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Identifying the Underlying Mechanisms of Change During Acceptance and Commitment Therapy (ACT): A Systematic Review of Contemporary Mediation Studies

Published online by Cambridge University Press:  04 October 2018

Daniel Stockton ,
Stephen Kellett ,
Raul Berrios ,
Fuschia Sirois ,
Nicolas Wilkinson  and
Georgina Miles
Daniel Stockton
Affiliation:
Mid Yorkshire Hospitals NHS Trust
Stephen Kellett
Affiliation:
Psychological Healthcare, Keresforth Centre, Barnsley, UK
Raul Berrios
Affiliation:
Universidad de Santiago de Chile
Fuschia Sirois
Affiliation:
Department of Psychology, University of Sheffield
Nicolas Wilkinson
Affiliation:
Sheffield Heath and Social Care NHS Foundation Trust
Georgina Miles
Affiliation:
Department of Psychology, University of Sheffield
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Abstract

Background: Mediation studies test the mechanisms by which interventions produce clinical outcomes. Consistent positive mediation results have previously been evidenced (Hayes et al., 2006) for the putative processes that compromise the psychological flexibility model of acceptance and commitment therapy (ACT). Aims: The present review aimed to update and extend the ACT mediation evidence base by reviewing mediation studies published since the review of Hayes et al. (2006). Method: ACT mediation studies published between 2006 and 2015 were systematically collated, synthesized and quality assessed. Results: Twelve studies met inclusion criteria and findings were synthesized by (a) the putative processes under investigation, and (b) the outcomes on which processes were tested for mediation. Mediation results were found to be generally consistent with the psychological flexibility model of ACT. However, studies were limited in methodological quality and were overly focused on a small number of putative processes. Conclusions: Further research is required that addresses the identified methodological limitations and also examines currently under-researched putative processes.

Keywords

ACTacceptance and commitment therapymediationmechanismsreview
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 47 , Issue 3 , May 2019 , pp. 332 - 362
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

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References

References (*denotes mediation study)

