The current study tested the effects of a cognitive defusion intervention on implicit attitudes toward milk and lemon as measured by the Implicit Relational Assessment Procedure (IRAP). One-hundred and eleven participants were randomly assigned to one of four conditions: control math, control defusion, half defusion, or full defusion. Participants filled out a series of self-report measures at the beginning of the study on psychological functioning, as well as attitudes toward milk and lemon. Participants then completed a task specific to their condition, with control math participants completing a simple math task while defusion conditions completed a defusion intervention – word repetition technique (WRT) – for certain words. The control defusion condition completed the WRT for the words “car” and “rabbit,” the half defusion condition completed the WRT for the word “milk,” and the full defusion condition completed the WRT for the words “milk” and “lemon.” After completing the condition specific tasks, all participants completed a milk/lemon IRAP that included the words “milk” and “lemon” and pictures of milk and lemon. All participants finished the study by completing a final set of self-report measures. Results of the study indicated that IRAP performance was not significantly different between conditions following various levels of a defusion intervention. However, results showed that the pattern of IRAP response latencies did significantly vary between conditions, but this effect was driven by a significant difference on a single response latency between two conditions suggesting this finding is an artifact. Thus, the current study cannot conclude that a defusion intervention can significantly affect implicit attitudes towards common objects, and any future research should consider applying a defusion intervention to clinically relevant stimuli to further assess for defusion effects in the IRAP.

Aim: This thesis describes the development and initial validation of a questionnaire to measure Hayes, Strosahl and Wilson’s (1999) constructs of cognitive fusion and cognitive defusion. Within the literature there is currently no specific measure of these constructs. Design and Method: Principal Component Analysis was conducted on two independent samples (Study One n = 425 and Study Two n = 167). Reliability analyses were conducted for both Study One and Study Two and validation analyses were conducted in Study Two. All participants in both studies completed the Cognitive Fusion Questionnaire (CFQ). Participants in Study Two completed additional measures related to their satisfaction with life, their beliefs about worry, mindful responding to unpleasant thoughts and images and levels of experiential avoidance. Results: The final solution revealed a two component fifteen item questionnaire accounting for 54% of the variance. Based on item content, the components were labelled fusion and defusion. The items within the questionnaire reflected Hayes et al. (1999) constructs of cognitive fusion and cognitive defusion. Internal consistencies as measured by Cronbach’s alpha were .91 (fusion), .71 (defusion) and .88 (total scale). The measure correlated moderately to highly and in the expected directions with questionnaires measuring individual beliefs about worry, mindful responding to unpleasant thoughts and images and levels of experiential avoidance. Similarly, there was a significant negative correlation between the current questionnaire and a measure related to satisfaction with life. Conclusions: The findings of the above research provide initial support for the CFQ. The results show support for the validity of the scale including content and convergent validity of the CFQ.

Background: The aim of this thesis was to provide a systematic examination of the potential of a Verbal Thought Disruption Technique (VTDT) in reducing ruminative and intrusive thoughts (RATs). Thought Suppression (TS) is a commonly used tactic to deal with RATs. In contrast, very little is known about VTDT as a specific cognitive defusion technique in particular, or as a cognitive behavioural technique in general. Methodology: A mixed methods case series design was used for this project. 10 individuals were involved over a 12-week period. An ABACAB design was utilised in which each individual received no intervention (A), a VTDT intervention (B) and a TS intervention (C) over the course of the study. Change was monitored quantitatively utilising the Meta-Cognitive Questionnaire-30 (MCQ-30), Thought Control Questionnaire (TCQ) and the General Health Questionnaire (GHQ). Additionally the measures were also completed at a one-month follow-up alongside the completion of Client Change Interview Protocol. The quantitative data was analysed by calculating the effect sizes of the reported change and the qualitative data analysed by thematic analysis. Results: Use of VTDT appeared to have a positive impact on RATs five MCQ-30 sub-measures (Cognitive Confidence, Need for Control, Cognitive Self-Consciousness, Positive and Negative Beliefs). VTDT use showed a positive impact as measured by the TCQ in four areas Distraction, Punishment Re-appraisal and Worry. The GHQ showed positive effects for VTDT use in the areas of Anxiety and Insomnia, and Social Dysfunction. TS had a negative impact on all measures. VTDT decreased numbers of RATs and severity of Subjective Units of Distress (SUDs) and TS increasing them, indicating a beneficial effect for VTDT and a detrimental effect for TS. The size of this effect was greater on SUDs than on RATs. Qualitative analysis at follow up identified factors that supported the use of VTDT and of the lack of utility of TS protocols to deal with RATs. Moderating factors for the first technique were found in the lack of willingness of some participants to use it in the future. A new working model of RATs was proposed. Conclusions: Conclusions reached are that VTDT may be a useful addition to an already wide range of cognitive defusion techniques already used in Acceptance and Commitment Therapy (ACT), and that it deserves further systematic research. TS, as previously found, appeared not to be a useful technique in dealing with RATs on most of the measures used.

