A Systematic Review of Values-Based Psychometric Tools Within Acceptance and Commitment Therapy (ACT)

A pilot RCT assessing feasibility of a single values-based versus standard goal-Setting session for community dwellers with acquired brain injury (ABI)

A pilot randomised controlled trial examined the feasibility (i.e., intervention demand, acceptability and initial efficacy) of a single-session (T1) and two-week follow-up (T2) values-based versus standard goal-setting intervention for ABI community dwellers. Twenty four participants (12 in each group) with ABI were recruited, 14 of whom were male (age: M = 61, SD = 9.3). Retention rate was at 92%, and both interventions were rated as acceptable (mean ratings ≥ 80%). Improvements in the primary outcome of wellbeing were greater in the values group (dppc2 = 0.30), while no differences between groups were found for goal attainment or memory of goals. Regarding attitudes towards goals measured at T1, motivation was higher for the values group with a small-to-medium effect size (d = -0.31), whereas confidence and anticipated pleasure from working on the goal were higher for the standard goal-setting group with small-to-medium (d = 0.28) and small (d = 0.17) effect sizes, respectively. The study found a modest improvement for the wellbeing of ABI community dwellers when their goals were embedded in values, while memory of goals and goal achievement was similar across both groups. Study limitations and future recommendations are discussed, and replication is required.

Translation, psychometric evaluation, and network analysis of the parental acceptance and action questionnaire (PAAQ) among Arab parents of children with and without specific learning disability (dyslexia)

OBJECTIVE

The current study evaluated psychometric properties and network analysis of the Parental Acceptance and Action Questionnaire (PAAQ) among Arab parents of children with and without dyslexia.

METHOD

419 parents of community sample children and 318 parents of children with dyslexia (CWD) completed the PAAQ, Interpersonal Mindfulness Scale (IMS), and a socio-demographic checklist. Exploratory Graph Analysis (EGA), Confirmatory Factor Analysis (CFA), and Exploratory Factor Analysis (EFA) were used to determine the factor structure of the PAAQ. Cronbach's alpha was used to estimate internal consistency. Finally, the centrality measures are derived from network theory (betweenness, closeness, and strength).

RESULTS

In both community and CWD samples, the author identified similar factor structures encompassing three dimensions: proactive behavior and adaptability in parenting, acceptance of personal parenting-related inner experiences, and acceptance of the child's negative inner experiences. Item 18 was removed due to poor factor loading in both samples, resulting in a final version of the PAAQ with 18 items (instead of 19 items). This factor structure was revealed through EFA analysis and confirmed by CFA and GFA, demonstrating the scale's consistency. For all subscales in both samples, Cronbach's alpha was more significant than 0.7, indicating suitable internal consistency. Regarding centrality, both the community and dyslexia groups had similar centrality measures in some items. However, the dyslexia group generally showed higher betweenness values than the community group in several items (e.g., PAAQ.6, PAAQ.7).

CONCLUSION

The PAAQ is a suitable scale for use with Arabic parents, including community samples and parents of children with dyslexia.

Integrating Acceptance and Commitment Therapy with Selective Optimization with Compensation to Predict Wellbeing

OBJECTIVES

Selective Optimization with Compensation (SOC) is an empirically supported model of successful aging. Acceptance and Commitment Therapy (ACT) is an empirically supported intervention that has a theoretical model which is complementary to the SOC model. Combining the two models can provide a more comprehensive view of successful aging. The relationships between key SOC and ACT variables in relation to age-related wellbeing were explored among a sample of older American adults.

METHODS

Older adult participants (n = 87) were recruited online from social media sites. This sample size provided sufficient power to test hypotheses. Participants completed measures of demographic characteristics, ACT constructs (acceptance, defusion, present-moment-awareness, self-as-context, values), SOC utilization, geriatric morale, purpose in life, and quality of life.

RESULTS

Acceptance and defusion were significantly correlated with SOC variables and wellbeing. Acceptance and defusion mediated the relationship between SOC utilization and age-related wellbeing.

CONCLUSIONS

Acceptance and defusion were associated with better adjustment to the potential losses that co-occur with aging. Acceptance and defusion may also promote more openness to making changes in daily behaviors that can permit optimization and compensation of age-related losses.

CLINICAL IMPLICATIONS

Interventions that promote acceptance and defusion may be promising for older adults as they navigate the aging process.

