Using network analysis to examine connections between Acceptance and Commitment Therapy (ACT) processes, internalizing symptoms, and well-being in a sample of undergraduates

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

The AAQ-II has been criticized for measuring psychological distress or neuroticism/negative affect rather than experiential avoidance.

“more recent criticisms of the scale have suggested that the AAQ-II is less a measurement of experiential avoidance, and instead measures psychological distress or neuroticism/negative affect (Wolgast et al., 2014; Rochefort et al., 2017; Tyndall et al., 2019; Ong et al., 2020).”

• cites Wolgast et al., 2014 sourceSupported
• cites Rochefort et al., 2017Not matched

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

• cites Tyndall et al., 2019 sourceSupported

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

ACT is effective for internalizing symptoms.

“There is a large body of evidence showing ACT is an effective treatment for internalizing concerns (Bai et al., 2020; Gloster et al 2020; Bluett et al., 2014).”

• cites Bai et al., 2020 sourceNot checked — no full text of the source
• cites Gloster et al 2020 sourceSupported
• cites Bluett et al., 2014 sourceNot checked — no full text of the source

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

The COVID-19 pandemic has been referred to as a collective traumatic event.

“the COVID-19 pandemic has been referred to as a collective traumatic event (Sanchez-Gomez, et al., 2021)”

• cites Sanchez-Gomez, et al., 2021 sourceSupported

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

Some literature indicates that college students may be more likely to endorse stress symptoms than depression or anxiety symptoms.

“there is some literature that indicates that college students may be more likely to endorse symptoms of stress, in comparison to depression or anxiety symptoms (Ramón-Arbués et al., 2020).”

• cites Ramón-Arbués et al., 2020 sourceSupported

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

College students are at higher risk for experiencing psychopathology generally and suicidality specifically.

“college students are at higher risk for experiencing both psychopathology generally and suicidality specifically (Mortier et al., 2018).”

• cites Mortier et al., 2018 sourcePartly supported

  The ‘Prevalence of college student STB worldwide’ section says college students are at marked risk for suicidal thoughts and behaviours, with pooled estimates higher than those for the general adult population. It does not establish higher risk for psychopathology generally, and it explicitly says whether students have higher suicidality risk than same-aged non-college peers is unclear. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

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

Previous literature has shown that psychological flexibility is associated with well-being.

“This finding is consistent with previous literature, which has shown psychological flexibility to associate with well-being (Brassell et al., 2016; Marshall & Brockman, 2016; Wersebe et al., 2018).”

• cites Brassell et al., 2016 sourceNot checked — no full text of the source
• cites Marshall & Brockman, 2016 sourceNot checked — no full text of the source
• cites Wersebe et al., 2018 sourceSupported

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

Suicidality may be considered a transdiagnostic symptom because it is a diagnostic criterion for several psychiatric disorders, a consequence of many more, and has genetic, environmental, and socio-cultural risk factors.

“suicidality may also be considered a transdiagnostic symptom in that it is a diagnostic criterion for several psychiatric disorders (e.g., depression, borderline personality disorder) and is considered a consequence of many more; further, there are genetic, environmental, and socio-cultural risk factors for suicidality (Fehling & Selby, 2021).”

• cites Fehling & Selby, 2021 sourcePartly supported

  In ‘Concurrent Validator: Patterns of Comorbidity’ (page unavailable), the paper says suicidality is a diagnostic criterion for MDD and BPD and that suicidal behavior occurs in the context of many psychiatric disorders. Its sections on familial aggregation, environmental risk, and socio-demographic and cultural factors describe the stated risk factors. The paper does not establish that suicidality is a consequence of the many other disorders; it describes their relationship as co-occurrence or comorbidity. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

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

Evidence indicates that U.S. college students experienced increases in depressive and anxiety symptoms and stress during the Spring and Fall 2020 semesters.

“There is evidence that college students in the U.S. experienced increases in depressive and anxiety symptoms and stress during the Spring and Fall 2020 semesters (Charles et al., 2021; Roche et al., 2022).”

• cites Charles et al., 2021 sourcePartly supported

  The Discussion reports higher depressive symptoms and perceived stress in spring 2020, but says the predicted increase in anxiety was not found and the detected increases were not present in fall 2020. The claim therefore overstates which symptoms increased and when. (LLM, conf=0.90)

  Experimental — accuracy not yet measured
• cites Roche et al., 2022 sourceSupported

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

The HiTOP system proposes that mania symptoms associate with obsessive-compulsive symptoms such as checking, ordering, and cleaning.

