Introduction
According to the World Health Organization (2017) mental health disorders are among the most prevalent sources of disability for young people worldwide with an estimated 10–20% of young people affected by some level of mental health problem (Kieling et al., 2011). US studies have shown that three quarters of all mental health problems emerge before the age of twenty-five (Kessler et al., 2005) with approximately 20% of adolescents experiencing clinical depression (Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993) and up to 31.9% showing some form of anxiety disorder (Merikangas et al., 2010). These rates have been found to be higher in the Irish context, where by 13 years, one in three young people experience a mental health concern with that figure rising to 1 in 2 by 24 years (Cannon, Coughlan, Clarke, Harley, & Kelleher, 2013). The emergence of many issues in adolescence can be linked to one's sense of self (Molloy, Ram, & Gest, 2011; Bolognini, Plancheral, Bettschart, & Halfon, 1996).
Issues related to the self have been widely regarded in psychology as critical to adolescent mental health and functioning (Harter, 1999, Marshall et al., 2015, Molloy et al., 2011). Over the past twenty years there has been an increase in research on the development of an individual's sense of self during adolescence (Biro et al., 2006, Harter et al., 1996, Molloy et al., 2011). One area that has received considerable attention is the issue of self-esteem and its role in adolescent mental health (Bolognini et al., 1996, Orth et al., 2008, Rieger et al., 2016). Findings from work in this area have found that negative self-esteem is implicated in the high rates of mental health concerns, and attempted suicide in this group (Lewinsohn et al., 1994, Sun and Hui, 2007).
Following on from these research findings, a number of attempts at improving mental health in adolescents have focused on building self-esteem (Mecca, Smelser, & Vasconcellos, 1989). Surprisingly, most of these programmes not only failed but these attempts to bolster self-esteem appeared to contribute to problematic behaviors including aggression, bullying, and narcissism (Baumeister et al., 2000, Baumeister et al., 2003, Baumeister et al., 1996). Furthermore, research has shown that attempts to maintain positive self-worth is linked with self-serving bias (i.e. taking personal responsibility for positive outcomes but attributing negative outcomes to external sources) (Shepperd, Malone, & Sweeny, 2008), and similarly rigid attachment to positive self-concepts result in young people avoiding constructive feedback that may potentially threaten their self concept (Blackwell et al., 2007, Hong et al., 1999). Believing one's self-concept is fixed (i.e. does not change over time) has also been linked to higher levels of stress, as well as feelings of exclusion and victimization (Yeager and Dweck, 2012, Yeager et al., 2014).
Despite the widespread attention and importance psychological research places on the self, psychological accounts of the self have been criticized for being imprecise and lacking strong theoretical foundations (Blyth and Monroe Traeger, 1983, Stewart et al., 2012). In a review of the self and self-related processes in chronic pain research, Yu, Norton, Harrison, and McCracken (2015) identified three categories of self that have been researched, specifically a sense of self based on evaluation (e.g. self-esteem), self based on attributes or description (e.g. role change), and finally, a detached sense of self (e.g. self-compassion). Self-esteem was identified as the most researched self-related variable and authors found that the conceptualization of self-esteem across studies was inconsistent. Similarly while investigations used the Rosenberg Self Esteem Scale, defined as a measure of personal worth, this definition was rarely stated or used interchangeably to describe other components of self esteem (e.g. overall self evaluation or appraisal). Moreover, the authors observed an overall lack of theoretical clarity across studies with most studies providing inconsistent definitions of self, and many failing to explicitly provide a definition (Yu et al., 2015).
A well defined, theoretically coherent account of the self is necessary for an in-depth understanding of the specific processes underlying this construct. In order to foster a healthy sense of self in adolescents, it is critical that the functional units underlying the self are understood. If the underlying processes involved in the development of a healthy sense of self are not understood then the design of interventions will be unlikely to be successful, as was reflected in the results of self esteem interventions with adolescents (Baumeister et al., 1996, Baumeister et al., 2000, Baumeister et al., 2003). What is needed is a bottom-up account of the specific processes and functional units underlying a healthy sense of self (and how they are developed) allowing for empirical investigation. One bottom up approach to issues such as the self can be found under the remit of Contextual Behavioral Science (CBS).
