Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes

May combine two claims.

Single case experimental designs provide a pragmatic alternative that can rival randomized controlled trial rigor while requiring fewer participants.

“Single case experimental designs (SCED) provide a pragmatic alternative that, when well-designed and executed, rival the scientific rigor of randomized controlled trials while requiring far fewer participants (Barlow, Nock, & Hersen, 2008; Smith, 2012; Vilardaga, 2014).”

• cites Barlow, Nock, & Hersen, 2008Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Smith, 2012 sourceSupported
• cites Vilardaga, 2014 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Therapists cannot be expected to learn each new treatment package supported by a randomized controlled trial, particularly when many EBPIs share core components and target similar psychological processes, making distinct training in complete treatment packages potentially redundant and unnecessary.

“Therapists cannot be expected to learn each new treatment package supported by a randomized controlled trial, particularly when many EBPIs share core components and target similar psychological processes, making distinct training in complete treatment packages potentially redundant and unnecessary (Chorpita et al., 2011).”

• cites Chorpita et al., 2011 sourcePartly supported

  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 measured

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

Modularity is an ideal fit with current trends toward disruptive innovations in EBPIs, as it is patient-centered, responsive to idiographic variables, and maintains a tight link to the evidence base while allowing therapists to select components matching their expertise and feasible in their settings.

“Modularity is also an ideal fit with current trends toward disruptive innovations in EBPIs, as it is patient-centered, responsive to idiographic variables that influence treatment engagement and response, and maintains a tight link to the evidence base while allowing therapists to select components that match their expertise and are feasible within their practice settings (Rotheram-Borus et al., 2”

• cites Rotheram-Borus et al., 2012 sourcePartly supported

  In “Synthesize and Diffuse Common and Robust Elements of EBIs” (page unavailable), the paper describes clinicians using evidence-based practice elements to customize interventions for a person’s characteristics and setting; it also presents a modular intervention as an example of this approach. It does not say that therapists select components to match their own expertise or that modularity specifically responds to individual variables influencing treatment engagement and response. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S2 (checkable).

The contextual behavioral scientific approach that gave rise to ACT is well-suited to modular treatment design and evaluation because both rest on a pragmatic philosophy that lends itself to inductive and iterative methodologies.

“The contextual behavioral scientific approach that gave rise to ACT (Hayes et al., 2013) is well-suited to modular treatment design and evaluation because both rest on a pragmatic philosophy that lends itself to inductive and iterative methodologies for knowledge development and dissemination.”

• cites Hayes et al., 2013 sourceSupported

May combine two claims.

In ACT ENGAGED, improvements on the Values Bullseye were large but did not occur until the fourth week of intervention for all participants.

“First, improvements on the Values Bullseye, though large, did not occur until the fourth week in the intervention phase for all participants in the ACT ENGAGED module, which targeted this process explicitly.”

May combine two claims.

Both modules were viewed as acceptable, with no session rated below 3 and an average TEI score of 4.17 on a 5-point scale.

“Both modules were viewed as acceptable, with no session rated below 3 and an average score of 4.17 on the 5-point scale of the TEI.”

May combine two claims.

In ACT OPEN, all 7 participants rated treatment average 4 or better, and 50% of sessions received the highest possible score.

“All 7 participants assigned to the ACT OPEN module rated the treatment with an average score of 4 or better, with 50% of sessions rated with the highest possible score.”

May combine two claims.

In ACT ENGAGED, 75% of the 8 participants rated treatment average 4 or better, and 40% of sessions received the maximum rating.

“Seventy-five percent of the 8 participants assigned to the ACT ENGAGED module rated the treatment with an average score of 4 or better, with 40% of sessions given the maximum rating.”

May combine two claims.

ACT OPEN participants showed small improvements at follow-up relative to baseline on the Values Bullseye, not reliably linked to treatment trends, and the omnibus effect was not significant.

“Participants who received the ACT OPEN module demonstrated small improvements at follow-up relative to baseline scores on the Values Bullseye, though these improvements were not reliably linked to treatment trends and the omnibus treatment effect was not significant.”

May combine two claims.

All ACT OPEN participants showed substantial improvement in acceptance, with moderately large session-by-session gains and almost no deterioration during the 3-month follow-up.

