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Twohig MP, Seydavi M, Capel LK, Levin ME, Akbari M. Scoping Review of Acceptance and Commitment Therapy for Obsessive-Compulsive Disorder in Iran. J Cogn Psychother 2024; 38:211-226. [PMID: 38991742 DOI: 10.1891/jcp-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Acceptance and commitment therapy (ACT) for obsessive-compulsive disorder (OCD) has been found efficacious in randomized clinical trials (RCTs), but the two widely known RCTs were conducted within the United States with predominantly White samples. Research that evaluates treatments like ACT for OCD outside the typical Western cultures is needed. The current scoping review summarizes the key characteristics and findings from 18 RCTs that evaluated ACT for OCD in Iran. These RCTs are largely unknown in the broader scientific literature despite representing the vast majority of ACT for OCD trials, in part because the majority are published in Persian. The preponderance of RCTs treated participants in groups, and most protocols did not include exposure exercises. Of 18 trials, 5 were single sex. Use of selective serotonin reuptake inhibitors (SSRIs) was common with all participants on stable doses at pretreatment in many of the trials. Methodological quality was low to medium. ACT was inconsistent against nontraditional comparison conditions, slightly favorable to empirically validated treatments, and favorable compared with the waitlist and SSRIs. The process of change data indicated that ACT increased the psychological flexibility more than cognitive behavior therapy or SSRIs. These results highlight that findings on ACT for OCD from Western populations replicate and generalize to individuals in Iran. These findings also offer insights gained from studying ACT in Iran and significantly expand the literature based on ACT for OCD that can be integrated into scholarship by all researchers.
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Affiliation(s)
- Michael P Twohig
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Mohammad Seydavi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Leila K Capel
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Michael E Levin
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
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Asdaq SMB, Alshehri S, Alajlan SA, Almutiri AA, Alanazi AKR. Depression in persons with disabilities: a scoping review. Front Public Health 2024; 12:1383078. [PMID: 38779421 PMCID: PMC11110534 DOI: 10.3389/fpubh.2024.1383078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Individuals with disabilities are more vulnerable to depression development than the general population. This study sought to map the evidence on current knowledge of depression, intervention strategies, and assessment tools among people with disabilities. This review was conducted following Arksey and O'Malley's scoping review methodology framework. An electronic search was performed on four English databases: PubMed, Cochrane Library, PsycINFO, and Web of Science. The original search returned 1802 results, with 1,116 from Web of Science, 626 from PubMed, 25 from Cochrane, and 35 from PsycINFO. After removing duplicates, 786 articles were chosen for the title and abstract screening processes. Finally, 112 full-text publications were deemed eligible, with 41 papers being included in this scoping review for analysis. A large proportion (32; 78.04%) of the studies chosen were cross-sectional, 14 (34.14%) of them reported general disability, 12 (29.26%) used a patient health questionnaire (PHQ-9) to measure depression, and 14 (34.14%) had interventions, including cognitive behavioral therapy, psychological counseling, social support, and physical activity. All interventions successfully reduced the severity of the depression. Cognitive behavioral therapies and psychological counseling were widely used interventions that had a significant impact on reducing depression. More randomized controlled trials are required, and they should focus on individuals with specific disabilities to provide disability-specific care that can improve the quality of life for disabled individuals.
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Kim AM, Park JH. Depression and its associated factors: A comparison between congenital and acquired physical disabilities. Int J Psychiatry Med 2023:912174231219037. [PMID: 38039192 DOI: 10.1177/00912174231219037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
OBJECTIVE While depression associated with disability has been extensively studied, how depression could differ depending on whether the disability is congenital or acquired remains to be investigated. The objective of this study was to compare depression and its related factors among people with congenital and acquired physical disabilities. METHODS We used the 2016 Panel Survey of Employment for the Disabled in Korea, a population-based survey for people with disability registered with the Korean government. Among 4577 participants, a total of 2128 participants with physical disability were analyzed using Chi-square test and binary logistic regression analysis. RESULTS The prevalence of depression was 12.9% in those with congenital physical disability and 16.0% in those with acquired physical disability. Stress due to disability and family relationship satisfaction were associated with higher and lower odds of depression, respectively, in both disability groups. Discrimination due to disability, divorce, social participation, and subjective social status were significant predictors of depression only in people with acquired disability. CONCLUSIONS Compared to those with congenital disability, individuals with acquired disability can be more susceptible to issues relating to social relationship, social standing and discrimination. Findings of this study suggest that acquired disability and adapting to changes associated with it can be a source of mental distress in addition to living with it. More efforts are needed to address discrimination, provide supportive social relationships, and provide supportive living conditions in order to reduce depression in persons living with disability, especially those with acquired disability.
