Helen Bolderston

The development and initial validation of The Cognitive Fusion Questionnaire

Acceptance and Commitment Therapy (ACT) emphasizes the relationship a person has with their thoughts and beliefs as potentially more relevant than belief content in predicting the emotional and behavioral consequences of cognition. In ACT, defusion interventions aim to unhook thoughts from actions and to create psychological distance between a person and their thoughts, beliefs, memories, and self-stories. A number of similar concepts have been described in the psychology literature (e.g., decentering, metacognition, mentalization, and mindfulness) suggesting converging evidence that how we relate to mental events may be of critical importance. While there are some good measures of these related processes, none of them provides an adequate operationalization of cognitive fusion. Despite the centrality of cognitive fusion in the ACT model, there is as yet no agreed-upon measure of cognitive fusion. This paper presents the construction and development of a brief, self-report measure of cognitive fusion: The Cognitive Fusion Questionnaire (CFQ). The results of a series of studies involving over 1,800 people across diverse samples show good preliminary evidence of the CFQs factor structure, reliability, temporal stability, validity, discriminant validity, and sensitivity to treatment effects. The potential uses of the CFQ in research and clinical practice are outlined.

Ameliorating Patient Stigma Amongst Staff Working With Personality Disorder: Randomized Controlled Trial of Self-Management Versus Skills Training.

BACKGROUNDnPatients diagnosed with a personality disorder (PD) are often stigmatized by the healthcare staff who treat them.nnnAIMSnThis study aimed to compare the impact on front-line staff of a self-management Acceptance and Commitment Therapy-based training intervention (ACTr) with a knowledge- and skills-based Dialectical Behaviour Training intervention (DBTr).nnnMETHODnA service-based randomized controlled trial was conducted comparing the effects of 2-day ACTr (N = 53) and DBTr (N = 47) staff workshops over 6 months. Primary outcome measures were staff attitudes towards patients and staff-patient relationships.nnnRESULTSnFor both interventions, staff attitudes, therapeutic relationship, and social distancing all improved pre- to postintervention, and these changes were maintained at 6-month follow-up.nnnCONCLUSIONSnAlthough offering different resources to staff, both ACTr and DBTr were associated with an improved disposition towards PD patients. Future research could evaluate a combined approach, both for staff working with PD patients and those working with other stigmatized groups.

Testing the differential effects of acceptance and attention-based psychological interventions on intrusive thoughts and worry

Background Worry is a key component of anxiety and may be an effective target for therapeutic intervention. We compared two psychological processes (attention and acceptance) on the frequency of intrusive worrying thoughts in an experimental worry task. Method 77 participants were randomised across three groups and completed either a 10 min attention or acceptance-based psychological exercise, or progressive muscle relaxation control. We subsequently measured anxiety, and the content and frequency of intrusive thoughts before and after a ‘worry induction task’. Results Groups did not differ in baseline worry, anxiety or thought intrusions. Both attention and acceptance-based groups experienced fewer negative thought intrusions (post-worry) compared to the relaxation control group. The acceptance exercise had the largest effect, preventing ‘worry induction’. Increases in negative intrusive thoughts predicted subjective anxiety. Discussion We provide evidence that acceptance and attention psychological exercises may reduce anxiety by reducing the negative thought intrusions that characterise worry.

Attention to faces and gaze-following in social anxiety: preliminary evidence from a naturalistic eye-tracking investigation

ABSTRACT Social attentional biases are a core component of social anxiety disorder, but research has not yet determined their direction due to methodological limitations. Here we present preliminary findings from a novel, dynamic eye-tracking paradigm allowing spatial–temporal measurement of attention and gaze-following, a mechanism previously unexplored in social anxiety. 105 participants took part, with those high (Nu2009=u200927) and low (Nu2009=u200925) in social anxiety traits (HSA and LSA respectively) entered into the analyses. Participants watched a video of an emotionally-neutral social scene, where two actors periodically shifted their gaze towards the periphery. HSA participants looked more at the actors’ faces during the initial 2s than the LSA group but there were no group differences in proportion of first fixations to the face or latency to first fixate the face, although HSA individuals’ first fixations to the face were shorter. No further differences in eye movements were found, nor in gaze-following behaviour, although these null effects could potentially result from the relatively small sample. Findings suggest attention is biased towards faces in HSA individuals during initial scene inspection, but that overt gaze-following may be impervious to individual differences in social anxiety. Future research should seek to replicate these effects.

Development and Evaluation of Acceptance and Commitment Therapy Delivered by Psychologists and Non-Psychologists in an NHS Community Adult Mental Health Service: a Preliminary Analysis

BACKGROUNDnPrevious studies have demonstrated that acceptance and commitment therapy (ACT) is effective for depression and may be useful for complex transdiagnostic clients.nnnAIMSnTo conduct a preliminary evaluation of whether ACT is feasible and effective when delivered by psychologists and non-psychologists for complex clients in a National Health Service (NHS) community mental health service for adults.nnnMETHODnStaff were trained in ACT and conducted one-to-one therapy with clients. Measures on general mental health, depression, fusion and values were given pre-therapy, post-therapy and at 3-month follow-up.nnnRESULTSnStandardized measures showed significant improvements post-therapy for global mental health, depression, cognitive fusion and values post-treatment. These were partially maintained at follow-up and remained after an intent-to-treat analysis. There were no differences in outcomes between psychologists and non-psychologists.nnnCONCLUSIONSnACT may be delivered effectively with limited training for complex cases in secondary care, though further research is needed.