceptance and commitment therapy may have an impact on how well they respond to their treatment.

Corrigendum: A multiple-baseline evaluation of acceptance and commitment therapy focused on repetitive negative thinking for comorbid generalized anxiety disorder and depression.

[This corrects the article DOI: 10.3389/fpsyg.2020.00356.].

Grappling with the Complexity of Behavioral Processes in Human Psychological Suffering: Some Potential Insights from Relational Frame Theory.

Relational frame theory (RFT) has historically been considered the basic explanatory science behind acceptance and commitment therapy (ACT). However, some have argued that there has been an increasing separation between the two in recent years. The primary aim of the current article is to explore the extent to which RFT concepts, particularly those that have been proposed recently in the context of "up-dating" the theory, may be used to build stronger links between basic and applied behavior analyses in which there is a shared language of relatively precise technical terms. As an example of this strategy, we outline RFT process-based experimental and conceptual analyses of the impact of one of the most widely used sets of interventions employed in the ACT literature, defusion. In addition, we suggest a potential experimental methodology for analyzing the basic behavioral processes involved. Overall, the current article should be seen as part of a broader research agenda that aims to explore how RFT may be used to provide a functional-analytic abstractive treatment of the behavioral processes involved in human psychological suffering.

The effect of psychological inflexibility on health-related quality of life, depression, and anxiety in patients with chronic tinnitus without hearing loss

SUMMARY OBJECTIVE: The purpose of this study was to investigate the relationship between psychological inflexibility, depression, anxiety, and quality of life in patients with chronic tinnitus without hearing loss. METHODS: The study was carried out involving 85 patients with chronic tinnitus without hearing loss and a control group of 80 individuals. All participants completed the Acceptance and Action Questionnaire-II, the State-Trait Anxiety Inventory-Trait, the Beck Depression Inventory, and Short Form-36. RESULTS: The patient group exhibited higher Acceptance and Action Questionnaire-II (t=5.418, p<0.001), State-Trait Anxiety Inventory-Trait (t=6.592, p<0.001), and Beck Depression Inventory (t=4.193, p<0.001) scores and lower physical component summary (t=4.648, p<0.001) and mental component summary (t=-5.492, p<0.001) scores than the control group. Psychological inflexibility predicted depression, anxiety, and impairment of quality of life. The effect of psychological inflexibility on physical component summary was mediated by depression (β=−0.15, [95%CI −0.299 to −0.017]), while its effect on mental component summary was mediated by anxiety and serial anxiety and depression (β=−0.17 [95%CI −0.344 to −0.055] and β=−0.06 [95%CI −0.116 to −0.100], respectively). CONCLUSION: Psychological inflexibility plays an important role in patients with chronic tinnitus without hearing loss. It is associated with increased levels of anxiety and depression and decreased quality of life.

Cuidadores familiares de pessoas com demência: um estudo exploratório randomizado utilizando a Terapia de Aceitação e Compromisso em grupo / Family caregivers of people with dementia: an exploratory randomized study using Group Acceptance and Commitment Therapy

