The current study examined the effectiveness of a computer-based cognitive defusion intervention on the degree of believability and discomfort of problematic thoughts in two adolescents and one young adult with Autism Spectrum Disorder (ASD) using a multiple probe design across participants. Participants identified a problematic thought that they often had during social interactions with peers which was then targeted throughout the intervention. Primary measures included rating scales for thought believability and discomfort and criterion for therapeutic change was a 30-increment decrease in the mean average of rating scores from baseline levels for three consecutive intervention sessions. Results demonstrated a significant change in the believability of one participant's thought believability that met the therapeutic criterion. However, the remaining participants' rating scores following the intervention did not decrease below the criterion. Secondary measures for cognitive fusion, psychological inflexibility, and mindfulness included the AAQ-II, BAFT, CFQ, and CAMM pre and posttests. Results from these pre and posttest measures did not indicate a significant therapeutic change following treatment. More research is needed to examine the effectiveness of an automated defusion intervention with this population.

The current study evaluated the effectiveness of Acceptance and Commitment Therapy (ACT) to help reduce anxiety experienced during an interview with three individuals with varying Developmental Disabilities (DD). A multiple baseline across participants with embedded probes was used to evaluate the effectiveness of the intervention. The intervention consisted of mindfulness and defusion exercises used directly before an interview was conducted. Data were collected during each interview using an interview checklist created specifically for this study. The checklist consisted of two parts: anxiety measures and an interview question portion. The checklist was used to help score the overall performance for each participant during an interview. A BST procedure was used for two of the three participants to help their skill acquisition of correctly answering interview questions. Secondary measures were taken for a pre and posttest that consisted of a modified state social anxiety scale. The results from the study indicated that the use of ACT helped decrease anxiety experienced during an interview and also helped increase their overall performance during an interview.

The role of common metaphors in Acceptance and Commitment Therapy was examined in a 35 min brief online workshop targeted at body image dissatisfaction. Participants consisted of 24 graduate level students who were randomly assigned to either the, "ACT as Usual" or "ACT without Metaphors" treatment condition. The "ACT as Usual" treatment condition incorporated common ACT metaphors into the workshop while the "ACT without Metaphors" utilized alternative exercises and literal explanations. Both of the workshops covered all six core components of ACT and provided the same basic information. Results of the present study indicated that there was a significant difference between pretest and posttest scores for the AAQ-W for both groups and no significant differences between pre and post CFQ-13 and PASTAS scores. Further, results indicate the use of common ACT metaphors did not significantly influence participant's scores. Future research should examine the use of ACT metaphors in a variety of settings and situations in order to determine their utility.

The present study examined the effects of a brief video-led mindfulness exercise on momentary choice impulsivity as measured by a monetary delay discounting survey. Participants in the experimental group watched a video requiring them to engage in a brief breathing exercise while participants in the control group viewed a video unrelated to the topics at hand. Switch point analyses suggested that the experimental group discounted less steeply following the intervention while the discounting slope of the control group remained relatively unchanged. A t-test comparing the average change in AUC values from pre-test to post-test for both groups revealed a significant difference: t (13.17) = 2.94, p = 0.0114. The experimental group demonstrated greater changes in AUC scores from pretest to posttest (M= 0.1036 ± 0.0328) than the control group (-0.00031 ± 0.01317). Additionally, an F-test was conducted to compare variances between the individual score changes of the experimental group and the control group (p < .05). The results suggest that there was a significant difference between the two groups: F = 5.682, p = 0.0082. The results of this study could have several implications for future research regarding delay discounting and mindfulness as an intervention for impulsivity and suggest that telecommunication may be a viable modality.

The following study aims to understand the effects Acceptance and Commitment Therapy, or ACT, has on individuals who have experienced discomfort through exposure to aversive stimuli. Experiencing discomfort is a natural part of human life. Each person has their own class of responses to respond to discomfort. A typical response may include avoiding an object, person, or situation that had made the person uncomfortable in the past. Batten, Follette, and Aban (2001) found that women who experienced childhood sexual abuse and scored high in experiential avoidance where more likely to engage in high risk sexual behaviors. Avoiding discomfort can have serious repercussions. ACT has been a proven therapy to treat anxiety, gambling, PTSD, eating disorders among other disorders. Previous studies show the effectiveness of ACT on treating discomfort (Cohrane, Barnes-Holmes, & Barnes-Holmes, 2008; Hayes, Bissett, Korn, Zettle, Rosenfarb, Cooper, & Grundt, 1999; Luciano, et al., 2010). This study extends the findings and further supports the utility of ACT to treat discomfort through a laboratory study. This study exposes participants to “disgusting” stimuli to evoke disgust and discomfort. A brief ACT session is administered to half the participants which is compared to a control task which includes a distraction/avoidance task. Findings from this study suggest the utility of ACT to increase tolerance to discomfort.

