Musikalisk prestationsångest (MPA) är ett vanligt förekommande problem bland musiker och kan i vissa fall omöjliggöra en karriär som musiker. Syftet med föreliggande studie var att utvärdera en 5 sessioners behandling med Acceptance and Commitment Therapy (ACT) för MPA. Resultatet är lovande, 7 av 8 deltagare fullföljde behandlingen och flera deltagare fick förbättringar på såväl ACT-relaterade mått som på mått för MPA. Resultatet motiverar vidare forskning om ACT för MPA. / Musical performance anxiety (MPA) is a common problem among musicians and can in certain cases make impossible a career as a musician. The aim with the present study was to evaluate a 5 sessions' treatment with Acceptance and Commitment Therapy (ACT) for MPA. The result is promising, 7 of 8 participants pursued treatment and several participants got improvements on ACT-related measures as well as on measures for MPA. The result justifies further research on ACT for MPA.

Tinnitus is the experience of sounds in the ears without any external auditory source and is a common, debilitating, chronic symptom for which we have yet to develop sufficiently efficacious interventions. Cognitive behavioral therapy (CBT) has evolved over the last 20 years to become the most empirically supported treatment for treating the adverse effects of tinnitus. Nevertheless, a significant proportion of individuals do not benefit from CBT-based treatments. In addition, the theoretical underpinnings of the CBT-model are poorly developed, the relative efficacy of isolated procedures has not yet been demonstrated, and the mechanisms of therapeutic change are largely unknown. These significant limitations preclude scientific progression and, as a consequence, leave many individuals with tinnitus suffering. To address some of these issues, a contextual multi-method, principle-focused inductive scientific strategy, based on pragmatic philosophy, was employed in the present thesis project. The overarching aim of the thesis was to explore the utility of a functional dimensional process in tinnitus: Experiential avoidance—experiential openness/acceptance (EA). EA is defined as the inclination to avoid or alter the frequency, duration, or intensity of unwanted internal sensations, including thoughts, feelings or physical sensations. The thesis is based on experimental work (Study II, VI), process and mediation studies (Study I, III, V), and on randomized controlled trials (Study III, IV). Three main sets of findings supported the utility of EA in tinnitus. First, an acceptance-based treatment (i.e.,Acceptance and Commitment Therapy, ACT) was found to be effective in controlled trials. Study III demonstrated that face-to-face ACT was more effective than a wait-list control and a habituation-based sound therapy. Study IV showed that internet-delivered ACT was more effective than an active control condition (internet-discussion forum) and equally effective as an established internet-delivered CBT treatment. Second, processes research (Study I, III, V) showed that key postulated processes of change were linked to the specific technology of ACT and that these changes in processes were associated with therapeutic outcomes. Specifically, Study V found evidence to that decreases in suppression of thoughts and feelings over the course of treatment were uniquely associated with therapeutic gains in ACT as compared with CBT. Third, experimental manipulations of experiential avoidance and acceptance processes provided support to the underlying dimension (Study II, VI). That is, Study II, employing an experimental manipulation, found that controlling background sounds were associated with reduced cognitive efficiency and increased tinnitus interference over repeated experimental trials. In addition, in normal hearing participants, experimentally induced mindfulness counteracted reduced persistence in a mentally challenging task in the presence of a tinnitus-like sound stemming from initial effortful suppression of the same sound (Study VI). It is concluded that a principle-, contextual-focused approach to treatment development may represent an efficient strategy for scientific progression in the field of psychological treatments of tinnitus severity. / Tinnitus är upplevelsen av ljud i frånvaro av en extern ljudkälla och är ett vanligt, långvarigt och svårbehandlat hälsotillstånd. Kognitiv beteendeterapi (KBT) har det starkaste forskningsstödet för att behandla de negativa konsekvenserna av tinnitus. Detta till trots svarar inte en stor andel på KBT-baserade behandlingar för tinnitus. Behandlingsutvecklingen av KBT försvåras som konsekvens av att teorier som behandlingen vilar på är dåligt utvecklade, effekten av isolerade tekniker har inte bevisats, och att förändringsmekanismer är till största del okända. Föreliggande avhandling avsåg att adressera några av ovanstående problem genom att tillämpa en induktiv, flermetod, principstyrd vetenskaplig strategi baserad på pragmatisk kontextuell filosofi. Det övergripande syftet med avhandlingen var att undersöka användbarheten i en funktionell processdimension vid tinnitus: upplevelsemässigt undvikande—upplevelsemässig acceptans (EA). EA definieras som benägenheten att undvika eller förändra frekvensen, durationen eller intensiteten av icke-önskade inre sensationer som tankar, känslor och fysiologiska sensationer. Avhandlingen är baserad på experimentella studier (Studie II, VI), process och mediationsstudier (Studie I, III, V) och randomiserade kontrollerade studier (Studie III, IV). Tre övergripande fynd bekräftade användbarheten av EA vid tinnitus. För det första kunde det påvisas i randomiserade, kontrollerade studier att en acceptans-baserad behandling (Acceptance and Commitment Therapy, ACT) hade effekt på tinnitusbesvär. Studie III fann stöd för att ACT var mer effektiv än en väntelistekontroll och en habitueringsfokuserad ljudterapi. Studie IV fann stöd för att internet-förmedlad ACT var mer effektiv än en aktiv kontrollbetingelse (internet-diskussionsforum) och lika effektiv som en etablerad internet-förmedlad KBT-behandling. För det andra kunde processforskning (Studie I, III, V) påvisa att teoretiskt viktiga processer var relaterade till specifika tekniker i ACT och att dessa processer var i sin tur associerade med behandlingsutfall. Exempelvis kunde Studie V styrka att minskning i individers benägenhet att tränga undan tankar och känslor i relation till tinnitus var unikt associerat med behandlingsutfall i ACT i jämfört med KBT. För det tredje påvisade experimentella manipulationer av acceptans- och undvikande-processer användbarheten av EA (Studie II, VI). Studie II fann stöd för att kontroll över maskeringsljud var associerad med minskad kognitiv prestationsförmåga och ökade besvära av tinnitus över upprepade experimentella manipulationer i jämfört med att inte ha kontroll över maskeringsljudet. Slutligen visade Studie VI att bland normalhörande kunde experimentellt inducerad mindfulness motverka minskad förmåga att hålla ut i en mentalt krävande uppgift i närvaro av ett tinnitusliknande ljud till följd av initial suppression av samma ljud. Den övergripande konklusionen av vetenskapliga arbeten som sammanfattas i avhandlingen var att en principstyrd och kontextuell vetenskaplig strategi kan vara en framkomlig väg för att utveckla psykologiska behandlingar för tinnitusbesvär.