From a behavioral point of view, self or self-awareness may be defined as discrimination of one's own behavior (Skinner, 1974). CBS builds upon this, describing human self-awareness as follows “not simply behaving with regard to his behavior, but is also behaving verbally with regard to his behavior” (Hayes & Wilson, 1993, p. 297). In other words verbal discrimination of one's own behavior (Hayes, Barnes-Holmes, & Roche, 2001). According to CBS, the self is a learned behavioral repertoire unique to language-able humans, based on the learned ability to take perspective (McHugh & Stewart, 2012). Perspective Taking, or deictic relating, is a language-based skill that underpins many core aspects of human social and emotional development including theory of mind, empathy, compassion, self-compassion, acceptance, and a transcendent sense of self (Ciarrochi et al., 2015, Hayes et al., 2011). Perspective Taking develops as a result of interactions wherein one talks about one's own perspective in relation to the perspective of others (Hayes, 1984). It is learned that one's own perspective is consistent and distinct from that of other people. CBS postulates that this ability gives rise to three different patterns of self discrimination. The CBS literature pragmatically conceptualizes the self in terms of these three self discriminations, Self-as-Content, Self-as-Process, and Self-as-Context, each of which has important implications for a healthy, functional sense of self (Hayes and Gregg, 2000, Hayes et al., 2001, Hayes, 1995).
Self-as-Content, also known as self-as-story or the conceptualized self, refers to one's thoughts and beliefs about the self, and how one relates to them (Atkins and Styles, 2015, Atkins and Styles, 2016, Hayes et al., 2001, Torneke, 2010). It is made up of all the evaluations and descriptions an individual develops about themselves throughout their lives. CBS postulates that humans naturally strive for coherence and therefore attempt to organize self-descriptions and evaluations into a coherent story (i.e., relational network) to create a consistent sense of self. This behavior is reinforced early on in life by one's social environment, as it is learned during childhood that is very helpful to describe personal characteristics, abilities, likes, dislikes etc (Atkins & Styles, 2015). This idea of a conceptualized self made up of one's evaluations and descriptions reflects the approach to understanding the self seen in the majority of psychological approaches, including the self-concept of humanistic psychology (e.g. Rogers, 1961), self-schemas of cognitivist psychology, and the narrative self (Gallagher, 2000).
According to CBS, as Self-as-Content becomes rigid and conceptualized, this may lead to beliefs and evaluations about the self being treated as literal truths (Atkins & Styles, 2015). As a result, individuals may behave in accordance with their conceptualizations, commonly resulting in dysfunctional behavior (e.g. behaving according to the self-conceptualiztion “I’m not good enough”). On the contrary, when an individual recognizes these beliefs and evaluations as not literally true, this facilitates a more flexible relationship to Self-as-Content, wherein self-conceptualizations do not rigidly impact behavior. On this basis, researchers describe two separate components of Self-as-Content, Self-as-Rigid-Content and Self-as-Flexible-Content (Atkins and Styles, 2015, Hayes et al., 2011).
Self-as-Content is considered to be overly simplified in the sense that it does not capture the full extent of our life history, and simply refers to the sense of self we have abstracted over time through observing our own behavior and others’ descriptions of our behavior. However, there are more dynamic, flexible aspects to the self beyond this typically rigid, abstracted sense of self (Atkins & Styles, 2015).
Self-as-Process, or the experiencing or knowing self, refers to the ongoing awareness of one's moment to moment experiences of self and flexible verbal self-knowledge in the here and now (Atkins and Styles, 2015, Atkins and Styles, 2016, Hayes et al., 2001, Torneke, 2010), in other words behavior occurring in the moment that constitutes what refers to as the self- thoughts, feelings, experiences etc. Foody, Barnes-Holmes, and Barnes-Holmes (2012) describe Self-as-Process as being synonymous with mindfulness or present moment awareness. Neuropsychological data provides empirical support for the differentiation between Self-as-Content and Self-as-Process. Specifically, Farb et al. (2007) used fMRI to investigate any distinction between a “narrative” self (i.e. Self-as-Content) and an experiencing sense of self, (i.e. Self-as-Process) and found a neural dissociation between the two. They described the narrative self in this sense as automatic self-reference that integrates experiences over time. The experiential self however was characterized by an awareness of the present moment. These findings provide evidence for these behaviourally distinct patterns of self discrimination.