Muscle disorders are chronic, progressive conditions, the majority of which are without disease modifying treatments. Quality of life (QoL) is reduced in these conditions, and alternative methods, such as psychological intervention, may offer ways to improve QoL. Previous work has suggested that aberrant illness perceptions may be influential targets for psychological interventions; however, emerging evidence suggests that psychological flexibility might offer another treatment target. This thesis first presents a longitudinal investigation of the role of these two variables, alongside disability level, in explaining life satisfaction and mood measured four months later. Participants were recruited from charities and online communities, with data collected via online questionnaires. Here, illness perceptions and psychological flexibility, but not disability level, were cross-sectionally associated with all dependent variables. In prospective analyses psychological flexibility accounted for greater variance in life satisfaction and anxiety; while illness perceptions explained more variance in depression. However, after controlling for variance in time one dependent variables, psychological flexibility alone was predictive of life satisfaction and anxiety at time two. Therefore, psychological flexibility represents a possible influential target for psychological intervention in muscle disorders. Acceptance and Commitment Therapy (ACT) is a psychological intervention specifically designed to improve psychological flexibility. Subsequently, the results of the empirical study imply that ACT is worthy of trial with muscle disorders. However, there has been no comprehensive review of the use of ACT in chronic disease or long-term conditions. Therefore, Chapter 2 presents a systematic review of ACT as applied to chronic disease/long-term conditions. The aims were to collate all ACT interventions with chronic disease/long-term conditions; evaluate their quality and comment on efficacy. Ovid MEDLINE, EMBASE and Psych Info were searched, with a further search of citing articles undertaken using Google Scholar. Studies with mental health or chronic pain populations were excluded. Study quality was then rated, with a proportion re-rated by a second researcher. Seventeen studies were included, of which: eight were randomised controlled trials (RCTs), three used pre-post designs, and seven were case studies. A broad range of applications were observed (e.g. improving quality of life and symptom control, reducing distress) across many diseases/conditions (e.g. HIV, cancer, epilepsy). However, study quality was generally low, and many interventions were of low intensity. The small number of RCTs per application and lower study quality emphasise that ACT is not yet a well-established intervention for chronic disease/long-term conditions. However, there was promising evidence for certain applications: the parenting of children with long-term conditions, seizure-control in epilepsy, psychological flexibility and possibly self-management/lifestyle. The studies comprising this thesis suggest that, whilst psychological flexibility appears influential in muscle disorders, high-quality research into ACT interventions for chronic disease/long-term conditions is generally lacking. Therefore one cannot confidently generalise from existing studies that ACT will improve outcomes in muscle disorders. Thus an evaluation of ACT in the context of muscle disorders is now required. This should adhere to the methodological suggestions provided in the systematic review.

