Acceptance and Commitment Therapy is Effective in Treating Substance Use Disorders

Acceptance and Commitment Therapy is Effective in Treating Substance Use Disorders

 

By John M. de Castro, Ph.D.

 

“Mindfulness reminds us that in stillness we find the wisdom to become a human being instead of a human doing. . .  Recovery is a journey, not a destination. Stillness opens our hearts and minds to the vast potential within us as we move through treatment.” – Beverly Conyers

 

Substance abuse is a major health and social problem. There are estimated 22.2 million people in the U.S. with substance dependence. It is estimated that worldwide there are nearly ¼ million deaths yearly as a result of illicit drug use which includes unintentional overdoses, suicides, HIV and AIDS, and trauma. Obviously, there is a need to find effective methods to prevent and treat substance abuse. There are a number of programs that are successful at stopping the drug abuse, including the classic 12-step program emblematic of Alcoholics Anonymous. Unfortunately, the majority of drug and/or alcohol abusers relapse and return to substance abuse.

 

Hence, it is important to find an effective method to treat substance abuse and prevent relapse but an effective treatment has been elusive. Most programs and therapies to treat addictions have poor success rates. Recently, mindfulness training has been found to be effective in treating addictionsAcceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

The evidence has been accumulating on the effectiveness of Acceptance and Commitment Therapy (ACT) for the treatment of substance use disorders. So, it makes sense to step back and summarize what has been learned in the most recent studies. In today’s Research News article “The Use of Acceptance and Commitment Therapy in Substance Use Disorders: A Review of Literature.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524566/ ) Osaji and colleagues review and summarize the published research on the effectiveness of ACT in treating patients with substance use disorders.

 

They identified 22 published research studies and report that the published research found that  Acceptance and Commitment Therapy (ACT) was effective for the treatment of substance use disorders. They report that the research demonstrates that ACT is effective when used alone or in combination with other therapies. ACT successfully reduced substance use or produced discontinuation. It has been shown that various forms of mindfulness training are effective in treating addictions. The present findings simply extends this to ACT.

 

So, Acceptance and Commitment Therapy is effective in treating substance use disorders.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

“mindfulness can play a very important role in substance abuse recovery: patients learn how to rethink the nature of stressful situations and stimuli that may otherwise trigger a harmful train of thought that leads to drinking or using. Prior to a mindfulness intervention, patients may have been oblivious to the various factors that start the chain reaction of negative thought and unhealthy behavior. Mindfulness treatment gives them the chance to examine those factors on a level playing field, in a calm, supportive and safe environment. In time, the triggers become less daunting and more manageable.” – Foundations Recovery Network

 

Study Summary

 

Osaji, J., Ojimba, C., & Ahmed, S. (2020). The Use of Acceptance and Commitment Therapy in Substance Use Disorders: A Review of Literature. Journal of Clinical Medicine Research, 12(10), 629–633. https://doi.org/10.14740/jocmr4311

 

Abstract

Background

Acceptance and commitment therapy (ACT) is a form of behavioral therapy that teaches people to learn to accept rather than avoid challenging situations in their lives. ACT has shown to be an intervention with great success in the reduction of various mental disorders and substance use disorders (SUDs). The core of ACT when used in SUD treatment is guiding people to accept the urges and symptoms associated with substance misuse (acceptance) and use psychological flexibility and value-based interventions to reduce those urges and the symptoms (commitment). The purpose of this study is to review the existing literature to examine the evidence on the use of ACT in the management of SUD.

Methods

A thorough search of four databases (CINAHL, PubMed.gov, PsycINFO and PsycNET) from 2011 to 2020 was conducted using search terms like ACT, ACT and SUD, ACT, and substance misuse. The articles retrieved were critically appraised using the Critically Appraised Topic (CAT) Checklist.

Results

Most of the studies showed that ACT was effective in the management of SUD showing significant evidence of a reduction in substance use or total discontinuation with subsequent abstinence.

Conclusions

The literature review concluded that success has been achieved using ACT either as monotherapy or in combination with other therapy in the treatment of individuals with SUD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524566/

 

Reduce Performance Anxiety in Student Vocalists with Mindfulness

Reduce Performance Anxiety in Student Vocalists with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness can really help you to stop worrying. While you can’t remove each and every stressor from your daily life, there are definitely steps you can try to feel more at ease with your performances.” – Petra Raspel

 

It is a common human phenomenon that being in a social situation can be stressful and anxiety producing. This includes the anxiety that occurs with artistic performance. Most people can deal with the anxiety and can become quite comfortable. But many do not cope well and the anxiety is overwhelming, interfering with the ability to perform. Anxiety disorders have generally been treated with drugs. But there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders.

 

A therapeutic technique that contains mindfulness training and Cognitive Behavioral Therapy (CBT) is Acceptance and Commitment Therapy (ACT). It focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. It is not known whether ACT may be effective in reducing artistic performance anxiety.

 

In today’s Research News article “Examining a Group Acceptance and Commitment Therapy Intervention for Music Performance Anxiety in Student Vocalists.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272702/ ) Clarke and colleagues recruited student vocalists who demonstrated performance anxiety and provided them with a six session group program of Acceptance and Commitment Therapy (ACT). Before and after ACT and 3 months later they were measured for music performance anxiety psychological flexibility, anxiety, depression, perceived stress, and well-being.

