Barbara S. Kohlenberg

Acceptance-Based Treatment for Smoking Cessation

This pilot study applied a theoretically derived model of acceptance-based treatment process to smoking cessation, and compared it to a pharmacological treatment based on a medical dependence model. Seventy-six nicotine-dependent smokers were randomly assigned to one of two treatments: Nicotine Replacement Treatment (NRT), or a smoking-focused version of Acceptance and Commitment Therapy (ACT). There were no differences between conditions at posttreatment; however, participants in the ACT condition had better long-term smoking outcomes at 1-year follow-up. As predicted by the acceptance process model, ACT outcomes at 1 year were mediated by improvements in acceptance-related skills. Withdrawal symptoms and negative affect neither differed between conditions nor predicted outcomes. Results were consistent with the functional acceptance-based treatment model.

The Impact of Acceptance and Commitment Training and Multicultural Training on the Stigmatizing Attitudes and Professional Burnout of Substance Abuse Counselors.

Empirically validated methods for reducing stigma and prejudice toward recipients of behavioral health-care services are badly needed. In the present study, two packages presented in 1-day workshops were compared to a biologically oriented educational control condition in the alleviation of stigmatizing attitudes in drug abuse counselors. One, Acceptance and Commitment Training (ACT), utilized acceptance, defusion, mindfulness, and values methods. The other, multicultural training, sensitized participants to group prejudices and biases. Measures of stigma and burnout were taken pretraining, posttraining, and after a 3-month follow-up. Results showed that multicultural training had an impact on stigmatizing attitudes and burnout post-intervention but not at follow-up, but showed better gains in a sense of personal accomplishment as compared to the educational control at follow-up. ACT had a positive impact on stigma at follow-up and on burnout at posttreatment and follow-up and follow-up gains in burnout exceeded those of multicultural training. ACT also significantly changed the believability of stigmatizing attitudes. This process mediated the impact of ACT but not multicultural training on follow-up stigma and burnout. This preliminary study opens new avenues for reducing stigma and burnout in behavioral health counselors.

Slow and steady wins the race: a randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders.

OBJECTIVE Shame has long been seen as relevant to substance use disorders, but interventions have not been tested in randomized trials. This study examined a group-based intervention for shame based on the principles of acceptance and commitment therapy (ACT) in patients (N = 133; 61% female; M = 34 years old; 86% Caucasian) in a 28-day residential addictions treatment program. METHOD Consecutive cohort pairs were assigned in a pairwise random fashion to receive treatment as usual (TAU) or the ACT intervention in place of 6 hr of treatment that would have occurred at that same time. The ACT intervention consisted of three 2-hr group sessions scheduled during a single week. RESULTS Intent-to-treat analyses demonstrated that the ACT intervention resulted in smaller immediate gains in shame, but larger reductions at 4-month follow-up. Those attending the ACT group also evidenced fewer days of substance use and higher treatment attendance at follow-up. Effects of the ACT intervention on treatment utilization at follow-up were statistically mediated by posttreatment levels of shame, in that those evidencing higher levels of shame at posttreatment were more likely to be attending treatment at follow-up. Intervention effects on substance use at follow-up were mediated by treatment utilization at follow-up, suggesting that the intervention may have had its effects, at least in part, through improving treatment attendance. CONCLUSIONS These results demonstrate that an approach to shame based on mindfulness and acceptance appears to produce better treatment attendance and reduced substance use.

Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes

Little is known about the assessment and treatment of self-stigma in substance abusing populations. This article describes the development of an acceptance based treatment (Acceptance and Commitment Therapy–ACT) for self-stigma in individuals in treatment for substance use disorder. We report initial outcomes from a study with 88 participants in a residential treatment program. The treatment involves 6 h of a group workshop focused on mindfulness, acceptance, and values work in relation to self-stigma. Preliminary outcomes showed medium to large effects across a number of variables at post-treatment. Results were as expected with one potential process of change, experiential avoidance, but results with other potential mediators were mixed.

