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Assemi K, Lombardero A, West DM, Smith G, Li I, Houmanfar RA, Jacobs NN. Exploring The Impact of Acceptance and Commitment Based Cultural Humility Training on Standardized Patient Interactions: Revisiting the Measurement Process. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10026-4. [PMID: 38980549 DOI: 10.1007/s10880-024-10026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 07/10/2024]
Abstract
Recent findings in health sciences and medical education highlight the importance of training healthcare professionals to interact with their patients in a culturally humble manner (Nadal et al., in Journal of Counseling and Development 92: 57-66, 2014; Pascoe & Smart Richman, in Psychological Bulletin 135: 531, 2009; Sirois & Burg, in Behavior Modification 27: 83-102, 2003; Williams & Mohammed, in Journal of Behavioral Medicine 32: 20-47, 2009). An important piece in the progression of our ability to address training challenges is the assessment of cultural humility. As an extension of previous research (Lombardero et al., in Journal of Clinical Psychology in Medical Settings, 30: 261-273, 2023), this study implemented an evidence-based cultural humility intervention (based on Acceptance and Commitment Training) to improve medical students' interactions with standardized patients (SPs) which was assessed via direct behavioral observation. Specifically, the observational measurement system was focused on culturally humble responses to patients reporting microaggressions to the medical professional. A pre-post comparison of the results demonstrated statistically significant improvements pertaining to participants' culturally humble responses to SPs' reports of microaggressions for one of the measurement scales used (i.e., ARISE), but not the other (i.e., Responsiveness to Racial Challenges Scale). Further analyses, on the bottom quartile of performers, were conducted to assess a possible ceiling effect of the scale that did not demonstrate significant change. These results and implications for future research will be discussed.
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Affiliation(s)
- Kian Assemi
- Reno Behavior Analysis Program, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA.
| | - Anayansi Lombardero
- Reno School of Medicine, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
| | - Donna M West
- Reno Behavior Analysis Program, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
| | - Greg Smith
- Reno Behavior Analysis Program, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
| | - Irene Li
- Reno School of Medicine, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
| | - Ramona A Houmanfar
- Reno Behavior Analysis Program, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
| | - Negar N Jacobs
- Reno School of Medicine, University of Nevada, 1664 N, Virginia Street, Reno, NV, 89557-0296, USA
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Luck SAM, Golijani-Moghaddam N, Dawson DL. A Systematic Quality Review of Single-Case Experimental Designs Using Acceptance and Commitment Therapy in Adult Clinical Populations. Behav Ther 2024; 55:856-871. [PMID: 38937055 DOI: 10.1016/j.beth.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 06/29/2024]
Abstract
Recent publications within Contextual Behavioral Science provided a rationale for the expansion of intervention efficacy research using methods that capture idiographic factors and processes. We conducted a systematic review of the use and quality of single-case experimental designs (SCED) within the Acceptance and Commitment Therapy (ACT) literature in adult clinical populations. The systematic review was conducted according to PRISMA guidelines and the databases CINAHL, MEDLINE, PsycINFO, PsycArticles and OpenGrey were searched for peer-reviewed articles. Further studies were sought through review of reference lists of all full text studies. Studies were assessed against What Works Clearinghouse (WWC) single-case design standards. Twenty-six studies met eligibility criteria and were conducted within research teams all implementing multiple-baseline designs. Twenty-four studies did not meet WWC standards with most failing to ensure a degree of concurrence across participants. The extent of randomisation methods was also captured. The review highlights the sparsity of SCEDs within ACT literature in clinical populations and current methodological practices. Limitations of the review and implications for future research are discussed.
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Affiliation(s)
- Safia A M Luck
- School of Medicine, The University of Nottingham & Nottinghamshire Healthcare NHS Foundation Trust.