 

They found that after therapy there were significant reductions in music performance anxiety and psychological inflexibility and significant increases in psychological flexibility and well-being that were maintained 3 months later. Hence, Acceptance and Commitment Therapy (ACT) produced a significant improvement in the psychological well-being of student vocalists who suffered from music performance anxiety. Although not measured, these results would suggest that their vocal performances would improve.

 

This was a small pilot study without a control, comparison, condition. So, great caution must be exercised in interpreting the results. The study though makes a convincing case that a larger randomized control trial should be conducted. Mindfulness training has been shown in prior research to reduce anxiety in clinical and non-clinical populations. So, the reductions in music performance anxiety observed in the present study were not surprising and probably due to the mindfulness training delivered in ACT.

 

So, reduce performance anxiety in student vocalists with mindfulness.

 

Qualitative results showed benefits of daily mindfulness exercises on breathing, micro-muscular awareness, vocal tone, text communication and problem solving.”Petra Raspel

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Clarke, L. K., Osborne, M. S., & Baranoff, J. A. (2020). Examining a Group Acceptance and Commitment Therapy Intervention for Music Performance Anxiety in Student Vocalists. Frontiers in psychology, 11, 1127. https://doi.org/10.3389/fpsyg.2020.01127

 

Abstract

Music performance anxiety (MPA) is a distressing and persistent anxious apprehension related to musical performance. The experience of MPA forces many musicians to give up performing or develop maladaptive coping mechanisms (e.g., avoidance or substance use), which can impact their career and wellbeing. High levels of MPA in students and vocalists are reported in the literature. Vocalists present a unique challenge for clinicians in that vocal and breathing mechanisms, required for performance, are negatively impacted when anxious. Acceptance and commitment therapy (ACT) has demonstrated efficacy for the treatment of a range of psychological problems including social anxiety disorder (of which MPA may be indicated as a subtype). This study sought to investigate whether group-based ACT may be a feasible and effective intervention for MPA in Australian student vocalists and aimed to design an intervention that could be adopted by music education providers. Potential participants (N = 31) completed an online survey including demographic questions and outcome measures. Six vocal students (four females; two males; aged M = 20.33 years) with elevated MPA scores participated in the ACT for MPA group program and 3-month follow-up. Group sessions were 2 h each week for six consecutive weeks. Participants were followed up 3 months post-intervention via online survey. There was a significant increase in psychological flexibility and significant decreases in MPA and psychological inflexibility. Gains were maintained at 3-month follow-up. The current study offers preliminary evidence for the feasibility and effectiveness of a group-based ACT protocol for musicians with performance anxiety which may be incorporated into tertiary performance training curricula.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272702/

 

Reduce Opioid Use after Surgery for Orthopedic Trauma with Mindfulness

Reduce Opioid Use after Surgery for Orthopedic Trauma with Mindfulness

 

By John M. de Castro, Ph.D.

 

mindfulness-based interventions could help people dependent on opioids increase their self-awareness and self-control over cravings and be less reactive to emotional and physical pain.” – Pain Week

 

Substance abuse and addiction is a terrible problem, especially opioid pain relievers. Opioid addiction has become epidemic and is rapidly increasing affecting more than 2 million Americans and an estimated 15 million people worldwide. In the U.S more than 20,000 deaths yearly were attributed to an overdose of prescription opioids. An effective treatment for addiction has been elusive. Most programs and therapies to treat addictions have poor success rates.

 

An encouraging alternative is mindfulness training. It has been found to be effective in treating addictions. One way that mindfulness may produce these benefits is by reducing cravings for opioids. The vast majority of the mindfulness training techniques, however, require a trained therapist. This results in costs that many patients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, mindfulness training over the internet has been developed. This has the tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations.

 

Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. Hence it would make sense to study ACT delivered over the internet to reduce opioid use with pain patients.

 

In today’s Research News article “Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458063/ ) Anthony and colleagues recruited hospital patients who had a bone fracture requiring surgery and randomly assigned them to a treatment as usual control condition or to receive automated text based messages communicating a Acceptance and Commitment Therapy (ACT) message twice a day for the two weeks following surgery.

A day 1 example message was:

Maintaining focus on what you value most in life is sometimes difficult after surgery. Do not let the momentary discomforts due to surgery take away from what you want most in life. Pick 3 things that matter most to you in life. Remind yourself of these 3 things you value most during your recovery process.”

They were measured before and after the 2-week messaging period for opioid use, pain intensity, pain interference, and anxiety.

 

They found that although both groups were prescribed the same amount of opioids after surgery, the Acceptance and Commitment Therapy (ACT) message group consumed significantly fewer, 37% less, opioid pills during the 2 weeks following surgery than the control group. In addition, the ACT group reported significantly lower pain intensity and pain interference than the control group two weeks after surgery.

 

The ability of Acceptance and Commitment Therapy (ACT) to reduce perceived pain and to reduce opioid use have been previously documented. The important contribution of the present study is that it demonstrated that these benefits can be attained with ACT taught through automated text messages. This suggests that the benefits of the therapy can be provided routinely, inexpensively and conveniently to large numbers of patients. Although there was no long term follow up, it would be hoped that this treatment would result in lower likelihood of opioid addiction resulting from post-surgical use in these patients.

 

So, reduce opioid use after surgery for orthopedic trauma with mindfulness.