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Affiliation(s)
- Agnus M Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyun Park
- Department of Social and Preventive Medicine, College of Medicine, Sungkyunkwan University, Suwon, Republic of Korea
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Zhao B, Wang Q, Wang L, Chen J, Yin T, Zhang J, Cheng X, Hou R. Effect of acceptance and commitment therapy for depressive disorders: a meta-analysis. Ann Gen Psychiatry 2023; 22:34. [PMID: 37679716 PMCID: PMC10486021 DOI: 10.1186/s12991-023-00462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To systematically evaluate the effect of Acceptance and Commitment Therapy (ACT) on depressive disorders. METHODS The electronic databases of Web of Science Core Collection, Pubmed, EMBASE, Cochrane Library, PsycInfo, CNKI, Wanfang and Weipu were used to select relevant publications. Screening, data extraction, and quality assessment were undertaken following PRISMA guidelines for preferred reporting of systematic reviews and meta-analysis. RevMan5.4 was used for meta-analysis. RESULTS 11 studies with a total of 962 patients were included. Random-effects model analysis showed that ACT could effectively reduce the level of depressive symptoms in patients with depressive disorders (SMD = - 1.05, 95% CI: - 1.43-- 0.66, P < 0.00001), improve psychological flexibility (MD = 4.84, 95% CI: 2.70-6.97, P < 0.00001), and have good maintenance effect (SMD = - 0.70, 95% CI: - 1.15-- 0.25, P = 0.002). All differences were statistically significant. CONCLUSIONS ACT not only improves depressive symptoms and psychological flexibility, but also has a good maintenance effect, and it is particularly effective in Chinese patients. Large randomized controlled trials are needed to validate the findings from this meta-analysis.
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Affiliation(s)
- Bing Zhao
- School of Humanities and Social Sciences, Binzhou Medical University, Yantai, China
| | - Qian Wang
- Shandong Mental Health Centre, Shandong University, Jinan, China
| | - Liping Wang
- School of Humanities and Social Sciences, Binzhou Medical University, Yantai, China
| | - Jie Chen
- Shandong Mental Health Centre, Shandong University, Jinan, China
| | - Tongtong Yin
- Shandong Mental Health Centre, Shandong University, Jinan, China
| | - Jingxuan Zhang
- Shandong Mental Health Centre, Shandong University, Jinan, China
| | - Xiaojing Cheng
- Shandong Mental Health Centre, Shandong University, Jinan, China
| | - Ruihua Hou
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Ma J, Ji L, Lu G. Adolescents' experiences of acceptance and commitment therapy for depression: An interpretative phenomenological analysis of good-outcome cases. Front Psychol 2023; 14:1050227. [PMID: 37034963 PMCID: PMC10074419 DOI: 10.3389/fpsyg.2023.1050227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Acceptance and commitment therapy (ACT) has been shown to help treat depression. However, little is known about the patient's experiences with ACT. This study aimed to learn how it was used in adolescents with major depressive disorder who have achieved good treatment outcomes. Methods Five adolescents with major depressive disorder with good treatment outcomes of ACT were enrolled in the semi-structured qualitative interview and analyzed using systematic textual condensation and interpretative phenomenological analysis. Results Four primary themes emerged from the investigation. "Therapist relationships and characteristics" describes the therapist's receptiveness and respect for adolescents with depression and having a trustworthy and sincere therapist. "Spaces to explore and experience" describes the ongoing process and content of acceptance of negative emotions and mindfulness practices in the healing process. "Do important things" refers to values and committed action. The "time settings" include the frequency and duration of treatment. Conclusion Adolescents make positive changes with a receptive and respectful therapist by exploring themselves in a genuine and trusting therapeutic relationship. Improvement seems to come from being open to all thoughts and feelings and developing the ability to live in the present moment. Teenagers attach great importance to value-oriented behaviour. Therefore, treatment should target the critical areas of depressed adolescents to guide them towards recovery effectively.