Does Acceptance and Relationship Focused Behavior Therapy Contribute to Bupropion Outcomes? A Randomized Controlled Trial of Functional Analytic Psychotherapy and Acceptance and Commitment Therapy for Smoking Cessation☆

This study evaluated a treatment combining bupropion with a novel acceptance and relationship focused behavioral intervention based on the acceptance and relationship context (ARC) model. Three hundred and three smokers from a community sample were randomly assigned to bupropion, a widely used smoking cessation medication, or bupropion plus functional analytic psychotherapy (FAP) and acceptance and commitment therapy (ACT). Objective measures of smoking outcomes and self-report measures of acceptance and relationship processes were taken at pretreatment, posttreatment, 6-month, and 1-year follow-up. The combined treatment was significantly better than bupropion alone at 1-year follow-up with 7-day point prevalence quit rates of 31.6% in the combined condition versus 17.5% in the medication-alone condition. Acceptance and the therapeutic relationship at posttreatment statistically mediated 12-month outcomes. Bupropion outcomes were enhanced with an acceptance and relationship focused behavioral treatment.

A Guide to Functional Analytic Psychotherapy

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Avoiding and Altering Rule-Control as a Strategy of Clinical Intervention

If rule-govemed behavior is as ubiquitous as it seems, it is only logical that many clinical disorders involve problems in verbal control of one kind or another. At least four types of problems can be discerned.

Burnout among the addiction counseling workforce: The differential roles of mindfulness and values-based processes and work-site factors

Although work-site factors have been shown to be a consistent predictor of burnout, the importance of mindfulness and values-based processes among addiction counselors has been little examined. In this study, we explored how strongly experiential avoidance, cognitive fusion, and values commitment related to burnout after controlling for well-established work-site factors (job control, coworker support, supervisor support, salary, workload, and tenure). We conducted a cross-sectional survey among 699 addiction counselors working for urban substance abuse treatment providers in six states of the United States. Results corroborated the importance of work-site factors for burnout reduction in this specific population, but we found that mindfulness and values-based processes had a stronger and more consistent relationship with burnout as compared with work-site factors. We conclude that interventions that target experiential avoidance, cognitive fusion, and values commitment may provide a possible new direction for the reduction of burnout among addiction counselors.

Substance abuse and psychological flexibility: The development of a new measure

Psychological flexibility is a relatively new clinical construct targeted by Acceptance and Commitment Therapy, a behavior analytic treatment incorporating mindfulness and values interventions, among other processes. Poor psychological flexibility has been shown to relate to clinical problems as well as normative life challenges, and efforts to increase psychological flexibility have correlated with improvements for a variety of psychological difficulties, including substance abuse. The Acceptance and Action Questionnaire (AAQ) is currently the standard measure of psychological flexibility, but in substance misusing samples, has not shown adequate psychometric properties. Content-specific variants of the AAQ have been effective in other treatment domains, suggesting that a substance abuse focused version of the AAQ may be useful. This article details the construction and initial validation of such a measure, the AAQ-SA, which demonstrated good internal consistency, factor structure, and construct validity. In addition, the AAQ-SA appeared to be empirically distinguishable from the AAQ. Future researchers are advised to address limitations of this study and encouraged to expand the empirical database on substance abuse treatment with this new measure.

The Development and Psychometric Properties of a New Measure of Perceived Stigma Toward Substance Users

A self-report measure of perceived stigma toward substance users was developed and studied. An initial measure was created based on a previously developed scale that was rated by experts for content validity and quality of items. The scale, along with other measures, was administered to 252 people in treatment for substance problems in the United States during 2006–2007. Refinement efforts resulted in an eight-item scale with good face validity, construct validity, and adequate levels of internal consistency. Most relationships with other constructs were as expected. Findings suggest that perceived stigma is distinct from other forms of stigma.