Introdução: Estima-se que a prevalência de sintomas ansiosos em cuidadores familiares de pessoas com demência é igual ou maior do que a prevalência de sintomas depressivos, embora a ansiedade tenha sido pouco explorada na literatura voltada para este público. Estudos têm demonstrado que a Terapia de Aceitação e Compromisso (ACT) pode ser utilizada com cuidadores familiares, com efeitos positivos sobre sintomas ansiosos. Entretanto, a ACT ainda não foi avaliada no formato em grupo e tampouco em países em desenvolvimento para este público. Objetivos: O trabalho foi subdividido em dois estudos. O objetivo do Estudo 1 foi revisar a literatura através de uma meta-análise e avaliar quantitativamente a eficácia da ACT em grupo, presencialmente, nos sintomas de ansiedade e depressão de adultos com 18 anos ou mais. O objetivo do Estudo 2 foi adaptar e avaliar os efeitos da ACT, em grupo, nos sintomas de ansiedade de cuidadores familiares de pessoas com demência. Método: No Estudo 1, quatro bases de dados foram pesquisadas em agosto/2018 e uma busca atualizada foi realizada em novembro/2021. Foram incluídos 48 estudos clínicos randomizados (3292 participantes: ansiedade = 34 ECRs; depressão = 40 ECRs). O Estudo 2, é um estudo exploratório randomizado, realizado em um único centro, não-cego. Cinquenta e sete cuidadores familiares de pessoas com demência foram randomizados para o grupo intervenção (n = 29) ou lista de espera (n = 28). O grupo intervenção participou de oito sessões de ACT em grupo, realizadas por vídeo conferência, semanalmente. Os participantes responderam aos questionários de avaliação de ansiedade, depressão, flexibilidade psicológica, qualidade de vida e sobrecarga, em três momentos diferentes: semanas 0, 9 e 20. Análises de regressão múltipla foram realizadas para comparar os escores dos participantes do grupo intervenção e controle, na semana 9 e 20. Os escores da linha de base foram usados como controle nas análises de intenção de tratamento (ITT) e dos participantes que participaram em pelo menos seis sessões de intervenção. Resultados: No Estudo 1 o tamanho de efeito para sintomas ansiosos foi de médio a grande (g=0,52, p < 0,001; 95% IC=0,30 ­ 0,73), já o tamanho de efeito para sintomas depressivos foi de pequeno a médio (g=0,47, p < 0,001; 95% IC=0,31 ­ 0,64). A amostra do Estudo 2 foi composta em sua maioria mulheres, de baixo a médio nível socioeconômico, com uma idade média de 52 anos e mediana de escolaridade de 15 anos. Participantes do grupo intervenção apresentaram pontuações mais baixas para sintomas de ansiedade e depressão, comparados com participantes do grupo controle. Este resultado foi encontrado nas semanas 9 e 20, tanto na análise de ITT, quanto na análise daqueles que completaram seis sessões ou mais. Apenas os participantes que participaram de pelo menos seis sessões, apresentaram redução da sobrecarga nas semanas 9 e 20, além de apresentarem melhora na qualidade de vida na semana 9. Os resultados não indicaram efeitos da intervenção na flexibilidade psicológica. Conclusão: Este estudo oferece evidências a favor da utilização da ACT em grupo, com familiares de pessoas com demência, auxiliando na redução dos sintomas ansiosos e depressivos.

Background: The prevalence of anxiety symptoms is estimated to be equal to or higher than the prevalence of depressive symptoms in family carers of people with dementia. However, anxiety is currently somehow neglected in the carer literature. Previous studies demonstrated that Acceptance and Commitment Therapy (ACT) is effective for treating anxiety symptoms in family carers of people with dementia, but the vast majority of these studies were conducted in developed countries. Objectives: The thesis was divided into two studies. Study 1 was a meta-analysis which aimed to quantitatively examine the efficacy of group-based ACT, delivered face-to-face, on anxiety and depressive symptoms in adults aged 18 or older. The Study 2 adapted and investigated the effectiveness of an ACT group intervention on the anxiety symptoms in Brazilian family carers of people with dementia. Method: In Study 1, four electronic databases were searched in August, 2018 and an update search was conducted in November, 2021. Forty-eight randomised controlled trials (RCTs) were included in this review (3292 participants: anxiety = 34 RCTs, depression = 40 RCTs). Study 2 was a single-centre, unblinded, double-arm exploratory randomised trial. Fifty-seven family carers of people with dementia presenting with mild to severe anxiety symptoms were randomised to the intervention group (n = 29) or waiting list group (n = 28). The intervention group received eight weekly sessions of group ACT, delivered through videoconference. Participants completed the measure of anxiety and depressive symptoms, caregiver burden, psychological flexibility and quality of life at Weeks 0, 9 and 20. Multiple linear regression analyses were performed to evaluate whether there was a significant difference in scores between the intervention and control groups, at weeks 9 and 20, while controlling for the baseline scores using both intention-to-treat (ITT) and completers data analyses. Results: In Study 1 the overall effect size for anxiety symptoms was medium-to-large (g = 0.52, p < 0.001; 95% CI =0.30­0.73), while the overall effect size was small-to-medium for depressive symptoms (g = 0.47, p < 0.001; 95% CI = 0.31­0.64). In Study 2 Participants were mostly women, from low- to middle-income socioeconomic levels, with a mean age of 52 years and median education of 15 years. Participants in the intervention group had lower scores of anxiety and depression symptoms compared to participants in the control condition at weeks 9 and 20 in both the ITT and completer analyses. Only participants who attended six or more sessions (i.e., completer sample) demonstrated reduced caregiver burden at both follow-up points. The completer sample also showed improvement in quality of life at week 9. The results did not show any effect of the intervention on psychological flexibility. Conclusion: This study provides evidence supporting the use of group ACT, delivered through videoconference, with family carers of people with dementia to help them cope better with anxiety and depressive symptoms.