This ability to monitor one's self experience from moment to moment is important for successful self-monitoring as well as for social contexts (Atkins & Styles, 2016). It provides predictive information to ourselves and others (e.g. I’m tired, I’m hungry etc.) and can be used to guide behavior in the moment, allowing ourselves and others to predict behavior and respond accordingly.
The third self is known as Self-as-Context and refers to a transcendence of one's own private events, known as psychological content, facilitating acceptance of that content (Atkins and Styles, 2015, Atkins and Styles, 2016, Hayes et al., 2001, Torneke, 2010). Self-as-Context, also referred to as the observing self, self-as-perspective, or the transcendent self, is an observing sense of self, wherein the self is a perspective or observer of one's experience. It is the viewpoint from which one's experience and content is observed. Hayes (2011) gives the following definition of self-as-context:
“Self-as-context is the coming together and flexible social extension of a cluster of deictic relations (especially I/Here/Now) that enable observation and description from a perspective or point of view. Self-as-context enables or facilitates many different experiences, including theory of mind, empathy, compassion, self-compassion, acceptance, defusion, and a transcendent sense of self”
Concepts that correspond most closely to Self-as-Context in other schools of psychology include meta-cognition or decentering (Bernstein et al., 2015, Naragon-Gainey and Demarree, 2016). The concept of Self-as-Context according to CBS is brought about as a result of deictic relational responding, as competencies in deictic relations allow us to observe and take perspective on our experience. The experience of Self-as-Context is the invariant in all perspective discriminations (Foody et al., 2012).
According to CBS, Self-As-Context facilitates acceptance of unwanted psychological experience and pain, which has important implications for relationships with others and social connection as it facilitates processes such as compassion, intimacy and acceptance/willingness (Barnes-Holmes, Hayes, & Dymond, 2001; McHugh, 2015). On this basis, deficits in Self-As-Context are thought to result in an array of social and psychological issues such as unstable identity or sense of self, issues with intimacy or connecting with others, as well as lack of empathy or self-compassion (McHugh, 2015).
While the three selves as conceptualized by CBS have an abundance of theoretical support with a large amount of conceptual literature on the topic, there was a dearth of empirical investigations until recently. Atkins and Styles (2016) coded qualitative interviews in a sample of 29 adults for incidents of a conceptualized self (negative Self-as-Content), experiential self (Self-as-Process), and an observing self (Self-as-Context). They examined the transcripts as predictive of positive affect and well-being. They observed that an observing sense of self (Self-as-Context) is predictive of lower depression long-term, while an overly conceptualized sense of self (Self-as-Content) is related to higher stress and more negative affect. Similarly Yu, Norton, and McCracken (2017) found that increased Self-as-Context was related to improved functioning and lower depression in a sample of 412 adults with chronic pain.
There have also been specific investigations into 2 distinct types of Self-as-Context. Two types of relating have been found to give rise to Self-as-Context, and each of which has separate implications for mental health (Foody et al., 2013, Foody et al., 2015; Gil-Luciano, Ruiz, Valdivia-Salas, & Suárez, 2017; Luciano et al., 2011). The first, known as distinction, involves one relating to one's own private psychological content as distinct and separate to themselves, while the second, known as hierarchy, involves the individual viewing themselves as the “container” or context of their private events, facilitating observation of ongoing psychological experience from a constant perspective, facilitating acceptance of said psychological experience.
Foody et al. (2013) and Foody et al. (2015) demonstrated that hierarchy was associated with less distress relative to distinction in samples of university students, while Gil-Luciano et al. (2017) found that hierarchy was associated with greater distress tolerance in a sample of adults. Luciano et al. (2011) similarly observed greater improvements in problem behavior, acceptance, and psychological flexibility for hierarchy relative to distinction in a sample of 15 clinically “at-risk” adolescents (m= 13.66 yrs). Although, no study has investigated these patterns of self-discrimination in a non-clinical sample of adolescents, these studies highlight the relationship of the three selves to mental health. On the basis of this, and due to the importance of a sense of self during adolescent development (Harter, 1999, Marshall et al., 2015), it is pertinent that these patterns of self-discrimination are investigated in relation to mental health in a non-clinical typically developing sample of adolescents. Findings may have important implications for self-based therapeutic work or self-based interventions with adolescent populations.
