The consequences of war and conflict on mental health remain long after the events are over. Several publications and reports highlight the need for effective and cost-effective treatments targeting mental ill-health in war affected low-income countries. This study investigated the effects of a two-session Acceptance and Commitment Therapy (ACT) intervention on quality of life, psychological flexibility and Steps taken in valued direction. Participants were women (N=6) seeking help for HIV, Pain and Sexual abuse at a Non Governmental Organization in Sierra Leone. A single case design with repeated measures and pre, mid, and post-measures was used. Results show support for the interventions effect on Quality of Life and Steps taken in valued direction. Due to the small sample size in this pilot study the significance of the findings is limited.

Thesis (Ph.D.) in Psychology--University of Maine, 2008. / Includes vita. Includes bibliographical references (leaves 157-191).

Background and Aims: Whilst bereavement is a generally a normal process of adjustment, for some individuals the outcome can be more serious. Current bereavement research has produced inconclusive results to date and been criticised on many levels. A gap has been identified between research and the practice of bereavement therapy.The aim of this thesis is to examine a relatively new and under researched approach to the treatment of grief, namely the use of Acceptance and Commitment Therapy (ACT). It is proposed that this approach could provide an empirically sound model on which therapists could base their interventions. Method: Firstly a conceptual review examines the key components of ACT and their applicability to grief work. Secondly, a qualitative piece of research uses interpretative phenomenological analysis to explore the lived experiences of both therapists and clients who have used the approach. Results: The conceptual review finds a good degree of fit between the components of the ACT therapeutic model and the needs and aims of bereavement work. The qualitative study provides preliminary support for the application of the model in the treatment of grief, indicating positive experiences for both therapists and clients particularly in its valuing of the individual nature of grief, its ability to put suffering into a positive context and its strength in dealing with emotional and thought related issues. Implications: The thesis provides a theoretical underpinning and an exploration of practice in the treatment of grief which may be useful for therapists considering a new approach to grief work or those developing services for the bereaved.

Introduction Acceptance and Commitment Therapy (ACT) has developed from traditional behavioural theory and seeks to reduce experiential avoidance and increase psychological flexibility. It is argued to be distinct from cognitive therapy and has been used to treat a variety of mental health problems in addition to chronic pain. ACT is linked to Relational Frame Theory and the research developments associated with this. One central process of ACT is termed ‘cognitive defusion’ and this process is used to encourage individuals to become less identified with the content of their cognitions. It is important to measure the extent to which individuals become ‘fused’ with their cognitions and a Cognitive Fusion Questionnaire (CFQ) has been developed to do this. The current studies build upon earlier research by subjecting the CFQ to further reliability and validity testing and assessment of its factor structure. Method A community sample was used throughout. The majority of participants took part online, however, some participants completed paper copies of the questionnaires. Study one had a sample of 47 and focused on construct validity of the CFQ where participants completed this measure and also measures of similar and distinct constructs. The other measures included a mindfulness questionnaire, a measure of experiential avoidance and a social desirability questionnaire. Study two concerned the test-retest reliability of the CFQ. There were 82 participants in this study who completed the CFQ on two occasions, one month apart. In this study, participants also completed a measure of anxiety and depression symptoms. Study three had 144 participants and assessed the factor structure of the CFQ. Results Results from study one indicate that the CFQ negatively correlates with a measure of mindfulness and positively correlates with a measure of experiential avoidance. This study also found that the CFQ has no relationship with a measure of conscious attempts to appear more desirable. Results from study two show that there is a strong positive correlation between scores on the CFQ at testing time one and testing time two. The CFQ was also found to correlate positively with a measure of anxiety and depression symptoms and to mediate the relationship between anxiety scores at testing time one and testing time two. Confirmatory factor analysis was used in study three to assess the factor structure of the CFQ and found a two factor model was the best fit for the data. Discussion The results are considered in relation to relevant research. Limitations of the current studies are assessed and possibilities for future research discussed. In particular, cognitive fusion is discussed in relation to anxiety and depression symptoms. The similarities between the CFQ and a measure of experiential avoidance are discussed and the different aspects of measurement are reflected upon.