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In the tradition of acceptance and commitment therapy (ACT), cognitive fusion is a transdiagnostic risk factor and occurs when one becomes overly attached to or "caught up" in their thoughts, leading to a more narrowed behavioral repertoire and difficulty taking effective action in response to life's demands. Cognitive defusion is ACT's curative answer to fusion, and denotes the process of taking a step back, seeing thoughts as "simply thoughts," thereby reducing the negative impact of distressing or anxiety-provoking thoughts. While these components have been widely studied in neurotypical (NT) samples, the purpose of this study was to extend findings to people diagnosed on the autism spectrum (AS). Specifically, this study aimed to examine the impact of cognitive fusion in this population and the effectiveness of a brief defusion technique. Forty-two AS participants and fifty-five neurotypical participants were given a battery of questionnaires measuring psychological distress and dispositional levels of cognitive fusion. Participants were then randomized into either a brief cognitive fusion technique or a brief active distraction technique. In both conditions participants chose a distressing thought and rated it on a visual analogue scale (VAS) in terms of thought discomfort and believability. They were then read a rationale regarding their assigned technique, practiced the technique, and applied the technique to their chosen distressing thought. After the intervention participants immediately re-rated the thought on the same VAS. Throughout the study, participants' heart rate and skin conductance were monitored to determine physiological effects of the conditions. Finally, a follow-up survey was sent at a one-week and two-week follow-up, where participants re-rated the believability and discomfort of their thoughts. Results of this study showed that the AS group had higher overall levels of fusion than the NT group, and that fusion was moderately to strongly related to psychological distress in the AS group and the NT group. In terms of the intervention effects, all interpretation statements must be taken with caution, as there were significant pre-group differences despite randomization. Both defusion and distraction worked equally well in immediately reducing thought believability and thought discomfort for AS and NT groups. Furthermore, treatment effects were maintained at the two-week follow-up period for all groups except for the AS group in the defusion condition. There were no treatment effects for physiology. The current study provides evidence that cognitive fusion may be an important factor in the psychiatric comorbidity that people with AS experience, and a brief technique can be effectively used.

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Cognitive performance is a central part of a range of daily activities. Acceptance and Commitment Therapy (ACT) interventions may improve cognitive performance by enhancing psychological flexibility. Previous research has found correlations between the constructs of psychological flexibility and cognitive flexibility (Whiting et al., 2017). However, there is a lack of empirical evidence to support the idea that enhancing psychological flexibility could enhance cognitive performance. The current study investigated whether a defusion exercise ‘The Observer’ could enhance cognitive performance in a nonclinical sample of adults (N=71). In addition, the study also sought to investigate whether a defusion exercise could have an effect on experienced levels of stress and also one’s evaluation of one’s own performance in comparison to others. Results indicated that there was no significant difference between the Defusion condition and Control condition regarding cognitive performance. Both conditions performed slightly worse post-intervention. No significant difference was found regarding the evaluations of one's own performance in comparison to others. However, the results showed that the defusion exercise had a positive effect in reducing experienced levels of stress for the Defusion condition compared to the Control condition.

Objective: The concept of recovery has become an integral part of modern mental health care. Understanding the outcomes and underlying mechanisms of key recovery interventions, such as Wellness Recovery Action Planning (WRAP), is essential in order to expand the theoretical understanding of recovery and inform how to target recovery in treatment. Therefore a systematic review of the literature was conducted to evaluate the mental health outcomes of WRAP for adults. The empirical study then explored three constructs in relation to WRAP and recovery. These were social problem solving, cognitive defusion and social identification. Method: The systematic review of the mental health outcomes of WRAP was conducted by searching four databases, contacting the authors of WRAP research and seeking evaluative information from organisations that deliver WRAP. Fourteen relevant studies met the inclusion criteria. Whereas, the empirical study recruited participants on a trans-diagnostic basis from across Scotland. Using a quantitative cross sectional design, 109 participant's completed 5 self-report questionnaires. These were the Knowledge, Attitudes and Beliefs about WRAP Questionnaire (WRAP beliefs), the Recovery Assessment Scale - Short (RAS-S), the Social Problem Solving Inventory - Revised - Short (SPSI-R-S), the Four Item Measure of Social Identification (FISI) and the Cognitive Fusion Questionnaire (CFQ). Correlation, regression and mediation analysis were used to explore relationships, and in particular, the predictors and mediators of recovery. Results: The systematic review provided strong evidence that WRAP has a significant positive impact on hope and also reduces the symptoms of mental illness. However, whether WRAP improves personal levels of recovery was unclear and a possible risk of disempowerment was found. Promising preliminary mental health outcomes in the areas of confidence in managing mental health, quality of life, service use, self-advocacy and knowledge attitudes and beliefs about recovery were highlighted. Only studies that did not use peer facilitators failed to find significant increases in hope compared to treatment as usual control groups. In the empirical study, the results indicated that all the constructs examined were correlated to recovery. In the regression analysis, WRAP beliefs, social problem solving and cognitive defusion also demonstrated a predictive relationship with recovery. Mediation analysis indicated that, social problem solving mediated two distinct relationships. One between WRAP beliefs and recovery, and another between cognitive defusion and recovery. The social problem solving subscales also showed how the two predictors relate to recovery through social problem solving in different ways. Social identification with the WRAP group did not significantly predict or mediate recovery. Conclusions: The systematic review indicated having peer facilitators delivering WRAP is key to helping participants foster hope and that a further randomised control trial could help clarify if improved personal recovery is an outcome of WRAP. It additionally suggested how the relationship between WRAP beliefs and recovery could be explored, as per the design of the empirical study. Findings from the empirical study implied that improving participants' social problem solving and cognitive defusion should be specifically targeted in WRAP delivery. The studies combined indicate that to achieve the best recovery results interventions, like WRAP, should target inspiring hope through peer support, improving knowledge, attitudes and beliefs about recovery and cognitive defusion from unhelpful thoughts.

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