Acceptance and commitment therapy for chronic pain: a quasiexperimental study / Terapia de aceitação e compromisso em grupo para dor crônica: estudo quase-experimental

Objective Chronic pain is an important health problem and affects both quality of life and mental health. This study assessed psychological inflexibility, pain intensity, quality of life, anxiety and depression symptoms, self-efficacy, and social support among patients with chronic pain. Method A quasiexperimental design was used to assess six adult participants pre- and post-group intervention (eight sessions) based on acceptance and commitment therapy. Results After the intervention, the patients experienced a reduction in psychological inflexibility, pain, and depression and anxiety symptoms and improvements in quality of life and self-efficacy. The quality of life and depression symptoms and the domains of quality of life and psychological inflexibility were negatively correlated. Conclusion Acceptance and commitment therapy is a promising treatment for the interdisciplinary treatment of the Pain Clinic.

Objetivo Dor crônica é um problema de saúde prevalente que acarreta prejuízos para qualidade de vida e saúde mental. Este estudo avaliou inflexibilidade psicológica, intensidade da dor, qualidade de vida, sintomas de ansiedade e de depressão, autoeficácia e suporte social em pacientes com dor crônica. Método Utilizou delineamento quase-experimental e os seis participantes adultos foram avaliados por meio de instrumentos no pré e pós-intervenção em grupo (oito sessões) com Terapia de Aceitação e Compromisso. Resultados Após a intervenção houve redução da inflexibilidade psicológica e da dor, melhora da qualidade de vida, redução dos sintomas de ansiedade e de depressão e aumento da autoeficácia. Houve correlação inversa entre qualidade de vida e sintomas de depressão e entre domínios da qualidade de vida e inflexibilidade psicológica. Conclusão Conclui-se que a Terapia de Aceitação e Compromisso é um tratamento promissor a ser integrado no atendimento interdisciplinar da Clínica de dor.

Terapia de aceitação e compromisso para redução do estresse em universitários: um estudo qualitativo / Acceptance and commitment therapy for university students: a qualitative study / Terapia de aceptación y compromiso para estudiantes universitarios: un estudio cualitativo

Este estudo teve como objetivo explorar a percepção de alunos de graduação em relação à sua participação em uma intervenção baseada na terapia de aceitação e compromisso (acceptance and commitment therapy[ACT]), para redução da inflexibilidade psicológica (IP) e do estresse em estudantes universitários. Parti­ciparam da pesquisa 21 alunos, de diferentes cursos de graduação, com idade média de 23,4 ± 5,61, sendo 71,4% do sexo feminino e 28,6% do sexo masculino. Os dados coletados nas entrevistas foram submetidos à análise de conteúdo e organizados em quatro categorias: experiência no programa, utilidade, viabilidade e sugestões e processos da ACT. Os resultados possibilitaram identificar que o programa foi uma experiên-cia positiva para os participantes. Além disso, constatou-se que a intervenção foi útil e viável, e possibili-tou que os estudantes desenvolvessem as habilidades necessárias para lidar melhor com as adversidades do dia a dia, sem que precisassem se afastar dos seus valores pessoais.

This study aims to explore undergraduate students' perception of their participation in an intervention, based on acceptance and commitment therapy (ACT), to reduce psychological inflexibility (PI) and stress in undergraduate students. Twenty­one students from different undergraduate programs participated in the research, with an average age of 23.4 ± 5.61, of whom 71.4% were female and 28.6% were male. The data collected in the interviews were submitted to content analysis and organized into four categories: experience in the program, utility, feasibility, and ACT suggestions and processes. The results made it possible to identify that the program was a positive experience for the participants, the intervention was useful and feasible and enabled students to develop the requirements to better deal with the adversities of daily life without departing from their personal values.

