ACCEPTANCE-RELATED RESEARCH

Dialectical behavior therapy (DBT), mindfulness-based cognitive therapy (MBCT), acceptance-based behavior therapy (ABBT), and Acceptance and Commitment Therapy (ACT) are all recent extensions of traditional cognitive-behavioral therapies grouped under the rubric of acceptance-based psychotherapies. These therapies focus on increased awareness and acceptance of one’s internal experiences (thoughts, feelings and sensations) to gain greater psychological distance from internal experiences, achieve greater clarity as to one’s core life values, and most importantly, to behave in ways that are consistent with these values. These interests drive several interrelated research projects, and our lab is currently developing and evaluating acceptance-based therapies for treatment of a variety of clinical problems.

Standard Versus Acceptance-Based Variations of Cognitive-Behavioral Therapy for Mood and Anxiety Disorders

This project compares outcomes and mechanisms of action for mood and anxiety-disordered patients randomly assigned to either standard CBT or ACT. The aim of the study is to allow a comparison between these two forms of therapy in terms of mediating mechanisms as well as their impact on symptom levels (depression, anxiety), life functioning (work, school, family, relational), and well being (quality of life, subjective well-being). Results thus far have indicated that ACT has comparable effectiveness to gold standard CBT, but, notably, that it is mediated through different pathways (Forman, Herbert, Moitra, Yeomans & Geller, in press).

Acceptance-based Behavior Therapy for Social Anxiety Disorder

This project examines the effectiveness of acceptance-based behavior therapy (ABBT) for the treatment of social anxiety disorder (SAD), as well the mechanisms of action by which it works (Dalrymple, Herbert & Forman, 2006; Dalrymple et al., in press). For this project, a comprehensive ABBT for SAD treatment manual was developed. Results provide strong support for its effectiveness.

Acceptance-based Behavior Treatment for Obesity

The Behavior Weight Loss Program investigates novel, acceptance-based behavioral approaches to weight control. Thus far, two studies in this area have been conducted.

Our first study compared acceptance-based and traditional, “control”-based approaches to coping with cravings in a group of undergraduates. Results indicated that the relative efficacy of the two approaches depended on individuals’ sensitivity to the food environment (Forman, Hoffman, McGrath, Herbert, Brandsma & Lowe, in press). More specifically, acceptance-based strategies were significantly superior in terms of both craving intensity and food consumption in those individuals who were the most sensitive to the food environment, whereas control-based strategies appeared to be advantageous for those who were less sensitive.

For our second study, an acceptance-based behavior treatment manual for weight control was developed and tested it in an uncontrolled trial among four groups of overweight women. Results supported the effectiveness of this approach, as well as the theorized mechanisms of action (Forman, Butryn, Hoffman, Herbert and Lowe, in preparation; Hoffman, Forman, Herbert, Butryn & Lowe, in preparation).

Acceptance and Commitment Therapy for Physical Activity Promotion

This project aims to examine the effectiveness of Acceptance and Commitment Therapy in promoting physical activity behaviors among individuals who are struggling to adhere to their physical activity goals. ACT outcomes and mechanisms of action for mood and anxiety-disordered patients randomly assigned to either standard CBT or ACT.targets individuals’ commitment to difficult behaviors and tolerance of distress, and as such can be theorized to be particularly successful in increasing physical activity adherence. Our first study, targeting undergraduate students, is set to launch shortly.

Acceptance-based Treatment for Test Anxiety (Lily Brown)

For this study, an acceptance-based treatment for test anxiety was developed. In contrast to traditional “control-” based approaches to test anxiety, which encourage individuals’ attempts to control their anxiety in testing scenarios, ACT attempts to break the perceived link between anxiety and performance. Our ACT for test anxiety protocol is currently being piloted in a sample of nursing students.