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Affiliation(s)
- Jinping Ma
- School of Public Health, Weifang Medical University, Weifang, China
| | - Lili Ji
- School of Nursing, Weifang Medical University, Weifang, China
| | - Guohua Lu
- School of Psychology, Weifang Medical University, Weifang, China
- *Correspondence: Guohua Lu,
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Butt MD, Ong SC, Butt FZ, Sajjad A, Rasool MF, Imran I, Ahmad T, Alqahtani F, Babar ZUD. Assessment of Health-Related Quality of Life, Medication Adherence, and Prevalence of Depression in Kidney Failure Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15266. [PMID: 36429988 PMCID: PMC9690334 DOI: 10.3390/ijerph192215266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Kidney failure is a global health problem with a worldwide mean prevalence rate of 13.4%. Kidney failure remains symptomless during most of the early stages until symptoms appear in the advanced stages. Kidney failure is associated with a decrease in health-related quality of life (HRQOL), deterioration in physical and mental health, and an increased risk of cardiovascular morbidity and mortality. This study aimed to evaluate the factors associated with decreased HRQOL and other factors affecting the overall health of patients. Another objective was to measure how medication adherence and depression could affect the overall HRQOL in patients with kidney failure. METHODOLOGY The study used a prospective follow-up mix methodology approach with six-month follow-ups of patients. The participants included in the study population were those with chronic kidney disease grade 4 and kidney failure. Pre-validated and translated questionnaires (Kidney Disease Quality of Life-Short Form, Hamilton Depression Rating Scale Urdu Version, and Morisky Lewis Greens Adherence Scale) and assessment tools were used to collect data. RESULTS This study recruited 314 patients after an initial assessment based on inclusion criteria. The mean age of the study population was 54.64 ± 15.33 years. There was a 47.6% male and a 52.4% female population. Hypertension and diabetes mellitus remained the most predominant comorbid condition, affecting 64.2% and 74.6% of the population, respectively. The study suggested a significant (p < 0.05) deterioration in the mental health composite score with worsening laboratory variables, particularly hematological and iron studies. Demographic variables significantly impact medication adherence. HRQOL was found to be deteriorating with a significant impact on mental health compared to physical health. CONCLUSIONS Patients on maintenance dialysis for kidney failure have a significant burden of physical and mental symptoms, depression, and low HRQOL. Given the substantial and well-known declines in physical and psychological well-being among kidney failure patients receiving hemodialysis, the findings of this research imply that these areas related to health should receive special attention in the growing and expanding population of kidney failure patients.
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Affiliation(s)
- Muhammad Daoud Butt
- School of Pharmaceutical Sciences, University Sains Malaysia, Penang 11800, Malaysia
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 15320, Pakistan
| | - Siew Chin Ong
- School of Pharmaceutical Sciences, University Sains Malaysia, Penang 11800, Malaysia
| | | | | | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60000, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60000, Pakistan
| | - Tanveer Ahmad
- Institute for Advanced Biosciences (IAB), CNRS UMR5309, INSERM U1209, Grenoble Alpes University, 38400 Saint-Martin-d’Hères, France
| | - Faleh Alqahtani
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield HD1 3DH, UK
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Akbari M, Seydavi M, Davis CH, Levin ME, Twohig MP, Zamani E. The current status of acceptance and commitment therapy (ACT) in Iran: A systematic narrative review. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ferreira MG, Mariano LI, Rezende JVD, Caramelli P, Kishita N. Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. J Affect Disord 2022; 309:297-308. [PMID: 35489560 DOI: 10.1016/j.jad.2022.04.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/04/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A comprehensive meta-analysis quantitatively examining the effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms is required to advance our understanding of its efficacy and moderating factors. METHODS Four electronic databases were searched in August 2018. An update search was conducted in November 2021. Forty-eight randomised controlled trials (RCTs) were included in this review (3292 participants: anxiety = 34 RCTs, depression = 40 RCTs). RESULTS The overall effect size for anxiety symptoms was medium-to-large (g = 0.52, p < 0.001; 95% CI = 0.30-0.73), while the overall effect size was small-to-medium for depressive symptoms (g = 0.47, p < 0.001; 95% CI = 0.31-0.64). Subgroup analyses demonstrated that group ACT was significantly superior to non-active controls (e.g., waiting list) in reducing anxiety and depressive symptoms. Group ACT was only significantly superior to active controls (e.g., CBT) in reducing depressive symptoms. Subgroup analyses also demonstrated that the effect size can vary depending on the number of sessions provided and the primary condition of participants recruited. LIMITATIONS The number of studies included in each category of subgroup analyses was small and the risk of bias varied across studies. There was high heterogeneity among the included studies, and this might have affected the results. CONCLUSION The current evidence suggests that group ACT may be effective in treating anxiety and depressive symptoms, perhaps more so for depressive symptoms when compared to other well-established treatments. The intensity of treatment and the targeted population may need to be considered when delivering group ACT.
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Affiliation(s)
- Michele Gomes Ferreira
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil
| | - Luciano Inácio Mariano
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6.627, CEP: 31270-901 Belo Horizonte, MG, Brazil
| | - Junio Vieira de Rezende
- Programa de Pós-Graduação em Psicologia, Faculdade de Filosofia e Ciências Humanas, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6.627, Caixa Postal N° 253, CEP: 31270-901 Belo Horizonte, MG, Brazil
| | - Paulo Caramelli
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil; Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil.
| | - Naoko Kishita
- School of Health Science, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.
