The major purpose of this project was to further evaluate the psychometric properties of the Self-as-Context Scale (SACS) and its 10 items by conducting an item response theory (IRT) analysis. Prior to doing so we conducted exploratory and confirmatory factor analyses with an aggregate college student sample (N = 1842) that confirmed an acceptable fit for a bidimensional model after dropping an item from the transcending subscale. The General Response Model we chose for the IRT analysis indicated strong discriminating power for both sets of remaining subscale items in their ability to adequately differentiate varying levels of their respective dimensional constructs. An evaluation of difficulty parameters suggested both sets of items covered an adequate span of latent traits, but that each might be improved, albeit in differing ways. For centering items, this would entail the elimination of the neutral response option from the Likert-type scale used in rating them, while increasing the difficulty level of transcending items through some rewording could be considered. Implications as well as limitations of the findings and ways of addressing them in the service of further evaluating and improving the quality of SACS as an assessment tool in clinical research and practice are discussed.
Similar to other low- and middle-income countries (LMICs) in Africa, workers in Uganda have limited access to evidence-based workplace mental health promotion programs. This pilot trial assesses the feasibility, acceptability, and cultural suitability of implementing and evaluating training derived from acceptance and commitment therapy (ACT) among Ugandan healthcare staff. A sample of 16 staff (primarily nurses and midwives) employed at a hospital in Kampala participated in four group sessions of training using the ACT Matrix, and completed pre- and post-intervention measures. The program's acceptability was assessed via the multidimensional Theoretical Framework of Acceptability. In addition, a subgroup of 7 participants provided qualitative data during a focus group immediately after completing the training. Despite reported challenges surrounding the timing of sessions, the ACT Matrix was rated as an acceptable, culturally relevant, and satisfying training approach in this context. Qualitative reports further suggested that participating staff experienced benefits across different life areas. Participants revealed no issues with English language psychometric instruments commonly used to evaluate ACT interventions, including prominent markers of perceived stress, well-being, and psychological flexibility/inflexibility. Positively framed measures of well-being and psychological flexibility exhibited promising signs of short-term change sensitivity in response to the ACT Matrix. Taken together, these quantitative and qualitative data signal that it is feasible and appropriate to progress to a next stage of intervention research, aimed at examining the effectiveness of workplace ACT Matrix training with similar groups of healthcare staff in Uganda.
Gay men are frequently exposed to discrimination and rejection, experiences that may contribute to intimacy avoidance and interpersonal distress. Functional Analytic Psychotherapy (FAP) is a contextual behavioral intervention that shapes clinically relevant interpersonal behaviors within therapy. This preliminary, exploratory study examined the feasibility, acceptability, and outcomes of six to nine weekly FAP sessions focused on intimacy-related behaviors and minority stress among three self-identified Latinx gay men. A randomized combined concurrent/nonconcurrent multiple-baseline design was used. All participants completed the intervention, and two completed follow-up and social validity assessments. Intimacy-seeking behaviors in session increased across participants, whereas changes in intimacy-avoidant behaviors were less consistent. Out-ofsession intimacy showed greater stability for two out of the three participants. Two participants also showed clinically reliable improvements in interpersonal functioning and lower overall minority stress indicators; however, one participant showed deterioration in community connectedness at follow-up. Social validity data from the two respondents suggested high perceived value of the intervention, along with concerns about session length and emotional openness. Overall, findings support the feasibility and acceptability of FAP and suggest possible clinical benefits. Given the small sample size, heterogeneous outcomes, short baselines, and limited follow-up, results should be interpreted cautiously and evaluated in larger, more diverse studies.
