Acceptance and commitment: Implications for prevention science
Open accessAbstract
Recent research in behavior analysis and clinical psychology points to the importance of language processes having to do with the control of negative cognition and emotion and the commitment to valued action. Efforts to control unwanted thoughts and feelings, also referred to as experiential avoidance (EA), appear to be associated with a diverse array of psychological and behavioral difficulties. Recent research shows that interventions that reduce EA and help people to identify and commit to the pursuit of valued directions are beneficial for ameliorating diverse problems in living. These developments have the potential to improve the efficacy of many preventive interventions. This paper reviews the basic findings in these areas and points to some ways in which these developments could enhance the impact of preventive interventions.
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Studies of CBT show improvement in depression, anxiety, and negative affect.
“and studies of CBT demonstrate improvement in depression, anxiety, and negative affect,65,72”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [65]
In “The Prevention of Depression” (page unavailable), the paper discusses CBT studies and compares CBT’s effects on depression with those of ACT and behavioral activation, supporting the depression portion. The passages found do not report CBT studies demonstrating improvement in anxiety or negative affect; the reported anxiety reduction followed acceptance instructions, not CBT. (LLM, conf=0.82)
Experimental — accuracy not yet measuredLack of psychological flexibility is a key factor in social anxiety disorder and leads to continuation or persistence and intensification of the disorder (Biglan et al., 2008; Masuda et al., 2011).
“On the other hand, what is considered as a key factor in social anxiety disorder (Biglan, Hayes, & Pistorello, 2008) and leads to the continuation or persistence and intensification of the disorder is lack of psychological flexibility”
From Effectiveness of Acceptance and Commitment Therapy on Interpersonal Problemsand Psychological Flexibility in Female High School Students With Social Anxiety Disorder (2015) · cites this paper as Biglan, Hayes, & Pistorello, 2008
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredACT explicitly incorporates many elements from both dimensions of mental health.
“More so than for its effectiveness, we included ACT in this study as ACT is explicitly aligned with many elements of both mental health dimensions.”
From Both positive mental health and psychopathology should be monitored in psychotherapy: Confirmation for the dual-factor model in acceptance and commitment therapy (2017) · cites this paper as Biglan, Hayes, & Pistorello, 2008
Psychological flexibility is a possible target for a transdiagnostic prevention approach.
“A powerful possible target for a transdiagnostic prevention approach is psychological flexibility,17–19”
From Feasibility of a Prototype Web-Based Acceptance and Commitment Therapy Prevention Program for College Students. (2014) · cites this paper as [17]
The unique and ultimate goal of acceptance and commitment therapy is to promote one's psychological flexibility as a critical process of human adaptation and well-being.
“The unique and ultimate goal of ACT is to promote one’s psychological flexibility as a critical process of human adaptation and well-being [20].”
From Acceptance and Commitment Therapy for Destructive Experiential Avoidance (ACT-DEA): A Feasibility Study (2022) · cites this paper as [20]
Psychological flexibility is broadly beneficial to individual health and functioning, including anxiety, depression, physical health outcomes, satisfaction with life, and work performance.
“there is an extensive literature base demonstrating that this adaptive skill set is broadly beneficial to individual health and functioning [50] (including anxiety, depression, physical health outcomes, satisfaction with life, and work performance [47,72,103]).”
From Evaluation of an App-Delivered Psychological Flexibility Skill Training Intervention for Medical Student Burnout and Well-being: Randomized Controlled Trial (2023) · cites this paper as [103]
Flexibility ameliorates the negative consequences of stressors on mental health.
“It was also demonstrated that flexibility ameliorates the negative consequences of stressors on mental health [76,77].”
Flexibility is central to human adaptation, well-being, and life satisfaction.
“It can also be considered central to human adaptation, well-being, and life satisfaction [76,77].”
EA is a negative reinforcement process.
“We believe that EA is a negative reinforcement process [49].”
Improvements in treatment groups in ACT studies were explained (mediated) by a common mechanism of action, reduced emotional and cognitive avoidance.
“These studies also showed that the improvements in treatment groups were explained (mediated) by a common mechanism of action, reduced emotional and cognitive avoidance.16”
From Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: Study protocol for a randomised controlled trial (2018) · cites this paper as [16]
Correlational and experimental evidence indicates that experiential avoidance, as the converse of acceptance, contributes to the development and maintenance of different psychological and behavioral problems.