Thesis (Ph. D.)--University of Nevada, Reno, 2007. / "August, 2007." Includes bibliographical references (leaves 81-100). Online version available on the World Wide Web.

Thesis (Ph.D.)--University of Nevada, Reno, 2006. / "August, 2006." Includes bibliographical references (leaves 65-83). Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2006]. 1 microfilm reel ; 35 mm. Online version available on the World Wide Web.

Thesis (M.Soc.Sc. Psychology)--University of Waikato, 2007. / Includes bibliographical references (leaves 57-68) Also available via the World Wide Web.

Thesis (Ph. D.)--University of Nevada, Reno, 2007. / "August 2007." Includes bibliographical references (leaves 84-102). Online version available on the World Wide Web.

Thesis (Ph. D.)--University of Nevada, Reno, 2008. / "December 2008." Includes bibliographical references (leaves 127-144). Online version available on the World Wide Web.

Purpose: This study explored therapeutic processes associated with developing a course for patients with persistent pain which integrated osteopathic treatment with Acceptance and Commitment Therapy (ACT). This 'third wave’ cognitive behavioural approach is effective for a range of physical and psychological problems, including persistent pain, and congruent with osteopathic principles of holism, function and agency, which provided a theoretical basis for developing an integrated intervention to promote resilience and well-being. A qualitative case study was conducted as part of a developmental research programme to explore how ACT could be integrated with osteopathic treatment for individual patients, and with what effects on processes and outcomes. Method: Linguistic ethnography was used to explore links between pain-related discourses, clinical decisions and responses to pain. Treatments were audio-recorded, transcribed, and coded. Extracts referring to discourses about pain experienced during manual therapy were subjected to micro-level conversation analysis, sociolinguistic analysis of participants’ roles, and macro-level analysis of links to broader healthcare discourses. A reflective diary was used to explore experiential learning and integrate auto-ethnographic information. Results: Two distinctive forms of mechanistic and facilitative pain discourse were identified. In predominantly mechanistic discourses, agency and expertise were located with the osteopath, and intention was focused on fixing ‘broken’ parts and relieving pain using ‘familiar’ osteopathic techniques. In facilitative discourses, the osteopath adopted a more collaborative role, focused on developing the patient's body and self-awareness to promote more flexible, active pain responses. Practitioner challenges included learning how to shift intention between mechanistic and facilitative interventions, a process that was enabled by mindfulness and willingness to tolerate uncertainty. Conclusions: In this study, ACT-informed osteopathy involved facilitative discourses, associated with increased patient agency and flexibility in response to pain. Further research is needed to explore whether this pattern of discourse is robust in other clinical settings; relationships between mechanistic and facilitative discourses and therapeutic outcomes; and effects of ACT training on practitioner mindfulness and attitude towards clinical uncertainty. Findings suggest that this integrated approach could expand the scope of osteopathic care for patients with persistent pain, and is worth further investigation.