Acceptance and commitment therapy processes and their association with distress in cancer: a systematic review and meta-analysis

Around 42% of individuals with cancer experience distress. Acceptance and commitment therapy (ACT) can reduce distress, but effects are small, and mechanisms unclear. This review aimed to identify associations between ACT processes and distress in cancer. Search terms included cancer, ACT processes, self-compassion, and distress. Six online databases and grey literature were searched until March 2022. Of 6555 papers screened, 108 studies were included with 17,195 participants. Five meta-analyses of 77 studies were conducted. Random effects meta-analyses of correlations revealed higher scores on flexible processes (acceptance, present moment awareness, self-compassion) were associated with lower distress (rpooled = -0.24, -0.39, -0.48, respectively); whilst higher scores on inflexible processes (experiential avoidance, cognitive fusion) were associated with higher distress (rpooled = 0.58, 0.57, respectively). Meta-analyses displayed moderate-to-high heterogeneity with most studies assessed as low risk of bias. Meta-regressions revealed no significant moderators (stage, time since diagnosis, gender and age). This review provides a theoretically aligned evidence base for associations between ACT processes and distress in cancer, supporting elements of ACT theory and providing targeted directions for intervention development. Due to limited evidence, future research should focus on self-as-context, values and committed action and conduct mediation analysis in controlled trials of ACT processes on distress in cancer.

Profiles of psychological flexibility and caregiving experience in dementia family caregivers: A latent profile analysis

OBJECTIVES

To explore the profiles of psychological flexibility among dementia family caregivers and examine their associations with psychological well-being and caregiving factors.

METHODS

Participants were 521 dementia family caregivers in Japan. Latent profile analysis was conducted to explore the profiles of psychological flexibility. The analyses examined differences in depression, anxiety, life satisfaction, and work-family conflict/enrichment between the profiles, and whether sociodemographic variables and caregiving stressors predict the profile.

RESULTS

Four distinct profiles were identified: high psychological flexibility (14.2%), moderate psychological flexibility with high commitment (24.7%), moderate psychological flexibility with low commitment (48.0%), and low psychological flexibility (13.1%). The low psychological flexibility profile exhibited the highest scores of depression, anxiety and work-family conflict, followed by the moderate psychological flexibility with low/high commitment profiles, and the high psychological flexibility profile. The high psychological flexibility and moderate psychological flexibility with high commitment profiles exhibited higher life satisfaction than the moderate psychological flexibility with low commitment profile. Caregiving stressors, marital status, and caregiver status predicted the profile.

CONCLUSION

Enhancing defusion and acceptance, rather than increasing commitment to personal values, may be beneficial in supporting distressed caregivers. Having more caregiving stressors, being single/divorced/bereaved, and being a primary caregiver may be useful indicators of decreased psychological flexibility among dementia family caregivers.

Bibliometric Mapping of Psychological Flexibility Research: Trends and Future Directions

In this article, we offer an exhaustive analysis of academic work on psychological flexibility using bibliometric techniques. We identify emerging trends in a dataset of 3535 scholarly articles from the Web of Science database. We highlight key publications, map out the field's intellectual framework, and anticipate future research avenues through co-citation and co-word analytics. The co-citation assessment revealed five distinct clusters, while the co-word analysis showed three. Although research regarding psychological flexibility has gained recent popularity, there remains a need for more scholarly initiatives to achieve a nuanced understanding of this subject.

The Scientific Status of Acceptance and Commitment Therapy: An Analysis From the Philosophy of Science

How good is the science in the Acceptance and Commitment Therapy (ACT) program? This article examines ACT philosophy, theory, and research on five dimensions: (1) the quality of its meta-science; (2) the clarity of its constructs; (3) the psychometrics of its principal measures; (4) the adequacy of its account of values; and (5) the quality of its research. Significant problems are found in each dimension, and suggestions for improvements are offered. ACT aligns with a Machiavellianism that is problematic in accurately describing these commitments and constituting a meta-stance that permits problematic values to be embraced. Relatedly, there is evidence of a positive bias in ACT research that has been ignored methodologically and in summaries of ACT. These problems justify significant skepticism regarding any claims from the science associated with ACT. Avoiding questionable research practices, psychometrically problematic measures, and research designs that weaken valid causal inference is recommended. Finally, an increased commitment to open science, intellectual humility, and severe testing is recommended.