 

People suffering from opioid addiction and chronic pain may have fewer cravings and less pain if they use both mindfulness techniques and medication for opioid dependence.” – Science Daily

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Anthony, C. A., Rojas, E. O., Keffala, V., Glass, N. A., Shah, A. S., Miller, B. J., Hogue, M., Willey, M. C., Karam, M., & Marsh, J. L. (2020). Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial. Journal of medical Internet research, 22(7), e17750. https://doi.org/10.2196/17750

 

Abstract

Background

Acceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain.

Objective

This study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries.

Methods

Adult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups.

Results

A total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone–based ACT intervention (P=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; P=.04).

Conclusions

In this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458063/

 

Improve Sleep and Reduce Insomnia with Mindfulness

Improve Sleep and Reduce Insomnia with Mindfulness

 

By John M. de Castro, Ph.D.

 

“If insomnia is at the root of your sleepless nights, it may be worth trying meditation. The deep relaxation technique has been shown to increase sleep time, improve sleep quality, and make it easier to fall (and stay) asleep.” – Sleep Foundation

 

Modern society has become more around-the-clock and more complex producing considerable pressure and stress on the individual. The advent of the internet and smart phones has exacerbated the problem. The resultant stress can impair sleep. Indeed, it is estimated that over half of Americans sleep too little due to stress. As a result, people today sleep 20% less than they did 100 years ago. Not having a good night’s sleep has adverse effects upon the individual’s health, well-being, and happiness. It has been estimated that 30 to 35% of adults have brief symptoms of insomnia, 15 to 20% have a short-term insomnia disorder, and 10% have chronic insomnia

 

Insomnia is more than just an irritant. Sleep deprivation is associated with decreased alertness and a consequent reduction in performance of even simple tasks, decreased quality of life, increased difficulties with memory and problem solving, increased likelihood of accidental injury including automobile accidents, and increased risk of dementia and Alzheimer’s disease. It also can lead to anxiety about sleep itself. This is stressful and can produce even more anxiety about being able to sleep. About 4% of Americans revert to sleeping pills. But these do not always produce high quality sleep and can have problematic side effects. So, there is a need to find better methods to treat insomnia. Mindfulness-based practices have been reported to improve sleep amount and quality and help with insomnia.

 

Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. It would seem reasonable to expect that Acceptance and Commitment Therapy (ACT) might improve sleep and relieve insomnia. A number of studies have been performed. So, it makes sense to examine what has been learned.

 

In today’s Research News article “The effect of acceptance and commitment therapy on insomnia and sleep quality: A systematic review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425538/ ) Salari and colleagues review and summarize the published research studies on the effects of Acceptance and Commitment Therapy (ACT) on sleep and insomnia.

 

They identified 19 published studies with a total of 1577 participants. They report that the published research found that Acceptance and Commitment Therapy (ACT) significantly improved sleep quality and reduced insomnia in healthy individuals and in patients with chronic insomnia. These benefits of ACT were still present up to a year after the completion of training.

 

Acceptance and Commitment Therapy (ACT) is a complex therapy and the studies do not identify which components or combination of components are necessary to produce the benefits. Nevertheless, the results clearly demonstrate that ACT is a safe and effective therapy for the improvement of sleep and the reduction in insomnia. This should have secondary effects of improving health and well-being

 

So, improve sleep and reduce insomnia with mindfulness.

 

The idea is to create a reflex to more easily bring forth a sense of relaxation. That way, it’s easier to evoke the relaxation response at night when you can’t sleep.” – Herbert Benson

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Salari, N., Khazaie, H., Hosseinian-Far, A., Khaledi-Paveh, B., Ghasemi, H., Mohammadi, M., & Shohaimi, S. (2020). The effect of acceptance and commitment therapy on insomnia and sleep quality: A systematic review. BMC neurology, 20(1), 300. https://doi.org/10.1186/s12883-020-01883-1

 

Abstract

Background

Acceptance and Commitment Therapy (ACT), as a type of behavioral therapy, attempts to respond to changes in people’s performance and their relationship to events. ACT can affect sleep quality by providing techniques to enhance the flexibility of patients’ thoughts, yet maintaining mindfullness. Therefore, for the first time, a systematic review on the effects of ACT on sleep quality has been conducted.

Methods

This systematic review was performed to determine the effect of ACT on insomnia and sleep quality. To collect articles, the PubMed, Web of Science (WOS), Cochrane library, Embase, Scopus, Science Direct, ProQuest, Mag Iran, Irandoc, and Google Scholar databases were searched, without a lower time-limit, and until April 2020.

Results

Related articles were derived from 9 research repositories, with no lower time-limit and until April 2020. After assessing 1409 collected studies, 278 repetitive studies were excluded. Moreover, following the primary and secondary evaluations of the remaining articles, 1112 other studies were removed, and finally a total of 19 intervention studies were included in the systematic review process. Within the remaining articles, a sample of 1577 people had been assessed for insomnia and sleep quality.

Conclusion

The results of this study indicate that ACT has a significant effect on primary and comorbid insomnia and sleep quality, and therefore, it can be used as an appropriate treatment method to control and improve insomnia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425538/

 

Improve Painful Diabetic Neuropathy with Mindfulness

Improve Painful Diabetic Neuropathy with Mindfulness

 

By John M. de Castro, Ph.D.