Acceptance and Commitment Therapy (ACT) is a behaviorally-based intervention that promotes values-driven behavior change. ACT teaches skills such as acceptance, present-moment awareness, commitment to values-based actions, and new ways to interact with stressful and anxiety provoking thoughts and feelings. Mindfulness is a popular component of present moment awareness that is often taught within an ACT model of intervention. The purpose of this study was to determine if mindfulness alone or ACT could influence the psychological flexibility and attention of children with autism and related disabilities aged 7-18. Ten participants received 4 weeks of either ACT or mindfulness training in a group therapy setting twice a week. A series of psychological flexibility and mindfulness questionnaires were administered to the participants along with computerized and physical attention tasks prior to and after completing the series of ACT and mindfulness activities sequence. The overall result of the study indicated that ACT may be a way to provide more wholistic services to children and adolescents with autism compared to mindfulness only, but that both interventions have value within this serviced population.

This thesis is an exploration of values-consistent behaviour from a contextual behavioural science perspective. The first chapter is a systematic review of the effectiveness of acceptance and commitment therapy in enhancing values-consistent behaviour. The results from this review were inconclusive, mainly due to a lack of psychometrically robust outcome measures, and inconsistent use of available measures. Recommendations were made to improve the utility of measures of values-consistent behaviour. The second chapter reports a cross-sectional survey of adolescents, aimed at testing the psychometric properties of values measures, and assessing the relationship between values-consistent behaviour and wellbeing. The measures used in this study were the Valued Living Questionnaire 2 (VLQ-2), Portrait Values Questionnaire – Second Revision, Child and Adolescent Mindfulness Measure, Avoidance and Fusion Questionnaire for Youth – Short Form, and the Warwick-Edinburgh Mental Well-being Scale. Using the VLQ-2 in its current form, values-consistent behaviour was found to account for an additional 13% of variance in wellbeing, above the contributions of demographics, mindfulness and experiential avoidance. However, a recommendation was made for adaptions to be made to the VLQ-2 to make it more suitable for adolescents.

Background: The aim of this thesis was to provide a systematic examination of the potential of a Verbal Thought Disruption Technique (VTDT) in reducing ruminative and intrusive thoughts (RATs). Thought Suppression (TS) is a commonly used tactic to deal with RATs. In contrast, very little is known about VTDT as a specific cognitive defusion technique in particular, or as a cognitive behavioural technique in general. Methodology: A mixed methods case series design was used for this project. 10 individuals were involved over a 12-week period. An ABACAB design was utilised in which each individual received no intervention (A), a VTDT intervention (B) and a TS intervention (C) over the course of the study. Change was monitored quantitatively utilising the Meta-Cognitive Questionnaire-30 (MCQ-30), Thought Control Questionnaire (TCQ) and the General Health Questionnaire (GHQ). Additionally the measures were also completed at a one-month follow-up alongside the completion of Client Change Interview Protocol. The quantitative data was analysed by calculating the effect sizes of the reported change and the qualitative data analysed by thematic analysis. Results: Use of VTDT appeared to have a positive impact on RATs five MCQ-30 sub-measures (Cognitive Confidence, Need for Control, Cognitive Self-Consciousness, Positive and Negative Beliefs). VTDT use showed a positive impact as measured by the TCQ in four areas Distraction, Punishment Re-appraisal and Worry. The GHQ showed positive effects for VTDT use in the areas of Anxiety and Insomnia, and Social Dysfunction. TS had a negative impact on all measures. VTDT decreased numbers of RATs and severity of Subjective Units of Distress (SUDs) and TS increasing them, indicating a beneficial effect for VTDT and a detrimental effect for TS. The size of this effect was greater on SUDs than on RATs. Qualitative analysis at follow up identified factors that supported the use of VTDT and of the lack of utility of TS protocols to deal with RATs. Moderating factors for the first technique were found in the lack of willingness of some participants to use it in the future. A new working model of RATs was proposed. Conclusions: Conclusions reached are that VTDT may be a useful addition to an already wide range of cognitive defusion techniques already used in Acceptance and Commitment Therapy (ACT), and that it deserves further systematic research. TS, as previously found, appeared not to be a useful technique in dealing with RATs on most of the measures used.

