[Development and Evaluation of an Acceptance and Commitment Therapy (ACT)-Based Group Intervention for Cancer Patients with Psychological Burden]. / Entwicklung und Evaluation einer Akzeptanz- und Commitment-Therapie (ACT)-basierten Gruppenintervention für psychisch belastete onkologische Patienten.

OBJECTIVE: Cancer is associated with many psychosocial stressors that lead to high psychological distress in over 50% of patients. About one third of patients make use of psycho-oncological services. Acceptance and Commitment Therapy (ACT), a transdiagnostic approach of the third wave of cognitive behavioral therapy, represents a promising approach for psycho-oncological interventions. However, the German-speaking area lacks a manualized ACT-based group intervention that is tested for feasibility and effectiveness. METHODS: To bridge this gap, we developed and preliminarily tested an ACT group intervention in this one-arm monocentric pilot study. It targets psychological burdened cancer patients in all disease stages. During 8 sessions, the ACT core processes mindfulness, values and acceptance are worked out by means of metaphors and experience-oriented exercises. RESULTS: Pre-Post-Data of our pilot study with n=25 patients indicate reductions in fear of progression, depression and psychological inflexibility, as well as an increase in psychological health-related quality of life and well-being. Regression analyses showed that changes in psychological flexibility predicted changes in all psychological outcome measures. The very high adherence underlines the feasibility of the intervention for the integrated outpatient clinic setting. DISCUSSION: Our pilot study provides first evidences for the good feasibility and effectiveness of an ACT-based group intervention in the German-speaking area. These results on effectivness should be interpreted with caution due to the lack of an experimental control group. CONCLUSION: Future studies should test the effectiveness of the intervention in randomized controlled trials (RCTs) with longer follow-up periods.

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

The "Evaluation of the Acceptance and Commitment Therapy (ACT) curriculum for domestic violence offenders" illustrates the methodological issues associated with interpreting program evaluations and applying them to policy. Despite the "preliminary" evidence, the authors promote ACTV as more effective in terms of recidivism compared with DU/CBT (cognitive-behavioral therapy) programming. A more critical consideration of the research, however, exposes further limitations that counter the initial speculations and interpretations of the study outcome. Consequently, the effectiveness of ACTV over the DU/CBT option remains in question and raises the need for a broader discourse on program effectiveness.

The effectiveness and acceptability of a guided self-help Acceptance and Commitment Therapy (ACT) intervention for psychogenic nonepileptic seizures.

This study utilized a nonconcurrent case-series design to examine the effectiveness and acceptability of a guided self-help Acceptance and Commitment Therapy (ACT) intervention for people with psychogenic nonepileptic seizures. A key aim of the study was to investigate the relationship between psychological flexibility (a key process within ACT), psychological health, quality of life, and seizure frequency. Six participants completed the study, with reliable and clinically significant changes in psychological flexibility, quality of life, and psychological health observed in the majority of participants. Notable reductions in self-reported seizure frequency were also observed. The implications of these findings for clinical practice are discussed and recommendations for future research suggested.

Effectiveness of Acceptance and Commitment Therapy in Increasing Resilience and Reducing Attrition of Injured US Navy Recruits.

INTRODUCTION: US Navy recruits who have injuries preventing them from participating in intense physical conditioning are pulled out of boot camp training and receive treatment that includes daily physical therapy, pain medications, and psychoeducational groups. Graduation from boot camp for these recruits requires not only recovering from their injuries but also passing a required Physical Fitness Assessment consisting of a timed 1.5-mile run, curl-ups, and push-ups. About 50-60% of these recruits will eventually be separated out and sent home. The purpose of this study is to examine the effectiveness of an Acceptance and Commitment Therapy (ACT)-based program called Mindfulness for Pain and Performance Enhancement (MPPE). This treatment program was designed to help recruits effectively handle pain and assist them in improving their physical performance in the service of recovery, boot camp completion, and entrance into the Navy. MATERIALS AND METHODS: This study was approved by the Edward Hines VA Hospital/Captain James A. Lovell Federal Health Care Center Institutional Review Board and the Naval Services Training Command. Treatment was voluntary and a total of 373 recruits enrolled in one of the 32 cycles of MPPE administered. Attrition was 35.1% (131 recruits). The control group comprised 310 recruits who did not enroll in MPPE. Recruits continued to receive standard treatment services (e.g., physical therapy, medical interventions, and psychoeducational groups) while participating in MPPE. Chi-square tests and one-way analysis of variance were used to analyze comparisons among treatment, control, and attrition groups on demographic, clinical, and boot camp training variables. Paired sample t-tests and Cohen's d effect sizes were computed to assess change on treatment outcome measures. Logistic regression was performed to identify demographic, clinical, and boot camp training variables predictive of graduation. RESULTS: All of the pre- to post-treatment outcome measures were significant and Cohen's d effect sizes ranged from 0.41 to 0.84. Effect size changes were small for anxiety and experiential avoidance; moderate for pain acceptance, mindfulness, cognitive inflexibility, and depression; and large for pain reduction. Treatment completers graduated at a higher rate (58.3%) than attrites (34.4%) or controls (45.5%). Based on a logistic regression model, variables predictive of graduation included MPPE completion, age, and reported pain rating. CONCLUSION: MPPE is a six-session, 2-wk-long Acceptance and Commitment Therapy-based approach to pain and physical performance that was added to existing treatment services. Results supported the use of this program for helping recruits recover from injuries and successfully pass physical training requirements for graduation. Recruits were not randomly assigned to treatment, thus limiting the interpretation of outcomes. Incorporating this treatment earlier in boot camp training and making it available to more recruits (i.e., not only injured recruits) may further reduce attrition and contribute to greater resiliency of sailors within the US Navy fleet.