Este estudio tiene como objetivo explorar la percepción de los estudiantes de pregrado sobre su participa-ción en una intervención, basada en la terapia de aceptación y compromiso (acceptance and commitment therapy [ACT]), para reducir la inflexibilidad psicológica (IP) y el estrés en los estudiantes de pregrado. En la investigación participaron 21 estudiantes de diferentes carreras, con una edad promedio de 23,4 ± 5,61, de los cuales el 71,4% eran mujeres y el 28,6% hombres. Los datos recolectados en las entrevistas fueron sometidos a análisis de contenido y organizados en cuatro categorías: experiencia en el programa, utilidad, factibilidad y sugerencias y procesos de ACT. Los resultados permitieron identificar que el programa fue una experiencia positiva para los participantes, la intervención fue útil y factible y permitió a los estudian-tes desarrollar los requisitos necesarios para enfrentar mejor las adversidades de la vida diaria, sin apar-tarse de sus valores personales.

Content validity and perceived utility of a self-help online acceptance and commitment therapy program focused on repetitive negative thinking.

Telehealth strategies have become essential for responding to the sanitary emergency due to the COVID-19 pandemic. In this context, developing online psychological interventions (OPIs) that can treat and prevent psychological difficulties is gaining more relevance. This article describes an acceptance and commitment therapy (ACT) based OPI focused on repetitive negative thinking (RNT). This OPI is called Disentangled, Aware, and Committed (DAC) and represents an attempt to adapt previous RNT-focused ACT protocols to this format type. Study 1 evaluated content validity through the assessment of four experts in ACT regarding clarity, utility, pertinence, conceptual adjustment, and therapeutic goal fulfillment for each component of the DAC program. In Study 2, forty-one undergraduate clinical psychology trainees rated the components of the DAC program according to its clarity and perceived utility. These participants were enrolled in a randomized controlled trial that analyzed the efficacy of the DAC to prevent the usually observed increase in emotional symptoms and RNT among this population. Expert reviewers in Study 1 rated all DAC components as clear and useful for potential users, following a logical order, theoretically coherent with the ACT model, and successfully fulfilling its stated goals. In Study 2, the participants also rated the DAC components as clear and potentially useful for their lives. In conclusion, the DAC appears to be a feasible transdiagnostic OPI for treating and preventing emotional symptoms, which warrants further studies analyzing its efficacy.

Scalability of an ACT-Based strategy for improving well-being in health care providers: A mix-method and preliminary evaluation of efficacy.

The burden of the COVID-19 pandemic has been mainly carried by health care providers. Technology-Mediated Interventions (TMI) seem to be a feasible alternative to increase access to behavioral health resources in this population. However, scaling-up treatments into TMI requires developing user-friendly, accepted, and accessible formats. A two-stage study was conducted to assess scalability of an Acceptance and Commitment Therapy (ACT) based strategy (named FACE COVID) delivered using technology. First, a mix-method design connected qualitative and quantitative data from health providers and ACT experts by which changes were performed to enhance scalability. Second, a pretest-posttest study was conducted to preliminary evaluate the efficacy of FACE COVID intervention on well-being, psychological distress, and psychological flexibility. Results showed a positive impact on well-being, but not distress and psychological flexibility. While this intervention has promising results, changes in dose intensity, social support, and mental health literacy could improve retention as well as increase opportunities to target distress and psychological flexibility in future studies.

Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis.