 

mindfulness specifically can also potentially improve quality of life for patients with neuropathy. . . Research indicates that in addition to improving pain, mindfulness also addresses the psychological consequences of chronic pain, including depression symptoms.” – Foundation for Peripheral Neuropathy

 

Diabetes can lead to a very painful condition known as diabetic neuropathy. The high blood glucose levels associated with diabetes can damage nerves and result in a burning pain and numbness, particularly from the legs and feet. It affects the majority of long-term diabetes patients. This is not only painful but is also disruptive to the normal life functions of these patients. There are no cures, but diabetic neuropathy can be prevented by blood glucose control in the diabetic patient with a rigorous program of measured diet and exercise. Treatment for diabetic neuropathy usually involves pain management with drugs.

 

Mindfulness practices have been shown to help with pain management and with quality of life in diabetes patients. and has been shown to improve the symptoms of diabetic neuropathy. A therapeutic technique that contains mindfulness training is Acceptance and Commitment Therapy (ACT). It is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT) and focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

It is important, then, to study the effectiveness of Acceptance and Commitment Therapy (ACT) for reducing pain and improving quality of life in patients with diabetic neuropathy. In today’s Research News article “The Effectiveness of Acceptance and Commitment Therapy on Pain Acceptance and Pain Perception in Patients with Painful Diabetic Neuropathy: A Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376796/) Taheri and colleagues recruited patients diagnosed with diabetic peripheral neuropathy, aged 35 to 65 years, and randomly assigned them to either receive 8 sessions of ACT or to a no-treatment control condition. They were measured before and after training and 3 months later for sensory pain, psychological pain, and chronic pain acceptance.

 

They found that in comparison to the baseline and the no-treatment control group the patients who received Acceptance and Commitment Therapy (ACT) had significant decreases in pain and significant increases in pain acceptance. These benefits of ACT were still significant at the 3-month follow up. So ACT were appears to produce significant and lasting improvements in diabetic peripheral neuropathy pain and its acceptance.

 

The trial did not have an active control group. So, the design is not the strongest and may be open to confounding. In addition, Acceptance and Commitment Therapy (ACT) is a complex therapy that includes mindfulness and Cognitive Behavioral Therapy (CBT), along with other therapeutic components. So, it cannot be determined which of these components or which combination of components were responsible for the effects. Previous research has shown that mindfulness training improves the symptoms of diabetic neuropathy. So, it is reasonable to conclude that the mindfulness component of ACT is effective. Hence, the study suggests that ACT is a safe, effective, and lasting treatment for diabetic peripheral neuropathy pain.

 

So, improve painful diabetic neuropathy with mindfulness.

 

by activating and reinforcing some areas of the brain used in pain processing, meditation has the overall effect of helping to reduce pain intensity in patients. Other theories on how meditation affects pain, including that it decreases stress, which in turn decreases pain.” – Foundation for Peripheral Neuropathy

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Taheri, A. A., Foroughi, A. A., Mohammadian, Y., Ahmadi, S. M., Heshmati, K., Hezarkhani, L. A., & Parvizifard, A. A. (2020). The Effectiveness of Acceptance and Commitment Therapy on Pain Acceptance and Pain Perception in Patients with Painful Diabetic Neuropathy: A Randomized Controlled Trial. Diabetes therapy : research, treatment and education of diabetes and related disorders, 11(8), 1695–1708. https://doi.org/10.1007/s13300-020-00851-9

 

Abstract

Introduction

Neuropathic pain is a complex phenomenon in patients with diabetes. These patients have many problems, such as psychological problems, high-level pain perception, and pain acceptance. This study aimed to evaluate the effectiveness of acceptance and commitment therapy on pain acceptance and pain perception in patients with painful diabetic neuropathy.

Methods

This study was performed according to the clinical trial method. The sample size was 50 participants. In this study, participants were divided into interventional and control groups. According to the diagnosis of neurologists, all participants received conventional medications to manage neuropathic pain. The intervention group received acceptance and commitment therapy for eight sessions. The results in the three phases of pre-test, post-test, and follow-up were evaluated. After completing the study, to comply with ethical standards, the control group received psycho-education. The tools used were the McGill Pain Questionnaire (MPQ) and the Chronic Pain Acceptance Questionnaire (CPAQ). Statistical analysis includes mean, standard deviation, and repeated-measures (ANOVA) conducted by SPSS software version 22.

Results

The results demonstrated that in the post-test and follow-up phases, acceptance and commitment therapy could improve pain acceptance and reduce pain perception in the intervention group compared to the control group (P < 0.01).

Conclusion

The results indicated that acceptance and commitment therapy could be used as a psychological intervention besides pharmacotherapy to improve pain acceptance and reduce pain perception in patients with painful diabetic neuropathy.

Key Summary Points

Why carry out this study?
Patients with painful diabetic neuropathy endure severe and excruciating pain that adversely affects their function. According to Melzack theory, one of the most important factors in pain perception is psychological factors.
Before this study, no clinical trial study had been performed to measure the effectiveness of psychological therapy in reducing the severity of pain perception in patients with painful diabetic neuropathy.
The main purpose of this study was to investigate the effectiveness of acceptance and commitment therapy (ACT) therapy on improving pain acceptance and subsequently reduction of pain perception.
What was learned from the study?
The results showed that compared to the control group, the interventional group had significant improvement in pain acceptance and also a major reduction in pain perception in the post-test phase. The same results were observed after a 3-month follow-up.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376796/

 

Mindfulness Improves Flexibility Which Improves Residual Symptoms of Depression

Mindfulness Improves Flexibility Which Improves Residual Symptoms of Depression

 

By John M. de Castro, Ph.D.

