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The relevance of individuals' values to clinical situations is increasingly recognised in political and clinical contexts. Enhancing an individual's capacity to live consistently with their values is assumed to facilitate mental well-being and quality of life (QoL). However, little research has empirically investigated whether this focus is appropriate. This collection of studies will examine the relationship between values, well-being and QoL. "Valued living" is a core aim of Acceptance and Commitment Therapy (ACT) but it has received little empirical attention. The values identified within ACT may not be equally applicable to all clinical populations. Encouraging value-consistent action is often assumed to be inappropriate to offender populations. Schwartz‟s universal model of human values is introduced to inform understanding of the relationship between values and well-being and whether mentally disordered offenders (MDOs) have similar values to a non-psychologically distressed comparison group. Method Study 1 investigated the relationship between values, quality of life (QoL), psychological distress and psychological inflexibility (cognitive fusion and experiential avoidance) amongst a sample from the non-clinical sample (N = 109) using an online survey. Study 2 compared a subsample from study 1 with MDOs detained in medium security (N = 15) on the same measures. Study 3 explored participants‟ beliefs about the origin and maintenance of meaningful values. Responses were coded according to ACT literature and analysed using content analysis. Results Amongst the non-clinical population, QoL was positively correlated with „valued living‟, and negatively correlated with psychological inflexibility and distress. Psychological distress and psychological inflexibility correlated positively with the Openness to Change value domain and conservatism correlated negatively with psychological distress. No other relationships were observed between psychological flexibility or distress and value domain in the non-clinical population. MDOs had higher rates of psychological distress and lower psychological flexibility and QoL than the non-distressed population; they also attributed less importance to the self-transcendence value domain and more to self-enhancement. Benevolence was ranked significantly lower by the MDO sample. Other large effect sizes were detected reflecting differences between the samples, but they were not statistically significant. Intrinsic reinforcement was considered an important factor that maintained values as meaningful to all participants. Self-report data suggests that there are similarities and differences to how each sample conceptualises values. Discussion A clinical focus on values appears to be justified. The addition of Schwartz‟s model provided insight into the values of MDOs. The clinical and theoretical implications of the results are discussed as are the strengths and limitations of the study.

Irritable Bowel Syndrome (IBS) is a common chronic illness thought to be originated and maintained by a combination of physiological, psychological and social factors. IBS is known to be associated with a high psychosocial impact on patients’ lives. Acceptance and Commitment Therapy (ACT) is an emerging model of conceptualization and treatment that states that most suffering in chronic illness can be explained by a lack of psychological flexibility or acceptance to experience aversive bodily sensations, thoughts or emotions. ACT treatments target the increase of psychological flexibility as a key change for improvement in outcomes. Recent studies suggest that ACT could not only be an effective alternative treatment for IBS, as it might provide a valuable model of understanding of the relations between the different factors related to this condition and its outcomes. The first aim of the present research was to investigate the role of psychological flexibility in IBS, in particular, how acceptance relates to psychological, emotional and physical factors in this condition. The second aim was to investigate the effectiveness of an ACT based intervention in increasing psychological flexibility in IBS and thereby improving IBS Outcomes. These aims were addressed by conducting two related studies. In Study 1, a sample of 121 IBS patients attending a specialized gastroenterology clinic completed a series of self-report measures of psychological flexibility (acceptance), psychological factors known to be associated with IBS and IBS outcomes. Results indicated that higher levels of acceptance were generally associated with and predicted better levels of IBS biopsychosocial factors. Results also showed that acceptance mediated most of the relationships between IBS predictors and Outcomes. Also, psychometric analyses of a novel measure of IBS Acceptance (i.e. IBS Acceptance and Action Questionnaire) created for this study demonstrated that it had good reliability and validity. In Study 2, fifty six IBS patients enrolled in an intervention involving a one day ACT workshop and an ACT based self-help workbook. Thirty six participants provided follow-up data up to 6 months after the workshop. Results indicated that there were significant increases in acceptance and significant improvement in IBS outcomes between pre-treatment and follow-up. Further to that, analyses indicated that changes in IBS Outcomes occurred through changes in acceptance as hypothesized by the ACT model. These studies suggest that psychological flexibility processes are important in the understanding of IBS and that improvement in this condition may result from a more psychologically flexible stance to it. Although preliminary, these studies provide a basis for the further development and application of the ACT model of conceptualization and treatment in IBS.

Aim: Schema therapy is becoming an increasingly popular psychological model for working with individuals who have a variety of mental health and personality difficulties. The aim of this review is to look at the current evidence base for schema therapy and highlight directions for further research. Method: A systematic search of the literature was conducted up until January 2011. All studies that had clinically tested the efficacy of schema therapy as described by Jeffrey Young (Young, 1994; Young et al., 2003) were considered. These studies underwent detailed quality assessments based on Scottish Intercollegiate Guidelines Network (SIGN-50) culminating in twelve studies being included in the review. Results: The culminative message (both from the popularity of this model and the medium to large effect sizes) is of a theory which has already demonstrated clinically effective outcomes in a small number of studies and which would benefit from ongoing research and development with complex client groups. Recommendations: It is imperative that psychological practice be guided by high quality research that demonstrates efficacious, evidence based interventions. It is therefore recommended that researchers and clinicians working with schema therapy seek to build on these positive outcomes and further demonstrate the clinical effectiveness of this model through ongoing research.

