Acceptance and Commitment Therapy, Relational Frame Theory, and the Third Wave of Behavioral and Cognitive Therapies
Steven C. Hayes, University of Nevada, Reno

A Preliminary Trial of Twelve-Step Facilitation and Acceptance and Commitment Therapy With Polysubstance-Abusing Methadone-Maintained Opiate Addicts
Steven C. Hayes, University of Nevada, Reno, Kelly G. Wilson, University of Mississippi, Elizabeth V. Gifford, Richard Bissett, Melissa Piasecki, University of Nevada, Reno, Sonja V. Batten, VA Maryland Health Care System and University of Maryland School of Medicine, Michelle Byrd, Eastern Michigan University, Jennifer Gregg, University of Nevada, Reno

The present study compared methadone maintenance alone to methadone maintenance in combination with 16 weeks of either Intensive Twelve-Step Facilitation (ITSF) or Acceptance and Commitment Therapy (ACT) in a preliminary efficacy trial with polysubstance-abusing opiate addicts who were continuing to use drugs while on methadone maintenance. Results showed that the addition of ACT was associated with lower objectively assessed opiate and total drug use during follow-up than methadone maintenance alone, and lower subjective measures of total drug use at follow-up. An intent-to-treat analysis which assumed that missing drug data indicated drug use also provided support for the reliability of objectively assessed total drug use decreases in the ACT condition. ITSF reduced objective measures of total drug use during follow-up but not in the intent-to-treat analyses. Most measures of adjustment and psychological distress improved in all conditions, but there was no evidence of differential improvement across conditions in these areas. Both ACT and ITSF merit further exploration as a means of reducing severe drug abuse.

Acceptance Theory-Based Treatment for Smoking Cessation: An Initial Trial of Acceptance and Commitment Therapy
Elizabeth V. Gifford, Department of Veterans Affairs and Stanford University School of Medicine, Barbara S. Kohlenberg, University of Nevada School of Medicine, Steven C. Hayes, University of Nevada, Reno, David O. Antonuccio, Melissa M. Piasecki, University of Nevada School of Medicine, Mandra L. Rasmussen-Hall, University of Nevada, Reno, Kathleen M. Palm, Brown University

This pilot study applied a theoretically derived model of acceptance-based treatment process to smoking cessation, and compared it to a pharmacological treatment based on a medical dependence model. Seventy-six nicotine-dependent smokers were randomly assigned to one of two treatments: Nicotine Replacement Treatment (NRT), or a smoking-focused version of Acceptance and Commitment Therapy (ACT). There were no differences between conditions at posttreatment; however, participants in the ACT condition had better long-term smoking outcomes at 1-year follow-up. As predicted by the acceptance process model, ACT outcomes at 1 year were mediated by improvements in acceptance-related skills. Withdrawal symptoms and negative affect neither differed between conditions nor predicted outcomes. Results were consistent with the functional acceptance-based treatment model.

A Mindfulness-Acceptance-Commitment–Based Approach to Athletic Performance Enhancement: Theoretical Considerations
Frank L. Gardner and Zella E. Moore, La Salle University

While traditional cognitive-behavioral skills-training-based approaches to athletic performance enhancement posit that negative thoughts and emotions must be controlled, eliminated, or replaced for athlete-clients to perform optimally, recent evidence suggests that efforts to control, eliminate, or suppress these internal states may actually have the opposite effect. Interventions based on mindfulness and acceptance suggest that internal cognitive and emotional states need not be eliminated, changed, or controlled in order to facilitate positive behavioral outcomes. Rather, it is suggested that an alternative or supplemental approach to the enhancement of athletic performance may be achieved through strategies and techniques that target the development of mindful (nonjudgmental) present-moment acceptance of internal experiences such as thoughts, feelings, and physical sensations, along with a clarification of valued goals and enhanced attention to external cues, responses, and contingencies that are required for optimal athletic performance.

Emotional Avoidance and Panicogenic Responding to a Biological Challenge Procedure
Maria Karekla, John P. Forsyth, and Megan M. Kelly, University at Albany, State University of New York

Healthy undergraduates high (n = 27) and low (n = 27) in experiential avoidance underwent twelve 20 s inhalations of 20% carbon dioxide–enriched air, while physiological (e.g., skin conductance, heart rate, EMG, and end-tidal CO2) and subjective (e.g., subjective units of distress, evaluative ratings, number and severity of panic symptoms endorsed) reactions were continuously monitored. Individuals high in experiential avoidance endorsed more panic symptoms, more severe cognitive symptoms, and more fear, panic, and uncontrollability than their less avoidant counterparts. Magnitude of autonomic response did not discriminate between groups, nor were the observed effects accounted for by other risk factors for challenge-induced panic such as anxiety sensitivity. Results are discussed in terms of the pathoplastic relation between emotional avoidance and exacerbation of unpleasant emotional responses and the view that emotional avoidance may constitute a risk factor in the development and maintenance of anxiety disorders.