Due to the importance of these patterns of self discrimination during adolescence and the apparent importance of a more flexible Self-as-Content, and increased Self-as-Process, and Self-as-Context for greater mental health and well being according to CBS, this study has two primary aims. The first is to investigate the relationship between three self-related variables as proposed by CBS, specifically Self-as-Content, Self-as-Process, Self-as-Context, and mental health, in order to understand how each functionally distinct pattern of self-discrimination relates to mental health, and the strength and direction of these relationships. The second is to examine the ability of a model of the three selves according to CBS, to predict mental health in adolescents. It is predicted that a more flexible relationship to Self-as-Content (positive or negative), higher levels of Self-as-Process, and higher levels of Self-as-Context will be predictive of lower levels of distress in adolescents. Participant gender will also be controlled for due to the well documented gender differences in self-relating, and their implications for mental health during adolescence (Bolognini et al., 1996, Crocetti et al., 2016, Dooley and Fitzgerald, 2012).
As no specific measure of Self-as-Content exists to date, the present study will use a composite of subscales from the Self Compassion Scale-Short Form to measure Self-as-Content, specifically the inverse scores from the self-judgment, isolation, and over identification scales. Rather than directly measuring self concepts and evaluations, the Self Compassion Scale-Short Form captures how the individual relates to these conceptualisations, in particular whether s/he treats his/her content with harsh judgment, allowing it to impact functioning and well being or holds it lightly, treating it with patience and understanding rather than evaluation (Neff, 2003; Raes, Pommier, Neff, & Van Gucht, 2011). This experience of self is comparable to flexible (versus rigid) self-as-content and this measure has therefore been selected as a suitable proxy.
Likewise, to the best of the author's knowledge, there is no specific measure of self-as-process. Self-as-Process has been described as awareness of the self in the present moment and is considered synonymous to mindfulness (Foody et al., 2012). Foody et al. (2012) give the following description of Self-as-Process “This sense of self is experiential awareness of the present moment and thus facilitates acceptance of thoughts, feelings, and emotions as what they are in that moment and nothing else (e.g., in past or future, etc.)”. For this reason, a measure of mindfulness will be an appropriate test of Self-as-Process. The Child and Adolescent Mindfulness Measure, a measure of mindfulness in young people, will be used to measure Self-as-Process in the present study (Greco, Baer, & Smith, 2011).
Self-as-Context will be measured using the Self-as-Context Scale (Gird, Zettle, Webster, & Hardage-Bundy, 2012). This scale is the only specific measure of Self-as-Context at the time of testing and while there are no published studies where it is used with adolescent samples, it has been found to have good validity and reliability in adult populations (Gird & Zettle, 2013). Although, differences have been observed in different types of Self-as-Context as discussed previously, at the time of testing no explicit measure of these two types of Self-as-Context existed. Although scale authors do not describe the scale as differentiating between distinction and hierarchy, scale items are more consistent with hierarchical relating (e.g. Even though there have been many changes in my life, I’m aware of a part of me that has witnessed it all.)
Finally, the Depression Anxiety and Stress Scale-21 will be used to measure mental health in adolescents. This scale has been used to measure mental health in previous research looking at the three selves (Atkins & Styles, 2016) and has been found to be appropriate for use with both clinical and non-clinical populations (Antony et al., 1998, Szabo, 2010), as well as adolescent samples (Mellor et al., 2015, Szabo, 2010).
Cited by (24)
A Review of Acceptance and Commitment Therapy for Adolescents: Developmental and Contextual Considerations
2022, Cognitive and Behavioral Practice
Citation Excerpt :
Although research is nascent, perspective taking and empathy (i.e., abilities involving a shift outside of one’s own perspective, a form of self-as-context) are associated with positive adolescent relationships with parents and peers (Boele et al., 2019). Additionally, elevated self-as-context is a significant predictor of reduced adolescent distress (Moran et al., 2018). Last, firmly connecting oneself to previous “stories” or personal narratives (i.e., “self-as-story” rather than self-as-context) was associated with reduced well-being and elevated avoidance behaviors in youth (Moran & McHugh, 2020).
