Many children and adolescents with autism spectrum disorder (ASD) suffer from anxiety, depression, and other disorders. These disorders make it difficult to leave healthy and productive lives and can be experienced across school and social life. The mechanisms underlying anxiety and other disorders can be explained through language and cognition and this is the rational underlying Relational Frame Theory (RFT). RFT suggests that human language and cognition are a direct cause of many human psychological problems as we are able to evaluate words. The cognitive fusion, experiential avoidance, and suppression described by RFT have been expanded to include treatment methods within Acceptance and Commitment Therapy (ACT). ACT is a psychotherapeutic approach that attempts to undermine emotional avoidance explained through RFT and promotes positive behavior change. The purpose of the current study was to evaluate the efficacy of ACT in increasing value-directed behavior in three adults with ASD. The results of this study revealed that brief ACT experiential exercises were effective in increasing value-directed behavior in all participants. Keywords: Autism spectrum disorder (ASD), relational frame theory (RFT), Acceptance and commitment therapy (ACT)

Values are directly relevant in a number of theoretical orientations in psychology, including Acceptance and Commitment Therapy (ACT). In ACT, clarification of one’s personal values is paramount. The present study examined the ability to predict clinical symptoms and psychological flexibility using variables derived from one’s performance on the ACT Values Card Sort (ACT-VCS), a novel values clarification exercise. The independent variables, obtained from the ACT-VCS, included 1) the number of values endorsed as very important in the initial sort (i.e., valuing propensity), 2) the number of values domains represented in the final sort (i.e., values diversity), and 3) the extent to which one’s values were oriented toward uncontrollable experiences (i.e., control agenda endorsement). Three hierarchical regressions were conducted to examine the extent to which these three predictors accounted for the variance in scores of a) depression, anxiety, and stress, b) psychological flexibility, and c) psychological inflexibility. The psychological flexibility model was significant (∆R squared = .25 (F (3, 69) = 12.20, p < .001) with valuing propensity (squared semi-partial correlation r = .13, p < .001) and control agenda endorsement (squared semi-partial correlation r = .05, p < .01), but not values diversity, independently accounting for a significant portion of the variance. Prior therapy experience moderated some of these relationships. These findings provide preliminary evidence for using performance variables from the ACT-VCS to predict clinical variables.

Philosophiae Doctor - PhD / The objective of this study was to determine if introducing acceptance and commitment therapy in the prevention of mother to child HIV transmission (PMTCT) program using weekly mobile phone messages would result in improved mental health status of HIV-positive, pregnant women in Nigeria. The study used a quantitative approach using a Solomon four-group (two intervention and two control groups) randomised design to evaluate the impact of an acceptance and commitment therapy program. The study population was 132 randomly selected (33 per site), HIV-positive pregnant women attending four randomly selected PMTCT centres in Nigeria. Two were Intervention and two were Control sites which functioned as Intervention and Control groups. The intervention groups were exposed to one session of acceptance and commitment therapy with weekly value-based health messages sent by mobile phone for three months during pregnancy. The control groups received only post-HIV test counselling.

The present study examined the effects of Acceptance and Commitment Therapy (ACT) as a core behavior modification method on students with severe behavior disorders. A pre/posttest design was implemented and both control and treatment groups were exposed to testing measures. Students in the treatment group were exposed to ACT as well as contingency based classroom management, and a token economy in an attempt to increase grade point average (GPA), days in attendance, and psychological flexibility. Results are discussed regarding the increase in GPA and attendance, and levels of psychological flexibility are also elaborated upon. Limitations, implications, and future research are also discussed.

The model of psychological flexibility and inflexibility presented within an Acceptance and Commitment Therapy (ACT) framework is one that is multifaceted and complex. Until recent years, however, measurement of the construct of psychological flexibility has largely been conducted in a unidimensional manner across research and clinical contexts. The emergence of the Multidimensional Psychological Flexibility Inventory (MPFI; Rolffs et al., 2016) has remedied this situation by providing the first assessment of its kind to simultaneously capture each dimension of the full psychological flexibility model in a theoretically consistent manner. The current study intends to provide independent validation of the MPFI’s psychometric properties and to further solidify the measure’s utility in more comprehensively measuring ACT constructs for research and clinical contexts. The study will examine the MPFI’s convergence with related measures, its predictive validity with pertinent outcomes, and its utility in relation to the current standard of psychological flexibility measurement.

Acceptance and commitment therapy (ACT) is an empirically supported cognitive behavioral therapy. The ACT model is designed around a set of six core processes utilized to increase psychological flexibility. Engagement with values, one of the six core processes, is associated with several indicators of well-being. However, recent reviews of ACT values measures from experts in the field raised concerns that current instruments do not adequately assess the values process. The current study examined the structure and psychometric properties of a new values measure, titled the Valued Living Questionnaire—Online version (VLQ-O), that was developed from considerations raised in these reviews. The results of an EFA indicated that the VLQ-O produced a three-factor structure comprised of Values Flexibility, Values Inflexibility, and Values Obligations. The Activity and Preferred Activity scores did not load consistently onto any discernable factor. The subscales of the VLQ-O produced poor internal consistency. The scores for Activity and Values Flexibility subscales correlated positively with measures of well-being and negatively with measures of psychological distress. Additionally, these subscales were significantly positively related to MPFI Flexibility and VQ Progress and well as negatively related to MPFI Inflexibility and VQ Obstruction. Values Inflexibility and Values Obligation correlated positively with measures of psychological distress and negatively with measures of well-being. The Values Obligation subscale did not correlate with social desirability. Multiple subscales of the VLQ-O demonstrated significant correlations with multiple subscales of the BFI. Additionally, the VLQ-O established predictive validity for measures of psychological distress and well-being. Further, it established improvements in predictive validity for flourishing and psychological distress when compared to the Valuing Questionnaire (VQ). Overall, the findings from this study provide some supportive preliminary evidence for the validity of the VLQ-O.

