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.

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.