Robert D. Zettle

Preliminary Psychometric Properties of the Acceptance and Action Questionnaire-II: A Revised Measure of Psychological Inflexibility and Experiential Avoidance

The present research describes the development and psychometric evaluation of a second version of the Acceptance and Action Questionnaire (AAQ-II), which assesses the construct referred to as, variously, acceptance, experiential avoidance, and psychological inflexibility. Results from 2,816 participants across six samples indicate the satisfactory structure, reliability, and validity of this measure. For example, the mean alpha coefficient is .84 (.78-.88), and the 3- and 12-month test-retest reliability is .81 and .79, respectively. Results indicate that AAQ-II scores concurrently, longitudinally, and incrementally predict a range of outcomes, from mental health to work absence rates, that are consistent with its underlying theory. The AAQ-II also demonstrates appropriate discriminant validity. The AAQ-II appears to measure the same concept as the AAQ-I (r=.97) but with better psychometric consistency.

THE IMPACT OF ACCEPTANCE VERSUS CONTROL RATIONALES ON PAIN TOLERANCE

Acceptance approaches, which have been receiving increased attention within behavior therapy, seek to undermine the linkage between private events and overt behavior, rather than attempting to control the form or frequency of private events per se. Research comparing control versus acceptance strategies is limited. The present study examined the behavioral and subjective impact of a control-based versus acceptance rationale, using a cold pressor task. Subjects in the acceptance group demonstrated greater tolerance of pain compared to the control-based and placebo groups. Only the control-based rationale targeted the subjective experience of pain but it did not differ across rationales. Results confirmed that acceptance was effective in manipulating the believability of reason giving, a key process measure. By encouraging individuals to distance themselves from their private events, acceptance methods may help reduce the use of emotional reasons to explain behavior and hence shift concern from moderating thoughts and feelings to experiencing the consequences of one’s action. Acceptance is a promising new technique. Its effect is all the more surprising given that it teaches principles (e.g., “thoughts do not cause behavior”) that run counter both to the popular culture and to the dominant approaches within empirical clinical intervention.

Group cognitive and contextual therapies in treatment of depression

Depressed subjects (N = 31) were treated with three different group therapies: (a) complete cognitive therapy (CCT); (b) partial cognitive therapy (PCT); or (c) comprehensive distancing (CD). All three groups showed significant, but equivalent, reductions in depression over 12 weeks of treatment and 2-month follow-up. However, significant reductions in dysfunctional attitudes obtained for CCT and PCT were not found for CD, which suggests different underlying therapeutic processes. Comparisons with other studies noted no differences in the efficacy of CT as a function of treatment format, but a trend toward reduced effectiveness for group vs. individual CD. Suggestions for further research in CT and CD are presented.

Dysfunctional control by client verbal behavior: The context of reason-giving.

Dysfunctional control exerted by reason-giving in adult psychopathology is interpreted from a radical behavioral perspective. Verbal-social contingencies which support the establishment of reason-giving and its control over maladaptive actions are reviewed. A contextual approach to psychotherapy, comprehensive distancing, which attempts to weaken dysfunctional verbal control is described briefly. Data relevant to therapeutic process are presented. The overall results suggest that comprehensive distancing facilitates therapeutic change through a process consistent with a behavioral analysis of reason-giving. Suggestions for further research and radical behavioral approaches to psychotherapy are discussed.

Acceptance and Commitment Therapy (ACT) vs. Systematic Desensitization in Treatment of Mathematics Anxiety

College students (N = 24) experiencing math anxiety were treated individually for 6 weeks with either acceptance and commitment therapy (ACT) or systematic desensitization. Statistical analyses indicated significant, but equivalent, reductions in self-report measures of math and test anxiety that were maintained at 2-month follow-up. Both statistically and clinically significant decrements in trait anxiety were limited to participants treated with systematic desensitization. No improvement in mathematical skills was noted for either treatment. As expected, pretreatment levels of experiential avoidance were more strongly related to therapeutic change among participants receiving ACT, suggesting that the two interventions, although generally comparable in reducing math anxiety, may do so through different processes. Implications of the findings for further research on ACT more generally and treatment of math anxiety, in particular, are discussed.