Acceptance and commitment therapy (ACT) offers a promising, transdiagnostic treatment approach for a wide range of mental health concerns in adolescents. Although research on ACT for adolescents is still developing, there is encouraging theoretical and empirical support in this area. The ability of ACT to adjust and account for developmental considerations and contexts in adolescence is discussed, alongside the theoretical support for using ACT with adolescents. A broad review of 34 studies on ACT with adolescents is then presented—ACT with adolescents has some preliminary support for anxiety, depression, disordered eating, chronic pain, and more. Detailed examples of how to implement each ACT process with adolescents are presented, along with a brief review of assessment tools. We hope this paper will act as an initial guide for clinicians implementing ACT with adolescents.
Roads less travelled to self-forgiveness: Can psychological flexibility overcome chronic guilt/shame to achieve genuine self-forgiveness?
2021, Journal of Contextual Behavioral Science
Self-forgiveness theorising and research has advanced significantly, especially with respect to responding to human wrongdoing and failings. However, there are three emotional contexts, namely chronic guilt, blameworthy (moral) shame and blameless (non-moral) shame, where the path to self-forgiveness remains hindered or obscure. In this paper, we seek to answer the question: “Is there a way from non-moral shame and high levels of moral guilt/shame to genuine self-forgiveness?” We argue that psychological flexibility provides a unifying framework to explicate the self-forgiveness process, including the roles of problematic guilt/shame. In so doing, we provide a theoretical rationale for how it is possible for individuals with extreme moral guilt/shame and non-moral shame to genuinely forgive themselves.
Investigating cognitive fusion, mindfulness and experiential avoidance in relation to psychosis-like symptoms in the general population
2021, Journal of Contextual Behavioral Science
Acceptance and Commitment Therapy (ACT) has demonstrated promising outcomes to date with clinical populations affected by psychosis, however there is a dearth of such investigations involving non-clinical samples despite evidence that symptoms of psychosis exist on a continuum in the general population. The present study aimed to investigate how key ACT processes relate to psychosis-like symptoms in the general population. A convenience sample of 77 adults completed self-report measures of cognitive fusion, mindfulness, experiential avoidance, and psychosis-like symptoms, and relative distress, intrusiveness and frequency. A series of correlational and hierarchical regression analyses investigated the relationship between target variables. Higher mindfulness was related to lower levels of psychosis-like symptoms as well as lower distress, intrusiveness, and frequency in relation to these experiences, as were lower levels of cognitive fusion and experiential avoidance. Higher levels of cognitive fusion and experiential avoidance, as well as lower levels mindfulness, emerged as significant predictors of higher levels of psychosis-like symptoms, and higher relative distress, intrusiveness, and frequency. Findings are discussed in relation to implications for future clinical research.
Self and rules in a sample of adults experiencing homelessness: Relationships to shame, well-being, and psychological inflexibility
2021, Journal of Contextual Behavioral Science
Citation Excerpt :
Functioning as a self-monitoring repertoire, self-as-process is necessary for both self-as-content (e.g., to know that I am “burned out” I must first notice that I experience symptoms of burnout) and self-as-context (i.e., observing the observer). Although self-as-process has been associated with increased well-being and decreased psychological inflexibility (Moran et al., 2018), findings are somewhat inconsistent across studies regarding its relation to other self-repertoires (Atkins & Styles, 2016; Styles & Atkins, 2018). Finally, self-as-context refers to the perspective from which the self is either distinct from or the container of internal experiences (Atkins & Styles, 2016).