“Interestingly, this is in line with the proposed Hierarchical Taxonomy of Psychopathology (HiTOP) system, where symptoms of mania are thought to associate with obsessive-compulsive symptoms like checking, ordering, and cleaning (Kotov et al., 2017, 2021).”

• cites Kotov et al., 2017 sourceNot checked — no full text of the source
• cites Kotov et al., 2021 sourcePartly supported

  Table 1 in §6.1 places both bipolar-related and obsessive-compulsive disorders within the internalizing spectrum, supporting a broad relationship in the HiTOP model. It does not say that mania symptoms specifically associate with checking, ordering, or cleaning; the Figure 1 text in §4 also does not establish those symptom-level associations. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

In the first auto-detected community of the partial network, tacting of function had the weakest expected influence, traumatic intrusions the strongest, and well-being the strongest negative expected influence value.

“Tacting of function also had the weakest expected influence, whereas traumatic intrusions had the strongest; and although not the strongest overall, well-being had the strongest negative expected influence value.”

May combine two claims.

In the second auto-detected community of the zero-order network, well-being had the lowest bridge strength and trauma intrusions the highest.

“For bridge strength in the second community, well-being had the lowest value and trauma intrusions had the highest.”

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

Missing items across scales and subscales ranged from 0.51% to 1.74%, and imputed items ranged from 0.06% to 0.29%.

“Across scales and subscales, 0.51–1.74% items were missing and 0.06–0.29% of items were imputed.”

May combine two claims.

In the partial correlation network, dysphoria and suicidality had the highest closeness, and appetite gain was the most distant.

“Both dysphoria and suicidality had the highest closeness values, and appetite gain was the most distant.”

May combine two claims.

Skewness was within normal limits except for suicidality and claustrophobia, which showed floor effects.

“Skewness values were within normal limits, except for suicidality and claustrophobia, with these domains showing low endorsement (i.e., floor effects).”

May combine two claims.

In the partial correlation network, Dysphoria and suicidality had the highest degree centrality, while appetite gain, engagement, and ill temper had the lowest.

“Dysphoria and suicidality had the highest degree centrality while appetite gain, engagement, and ill temper had the lowest.”

May combine two claims.

In the predefined ACT community of the zero-order network, experiential avoidance had the strongest bridge strength and indirect expected influence, while tacting of function had the weakest for both.

“For the ACT community, experiential avoidance had strongest bridge strength and expected influence value when considering indirect effects, whereas tacting of function had the weakest for both.”

May combine two claims.

In the first auto-detected community of the partial network, tacting of function had a bridge strength of zero and was not connected to nodes in other communities.

“In the first community, tacting of function had a bridge strength of zero, indicating it was not connected to nodes in any other community.”

May combine two claims.

In the partial correlation network, appetite gain was least central by weighted degree, while engagement, well-being, and tacting of function were least central by eigenvector centrality.

“Appetite gain was the least central based upon weighted degree whereas engagement, well-being, and tacting of function were the least central, based upon eigenvector centrality.”

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

Suicidality and claustrophobia means and standard deviations matched previously established national norms.

“The means and the standard deviations for the suicidality and claustrophobia subscales are in line with previously established national norms (Nelson et al., 2018).”

• cites Nelson et al., 2018 sourceNot checked — no full text of the source

May combine two claims.

In this sample, internal consistencies were AAQ-II α = .91, openness α = .79, awareness α = .90, engagement α = .86, and TOF α = .58.

“Internal consistencies of the measures in the current sample ranged from poor to excellent (AAQ-II: α = .91; openness: α = .79; awareness: α = .90; engagement: α = .86; TOF α: = .58).”

May combine two claims.

In the predefined IDAS-II community of the partial network, well-being had the strongest bridge strength, while insomnia, appetite loss, appetite gain, euphoria, social anxiety, and ordering had bridge strengths of zero and were not connected to the ACT community.

“in the IDAS-II community, well-being had the strongest bridge strength whereas insomnia, appetite loss, appetite gain, euphoria, social anxiety, and ordering all had bridge strengths of zero (not connected to the ACT community).”

May combine two claims.

In the partial correlation network, dysphoria had the highest weighted degree and eigenvector centrality.

“For weighted degree and eigenvector centrality, dysphoria had the highest value.”

