Jacqueline Pistorello

Measuring experiential avoidance: A preliminary test of a working model

The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items. A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAQ) were then examined in 8 additional samples. All totaled, over 2,400 participants were studied. As expected, higher levels of experiential avoidance were associated with higher levels of general psychopathology, depression, anxiety, a variety of specific fears, trauma, and a lower quality of life. The AAQ related to more specific measures of avoidant coping and to self-deceptive positivity, but the relation to psychopathology could not be fully accounted for by these alternative measures. The data provide some initial support for the model of experiential avoidance based on Relational Frame Theory that is incorporated into Acceptance and Commitment Therapy, and provides researchers with a preliminary measure for use in population-based studies on experiential avoidance.

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.

Acceptance and commitment: implications for prevention science.

Recent research in behavior analysis and clinical psychology points to the importance of language processes having to do with the control of negative cognition and emotion and the commitment to valued action. Efforts to control unwanted thoughts and feelings, also referred to as experiential avoidance (EA), appear to be associated with a diverse array of psychological and behavioral difficulties. Recent research shows that interventions that reduce EA and help people to identify and commit to the pursuit of valued directions are beneficial for ameliorating diverse problems in living. These developments have the potential to improve the efficacy of many preventive interventions. This paper reviews the basic findings in these areas and points to some ways in which these developments could enhance the impact of preventive interventions.

Dialectical behavior therapy (DBT) applied to college students: a randomized clinical trial.

OBJECTIVE College counseling centers (CCCs) are increasingly being called upon to treat highly distressed students with complex clinical presentations. This study compared the effectiveness of Dialectical Behavior Therapy (DBT) for suicidal college students with an optimized control condition and analyzed baseline global functioning as a moderator. METHOD The intent-to-treat (ITT) sample included 63 college students between the ages of 18 and 25 years who were suicidal at baseline, reported at least 1 lifetime nonsuicidal self-injurious (NSSI) act or suicide attempt, and met 3 or more borderline personality disorder (BPD) diagnostic criteria. Participants were randomly assigned to DBT (n = 31) or an optimized treatment-as-usual (O-TAU) control condition (n = 32). Treatment was provided by trainees, supervised by experts in both treatments. Both treatments lasted 7-12 months and included both individual and group components. Assessments were conducted at pretreatment, 3 months, 6 months, 9 months, 12 months, and 18 months (follow-up). RESULTS Mixed effects analyses (ITT sample) revealed that DBT, compared with the control condition, showed significantly greater decreases in suicidality, depression, number of NSSI events (if participant had self-injured), BPD criteria, and psychotropic medication use and significantly greater improvements in social adjustment. Most of these treatment effects were observed at follow-up. No treatment differences were found for treatment dropout. Moderation analyses showed that DBT was particularly effective for suicidal students who were lower functioning at pretreatment. CONCLUSIONS DBT is an effective treatment for suicidal, multiproblem college students. Future research should examine the implementation of DBT in CCCs in a stepped care approach.

An Investigation of Experiential Avoidance, Emotion Dysregulation, and Distress Tolerance in Young Adult Outpatients with Borderline Personality Disorder Symptoms

In this study we investigated 3 domains of emotional functioning--emotion dysregulation, distress tolerance, and experiential avoidance--in young adult outpatients with borderline personality disorder (BPD) symptoms. Participants were 40 young adult outpatients at a university counseling center who reported current suicidal ideation and met diagnostic criteria for BPD or experienced subthreshold BPD symptoms (i.e., met diagnostic criteria for 3 or 4 symptoms). Participants completed 3 self-report measures of emotional functioning-experiential avoidance (Acceptance and Action Questionnaire-2; Bond et al., 2011; Hayes et al., 2004), emotion dysregulation (Difficulties in Emotion Regulation Scale; Gratz & Roemer, 2004), and distress tolerance (Distress Tolerance Scale; Simons & Gaher, 2005)-and a behavioral measure of distress tolerance (Paced Auditory Serial Addition Task-Computerized; Lejuez, Kahler, & Brown, 2003), in addition to self-report measures of depression and BPD symptom severity. Partial correlations demonstrated that both emotion dysregulation and experiential avoidance were significantly associated with BPD symptom severity after accounting for depression. However, neither the self-report nor behavioral measure of distress tolerance were related to BPD symptom severity. A regression analysis with emotion dysregulation and experiential avoidance as independent variables revealed that only experiential avoidance was significantly associated with BPD symptom severity after controlling for depression symptoms. The current findings suggest that experiential avoidance may be a central process in BPD symptom severity. Future research directions are discussed.