Identification with a stigmatized group, such as people experiencing homelessness, is an important contributor to shame. Shame is relevant to issues of the self, other-generated conceptualizations of the self, and rule-governed behavior. Contextual behavioral science outlines a philosophically sound, theoretically coherent, evidence-based account of the self that lends itself to empirical work. More specifically, recent developments in relational frame theory have resulted in a behavioral measure of both self and other discriminations and types of rule-governed behavior evident in naturally occurring language, namely the Functional Self-Discrimination Measure (FSDM). Using the FSDM with a sample of adults experiencing homelessness (n=22), the present study examined the relationships between occurrences of self and other discriminations and shame, well-being, and psychological inflexibility. The present study also explored whether occurrences of self, other, and rules codes were related. Findings indicated that both shame and psychological inflexibility were associated with greater unfavorable self-evaluations and greater references to rule-governed behavior and the self as distinct from private events. Well-being was associated with greater favorable self-evaluations and greater references to values-oriented self-rules and beliefs. Findings are discussed with reference to a need to further refine existing FSDM codes, examine FSDM data at more than one time-point, and explore other aspects of relational responding in addition to the frequency of occurrence in natural-language speech.
An experimental investigation of the effects of perspective-taking on emotional discomfort, cognitive fusion and self-compassion
2021, Journal of Contextual Behavioral Science
Citation Excerpt :
Self as context refers to a flexible repertoire of perspective taking skills that enhance defusion by adding a sense of containment of psychological experience. In ACT, skills of flexible perspective-taking are used to detach from unhelpful patterns of thinking, develop a more observer-based stance, and to foster empathy and compassion towards one's self and others (Hayes, Strosahl, & Wilson, 2012; Moran, Almada, & McHugh, 2018). The fact that many therapy modalities have employed these kinds of interventions has led some researchers to outline commonalities and distinctions between these at the level of underlying construct, referring to that as ‘Metacognition’ (Bernstein et al., 2015).
Perspective-taking exercises are used in a range of therapies, such as Acceptance and Commitment Therapy (ACT), Cognitive Therapy (CT), Dialectical Behavioural Therapy (DBT) and Compassion-Focused Therapy (CFT). Perspective-taking has been theorised in ACT to foster cognitive defusion, self-compassion and a sense of self as distinct from and containing self-related negative thoughts and feelings. To date, few experimental studies have investigated the impact of typical perspective-taking exercises. This study sought to investigate whether perspective-taking exercises were able to decrease state cognitive fusion and emotional discomfort and increase state self-compassion associated with a self-related, negative thought (SRNT). It also sought to investigate whether there are differences in effects between temporal (‘now’ vs ‘then’) and interpersonal (‘self’ vs ‘other’) perspective-taking and between giving and receiving perspectives.
A convenience sample of non-clinical participants (n=61) generated a SRNT and then rated levels of emotional discomfort, state cognitive fusion and state self-compassion in relation to the thought. Participants were then guided through three within-participant conditions: a control procedure, a giving perspective and a receiving perspective condition. Participants were allocated to one of two groups: temporal perspective-taking or interpersonal perspective-taking. Mixed ANOVAs showed that both interpersonal and temporal exercises significantly reduced emotional discomfort and cognitive fusion and increased self-compassion associated with a SRNT. The effects of giving or receiving perspective differed between interpersonal and temporal groups.
These results provide experimental evidence that perspective-taking is a psychologically beneficial process, therefore supporting the existing use of perspective-taking exercises in clinical practice.
The Relationship Between Flexible Perspective Taking and Emotional Well-Being: A Systematic Review of the “Self-as-Context” Component of Acceptance and Commitment Therapy
2020, Behavior Therapy
Citation Excerpt :
Each of the correlational studies necessarily included a measurement of SAC. Three of the six publications used the SEQ (McCracken et al., 2018; Yu et al., 2016; Yu, Norton, & McCracken, 2017), while two of the six publications used the SACS (Moran et al., 2018; Zettle et al., 2018). The sixth study by Sinha (2014), which examined posttraumatic stress symptoms, used the inverse of the Centrality of Events Scale as a proxy for SAC.