 

Living resiliently represents a whole new way of being and doing. It isn’t just for the hard times — it’s for all times. Empowering us to live, love, and work adventurously in the face of change, it builds a well from which we can draw for the rest of our lives.” – Lynda Klau

 

Depression affects over 6% of the population. Depression can be difficult to treat. It is usually treated with antidepressant medication. But, of patients treated initially with drugs only about a third attained remission of the depression. Even after remission there are a number of symptoms that remain. These include lingering dysphoria, impaired psychosocial functioning, fatigue, and decreased ability to work. These residual symptoms can lead to relapse.

 

Mindfulness training is an alternative treatment for depression. It has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs failAcceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

It is not known how Acceptance and Commitment Therapy (ACT) might affect the residual symptoms in individuals in remission from depression. In today’s Research News article “Psychological Flexibility in Depression Relapse Prevention: Processes of Change and Positive Mental Health in Group-Based ACT for Residual Symptoms.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7119364/), Østergaard and colleagues recruited patients in remission from major depressive disorder and provided them with 8 weekly sessions of group based Acceptance and Commitment Therapy (ACT). They were measured before and after ACT and 6 months and 1 year later for psychiatric symptoms, mental health depression, cognitive defusion, flexibility, values, engaged living and mindfulness.

 

They found that after treatment and for the year following there were significant reductions in depression and increases in positive mental health. Mediation analysis revealed that Acceptance and Commitment Therapy (ACT) decreased depression and increased positive mental health directly and indirectly by increasing psychological flexibility. That is ACT not only directly decreased depression and increased positive mental health but also increased psychological flexibility which in turn decreased depression and increased positive mental health. They also showed that ACT had these effects by changing acceptance, cognitive defusion, values, and committed action, all of which increased psychological flexibility.

 

Psychological flexibility is the ability to make changes in behavior in order to produce positive effects. It’s the individual’s ability to avoid rumination and brooding over negative emotions that contribute to depression. In this way psychological flexibility contributes to maintaining positive mental health. The study shows that ACT directly reduces residual symptoms and also increases psychological flexibility which in turn reduces residual symptoms in patients in remission from major depressive disorder. It is important to note that these benefits produced by ACT were enduring lasting over the year of testing. Hence, treatment with ACT  should reduce the likelihood of future depressive episodes.

 

So, mindfulness improves flexibility which improves residual symptoms of depression.

 

Mindfulness is a shallow description of a much larger process that makes us resilient when bad things happen.” – Michael Unger

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Østergaard, T., Lundgren, T., Zettle, R. D., Landrø, N. I., & Haaland, V. Ø. (2020). Psychological Flexibility in Depression Relapse Prevention: Processes of Change and Positive Mental Health in Group-Based ACT for Residual Symptoms. Frontiers in psychology, 11, 528. https://doi.org/10.3389/fpsyg.2020.00528

 

Abstract

Relapse rates following a depressive episode are high, with limited treatments available aimed at reducing such risk. Acceptance and commitment therapy (ACT) is a cognitive-behavioral approach that has gained increased empirical support in treatment of depression, and thus represents an alternative in relapse prevention. Psychological flexibility (PF) plays an important role in mental health according to the model on which ACT is based. This study aimed to investigate the role of PF and its subprocesses in reducing residual symptoms of depression and in improving positive mental health following an 8-week group-based ACT treatment. Adult participants (75.7% female) with a history of depression, but currently exhibiting residual symptoms (N = 106) completed measures before and after intervention, and at 6 and 12-month follow-up. A growth curve model showed that positive mental health increased over 12-months. Multilevel mediation modeling revealed that PF significantly mediated these changes as well as the reduction of depressive symptoms, and that processes of acceptance, cognitive defusion, values and committed action, in turn, mediated increased PF.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7119364/

 

Relieve Generalized Anxiety and Depression with a 2-Session Acceptance and Commitment Therapy (ACT)

Relieve Generalized Anxiety and Depression with a 2-Session Acceptance and Commitment Therapy (ACT)

 

By John M. de Castro, Ph.D.

 

“ACT is about acceptance and it is about change at the same time. Applied to anxiety disorders, patients learn to end the struggle with their anxiety-related discomfort and take charge by engaging in actions that move them related to their chosen life aims.” – Mohsen Hasheminasab 

 

Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. A characterizing feature of anxiety disorders is that the suffer overly identifies with and personalizes their thoughts. The sufferer has recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. Anxiety disorders have generally been treated with drugs. But there are considerable side effects and these drugs are often abused.

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. Depression can be difficult to treat and is usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression.

 

There are a number of psychological therapies for anxiety and depression. But, les than half the patients treated respond to the therapy and do not relapse. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders. A therapeutic technique that contains mindfulness training is Acceptance and Commitment Therapy (ACT). It is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT) and has also been shown to relieve anxietyACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

In prior research Ruiz and associates have demonstrated that a 3 session Acceptance and Commitment Therapy (ACT) is effective Generalized Anxiety Disorder (GAD) and for depression. In today’s Research News article “Efficacy of a two-session repetitive negative thinking-focused acceptance and commitment therapy (ACT) protocol for depression and generalized anxiety disorder: A randomized waitlist control trial.” (See summary below or at: https://pubmed.ncbi.nlm.nih.gov/31944806/), Ruiz and colleagues examine the efficacy of a 2-session ACT for Generalized Anxiety Disorder (GAD) and for depression.