Acceptance and Commitment Therapy Processes and Mediation: Challenges and How to Address Them

Acceptance and commitment therapy (ACT) emphasizes a focus on theory-driven processes and mediating variables, a laudable approach. The implementation of this approach would be advanced by addressing five challenges, including (a) distinguishing ACT processes in measurement contexts, (b) developing and rigorously validating measures of ACT processes, (c) the wide use of psychometrically weaker ACT process measures and the more limited use of stronger measures in earlier work, (d) the inconsistency of past evidence that ACT processes are sensitive or specific to ACT or mediate ACT outcomes specifically, and (e) improving statistical power and transparency. Drawing on the existing literature, we characterize and provide evidence for each of these challenges. We then offer detailed recommendations for how to address each challenge in ongoing and future work. Given ACT's core focus on theorized processes, improving the measurement and evaluation of these processes would significantly advance the field's understanding of ACT.

Blended intervention based on acceptance and commitment therapy for informal caregivers of people with dementia (ACT-IC): protocol of a mixed-methods feasibility study

INTRODUCTION

Numerous caregiver support programmes have shown promise in promoting the mental health of informal caregivers of people with dementia (PwD). However, there is still a lack of evidence-based interventions tailored to the specific needs of this population. This mixed-methods study aims to evaluate the feasibility, acceptability and preliminary efficacy of a blended intervention based on acceptance and commitment therapy (ACT) for informal caregivers of PwD, leading to a better understanding of intervention refinements for future controlled trials.

METHODS AND ANALYSIS

This study includes an uncontrolled pre-post intervention pilot study. A total of 30 informal caregivers of PwD will be recruited through memory clinics and social media platforms in the Netherlands. The ACT for informal caregiver (ACT-IC) intervention will be delivered over a 9-week period and consists of a collaborative goal-setting session, nine online ACT modules, nine telephone-based motivational coaching sessions and 6 monthly booster sessions following the main intervention period. Feasibility and acceptability will be assessed using attrition rate, adherence to and engagement with the intervention, proportion of missing data and semistructured interviews. Preliminary efficacy will be assessed with retrospective measures of depression, anxiety, stress, sense of competence, burden and self-efficacy at baseline, postintervention, at 3-month and 6-month follow-ups.

ETHICS AND DISSEMINATION

The Medical Ethical Committee from the Maastricht academic hospital and Maastricht University approved the study. The findings of this study will be shared with healthcare professionals, researchers and public audience through various channels, including scientific publications, conference presentations, online forums and community outreach programmes.

TRIAL REGISTRATION NUMBER

NCT05064969.

Examining the role of experiential avoidance and valued action in the negative effects of weight self-stigma

Harmful effects of weight self-stigma on quality of life and health behaviors have been well-established. However, the processes that lead to these negative outcomes are less understood. Psychological inflexibility is defined as a pattern of rigid psychological reactions dominating over values and meaningful actions. A lack in valued action is characterized by the absence of activities that are connected to what is personally meaningful. In this secondary analysis, we aim to extend research by examining two subprocesses of psychological inflexibility, experiential avoidance and lack of valued action, as statistical mediators of the relations between weight self-stigma and quality of life/health behavior outcomes. Baseline data from a clinical trial comparing weight loss maintenance interventions in a sample of 194 adults living with overweight or obesity and seeking treatment is analyzed. Results show that greater experiential avoidance and lower valued action were significantly related to lower quality of life and satisfaction with social roles, as well as greater depression, anxiety, and binge eating. Further, results from a parallel mediation analysis indicated that weight self-stigma is indirectly related to anxiety, disinhibited eating, and hunger through the relationship with experiential avoidance and lack of valued action.

Comparative effectiveness of mobile health smoking cessation approaches among underserved patients in primary care: Study protocol for the PROMOTE-UP trial

INTRODUCTION

Tobacco smoking is the leading cause of preventable disease, disability, and premature death in the United States. Recent advances have led to two efficacious mobile health (mHealth) treatments for smoking cessation: iCanQuit, an Acceptance and Commitment Therapy-based behavioral treatment promoting cessation through accepting triggers and committing to values; and Motiv8, a contingency management intervention promoting smoking cessation with financial incentives via biochemically verified abstinence. This study will evaluate the comparative effectiveness of the Florida Quitline, iCanQuit alone, and iCanQuit+Motiv8 in a pragmatic trial among patients who smoke in underserved primary care settings.