The Avoidance and Fusion Questionnaire for Youth (AFQ-Y) and its 8-item short form (AFQ-Y8) are widely used measures of psychological inflexibility in adolescents. This study evaluated the validity, reliability, responsiveness, and interpretability of the Finnish AFQ-Y8 using an observational psychometric design with a nested RCT subsample for longitudinal analyses. The main analyses were conducted in a community sample of 885 Finnish adolescents from 15 secondary schools (aged 14-18 years; 56.2% female). To examine cross-cultural validity (measurement invariance testing), data from 246 Spanish adolescents (48.4% female) and 152 Portuguese adolescents (60.5% female) from previous AFQ-Y8 validation studies were also included. Confirmatory factor analysis (CFA; WLSMV estimator), multi-group CFA for measurement invariance (configural, metric, scalar, and strict) across gender, depression status, time, and countries, correlations with related constructs (depression, stress, mindfulness, and life satisfaction), ROC curve analyses, reliability indices (including 7-week test-retest), and the estimation of clinically useful change indices were computed. CFA supported a robust single-factor structure (CFI = .989, TLI = .985, RMSEA = .069, 90% CI [.056, .083]) and broad measurement invariance, with partial strict invariance across Finland, Spain, and Portugal. AFQ-Y8 scores correlated strongly with symptoms of depression and stress, mindfulness, and life satisfaction. The scale also demonstrated good internal consistency (alpha = .89, omega = .89), satisfactory test-retest reliability (ICC = .84), and promising utility for identifying depression caseness and interpreting meaningful change. These findings support the use of the AFQ-Y8 to identify and monitor psychological inflexibility in adolescents, a core process targeted in ACT.
Digital technology use has become near universal in modern society. Alongside benefits such as opportunities for social connection, there are increasing concerns about the potential risks of particular behaviours and affordances, e.g., problematic social media use and online gambling, prompting the development of targeted interventions for digital technology-related issues. While a growing number of Acceptance and Commitment Therapy (ACT) interventions have been developed in this area, little is known about the nature or scope of this research. Consequently, a scoping review was undertaken to identify and describe existing literature detailing ACT interventions for digital technology-related issues. A comprehensive search strategy was employed of four key databases and PRISMA-ScR guidelines followed. Studies were included if they described an ACT intervention that targeted a digital technology-related issue and included at least one related outcome measure. Twenty studies met inclusion criteria, describing 21 interventions. These targeted a range of issues, including internet use, smartphone use, social media use, gaming and internet pornography use, as well as experiences of cyberbullying. The findings highlight the growing application of ACT interventions for digital technology-related issues. While acknowledging the pilot nature of this research, we suggest that future studies should provide more detail of intervention content (ideally including protocols), targets of intervention, and proposed mechanisms of change, and further, incorporate higher quality methodologies, including randomised controlled trials with larger sample sizes.
Relational Frame Theory (RFT) has inspired a considerable body of research demonstrating fundamental aspects of arbitrarily applicable relational responding (AARR) purported to be the building blocks of human language and cognition. Current empirical research has certain limitations, however. Computational modelling allows researchers to circumvent certain practical limitations to studying (the development of) complex forms of AARR and force them to scrutinize the theory, yet limited research has sought to develop computational models of AARR. RFT can guide researchers developing computational models of AARR by emphasizing its operant and context-sensitive nature and by clarifying the nature of the learning history that is required for its development. We describe a partially hardcoded computational model of AARR inspired by RFT. By combining computational reinforcement learning with hardcoded relational knowledge, we simulate AARR as observed in a conceptual replication of the seminal Steele and Hayes (1991) study. Our results add to a growing literature modeling relational behavior and illustrate that RFT can be useful for researchers interested in computational modelling. Implications and future research directions are discussed.