 

They recruited via social media patients diagnosed with either Generalized Anxiety Disorder (GAD) or depression and randomly assigned them to either a wait-list control condition or to receive 2 60-minute individual sessions of Acceptance and Commitment Therapy (ACT). They were measured before and after treatment and 1- and 3-months month later for anxiety, depression, perceived stress, perseverative thinking, experiential avoidance, cognitive fusion, valued living, and generalized pliance (rule governed behavior).

 

They found that in comparison to baseline and the wait-list control group, the patients who received Acceptance and Commitment Therapy (ACT) had significantly improved levels of all outcome measures including anxiety, depression, perceived stress, perseverative thinking, experiential avoidance, cognitive fusion, valued living, and generalized pliance that persisted at the 1- and 3-month follow-ups. Fully 91% of the patients receiving ACT had clinically significant changes in their Generalized Anxiety Disorder (GAD) or depression compared to 9% of the wait-list controls.

 

The findings are remarkable in that 2 1-hour sessions of Acceptance and Commitment Therapy (ACT) produced such large, significant and lasting improvements in patients with Generalized Anxiety Disorder (GAD) or depression. These disorders are widespread affecting a large number of people and are frequently debilitating or at least interfere with their ability to conduct their lives. It is exciting that a brief treatment that can be implemented cost-effectively is capable of relieving their suffering.

 

The study, however, lacked an active control condition, e.g. exercise, and so is open to a variety of confounding variables. Future research should include such an active control. The effects of confounding variables, however, generally fade fairly quickly over time. So, the fact that the current results were still large and significant 3-months later argues that the benefits were produced by ACT.

 

So, relieve generalized anxiety and depression with a 2-session Acceptance and Commitment Therapy (ACT).

 

ACT has been used effectively to help treat workplace stress, test anxiety, social anxiety disorder, depression, obsessive-compulsive disorder, and psychosis.” – Psychology Today

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Ruiz FJ, Peña-Vargas A, Ramírez ES, et al. Efficacy of a two-session repetitive negative thinking-focused acceptance and commitment therapy (ACT) protocol for depression and generalized anxiety disorder: A randomized waitlist control trial [published online ahead of print, 2020 Jan 16]. Psychotherapy (Chic). 2020;10.1037/pst0000273. doi:10.1037/pst0000273

 

Abstract

This parallel randomized controlled trial aimed to evaluate the effect of acceptance and commitment therapy (ACT) focused on disrupting repetitive negative thinking (RNT) versus a waitlist control (WLC) in the treatment of depression and generalized anxiety disorder (GAD). Forty-eight participants with a main diagnosis of depression and/or GAD were allocated by means of simple randomization to a 2-session RNT-focused ACT intervention or to the WLC. The primary outcomes were emotional symptoms as measured by the Depression, Anxiety, and Stress Scales-21. Process outcomes included ACT- and RNT-related measures: general RNT, experiential avoidance, cognitive fusion, values, and generalized pliance. At the 1-month follow-up, linear mixed effects models showed that the intervention was efficacious in reducing emotional symptoms (d = 2.42, 95% confidence interval [1.64, 3.19]), with 94.12% of participants in the RNT-focused ACT condition showing clinically significant change in the Depression, Anxiety, and Stress Scales-21 total scores versus 9.09% in the WLC condition (70% vs. 8% in intention-to-treat analysis). The intervention effects were maintained at the 3-month follow-up. No adverse events were found. A very brief RNT-focused ACT intervention was highly effective in the treatment of depression and GAD.

Clinical Impact Statement Question: What is the applied clinical practice question this paper is hoping to address?

To analyze whether a 2-session acceptance and commitment therapy (ACT) intervention focused on disrupting repetitive negative thinking (RNT) is effective in treating depression and GAD. Findings: How would clinicians meaningfully use the primary findings of this paper in their applied practice? Clinicians might use the RNT-focused ACT protocol to treat depression and GAD. Meaning: What are the key conclusions and implications for future clinical practice and research? The RNT-focused ACT protocol was highly effective in treating depression and GAD. Next Steps: Based on the primary findings and limitations of this paper, what are future directions to be explored in clinical practice and research? To analyze the long-term effects of the RNT-focused ACT protocol.

https://pubmed.ncbi.nlm.nih.gov/31944806/

 

Improve Quality of Life after a Heart Attack with Mindfulness

Improve Quality of Life after a Heart Attack with Mindfulness

 

By John M. de Castro, Ph.D.

 

Not only can meditation improve how your heart functions, but a regular practice can enhance your outlook on life and motivate you to maintain many heart-healthy behaviors.” – John Denninger

 

Cardiovascular disease is the number one killer. A myriad of treatments has been developed including a variety of surgical procedures and medications. In addition, lifestyle changes have proved to be effective including quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses. Unfortunately, for a variety of reasons, 60% of cardiovascular disease patients decline participation, making these patients at high risk for another attack.

 

Contemplative practices have been shown to be safe and effective alternative treatments for cardiovascular disease. Practices such as meditation, tai chi, and yoga, have been shown to be helpful for heart health and to reduce the physiological and psychological responses to stress. They have also been shown to be effective in maintaining cardiovascular health and the treatment of cardiovascular disease.

