A Meta-analytic Review of Acceptance-Based Behavioral Interventions for the Treatment of Anxiety

The relative popularity of acceptance and commitment therapy (ACT) has grown in recent years, and inspired the development of contemporary acceptance-based treatment approaches. Acceptance-based therapies differ from traditional cognitive- behavior therapy (CBT) on pragmatic grounds, the import of which implicates the purpose of therapy. CBT utilizes exposure and cognitive change techniques primarily in service of symptom change outcomes; whereas, ACT utilizes exposure and acceptance for purposes of promoting psychological flexibility in the pursuit of personal values. The purpose of this meta-analytic study was to determine the relative efficacy of acceptance- based versus symptom-change behavioral approaches with anxiety disorders and to quantify this impact. A comprehensive literature search turned up 18 studies that met inclusion criteria for this analysis. An effect size was calculated using the standardized mean gain procedure for both the acceptance-based and symptom-change approaches, along with the waitlist control groups. The results demonstrate a large effect size for the acceptance-based approach (Weighted mean ES = .83) and a medium effect size for symptom-change approach (Weighted mean ES = .60). The waitlist control groups demonstrated a small effect size (Weighted mean ES = .24). Based on this review, it is suggested that graduate and internship programs in Clinical Psychology should promote evidence-based training in the use of acceptance-inspired behavioral therapies.

The Relationships Between Child Maltreatment and Exploratory Behavior Implications for Development.

Findings from the fields of attachment theory, physiology, neurology, neurobiology and cognitive theory, when considered together, enhance understanding of the behavior and development of maltreated children. Each field describes from its own vantage how emotional trauma influences the quality and quantity of exploratory behavior. Development in many spheres is influemced by behavior. There is evidence from the field of neurobiology that experience ultimately influences the anatomy of the brain. Therefore, it can be hypothesized that constricted, overly defensive behavior in childhood ultimately compromises the development of the central nervous system itself. The altered neurobiology may help explain some of the developmental delays and failures seen in some maltreated children. Such developmental disruptions may include lowered intellectual performance, impaired ability to learn from experience, behavioral regressions under stress, and characterological abnormalities. This neurobiologic hypothesis has implications for research, intervention and training of professionals.It encourages 1) the identification of those deficit capacities most vulnerable to becoming neurologically based, 2) identification of ways to help the maltreated child explore and be accessible to developmental experiences, 3) more emphasis on the development of cognitive capacities, and 4) more breadth of training for professionals who work with maltreated children and their families.

Convention, Tradition, and the New Wave : Assessing Clinician Identity within Behavior Therapy

In the first wave, behaviorists questioned the conventional wisdom that inner experience was relevant to understanding human behavior. In the 1970s, cognitive-behavioral theories emphasized the importance of the cognitive element, not just the environment, in explaining and modifying behavior. The third wave is drawn from advances in basic and applied behavior analysis of language, Eastern mystical traditions, and less empirically oriented therapeutic approaches. Examples include Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Functional Analytic Psychotherapy (FAP), and Mindfulness Based Cognitive Therapy (IBCT). This study reports a survey of clinicians and non-clinicians who self-identify with second or third wave approaches, and a group of undergraduate psychology students intended to represent a layperson or folk psychological approach. Their preferences, in the context of 10 clinical vignettes, among 5 different therapeutic responses or interventions that included "ACT-like," "cognitive," and commonsense or "neutral" options were measured. Third wave-oriented respondents exhibited more consistency than others in their preference for interventions that match their self-identified theoretical orientation, however the author suggests that construction of the vignettes may have influenced this result.