This thesis is an exploration of two interconnected areas: Acceptance and Commitment Therapy (ACT) training for helping professionals (HPs) and psychological flexibility in helping professionals. The ACT model holds that HPs need to be psychologically flexible (or, herein, flexible) in order to be effective ACT practitioners, and thus a primary goal of ACT training is to enhance participant flexibility. The first chapter is a systematic review of studies that have evaluated the effectiveness of ACT training. It focused on ACT training practices and outcomes related to knowledge, skills, and psychological flexibility in HPs. The results of this review suggested that ACT training can be effective in providing HPs from a range of occupational background with the necessary knowledge and competency to deliver ACT interventions. Furthermore, ACT training can increase HP flexibility. However, confidence in these findings is limited due to methodological weaknesses, particularly variability in ACT training practices, inconsistent use of available measures, a lack of psychometrically robust measures to assess ACT knowledge, and the absence of a flexibility measure designed for use with HP populations. Recommendations were made regarding future research needs in this area, including the development of a HP-specific measure of flexibility. The second chapter reports on the development and initial validation of a measure designed to assess flexibility in the specific context of professional helping, called the Mindful Healthcare Scale (MHS). The results of two studies employing two separates samples of HPs provided good preliminary evidence of the MHS's factor structure and internal validity. The MHS was also found to converge in theoretically-consistent ways with other measures of flexibility and constructs related to the occupational functioning of HPs including burnout syndrome, self-compassion, and empathy. These findings suggest that the MHS may have considerable utility in relation to ACT training for HPs and may also advance our understanding of flexibility's role in HP occupational well-being and functioning.

Trauma exposure among youth in the United States is a common event. Although the number of individuals who meet criteria for a diagnosis of posttraumatic stress disorder (PTSD) is only a small percentage of those exposed to trauma, many individuals who do not meet full criteria for PTSD continue to experience problematic posttraumatic stress symptomology. Acceptance and commitment therapy (ACT) is an empiricallybased psychological intervention that has shown effectiveness in the treatment of a number of concerns among both adults and adolescents. ACT has shown preliminary effectiveness in the treatment of adult PTSD, but its effectiveness in treating adolescent posttraumatic stress is currently unknown. Using a multiple-baseline design, the present study investigated the effectiveness of a 10-week ACT protocol to treat adolescents experiencing posttraumatic stress. Seven individuals between the ages of 12 and 17 participated in the treatment, four of who were from a community sample and three who were in residential care to treat comorbid eating disorders. Structured interviews were completed at pretreatment and individuals reported baseline data for anywhere from 7 to 66 days before engaging in treatment. Symptom and process measures were completed at each session. Postassessment was completed one week following the final session. Results revealed a decrease in posttraumatic stress symptomology across both samples, with a 73.7% mean reduction in self-reported posttraumatic stress symptomology and a mean reduction of 58.8% on clinician-rated measures of PTSD. Overall results provide preliminary support for ACT as an effective treatment for adolescent posttraumatic stress. Empirical and clinical implications of results as well as limitations and future directions are discussed.

A number of objective personality questionnaires have been published which aim to measure the six processes related to Acceptance and Commitment Therapy's model of treatment (acceptance, defusion, present moment awareness, self-as-context, values, and committed action). These measures operationally define these hypothesized processes in research settings. However, little research has been done to investigate whether these processes, as measured by these questionnaires, are differentiable from each other or from other, seemingly similar constructs such as distress tolerance and coping styles. Additionally, it is unclear whether these questionnaire measures have differing relationships with other potentially relevant constructs, such as psychopathology, functioning, and personality. The structure of these process measures was investigated across two participant samples. A multi-trait structure of ACT processes was found, with three higher order dimensions consisting of psychological inflexibility/cognitive fusion, mindfulness, and avoidance, as well as a number of distinguishable lower order traits. This structure was found across multiple samples, and measures of these factor analytically-derived traits were found to have incremental validity and to be distinguishable from other, superficially similar psychological processes. These results provide guidance for measurement selection and suggest future directions for scale development. Relevance to treatment outcome research is also discussed.