One of the core processes of acceptance and commitment therapy (ACT) is “self-as-context” (SAC). SAC is conventionally taught as an extension of mindfulness, which enables individuals to focus on a stable, grounded, and enduring sense of self that is able to have a flexible perspective. There has been a growing number of studies that have evaluated the effects of the SAC component in improving emotional well-being in various samples. The objective of this systematic review was twofold: (a) to evaluate whether SAC can be effectively taught and assessed in component analyses, and (b) to evaluate whether SAC improves emotional well-being. The electronic databases of PsycInfo and Medline were searched to identify relevant studies with the final search completed in August 2019. All studies that examined SAC as a stand-alone construct were considered. A total of 20 studies (published in 14 papers) met inclusion criteria for this review. Seven studies were based on a single-session lab trial, two studies were based on intervention trials, and 11 studies utilized cross-sectional assessment designs. On the basis of four identified studies, there is only provisional but very limited evidence to suggest that SAC can be effectively taught and implemented as a stand-alone process to manage emotional well-being. Mixed findings emerged in relation to SAC improving emotional well-being. The methodological quality of the studies was variable, which contributed to the mixed outcomes. There is limited evidence to support the use of the SAC component as a stand-alone process in ACT-based interventions, and research recommendations are discussed.
Recommended articles (6)
Research article
The PIIRAP: An alternative scoring algorithm for the IRAP using a probabilistic semiparametric effect size measure
Journal of Contextual Behavioral Science, Volume 7, 2018, pp. 97-103
The Implicit Relational Assessment Procedure (IRAP) has been used to assess the probability of arbitrarily applicable relational responding or as an indirect measure of implicit attitudes. To date, IRAP effects have commonly been quantified using the DIRAP scoring algorithm, which was derived from Greenwald, Nosek and Banaji's (2003) D effect size measure. In the article, we highlight the difference between an effect size measure and a scoring algorithm, discuss the drawbacks associated with D, and propose an alternative: a probabilistic, semiparametric measure referred to as the Probabilistic Index (Thas, De Neve, Clement, & Ottoy, 2012). Using a relatively large IRAP dataset, we demonstrate how the PI is more robust to the influence of outliers and skew (which are typical of reaction time data). Finally, we conclude that PI models, in addition to producing point estimate scores, can also provide confidence intervals, significance tests, and afford the possibility to include covariates, all of which may aid single subject design studies.
Research article
Concept and validation of the German version of the Cognitive Fusion Questionnaire (CFQ-D)
Journal of Contextual Behavioral Science, Volume 9, 2018, pp. 30-35
Within the ACT model of psychological flexibility, cognitive fusion (CF) refers to individuals’ attitudes towards their own thoughts and beliefs, more specifically, the extent to which they identify with and are behaviorally regulated by the form and content of their own thoughts and beliefs. This concept is of growing interest for those treating chronic conditions. Evidence supports the relevance of CF in the context of pathological conditions such as chronic pain. Recently developed measures of CF are available in English but so far, have been lacking in German. This study aims to explore the reliability and validity of the German translation of the Cognitive Fusion Questionnaire (CFQ) within a clinical sample (n = 216) of patients suffering from chronic pain at a rehabilitation clinic and a non-clinical sample (n = 166). Participants also completed a set of standard clinical measures as well as the German translation of the Psychological Inflexibility in Pain Scale (PIPS) to assess concurrent and convergent validity. Confirmatory factor analysis (CFA) confirmed a one-factor solution, referred to as CF, which had been identified previously. The scale had good psychometric properties. Furthermore, the CFQ-D total sum score was correlated with measures of psychological inflexibility in pain, pain intensity, self-reported state of health and limitation of physical functioning, functional ability, quality of life, pain related self-instructions and depression. Further analyses indicate that CFQ-D is a reliable and valid instrument for assessing CF in a German-speaking population.