The Process-Based Assessment Tool (PBAT) was developed within the framework of process-based therapy, an alternative to symptom-focused diagnostic models, to monitor biopsychosocial change processes and support personalized therapeutic interventions. This cross-sectional study validated the Spanish PBAT by replicating the original U.S. study protocol in 602 Spanish adults. We also aimed to compare predictive process-outcome networks across Spain, the U.S., Sweden, and Poland using link community network analysis. Structural validity was assessed through inter-item correlations, and criterion validity through associations between PBAT items and clinical outcomes and need satisfaction/frustration. The Boruta algorithm identified the most predictive items for each outcome. Results confirmed the structural and criterion validity of the Spanish PBAT. Link community network analysis revealed country-specific differences in which processes most strongly predicted distress: difficulties finding appropriate emotional outlets were most central in Spain, perceived inability to change ineffective was relatively prominent in the U.S., and cognitive interference and attentional difficulties were most prominent in Sweden, while Poland showed a more distributed pattern across these three processes. Future research could extend this approach to individual longitudinal data, potentially enabling clinicians to identify and target core psychological processes based on a person's unique profile.
Psychological interventions for anxiety are widely supported as effective, yet the lived processes of therapeutic change remain contextually underexplored. This systematic review synthesised qualitative studies examining clients’ accounts of therapy for anxiety. A comprehensive search across six databases (CINAHL, MEDLINE, PsycINFO, PubMed, Scopus, and Web of Science) returned 3,529 records. Following screening and full-text assessment, 27 studies were included in the synthesis. A realist-informed thematic approach was used to examine how specific processes enabled or constrained change across therapeutic contexts. Four categories of therapeutic mechanisms were identified: cognitive, emotional, behavioural, and relational. These were integrated into a model of Therapeutic Growth. Within this model, four dyadic processes captured recurrent ways in which participants described engaging with therapy over time (Reflective Action, Courageous Participation, Nurtured Expression, and Co-Constructed Meaning). Additionally, four triadic domains reflected more complex patterns in which multiple mechanisms interacted across relational and contextual conditions. Therapeutic growth was experienced as gradual and context-dependent, emerging through experiences of insight, emotional safety, behavioural engagement, and relational connection. This review offers a process-oriented account of how therapy for anxiety may support change. The Therapeutic Growth model may assist practitioners in identifying which cognitive, emotional, behavioural, or relational processes are most salient for a given client and how these processes might be supported flexibly over time.
Background: Negative self-referential thoughts often acquire aversive and rigid functions through relational framing, contributing to psychological inflexibility. Cognitive defusion techniques aim to alter these verbally derived functions by reducing the extent to which thoughts govern behavior or evoke distress. Despite their centrality in ACT, no meta-analysis has focused specifically on defusion procedures applied to self-referential stimuli or on functionally distinct outcomes such as believability and discomfort. Methods: Experimental studies conducted with adult non-clinical samples employing an isolated defusion technique and assessing believability and/or discomfort pre-post intervention were eligible for inclusion. Searches were conducted in PubMed and EBSCOhost through October 30, 2025. Risk of bias was evaluated using the RoB 2 tool. Random-effects models were applied, and subgroup analyses examined differences across defusion procedures. Results: Twelve studies (22 samples; n = 659) met inclusion criteria. Defusion produced large reductions in believability (Hedges' g = 1.04, SE = 0.12) and discomfort (g = 1.12, SE = 0.17). Word repetition yielded larger effects on believability (g =1.29) than other techniques (g = 0.59), with a similar pattern for discomfort (1.38 vs. 0.76). Discussion: Defusion reliably alters both discriminative (believability) and eliciting (discomfort) stimulus functions of self-referential thoughts. Differences across techniques suggest that distinct defusion procedures engage different behavioral processes, highlighting the relevance of analyzing defusion as a procedure, a process, and an outcome within a process-based CBS framework.
