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

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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.

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A crucial step in assessing the scientific basis of a psychotherapeutic intervention is examining the individual components of the treatment to determine if they are additive or important to treatment outcomes. The construct of self-as-context (S-A-C), a central process in the acceptance and commitment therapy (ACT) approach, has not yet been studied in a component analysis. A previous dismantling trial, however, has shown this process has an additive effect as part of an ACT package (Williams, 2006). The current study is a preliminary trial of feasibility and efficacy to determine a) the practicality of assessing S-A-C in isolation in a laboratory setting, and b) the impact of manipulating S-A-C on theoretically related variables, including theorized mechanisms of change in various clinical approaches. 68 participants (55 female, 13 male) were randomly assigned to receive either a brief S-A-C intervention employing a common therapeutic metaphor (the chessboard metaphor), or the control condition, which involved discussing a mildly positive topic with the researcher. Results from the main analyses showed that there was no group-by-time interaction on measures to assess immediate impact on the construct, previously validated therapeutic mediation measures, or symptom measures. Several possible explanations for the failure to identify significant findings are discussed, including limitations of construct measurement. When analyses were repeated using only those participants whose scores were in the mild range or higher for stress, anxiety, or depression, time by condition interactions were significant for stress and approached significance for depression, with participants in the S-A-C group doing better than those in the control group, offering tentative support for the utility of this process among individuals with clinical difficulties. Implications for future studies are reported. / Ph. D.

Tinnitus is a highly prevalent health condition creating moderate or severe interference on mood, sleep and daily functioning for a group of those affected. The aims of this thesis were 1) to explore the role of acceptance and psychological flexibility in understanding tinnitus interference both experimentally and with a longitudinal design 2) to evaluate the immediate and long-term outcomes of an acceptance based behaviour therapy (Acceptance and Commitment Therapy; ACT) in the treatment of people with tinnitus and, 3) to investigate the relationship between treatment outcome and processes assumed to be the active ingredients of treatment (acceptance and cognitive defusion). Study I (n=47) was an experiment comparing the impact of acceptance to that of thought suppression or a neutral instruction on the ability to maintain attention on an imagery task. Results indicated that participants could benefit from an acceptance strategy when performing the task. Study II (n=47) was a longitudinal trial studying the mediating role of acceptance on the relationship between tinnitus interference at baseline and tinnitus interference, anxiety, life quality, and depression at a seven-month follow-up. Full mediation was found for life quality and depression, and partial mediation for tinnitus interference. Study IV (n=64) was a randomised controlled trial evaluating the immediate and long-term effects of ACT in comparison to those of Tinnitus Retraining Therapy (TRT) and to a wait list control. Results showed that ACT had large immediate effects on tinnitus interference in comparison to wait list, and medium long-term effects in comparison to TRT. Results were also seen on secondary outcome. Self-reported tinnitus acceptance significantly mediated the immediate outcome of ACT. Study III (n=24) was a process study where the video recorded sessions of ACT from study IV were observed and rated with regard to client behaviour. Results showed that in-session acceptance and defusion behaviours rated early in therapy were predictors of sustained positive treatment effects of ACT. These associations continued to be substantial even when controlling for the prior improvement in outcome. This whereas prior symptom change could not predict process variables rated late in therapy. Participants in all trials were chronic tinnitus patients, mainly from different departments of audiology. These findings implicate that 1) acceptance and psychological flexibility may contribute to the understanding of tinnitus interference 2) ACT can reduce tinnitus interference in a group of normal hearing tinnitus patients and 3) acceptance and cognitive defusion are important processes in ACT, related to outcome. / Tinnitus är ett mycket vanligt hälsoproblem där en grupp av de drabbade upplever påtagliga besvär såsom påverkan på sömn, välbefinnande och funktionsnivå. Denna avhandlings syften var att 1) utforska den roll acceptans och psykologisk flexibilitet har för förståelsen av tinnitusbesvär såväl experimentellt som med en longitudinell design 2) utvärdera de omedelbara och långsiktiga effekterna av en acceptansinriktad beteendeterapi (Acceptance and Commitment Therapy; ACT) vid behandling av personer med tinnitus samt 3) undersöka relationen mellan behandlingsutfall och processer som antas utgöra behandlingens aktiva komponenter (acceptans och kognitiv defusion). Studie I (n=47) var ett experiment där man jämförde förmågan att bibehålla uppmärksamheten på en mental bild vid tre olika betingelser: acceptans, tankesuppression eller en neutral betingelse. Resultaten indikerade att deltagarna som slumpats till acceptans var hjälpta av denna strategi i genomförandet av uppgiften. Studie II (n=47) var en självrapportstudie med longitudinell design där det undersöktes om acceptans fungerade som en mediator i sambandet mellan tinnitusbesvär i baslinjen och livskvalitet, depression, ångest och tinnitusbesvär vid en uppföljning efter sju månader. För variablerna livskvalitet och depression visade resultaten en fullständig mediation och för tinnitusbesvär en partiell mediation. Studie IV (n=64) var en randomiserad kontrollerad prövning av de omedelbara och långsiktiga effekterna av ACT i jämförelse med Tinnitus Retraining Therapy (TRT) och en väntelistekontrollgrupp. Resultaten visade att ACT hade en stor omedelbar effekt på tinnitusbesvär i jämförelse med väntelistan och en medelstor effekt i jämförelse med TRT. Även sekundära utfallsmått visade på effekter. Utfallet i ACT medierades av självrapporterad acceptans av tinnitus. Studie III (n=24) studerade processer i ACT-behandlingen genom observation och skattning av klientbeteenden under de videoinspelade sessionerna. Resultaten visade att klienternas acceptans- och defusionbeteende under sessioner tidigt i terapin predicerade det långsiktiga utfallet i behandlingen. Dessa samband kvarstod även när man kontrollerade för symtomförbättring fram till den skattade sessionen. Detta medan tidigare symtomförbättring inte predicerade klientbeteende senare i behandling. Deltagare i samtliga studier var patienter med kronisk tinnitus, huvudsakligen rekryterade från reguljär hörselvård. Resultaten från dessa studier indikerar att 1) acceptans och psykologisk flexibilitet kan bidra till förståelsen av tinnitusbesvär 2) ACT kan minska tinnitusbesvär hos en grupp normalhörande patienter 3) acceptans och kognitiv defusion är viktiga processer i ACT vilka är relaterade till behandlingutfallet.