“All participants who received the ACT OPEN module showed substantial improvement in acceptance, with moderately large session-by-session gains and almost no deterioration during the 3-month follow-up period.”

May combine two claims.

The ACT OPEN module had a large effect on symptom severity, while ACT ENGAGED showed only moderate improvements.

“The ACT OPEN module had a large effect on symptom severity, while the ACT ENGAGED module showed only moderate improvements.”

May combine two claims.

Both ACT OPEN and ACT ENGAGED modules were acceptable to adults seeking mental health treatment, with 100% treatment completion and very high patient satisfaction post-treatment and at 3-month follow-up.

“Both the ACT OPEN and ACT ENGAGED modules were acceptable to adults seeking mental health treatment, demonstrating 100% treatment completion rates and very high levels of patient satisfaction post-treatment and at 3-month follow-up.”

May combine two claims.

These two cases were the only ones in either condition to become more cognitively fused (Tau = .64, p = .00), less accepting (Tau = .56, p = .00), and fail to improve in reactivity (Tau = .07, p = .71).

“These were the only cases in either condition to become more cognitively fused (Tau = .64, p = .00) and less accepting of thoughts and feelings (Tau = .56, p = .00), and to fail to show improvement in reactivity (Tau = .07, p = .71).”

May combine two claims.

No significant between-condition differences were detected for awareness (Tau-U = .02, SE = .20, p = .83) or nonreactivity (Tau-U = .01, SE = .09, p = .93).

“Between-group analyses detected no significant differences by condition for awareness (Tau-U = .02, SE = .20, p = .83) or nonreactivity (Tau-U = .01, SE = .09, p = .93).”

May combine two claims.

All participants reported large WHOQoL improvements over baseline, maintained across the three months of follow-up.

“All participants reported large WHOQoL improvements over baseline and these gains were maintained across the three months of follow-up assessment.”

May combine two claims.

The two cases did not differ at baseline from participants in either condition on demographics, number of past or current diagnoses, symptom severity, or any process measure.

“These cases did not differ from participants in either condition at baseline on any demographic variable, number of past or current diagnoses, symptom severity, or any process measure.”

May combine two claims.

In ACT ENGAGED, moderate symptom reduction and large quality-of-life improvements occurred even though judgment and believability of negative thoughts remained high.

“It is interesting to note that moderate symptom reduction and large quality of life improvements occurred even though judgment and believability of negative thoughts remained high in this condition.”

May combine two claims.

The two ACT OPEN participants with current PTSD showed improvement patterns consistent with other ACT OPEN participants and no deterioration on process or outcome measures.

“It is notable that the two participants in the ACT OPEN condition meeting criteria for a current PTSD diagnosis displayed patterns of improvement consistent with other participants within that treatment condition and showed no deterioration on process or outcome measures.”

May combine two claims.

ACT ENGAGED produced large improvements over baseline and reliable session-by-session growth in values-based action.

“This process was explicitly targeted only by the ACT ENGAGED module, which produced large improvements over baseline scores and reliable session-by-session growth in values-based action.”

The quote only partly states this claim.

The ACT ENGAGED condition showed moderately greater quality-of-life improvements than the comparison condition (Tau-U = .38, SE = .17, p = .02).

“However, participants in the ACT ENGAGED condition showed moderately greater improvements over those in the ACT ENGAGED condition (Tau-U = .38, SE = .17, p = .02).”

May combine two claims.

The difference between modules in values-based action was significant, with ACT ENGAGED superior (Tau-U = .54, SE = .10, p = .00).

“The difference between modules was significant, with ACT ENGAGED demonstrating superior treatment effects (Tau-U = .54, SE = .10, p = .00).”

May combine two claims.

The two cases had 69% less improvement in quality of life (p = .04) and 68% less improvement in symptom severity (p = .00) than other ACT ENGAGED participants.

“Compared to scores of other participants in the ACT ENGAGED condition, the two cases displayed 69% less improvement in quality of life (p = .04) and 68% less improvement in symptom severity (p = .00).”

Classified as probably not a substantial claim.

Including a lag in statistical analysis would not fairly represent the amount of change due to the intervention.

“It has been suggested that inclusion of such a lag in statistical analysis would not fairly represent the amount of change due to the intervention (Parker & Vannest, 2012), so the first three weekly data points in the intervention phase were excluded from Tau-U analysis of the Values Bullseye.”

