Common Physical Properties Improve Metaphor Effect Even in the Context of Multiple Examples

ACT: A Process-Based Therapy in Search of a Process

A large array of randomized controlled trials and meta-analyses have determined the efficacy of Acceptance and Commitment Therapy (ACT). However, determining that ACT works does not tell us how it works. This is especially important to understand given the current emphasis on Process-Based Therapy, the promise of which is to identify manipulable causal mediators of change in psychotherapy, and how their effectiveness is moderated by individual contexts. This paper outlines four key areas of concern regarding ACT's status as a Process-Based Therapy. First, the relationship between ACT and Relational Frame Theory has been widely asserted but not yet properly substantiated. Second, most of the studies on ACT's core process of change, psychological flexibility, have used invalid measures. Third, while lots of research indicates means by which individuals can be helped to behave consistently with their values, there is virtually no research on how to help people effectively clarify their values in the first instance, or indeed, on an iterative basis. Finally, the philosophy underlying ACT permits a-moral instrumentalism, presenting several ethical challenges. We end by making several recommendations for coherent methodological, conceptual, and practical progress within ACT research and therapy.

What the Body Reveals about Lay Knowledge of Psychological Flexibility

The embodied knowledge of psychological flexibility processes was tested by examining the ability of raters to score whole body pictures based on the degree to which they were open, aware, and engaged. Participants’ best and worst physical posture was photographed when asked to think of a difficult psychological matter. Naïve and untrained raters (n = 16) showed excellent reliability while rating the postures of 82 persons from the general population in Reno and Chicago in the USA and recent Iranian immigrants in the Maryland/DC area. Participants showed embodied knowledge of psychological flexibility concepts across all three locations (though significantly less among those recently from Iran). Thus, experience alone appears to teach people that psychological flexibility is helpful, even if they are unable to express this knowledge in words. Implications for psychotherapeutic work is considered.

Empirical Investigation of the Verbal Cues Involved in Delivering Experiential Metaphors

Delivering metaphors experientially has been emphasized in several psychotherapies, such as acceptance and commitment therapy. However, few research has analyzed the variables involved in the efficacy of metaphors. This experimental analog study aims to advance in this topic by analyzing the effect of two components involved in the experiential delivery of metaphors in psychotherapy. The first component is presenting the metaphor by asking the individual to imagine herself as the protagonist of the story versus presenting the metaphor in the third person (Self vs. Other). The second component is the inclusion of verbal cues prompting the relational elaboration of the rules derived from the metaphor content versus not including these prompts (Elaboration vs. No Elaboration). The effect of these components was tested in a double-blind, randomized, 2 × 2 factorial experiment that used the cold pressor task (CPT). Eighty-four participants were exposed to the CPT at the pretest. Afterward, participants were randomly assigned to four experimental protocols. The protocols were audiotaped and consisted of the same metaphor presented in four slightly different ways. Specifically, the protocol of Condition A involved a metaphor with Self and Elaboration, Condition B involved Self and No Elaboration, Condition C involved Other and Elaboration, and Condition D involved Other and No Elaboration. Then, participants were re-exposed to the CPT in the posttest. We hypothesized that Condition A (Self and Elaboration) would show a higher mean increase in pain tolerance than the remaining conditions, which would show similar results. The results were consistent with this hypothesis because Condition A showed a higher percentual increase in pain tolerance (Condition A: M = 268.21, SD = 167.47; Condition B: M = 180.86, SD = 73.01; Condition C: M = 204.81, SD = 100.19; Condition D: M = 175.41, SD = 76.00). A Bayesian informative hypothesis evaluation showed that this hypothesis obtained the highest posterior model probability. Thus, the results indicate that introducing metaphors by asking the individual to imagine herself as the protagonist of the story and providing prompts for relational elaboration might increase the therapeutic effect of the metaphor.

A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression

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.