TITLE: IMPULSIVNENESS AND SELF-REOPRTED VALUES MAJOR PROFESSOR: Dr. Mark R. Dixon Towards developing an applied behavior technology that treats vales as the dependent variable of interest, there is a necessity for understanding the relationship between impulsiveness and self-reported values. The purpose of this study was to evaluate how values affected social and delay discounting. Thirty participants were given two surveys, one was a social discounting survey, and the other was a delay discounting survey. Finally, participants were given a valued-living questionnaire. In the social discounting survey, participants were asked to mentally make a list of people they knew from 1-100, 1 being the closest to them and 100 being a distant acquaintance. They were then asked to pick between two choices involving hypothetical money. Starting with the choice of keeping $85 for themselves, or giving $75 to the 1st person on their list. The second choice was to keep $75 for themselves, or give $75 to the #1 person on their list. The monetary value continued to decrease by 10, while the value to give to another person remained the same, these were continued for person #2, # 5, #10, #20, and #50 on their list. The delay discounting instructed participants to choose between two hypothetical choices. The first was receiving $85 today or $75 in 1 week. The second choice was to receive $75 today, or $75 in 1 week. The hypothetical monetary value was decreased by $10, until it reached $5. The valued living questionnaire used a Likert-scale from 1-10 with 1 being ‘not at all important and ’10 being ‘extremely important’ across 10 areas (family-other than marriage or parenting, i marriage/couples, intimate relations, parenting, friends/social life, work, education/training, recreation/fun, spirituality, citizenship/community life, and physical self-care (diet, exercise, sleep). The second section of the questionnaire evaluated committed action, and asked participants to rate how consistent their actions have been with each of these value areas within the past week. A Likert-scale was also used from 1-10, with 1 being ‘not at all consistent with my value’ and 10 being ‘completely consistent with my value’. A Pearson product-movement correlation coefficient was composed to access the relationship between the switch point of discounting and rating of each area of valued living. There were to valued living areas with significant findings. There was a positive correlation between Social AUC and VLQ: Importance- Social/Friends (r=.503, n=30, p=.005). There was also a positive correlation between Delay AUC and VLQ: Importance- Physical self-care (r=.448, n=30, p=.013). There was no correlation between either social AUC and delay AUC and any of the committed action values. The results have implications for a translational understanding of the influence of discounting on reported values and committed action processes.

Procrastination has been a concept that has recently gained attention. Current research has provided data that suggests there is a positive relationship between committed action (goal setting) and procrastination (Gagnon, Dionne, & Pychyl, 2016). This study had collected data from self-report only using a procrastination scale that has been globally validated (Steel, 2010). Acceptance and Commitment Therapy (ACT) interacts with a person’s psychological flexibility, which can be described as the ability to contact the present moment and then adapt to changes in that moment (Hayes, Strosahl, & Wilson, 2011). Committed action is just part of the six components that make up ACT. Committed action as a concept is concerned with the goals we take on a daily basis that bring us closer to our values. It stands to reason, that the more a person commits to these actions, the less they might procrastinate. The current study extends the existing literature by exploring the possible effect committed action (goal setting) sessions may have on the relationship between procrastination and committed action by examining discussion question turn in across two groups. The outcomes of this analysis may lend to the literature concerning developing a more effective classroom setting (Bijou, 1970). The current study’s purpose is then to increase the level of understanding we have concerning procrastination through a committed action intervention.