Acceptance-based strategies to Promote HIV Medication Adherence (Ethan Moitra)

Despite the existence of effective pharmacological treatments, such as highly active antiretroviral therapy (HAART), a significant number of Americans with HIV do not maintain adequate adherence levels for treatment to work. It is thought that an acceptance-based intervention may be preferable to traditional cognitive behavior approaches to medication adherence because of the significant role that denial and experiential avoidance play in this population. Our lab is currently comparing treatment-as-usual to an acceptance-based intervention for increasing HAART adherence in a predominantly minority, low socio-economic status sample of uninsured adults in a Philadelphia primary care clinic.

Acceptance of pain in Juvenile Idiopathic Arthritis (Amanda Feinstein)

It has been demonstrated that acceptance of pain is associated with better functional outcomes (including decreased disability, depression, anxiety, and catastrophizing) among chronic pain patients. Our lab is examining the role of acceptance of pain in adolescents with juvenile arthritis. We are currently exploring whether acceptance of pain has moderating effects on pain intensity, disability, anxiety, and quality of life measures. Results may lend support for the use of acceptance-based treatments in conjunction with standard medical treatment for youths with arthritis.

Measuring Cognitive Defusion (Erica England)

Cognitive defusion is an integral but rarely researched component of Acceptance and Commitment Therapy. Our lab is currently examining the usefulness of the Implicit Relational Assessment Procedure (IRAP), a technology based on Relational Frame Theory, in assessing undergraduates' levels of defusion. Our aims are to explore the relationship between psychopathology, psychological functioning, and defusion (measured both explicitly and implicitly).

DEVELOPMENT OF ACT-RELATED MEASURES

As acceptance-based therapies are relatively new, measures for tracking change in related constructs are in need of development and refinement. Defusion and mindfulness are considered crucial elements of acceptance-based treatment and measurement of these constructs is of vital importance. To this end, our lab has developed the Philadelphia Mindfulness Scale (Cardaciotto, Herbert, Forman, Moitra, & Farrow, in press) and the Drexel Defusion Scale. Both of these measures provide important data relevant to understanding therapeutic processes.

ACT/CT Adherence and Competence Rating Scale (Katie McGrath)

In order to assess therapist practices specific to ACT and Cognitive Therapy and general therapist attributes, the Drexel University ACT/CT Adherence and Competence Rating Scale was developed. Preliminary results suggest that that the measure has good interrater reliability, internal consistency, and discriminant validity. Furthermore, there is some evidence to suggest that the measure may be predictive of psychotherapy outcome.

ANXIETY DISORDERS

Social Anxiety Disorder

Social Anxiety Disorder (SAD), or Social Phobia, is one of the most common psychiatric disorders and investigating its etiology, topology and treatment has been a long-standing focus of the lab. Recently, our lab has investigated novel treatments for SAD (e.g., ACT), the mechanisms of action at work in SAD, and the application of newer functional imaging techniques to the study of SAD.

Frontal Asymmetry in Social Anxiety Using Functional Near-Infrared Spectroscopy (Lori Tuscan)

Our lab is currently using functional near-infrared spectroscopy (fNIRS), a new imaging technique that collects data on cerebrovascular activity during in vivo tasks. The increased portability of this innovative procedure allows us to examine prefrontal hemispheric brain activity in a larger variety of social situations. Because fNIRS has not been used in anxiety research, our lab aims to explore and develop the utility of fNIRS to provide useful data regarding frontal brain activity in social anxiety.

Validity of The Construct of PTSD

Although the diagnostic entity of PTSD is widely accepted, there are some indications that the construct (as currently conceived) is flawed. For instance, most notions of PTSD assume that the post-traumatic reactions are universal biological responses to profound trauma that should be equally present in people from all cultures. However, a growing body of work, including some from our lab (Yeomans, Herbert & Forman, in press), suggests that this is not the case. In fact, there is evidence that some post-traumatic reactions may be in fact be closely tied to one’s expectations of what type of symptoms one ought to experience following a trauma. This important research highlights the fact that Western-style education and intervention efforts may be creating PTSD symptoms in trauma victims where they otherwise would not have existed.