A large body of research has examined the appropriate time course of psychotherapy across a variety of therapeutic modalities. Research in the area of Acceptance and Commitment Therapy (ACT) has indicated the efficacy of single-session interventions in improving anxiety, depression, and even weight loss. These findings, though promising, are accompanied by the question of how much ACT is enough to make a statistically and clinically significant difference in symptoms. The present study sought to clarify this question among individuals with depression. Adults (N = 271) with elevated depressive symptoms were recruited via mass emails for a study comparing the relative effectiveness of time-variant single-session ACT interventions (90 minutes, 3 hours, 6 hours). Inclusion criteria included PHQ-8 score 10, no history of TBI, no current psychotherapy, and no medication changes in the past 60 days. Eligible participants completed a screening interview, which included modules from the M.I.N.I. Exclusion criteria included active suicidality, past or current mania, and past or current psychoses. If interested in participating (n=351), eligible participants could complete the baseline measure after enrolling in the study. Participants were randomized to a single-session 90-minute, 3-hour, or 6-hour group ACT intervention. About half (51.2%) of enrolled and randomized participants completed their assigned group intervention. Follow-up assessments were completed at 1-month and 3-months post-intervention with limited attrition. Longitudinal mixed-effects modeling was used to examine change over time and between conditions. Findings indicated that depressive symptoms and avoidance decreased over time, and social satisfaction increased over time. Differences between conditions and interactions between time and condition were not observed. Equivalency analyses revealed that the 3- and 6-hour groups were not within the margin of equivalence in terms of depressive symptoms. Mindfulness analyses revealed that at 3-month follow-up, the 3- and 6-hour groups reported higher mindfulness than the 90-minute group. The findings have public health implications in terms of reaching a larger number of patients with increased efficiency. Given the far greater patient demand than number of therapists available, increased access and efficiency are of great importance. The results also suggest that individuals with depression can make rapid, sustainable changes, and this is of critical importance clinically. Limitations included a homogenous sample of primarily white, highly educated females, and the lack of a no-treatment control group. The findings of the current study indicate that brief group ACT interventions can result in change in both processes (avoidance, mindfulness) and functioning (depressive symptoms, social satisfaction) months after the single-session intervention. Future research should examine the effectiveness of brief interventions with other symptomatology as compared to a no-treatment control or a more traditional course of psychotherapy.

A non-concurrent multiple baseline design across eight participants was used to determine whether working through Hayes and Smith's (2005) book would help those with public speaking anxiety. Hayes and Smith (2005) is based on Acceptance and Commitment Therapy. It encourages people to accept internal experiences as opposed to avoiding and struggling with them. For the purposes of this study, the book was divided into nine components, which participants discussed with the researcher. They also completed measures daily, during baseline and over the intervention period, as well as a battery of tests pre-baseline, mid and post intervention. The multiple baseline data showed that self-reported willingness to approach public speaking situations increased while self-reported avoidance decreased over the intervention. The pre and post measures also showed avoidance of internal experiences decreased significantly after the intervention. These outcomes are in line with changes suggested to result from engaging in such a therapy. The pre and post results also showed that quality of life increased significantly from mid to post-intervention. However, engagement with values did not change. While this measure is expected to change after such an intervention, this result may have occurred because the ideas about values were introduced last in the book. The intervention also led to significant decreases in anxiety, significant changes in thoughts about public speaking and significant increases in anxiety control as shown by the test battery. These findings are positive but are not predicted by processes posited for this therapy. However, there was no control group so these pre vs post comparisons must be interpreted with caution. Despite this limitation, the results suggest that the book, together with therapist contact, can help those with public speaking anxiety.

Anorexia nervosa är ett allvarligt tillstånd med hög dödlighet i långtidsuppföljningar. Trots detta finns i dagsläget ingen tydlig evidens vad gäller val av metod eller effektivitet när det gäller behandling för denna problematik. Föreliggande uppsats rapporterar preliminära resultat från en randomiserad kontrollerad studie av självhjälp med e-poststöd för individer med full och partiell anorexia nervosa. Syftet var att undersöka huruvida en behandling i självhjälpsformat som bygger på rekommenderade riktlinjer för vård av anorexia nervosa samt acceptance and commitment therapy är effektiv med avseende på beteende-, attityd- ochpersonlighetsvariabler relaterade till ätstörningsproblematik samt generella variabler som depression, självkänsla, tillfredställelse med livet och social anpassning. Under tidsperioden inkluderades 15 deltagare i studien och randomiserades till behandling(N=7) eller väntelista (N=8). Deltagare genomgick EDE-intervju före och efter behandling respektive väntelista samt svarade på en rad självskattningsformulär. Behandling respektive väntelista pågick under 12 veckor där deltagare i behandlingsgruppen arbetade på egen handmed ett nyskrivet självhjälpsmaterial med stöd via e-post från en kontaktperson.”Intent-to-treat”-analyser visade på enstaka signifikanta förbättringar i inomgruppsjämförelser mellan för- och eftermätning för behandlingsgruppen på attitydvariabler. Deltagarna i behandlingsgruppen försämrades dock signifikant på den generella variabeln social anpassning. Beräkning av kliniskt signifikanta förbättringar visade på enstaka förbättringar för enskilda deltagare. Ingen deltagare rörde sig ur en ätstörningsdiagnos men två deltagare i behandlingsgruppen ökade i vikt. Ingen deltagare i väntelistgruppen ökade lika mycket, istället gick tre ner motsvarande vikt. Slutsatserna är att resultaten är för preliminära för att med säkerhet kunna uttala sig ombehandlingsformatets effektivitet för denna problematik. Data från fler deltagare samt uppföljningsmätningar behövs för att kunna besvara frågeställningarna på ett adekvat sätt.