Human valuing is a topic of study in many disciplines concerned with the behavior of humans in terms of its relationship to individual as well as group behavior. Many disciplines provide a theory of how values effect behavior, however a behavior analytic approach may demonstrate utility in terms of both understanding the formation of values as well as procedures that incorporate valuing into interventions for common psychological problems. Relational Frame Theory (RFT), a psychological account of human language and cognition, which has its foundation in behavior analysis, may provide an empirically-valid account of the formation of values and the mechanisms though which it effects behavior. Language processes including hierarchical, or categorical, relational responding, the transformation of consequential stimulus function, and rule-governed behavior may contribute to the act of human valuing. Acceptance and Commitment Therapy (ACT), a clinical derivative of RFT, incorporates values as a central component of treatment. This series of three studies sought to add to the empirical understanding of human valuing through two basic and one translational study. Study 1 examined the transformation of consequential stimulus functions in accordance with hierarchical networks, completed in a multiple baseline design. Results of this study suggest that, given sufficient strength of derived relations, the transformation was demonstrated by five of six participants. Study 2 evaluated the motivative effect of stimuli in a hierarchical relational network, completed in a multiple baseline design. The results suggest that in the presence of directly trained stimuli the motivative augmentals did not influence responding for four of four participants, however they did in a novel context for three of three participants. Study 3 sought to measure the effect of an arbitrary symbol related to a values-focused hierarchy as a motivative augmental for academic performance with a sample of undergraduate university students in a classroom setting. Together, these studies reflect a number of the languages processes necessary if an RFT-focused conceptualization of human valuing is accurate.

The science of psychotherapy is reliant on various research designs to provide evidence for and bolster the efficacy of therapeutic interventions, techniques, and packages. Among the therapeutic orientations with ample evidence of support is Acceptance and Commitment Therapy (ACT; Hayes et al., 1999). The creators of ACT propose targeting psychological flexibility, broadly defined as engaging with personal values with no regard of the presence of unwanted and undesired experiences. The Life Skills Modules protocol was developed to provide graduate student trainees with a simple and accessible tool to provide effective ACT treatment clients from the local community seeking treatment at the Southern Illinois University Clinical Center. The results of the study indicates that the clients improved in psychological flexibility, inflexibility, and symptoms of anxiety and depression, though this improvement is not explained by number of sessions nor completion of the protocol. Additionally, improvement in flexibility and inflexibility accounted for a significant portion of the variance in the improvement in symptoms as well. Flourishing did not improve within the clients. This study, while being marred with significant limitations, supports the ACT model of change of targeting psychological flexibility and inflexibility as being important towards improvement in treatment. The results of the study do not indicate the use of the protocol is the explicit cause of improvement. Discussion of the results and limitations are provided.

博士(心理学) / Doctor of Philosophy in Psychology / 同志社大学 / Doshisha University

Perfectionism is a transdiagnostic process implicated in several disorders, and is defined in the literature as having standards of performance that are excessively high and often unrealistic, rigidly pursuing these standards, and subsequently measuring one’s own self-worth on their ability to meet these self-set standards (Egan et al., 2011). Perfectionism is related to many negative outcomes for physical and mental health, warranting the need to identify effective treatments that are accessible to individuals experiencing clinical perfectionism. There is a growing need for discrete, single session therapeutic interventions, and research has found that patients who were provided with a brief intervention exhibited accelerated rates of change, compared to patients whose treatment was longer (Baldwin et al., 2009; Kroska, 2018). Therefore, the purpose of this study was to examine the effects of a 90-minute, single-session ACT intervention targeting psychological flexibility for perfectionistic beliefs and behaviors on perfectionism, psychological distress, and well-being utilizing a multiple baseline across participants experimental design. Four individuals completed the following self-report measures at each time point: the Personalized Psychological Flexibility Inventory (PPFI), the Multidimensional Psychological Flexibility Inventory (MPFI), the Frost Multi-Dimensional Perfectionism Scale (FMPS), the Self-Compassion Scale (SCS), the Depression, Anxiety, and Stress Scale-21 item (DASS-21), and the Flourishing Scale (FS). These measures were completed once per week for the five-week baseline period. After baseline, participant engaged in a 90-minute single-session ACT intervention targeting the development of psychological flexibility. For follow-up, participants completed the same measures twice a week for four weeks. Researchers hypothesized that the intervention would increase psychological flexibility, flourishing, self-compassion, and progress towards an idiographic goal, and decrease perfectionism, psychological inflexibility, and psychological distress post-intervention compared to the baseline assessment. A TAR trend analysis was conducted, and Bayes Factors were computed for each individual for each outcome variable to examine within-participant results. A between-case standardized mean difference effect size for SCED was calculated for each outcome variable to examine the results across participants, resulting in a d-statistic. Within participants, while two individuals completed the study with perfectionistic concerns scores below cut offs, this outcome did not change significantly from baseline, with greater evidence for a null effect on this outcome variable for most participants. However, there was evidence for treatment effects for decreasing perfectionistic strivings, psychological distress, and psychological inflexibility and increasing psychological flexibility and flourishing. Across participants, the intervention demonstrated small to large effect sizes. There were small effects on perfectionistic concerns, perfectionistic strivings, psychological distress, and psychological flexibility towards an individual goal. There were medium effects for psychological flexibility and flourishing. Large effects were demonstrated for psychological inflexibility and self-compassion. Overall, the results demonstrate promising evidence for increasing well-being within the context of clinical perfectionism using a single session intervention.