PSYCHOTHERAPY: PROCESSES, OUTCOMES, AND DECISION-MAKING

Investigations of Mechanisms of Action of Psychotherapy

Each psychotherapy perspective has a theory purporting to explain how it works. In the case of traditional cognitive-behavioral therapy, the theory, in part, suggests that a reduction in distorted thinking is responsible for the effects of the therapy. Acceptance-based therapies call for different mechanisms of action, e.g. increases in experiential awareness and acceptance as well as increases in the ability to “defuse” from or separate from one’s thoughts and feelings. Our group has been investigating the extent to which the two therapies operate through the mechanisms their theoretical frameworks purport. It is hoped that knowledge about such mechanisms of action will translate into the ability to create more effective and efficient therapies.

Evaluation of Psychotherapy Outcome

Our research group is interested in questions such as: Which therapies are most effective? How should effectiveness be measured? How should therapies be labeled as “empirically-supported treatments”?

Clinical Decision-Making

While there is a long history of clinicians making use of a complex assortment of data to aid in clinical decision-making and conceptualization, virtually no empirical support for the usefulness of such data in sound decision making exists. Our lab group is pursuing research aiming to investigate the degree to which data such as developmental, relationship, and family history demonstrably and empirically aid clinical decision-making.

Science and Pseudoscience

Claims about the legitimacy of mental health interventions are not necessarily grounded in acceptable scientific approaches. Our research group is interested in developing general principles that help to separate true scientific approaches from those that are better described as pseudoscientific, because their grounding principles violate core tenets of the scientific approach. In addition, our group has an interest in identifying psychotherapeutic approaches (e.g. thought field therapy) that claim a scientific grounding but are best labeled as pseudoscientific.

Sudden Gains in Psychotherapy (Kathleen Marquez)

Sudden gains in psychotherapy, defined as large enduring reductions in symptom intensity from one therapy session to the next, suggest that progress is not gradual, but marked by sharp discontinuities. This instability, often attributed to life events, is thought to be noise that obscures signs of gradual improvement. However, current research suggests that some sudden gains represent enduring improvements. Our research group is interested in questions such as: Do sudden gains represent transient noise or long lasting decreases in patients’ symptom severity? Do sudden gains observed in efficacy studies also exist in routine clinical settings, and are they present in all forms of psychotherapy?

OTHER RESEARCH PROJECTS

Body Image Satisfaction (Jessica Collins)

In light of the rising rates of eating disorders, it is increasingly important to understand the etiology of such disorders. This study investigates the relationships among physical activity, dietary restraint, and body image satisfaction in a sample of female college students.

Impact of Parenting on Adolescent Adjustment (Alex Johnson)

Previous research suggests that parental psychological control and support impede the development of autonomy and identity in adolescents, whereas behavioral control and support are linked to positive outcomes. This study examines the impact of parental behavior on internalizing and externalizing behavior in adolescents living in a nontraditional family context (i.e., a residential setting).

Multiple Suicide Attempters (Anthony Ruocco)

Emerging evidence suggests that those individuals who make multiple suicide attempts represent a distinct population with specific and identifiable personality, psychiatric, neuropsychological and neurobiological profiles. Our lab is interested in understanding the interrelationships between psychoticism and repeated suicide-related behavior and between suicidality, trauma histories and core beliefs (central ideas about the self). Additionally, we are collaborating on a project to measure differences in brain activity between chronically suicidal individuals (diagnosed with borderline personality disorder; BPD) and “healthy” controls by assessing study participants’ hemodynamic brain activity using functional near infrared spectroscopy (fNIRS). Because fNIRS devices can be worn while engaging in varied activities, such assessments can take place under many conditions, in this case while participants were engaged in social challenge tasks.