“Correlational and experimental evidence indicates that experiential avoidance, as the converse of acceptance, contributes to the development and maintenance of different psychological and behavioral problems [32].”
A diathesis-stress model of experiential avoidance proposes that experiential avoidance makes people vulnerable to stressors.
“A diathesis-stress model of experiential avoidance has been proposed, suggesting that experiential avoidance makes people vulnerable to stressors, in that individuals who typically try to avoid internal distressing experiences may continue this approach when faced with stressful life events (Biglan, Hayes, & Pistorello, 2008).”
From Psychological Flexibility in Caregivers of Children With Congenital Craniofacial Conditions in the United Kingdom. (2026) · cites this paper as Biglan, Hayes, & Pistorello, 2008
These results are consistent with the view that the processes designed to promote psychological flexibility will apply across a wide range of psychological and behavioural difficulties.
“Second, these results are consistent with the view that the processes designed to promote psychological flexibility will apply across a wide range of psychological and behavioural difficulties (Biglan, Hayes, & Pistorello, 2008; Hayes et al., 2006).”
From A randomised worksite comparison of acceptance and commitment therapy and stress inoculation training (2010) · cites this paper as Biglan, Hayes, & Pistorello, 2008
There is increasing interest in the theory and practice of acceptance and commitment therapy (ACT), not only as a treatment for a range of psychological and behavioural problems, but also for promoting workplace mental health.
“In particular, there is increasing interest in the theory and practice of acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999), not only as a treatment for a range of psychological and behavioural problems, but also for promoting workplace mental health (Biglan, Hayes, & Pistorello, 2008; Bond & Bunce, 2000; Hayes, Bissett et al., 2004).”
From A randomised worksite comparison of acceptance and commitment therapy and stress inoculation training (2010) · cites this paper as Biglan, Hayes, & Pistorello, 2008
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Self-citationHistory of behavior modification : experimental foundations of contemporary research
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Managing Adolescent Behavior A Multiyear, Multischool Study
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Prevention of depression with primary care patients: A randomized controlled trial
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Helping Adolescents at Risk: Prevention of Multiple Problem Behaviors
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A preliminary test of the role of experiential avoidance in post-event functioning
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Effects of suppressing thoughts about emotional material.
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Psychological acceptance and quality of life in the elderly
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The role of emotion in the psychological functioning of adult survivors of childhood sexual abuse
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Arbitrarily applicable comparative relations: Experimental evidence for a relational operant
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Self-citationTransformation of the discriminative and eliciting functions of generalized relational stimuli
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“Wicksell et al. (2007) reported substantial improvements for 14 adolescents with chronic pain (effect sizes ranging from 0.47 to 1.53).”
InfluentialLappalainen, R., Lehtonen, T., Skarp, E., Taubert, E., Ojanen, M., & Hayes, S. C. (2007) · Behavior Modification · doi:10.1177/0145445506298436 · Cited by 162 · see citing works
Self-citationHelping Adolescents At Risk. Prevention of Multiple Problem Behaviors
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Irvine, A. B., Biglan, A., Smolkowski, K., Metzler, C. W., & Ary, D. V. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.67.6.811 · Cited by 150 · see citing works
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Replication of a Problem Behavior Model with American Indian, Hispanic, and Caucasian Youth
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Self-citationRelationships Between Peer Harassment and Adolescent Problem Behaviors
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Psychological Distress in a Sample of Teachers
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CONVERSATIONAL SKILLS INSTRUCTION FOR COMMUNICATION APPREHENSION AND AVOIDANCE
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Self-citationGroup cognitive and contextual therapies in treatment of depression
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Research works printed but not linked: 11
- Barnes-Holmes Y Barnes-Holmes D Smeets PM Strand P Friman P 2004 Testing and training relational responding in accordance with the relational frame of opposite in young children International Journal of Psychology and Psychological Therapy 4 559 586