• cites Parker & Vannest, 2012 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interrater reliability was excellent for ACT OPEN (ICC = .94) and ACT ENGAGED (ICC = .96).

“ICCs indicated excellent agreement between the two raters in the ACT OPEN (ICC = .94, 95% CI = .90, .96) and ACT ENGAGED (ICC = .96, 95% CI = .95, .98) modules.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Values Bullseye had α = .95 in the current study.

“In the current study, α = .95.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Random allocation to baseline length used a computer random number generator.

“Following enrollment, participants were randomly allocated to an assessment-only baseline of 3, 4, or 5 weeks in fixed blocks of 3 using a computer random number generator.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Brief Symptom Inventory global severity index had α = .85 in the current study.

“In the current study, α = .85.”

Probably not a substantial claim: may not pass S3 (load-bearing).

No participant refused treatment after being informed of their random assignment.

“No participant refused treatment after being informed about the intervention to which they were randomly assigned.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All randomized participants (N = 15) were included in the main analyses, and no participants refused after random assignment.

“No participants refused participation after random assignment and all randomized participants (N = 15) were included in the main analyses.”

Classified as probably not a substantial claim. May combine two claims.

Therapists value the science behind evidence-based psychosocial interventions but are concerned standardized manuals do not meet real-world client and practice setting needs.

“Therapists report that they value the science behind EBPI, but are concerned that standardized manuals do not meet the needs of real-world clients and practice settings (Addis & Krasnow, 2000; Borntrager, Chorpita, Higa-McMillan, & Weisz, 2009; Nelson & Steele, 2007).”

• cites Addis & Krasnow, 2000 sourceNot checked — no full text of the source
• cites Borntrager, Chorpita, Higa-McMillan, & Weisz, 2009 sourceNot checked — no full text of the source
• cites Nelson & Steele, 2007 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Therapists were doctoral students in clinical psychology with at least 3 years of ACT training, supervised by a treatment developer.

“The clinical assessor and therapists were doctoral students in clinical psychology with at least 3 years of training in ACT and directly supervised by a developer of the treatment (SCH).”

Classified as probably not a substantial claim. May combine two claims.

The Tau-U analytic approach is free from distribution and linearity assumptions, robust to serial dependence in time-series designs, more powerful and precise than other SCED effect size indices, and allows examination of mean level and trend changes.

“This approach is free from assumptions of distribution and linearity, robust to serial dependence inherent in time-series designs, superior in power and precision over other SCED effect size indices, and allows for examination of changes in both mean levels and trend (Parker, Vannest, Davis, & Sauber, 2011).”

• cites Parker, Vannest, Davis, & Sauber, 2011 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Both modules targeted self-awareness processes but had zero overlap in therapy tasks or techniques.

“In summary, both modules targeted self-awareness processes, but there was zero overlap in therapy tasks or techniques.”

May combine two claims.

The study used a randomized, nonconcurrent, multiple-baseline across participants design with 15 adults seeking mental health treatment.

“A randomized, nonconcurrent, multiple-baseline across participants design was used to examine component effects on treatment processes and outcomes in 15 adults seeking mental health treatment.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Random allocation to therapist and intervention module used computer-generated randomly varied blocks.

“Upon completion of baseline assessment, participants were allocated to therapist and intervention module in randomly varied blocks of 3–5 generated by a computer random number generator.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Automatic Thoughts Questionnaire-Believability Scale had α = .89 in the current study.

“In the current study α = .89.”

Classified as probably not a substantial claim. May combine two claims.

Fidelity was assessed with the 16-item ACT Integrity Coding System, and 20% of each therapist's sessions in each condition were rated by two coders.

“Fidelity was assessed using the 16-item ACT Integrity Coding System (Plumb & Vilardaga, 2010).”

• Also stated in: § Measures · plain

  “Twenty percent of each therapist’s sessions in each condition were rated for fidelity by two bachelors-level coders who completed 40 hours of training with a peer-reviewed ACT trainer.”

• cites Plumb & Vilardaga, 2010 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The Treatment Evaluation Inventory short form had α = .96 in the current trial.

“In the current trial α = .96.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The FFMQ Nonjudging of Inner Experience subscale had α = .87 in the current study.