Acceptance and Commitment Therapy (ACT) is designed to target psychological flexibility, broadly defined as engagement with personal values regardless of the presence of difficult private events. As engagement with valued behaviors is imperative to psychological flexibility, clarification of values is an essential skill for clients to learn. Practicing of skills in treatment has historically been a difficult hurdle for clinicians to implement between sessions for clients as well. The present study examined the utility of a novel values card sort activity, as well as the utility of a rubber band to act as a reminding agent for engagement with values. 112 undergraduate students were randomly assigned to one of three conditions: a values card sort condition, a values card sort condition with a rubber band given to the participant, and a control card sort condition. Each participant completed questionnaires assessing connection with values, lack of contact with values, negative affect, and quality of life at baseline and at a one-week follow-up. A series of ANCOVAs were conducted to determine if there were any group differences between the three conditions at follow-up, with baseline scores as a covariate. The analyses indicate no significant difference between the conditions at follow-up across any of the variables of interest. Endorsement of prior therapy experience suggested unique trends and differential reaction to the card sorting activity. These findings suggest the values card sort may not be an effective intervention for subclinical populations but may be a fruitful intervention for clinically-elevated individuals.

Compulsive pornography use (CPU) is generally defined by the inability to control the use of pornography and the resulting negative effects on quality of life or general functioning including damaged relationships, loss of productivity, impaired performance at work or school, job loss, financial expenses, guilt/shame, and personal distress. Statistics indicate that CPU may be as common as other psychological disorders and that the effects of the behavior can be just as severe. It is estimated that 1.5% to 3% of the adult population of the United States meets the criteria for compulsive pornography use. A review of the literature found no randomized controlled investigations of psychosocial treatments for this problem. This study reports the results of a randomized clinical trial of acceptance and commitment therapy (ACT) for the treatment of compulsive pornography use comparing an active treatment condition (n = 14) with a waitlist control (n = 14). The results showed a significant 93% decrease in self-reported hours viewed per week from pretreatment to posttreatment compared to the control condition, which experienced a 21% decrease. In a 20-week follow-up assessment, the treatment group did not change significantly from posttreatment to follow-up with an 84% decrease, indicating relative maintenance of the treatment gains. The control condition received the active treatment after the waiting period and was combined with the treatment group to calculate an overall effect size from pretreatment to posttreatment of 1.86. This is supported by clinical effectiveness data that shows 54% of the participants completely stopped viewing at posttreatment and another 39% of participants reduced viewing by at least 70% of pretreatment levels by posttreatment. Additional measures of quality of life, sexual compulsivity, and negative outcomes of sexual behavior were also completed and support the behavioral self-report results. These results are significant because they provide the first randomized group evidence of an effective treatment for compulsive pornography use. Implications and future directions are discussed.

The current research was a randomised two group (control and treatment) study that evaluated the effectiveness of an ACT-based self-help book for people with chronic pain. Over a 6-week period, 6 participants read the book and completed exercises from it with weekly telephone support while 8 others waited. Five of these others began the intervention after a 6-week control period. Participants completed pre- and post-intervention questionnaires for acceptance, values illness, quality of life, satisfaction with life, depression, anxiety and pain. Initial outcome data were collected for 8 control participants and 6 intervention participants. A total of 11 participants completed pre- and post-intervention measures. Participants' who read the book, rated the content of the book each week according to reading level and usefulness, and their comprehension of the content was also assessed. Original group data showed statistically significant improvement in acceptance and quality of life for those who completed the intervention. Once the data were pooled, statistically significant improvements in acceptance, quality of life, satisfaction with life, and values illness were found. In general, using the self-help book did not result in reduced pain, depression or anxiety, although for some individuals gains were made in these areas. Individual perceptions of the book components were varied but findings suggest that cognitive defusion and mindfulness were parts of the book that participants found hard. The current findings support the hypothesis that using the self-help book would add value to the lives of people who experience chronic pain. Thus, the book may be a useful tool for people who experience chronic pain.