- Dahl J Wilson KG Luciano C Hayes SD 2005 Acceptance and Commitment Therapy and chronic pain Reno, NV Context Press
- Donaldson E Bond FW 2004 Psychological acceptance and emotional intelligence in relation to workplace wellbeing British Journal of Guidance and Counseling 34 187 203
- Erickson-Cornish JA Riva MT Cox-Henderson M Kominars KD McIntosh S 2000 Perceived distress in university counseling center clients over a six-year time span Journal of College Student Development 41 1 104 109
- Hayes SC 2004 Acceptance and Commitment Therapy, Relational Frame Theory, and the third wave of behavior therapy Behavior Therapy 35 639 665 27993338
- Jakobsson C Wellin J 2006 ACT Stress i skolan: En tvåårsuppföljning av interventionsbehandlingen Unpublished doctoral dissertation University of Uppsala Sweden
- Livheim F 2004 Acceptance and Commitment Therapy i skolan - att hantera stress: En randomiserad, kontrollerad studie Unpublished doctoral dissertation University of Uppsala Sweden
- Luoma J Hayes SC Walser R in press Learning ACT Oakland, CA New Harbinger
- Marx BP Sloan DM 2005 Experiential avoidance, peritraumatic dissociation, and post-traumatic stress disorder Behaviour Research and Therapy 43 569 583 15865913
- Takahashi M Muto T Tada M Sugiyama M 2002 Acceptance rationale and increasing pain tolerance: Acceptance-based and FEAR-based practice Japanese Journal of Behavior Therapy 28 35 46
- Varra AA Hayes SC Roget N Fisher G 2007 Using mindfulness and acceptance to increase the impact of continuing education in pharmacotherapy American Journal of Psychiatry under review
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(2009)
The critical role of nurturing environments for promoting human well-being.
Biglan, A., Flay, B. R., Embry, D. D., & Sandler, I. N. (2012) · American Psychologist · doi:10.1037/a0026796 · Cited by 399 · see citing works
Self-citationMaterialism and Diminished Well–Being: Experiential Avoidance as a Mediating Mechanism
Kashdan, T. B., & Breen, W. E. (2007) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2007.26.5.521 · Cited by 348 · see citing works
Evidence-based Kernels: Fundamental Units of Behavioral Influence
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Self-citationBohlmeijer, E. T., Fledderus, M., Rokx, T. A. J. J., & Pieterse, M. E. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.10.003 · Cited by 232 · see citing works
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An Exploration of Formal and Informal Mindfulness Practice and Associations with Wellbeing
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Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach
Zhang, C.-Q., Leeming, E., Smith, P., Chung, P.-K., Hagger, M. S., & Hayes, S. C. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.02350 · Cited by 199 · see citing works
“Perhaps the most studied set of contextual processes of this kind is psychological flexibility, which is “the ability to contact the present moment more fully as a conscious human being and to change, or persist in, behavior when doing so serves valued ends” (Biglan et al., 2008).”
BackgroundSelf-citationFledderus, M., Bohlmeijer, E. T., Smit, F., & Westerhof, G. J. (2010) · American Journal of Public Health · doi:10.2105/ajph.2010.196196 · Cited by 197 · see citing works
Further evaluation of the psychometric properties of the acceptance and action questionnaire-II
Fledderus, M., Oude Voshaar, M. A. H., ten Klooster, P. M., & Bohlmeijer, E. T. (2012) · Psychological Assessment · doi:10.1037/a0028200 · Cited by 195 · see citing works
Flaxman, P. E., & Bond, F. W. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.05.004 · Cited by 197 · see citing works
Wynne, B., McHugh, L., Gao, W., Keegan, D., Byrne, K., Rowan, C., Hartery, K., Kirschbaum, C., Doherty, G., Cullen, G., et al. (2019) · Gastroenterology · doi:10.1053/j.gastro.2018.11.030 · Cited by 188 · see citing works
Trompetter, H. R., ten Klooster, P. M., Schreurs, K. M. G., Fledderus, M., Westerhof, G. J., & Bohlmeijer, E. T. (2013) · Psychological Assessment · doi:10.1037/a0033813 · Cited by 184 · see citing works
Levin, M. E., Pistorello, J., Seeley, J. R., & Hayes, S. C. (2014) · Journal of American College Health · doi:10.1080/07448481.2013.843533 · Cited by 179 · see citing works
“90 These findings raise the question of whether ACT could similarly be applied to prevent mental health problems by targeting psychological flexibility/experiential avoidance in nonclinical samples.(18) A series of studies have found that ACT can improve mental health and positive functioning in the context of worksit…”
Self-citationLivheim, F., Hayes, L., Ghaderi, A., Magnusdottir, T., Högfeldt, A., Rowse, J., Turner, S., Hayes, S. C., & Tengström, A. (2015) · Journal of Child and Family Studies · doi:10.1007/s10826-014-9912-9 · Cited by 169 · see citing works
Self-citationFledderus, M., Bohlmeijer, E. T., Fox, J.-P., Schreurs, K. M. G., & Spinhoven, P. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.11.007 · Cited by 133 · see citing works
A systematic review of the use of acceptance and commitment therapy in supporting parents.