Background Diabetes is a devastating disease that disproportionately affects Hispanic/Latino/ Latinx (H/L) populations. Assessing factors that influence diabetes outcomes is crucial, including diabetes acceptance, which is linked to better glycemic control, improved physical and mental health, and enhanced quality of life. The Acceptance and Action Diabetes Questionnaire (AADQ) is an established measure of diabetes acceptance, available in five languages. However, despite the incidence of diabetes in H/L communities being more than twice that of non-Hispanic White patients, no Spanish-language version of the AADQ currently exists. Therefore, this study aimed to evaluate the psychometric properties of a Spanish translation of the AADQ (AADQ-S). Methods The AADQ-S was developed by a team of bilingual experts following best practices for translation. To evaluate its psychometric properties, the study evaluated associations among the AADQ-S and self-reported current HbA1c, diabetes self-care (Summary of Diabetes Self-Care Activities), and health-related quality of life (HRQOL) among 144 Spanish-speaking participants at a diabetes center in the southwestern United States. Descriptive, correlational, and factor analytic models were conducted. Results Most participants (71%) reported female cis-gender identity, 54% had completed at least high school, and more than half reported an annual income below $20,000. Nearly half (43%) reported they were born in Mexico; most (76%) had unmanaged diabetes (HbA1c >7%). A series of factor analyses was conducted to evaluate the structure with best fit to the data. Cronbach’s alpha coefficient was also calculated to evaluate internal consistency reliability. The resulting 10-item AADQ-S demonstrated good internal consistency reliability (0.85). Results indicate lower AADQ-S scores (i.e., lower diabetes acceptance) were associated with higher HbA1c (r = -0.24) and worse self-rated general health (r = -0.23). However, the AADQ-S was unrelated to days of healthy self-care (r = 0.06), indicating mixed convergent validity. Discussion This study found that the AADQ-S demonstrated good internal consistency reliability and evidence of construct validity. Also discovered in this study, the link between diabetes acceptance and self-reported self-management may be more complex than previously understood, especially in marginalized populations, requiring further investigation. Limitations include the modest sample size and self-reported HbA1c. The AADQ-S allows a better understanding of diabetes acceptance, a critical target to improve assessment, treatment targets, and outcomes for H/L populations dealing with type 2 diabetes.
Introduction Idiographic network analysis, assessing associations between a system of variables of interest, also called nodes, is a proposed method for personalizing psychological treatment. The aim of this study was to test the centrality hypothesis that a treatment condition delivering interventions guided by the most central network node will yield better outcomes compared to a treatment condition delivering interventions guided by the least central node. We tested this using perceived causal networks (PECAN) and focusing on psychological inflexibility processes. Effects were examined in terms of pain interference, motivation, and pain intensity. Method We used a single case design with multiple baselines across six participants. Therapists were blind to treatment conditions. While participants were not blind to the responses that they provided for creating the PECAN, they were blind to the resulting network and the treatment conditions. Randomization was applied to baseline length and to whether the most central node or the least central node intervention came first. Results All participants had at least one outcome changing in beneficial directions in line with hypotheses. However, two participants also had one outcome each that changed in contradiction to the hypotheses. Discussion Adapting psychological treatment by matching interventions to the most central node in a perceived causal network looks promising. However, it is unlikely that this method will always be the best matching method. We need to keep exploring additional personalization methods and under which circumstances they are efficient.
This study examined how two person-level contextual factors, heterosexism during childhood and interoceptive awareness, shape LGBQ individuals’ psychophysiological responses to perceived everyday discrimination and affirmation. Situated within minority stress and social safeness perspectives, and guided by an idionomic approach to within-person heterogeneity, we investigated both the prospective associations of these factors with health indicators and their moderating roles in momentary responses. A sample of 141 LGBQ adults in Hong Kong completed baseline measures of early exposure to heterosexism and interoceptive awareness before participating in a recall-based, repeated-measures lab task involving discrimination, affirmation, and neutral writing conditions. Outcomes included LGBQ collective self-esteem, rumination, affect, somatic distress, and heart rate variability (HRV). Both early heterosexism and interoceptive awareness prospectively predicted nearly all self-reported outcomes in expected directions. Moderation analyses showed that, among individuals with greater early heterosexism, the beneficial effects of perceived affirmation on LGBQ collective self-esteem, rumination, and negative affect were smaller whereas the adversarial effects of perceived discrimination on somatic distress and a frequency-domain HRV indicator were larger. In contrast, the moderating role of interoceptive awareness was limited to positive affect with unexpected simple effects. Effects on HRV indicators were inconclusive. Findings highlight the importance of trauma-informed and body-oriented approaches in clinical and community services for LGBQ people. These results also underscore the value of assessing contextual antecedents for advancing LGBQ health research and intervention.