The quote only partly states this claim.

Community analysis showed well-being as the most influential node in the partial/concentration network.

“In community analyses, experiential avoidance had the strongest influence in the association network, whereas well-being had the strongest influence in the concentration network.”

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

In this sample, IDAS-II subscale internal consistencies were adequate, ranging from .75 for euphoria to .92 for dysphoria.

“Internal consistency across all subscales in the current sample was adequate and ranged from .75 (euphoria) to .92 (dysphoria).”

May combine two claims.

In the partial correlation network, dysphoria had the highest betweenness and appetite gain the lowest.

“Lastly, dysphoria had the highest betweenness value, whereas appetite gain was the lowest.”

May combine two claims.

In the second auto-detected community of the zero-order network, well-being had the lowest indirect expected influence and dysphoria the strongest.

“For expected influence for indirect effects, well-being again had the lowest value whereas dysphoria had the strongest value.”

May combine two claims.

In the third auto-detected community of the partial network, insomnia had the lowest bridge strength and dysphoria the highest.

“Lastly, in community three, insomnia had the lowest bridge strength while dysphoria had the highest.”

May combine two claims.

In the predefined IDAS-II community of the zero-order network, dysphoria had the strongest bridge strength and indirect expected influence, while euphoria had the weakest for both.

“in the IDAS-II community, dysphoria had the strongest bridge strength and expected influence value when considering indirect effects, whereas euphoria was weakest for both.”

May combine two claims.

In the predefined IDAS-II community of the partial network, well-being had the strongest indirect expected influence, appetite gain the weakest, and suicidality the strongest negative value.

“For expected influence when considering indirect effects, well-being again had the strongest value while appetite gain had the weakest value. Of note, suicidality had the strongest negative value.”

May combine two claims.

In the zero-order network, the same ten IDAS-II nodes had the highest closeness, while Well-Being and Euphoria were the most distant.

“For closeness, the same ten nodes as listed above had the highest closeness value, whereas Well-Being and Euphoria were the most distant nodes.”

May combine two claims.

In the second auto-detected community of the partial network, ordering had the weakest bridge strength and suicidality the strongest.

“In community two, ordering had the weakest bridge strength, and suicidality had the strongest bridge strength.”

May combine two claims.

In the zero-order network, the same ten IDAS-II nodes had the highest betweenness, and ordering had the lowest.

“Lastly, for betweenness, the same ten nodes had the highest betweenness values, whereas ordering had the lowest.”

May combine two claims.

In the second auto-detected community of the partial network, appetite gain had the weakest expected influence and panic the strongest.

“As for expected influence, appetite gain was weakest, whereas panic was strongest.”

May combine two claims.

In the zero-order network, Dysphoria was the most central node and Well-Being the least central node for weighted degree and eigenvector centrality.

“For both weighted degree and eigenvector centrality, the most central node was Dysphoria, whereas the least central node was Well-Being.”

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

Model variables showed a large degree of variability.

“Overall, there was a large degree of variability across model variables (see Table S1).”

May combine two claims.

In the predefined ACT community of the partial network, experiential avoidance had the strongest indirect expected influence and engagement the weakest.

“For expected influence when considering indirect effects, experiential avoidance was the strongest whereas engagement was the weakest.”

May combine two claims.

In the first auto-detected community of the zero-order network, euphoria had the lowest bridge strength and expected influence, while mania had the highest.

“In the first community, euphoria had the lowest bridge strength and expected influence while mania had the highest.”

May combine two claims.

In the predefined ACT community of the partial network, openness had the strongest bridge strength and tacting of function the weakest.

“For bridge strength in the ACT community, openness had the strongest value, and tacting of function had the weakest value.”

May combine two claims.

In the second partial network, CompACT and AAQ nodes were again the most central ACT process nodes depending on the metric, while dysphoria remained most central overall.

“The CompACT and AAQ nodes were again most central of the ACT process measure nodes, depending on the metric prioritized, although dysphoria remained most central overall.”

May combine two claims.

A second partial network collapsing the three CompACT subscale nodes into one total score was evaluated, and results differed most within the auto-detected community analyses.

“Again, a second network collapsing the three CompACT subscale nodes into one total score node was also evaluated results are presented in the supplemental section. Results differed most within the auto-detected community analyses.”

May combine two claims.

In the third auto-detected community of the partial network, appetite loss had the weakest expected influence, dysphoria the strongest, and insomnia the strongest negative expected influence.