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Duan W, Wu T, Bu H, He L. Development of a Three-Stage Strength-Based Meaning Intervention to Promote Mental Health Among Individuals with Physical Disabilities in Disadvantaged Communities: A Randomized Controlled Trial. JOURNAL OF HAPPINESS STUDIES 2022; 23:3865-3887. [PMID: 36213307 PMCID: PMC9531229 DOI: 10.1007/s10902-022-00578-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 05/08/2023]
Abstract
A three-stage strength-based meaning intervention (SMI) was developed in the present study, and its utility in facilitating the mental health of individuals with physical disabilities in low-income communities was tested. A randomized controlled and single-blind trial was adopted. A total of 50 qualified participants (mean age = 42.12, standard deviation = 8.68; 48% males; 26 for the intervention group, 24 for the control group) completed the pre-intervention test, post-intervention test, and three-month follow-up test. No significant difference was observed between the two groups at pre-intervention assessment . After intervention, the results in terms of strength knowledge, strength use, sense of meaning in life and mental health showed a significant improvement in the intervention group, with the changes maintained over three months except mental health. The differences in mental health between the post-intervention test and the three-month follow-up test were not significant in the intervention group. The results imply that the SMI model is a promising approach in promoting the mental health of individuals with physical disabilities in low-income communities as it promotes improved knowledge and use of strength and sense of meaning in life.
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Affiliation(s)
- Wenjie Duan
- School of Social and Public Administration, East China University of Science and Technology, 130 Meilong Road, Xuhui District, Shanghai, People’s Republic of China
| | - Tong Wu
- School of Social and Public Administration, East China University of Science and Technology, 130 Meilong Road, Xuhui District, Shanghai, People’s Republic of China
| | - He Bu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR People’s Republic of China
| | - Longtao He
- Research Institute of Social Development, Southwestern University of Finance and Economics, 555, Liutai Avenue, Wenjiang District, Chengdu, Sichuan People’s Republic of China
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The Effect of Acceptance and Commitment Therapy for Improving Psychological Well-Being in Parents of Individuals with Autism Spectrum Disorders: A Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11070880. [PMID: 34209171 PMCID: PMC8301771 DOI: 10.3390/brainsci11070880] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/19/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Acceptance and Commitment Therapy (ACT) has been demonstrated as effective in improving psychological well-being in several clinical domains, but there is no evidence regarding the parents of children with Autism Spectrum Disorder (ASD). Methods: In this randomized controlled trial, we evaluated the efficacy of the ACT matrix behavioral protocol in comparison to the Parent Training (PT) program, measuring several primary and secondary outcomes prior to and following treatments. Twelve parents were randomly and equally assigned to two demographically matched groups wherein individuals underwent 24 weekly meetings of ACT protocol (experimental group) or conventional PT (control group). Results: Parents enrolled in the ACT protocol demonstrated significant improvement in psychological flexibility, awareness states, personal values in everyday life, and parental stress, whereas reduced scores were elicited in parents’ perceptions of their child’s disruptive behaviors. Conclusions: The results of this randomized controlled trial, if repeated with a large number of subjects, could open the way to include ACT protocols in daily practice to support the development of new parenting skills.
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Salari N, Rezaie L, Khazaie H, Bokaee S, Ghasemi H, Mohammadi M, Khaledi-Paveh B. The effect of acceptance and commitment therapy on anxiety and depression in patients with cancer: A systematic review. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zemestani M, Salavati M, Seyedolshohadayi A, Petersen JM, Ong CW, Twohig MP, Ghaderi E. A Preliminary Examination of Acceptance and Commitment Therapy Versus Exposure and Response Prevention for Patients with Obsessive-Compulsive Disorder on an Optimal Dose of SSRIs: A Randomized Controlled Trial in Iran. Behav Modif 2020; 46:553-580. [DOI: 10.1177/0145445520982977] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study compared the effects of adding acceptance and commitment therapy (ACT) or exposure and response prevention (ERP) to adults diagnosed with obsessive compulsive disorder (OCD) already on an optimal and stable dose of selective serotonin reuptake inhibitors (SSRIs). Forty adults on SSRIs who were diagnosed with OCD participated in a randomized controlled trial in Iran of 12 individual weekly sessions of either ACT+SSRI, ERP+SSRI, or continued SSRI only. The results showed significant reductions in OCD symptom severity in ACT+SSRI and ERP+SSRI conditions at posttreatment with significantly greater reductions in both conditions compared to SSRI-only at follow-up. Additionally, psychological inflexibility and use of thought control strategies significantly decreased in the ACT+SSRI condition at posttreatment and follow-up compared to the ERP+SSRI and SSRI conditions. Both conditions led to decreases in perceived importance of stop signals. Results provide cross-cultural support for the treatment of OCD using ACT and ERP as adjuncts to SSRI and modest process of change differences between ACT and ERP. Future directions and study limitations are discussed.
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