Feasibility of a Prototype Web-Based Acceptance and Commitment Therapy Prevention Program for College Students

Abstract Objective: This study examined the feasibility of a prototype Web-based acceptance and commitment therapy (ACT) program for preventing mental health problems among college students. Participants: Undergraduate first-year students (N = 76) participated between May and November 2011. Methods: Participants were randomized to ACT or a waitlist, with assessments conducted at baseline, posttherapy, and 3-week follow-up. Waitlist participants accessed the program after the second assessment. Results: Program usability/usage data indicated high program acceptability. Significant improvements were found for ACT knowledge, education values, and depression with ACT relative to waitlist. Subgroup analyses indicated that ACT decreased depression and anxiety relative to waitlist among students with at least minimal distress. Within the ACT condition, significant improvements were observed from baseline to 3-week follow-up on all outcome and process measures. Conclusions: Results provide preliminary support for the feasibility of a Web-based ACT prevention program.

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.

Examining psychological inflexibility as a transdiagnostic process across psychological disorders

The current cross-sectional study examined psychological inflexibility, a process in which behavior is rigidly guided by psychological reactions rather than direct contingencies or personal values, as a transdiagnostic process relevant to a range of depressive, anxiety, substance use and eating disorders. A sample of 972 first-year college students between 17 and 20 years of age completed self-report measures of psychological inflexibility and psychological distress as well as a structured diagnostic interview. Psychological inflexibility was significantly higher across a range of current and lifetime depressive and anxiety disorders as well as lifetime history of eating disorders, relative to students with no disorder, even after controlling for general psychological distress. Findings were mixed for substance use disorders, with a more consistent pattern for lifetime history than for current disorders. Psychological inflexibility was also related to having comorbid depressive, anxiety, and substance use disorders relative to only having one of these diagnoses. Results are discussed in relation to research on psychological inflexibility as a transdiagnostic pathological process and target for interventions.

Exploring the Relationship Between Experiential Avoidance, Alcohol Use Disorders and Alcohol-Related Problems Among First-Year College Students

Abstract Objective: This study explored the relationship of experiential avoidance (eg, the tendency to avoid, suppress, or otherwise control internal experiences even when doing so causes behavioral harm) to alcohol use disorders and alcohol-related problems. Participants: Cross-sectional data were collected from 240 undergraduate college students in their first year in college between December 2009 and April 2010. Methods: Participants completed a diagnostic interview and online self-report survey. Results: Students with a history of alcohol abuse or dependence had significantly higher levels of experiential avoidance relative to students with no alcohol use disorder diagnosis. A hierarchical linear regression analysis found that experiential avoidance significantly predicted alcohol-related problems, even after controlling for gender and psychological distress. Furthermore, experiential avoidance mediated the relationship of psychological distress to alcohol-related problems. Conclusions: These findings suggest that experiential avoidance may play a role in problematic alcohol use among college students.

Feasibility of an Acceptance and Commitment Therapy adjunctive web-based program for counseling centers

Web-based adjunctive tools provide a promising method for addressing the challenges college counseling centers face in meeting the mental health needs of students. The current study tested an initial adjunctive prototype based on acceptance and commitment therapy (ACT) in a pre-post open trial with 30 counselors and 82 student clients across 4 counseling centers. Results indicated high ratings of program satisfaction and usability with counselors and students. The majority of students completed at least part of the program. Significant improvements were found across almost all outcome and ACT process measures with student clients. Improvements in student outcomes were predicted by both changes in psychological inflexibility and how often counselors discussed the program with students. Results are discussed in relation to support for and future development of a flexible, adjunctive ACT program for counseling centers.