Jesse M. Crosby

Acceptance and commitment therapy as a treatment for problematic internet pornography viewing.

Despite the prevalence of problematic Internet pornography viewing and the breadth of intervention approaches to potentially address it, no studies to address this problem have been reported to date. An emerging treatment approach, Acceptance and Commitment Therapy (ACT), holds promise as a treatment for Internet pornography viewing because of its focus on processes hypothesized to underlie this maladaptive behavior. In the first experiment on the treatment of problematic Internet pornography viewing, 6 adult males who reported that their Internet pornography viewing was affecting their quality of life were treated in eight 1.5-hour sessions of ACT for problematic pornography viewing. The effects of the intervention were assessed in a multiple-baseline-across-participants design with time viewing pornography as the dependent variable. Treatment resulted in an 85% reduction in viewing at posttreatment with results being maintained at 3-month follow-up (83% reduction). Increases were seen on measures of quality of life, and reductions were seen on measures of OCD and scrupulosity. Weekly measures of ACT-consistent processes showed reductions that corresponded with reductions in viewing. Large reductions were seen on a measure of psychological flexibility, and minor reductions were seen on measures of thought-action fusion and thought control. Overall, results suggest the promise of ACT as a treatment for problematic Internet pornography viewing and the value of future randomized trials of this approach.

Viewing Internet Pornography: For Whom is it Problematic, How, and Why?

This study investigated the prevalence of problematic Internet pornography viewing, how it is problematic, and the psychological processes that underlie the problem in a sample of 84 college-age males using an anonymous online survey. It was found that approximately 20%–60% of the sample who view pornography find it to be problematic depending on the domain of interest. In this study, the amount of viewing did not predict the level of problems experienced. Mediational analyses suggest that the manner in which an individual interacts with urges to view pornography may be related to whether viewing is problematic or not.

Treatment of Three Anxiety Disorder Cases with Acceptance and Commitment Therapy in a Private Practice

Acceptance and commitment therapy (ACT) for anxiety disorders is a type of cognitive behavioral therapy that focuses on decreasing the behavior regulatory function of anxiety and related cognitions, and has a strong focus on behavior change that is consistent with client values. In this case series, 3 consecutive referrals seeking treatment for anxiety disorders at a private practice were treated with 9–13 sessions of ACT. In-session exposure therapy was not included to determine the effects of ACT without the compounding effects of already proven treatment procedures. The treatment procedure was identical across disorders to test the use of a unified treatment protocol for anxiety disorders: panic disorder with agoraphobia, comorbid social phobia and generalized anxiety disorder, and posttraumatic stress disorder. All participants showed clinical improvement in their specific anxiety disorders as rated on multiple standardized assessments after treatment, with gains maintained at follow-up (8 months or more). Time series assessments, taken throughout treatment, of anxiety and avoidance behaviors showed large decreases in avoidance but not in anxiety, suggesting ACT was effective by changing the way participants responded to anxiety rather than anxiety itself.

Acceptance and Commitment Therapy for Problematic Internet Pornography Use: A Randomized Trial ☆

Problematic Internet pornography use is the inability to control the use of pornography, the experience of negative cognitions or emotions regarding pornography use, and the resulting negative effects on quality of life or general functioning. This study compared a 12-session individual protocol of acceptance and commitment therapy (ACT) for problematic Internet pornography use to a waitlist control condition with 28 adult males, all but 1 of whom were members of the Church of Jesus Christ of Latter-day Saints. Measures of self-reported pornography viewing, standardized measures of compulsive sexual behavior and related cognitions, and quality of life occurred at pretreatment, posttreatment, and 3-month follow-up. Results demonstrate significant between-condition reductions in pornography viewing compared to the waitlist condition (93% reduction ACT vs. 21% waitlist). When combining all participants (N=26), a 92% reduction was seen at posttreatment and an 86% reduction at 3-month follow-up. Complete cessation was seen in 54% of participants at posttreatment and at least a 70% reduction was seen in 93% of participants. At the 3-month follow-up assessment, 35% of participants showed complete cessation, with 74% of participants showing at least 70% reduction in viewing. Treatment suggestions and future directions are discussed.