Byrne, G., Ghráda, Á. N., O’Mahony, T., & Brennan, E. (2021) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12282 · Cited by 129 · see citing works
Trompetter, H. R., Lamers, S. M. A., Westerhof, G. J., Fledderus, M., & Bohlmeijer, E. T. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.01.008 · Cited by 126 · see citing works
Worksite stress management training: Moderated effects and clinical significance
Flaxman, P. E., & Bond, F. W. (2010) · Journal of Occupational Health Psychology · doi:10.1037/a0020522 · Cited by 126 · see citing works
Fledderus, M., Bohlmeijer, E. T., & Pieterse, M. E. (2010) · Behavior Modification · doi:10.1177/0145445510378379 · Cited by 123 · see citing works
In search of meaning: Values in modern clinical behavior analysis
Plumb, J. C., Stewart, I., Dahl, J., & Lundgren, T. (2009) · The Behavior Analyst · doi:10.1007/bf03392177 · Cited by 127 · see citing works
Viskovich, S., & Pakenham, K. I. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.22848 · Cited by 123 · see citing works
Frögéli, E., Djordjevic, A., Rudman, A., Livheim, F., & Gustavsson, P. (2016) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2015.1025765 · Cited by 114 · see citing works
A randomized trial of ACT bibliotherapy on the mental health of K-12 teachers and staff
Jeffcoat, T., & Hayes, S. C. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.05.008 · Cited by 107 · see citing works
Self-citationMemory suppression and its deficiency in psychological disorders: A focused meta-analysis.
Stramaccia, D. F., Meyer, A.-K., Rischer, K. M., Fawcett, J. M., & Benoit, R. G. (2020) · Journal of Experimental Psychology General · doi:10.1037/xge0000971 · Cited by 105 · see citing works
Levin, M. E., Hayes, S. C., Pistorello, J., & Seeley, J. R. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22254 · Cited by 103 · see citing works
Self-citationRamírez‐Maestre, C., & Esteve, R. (2014) · Journal of Pain · doi:10.1016/j.jpain.2014.02.006 · Cited by 103 · see citing works
The value of workshops on psychological flexibility for early childhood special education staff
Biglan, A., Layton, G. L., Jones, L. B., Hankins, M., & Rusby, J. C. (2013) · Topics in Early Childhood Special Education · doi:10.1177/0271121411425191 · Cited by 98 · see citing works
Self-citationHahs, A. D., Dixon, M. R., & Paliliunas, D. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.03.002 · Cited by 93 · see citing works
Ramaci, T., Bellini, D., Presti, G., & Santisi, G. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01302 · Cited by 95 · see citing works
Applications and adaptations of acceptance and commitment therapy (ACT) for adolescents
Halliburton, A. E., & Cooper, L. D. (2015) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2015.01.002 · Cited by 95 · see citing works
Fonseca, S., Trindade, I. A., Mendes, A. L., & Ferreira, C. (2020) · Clinical Psychologist · doi:10.1111/cp.12194 · Cited by 89 · see citing works
Zakiei, A., Khazaie, H., Rostampour, M., Lemola, S., Esmaeili, M., Dürsteler, K., Brühl, A., Sadeghi-Bahmani, D., & Brand, S. (2021) · Life · doi:10.3390/life11020133 · Cited by 84 · see citing works
Li, H., Wong, C. L., Jin, X., Chen, J., Chong, Y. Y., & Bai, Y. (2021) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2021.103876 · Cited by 81 · see citing works
Viskovich, S., & Pakenham, K. I. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22656 · Cited by 77 · see citing works
Development of a web-based intervention for the indicated prevention of depression
Kelders, S. M., Pots, W. T., Oskam, M. J., Bohlmeijer, E. T., & van Gemert-Pijnen, J. E. (2013) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-13-26 · Cited by 80 · see citing works
“This intervention is based on acceptance and commitment therapy (ACT; [44]) and mindfulness [45,46], and targets experiential avoidance that can be considered as a generic risk factor for mental illnesses [47].”