Psychological therapies based on contextual behavioral (CB) principles have been a focus of training and dissemination over the last 25 years. It is recognized that practitioners wanting to practice these therapies in safe and effective ways should engage in clinical supervision. However, clinical supervision, while regarded as essential, is an under-researched, area of psychological practice in general, and in contextual behavioral science. This study aimed to explore whether there are distinct and agreed-upon features of clinical supervision when taking a contextual behavioral (CB) approach. Practitioners who had published in peer reviewed journals and/or presented at Association for Contextual Behavioral Science conferences on CB supervision in the last 20 years were invited to take part in a Delphi study to find consensus: 20 participants provided responses to an open-ended online questionnaire on CB supervision. A reflexive thematic analysis, within a qualitative research design, was used to interpret common ideas and themes within the data. Through analysis, four main themes were generated: contextual factors, tasks and behaviors, supervision qualities, and supervision purposes. A further round to find consensus was then conducted, with participants providing ratings of statements based on these themes in an online survey. Consensus ratings indicated that functional analysis and experiential learning methods appeared to be central to the practice of CB supervision. Overall, participants described features of CB supervision, which were both consistent with existing ideas on CB supervision and contextual behavioral science, as well as clinical supervision more broadly. The results serve to form a foundation for future research through identifying common and agreed upon factors in CB supervision an inform future research in the area.
Past research has relied on normative analyses for establishing the positive relationship between psychological flexibility (PF) process and well-being. These analyses, however, assume that aggregate-level effects (i.e., this positive relationship) also apply to most individuals, limiting our ability to explore the dynamic and complex nature of PF processes that interact with individual factors. Idionomic analyses, which use idiographic effects as a foundation from which to draw normative conclusions, provide a possible solution. This study used idionomic analysis to assess the degree of non-random individual heterogeneity in the relationship between each PF process and mood, how this relationship changes over time, and the unique effects of each process. From a pre-existing dataset, we analysed data from 103 psychiatric patients (Mage = 37 years, SD = 11.7 years; 47% male) who completed an ACT intervention. Experience sampling methods were used to repeatedly measure PF processes and mood at pre- and post-intervention. Traditional normative analyses showed an average positive relationship between each PF process and mood. However, idionomic analyses uncovered significant person-specific heterogeneity for several PF processes. The strength and direction of each relationship varied depending on the person, the specific PF process, and the temporal effects that were masked in the aggregate findings. We highlight the value of idionomic analyses in capturing, with greater depth and precision, within-person heterogeneity in the PF process-mood relationship. Idionomics has the potential to advance our development of empirically-based and personalised interventions, thus going beyond the general statement of "it depends" to a specification of how it does so.