Intensive residential treatment for severe obsessive-compulsive disorder: Characterizing treatment course and predictors of response

BACKGROUNDnIntensive residential treatment (IRT) is effective for severe, treatment-resistant obsessive-compulsive disorder (OCD). We sought to characterize predictors and course of response to IRT.nnnMETHODSnAdmission, monthly, and discharge data were collected on individuals receiving IRT. We examined the association between baseline characteristics and percent change in OCD symptoms as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) using linear regression. We compared baseline characteristics of IRT responders (≥35% reduction in Y-BOCS) versus non-responders, and of patients who did versus those who did not achieve wellness (Y-BOCSxa0≤xa012) using non-parametric tests. To examine the course of OCD severity over time, we used linear mixed-effects models with randomly varying intercepts and slopes.nnnRESULTSnWe evaluated 281 individuals admitted to an IRT program. Greater baseline Y-BOCS scores were associated with a significantly greater percent reduction in Y-BOCS scores (βxa0=xa0-1.49 ([95% confidence interval:xa0-2.06 toxa0-0.93]; Pxa0<xa0.001)). IRT responders showed significantly greater baseline Y-BOCS scores than non-responders (mean (SD) 28 (5.2) vs. 25.6 (5.8); Pxa0=xa0.003) and lower past-year alcohol use scores than non-responders (1.4 (1.9) vs. 2.1 (2.2); Pxa0=xa0.01). Participants who achieved wellness displayed lower hoarding factor scores than those who did not (5 (4.6) vs. 9.53 (6.3); Pxa0=xa0.03). OCD symptoms declined rapidly over the first month but more slowly over the remaining two months.nnnCONCLUSIONSnHigher baseline OCD severity, lower past-year alcohol use, and fewer hoarding symptoms predicted better response to IRT. IRT yielded an initial rapid reduction in OCD symptoms, followed by a slower decline after the first month.

How willing are you? Willingness as a predictor of change during treatment of adults with obsessive-compulsive disorder

Exposure and response prevention (ERP) is an effective treatment for individuals with obsessive–compulsive disorder (OCD), yet a substantial number of individuals with OCD do not fully respond to this intervention. Based on emerging experimental and clinical research on acceptance, this study sought to explore whether willingness to experience unpleasant thoughts, emotions, and bodily sensations during ERP was associated with improved treatment response.

Can Distressing Sexual Thoughts Be Regulated? Experiential Willingness Versus Distraction

This study examines the effects of different techniques on the management of unwanted sexual thoughts. Participants (N = 150; 67 who found sexual thoughts distressing, 83 participants who did not) were randomly placed into one of three experimental conditions: experiential willingness, distraction, or no strategies for dealing with unwanted sexual thoughts. Participants answered questions assessing attitudes about their sexual thoughts and recorded sexual thought frequency for a 3-minute period pre- and post-intervention. Thought frequencies decreased for all groups post intervention for both the distressed and nondistressed samples. Acceptability of thoughts increased for the experiential willingness group, remained similar for the distraction group, and decreased for the control group. The findings indicate that distraction was more easily implemented, more commonly used, and equally effective to experiential willingness at reducing sexual thoughts in the short term. However, the short experiential willingness intervention increased acceptability of sexual thoughts, which could have an impact on longer-term results.

Validation of the distress tolerance scale-short form in obsessive compulsive disorder

OBJECTIVEnThis study aimed to develop and validate the Distress Tolerance Scale-Short Form (DTS-SF), a modification of the original Distress Tolerance Scale, in a severe/complex sample of individuals with obsessive compulsive disorder (OCD). Currently, there are multiple self-report measurements of distress tolerance (DT), highlighting the need for a more refined measure.nnnMETHODnParticipants included 222 individuals with a primary diagnosis of OCD (57% male, average agexa0=xa031) seeking intensive/residential treatment. Participants completed surveys at admission, discharge, and each week.nnnRESULTSnAn exploratory factor analysis revealed a one-factor solution representing overall DT ability. The DTS-SF was found to be sensitive to treatment effects. Appropriate associations between the DTS-SF and other measures were also found, with lower DT associated with greater OCD and depression severity and lower reported quality of life.nnnCONCLUSIONnThe DTS-SF was found to be a valid and reliable measure with high clinical utility for quickly and accurately measuring DT.

Validating an abbreviated version of the Obsessive Beliefs Questionnaire

OBJECTIVESnA shorter version of the Obsessive Beliefs Questionnaire (OBQ-44) is needed to promote the use of this measure in research and increase our understanding of cognitive phenomena maintaining obsessive-compulsive disorder (OCD). Additionally, an abbreviated version of the OBQ-44 would encourage frequent monitoring of dysfunctional beliefs in intensive care settings. This study aimed to validate a nine-item version of the questionnaire (OBQ-9).nnnMETHODnParticipants seeking intensive/residential treatment for OCD (Nxa0=xa0311) completed relevant measures on a weekly basis and at admission and discharge.nnnRESULTSnA confirmatory factor analysis revealed that the OBQ-9s factor structure replicated the three-factor solution of the OBQ-44. The OBQ-9 demonstrated good psychometric properties and convergent validity and was sensitive to treatment effects. Finally, the OBQ-9 subscales predicted specific OCD dimensions over and above depressive symptoms.nnnCONCLUSIONnThe OBQ-9 appears to be a psychometrically sound tool for routine outcome monitoring of dysfunctional beliefs in hospital-based settings.