Kate L. Morrison

Acceptance and Commitment Therapy for Anxiety and OCD Spectrum Disorders: An Empirical Review

A fair amount of research exists on acceptance and commitment therapy (ACT) as a model and a treatment for anxiety disorders and OCD spectrum disorders; this paper offers a quantitative account of this research. A meta-analysis is presented examining the relationship between psychological flexibility, measured by versions of the Acceptance and Action Questionnaire (AAQ and AAQ-II) and measures of anxiety. Meta-analytic results showed positive and significant relationships between the AAQ and general measures of anxiety as well as disorder specific measures. Additionally, all outcome data to date on ACT for anxiety and OCD spectrum disorders are reviewed, as are data on mediation and moderation within ACT. Preliminary meta-analytic results show that ACT is equally effective as manualized treatments such as cognitive behavioral therapy. Future directions and limitations of the research are discussed.

Acceptance and Commitment Therapy for the Treatment of Posttraumatic Stress Among Adolescents

The number of individuals who meet diagnostic criteria for posttraumatic stress disorder (PTSD) is a small percentage of those exposed to trauma; many youth who do not meet criteria for PTSD continue to experience problematic posttraumatic stress (PTS) symptomology. Acceptance and commitment therapy (ACT) has shown preliminary effectiveness in the treatment of adult PTSD, but its effectiveness in treating PTS in youth is unknown. Using a multiple-baseline design, this study investigated the effectiveness of 10 weeks of ACT to treat PTS in youth. Four adolescents from a community sample and three adolescents from a residential sample participated. The Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA), Child PTSD Symptom Scale (CPSS), and Comprehensive Quality of Life Scale were completed at pretreatment, posttreatment, and 3-month follow-up. Individuals reported baseline data for 7 to 66 days. Symptom and process measures were completed at each session. Results revealed a decrease in PTS symptomology across both samples with mean reductions in self-reported PTS symptomology at posttreatment of 69% and 81% for the community and residential samples, respectively, and an overall 68% and 84% respective reduction at follow-up. Reductions in clinician rated measures of PTSD were observed for all participants with mean reductions of 57% and 61% in the community and residential samples at posttreatment, and 71% and 60% at follow-up, respectively. Results provide preliminary support for ACT as a treatment for adolescent PTS. Empirical and clinical implications as well as limitations and future directions are discussed.

Acceptance and Commitment Therapy as a Treatment for Scrupulosity in Obsessive Compulsive Disorder

This study evaluated acceptance and commitment therapy (ACT) for scrupulosity-based obsessive compulsive disorder (OCD). Five adults were treated with eight sessions of ACT, without in-session exposure, in a multiple baseline across participants design. Daily monitoring of compulsions and avoided valued activities were tracked throughout the study. The Obsessive Compulsive Inventory–Revised, Yale–Brown Obsessive Compulsive Scale (Y-BOCS), Penn Inventory of Scrupulosity, Beck Depression Inventory–II, Quality of Life Scale, Santa Clara Strength of Religious Faith Questionnaire, and the Acceptance and Action Questionnaire–II were completed at pretreatment, posttreatment, and 3-month follow-up. The Treatment Evaluation Inventory was completed at posttreatment. Average daily compulsions reduced as follows: pretreatment = 25.0, posttreatment = 5.6, and follow-up = 4.3. Average daily avoided valued activities reduced as follows: pretreatment = 6.0, posttreatment = 0.7, and follow-up = 0.5. Other measures showed similar patterns. Religious faith only slightly declined: 4% at posttreatment and 7% at follow-up. Treatment acceptability was high.

Acceptance and Commitment Therapy for Obsessive Compulsive Disorder and Obsessive Compulsive Spectrum Disorders: A Review

This paper reviews Acceptance and Commitment Therapy (ACT) for Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive (OC) spectrum disorders (e.g., trichotillomania and chronic skin picking). It reviews the philosophy of science that underlies ACT: functional contextualism; the basic research that informs it: learning theory, rule governed behavior and relational frame theory; ACT’s model: psychological flexibility; and the research to date that supports ACT for OCD and OC spectrum disorders. Limitations to this research and future directions are discussed.

Acceptance and Commitment Therapy for Trichotillomania: A Randomized Controlled Trial of Adults and Adolescents

The purpose of this study was to examine acceptance and commitment therapy (ACT) as a standalone treatment for trichotillomania in a randomized controlled trial of adults and adolescents. Participants consisted of a community sample of treatment seeking adults and adolescents with trichotillomania. Of the eligible 39 participants randomized into treatment and waitlist groups, 25 completed treatment and were included in the final analysis. Treatment consisted of a 10-session ACT protocol. Multiple mixed models repeated measures analyses were utilized to evaluate changes in trichotillomania symptom severity, daily number of hairs pulled and urges experienced, and experiential avoidance from pretreatment to posttreatment. Findings indicated significant changes in symptom severity and daily hairs pulled, but not daily urges experienced or psychological flexibility. However, psychological flexibility saw a 24.5% decrease in the treatment group and reduced from clinical to subclinical levels on average. This study suggests that ACT alone is an effective treatment for adults and adolescents with trichotillomania. Outcomes appear to be similar to trials that combined ACT and habit reversal training (HRT).

A Functional and Cohesive Treatment of Tourette’s Disorder and Chewing Tobacco Use

Acceptance and commitment therapy (ACT) is a function-based treatment that can be applied to multiple clinical concerns where psychological inflexibility is a mediating issue. This case study describes the use of ACT in combination with habit reversal training for a man with a primary concern of Tourette’s disorder and a secondary concern of chewing tobacco use. Large reductions were seen in the primary outcomes of motor and vocal tics (measured by behavioral tracking and a semi-structured assessment) and chewing tobacco use after 19 individual sessions. Furthermore, increases in psychological flexibility and quality of life and decreases in overall symptomatology were seen at posttreatment. This article conceptualizes this case from a cohesive theory, describes the details of the presenting concerns, and explains the treatment used and treatment outcomes. A description of barriers and suggestions for further treatment and research are also presented.