Improvements in Depression and Mental Health After Acceptance and Commitment Therapy are Related to Changes in Defusion and Values-Based Action
Open accessAbstract
Acceptance and commitment therapy (ACT) has been found to be effective for various mental health disorders but the processes through which it affects change remain unclear. Much process research in the area is on physical rather than mental health, and focuses on the broad concept of psychological flexibility with little research on specific mechanisms identified in theory such as fusion and values. This study explored whether there was a relationship between two of the main ACT processes (cognitive defusion and values) and levels of depression and distress. Thirty-three participants completed questionnaires at the start and end of their treatment measuring general mental health and distress, depression, levels of cognitive fusion and how much they were living in line with their values and how important their values were to them. Results showed reductions in levels of fusion and increases in values-based action were significantly related to reductions in distress and depression. There was no correlation between changes in values importance and changes in distress or depression. This study therefore suggests decreased defusion and increased values-based action is an important mechanism in the efficacy of ACT in those with depression and mental health problems. The study is however limited by a small sample size and future research with a sample large enough for mediation analysis would be beneficial.
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Cognitive fusion predicts stress, depression, and anxiety indicators.
“The predictive role of cognitive fusion on psychopathological indicators of stress, depression, and anxiety has been demonstrated in previous studies (Bramwell & Richardson, 2018)”
From Mental fatigue and negative emotion among nurses during the COVID-19 pandemic (2022) · cites this paper as Bramwell & Richardson, 2018
The Results (Bivariate Correlations; page unavailable) report that changes in cognitive fusion correlated with changes in depression and overall distress. The Methods (Statistical Analysis; page unavailable) say the sample was too small for regression, and the Discussion proposes examining individual distress subscales in future work. The paper therefore does not demonstrate that fusion predicts separate stress and anxiety indicators. (LLM, conf=0.88)
Experimental — accuracy not yet measuredResearch indicates that the processes of psychological flexibility (e.g., Defusion) can help individuals better manage distressing emotions and thoughts, ultimately promoting emotional well-being and healthier behaviors.
“Research indicates that the processes of psychological flexibility (e.g., Defusion) can help individuals better manage distressing emotions and thoughts, ultimately promoting emotional well-being and healthier behaviors.29”
From Differential associations of Acceptance and Commitment Therapy processes with psychological distress across racial groups. (2026) · cites this paper as [29]
The Introduction describes cognitive defusion as helping people relate differently to thoughts and feelings, and the Discussion reports that reduced fusion was associated with reduced distress and depression. But the Discussion explicitly says the study could not establish causation, and the reported findings do not show that defusion promoted healthier behaviors. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMental fatigue lowers cognitive control and makes cognitive fusion more likely.
“mental fatigue leads to reduced cognitive control and is more likely to trigger cognitive fusion (Bramwell & Richardson, 2018).”
From Mental fatigue and negative emotion among nurses during the COVID-19 pandemic (2022) · cites this paper as Bramwell & Richardson, 2018
The Discussion reports that reductions in cognitive fusion were associated with improvements in distress and depression, but it does not address mental fatigue or cognitive control. Searches for mental fatigue, reduced cognitive control, and related terms found no passage supporting the claimed sequence. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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- Authors
- Bramwell, K., & Richardson, T.
- Affiliations
- University of Southampton (GB)
- Solent NHS Trust (GB)
- Corresponding author
- Bramwell, Kate
- Venue
- Journal of Contemporary Psychotherapy
- Published
- 2017-09-02
- Volume
- 48
- Issue
- 1
- Pages
- 9-14
- ISSN
- 0022-0116 (ISSN-L)
- 1573-3564
- PMC
- PMC5830477
- OpenAlex
- W2751427536
- Cited by
- 65
- References
- 29
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 13 · 2023: 4 · 2022: 9 · 2021: 10 · 2020: 6 · 2019: 2 · 2018: 1
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Contemporary Psychotherapy (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Funders
- Solent NHS Trust
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- acceptance and commitment therapy, depression, mental health, cognitive defusion, cognitive fusion, values-based action, psychological flexibility, distress, therapeutic mechanisms, process research
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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