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.

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.

Acceptance and Commitment Training (ACT) is a psychological intervention that combines acceptance and mindfulness approaches with behavior change strategies to increase psychological flexibility, defined as present moment awareness despite unpleasant private events, and behaving based on personal values. Obesity is a socially significant problem effecting duration and quality of life. Quantifying differences between high and low exercise groups and evaluating interventions that affect exercise value represent an avenue to understand obesity and change behavior. This study assessed the effects of a brief ACT exercise on the demand for general and sport-specific exercise and delay discounting rates of four commodities (i.e., money, food, general exercise, and sport-specific exercise) in Division I athletes (n=78) and non-athletes (n=78) from the same university. Statistically significant main effects for general exercise were observed between athletes compared to non-athletes for intensity, elasticity, and breakpoint. Differences in demand for sport-specific exercise between athletes and non-athletes were observed across all behavioral economic indices. The ACT intervention did not alter the demand for general or sport-specific exercise. General and sport-specific exercise were valued similarly between individual participants in each group. In the delay discounting task, ACT significantly decreased degree of discounting of all four commodities (increased the area under the curve) in both athletes and non-athletes. No differences were observed between athletes and non-athletes for any of the four commodities, indicating that athletes and non-athletes discounted these commodities similarly. Results from the demand task provide initial support for the extension of hypothetical purchase tasks to exercise behavior. which would offer a standardized method to quantify exercise value efficiently. Results from the discounting task provide initial evidence indicating that ACT may be effective in reducing discounting rates across commodities. Given that steep discounting rates are considered to play an important causal role in maladaptive behaviors related to obesity, evidence of a therapeutic intervention with the potential to produce longer-lasting change in decision-making is encouraging.

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.