“In the current study α = .87.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The FFMQ Acting with Awareness subscale had α = .82 in the current study.

“In the current study, α = .82.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The FFMQ Nonreactivity to Inner Experiences subscale had α = .79 in the current study.

“In the current study, α = .79, which is consistent with published reports of internal consistency in the FFMQ.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The WHOQOL had α = .89 in the current study.

“In the current study, α = .89.”

Classified as probably not a substantial claim.

It is possible that modules targeting acceptance and defusion may be necessary precursors to modules aimed at values-based behavioral activation for individuals with a current PTSD diagnosis.

“It is possible that modules targeting acceptance and defusion may be necessary precursors to modules aimed at values-based behavioral activation for individuals with a current PTSD diagnosis.”

May combine two claims.

The ACT OPEN module produced greater session-by-session improvement and larger overall reductions in symptom severity than ACT ENGAGED.

“The ACT OPEN module, which targeted acceptance and cognitive defusion processes, produced greater session-by-session improvement and larger overall reductions in symptom severity.”

Probably not a substantial claim: may not pass S2 (checkable).

Single case experimental designs are ideal for treatment distillation and matching because they allow rapid knowledge generation based on critical comparisons at the level of clinical decision-making.

“Single case experimental designs are ideal for this kind of treatment distillation and matching because they allow for rapid knowledge generation based on critical comparisons at the level of clinical decision-making.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The present study design provided a good balance between external validity and experimental control.

“Though the present study design provided a good balance between external validity and experimental control (e.g., randomization, replication across participants), critical comparisons should be replicated to see if current results hold across experimenters, treatment settings, therapists, and participants.”

May combine two claims.

Fidelity monitoring showed that ACT modules can be functionally independent and distinct, adequately addressing a wide range of clinical content across 8 sessions with no contamination of therapy procedures across modules or use of procedures not specified by the module.

“Fidelity monitoring within the current study demonstrated that ACT modules can be functionally independent and distinct, adequately addressing a wide range of clinical content across 8 sessions with no contamination of therapy procedures across modules or use of procedures not specified by the module (e.g., non-adherence).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Time-lagged associations between process and outcome variables are possible within single case experiments.

“While formal mediation analyses were beyond the scope of the current study, examination of time-lagged associations between process and outcome variables are possible within single case experiments (Hilliard, 1993; Tschacher & Ramseyer, 2009) and are recommended for developing modular treatment protocols that optimize exposure to key treatment mechanisms.”

• cites Hilliard, 1993 sourceNot checked — no full text of the source
• cites Tschacher & Ramseyer, 2009 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Results from SCED can be aggregated to provide guidelines for personalized selection and evaluation of treatment components.

“Though group designs would require massive samples to power so many interaction effects, results from SCED, including the current study, can be aggregated to provide guidelines for personalized selection and evaluation of treatment components (Van den Noortgate & Onghena, 2007).”

• cites Van den Noortgate & Onghena, 2007 sourceNot checked — no full text of the source

May combine two claims.

The study suggests that treatment modules targeting components of ACT's psychological flexibility model are feasible and effective in treating adults with mixed anxiety and depression.

“The current study suggests that treatment modules targeting components of ACT’s psychological flexibility model are feasible and effective in treating adults with mixed anxiety and depression.”

May combine two claims.

Both modules demonstrated broad symptom improvements and sustained increases in quality of life, though they comprised wholly different interventions and produced distinct changes in psychological processes.

“Both modules demonstrated broad symptom improvements and sustained increases in quality of life, though they were comprised of wholly different interventions and produced distinct changes in psychological processes.”

May combine two claims.

Both ACT modules yielded significant symptom-severity and quality-of-life improvements, though with different rates, magnitudes, and techniques.

“Both of the ACT component modules produced significant improvements in symptom severity and quality of life, but at different rates and magnitudes and using different techniques.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Some ACT OPEN participants independently brought their behaviors into greater alignment with personal values after learning to relate differently to thoughts and feelings, despite the module not targeting values and commitment.

“Though the ACT OPEN component did not directly target values and commitment processes, it appears that some participants in this condition independently brought their behaviors into greater alignment with their personal values after learning to relate differently to their thoughts and feelings.”