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Arch JJ, Fishbein JN, Finkelstein LB, Luoma JB. Acceptance and Commitment Therapy Processes and Mediation: Challenges and How to Address Them. Behav Ther 2023; 54:971-988. [PMID: 37863588 PMCID: PMC10665126 DOI: 10.1016/j.beth.2022.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 05/03/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Joanna J Arch
- University of Colorado Boulder and University of Colorado Cancer Center.
| | | | | | - Jason B Luoma
- Portland Psychotherapy Clinic, Research and Training Center
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O'Donohue W. The Scientific Status of Acceptance and Commitment Therapy: An Analysis From the Philosophy of Science. Behav Ther 2023; 54:956-970. [PMID: 37863587 DOI: 10.1016/j.beth.2023.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 10/22/2023]
Abstract
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.
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McKay D, O'Donohue W. Conceptual, Psychometric, Methodological and Value Problems in Acceptance and Commitment Therapy: Introduction to the Special Section, "A Critical Appraisal of Acceptance and Commitment Therapy". Behav Ther 2023; 54:929-938. [PMID: 37863585 DOI: 10.1016/j.beth.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 10/22/2023]
Abstract
There is a voluminous and expanding literature regarding ACT, from descriptions of its theory to its stated roots in relational frame theory, the particulars of its therapy techniques and exercises, favored metaphors, randomized controlled trials, to many self-help books for a wide variety of problems. The therapy is widely marketed through workshops and many self-help books. ACT is associated with its own journal and its own professional organization, the Association for Contextual Behavioral Science (ACBS). This literature is interpreted by ACT proponents as demonstrating the causal efficacy of ACT for a wide range of problems and, at times, even being superior to treatment as usual, which are often more traditional forms of cognitive behavior therapy (CBT). This special section contains a series of 6 papers examining these claims. Correctly understanding and evaluating the claims of ACT proponents is warranted because these can have direct implications for treatment decisions by therapists attempting to deliver the most effective treatment for their clients' problems. The papers, individually and as a whole, urge considerable caution, particularly because much of its research has involved serious measurement problems, problematic research designs, and a unique and problematic conceptualization and perhaps the practice of values and ethics. These papers call for methodological improvements and a commitment to more traditional values associated with science so that ACT can be more fairly evaluated to accurately understand its assets and limitations.
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Robinson A, De Boos D, Moghaddam N. Acceptance and commitment therapy (
ACT
) for people with dementia experiencing psychological distress: A hermeneutic single‐case efficacy design (
HSCED
) series. COUNSELLING & PSYCHOTHERAPY RESEARCH 2023. [DOI: 10.1002/capr.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- Amie Robinson
- Division of Psychiatry and Applied Psychology University of Nottingham B Floor Yang Fujia, Jubilee Campus Nottingham UK
| | - Danielle De Boos
- Division of Psychiatry and Applied Psychology University of Nottingham B Floor Yang Fujia, Jubilee Campus Nottingham UK
| | - Nima Moghaddam
- College of Social Science University of Lincoln Brayford Pool Lincoln UK
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Szarko AJ, Houmanfar RA, Smith GS, Jacobs NN, Smith BM, Assemi K, Piasecki M, Baker TK. Impact of Acceptance and Commitment Training on psychological flexibility and burnout in medical education. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Thompson M, Bond FW, Lloyd J, Anslow S, Berry E. Exploring the role of contextual behavioural science variables and education in the prosocial domain of global poverty and human rights. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Catrone RG, Koch DS. A Behavioral Approach to Increasing Perceptions of Capability Toward People With Disabilities. BEHAVIOR AND SOCIAL ISSUES 2021. [DOI: 10.1007/s42822-021-00059-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ruiz FJ, Suárez-Falcón JC, Segura-Vargas MA, Gil-Luciano B. Psychometric properties of the spanish version of the Valuing Questionnaire in Colombian clinical and nonclinical samples. J Clin Psychol 2021; 78:233-248. [PMID: 34240421 DOI: 10.1002/jclp.23212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 05/01/2021] [Accepted: 06/13/2021] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Francisco J Ruiz
- Faculty of Psychology, Fundación Universitaria Konrad Lorenz, Bogotá, Colombia
| | - Juan C Suárez-Falcón
- Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Constructs, Events, and Acceptance and Commitment Training. Behav Anal Pract 2021; 15:83-89. [DOI: 10.1007/s40617-021-00598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 11/26/2022] Open