Background: Mobile apps show promise for teaching mindfulness skills, but poor engagement limits their therapeutic impact. Most apps rely on audio-guided meditations, highlighting the need to explore novel delivery methods. This study evaluated the feasibility of delivering the dropping anchor mindfulness exercise as an annotated image sequence via the ACTaide prototype app. Methods: This 4-week, parallel two-arm randomized feasibility trial was conducted virtually from October to December 2024. Distressed Canadian adults were recruited through Prolific. Participants were randomized (blinded) using a computer-generated allocation sequence to the ACTaide prototype (annotated image sequence plus reminders) or a control app (reminders only). Both conditions included a 1-h workshop introducing the exercise and two weeks of practice using their assigned app. Primary feasibility outcomes included app acceptability, adherence, and retention. Results: Over one month, 296 Prolific members completed screening and 82 were eligible. Of these, 77 were randomized and N = 62 received the intervention (intervention n = 30; control n = 32). Acceptability: 85.71% (95% CI [0.69, 0.94]) of intervention participants rated the ACTaide prototype as sufficiently acceptable. Participants described the image sequence as a helpful tool for focus and memory. Adherence: Despite technical issues with reminders, 73.33% (95% CI: [0.56, 0.86]) of intervention and 81.25% (95% CI: [0.65, 0.91]) of control participants practiced at least once daily on average. Retention: Among participants who received the intervention, 96.77% (95% CI: [89%, 99%]) completed the follow-up. Overall, progression criteria were met and no adverse events occurred. Conclusions: The ACTaide prototype demonstrated feasibility, with participants highlighting the image sequence as an effective tool for learning, remembering, and practicing the mindfulness exercise. Findings support advancement to future trials and provide guidance for assessing efficacy.
Although Acceptance and Commitment Therapy (ACT) has demonstrated efficacy in improving sleep quality and addressing maladaptive sleep-related cognitions, the specific dimensions of psychological (in)flexibility most strongly associated with sleep-related outcomes remain unclear. This study applied network analysis to elucidate the complex relationships between sleep quality, dysfunctional sleep-related cognitions, and psychological (in)flexibility in college students, aiming to identify potential intervention targets. A sample of 1071 Chinese college students (60% female) completed a survey including the Multidimensional Psychological Flexibility Inventory Short Form (MPFI-24), Pittsburgh Sleep Quality Index (PSQI), Dysfunctional Beliefs and Attitudes about Sleep Scale-16 (DBAS-16), and Insomnia Severity Index (ISI). Two complementary network analytic approaches were utilized: a Gaussian Graphical Model (GGM) to identify central and bridge nodes, and a Directed Acyclic Graph (DAG) to reveal plausible directional associations among core variables by detecting potential upstream nodes and directional paths. The GGM identified several core components of the network: attachment to the conceptualized self, cognitive fusion, inaction, and contact with the present moment. Experiential avoidance emerged as a pivotal bridge symptom, linking different variables clusters and potentially facilitating symptom co-occurrence. The DAG analysis revealed contact with the present moment occupied a potential upstream position, displaying direct and/or indirect directed associations with other core components identified in the GGM. Furthermore, daytime dysfunction and values were also identified as significant upstream variables. These findings suggest that contact with the present moment, values, and experiential avoidance may be candidate targets for ACT-based interventions addressing insomnia.
Background This study showcases how three advanced algorithms—iARIMAX, iBoruta, and tsBoruta—identify personalized treatment processes in clinical psychology, using hair-pulling (trichotillomania) as an empirical case. Method We compared these methods with previous findings and assessed their ability to detect linear and nonlinear associations. We predicted the methods to converge on cognitive fixation as a core predictor of hair-pulling and expected substantial heterogeneity in process-outcome associations—heterogeneity that, if systematic rather than random, could inform the design of personalized interventions. We also predicted tsBoruta would outperform iBoruta due to its consideration of time series elements. Results All three methods confirmed cognitive fixation as a key aggregate level predictor of hair-pulling. While iARIMAX initially showed stronger connections, these became more modest—but still meaningful—when accounting for multiple processes. The Boruta methods showed notable differences in idiographic conclusions, with tsBoruta proving more conservative in confirming significant effects. Notably, 61.11% of participants showed unique combinations of relevant process-outcome links. Targeting three key processes of cognitive fixation, valued action, and anxiety could potentially benefit 52 out of 54 individuals in the sample. Conclusions The findings support combining standardized protocols with personalized interventions that may be valuable for trichotillomania treatment. More broadly, this study provides a methodological tutorial and illustrates how tsBoruta offers a powerful, balanced approach to modeling complexity in clinical data for treatment planning.