The Effects of Acceptance Versus Suppression of Emotion on Subjective and Psychophysiological Response to Carbon Dioxide Challenge in Patients With Panic Disorder
Jill T. Levitt, New York University School of Medicine, Timothy A. Brown, Susan M. Orsillo, and David H. Barlow, Boston University

The effects of acceptance versus suppression of emotion were examined in 60 patients with panic disorder. Prior to undergoing a 15-minute 5.5% carbon dioxide challenge, participants were randomly assigned to 1 of 3 conditions: a 10-minute audiotape describing 1 of 2 emotion-regulation strategies (acceptance or suppression) or a neutral narrative (control group). The acceptance group was significantly less anxious and less avoidant than the suppression or control groups in terms of subjective anxiety and willingness to participate in a second challenge, but not in terms of self-report panic symptoms or physiological measures. No differences were found between suppression and control groups on any measures. Use of suppression was related to more subjective anxiety during the challenge, and use of acceptance was related to more willingness to participate in a second challenge. The results suggest that acceptance may be a useful intervention for reducing subjective anxiety and avoidance in patients with panic disorder.

Comparison Between an Acceptance-Based and a Cognitive-Control-Based Protocol for Coping With Pain
Olga Gutiérrez, Carmen Luciano, Miguel Rodríguez, Universidad de Almería, and Brandi C. Fink, The University of New Mexico

This study compares specific acceptance-based strategies and cognitive-control-based strategies for coping with experimentally induced pain. Forty participants were randomly assigned to an acceptance-based protocol (ACT), the goal of which was to disconnect pain-related thoughts and feelings from literal actions, or to a control-based protocol (CONT) that focused on changing or controlling pain-related thoughts and feelings. Participants took part in a nonsense-syllables-matching task that involved successive exposures to increasingly painful shocks. In both conditions, the task involved an overall value-oriented context that encouraged the participants to continue with the task despite the exposure to pain. At times throughout the task, participants were asked to choose to continue with the task and be shocked or stop the task and avoid being shocked. Each choice had specific costs and benefits. Participants performed the task twice, both before and after receiving the assigned experimental protocol. Two measures were obtained at pre- and post-intervention: tolerance of the shocks and self-reports of pain. ACT participants showed significantly higher tolerance to pain and lower believability of experienced pain compared to the CONT condition. Conceptual and clinical implications are discussed.

Acceptance and Commitment Therapy and the Treatment of Persons at Risk for Long-Term Disability Resulting From Stress and Pain Symptoms: A Preliminary Randomized Trial
JoAnne Dahl, University of Gävle, Kelly G. Wilson, University of Mississippi, and Annika Nilsson, University of Gävle

Approximately 14% of the working-age Swedish population are either on long-term sick leave or early retirement due to disability. Substantial increase of sick listing, reports of work disabilities and early retirement due to stress and musculoskeletal chronic pain suggest a need for methods of preventing loss of function resulting from these conditions. The present preliminary investigation examined the effects of a brief Acceptance and Commitment Therapy (ACT) intervention for the treatment of public health sector workers who showed chronic stress/pain and were at risk for high sick leave utilization. ACT was compared in an additive treatment design with medical treatment as usual (MTAU). A group of 19 participants were randomly distributed into 2 groups. Both conditions received MTAU. The ACT condition received four 1-hour weekly sessions of ACT in addition to MTAU. At post and 6-month follow-up, ACT participants showed fewer sick days and used fewer medical treatment resources than those in the MTAU condition. No significant differences were found in levels of pain, stress, or quality of life. Improvements in sick leave and medical utilization could not be accounted for by remission of stress and pain in the ACT group as no between-group differences were found for stress or pain symptoms.

A Preliminary Investigation of Acceptance and Commitment Therapy and Habit Reversal as a Treatment for Trichotillomania
Michael P. Twohig and Douglas W. Woods, University of Wisconsin-Milwaukee

In this study, the combination of Acceptance and Commitment Therapy and Habit Reversal (ACT/HR) was evaluated as a treatment for trichotillomania with 6 adults. The effectiveness of ACT/HR was assessed within two separate multiple baseline designs. Self-monitoring data showed that treatment was successful in decreasing the numbers of hairs pulled to near-0 levels for 4 of the 6 participants, with results being maintained for 3 of the f4our participants at the 3-month follow-up. These findings were confirmed with ancillary measures. The treatment was found to be acceptable by all participants.

The Impact of Acceptance and Commitment Training and multicultural training on the Stigmatizing Attitudes and Professional Burnout of Substance Abuse Counselors
Steven C. Hayes, Richard Bissett, Nancy Roget, Michele Padilla, Barbara S. Kohlenberg, Gary Fisher, Akihiko Masuda, Jacqueline Pistorello, Alyssa K. Rye, Kristen Berry, and Reville Niccolls, University of Nevada, Reno

Empirically validated methods for reducing stigma and prejudice toward recipients of behavioral health-care services are badly needed. In the present study, two packages presented in 1-day workshops were compared to a biologically oriented educational control condition in the alleviation of stigmatizing attitudes in drug abuse counselors. One, Acceptance and Commitment Training (ACT), utilized acceptance, defusion, mindfulness, and values methods. The other, multicultural training, sensitized participants to group prejudices and biases. Measures of stigma and burnout were taken pretraining, posttraining, and after a 3-month follow-up. Results showed that Multicultural training had an impact on stigmatizing attitudes and burnout post-intervention but not at follow-up, but showed better gains in a sense of personal accomplishment as compared to the educational control at follow-up. ACT had a positive impact on stigma at follow-up and on burnout at posttreatment and follow-up and follow-up gains in burnout exceeded those of multicultural training. ACT also significantly changed the believability of stigmatizing attitudes. This process mediated the impact of ACT but not multicultural training on follow-up stigma and burnout. This preliminary study opens new avenues for reducing stigma and burnout in behavioral health counselors.