The Impact of Treatment Components Suggested by the Psychological Flexibility Model: A Meta-Analysis of Laboratory-Based Component Studies

doi:10.1016/j.beth.2012.05.003

Behavior Therapy

Volume 43, Issue 4, December 2012, Pages 741-756

https://doi.org/10.1016/j.beth.2012.05.003 Get rights and content

Abstract

An important aspect of psychotherapy research is the examination of the theoretical models underlying intervention approaches. Laboratory-based component research is one useful methodology for this endeavor as it provides an experimental means of testing questions related to intervention components and the change process they engage with a high level of control and precision. A meta-analysis was conducted of 66 laboratory-based component studies evaluating treatment elements and processes that are suggested by the psychological flexibility model that underlies Acceptance and Commitment Therapy (acceptance, defusion, self as context, committed action, values, and present moment), but also touches on a variety of contextual forms of cognitive behavior therapy. Significant positive effect sizes were observed for acceptance, defusion, present moment, values, mixed mindfulness components, and values plus mindfulness component conditions compared to inactive comparison conditions. Additional analyses provided further support for the psychological flexibility model, finding larger effect sizes for theoretically specified outcomes, expected differences between theoretically distinct interventions, and larger effect sizes for component conditions that included experiential methods (e.g., metaphors, exercises) than those with a rationale alone. Effect sizes did not differ between at-risk/distressed and convenience samples. Limitations with the meta-analysis and future directions for laboratory-based component research are discussed.

Highlights

► Meta-analysis of lab-based component studies related to psychological flexibility. ► Significant positive effect size for each component compared to inactive conditions. ► Larger effect size for theoretically specified outcomes. ► Significant positive effect sizes relative to theoretically distinct interventions. ► Larger effect size for conditions with experiential methods than rationale-alone.

Section snippets

Eligibility criteria

The current meta-analysis included English-language published, peer-reviewed laboratory-based studies testing single-session component conditions targeting a subset of psychological flexibility components (acceptance, defusion, present moment, self as context, values, committed action) as compared to alternative conditions to which participants were randomly assigned (e.g., distraction, attention control condition). Studies had to include at least one outcome of possible applied or theoretical

Are psychological flexibility components psychologically active?

At the most basic level, it seems important to determine whether psychological flexibility components generally affect outcome variables in laboratory-based component studies, whether or not these outcomes are targeted theoretically. In order to assess whether components were psychologically active (i.e., have any effect on psychological outcomes), their impact on all outcomes was examined relative to inactive comparison conditions. Effect sizes were calculated for each psychological

Discussion

In broad terms, the present meta-analysis of laboratory-based component studies provides support for the usefulness and theoretical coherence of components specified by the psychological flexibility model. Significant positive effect sizes were observed for acceptance, defusion, present moment, values, mixed mindfulness, and values plus mindfulness conditions compared to inactive conditions, suggesting these components of psychological flexibility are psychologically active. Larger effect sizes

References (0)

Cited by (313)