Ahn, H. and Wampold, B. E. (2001). Where oh where are the specific ingredients? A meta-analysis of component studies in counselling and psychotherapy. Journal of Counselling Psychology, 48, 251–257.Google Scholar
*Arch, J. J., Wolitzky-Taylor, K. B., Eifert, G. H. and Craske, M. G. (2012). Longitudinal treatment mediation of traditional cognitive behavioral therapy and acceptance and commitment therapy for anxiety disorders. Behaviour Research and Therapy, 50, 469–478.Google Scholar
A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J. and Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84, 30–36.Google Scholar
*Bach, P., Gaudiano, B. A., Hayes, S. C. and Herbert, J. D. (2013). Acceptance and commitment therapy for psychosis: intent to treat, hospitalization outcome and mediation by believability. Psychosis, 5, 166–174.Google Scholar
Baron, R. M. and Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.Google Scholar
Bollen, K. A. and Stine, R. (1990). Direct and indirect effects: classical and bootstrap estimates of variability. Sociological Methodology, 20, 115–140.Google Scholar
Boulanger, J. L., Hayes, S. C. and Pistorello, J. (2010). Experiential avoidance as a functional contextual concept. In Emotion Regulation and Psychopathology: A Transdiagnostic Approach to Etiology and Treatment (pp. 107–136). New York, NY: Guilford Press.Google Scholar
*Bricker, J., Wyszynski, C., Comstock, B. and Heffner, J. L. (2013). Pilot randomized controlled trial of web-based acceptance and commitment therapy for smoking cessation. Nicotine and Tobacco Research, 15, 1756–1764.Google Scholar
Cantor, A. B. (1996). Sample-size calculations for Cohen's kappa. Psychological Methods, 1, 150–153.Google Scholar
Cohen, J. (1968). Weighted kappa: nominal scale agreement provision for scaled disagreement or partial credit. Psychological Bulletin, 70, 213–220.Google Scholar
Cole, D. A. and Maxwell, S. E. (2003). Testing mediational models with longitudinal data: questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112, 558.Google Scholar
Ding, Z., Ng, F. and Li, J. (2015). A parallel multiple mediator model of knowledge sharing in architectural design project teams. International Journal of Project Management, 32, 54–65.Google Scholar
*Flaxman, P. E. and Bond, F. W. (2010). A randomised worksite comparison of acceptance and commitment therapy and stress inoculation training. Behaviour Research and Therapy, 48, 816–820.Google Scholar
*Forman, E. M., Chapman, J. E., Herbert, J. D., Goetter, E. M., Yuen, E. K. and Moitra, E. (2012). Using session-by-session measurement to compare mechanisms of action for acceptance and commitment therapy and cognitive therapy. Behavior Therapy, 43, 341–354.Google Scholar
*Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D. and Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31, 772–799.Google Scholar
Gootzeit, J. H. (2014). ACT process measures: specificity and incremental value. Unpublished doctoral dissertation, University of Iowa, Iowa City, IA.Google Scholar
Gregg, J. A. (2004). A randomized controlled effectiveness trial comparing patient education with and without Acceptance and Commitment Therapy. Doctoral dissertation available from the University of Nevada, Reno.Google Scholar
Hacker, T., Stone, P. and Macbeth, A. (2015). Acceptance and commitment therapy – do we know enough? Cumulative and sequential meta-analyses of randomised controlled trials. Journal of Affective Disorders, 190, 551–565.Google Scholar
Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York, NY: Guilford Press.Google Scholar
Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G. et al. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35, 821–835.Google Scholar
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A. and Lillis, J. (2006a). Acceptance and commitment therapy: model, processes and outcomes. Behavior Research and Therapy, 44, 1–25.Google Scholar
Hayes, S. C., Strosahl, K. D. and Wilson, K. G. (2011a). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. New York, NY: Guildford Press.Google Scholar
Hayes, S. C., Strosahl, K. and Wilson, K. G. (2012). Acceptance and Commitment Therapy. New York, NY: Guilford Press.Google Scholar
Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D. et al. (2006b). Measuring experiential avoidance: a preliminary test of a working model. The Psychological Record, 54, 553–578.Google Scholar
Hayes, S. C., Villatte, M., Levin, M. and Hildebradt, M. (2011b). Open, aware and active; contextual approaches as an emerging trend in the behavioural and cognitive therapies. Annual Review of Clinical Psychology, 7, 141–168.Google Scholar
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M. and Strosahl, K. (1996). Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152–1168.Google Scholar
*Hesser, H., Westin, V. Z. and Andersson, G. (2013). Acceptance as a mediator in internet-delivered acceptance and commitment therapy and cognitive behavior therapy for tinnitus. Journal of Behavioral Medicine, 37, 756–767.Google Scholar
Judd, C. M. and Kenny, D. A. (1981). Process analysis: estimating mediation in treatment evaluations. Evaluation Review, 5, 602–619.Google Scholar
Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27.Google Scholar
Kenny, D. A., Korchmaros, J. D. and Bolger, N. (2003). Lower level mediation in multilevel models. Psychological Methods, 8, 115.Google Scholar
Krull, J. L. and MacKinnon, D. P. (2001). Multilevel modeling of individual and group level mediated effects. Multivariate Behavioral Research, 36, 249–277.Google Scholar
Levin, M. E., Hildebrandt, M. J., Lillis, J. and Hayes, S. C. (2012). The impact of treatment components suggested by the psychological flexibility model: a meta-analysis of laboratory-based component studies. Behavior Therapy, 43, 741–756.Google Scholar
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of Internal Medicine, 151, 741–756.Google Scholar
*Lundgren, T., Dahl, J. and Hayes, S. C. (2008). Evaluation of mediators of change in the treatment of epilepsy with acceptance and commitment therapy. Journal of Behavioral Medicine, 31, 225–235.Google Scholar
Luoma, J. B., Hayes, S. and Walser, R. D. (2007). Learning ACT; An Acceptance and Commitment Therapy Skills-Training Manual for Therapists. Oakland, CA: New Harbinger Publications.Google Scholar
MacKinnon, D. P. and Fairchild, A. J. (2009). Current directions in mediation analysis. Current Directions in Psychological Science, 18, 16–20.Google Scholar
MacKinnon, D. P., Fairchild, A. J. and Fritz, M. S. (2007). Mediation analysis. Annual Review of Psychology, 58, 593.Google Scholar
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G. and Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83.Google Scholar
MacKinnon, D. P., Lockwood, C. M., and Williams, J. (2004). Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivariate Behavioral Research, 39, 99–128.Google Scholar
Martell, C. R., Addis, M. E. and Jacobson, N. S. (2001). Depression in Context: Strategies for Guided Action. London, UK: WW Norton and Company.Google Scholar
McCracken, L. M. and Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. American Psychologist, 69, 178.Google Scholar
*Niles, A. N., Burklund, L. J., Arch, J. J., Lieberman, M. D., Saxbe, D. and Craske, M. G. (2014). Cognitive mediators of treatment for social anxiety disorder: comparing acceptance and commitment therapy and cognitive-behavioral therapy. Behavior Therapy, 45, 664–677.Google Scholar
Öst, L. G. (2008). Efficacy of third wave behavioural therapies: a systematic review and meta-analysis. Behaviour Research and Therapy, 46, 296–321.Google Scholar
Öst, L. G. (2014). The efficacy of acceptance and commitment therapy: an updated systematic review and meta-analysis. Behaviour Research and Therapy, 61, 105–121.Google Scholar
Preacher, K. J. and Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.Google Scholar
PowersM, B. M, B., Zum, M. B. and Emmelkamp, P. M. (2009). Acceptance and commitment therapy: a meta-analytic review. Psychotherapy and Psychosomatics, 78, 73–80.Google Scholar
Rhodes, R. E. and Pfaeffli, L. A. (2010). Mediators of physical activity behavior change among adult non-clinical populations: a review update. International Journal of Behaviour Nutrition and Physical Activity, 7, 37–47.Google Scholar
Rolffs, J. L., Rogge, R. D. and Wilson, K. G. (2016). Disentangling components of flexibility via the hexaflex model: development and validation of the multidimensional psychological flexibility inventory (MPFI). Assessment, 12, 1–25.Google Scholar
*Rost, A. D., Wilson, K., Buchanan, E., Hildebrandt, M. J. and Mutch, D. (2012). Improving psychological adjustment among late-stage ovarian cancer patients: examining the role of avoidance in treatment. Cognitive and Behavioral Practice, 19, 508–517.Google Scholar
Ruiz, F. J. (2010). A review of acceptance and commitment therapy (ACT) empirical evidence: correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10, 125–162.Google Scholar
Smout, M. F., Hayes, L., Atkins, P. W. B., Klausen, J. and Duguid, J. E. (2012). The empirically supported status of acceptance and commitment therapy: an update. Clinical Psychologist, 16, 97–109.Google Scholar
Villate, J. L. Vilardaga, R., Villate, M., Viladaga, J. C. P., Atkinds, D. and Hayes, S. (2016). Acceptance and commitment modules: differential impact on treatment processes and outcomes. Behaviour Research and Therapy, 77, 52–61.Google Scholar
*Wicksell, R. K., Olsson, G. L. and Hayes, S. C. (2011). Mediators of change in acceptance and commitment therapy for pediatric chronic pain. Pain, 152, 2792–2801.Google Scholar
Wilt, J. (2012). Mediators and mechanisms of psychotherapy: evaluating criteria for causality. Graduate Student Journal of Psychology, 14, 53–60.Google Scholar
Yu, L., Norton, S. and McCracken, L. M. (2016). The self experiences questionnaire (SEQ): preliminary analyses for a measure of self in people with chronic pain. Journal of Contextual Behavioral Science, 5, 127–133.Google Scholar
*Zettle, R. D., Rains, J. C. and Hayes, S. C. (2011). Processes of change in acceptance and commitment therapy and cognitive therapy for depression: a mediation reanalysis of Zettle and Rains. Behavior Modification, 35, 265–283.Google Scholar
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