Pears, S., & Sutton, S. (2021) · Health Psychology Review · doi:10.1080/17437199.2020.1727759 · Cited by 74 · see citing works
Scent, C. L., & Boes, S. R. (2014) · Journal of College Student Psychotherapy · doi:10.1080/87568225.2014.883887 · Cited by 77 · see citing works
Lappalainen, R., Lappalainen, P., Puolakanaho, A., Hirvonen, R., Eklund, K., Ahonen, T., Muotka, J., & Kiuru, N. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.01.007 · Cited by 69 · see citing works
van Aubel, E., Bakker, J. M., Batink, T., Michielse, S., Goossens, L., Lange, I., Schruers, K., Lieverse, R., Marcelis, M., van Amelsvoort, T., et al. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103592 · Cited by 57 · see citing works
Volkaert, B., Wante, L., Beveren, M. V., Vervoort, L., & Braet, C. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10073-4 · Cited by 69 · see citing works
Ramírez‐Maestre, C., Esteve, R., & López-Martínez, A. E. (2014) · Annals of Behavioral Medicine · doi:10.1007/s12160-014-9619-6 · Cited by 64 · see citing works
A framework for intentional cultural change
Biglan, A., & Embry, D. D. (2013) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2013.06.001 · Cited by 65 · see citing works
Self-citationScanlon, G. M., & Barnes‐Holmes, Y. (2013) · Emotional and Behavioural Difficulties · doi:10.1080/13632752.2013.769710 · Cited by 62 · see citing works
TEACHER DISTRESS AND THE ROLE OF EXPERIENTIAL AVOIDANCE
Hinds, E., Jones, L. B., Gau, J. M., Forrester, K. K., & Biglan, A. (2015) · Psychology in the Schools · doi:10.1002/pits.21821 · Cited by 59 · see citing works
Self-citationAcceptance and Commitment Therapy-Oriented Parent-Training for Parents of Children with Autism
Corti, C., Pergolizzi, F., Vanzin, L., Cargasacchi, G., Villa, L., Pozzi, M., & Molteni, M. (2018) · Journal of Child and Family Studies · doi:10.1007/s10826-018-1123-3 · Cited by 58 · see citing works
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Increasing psychological flexibility to influence cultural evolution
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“Owing to its adaptability, the ACT has been widely applied in various fields (Biglan et al., 2008; Ost, 2008; Powers et al., 2009; Andersson et al., 2014; Ost, 2014; A-Tjak et al., 2015; Graham et al., 2016; Carlbring et al., 2018; Andersson et al., 2019; Gloster et al., 2020; Thompson et al.,…”
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“These studies also showed that the improvements in treatment groups were explained (mediated) by a common mechanism of action, reduced emotional and cognitive avoidance.(16) Some support also exists for ACT among individuals with type 2 diabetes, which has indicated changes in acceptance coping, self-management and Hb…”
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- Authors
- Biglan, A., Hayes, S. C., & Pistorello, J.
- Affiliations
- Oregon Research Institute (US)
- University of Nevada, Reno (US)
- Corresponding author
- Biglan, Anthony
- Venue
- Prevention Science
- Published
- 2008-08-09
- Volume
- 9
- Issue
- 3
- Pages
- 139-152
- ISSN
- 1389-4986 (ISSN-L)
- 1573-6695
- PMC
- PMC2727477
- OpenAlex
- W2090211322
- Semantic Scholar
- 083b59b6411c8db418bb66ff1bda2cb60f66af6b
- Cited by
- 240
- References
- 143
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 19 · 2023: 23 · 2022: 16 · 2021: 18 · 2020: 18 · 2019: 11 · 2018: 17 · 2017: 6 · 2016: 12 · 2015: 18 · 2014: 15 · 2013: 12 · 2012: 13
- FWCI
- 10.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Prevention Science (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Public Health Service (PA018760)
- National Institute of Mental Health (MH074968, R21MH074968)
- National Institute on Drug Abuse (P30DA018760, R01DA017868, DA018760, DA017868)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- acceptance and commitment therapy, experiential avoidance, prevention interventions, valued action, negative thinking, emotion regulation, intrusive thoughts
- MeSH terms
- Adaptation, Psychological, Avoidance Learning, Behavior, Behavior Therapy, Humans, Models, Psychological, Preventive Medicine, Psychology, Social, Behavioral Research
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