Research article
Valued living, life fulfillment, and suicide ideation among psychiatric inpatients: The mediating role of thwarted interpersonal needs
Journal of Contextual Behavioral Science, Volume 7, 2018, pp. 8-14
Suicide is one of the leading causes of death in psychiatric hospitals with an estimated rate of 100–400 per 100,000 admissions. The current study aimed to examine suicide ideation among psychiatric inpatients utilizing perspectives from the psychological flexibility model (Hayes, Strosahl, & Wilson, 2012) and the interpersonal theory of suicide (Joiner, 2005; Van Orden et al., 2010) to better understand suicide risk among psychiatric inpatients. We hypothesized that valued living (i.e., connection with one's values and committed action) and life fulfillment would each be negatively associated with suicide ideation and that these relations would be mediated by thwarted interpersonal needs (i.e., additive effect of thwarted belongingness and perceived burdensomeness) in parallel. We also hypothesized that the direct and indirect association between valued living and suicide ideation would be moderated by life fulfillment, such that those lower in life fulfillment would report a stronger direct and indirect association between valued living and suicide ideation. Results obtained from bootstrapped parallel mediation regression procedures indicated greater valued living and life fulfillment were each associated with lower thwarted interpersonal needs and suicide ideation. Further, a significant interaction between valued living and life fulfillment suggests those lower in both valued living and life fulfillment reported the greatest suicide ideation. Research examining the psychological flexibility model in the context of the interpersonal theory of suicide may improve suicide risk conceptualization, assessment and treatment among psychiatric inpatients.
Research article
Psychological flexibility and ostracism: Experiential avoidance rather than cognitive fusion moderates distress from perceived ostracism over time
Journal of Contextual Behavioral Science, Volume 7, 2018, pp. 72-80
Psychological inflexibility has been found to moderate psychological distress following perceived ostracism. Two component processes of psychological inflexibility, experiential avoidance and cognitive fusion, are considered key in exacerbating general emotional distress. The present study (n = 286) examined whether both experiential avoidance and cognitive fusion moderate distress from perceived ostracism or whether one of these processes alone underpins the moderation effect of psychological inflexibility. In a structural equation model analysis, when accounting for both factors, experiential avoidance moderated distress from perceived ostracism alone. Thus, it seems that experiential avoidance is a key driver underlying emotional regulation of psychological distress in the context of perceived ostracism.
Research article
Development and initial validation of the Generalized Pliance Questionnaire
Journal of Contextual Behavioral Science, Volume 12, 2019, pp. 189-198
Empirical research on functional classes of rule-governed behavior has been scarce, which might be due to the absence of valid behavioral or self-report measures. We describe the development and initial examination of the Generalized Pliance Questionnaire (GPQ) through three studies with a total of 2127 participants. In Study 1, a pool of 77 items reflecting generalized pliance was designed. Thirty-eight of these items were rated as high-quality by at least one of two experts in RFT and were administered to 130 undergraduates. A preliminary version of the GPQ consisting of 18 items (i.e., GPQ-18) was obtained. In Study 2, the GPQ-18 was applied to 410 undergraduates. The results of the exploratory factor analysis showed that the GPQ-18 can be considered as a unidimensional measure and that all items showed good functioning. A shorter, 9-item version of the GPQ (i.e., GPQ-9) was also obtained. In Study 3, the GPQ-18 was applied to three samples, including large samples of undergraduates, the general population and a smaller clinical sample. Confirmatory factor analyses showed that the one-factor model obtained a good fit for the GPQ-18 and acceptable for the GPQ-9. Both versions of the GPQ showed excellent internal consistency and theoretically coherent correlations with a wide range of constructs. In conclusion, the GPQ seems to be a valid and reliable measure of generalized pliance.
Research article
Using conceptual developments in RFT to direct case formulation and clinical intervention: Two case summaries
Journal of Contextual Behavioral Science, Volume 7, 2018, pp. 89-96
The current paper is part of an ongoing effort to better connect RFT with the complexities of clinical phenomena. The paper outlines two broad areas, referred to as ‘verbal functional analysis’ and the ‘drill-down’, in which we believe the basic theory is showing increasingly direct application to therapy. The paper also comprises two case summaries in which verbal functional analysis and the drill-down featured strongly in case formulation and clinical focus. Case 1 involves an adult woman who presented with paranoia, had been diagnosed with psychosis, and had an extended history of familial and other abuse. Case 2 describes a teenager who had been placed in foster care, following parental neglect. For comparative purposes and to provide exemplars of similar functional-analytic processes, both case summaries are presented in a similar format. The article attempts to illustrate how therapeutic work can be connected to the basic theory and argues that it will be important in future work to further expand these connections with ongoing developments in RFT.
© 2018 Association for Contextual Behavioral Science. Published by Elsevier Inc. All rights reserved.