BACKGROUND: A comprehensive meta-analysis quantitatively examining the effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms is required to advance our understanding of its efficacy and moderating factors. METHODS: Four electronic databases were searched in August 2018. An update search was conducted in November 2021. Forty-eight randomised controlled trials (RCTs) were included in this review (3292 participants: anxiety = 34 RCTs, depression = 40 RCTs). RESULTS: The overall effect size for anxiety symptoms was medium-to-large (g = 0.52, p < 0.001; 95% CI = 0.30-0.73), while the overall effect size was small-to-medium for depressive symptoms (g = 0.47, p < 0.001; 95% CI = 0.31-0.64). Subgroup analyses demonstrated that group ACT was significantly superior to non-active controls (e.g., waiting list) in reducing anxiety and depressive symptoms. Group ACT was only significantly superior to active controls (e.g., CBT) in reducing depressive symptoms. Subgroup analyses also demonstrated that the effect size can vary depending on the number of sessions provided and the primary condition of participants recruited. LIMITATIONS: The number of studies included in each category of subgroup analyses was small and the risk of bias varied across studies. There was high heterogeneity among the included studies, and this might have affected the results. CONCLUSION: The current evidence suggests that group ACT may be effective in treating anxiety and depressive symptoms, perhaps more so for depressive symptoms when compared to other well-established treatments. The intensity of treatment and the targeted population may need to be considered when delivering group ACT.

Psychometric properties of the Valuing Questionnaire in a Spaniard sample and factorial equivalence with a Colombian sample.

BACKGROUND: The Valuing Questionnaire (VQ) is considered as one of the most psychometrically robust instruments to measure valued living according to the acceptance and commitment therapy model. It consists of 10 items that are responded to on a 7-point Likert-type scale and has two factors: Progression and Obstruction. The Spanish version of the VQ showed good psychometric properties in Colombian samples. However, there is no evidence of the psychometric properties of the VQ in Spaniard samples. This study aims to analyze the validity of the VQ in a large Spaniard sample and analyze the measurement invariance with a similar Colombian sample. METHOD: The VQ was administered to a Spaniard sample of 846 adult participants from general online population. Cronbach's alpha and McDonald's omega were computed to analyze the internal consistency of the VQ. The fit of the VQ's two-factor model was tested through a confirmatory factor analysis with a robust maximum likelihood (MLR) estimation method. Afterward, we analyzed the measurement invariance across countries and gender. Convergent construct validity was analyzed with a package of questionnaires that evaluated experiential avoidance (Acceptance and Action Questionnaire-II, AAQ-II), emotional symptoms (Depression Anxiety and Stress Scale-21, DASS-21), life satisfaction (Satisfaction with Life Scale, SWLS), and cognitive fusion (Cognitive Fusion Questionnaire, CFQ). RESULTS: The internal consistency across samples was adequate (alphas and omegas were .85 for VQ-Progress and .84 for VQ-Obstruction). The two-factor model obtained a good fit to the data (RMSEA = 0.073, 90% CI [0.063, 0.083], CFI = 0.98, NNFI = 0.97, and SRMR = 0.053). The VQ showed strict invariance across countries and gender and showed theoretically coherent correlations with emotional symptoms, life satisfaction, experiential avoidance, and cognitive fusion. In conclusion, the Spanish version of the VQ demonstrated good psychometric properties in a large Spaniard sample.

Psychometric properties of the spanish version of the Valuing Questionnaire in Colombian clinical and nonclinical samples.

OBJECTIVE: To examine the psychometric properties of the Spanish version of the Valuing Questionnaire (VQ) in Colombian clinical and nonclinical samples. METHOD: The VQ was administered to a total sample of 1820 participants, which included undergraduates (N = 762), general population (N = 724), and a clinical sample (N = 334). The questionnaire packages included measures of experiential avoidance, cognitive fusion, mindfulness, life satisfaction, and psychological difficulties. RESULTS: Across the different samples, internal consistency was good (global Cronbach's alpha of 0.83 for Progress and 0.82 for obstruction). Measurement invariance was found across samples and gender, and the two-factor model obtained a good fit to the data. The latent means of progress and obstruction of the clinical sample were lower and higher, respectively, than the latent means of the nonclinical samples. Correlations with other variables were in the expected direction. CONCLUSION: The Spanish version of the VQ showed good psychometric properties.

