Jason Lillis

The Impact of Treatment Components Suggested by the Psychological Flexibility Model: A Meta-Analysis of Laboratory-Based Component Studies

An important aspect of psychotherapy research is the examination of the theoretical models underlying intervention approaches. Laboratory-based component research is one useful methodology for this endeavor as it provides an experimental means of testing questions related to intervention components and the change process they engage with a high level of control and precision. A meta-analysis was conducted of 66 laboratory-based component studies evaluating treatment elements and processes that are suggested by the psychological flexibility model that underlies Acceptance and Commitment Therapy (acceptance, defusion, self as context, committed action, values, and present moment), but also touches on a variety of contextual forms of cognitive behavior therapy. Significant positive effect sizes were observed for acceptance, defusion, present moment, values, mixed mindfulness components, and values plus mindfulness component conditions compared to inactive comparison conditions. Additional analyses provided further support for the psychological flexibility model, finding larger effect sizes for theoretically specified outcomes, expected differences between theoretically distinct interventions, and larger effect sizes for component conditions that included experiential methods (e.g., metaphors, exercises) than those with a rationale alone. Effect sizes did not differ between at-risk/distressed and convenience samples. Limitations with the meta-analysis and future directions for laboratory-based component research are discussed.

Applying acceptance, mindfulness, and values to the reduction of prejudice - : A pilot study

Two classroom approaches to reducing racial and ethnic prejudice among college students were compared: a class session based on acceptance and commitment therapy (ACT) and an educational lecture drawn from a textbook on the psychology of racial differences. Undergraduates who were enrolled in two separate classes on racial differences were exposed to each approach in a counterbalanced order. Results indicate that only the ACT intervention was effective in increasing positive behavioral intentions at post and a 1-week follow-up. These changes were associated with other self-reported changes that fit with the ACT model. Implications of a potentially new model of prejudice are briefly discussed.

Measuring Avoidance and Inflexibility in Weight Related Problems

There is growing evidence that experiential avoidance and psychological inflexibility plays a role in a variety of clinical presentations, including health problems. The present study presents preliminary data on a new measure of these processes in relation to difficult weight-related thoughts, feelings, and actions: The Acceptance and Action Questionnaire for Weight-Related Difficulties (AAQW). Data were examined from 84 participants enrolled in a weight maintenance study. The AAQW showed good internal consistency (α=.88) and correlated with other related measures, including the original Acceptance and Action Questionnaire (AAQ). The AAQW also changed when targeted by Acceptance and Commitment Therapy. The AAQW, while still in need of refinement, shows promise to become a useful measure for evaluating new intervention targets in weight control intervention, such as acceptance of difficult emotions.

Measuring weight self-stigma: the weight self-stigma questionnaire.

Stigma associated with being overweight or obese is widespread. Given that weight loss is difficult to achieve and maintain, researchers have been calling for interventions that reduce the impact of weight stigma on life functioning. Sound measures that are sensitive to change are needed to help guide and inform intervention studies. This study presents the weight self‐stigma questionnaire (WSSQ). The WSSQ has 12 items and is designed for use only with populations of overweight or obese persons. Two samples of participants—one treatment seeking, one nontreatment seeking—were used for validation (N = 169). Results indicate that the WSSQ has good reliability and validity, and contains two distinct subscales—self‐devaluation and fear of enacted stigma. The WSSQ could be useful for identifying individuals who may benefit from a stigma reduction intervention and may also help evaluate programs designed to reduce stigma.

Exploring the relationship between body mass index and health-related quality of life: A pilot study of the impact of weight self-stigma and experiential avoidance

Health-related quality of life (HRQL) has been shown to deteriorate as body mass index (BMI) increases. Recent research suggests weight stigma and experiential avoidance may partially account for the relationship between BMI and HRQL. Eighty-seven adults recruited from a weight-loss clinic completed an intake assessment, which consisted of physical measurement taking and completion of self-report measures. Experiential avoidance and weight self-stigma were significant predictors of HRQL and mediated the relationship between BMI and HRQL. Results provide preliminary support for targeting weight stigma and experiential avoidance in order to produce changes in HRQL with or without concurrent weight loss.

Binge Eating and Weight Control: The Role of Experiential Avoidance.

Two thirds of the adults in the United States are overweight or obese. Binge eating is a barrier to treatment adherence and sustained weight loss, and can be seen as a form of experiential avoidance. The current study analyzed the impact of binge eating on weight reduction in a previously published study of a 1-day acceptance and commitment therapy (ACT) workshop (N = 83) and the psychological processes accounting for the binge-eating results. ACT participants reported less binge eating, which in turn significantly mediated changes in weight. Mediation analyses also showed that reductions in binge eating were mediated by changes in experiential avoidance. The study suggests that ACT and its targeted processes of change may be particularly relevant to binge eating, and that targeting binging is a possible pathway for improving weight management.

A Parametric Study of Cognitive Defusion and the Believability and Discomfort of Negative Self-Relevant Thoughts

A previous time-series study showed that rapidly repeating a single-word version of a negative self-referential thought reduced the discomfort and the believability associated with that thought. The present parametric study examined whether durations of word repetition were differentially effective in altering the discomfort and believability of negative self-referential thought. In two studies, both discomfort and believability varied systematically with the duration of word repetition. The effects of rapid repetition on emotional discomfort bottomed out after 3 s to 10 s of rapid repetition, whereas the effects on believability did so after 20 s to 30 s of repetition. This study lends support to the cognitive defusion interpretation of the effect of word repetition, suggesting that emotional discomfort and believability may be distinctive functional aspects of cognitive events.

When is Online Pornography Viewing Problematic Among College Males? Examining the Moderating Role of Experiential Avoidance

Internet pornography viewing is common among college-aged males, but it is unclear whether and for whom such viewing is problematic. One potential process that may account for whether viewing is problematic is experiential avoidance: seeking to reduce the form, frequency, or situational sensitivity of private experiences even when doing so causes behavioral harm. The current study examined the relationship of Internet pornography viewing and experiential avoidance to a range of psychosocial problems (depression, anxiety, stress, social functioning, and problems related to viewing) through a cross-sectional online survey conducted with a non-clinical sample of 157 undergraduate college males. Results indicated that frequency of viewing was significantly related to each psychosocial variable, such that more viewing was related to greater problems. Furthermore, experiential avoidance moderated the relationship between viewing and two psychosocial variables, such that viewing predicted anxiety and problems related to viewing only among those participants with clinical levels of experiential avoidance. These results are discussed in the context of research on experiential avoidance and treatment approaches that target this process.

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.

Avoidance and Inflexibility as a Common Clinical Pathway in Obesity and Smoking Treatment

This brief study presents reductions in avoidance and inflexibility as a potential common clinical pathway to intervene on for both smoking cessation and weight control. A mediation analysis—using the Avoidance and Inflexibility Scale (AIS)—was conducted on a group of participants (N = 84) who were shown to improve weight control outcomes after receiving an Acceptance and Commitment Therapy (ACT) intervention. Results were then compared to a previous study using the same process measure (AIS) for smoking cessation. Results suggest a common clinical pathway.