Examining domains of psychological flexibility and inflexibility as treatment mechanisms in acceptance and commitment therapy: A comprehensive systematic and meta-analytic review
2024, Clinical Psychology Review
The current systematic and meta-analytic review sought to integrate a growing number of studies examining dimensions of psychological flexibility as treatment mechanisms for Acceptance and Commitment Therapy (ACT). Analyses of 77 records (67 unique studies; N_total = 9123 participants) from comprehensive searches of multiple databases suggested that ACT interventions led to reduced inflexibility (i.e., lowered global inflexibility, lack of present moment awareness, cognitive fusion, experiential avoidance, self-as-content, & inaction) and increased flexibility (i.e., committed action/contact with values, global flexibility/acceptance, & defusion). Those changes remained significant when ACT was compared with waitlist or active treatments and were significantly linked to corresponding drops in psychological distress, supporting their roles as ACT treatment mechanisms. Moderation analyses revealed that the use of student samples, exclusion of clinically symptomatic individuals, and comparisons of ACT with other active treatments weakened these effects whereas offering ACT as an individual therapy and excluding individuals in extreme crisis (i.e., with suicidal ideation) strengthened them. The meta-analytic findings and systematic review suggested specific recommendations for future clinical work and research on ACT mechanisms: (1) Evaluate both psychological flexibility and inflexibility as distinct treatment mechanisms, (2) Evaluate specific dimensions of psychological flexibility/inflexibility as mechanisms with multidimensional scales (CompACT, MPFI), (3) Broaden treatment outcomes to include forms of wellbeing (peace of mind, vitality, connectedness), (4) Assess mechanisms and outcomes repeatedly throughout treatment to model the process of therapeutic change, (5) Investigate non-specific factors (therapeutic alliance, treatment adherence) as mechanisms, and (6) Explore treatment mechanisms in effectiveness studies.
Testing the applicability of idionomic statistics in longitudinal studies: The example of ‘doing what matters’
2024, Journal of Contextual Behavioral Science
This study evaluated idionomic methods for identifying within-person links between therapeutically relevant processes and outcomes, using an ecological momentary assessment dataset of valued action and hedonic well-being (participants (n) = 425; 71.76% female; age = M(SD) = 22.20 (6.85); sampling design: 3–4 prompts per day; total measurements (n) = 6456). We compared the idionomic approach, integrating idiographic and nomothetic insights, with traditional multilevel modeling (MLM). Our methods included idiographic autoregressive integrative moving average models with an exogenous variable (i-ARIMAX), multivariate random-effects meta-analysis (RE-MA), deep Gaussian mixture modeling (DGMM), and multilevel vector autoregression modeling (Multilevel-VAR). The results showed that i-ARIMAX outperformed MLM in capturing within-person heterogeneity in the links between valued action and affect variables. Increases in values-based living were positively related to hedonic well-being but this effect showed a high degree of heterogeneity. A sub-group was identified, which we labeled the ‘Stoics,’ whose daily engagement in valued actions did not produce higher hedonic well-being (e.g., lower sadness or higher joy). Multilevel-VAR further revealed that for Stoics, stressful situations were linked to valued action, but not hedonic well-being. For Non-Stoics, valued action was less likely in stressful situations, but when valued action did occur it was associated with more joy and less sadness. The study offers initial evidence suggesting the superiority of an idionomic approach over a purely nomothetic one in capturing diverse pathways to clinically relevant outcomes. Idionomic methods may be useful or even necessary in personalizing psychological interventions, and thus may need to be considered by researchers and practitioners alike.
Reduced attentional control in individuals with a history of suicide attempts compared to those with suicidal ideation: Results from a systematic review and meta-analysis
2024, Journal of Affective Disorders
Neurocognitive profiles may be especially useful to identify factors that facilitate transitioning from contemplating suicide to attempting suicide. Generally, those who attempt suicide show greater disruptions in neurocognitive ability compared to those who think about suicide but do not proceed to attempt. The goal of this systematic review and meta-analysis is to test whether this pattern is observed with attentional control.
We systematically searched PubMed, PsychINFO, CINAHL, and Google Scholar to find pertinent studies. All included studies compared attentional functioning using neutral stimuli. Each sample featured adults with a history of suicidal ideation (SI) and no history of suicide attempts (SA) compared to those with a history of SA.
We identified 15 studies with 32 effect sizes (N = 931; n = 506 with SI only; n = 425 with SA). SA groups, compared to SI groups, exhibited worse accuracy yet similar reaction time, suggesting a comparatively blunted speed-accuracy tradeoff. Relative to SI, SA groups performed worse on Stroop-like and Go/NoGo tasks. SA performed better than SI on Trail Making Test B, but not A.
There were few available studies. Most samples were small. We did not differentiate current vs. past SI or high vs. low lethality SA. Only English and Spanish language articles were included.
Disrupted attentional control may convey risk for transitioning to SA from SI. More work is needed to determine which components of attention are most associated with suicide risk.
Compatibility of Components in Cognitive Behavioral Therapies: A Call for Combinatory Congruency
2024, Cognitive and Behavioral Practice
A large minority of psychotherapists endorse practicing integrative therapy, drawing from different schools of therapy, and an increasing number of contemporary therapies are designed by combining elements or components from different treatment models (e.g., modular treatments, process-based therapy). As a result, clients are likely to be the recipients of a number of different techniques or strategies, based on different theoretical models, emphasizing different change principles. This paper sets out to explore the potential challenges introduced by integrative treatments, exemplified with the diverse therapies found under the umbrella of cognitive behavioral therapies (CBTs). Although several scholars have proposed a unifying agenda for CBTs by underscoring commonalities and shared change principles, which is an important perspective, the extent to which compatibility exists between CBTs remains an underexplored scientific question. In this paper, we argue that integrative therapy can risk detracting from a positive outcome when the compatibility between distinct strategies or components is not ensured. We call for practitioners and researchers to ensure combinatory congruency, that is, compatibility between components manifested as their efficient and effective delivery together. We conclude by suggesting ways in which combinatory congruency can be established in the design phase of an integrative treatment or as an important step in additive and dismantling studies of existing integrative treatment packages.
Profiles of psychological flexibility in Japan: A conceptual replication
2024, Journal of Contextual Behavioral Science
This study aimed to conceptually replicate previous research. It detected subgroups of psychological flexibility (PF), which are based on the overall PF subcomponent, using latent class analysis and examined the relationships among the subgroups, well-being, and psychological distress. A total of 672 Japanese community sample participants completed the online survey. Analyses revealed three distinct profiles, namely, high-, moderate-, and low-PF groups. Well-being and psychological distress significantly differed across the groups. The high-PF group exhibited the highest levels of well-being and the lowest levels of distress, while the opposite results are true for the low-PF group. Furthermore, the high-PF group included more men than women and older participants. These results were almost consistent with previous data and demonstrated the stability of the subgroup structures of the PF level. The study discussed future directions for the PF profiles and cultural variables.
The use of Acceptance and Commitment Therapy (ACT) in informal caregivers of people with dementia and other long-term or chronic conditions: A systematic review and conceptual integration
2023, Clinical Psychology Review
Informal caregivers are the primary source of support for adults with chronic conditions and disabilities. Empirical research highlights chronic stress and other risks of adverse outcomes of caregiving. Acceptance and Commitment Therapy (ACT) is an emerging evidenced-based practice that shows promise in improving an array of outcomes, theoretically by increasing psychological flexibility as the primary process of change. Research has begun to evaluate ACT among informal caregivers of adult populations, and a systematic review is now needed to summarise this evidence base.
Electronic searches from five databases, including PubMed, PsycInfo, Embase, CINAHL, and Cochrane Library, yielded an initial 7896 hits, which after screening for inclusion criteria, resulted in 21 clinical trials. Studies were coded to synthesise the feasibility, effectiveness, and quality of evidence. Findings show that ACT was reported to be largely feasible and acceptable. However, the efficacy of ACT was mixed, with a more consistent pattern for informal caregivers of people with dementia.
Several methodological quality issues limited the findings. However, theoretical synthesis and preliminary evidence support the promising effect of ACT in subgroups of informal caregivers. Research on the process of change, as well as larger-scale, methodologically rigorous trials, are needed to consolidate these findings.

View all citing articles on Scopus

View full text