ACT em grupo para manejo de ansiedade entre universitários: ensaio clínico randomizado / Group therapy based on act for anxiety management among university students: randomized clinical trial / Terapia grupal basada en ACT para el manejo de la ansiedad entre estudiantes universitarios: ensayo clínico aleatorizado

Estima-se que um a cada cinco estudantes universitários ao redor do mundo apresenta algum tipo de transtorno psicológico, dentre os quais os transtornos de ansiedade são os mais prevalentes. Este estudo consiste em um ensaio clínico randomizado com o objetivo de avaliar a eficácia e efetividade de um protocolo semiestruturado de psicoterapia em grupo baseado nos princípios da Terapia de Aceitação e Compromisso (ACT) para o tratamento de ansiedade entre estudantes universitários. Os participantes foram alocados aleatoriamente entre os grupos intervenção e controle. Os níveis de ansiedade pré e pós-intervenção foram avaliados por meio do instrumento General Anxiety Disorders-7 (GAD-7). A amostra final do estudo foi composta por 15 pessoas, dentre as quais 10 foram alocadas no grupo intervenção e 5, no grupo controle. Os resultados foram analisados de duas formas: a) por protocolo (Per-protocol analysis); e b) por intenção de tratar (Intention-to-treat Analysis). Este tratamento reduziu a sintomatologia ansiosa em 39,7% entre os pacientes que completaram o tratamento (por protocolo, p=0,030) e em 30,8% entre todos alocados para o grupo intervenção (i.e., por intenção de tratar, incluindo os dropouts, p=0,035), enquanto os controles não tiveram redução significativa no mesmo período. Portanto, recomenda-se a utilização deste protocolo dentro do contexto universitário como uma alternativa viável ao acompanhamento individual em situações de transtornos de ansiedade. Pesquisas futuras com amostras maiores podem contribuir na consolidação deste protocolo.

One in every five university students around the world is estimated to have some type of psychological disorder, considering anxiety disorders as the most prevalent. This study consists in a randomized clinical trial aimed to evaluate efficacy and effectiveness of a semi-structured group psychotherapy protocol based on the principles of Acceptance and Commitment Therapy (ACT) for the treatment of anxiety among university students. Participants were randomly allocated in the intervention and control groups. Pre- and post-intervention anxiety levels were measured using the General Anxiety Disorders-7 (GAD-7) questionnaire. The study sample was composed of 15 people, 10 of whom were allocated to the intervention group and 5 to the control group. Results were analyzed in two ways: 1) Per protocol analysis; and 2) Intention-to-treat analysis. This treatment reduced anxiety symptoms by 39.7% among patients who completed treatment (Per protocol, p=0.003) and by 30.8% among all those allocated to the intervention group (i.e., by Intention-to-treat, including dropouts, p=0.035), whereas controls showed no significant reduction in same period. Therefore, we recommend the use of this protocol within the university context as a viable alternative to individual counselling in situations of anxiety disorders. Future research with larger samples may contribute to consolidate this protocol.

Se estima que uno de cada cinco estudiantes universitarios en todo el mundo tiene algún tipo de trastorno psicológico, entre los cuales los trastornos de ansiedad son los más frecuentes. Este estudio consiste en un ensayo clínico aleatorizado cuyo objetivo fue evaluar la eficacia y efectividad de un protocolo de psicoterapia grupal semiestructurada basado en los principios de la Terapia de Aceptación y Compromiso (ACT) para el tratamiento de la ansiedad en estudiantes universitarios. Se asignaron aleatoriamente a los participantes en los grupos de intervención y control. Los niveles de ansiedad antes y después de la intervención se midieron utilizando el instrumento General Anxiety Disorders-7 (GAD-7). La muestra final del estudio estuvo compuesta por 15 personas, de las cuales 10 fueron asignadas al grupo de intervención y 5 al grupo de control. Los resultados se analizaron de dos maneras: 1) por protocolo (Per protocol analysis); y 2) por intención de tratar (Intention-to-treat Analysis). Con este tratamiento los síntomas de ansiedad se redujeron en un 39,7% entre los pacientes que completaron el tratamiento (por protocolo, p=0,030) y en un 30,8% entre todos los asignados al grupo de intervención (es decir, por intención de tratar, incluidos los dropouts, p=0,035), mientras que los controles no tuvieron una reducción significativa en el mismo periodo. Por lo tanto, se recomienda utilizar este protocolo dentro del contexto universitario como una alternativa viable a lo asesoramiento individual en situaciones de trastornos de ansiedad. La investigación futura con muestras más grandes puede contribuir a la consolidación de esta modalidad.

