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Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders Different treatments, similar mechanisms?

25 important questions on Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders Different treatments, similar mechanisms?

What is the aim of CBT in the treatment of anxiety disorders?

It aims to help clients reduce their distress by changing their cognitive and behavioral responses to anxiety. It enables clients to develop a new associative network of adaptive thoughts and behaviors that compete with or modify maladaptive, fear-based networks and memories.

What components might be included in CBT for anxiety disorders? (8)

1. Psychoeducation
2. Self-monitoring
3. Relaxation
4. Cognitive restructuring
5. Behavioral experiments
6. Imaginal and in vivo exposure
7. Weaning of safety signals
8. Response and relapse prevention

What does psychological flexibility mean?

The capacity to make contact with one's experience in the present moment and, based on what is possible for them at that moment, to choose to act in ways consistent with their values.
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What components are included in ACT? (5)

1. Psychoeducation
2. Creative hopelessness (recognize that past efforts have not worked and have led them to avoidance)
3. Life values work
4. Value-guided exposure (e.g. epitaph to discover values)
5. Behavioral willingness/committed action (behaving according to chosen values in the face of painful thoughts and feelings that may arise)

What is an important implication of the relational frame theory (RFT)? (The theory that ACT is based on)

that verbally mediated relationships among objects can alter behavioral processes.

What does the central ACT-component of cognitive defusion teach?

To expand behavior and overcome action-limiting language (linked to RFT)

How is language associated with psychopathology due to RFT?

It argues that language is associated with psychopathology due to its functioning in a context in which valued behavior is narrowed or abandoned in order to cope with cognitive activity.

What is the relation between ACT and RFT?

ACT helps clients alter the context of the symbolic activity or the functional significance of action-limiting language. Therefore, a central ACT component is teaching cognitive defusion skills. This is framed within the perspective of mindfulness, so thoughts do not have to be logically disconfirmed like in CBT.

What is the criticism of ACT on cognitive restructuring in CBT?

That countering anxious thoughts with judging and modifying thought content may intensify the struggle to rid oneself of anxious thinking. Acceptance and cognitive defusion are proposed as means of side-stepping the ruminative trap of cognition and accessing experience directly.

How are cognitive restructuring and cognitive defusion/acceptance related despite apparent differences? (4)

1. Both are approach-oriented techniques for responding to anxiety
2. By the notion of thoughts as facts by proposing that anxiety-related thoughts are hypotheses, the same distance can be created as in cognitive defusion
3. Both ACT and CBT require additional thinking (self-talk/coaching)
4. Both therapies may risk thought suppression, but they may also both facilitate exposure and therefore reduce experiential avoidance

What are the risks of ACT? (2)

1. The notion of letting thoughts go can be misunderstood as encouragement of thought suppression (especially in clinically anxious patients)
2. Cognitive defusion does not specify which thoughts to defuse. Instructing them to defuse thought that get in the way of living a valued live return to the notion of thoughts as good and bad.

Why would component and mediational analysis of ACT to address the utility of cognitive defusion & acceptance be useful?

Because it has frequently been argued that the cognitive components of CBT do not significantly improve the outcome of behavioural therapy alone (though they can mediate outcomes)

How can an increased sense of prediction and control be a core feature of ACT, even though it states that: ''Control is the problem, not the solution?'' (2)

1. The process of learning a different way of responding to internal cues may give clients an illusion of internal control.
2. By decreasing aversive internal symptoms through acceptance, acceptance may increase clients' sense of mastery and control over such symptoms.

Why may it not be truly feasible to have a primary treatment motivation or end goal other than fear reduction?

Because attempts to control fear and anxiety are a basic drive due to the inherently aversive, defense-evoking nature of these states.

How is mindful observation linked to predictability?

Mindful observation of the self and the surrounding environment likely allows patients to notice and comprehend anxiety-related contingencies and thus increases awareness of symptom contingencies (the cornerstone of predictability).

What critique and development within CBT make that processes within CBT can now be seen as more equal to act?

Findings show that fear reduction within exposure trials is not predictive of the overall outcome. In a new approach, the exposure element in CBT is viewed as a technique to facilitate exposure rather than a direct means to minimize fear and anxiety.

What could still be seen as a difference between CBT and ACT in acceptance and willingness?

The time-span. In CBT, acceptance and willingness are promoted in the short run in the name of eventual anxiety reduction. In act, these approaches are promoted in both the short and long run, with valued living as the stated goal.

How is valued living addressed implicitly in CBT? (2)

1. In the creation and enactment of client-driven exposure hierarchies
2. Behavioral exposure to feared situations that likely represent personally valued behaviors may lead to anxiety reduction, which increases the likelihood of engagement in previously avoided, valued-behaviours

How is valued living addressed directly in ACT? (2)

1. Via creative exercises and explicit discussion
2. May lead to behavioral exposure and hence to anxiety reduction (values-driven behavior that reduces anxiety likely reinforces valued living)

Why are values-based and anxiety-reduction goals not mutually exclusive? (2)

1. CBT therapists are unlikely to aim to reduce anxiety for no reason (achieving life goals is easier in the context of less anxiety)
2.  No evidence that promoting anxiety symptom reduction in CBT vs. valued living in ACT results in different therapy outcomes

In what way may the relationship between symptom reduction and valued living be conceptualized as a mediation analysis? (2)

1. Symptom reduction and/or increases in perceived prediction and control may mediate increases in value-driven behavior
2. Increases in value-driven behavior may heighten perceived control and reduce anxiety symptoms via direct exposure

What is important regarding the timing of the measurement of mediators in mediation analysis with the aim of finding out the pathways of ACT and CBT? (2)

1. Establishing that changes in the mediator cause changes in the treatment outcome require that the measurement of mediators occurs prior to the assessment of the outcomes
2. There could be different point in treatment for the different therapies depending on the therapy strategies, individual variables or the particular treatment approach

What are important considerations in the choice of which mediator to measure? (3)

1. That this is challenging for newer treatments like ACT because measures of hypothesized treatment mechanisms are still being established
2. Measuring the same mediation measures for CBT and ACT  facilitates the examination of shared and distinct processes of change
3. Cognitive and attentional processes may be mediational pathways with the potential to illuminate similarities and differences (attentional processes are central in anxiety)

What is needed to research whether the potentially different pathways and processes of change in ACT and CBT produce the same level of symptom and life improvement?

A broader range of treatment outcome measures

In what way does CBT inherently contain elements of acceptance? And how is this linked to emotional processing? (2)

1. Emotional processing theory posits that exposure to the feared stimulus leads to the development of a non-fear structure that competes with the original structure.
2. The aim to demonstrate clients that they can tolerate fear and anxiety of violate exposure-outcome expectancies involves the ACT notion of ''acting with anxiety''

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Positive Clinical Psychology

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