Processes of change in acceptance and commitment therapy and cognitive therapy for depression: a mediation reanalysis of Zettle and Rains

Several articles have recently questioned the distinction between acceptance and commitment therapy (ACT) and traditional cognitive therapy (CT). This study presents a reanalysis of data from Zettle and Rains that compared 12 weeks of group CT with group ACT. For theoretical reasons, Zettle and Rains also included a modified form of CT that did not include distancing, and no intent-to-treat analysis was included. Particularly because that unusual third condition did somewhat better than the full CT package, it contaminated the direct comparison of ACT and CT, which has of late become theoretically interesting. In the present study, data from participants in the ACT and CT conditions were reanalyzed. ACT was shown to produce greater reductions in levels of self-reported depression using an intent-to-treat analysis. Posttreatment levels of cognitive defusion mediated this effect at follow-up. The occurrence of depressogenic thoughts and level of dysfunctional attitudes did not function as mediators. This study adds additional evidence that ACT works through distinct and theoretically specified processes that are not the same as CT.

Component and Process Analysis of Cognitive Therapy

A component and process analysis of cognitive therapy was conducted. Three components, distancing, cognitive restructuring, and behavioral homework, were presented in various sequential combinations during 12 wk. of treatment to 12 women between 22 and 64 yr. of age (M = 41.5 yr.). Time-series analyses of individual improvement suggested that components combined in an additive rather than interactive manner. The mechanisms through which components initiated therapeutic change were evaluated by measures assessing both cognitive and behavioral processes specific to depression. The results of the component and process analysis differed from predictions derived from cognitive theory. Replication with a larger sample is needed. Implications for the practice of and further research in cognitive therapy are discussed.

TREATING INPATIENTS WITH COMORBID DEPRESSION AND ALCOHOL USE DISORDERS: A COMPARISON OF ACCEPTANCE AND COMMITMENT THERAPY VERSUS TREATMENT AS USUAL

Inpatients involuntarily committed to a chemical dependency unit and exhibiting a co-occurring depressive disorder received either individual sessions of acceptance and commitment therapy (ACT) or treatment as usual (TAU) within the context of an ongoing 12-step program. Results indicated significant, but equivalent, reductions in levels of depression for both treatment conditions. However, participants randomly assigned to receive ACT (n = 12) required a shorter treatment phase and smaller dose of individual therapy to meet criteria for discharge compared to their TAU counterparts (n = 12). As expected, an analysis of the therapeutic process suggested that a differential reduction in levels of experiential avoidance associated with ACT may have contributed to its apparent relatively greater therapeutic impact. Limitations of the study, as well as its possible implications for the treatment of comorbid depression and alcohol use disorders in particular, and of co-occurring presenting clinical problems in general, are discussed.

Differential strategies in coping with pain as a function of level of experiential avoidance

Participants displaying high versus low levels of experiential avoidance as assessed by the Acceptance and Action Questionnaire (Hayes, Strosahl, et al., 2004) were compared in their reactions to and efforts to cope with pain induced by the cold pressor task. As expected, high avoidant participants were less tolerant of pain and more likely to report using dysfunctional coping strategies, but did not differ from their low avoidant counterparts in their sensitivity to pain nor ratings of its intensity. Implications of the findings for the assessment, further investigation, and conceptualization of experiential avoidance as a possible core pathogenic process are discussed.

The Evolution of a Contextual Approach to Therapy: From Comprehensive Distancing to ACT.

This paper traces the developmental history of acceptance and commitment therapy (ACT) from its beginning as comprehensive distancing to its current form and status. It is maintained that technical differences between the two approaches are overshadowed by ones of conceptualization. Comprehensive distancing emerged from efforts to extend Skinner’s work on verbal behavior and rule-governance to clinical phenomena, while relational frame theory as a post-Skinnerian account of human language has served as the conceptual foundation for ACT. Possible research strategies to further clarify conceptual differences between the two approaches are discussed.