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Lavefjord A, Sundström FT, Buhrman M, McCracken LM. Assessment methods in single case design studies of psychological treatments for chronic pain: A scoping review. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Garcia Y, Keller-Collins A, Andrews M, Kurumiya Y, Imlay K, Umphrey B, Foster E. Systematic Review of Acceptance and Commitment Therapy in Individuals with Neurodevelopmental Disorders, Caregivers, and Staff. Behav Modif 2021; 46:1236-1274. [PMID: 34154376 DOI: 10.1177/01454455211027301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this review was to quantitatively synthesize studies using acceptance and commitment therapy (ACT) with individuals with neurodevelopmental disorders (NNDs), their parents, and staff members that support them. Thirty studies published in peer-reviewed journals between 2006 and 2020 met inclusion criteria. They were reviewed and coded on variables associated with participants' characteristics, settings, dropouts, design type, ACT procedures and measures, social validity, treatment integrity, and main findings. The What Works Clearinghouse (WWC), the revised Cochrane risk-of-bias tool for randomized trials (RoB2) and the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) were applied to evaluate the quality of the studies. Results indicated that 20 studies used group designs and 10 studies used single-case designs. Participants with NNDs consisted predominantly of those with autism spectrum disorder, attention deficit hyperactivity disorder, and learning disabilities. Group studies reported process and outcome measures exclusively; whereas, single-case studies also incorporated behavioral/direct measures. Overall, results showed mixed improvements across studies using indirect and direct measures. Lastly, quality assessment for group studies presented moderate or serious risk of bias and two single-case studies did not meet WWC evidence of effectiveness. Directions for future research and practice are discussed.
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Affiliation(s)
- Yors Garcia
- The Chicago School of Professional Psychology, IL, USA
| | | | | | | | - Kaleiya Imlay
- The Chicago School of Professional Psychology, IL, USA
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Is Acceptance and Commitment Training or Therapy (ACT) a Method that Applied Behavior Analysts Can and Should Use? PSYCHOLOGICAL RECORD 2020. [DOI: 10.1007/s40732-020-00436-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Sandoz EK, Kellum KK. Tracking measurement behavior and correcting course: Introduction to the special issue on measurement in JCBS. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Wright SP. Descriptive Contextualism in service of Functional Contextualistic aims: A practitioner's perspective on Hayes and Fryling (2019). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Vilardaga R, Davies PS, Vowles KE, Sullivan MD. Theoretical Grounds of Pain Tracker Self Manager: An Acceptance and Commitment Therapy Digital Intervention for Patients with Chronic Pain. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 15:172-180. [PMID: 32269915 PMCID: PMC7141572 DOI: 10.1016/j.jcbs.2020.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To report the theoretical basis and design of a novel digital Acceptance and Commitment Therapy (ACT) intervention for people with chronic pain, the Pain Tracker Self Manager (PTSM), which had promising efficacy in a recent pilot trial. METHODS Content development by a multidisciplinary panel of experts in psychiatry, clinical psychology, nursing and social work, with feedback from a group of patients with chronic pain and their providers. Materials included paper-based sketching of a story character, visual metaphors, and a series of stories designed to deliver the theory-based components of our behavioral intervention. RESULTS This development and design process resulted in 4 digitally delivered clinical modules that combine visual and verbal cues. In addition, it generated a series of novel ACT metaphors specifically tailored to patients with chronic pain: Pain: Injury vs. Threat, Life Navigation System, The Fog of Pain, and Get Rhythm. Consistent with ACT theory and the contextual behavioral science framework, PTSM utilized: perspective-taking, values clarification, acceptance strategies, and nursing and psychological care recommendations. DISCUSSION Reports of the design and theoretical basis of digital health interventions are highly needed to increase the rigor of their development process and more progressively advance our body of knowledge. This pilot study developed and tested a series of ACT metaphors that can be readily used by ACT clinicians working with this population. CONCLUSION PTSM is a novel digital ACT intervention for patients with chronic pain with features directly linked to ACT processes and theory.
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Affiliation(s)
| | | | - Kevin E. Vowles
- School of Psychology, Queen’s University Belfast, Northern Island, UK
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