“For expected influence, appetite loss had the weakest value, and dysphoria had the strongest value; insomnia had the strongest negative expected influence value.”

May combine two claims.

In the concentration network, experiential avoidance and openness had nearly identical direct influences, while experiential avoidance had the highest indirect influence.

“In the concentration network, however, both experiential avoidance and openness had nearly identical direct influences, while experiential avoidance had the highest indirect influence.”

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

The University of Iowa IRB approved all study procedures, and participants gave informed consent.

“All study procedures were approved by the University of Iowa institutional review board, and all participants provided informed consent.”

May combine two claims.

Baker and Berghoff (2021) found clusters matching psychological flexibility and inflexibility, but no clear links to psychopathology.

“Baker and Berghoff (2021) results showed clusters consistent with psychological flexibility and inflexibility, though with no clear associations with psychopathology.”

• cites Baker and Berghoff (2021) sourceNot checked — no full text of the source

May combine two claims.

Benfer et al. (2021) reported that experiential avoidance was the most influential ACT process and lack of connectedness with values the second most influential for post-traumatic stress symptoms.

“Benfer et al. (2021) found that of the ACT processes, experiential avoidance had the strongest influence, and lack of connectedness with values had the second strongest influence on post-traumatic stress symptoms.”

• cites Benfer et al., 2021 sourceNot checked — no full text of the source

May combine two claims.

Well-being, dysphoria, and suicidality may be useful targets in process-based treatment.

“Well-being, dysphoria, and suicidality may be important process-based treatment targets.”

• AssumptionRests on an assumption: Knowing which ACT processes are most strongly linked to particular symptoms or well-being domains can help clinicians choose ACT process targets in treatment.
• AssumptionRests on an assumption: Centrality metrics from network analysis can guide clinicians in selecting symptoms to target for the greatest downstream effect.

Classified as probably not a substantial claim.

The study used a cross-sectional design.

“The present study was cross-sectional and included a largely White, female, undergraduate sample.”

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

Another possibility is that the auto-detected communities identified scales based on their initial development and validation.

“However, another possibility may be that the auto-detected communities identified scales based on initial development and validation.”

May combine two claims.

Because the sample is non-clinical, majority White (82%), and cisgender, the results may not generalize to people of color, gender diverse individuals, other marginalized identities, or broader community and clinical samples.

“an important limitation of the present sample that should be noted is that it is non-clinical, majority White (82%) and cisgender, and results may not generalize to people of color, gender diverse individuals or other marginalized identities, or more broad community and clinical samples.”

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

The current findings suggest the potential importance of a process-based approach for individuals with internalizing symptoms.

“findings from the current study suggest the potential importance of using a process-based approach for individuals experiencing internalizing symptoms.”

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

The original IDAS scale contained 11 subscales, all of which were included in the second community except appetite gain.

“The original IDAS scale contained 11 subscales (dysphoria, social anxiety, lassitude, ill temper, traumatic intrusions, panic, suicidality, insomnia, appetite loss, appetite gain, and well-being; Watson et al., 2007), all of which were included in the second community, except for appetite gain.”

• cites Watson et al., 2007 sourceNot checked — no full text of the source

May combine two claims.

Dysphoria and suicidality may be important symptoms or areas to target in treatment.

“Both dysphoria and suicidality may be important symptoms or areas to target via treatment.”

May combine two claims.

Dysphoria and Suicidality were the two nodes with the most influence on other nodes in the network.

“meaning that they were the two nodes with the most influence on other nodes in the network.”

May combine two claims.

Skewed IDAS-II data, including floor effects for suicidality and claustrophobia, can affect centrality metric computation and make the metrics less stable.

“the skewed data on the IDAS-II (i.e., floor effects for suicidality and claustrophobia), although in line with national community samples and what’s expected, can impact the computation of centrality metrics and make them less stable.”

May combine two claims.

The ACT processes may be more helpful in treating major depressive disorder and/or panic, social anxiety, and intrusive thinking than bipolar disorder or obsessive-compulsive-spectrum disorders.

“These findings indicate that the ACT processes may be more helpful in the treatment of major depressive disorder and/or panic, social anxiety, and intrusive thinking than bipolar disorder or obsessive/compulsive-spectrum disorders.”

Classified as probably not a substantial claim.

The IDAS-II does not require respondents to specify which event or memory they are considering when answering.