Group-based Acceptance and Commitment Therapy (ACT) for Older Veterans: Findings from a Quality Improvement Project.

OBJECTIVES: The purpose of this project was to develop, implement, and evaluate a 12-session Acceptance and Commitment Therapy (ACT) for Older Veterans group protocol. METHODS: The Plan-Do-Study-Act (PDSA) quality improvement model was the foundational process for this project. Veterans age 55 years and older participated in an ACT for Older Veterans group in an outpatient geropsychology clinic at a Veterans Affairs Medical Center. Study methods included analysis of participant feedback gathered in a focus group, process measures (i.e., number of sessions attended and number of early terminations), and outcome measures (i.e., depressive symptoms, anxiety symptoms, and psychological flexibility). RESULTS: Seventeen participants completed an average of ten sessions. Less than 25% of participants terminated early. Depressive symptoms improved, though there were no statistically significant changes in anxiety symptoms and psychological flexibility. The focus group yielded several recommendations that were implemented in subsequent groups. CONCLUSIONS: The PDSA model helped in the development of a group therapy intervention that is both relevant and beneficial to older Veterans presenting with a variety of biopsychosocial issues. Results provide support for further research investigation of ACT for Older Veterans Group. CLINICAL IMPLICATIONS: ACT used in a group format is a feasible and acceptable psychotherapy for older Veterans.

Dificultades y barreras del terapeuta en el aprendizaje de la Terapia de Aceptación y Compromiso (ACT) / Difficulties and Therapist’s Barriers while Learning ACT

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Contextual therapies are at its peak nowadays, as plenty of workshops, expertise courses, conferences on this matter are given every year around the world. Acceptance and Committment Therapy (ACT) is a contextual therapy that gathers a vast empirical evidence, and its application is currently widespread to multiple contexts. Nevertheless, when learning ACT some difficulties can arise, especially when theory and practice, as the two sides of the same coin, are set apart. Learning ACT involves the theotherical-applied dimension about the laws concerning human behavior, especially about human language. Moreover, about the conditions under which these laws applied to the processes and methods to generate psychological flexibility. While learning ACT, one of the main problems is related to learn ACT methods or tools without a basic, systematic, precise and contextualized training. An additional problem is related to the difficulties that emerge in the therapists themselves when interacting upon their clients behavior. Their actions might not to be frequently adjusted to the function of their clients’ behaviors -and, consequently, there should not be the appropriate context for helping the client to interact with his/her own private events without losing the direction of a valued-life. These latter difficulties have been named "the therapist's barriers". The present article addresses part of this problem. The experience gathered in researching and training professionals in ACT is briefly described, and some effective interventions are presented. This study advances over the need in isolating, experimentally, these ways of proceeding (AU)

Teoría y práctica del consentimiento informado / Theory and practice of informed consent

Por consentimiento informado se entiende el proceso de comunicación entre el profesional (personal sanitario y/o investigador) y el enfermo que culmina en la decisión respecto a una intervención concreta. Sin embargo, en nuestro medio el concepto de consentimiento informado se suele limitar al documento que se pasa a firmar al paciente que va a someterse a procedimientos diagnósticos o terapéuticos de mayor riesgo. Igual que este consentimiento se entiende mejor como un proceso que como un acto, también el consentimiento se suele dar sobre procesos asistenciales más que sobre actos concretos: la aceptación de un proceso supone de manera tácita aceptar los diferentes componentes habituales de este proceso. Son muchos los pasos del proceso asistencial en los que esta aceptación se entiende mejor como un sencillo permiso que como un consentimiento complejo… Por último, en contra de la práctica habitual, el documento de aceptación del consentimiento debería ser breve, claro y comprensible, flexible y con capacidad de adaptarse a las circunstancias y los deseos del paciente dentro de lo posible y, todo ello, en un clima de confianza e información verbal que permita que el paciente que delegue las decisiones en el profesional no se vea obligado a afrontar toda la información