La thérapie cognitive (TC) et la thérapie d’acceptation et d’engagement (ACT) reposent sur de différents principes philosophiques. La TC cible le changement de la forme et de la fréquence des expériences mentales, tandis que le ACT se concentre sur la compréhension du contexte des pensées et des sentiments. L’intégration de ces deux approches thérapeutiques dans une seule thérapie psychologique pourrait s’avérer bénéfique vu que les clients se voient ainsi offerts une plus grande flexibilité et un plus vaste répertoire de stratégies thérapeutiques. Dans le cadre d'une thérapie combinée, les clients pourraient se voir proposer des lignes directrices qui expliquent quand les techniques orientées vers le changement (par exemple, la restructuration cognitive) seraient plus efficaces et quand les techniques d'acceptation (par exemple, la défusion) seraient à privilégier. Un traitement combiné pourrait également être avantageux pour les clients souffrant de dépression qui n'ont pas connu de soulagement de symptômes en utilisant une modalité thérapeutique traditionnelle, grâce à un plus vaste choix d'outils pour faire face à leurs défis. Cette thèse traitera de l'utilité de l'intégration de la thérapie cognitive (TC) et de la thérapie d'acceptation et d'engagement (ACT) pour le traitement de la dépression et/ou de la dysthymie dans un contexte de thérapie de groupe. Avec la contribution de deux articles, la justification de l'intégration sur des bases théoriques sera présentée, ainsi que les principaux résultats empiriques d'une étude portant directement sur la question. Le premier article est de nature théorique et décrit la justification pour l'intégration des deux approches thérapeutiques, qui reposent sur des bases philosophiques différentes, pour traiter la dépression et la dysthymie. De son côté, la thérapie cognitive traditionnelle vise à aider les clients à modifier leurs distorsions cognitives et à créer de nouvelles pensées adaptatives. Ce processus, à son tour, peut améliorer l'humeur. La thérapie d'acceptation et d'engagement (ACT), quant à elle, vise à aider les clients à développer des stratégies pour mieux accepter et pour se détacher de leurs pensées et émotions angoissantes plutôt que de les restructurer ou d'essayer d’aider le client à s’en débarrasser. Les clients sont encouragés à développer une connexion avec leurs valeurs personnelles et à s'engager à prendre des mesures concrètes pour avancer, malgré leurs états d'humeur difficiles. Il y a aussi d'autres différences importantes entre les deux approches, dont les suivantes: la TC a tendance à se concentrer sur la forme et la fréquence des pensées et des événements mentaux, tandis que le ACT a tendance à se concentrer sur le contexte des pensées, des sentiments et des sensations physiques (Twohig, 2009). En outre, la TC met l'accent sur la réduction des symptômes bouleversants. L’ACT, quant à elle, estime que la réduction des symptômes est moins importante que de vivre selon ses valeurs personnelles (Arch & Craske, 2008). Quoique la réduction des symptômes soit la bienvenue, elle est considérée comme un sous-produit du processus d’acceptation et d’engagement, plutôt que d’en être l’objectif premier. Je propose qu'il soit habilitant d’offrir aux clients des stratégies qui ont pour origine les deux approches thérapeutiques et de leur offrir la possibilité de sélectionner les outils qui conviennent le mieux à leurs réalités personnelles et à leurs personnalités. Le premier article théorique traitera de l'utilisation de directives particulières que j'ai compilées pour aider les clients à sélectionner les stratégies les mieux adaptées des deux approches contrastées. Certains chercheurs ont été source d'inspiration, et leurs théories sont présentées dans le premier article. Le deuxième article est de nature empirique et présente les résultats de mes recherches sur la faisabilité de la combinaison des thérapies cognitives et d’acceptation et d’engagement dans un échantillon communautaire de participants souffrant de dépression et/ou de dysthymie. Sur une période de deux ans, quatre groupes consécutifs ont été vus dans une clinique communautaire, dont 24 participants ont complété un traitement d’une durée de 15 semaines. Des données post-traitement et de suivi ont démontré que les participants étaient satisfaits à l'égard du traitement, et qu’ils ont connu des diminutions importantes de la gravité de la dépression et des augmentations significatives de leur qualité de vie sur les cinq périodes d’étude. Les résultats confirment qu’il est acceptable et faisable d'intégrer deux approches différentes (la TC et le ACT) pour traiter la dépression et/ou la dysthymie. / Abstract : Cognitive therapy (CT) and Acceptance and Commitment therapy (ACT) have been shown to be effective in treating depression. Though integrating ACT with CT is used for the treatment of anxiety, there is a paucity of integrated CT and ACT treatments for depression and/or dysthymia. The purpose of this study is to determine the feasibility of integrating CT and ACT into a manualized group therapy treatment for depression and/or dysthymia. Over a period of two years, four consecutive groups were held at a community clinic, with 24 completing the 15-week treatment. Post-treatment and follow-up data revealed satisfaction with the treatment, significant decreases in depression severity, and significant increases in quality of life over the five time points. The results support the acceptability and feasibility of a manualized integrated CT/ACT group therapy program for depression and dysthymia.

The present study sought to evaluate whether a brief ACT session which utilized values and committed action activities was effective in changing how student veterans responded on two different discounting surveys. Participants in experimental and control groups completed a monetary temporal discounting survey and a death probability discounting survey before and after completing either a brief ACT session or completing a control activity. Twenty-three student veterans participated in the present study and a pre-, post-group control group design was utilized to evaluate the effects of the intervention. Independent t-tests were conducted, and the results of those analyses showed that ACT was effective in decreasing discounting on the monetary temporal discounting survey (t(10) = 1.997, p = 0.0368) when compared to the control group (t(11) = 0.2088, p = 0.4192). However, there were no statistically significant changes on the death probability survey in the ACT group (t(10) = 0.2459 p = .4504) or control group (t(11) = 0.8784, p = 0.1992). Implications of these findings and future research are discussed.

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