“the IDAS-II does not require participants to specify which event or memory respondents are considering when answering.”

The quote only partly states this claim.

It cannot be determined whether respondents had the COVID-19 pandemic in mind when responding to the traumatic intrusions and traumatic avoidance items.

“Thus, it cannot be determined whether respondents had the COVID-19 pandemic in mind when responding to the items that measure traumatic intrusions”

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

The COVID-19 pandemic may have affected the IDAS-II trauma subscales of traumatic intrusions and traumatic avoidance.

“which may have had an impact on the trauma subscales of the IDAS-II (traumatic intrusions and traumatic avoidance).”

May combine two claims.

Compared with the association network, the concentration network appears less affected by method effects and measurement artifacts and shows clearer communities of symptoms related to avoidance and trauma memory, high arousal, and low arousal.

“In contrast to the association network, the concertation network appears to be less affected by method effects and measurement artifacts and appears to show a clearer communities of symptoms related to avoidance and trauma memory, high arousal, and low arousal.”

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

The reviewed meta-analysis indicates that ACT is helpful for improving well-being in both non-clinical and clinical populations.

“Overall, the findings of the review indicate that ACT is helpful in improving well-being in both non-clinical and clinical populations.”

• cites Stenhoff et al., 2020 sourceNot checked — no full text of the source

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

Partial correlation networks have been criticized as often being unstable over time and across samples and thus often unable to be replicated.

“partial correlation networks have received criticisms as well. Importantly, these networks are often not stable over time or across samples and thus often may be unable to be replicated (Forbes et al., 2017a, 2017b).”

• cites Forbes et al., 2017aNot matched

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

• cites Forbes et al., 2017bNot matched

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

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

Hayes et al. (2019) note the importance of dynamic network models and longitudinal data for understanding how processes unfold over time, influence one another, and may influence symptom or treatment trajectories.

“Hayes et al. (2019) note the importance of dynamic network models and including longitudinal data to understand how processes unfold overtime, influence one another, and may influence symptom or treatment trajectories.”

• cites Hayes et al., 2019 sourceNot checked — no full text of the source

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

A recently published meta-analysis examined the efficacy of ACT interventions for improving well-being.

“In fact, a recently published meta-analysis that examined the efficacy of ACT interventions on improving well-being (Stenhoff et al., 2020).”

• cites Stenhoff et al., 2020 sourceNot checked — no full text of the source

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

Individuals with dysphoria and suicidality may benefit from targeting experiential avoidance, openness, and awareness.

“Findings from this study, although not at the individual idiographic level, do suggest that individuals experiencing symptoms of dysphoria and suicidality may benefit from targeting experiential avoidance, openness, and awareness.”

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

To promote well-being, treatments should focus on increasing values-based behaviors.

“Findings from the current study also indicate that to promote well-being, treatments should focus on increasing values-based behaviors.”

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

Hayes et al. (2019) note the importance of using network analyses to analyze process-focused data at an idiographic level.

“Hayes et al. (2019) specifically note the importance of using network analyses to analyze process-focused data at an idiographic level”

• cites Hayes et al., 2019 sourceNot checked — no full text of the source

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

Contextual stressors experienced by college students may have led to higher perceived stress without presenting as clinical or diagnostic symptoms.

“Some of the contextual stressors that college students experienced may have resulted in reports of higher perceived stress but may not have presented as clinical or diagnostic symptoms.”

May combine two claims.

The AAQ-II's possible measurement of distress may explain why experiential avoidance showed high influence in the networks and should be considered when interpreting the results.

“This may be why experiential avoidance demonstrated high influence in the networks and should be considered when interpreting the results of the current study.”

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

The low TOF reliability may contribute to unstable model estimates and may indicate a need to refine the scale in future research.

“This may also contribute to unstable model estimates and may indicate the need to refine this scale in future research”

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

Network analysis may help clinicians generate accurate case conceptualizations and select appropriate treatment strategies.

“It has been suggested that network analysis may help clinicians generate accurate case conceptualizations and select appropriate strategies for treatment (Hoffman, Curtiss, Hayes, 2020).”

• cites Hoffman, Curtiss, Hayes, 2020Not matched

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

May combine two claims.

Overall, experiential avoidance has the largest influence on internalizing domains, and dysphoria has the largest influence on ACT processes.

“This indicates that overall, experiential avoidance has the largest influence on internalizing domains, and dysphoria has the largest influence on ACT processes.”