 

Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. So, it makes sense to study the efficacy of ACT for patients recovering from a heart attack.

 

In today’s Research News article “The Effectiveness of Acceptance and Commitment Therapy on Quality of Life in a Patient with Myocardial Infarction: A Randomized Control Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193234/), Ghahnaviyeh and colleagues recruited patients over 30 years of age who had had a myocardial infarction. They were randomly assigned to either receive 8 weekly 90 minute sessions of Acceptance and Commitment Therapy (ACT) or to a treatment as usual control condition. They were measured before and after therapy and 6 months later for health status and quality of life.

 

They found that after therapy and 6 months later the group that received Acceptance and Commitment Therapy (ACT) had significantly greater overall quality of life including significantly greater physical and psychological quality of life. These results suggest that ACT improves the quality of life of patients having had myocardial infarction. It remains for future research to determine the mechanisms of these effects of ACT.

 

So, improve quality of life after a heart attack with mindfulness.

 

this practice may be clinically useful in the secondary prevention of cardiovascular disease.” – Heart Matters

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Ahmadi Ghahnaviyeh, L., Bagherian, B., Feizi, A., Afshari, A., & Mostafavi Darani, F. (2020). The Effectiveness of Acceptance and Commitment Therapy on Quality of Life in a Patient with Myocardial Infarction: A Randomized Control Trial. Iranian journal of psychiatry, 15(1), 1–9.

 

Abstract

Objective: Acceptance and commitment therapy (ACT) interventions increase psychological flexibility and improve mental health and quality of life in patients with myocardial infarction.

Study design: A controlled clinical trial study was conducted to evaluate the efficacy of an ACT intervention in improving the quality of life in patients with MI in Isfahan, Iran.

Method : The present controlled clinical trial with a pre and post-test design was conducted on a statistical population consisting of patients with MI admitted to hospitals in Isfahan (n = 60) who were selected through sequential sampling based on the study inclusion criteria and were randomly divided into an intervention and a control group (n1 = n2 = 30). The case group received 8 weekly 90-minute sessions of ACT and the control group received no interventions. The pretest-posttest design was administered in both groups using a demographic questionnaire and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) designed to assess the health status of patients with heart failure in terms of quality of life. The data obtained were analyzed in SPSS-20 using descriptive statistics and the ANCOVA.

Results: In this study, 2 general areas of quality of life, including physical and mental health, were examined in the patients. There was a significant increase in the quality of life and subscales of mental and physical health in the experimental group (p < 0.001).

Conclusion: Considering the effectiveness of ACT in improving quality of life in these patients, this method of intervention can be used as a complementary therapy in health care centers to reduce the side-effects experienced by these patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193234/

 

Improve Major Depressive Disorder with Acceptance and Commitment Therapy

Improve Major Depressive Disorder with Acceptance and Commitment Therapy

 

By John M. de Castro, Ph.D.

 

Insecure attachment styles are more prevalent in individuals with mood disorders and has been associated with worse clinical outcomes, whereas a secure attachment is linked to more positive health behaviors, such as greater adherence to health plans and preventive health behaviors.” – Tamara Cassis

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating and difficult to treat. It is usually treated with antidepressant medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time.

 

Attachment has been shown to affect the individual’s well-being. There are a variety of ways that individuals attach to others. They are secure, insecure, avoidant, ambivalent, fearful, preoccupied, and disorganized attachment styles. Secure attachment style is healthy and leads to positive development while all of the others are maladaptive and unhealthy. All of the  attachment styles, save secure attachment, are associated with depression.

 

Mindfulness training is an alternative treatment for depression. It has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs failAcceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

It is possible that Acceptance and Commitment Therapy (ACT) may improve depression by affecting attachment. In today’s Research News article “Explicit and implicit attachment and the outcomes of acceptance and commitment therapy and cognitive behavioral therapy for depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137238/),  A-Tjak and colleagues explore this possibility. They recruited adult patients diagnosed with major depressive disorder and randomly assigned them to receive 18 weekly 50 minute sessions of Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT). They were measured before and after treatment and 6 months later for depressive symptoms, quality of life, attachment anxiety, and attachment avoidance. Implicit attachment was measured with a card sorting task.

 

They found that the two treatments were equally effective producing 75% to 80% rates of remission from depression and significant reductions in depression, attachment anxiety, and attachment avoidance and increases in quality of life. The effects were still present at the 6-month follow-up. The decreases in attachment anxiety and attachment avoidance were associated with decreases in depression and increases in quality of life while no relationships were present for implicit attachment.

 

The fact that Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) were equally effective for major depression is not surprising as ACT incorporates CBT. It is interesting that the magnitude in the changes in attachment anxiety and attachment avoidance were related to the improvements in depression and quality of life. But these results do not demonstrate causation, changes in attachment might cause changes in depression, changes in depression might cause changes in attachment, or therapy might change both independently. What is clear is that both ACT and CBT are highly effective and lasting treatments for major depressive disorder.

 

So, improve major depressive disorder with Acceptance and Commitment Therapy.

 

Mindfulness training can “generate positive emotions by cultivating self-compassion and self-confidence through an upward spiral process.” – Amanda MacMillan

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

A-Tjak, J., Morina, N., Boendermaker, W. J., Topper, M., & Emmelkamp, P. (2020). Explicit and implicit attachment and the outcomes of acceptance and commitment therapy and cognitive behavioral therapy for depression. BMC psychiatry, 20(1), 155. https://doi.org/10.1186/s12888-020-02547-7

 

Abstract

Background

Attachment theory predicts that patients who are not securely attached may benefit less from psychological treatment. However, evidence on the predictive role of attachment in the effectiveness of treatment for depression is limited.