Empirical Investigation of the Verbal Cues Involved in Delivering Experiential Metaphors.

Delivering metaphors experientially has been emphasized in several psychotherapies, such as acceptance and commitment therapy. However, few research has analyzed the variables involved in the efficacy of metaphors. This experimental analog study aims to advance in this topic by analyzing the effect of two components involved in the experiential delivery of metaphors in psychotherapy. The first component is presenting the metaphor by asking the individual to imagine herself as the protagonist of the story versus presenting the metaphor in the third person (Self vs. Other). The second component is the inclusion of verbal cues prompting the relational elaboration of the rules derived from the metaphor content versus not including these prompts (Elaboration vs. No Elaboration). The effect of these components was tested in a double-blind, randomized, 2 × 2 factorial experiment that used the cold pressor task (CPT). Eighty-four participants were exposed to the CPT at the pretest. Afterward, participants were randomly assigned to four experimental protocols. The protocols were audiotaped and consisted of the same metaphor presented in four slightly different ways. Specifically, the protocol of Condition A involved a metaphor with Self and Elaboration, Condition B involved Self and No Elaboration, Condition C involved Other and Elaboration, and Condition D involved Other and No Elaboration. Then, participants were re-exposed to the CPT in the posttest. We hypothesized that Condition A (Self and Elaboration) would show a higher mean increase in pain tolerance than the remaining conditions, which would show similar results. The results were consistent with this hypothesis because Condition A showed a higher percentual increase in pain tolerance (Condition A: M = 268.21, SD = 167.47; Condition B: M = 180.86, SD = 73.01; Condition C: M = 204.81, SD = 100.19; Condition D: M = 175.41, SD = 76.00). A Bayesian informative hypothesis evaluation showed that this hypothesis obtained the highest posterior model probability. Thus, the results indicate that introducing metaphors by asking the individual to imagine herself as the protagonist of the story and providing prompts for relational elaboration might increase the therapeutic effect of the metaphor.

Acceptance and commitment therapy-based behavioral intervention for insomnia: a pilot randomized controlled trial

Objective: To evaluate a protocol for acceptance and commitment therapy-based behavioral intervention for insomnia (ACT-BBI-I) in adults compared to cognitive behavioral therapy for insomnia (CBT-I). Methods: Forty-five adults with chronic insomnia were randomized to ACT-BBI-I or CBT-I. Both interventions were performed in six weekly group sessions. The common treatment elements in both protocols included stimulus control and sleep restriction. CBT-I is focused on the cognitive restructuring of maladaptive beliefs about sleep and the daytime effects of insomnia. ACT-BBI-I focuses on therapeutic processes of acceptance, availability, values, defusion, and commitment. The results were evaluated through the following instruments: a sleep diary, the Insomnia Severity Index, the Epworth Sleepiness Scale, the Hospital Anxiety and Depression Scale, the Acceptance and Action Questionnaire-II, and the Dysfunctional Beliefs and Attitudes about Sleep scale. Results: Both interventions had a significant positive impact on sleep patterns, insomnia, anxiety, beliefs about sleep, and psychological flexibility. All improvement was maintained at the 6-month follow-up. Conclusion: The results suggest that integrating principles of ACT with behavioral techniques may be useful for treating insomnia. Further research should identify whether the principles of ACT result in added effectiveness compared to behavioral components alone. Clinical trial registration: RBR-7nc5wq

Efficacy of acceptance and commitment therapy (ACT) on depression, pain acceptance, and psychological flexibility in married women with breast cancer: a pre- and post-test clinical trial.

