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.

Interpreting Empirical Assessments from a Behavioral Perspective: A Rationale for Why and How

This paper provides a rationale on why and how to utilize assessment tools effectively within the behavioral framework through idiographic assessment. Empirical assessment instruments can provide guidance to the behaviorist that may prove useful in the idiographic formation of a behaviorally-based treatment plan. The paper will focus on two of the major traditional instrument tools, the Minnesota Multiphasic Personality Inventory and the Rorschach inkblot test.

Leading With the Relationship: The Role of the Therapeutic Relationship in Motivational Interviewing

Motivational Interviewing (MI) is a brief evidence-based treatment that is most commonly used to treat addictive behaviors and to encourage diet and lifestyle changes and treatment adherence in health care settings. In recent years MI's use has been expanded to multiple other client populations in clinical psychology, as well as to other sectors, such as in education, and international non-profit work (Hettema at al., 2005). MI was inspired by research that demonstrated a high correlation between therapist application of the client-centered skill of accurate empathy and a reduction in drinking behaviors (Miller et al., 1980). MI contains both relational and technical components that are intended to operate synergistically. Despite a large body of research on MI treatment outcomes, variation in effectiveness has been found among studies, and the active ingredients of MI, particularly the relational aspects, are not well understood. As a result, the use of MI in many treatment settings is limited to the technical components of MI without a theory-based integration of the therapeutic relationship. This paper focuses on the contribution of the relational component to the effectiveness of MI, and explores the synergistic relationship between the technical and relational components of MI. A literature review of MI and the trans-theoretical literature on the therapeutic relationship is followed by two case illustrations. The paper concludes with recommendations for the field.

Psychological and Social Perspectives on Malingering and Symptom Exaggeration: Conceptualization and Interventions Using Acceptance and Commitment Therapy

Malingering and the production of false symptoms seen in such disorders as Factitious Disorder are an ongoing mystery to medical and mental health professionals. Historically, these presentations have been difficult to identify and treat. As might be expected, individuals with such symptomology rarely agree to participate in research, possibly because of a reluctance to admit to the feigning or exaggerating behaviors and a fear of reprisals. Many different etiologies have been proposed, including the assumption of roles in order to manage impressions, taking control of symptoms in order to gain attention or other rewards or avoid aversive events, and even the production of symptoms that is largely out of awareness such as is seen in conversion or somatoform presentations. By examining historical and present-day beliefs about etiology and treatment interventions, professionals can explore what new types of effective treatment might look like. The behaviorist philosophy that underlies Acceptance and Commitment Therapy proposes a perspective emphasizing effective working in context. This philosophy also suggests individuals sometimes engage in behavior in order to escape from or avoid aversive experiences. Utilizing case examples and fresh behavioral perspectives provides insight and ideas for conceptualization of these behaviors of interest. Using the above conceptualizations, an ACT based treatment of those who produce false symptoms is introduced.

Weight-Based Emotional Abuse: Self Psychological Implications for Treatment

The aim of this paper is to provide evidence that overweight individuals are at increased risk for emotional abuse compared to their normal weight counterparts. Studies examining weight-based discrimination and bullying demonstrate examples of emotional abuse aimed at overweight individuals. The psychological difficulties associated with emotional abuse, such as symptoms of anxiety, depression and social difficulties, are reviewed. It is hypothesized that similar psychological difficulties are experienced when obese persons experience weight based emotional abuse. A self psychological conceptualization is applied to understand the effect emotional abuse has on one's sense of self. A treatment proposal, which aims to utilize self-object transferences to strengthen the self, is offered. Future research for the application of self psychology in a group therapy format is discussed.

Acceptance and Commitment Therapy-Based Exposure Treatment of Choking Phobia: A Case Study

One might choke if they observed the lack of research on choking phobia. McNally's (1994) review of the literature on choking phobia found only 25 studies addressing the treatment of choking phobia. The vast majority of these were case studies and none were randomized controlled trials. A search of the literature since then yielded only a few more studies. Given the dearth of information available about choking phobia and its treatment, it is important to document cases treated successfully with novel approaches. My goal in this paper is therefore to illustrate the use of exposure therapy augmented by Acceptance and Commitment Therapy (ACT; e.g., see Hayes, Strosahl, & Wilson, 1999; Hayes and Strosahl, 2004) in the treatment of an adult male presenting with fear of choking and to offer suggestions for the optimal treatment of choking phobia. To my knowledge, there are no documented cases of elements of ACT being used in the treatment of choking phobia to be found in the literature.