METHODS

The study will be an individually-randomized controlled trial with three arms (Florida Quitline, iCanQuit alone, iCanQuit+Motiv8 combined) conducted in multiple primary care practices affiliated with the OneFlorida+ Clinical Research Consortium. Adult patients who smoke will be randomized to one of the 3 study arms (n = 444/arm), stratified by healthcare setting (academic vs. community). The primary outcome will be 7-day point prevalence smoking abstinence at 6 months post-randomization. Secondary outcomes will be 12-month smoking abstinence, patient satisfaction with the interventions, and changes in patient quality of life and self-efficacy. The study will also assess how and for whom the interventions help sub-group patients in achieving smoking abstinence by measuring theory-derived factors that mediate smoking outcome-specific baseline moderators.

CONCLUSIONS

Results from this study will provide evidence for the comparative effectiveness of mHealth smoking cessation interventions in healthcare settings. Use of mHealth interventions can make smoking cessation resources more equitably accessible and have far-reaching impact on community and population health.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05415761, Registered 13 June 2022.

Reliability and validity of the Japanese version of the Valued Living Questionnaire Adapted to Caregiving

OBJECTIVES

This study developed the Japanese version of the Valued Living Questionnaire Adapted to dementia Caregiving (J-VLQAC) and assessed its reliability and validity.

METHODS

A 2-wave longitudinal survey with an interval of two weeks was conducted with Japanese dementia family caregivers (n = 521 at T1; n = 424 at T2).

RESULTS

Confirmatory factor analysis demonstrated a poor fit to our data for the original 2-factor model. Exploratory factor analysis resulted in a new 3-factor model (i.e., Own Values, Family Values, and Health Values). Both models showed similar good internal consistency (Cronbach's alpha) and test-retest reliability. Significant correlations between the J-VLQAC and the Valuing Questionnaire (VQ) and measures assessing related constructs (e.g., cognitive fusion) supported good criterion validity and acceptable level of construct validity for both models. Compared to the original 2-factor model, the new 3-factor model showed higher incremental validity, which was assessed through the hierarchical regression analysis examining whether the J-VLQAC predicts depression, anxiety, and life satisfaction over and above the VQ.

CONCLUSIONS

The J-VLQAC has good reliability and acceptable validity.

CLINICAL IMPLICATIONS

The information gathered from the J-VLQAC can be used to tailor psychological support and help caregivers engage in activities that reflect their personal values.

Examining daily-level associations between nightly alcohol use and next-day valued behavior in college students

ObjectiveAdverse consequences of binge drinking episodes are well-established, but fewer studies have investigated how incremental changes in daily alcohol use relate to well-being. We examined within- and between-person associations in alcohol use and next-day valued living to enhance our understanding of the impact of alcohol use on following-day outcomes in college students. Participants. During November 2018, 73 undergraduate participants (65.7% female) completed surveys through Qualtrics. Method: Using daily diary methodology, participants completed nightly surveys (N = 784) on their cellular devices over a two-week period. Results: Within-participant variations in evening alcohol use demonstrated a negative linear association with next-day valued living, controlling for relevant variables. Conclusions: Findings supplement other studies demonstrating the impact of individual variability in alcohol use on engagement in valued behaviors. Knowledge of the hazards of alcohol use within the context of valued living has the potential to inform alcohol use prevention and intervention programs.

Values: A Core Guiding Principle for Behavior-Analytic Intervention and Research

Values represent qualities or beliefs that are of high priority to individuals or society and represent one of the core processes within acceptance and commitment therapy or training (ACT or ACTr). The current article discusses values and valuing not only as a centralized process in ACT but also as a core process guiding the field of applied behavior analysis with applications that extend across several intervention domains. A relational frame theory model of values as hierarchical frames that augment reinforcing functions that can influence socially meaningful behavior change is reviewed. This basic model is then extended to encompass temporal, deictic, and causal frames. Values-based intervention research is emerging in areas such as guided decision making, professional development, organizational behavior management, parent training, and treatment plans for children and adults. Although this research is promising, more work is needed to further explore the role of values and valuing within ACT, and when they are used within other intervention strategies. Several potential avenues for future research that may aid in the development of values-based intervention by behavior analysts and extend the scope of our field and practice are discussed.