OBJECTIVE: Breast cancer is the most common cancer in women worldwide. Many of these patients suffer from multiple psychological symptoms. The present study aimed to investigate the impact of acceptance and commitment therapy (ACT) on depression, pain acceptance, and psychological flexibility in married women with breast cancer. METHODS: The present study was a pre- and post-test clinical trial with intervention and control groups. The research population consisted of women with breast cancer referred to the Ayatollah Yasrebi and Shahid Beheshti Hospitals in Kashan in 2018. Through a purposive sampling method, 40 women were selected and randomly divided into two groups, namely, intervention (n = 20) and control (n = 20). The applied tools included the Depression, Anxiety and Stress Scale (DASS-21), Chronic Pain Acceptance Questionnaire 8 (CPAQ-8), and Acceptance and Action Questionnaire - II (AAQ-II). Data were analyzed by SPSS 16 using descriptive statistics and analysis of variance (ANOVA). RESULTS: The results showed that ACT treatment significantly reduced the mean scores of depression compared to the control group (F = 107.72, p < 0.001). The mean scores of pain acceptance (F = 9.58, p < 0.05) and psychological flexibility (F = 10.61, p < 0 .05) significantly increased in comparison with the control group. CONCLUSION: ACT can be considered as an effective therapeutic approach to reduce depression and increase pain acceptance and psychological flexibility in women with breast cancer. These changes appear to be due to improved acceptance of thoughts and feelings associated with cancer and increased psychological flexibility, which is the primary goal of ACT treatment. CLINICAL TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT), IRCT20190518043620N1.

The safety and efficacy of acceptance and commitment therapy against psychotic symptomatology: a systematic review and meta-analysis

Objective: Acceptance and commitment therapy (ACT) is a third-wave psychological intervention that has attracted considerable clinical and research attention. A previous meta-analysis of ACT trials in psychosis reported a large effect size of ACT against overall psychotic symptomatology. However, there were critical methodological issues in the review that justify replication. Methods: Systematic review and meta-analysis of randomized controlled trials (RCTs) testing ACT vs. any comparator condition in a sample of adults with psychosis. The outcome of interest was overall psychotic symptomatology. Results: The search identified seven published and eight unpublished trials (of which we were able to obtain data from one). Data on symptomatology were extracted from six trials that involved 274 participants. The summary effect size (Hedge's G) for overall symptomatology was small and not significant (-0.21, 95%CI -0.60-0.18). Trials were generally rated as having a high risk of bias. Safety reporting was inadequate across included trials. Conclusions: Our observed effect size contrasted with that reported in a previous meta-analysis; differences were likely explained by errors in data extraction. The findings of this review suggest that there is currently inadequate evidence to conclude that ACT is a safe and effective treatment against psychotic symptomatology. Systematic review registration: CRD42018097200

Efficacy of acceptance and commitment therapy (ACT) on depression, pain acceptance, and psychological flexibility in married women with breast cancer: a pre- and post-test clinical trial

Abstract Objective: Breast cancer is the most common cancer in women worldwide. Many of these patients suffer from multiple psychological symptoms. The present study aimed to investigate the impact of acceptance and commitment therapy (ACT) on depression, pain acceptance, and psychological flexibility in married women with breast cancer. Methods: The present study was a pre- and post-test clinical trial with intervention and control groups. The research population consisted of women with breast cancer referred to the Ayatollah Yasrebi and Shahid Beheshti Hospitals in Kashan in 2018. Through a purposive sampling method, 40 women were selected and randomly divided into two groups, namely, intervention (n = 20) and control (n = 20). The applied tools included the Depression, Anxiety and Stress Scale (DASS-21), Chronic Pain Acceptance Questionnaire 8 (CPAQ-8), and Acceptance and Action Questionnaire - II (AAQ-II). Data were analyzed by SPSS 16 using descriptive statistics and analysis of variance (ANOVA). Results: The results showed that ACT treatment significantly reduced the mean scores of depression compared to the control group (F = 107.72, p < 0.001). The mean scores of pain acceptance (F = 9.58, p < 0.05) and psychological flexibility (F = 10.61, p < 0 .05) significantly increased in comparison with the control group. Conclusion: ACT can be considered as an effective therapeutic approach to reduce depression and increase pain acceptance and psychological flexibility in women with breast cancer. These changes appear to be due to improved acceptance of thoughts and feelings associated with cancer and increased psychological flexibility, which is the primary goal of ACT treatment. Clinical trial registration: Iranian Registry of Clinical Trials (IRCT), IRCT20190518043620N1.