Informed consent is the process of communication between the professional (medical staff and/or investigator) and patient culminating in the decision regarding a particular intervention. However, in our country the concept of informed consent is usually limited to the document that must be signed by the patient to undergo diagnostic or therapeutic procedures riskier. This consent is best understood as a process rather than an event, and also it usually gives consent on care processes rather than on specific events: the acceptance of a process involves a tacitly acceptance of the different components that are usually part of this process. There are many steps in the care process in which a simple permission could be enough, not needing a specific and formal consent... finally, contrary to the usual practice, the acceptance document of consent should be short, clear and understandable, flexible, and with the ability to adapt to the circumstances and the patient’s wishes as far as possible and, all in an atmosphere of trust and verbal information that enables the patient, not forced to confront all the information, to delegate decisions on the professional

Acceptance and Commitment Therapy and Selective Optimization with Compensation for Institutionalized Older People with Chronic Pain.

OBJECTIVE: Recent studies support the efficacy of Acceptance and Commitment Therapy (ACT) with people with chronic pain. In addition, Selective Optimization with Compensation strategies (SOC) can help the elderly with chronic pain to accept their chronic condition and increase functional autonomy. Our aim was to analyze the efficacy of an ACT treatment program combined with training in SOC strategies for elderly people with chronic pain living in nursing homes. METHODS: 101 participants (mean age = 82.26; SD = 10.00; 78.6% female) were randomized to the intervention condition (ACT-SOC) or to a minimal support group (MS). Complete data are available for 53 participants (ACT-SOC: n = 27; MS: n = 26). Assessments of functional performance, pain intensity, pain acceptance, SOC strategies, emotional well being and catastrophizing beliefs were done preintervention and postintervention. RESULTS: Significant time by intervention changes (P = 0.05) were found in acceptance, pain related anxiety, compensation strategies, and pain interference in walking ability. Simple effects changes were found in acceptance (P = 0.01), selection strategies (P = 0.05), catastrophizing beliefs (P = 0.03), depressive symptoms (P = 0.05), pain anxiety (P = 0.01) and pain interference in mood and walking ability (P = 0.03) in the ACT-SOC group. No significant changes were found in the MS group. CONCLUSIONS: These results suggest that an ACT intervention combined with training in SOC strategies could help older people with pain to improve their emotional well being and their functional capability.

Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes.

A modular, transdiagnostic approach to treatment design and implementation may increase the public health impact of evidence-based psychosocial interventions. Such an approach relies on algorithms for selecting and implementing treatment components intended to have a specific therapeutic effect, yet there is little evidence for how components function independent of their treatment packages when employed in clinical service settings. This study aimed to demonstrate the specificity of treatment effects for two components of Acceptance and Commitment Therapy (ACT), a promising candidate for modularization. A randomized, nonconcurrent, multiple-baseline across participants design was used to examine component effects on treatment processes and outcomes in 15 adults seeking mental health treatment. The ACT OPEN module targeted acceptance and cognitive defusion; the ACT ENGAGED module targeted values-based activation and persistence. According to Tau-U analyses, both modules produced significant improvements in psychiatric symptoms, quality of life, and targeted therapeutic processes. ACT ENGAGED demonstrated greater improvements in quality of life and values-based activation. ACT OPEN showed greater improvements in symptom severity, acceptance, and defusion. Both modules improved awareness and non-reactivity, which were mutually targeted, though using distinct intervention procedures. Both interventions demonstrated high treatment acceptability, completion, and patient satisfaction. Treatment effects were maintained at 3-month follow up. ACT components should be considered for inclusion in a modular approach to implementing evidence-based psychosocial interventions for adults.

Psychotherapies for adult depression: recent developments.

PURPOSE OF REVIEW: Much has been learned from the 400 randomized trials on psychotherapies for adult depression that have been conducted, but much is also still unknown. In this study some recent attempts to further reduce the disease burden of depression through psychotherapies are reviewed. RECENT FINDINGS: In the past, many new psychotherapies have promised to be more effective than existing treatments, usually without success. We describe recent research on two new therapies, acceptance and commitment therapy and cognitive bias modification, and conclude that both have also not shown to be more effective than existing therapies. A growing number of studies have also focused on therapies that may be successful in further reducing the disease burden, such as treatments for chronic depression and relapse prevention. Other studies are aimed at scaling up psychological services, such as the training of lay health counselors in low-income and middle-income countries, telephone-based, and internet-based therapies. SUMMARY: Psychotherapies are essential tools in the treatment of adult depression. Randomized trials have shown that these treatments are effective, and by focusing on key issues, such as chronic depression, relapse, and scaling them up, psychotherapies contribute more and more to the reduction of the disease burden of depression.