Psychometric properties of the Valuing Questionnaire in a Spaniard sample and factorial equivalence with a Colombian sample

BACKGROUND

The Valuing Questionnaire (VQ) is considered as one of the most psychometrically robust instruments to measure valued living according to the acceptance and commitment therapy model. It consists of 10 items that are responded to on a 7-point Likert-type scale and has two factors: Progression and Obstruction. The Spanish version of the VQ showed good psychometric properties in Colombian samples. However, there is no evidence of the psychometric properties of the VQ in Spaniard samples. This study aims to analyze the validity of the VQ in a large Spaniard sample and analyze the measurement invariance with a similar Colombian sample.

METHOD

The VQ was administered to a Spaniard sample of 846 adult participants from general online population. Cronbach's alpha and McDonald's omega were computed to analyze the internal consistency of the VQ. The fit of the VQ's two-factor model was tested through a confirmatory factor analysis with a robust maximum likelihood (MLR) estimation method. Afterward, we analyzed the measurement invariance across countries and gender. Convergent construct validity was analyzed with a package of questionnaires that evaluated experiential avoidance (Acceptance and Action Questionnaire-II, AAQ-II), emotional symptoms (Depression Anxiety and Stress Scale-21, DASS-21), life satisfaction (Satisfaction with Life Scale, SWLS), and cognitive fusion (Cognitive Fusion Questionnaire, CFQ).

RESULTS

The internal consistency across samples was adequate (alphas and omegas were .85 for VQ-Progress and .84 for VQ-Obstruction). The two-factor model obtained a good fit to the data (RMSEA = 0.073, 90% CI [0.063, 0.083], CFI = 0.98, NNFI = 0.97, and SRMR = 0.053). The VQ showed strict invariance across countries and gender and showed theoretically coherent correlations with emotional symptoms, life satisfaction, experiential avoidance, and cognitive fusion. In conclusion, the Spanish version of the VQ demonstrated good psychometric properties in a large Spaniard sample.

Validation of the Acceptance and Action Questionnaire-II in the general Spanish population

Acceptance and Commitment Therapy states that Experiential Avoidance contributes to the development of psychological issues. The Acceptance and Action Questionnaire-II measures Experiential Avoidance. The objective of the current study is to perform a validation of the Acceptance and Action Questionnaire-II in the general Spanish population. A sample of 964 participants from all over Spain was used (M = 43.43 years; SD = 15.27). The psychometric properties of the questionnaire were examined according to Classical Test Theory. In addition, assessments were made of participants’ personality, Emotional Intelligence, Anxiety, and Depression, and the influence of sex and age on Experiential Avoidance was examined. The Acceptance and Action Questionnaire-II is a unidimensional instrument, with excellent reliability (α = .93) and adequate evidence of validity. Differences were observed based on sex, with women scoring higher, and based on age, with lower scores in the older age groups. The Acceptance and Action Questionnaire-II is a valid, reliable instrument for use in the general Spanish population.

"Comprehensive Assessment of ACT Processes CompACT. Romanian Adaptation and Short Form Validation"

"The current paper presents the translation and validation for Romanian non-clinical population of Comprehensive Assessment of ACT Processes – CompACT (Francis et al., 2016), an instrument that evaluates three dimensions of psychological flexibility: openness to experience, present moment awareness (mindfulness) and valued action. The psychometric properties of the Romanian version of the instrument were investigated, convergent validity in relation with AQQ-II and concurrent validity in relation with DASS-21 (with comparable results with ones reported for the original instrument). Considering modest model fit with theoretical factor structure of the instrument, current paper proposes a shorter, more stable Romanian Version, and tests its psychometric properties."

Psychometric properties of the spanish version of the Valuing Questionnaire in Colombian clinical and nonclinical samples

OBJECTIVE

To examine the psychometric properties of the Spanish version of the Valuing Questionnaire (VQ) in Colombian clinical and nonclinical samples.

METHOD

The VQ was administered to a total sample of 1820 participants, which included undergraduates (N = 762), general population (N = 724), and a clinical sample (N = 334). The questionnaire packages included measures of experiential avoidance, cognitive fusion, mindfulness, life satisfaction, and psychological difficulties.

RESULTS

Across the different samples, internal consistency was good (global Cronbach's alpha of 0.83 for Progress and 0.82 for obstruction). Measurement invariance was found across samples and gender, and the two-factor model obtained a good fit to the data. The latent means of progress and obstruction of the clinical sample were lower and higher, respectively, than the latent means of the nonclinical samples. Correlations with other variables were in the expected direction.

CONCLUSION

The Spanish version of the VQ showed good psychometric properties.