Methods

Explicit attachment styles, levels of attachment anxiety and attachment avoidance, as well as implicit relational self-esteem and implicit relational anxiety were assessed in 67 patients with major depressive disorder (MDD) receiving Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy (CBT). ANOVA and hierarchical regression analyses were performed to investigate the predictive power of explicit and implicit attachment measures on treatment outcome.

Results

Explicit attachment avoidance at pre-treatment significantly predicted reduction of depressive symptoms following treatment. Reductions in attachment anxiety and avoidance from pre- to post-treatment predicted better treatment outcomes. Neither one of the implicit measures, nor change in these measures from pre- tot post-treatment significantly predicted treatment outcome.

Conclusions

Our findings show that attachment avoidance as well as reductions in avoidant and anxious attachment predict symptom reduction after psychological treatment for depression. Future research should use larger sample sizes to further examine the role of attachment orientation as moderator and mediator of treatment outcome.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137238/

 

Improve Generalized Anxiety Disorder with Acceptance and Commitment Therapy (ACT)

Improve Generalized Anxiety Disorder with Acceptance and Commitment Therapy (ACT)

 

By John M. de Castro, Ph.D.

 

Acceptance and commitment therapy (ACT) is a type of psychotherapy gaining popularity in the treatment of anxiety disorders like generalized anxiety disorder (GAD). It is also used to treat other conditions including depression, eating disorders, chronic pain, and substance use disorders.” – Deborah Glasofer

 

Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. A characterizing feature of anxiety disorders is that the suffer overly identifies with and personalizes their thoughts. The sufferer has recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. Anxiety disorders have generally been treated with drugs. But there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders.

 

A therapeutic technique that contains mindfulness training is Acceptance and Commitment Therapy (ACT). It is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT) and has also been shown to relieve anxietyACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

In today’s Research News article “A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082425/), Ruiz and colleagues recruited 6 adults with Generalized Anxiety Disorder (GAD) and also depression. They received a 3 session Acceptance and Commitment Therapy (ACT) protocol of 90, 60, and 60 minutes focused on repetitive negative thinking implemented at different times on a multiple baseline. They were measured weekly over the internet for emotional symptoms (a combination of anxiety, depression and perceived stress), worry, experiential avoidance, cognitive fusion, perseverative thinking, and valuing.

 

They found that all participants demonstrated no significant changes during the 5 or more weeks of the baseline period in emotional symptoms or worry. But once Acceptance and Commitment Therapy (ACT) was provided all participants immediately demonstrated a precipitous decline in emotional symptoms, worry, experiential avoidance, cognitive fusion, and perseverative thinking that was maintained for 3 months. Effect sizes were very large and 5 of the 6 participants had clinically significant changes in emotional symptoms and worry.

 

It is well established that mindfulness training reduces anxiety, depression, perceived, stress, and worry. Nevertheless, the results of the present study are striking. Administration of a brief Acceptance and Commitment Therapy (ACT)  focused on repetitive negative thinking produced dramatic clinically significant improvements in the core symptoms of Generalized Anxiety Disorder (GAD) and depression. The fact that this was accomplished in 3-sessions is important as it reduces the investment of therapists in treatment, reducing costs and improving the numbers of people being able to be treated. These findings suggest that this brief form of mindfulness-based therapy be implemented for anxiety and deprressive disorders.

 

So, improve Generalized Anxiety Disorder with Acceptance and Commitment Therapy (ACT).

 

ACT helps you take action on your values, instead of letting your anxiety dictate your decisions and your days.” –  Margarita Tartakovsky

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Ruiz, F. J., Luciano, C., Flórez, C. L., Suárez-Falcón, J. C., & Cardona-Betancourt, V. (2020). A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression. Frontiers in psychology, 11, 356. https://doi.org/10.3389/fpsyg.2020.00356

 

Abstract

Repetitive negative thinking (RNT) is a core feature of generalized anxiety disorder (GAD) and depression. Recently, some studies have shown promising results with brief protocols of acceptance and commitment therapy (ACT) focused on RNT in the treatment of emotional disorders in adults. The current study analyzes the effect of an individual, 3-session, RNT-focused ACT protocol in the treatment of severe and comorbid GAD and depression. Six adults meeting criteria for both disorders and showing severe symptoms of at least one of them participated in the study. A delayed multiple-baseline design was implemented. All participants completed a 5-week baseline without showing improvement trends in emotional symptoms (Depression Anxiety and Stress Scale – 21; DASS-21) and pathological worry (Penn State Worry Questionnaire; PSWQ). The ACT protocol was then implemented, and a 3-month follow-up was conducted. Five of the six participants showed clinically significant changes in the DASS-21 and the PSWQ. The standardized mean difference effect sizes for single-case experimental design were very large for emotional symptoms (d = 3.34), pathological worry (d = 4.52), experiential avoidance (d = 3.46), cognitive fusion (d = 3.90), repetitive thinking (d = 4.52), and valued living (d = 0.92 and d = 1.98). No adverse events were observed. Brief, RNT-focused ACT protocols for treating comorbid GAD and depression deserve further empirical tests.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082425/