Effectiveness of ACT for Anxiety Disorders
Introduction
Acceptance and commitment therapy (ACT) has a lack of research supporting its validity as an evidence-based approach for anxiety. The main objective of this study is to evaluate if ACT is effective as for anxiety disorders as a unified treatment approach by using different delivery methods of the treatment and its efficiency in age groups by reviewing six peer-reviewed articles. An article that evaluates the effectiveness of ACT for anxiety-related concerns by using self-help workbook without no therapist contact has been selected for review. There is also an article that utilized three case studies to exemplify the use of ACT as a unified control protocol. Another article presented the relevance of evaluating children anxiety and psychological flexibility as a means of studying the usefulness of acceptance commitment therapy (ACT). The fourth article examined the treatment of three consecutive referrals under ACT sessions in private practice for anxiety disorder. There was also an article on rationale and considerations of using ACT for older adults. The last article was a study on a randomized controlled trial for ACT in children with an anxiety disorder.
Eifert, G. H., Forsyth, J. P., Arch, J., Espejo, E., Keller, M., & Langer, D. (2009). Acceptance and commitment therapy for anxiety disorders: Three case studies exemplifying a unified treatment protocol. Cognitive and Behavioral Practice, 16(4), 368-385.
When examining this article, Eifert et al. (2009) have employed three cases that employ a unified control protocol of ACT for the treatment of anxiety disorder. In the introduction, the researchers have made an effort to identify the current research by seeking to explain the effectiveness of ACT in treating anxiety disorder. There is no clear identification of the research aims and objectives. It was expected that the researchers could have written a subtopic to indicate the research aims and objectives. Nevertheless, the researchers have clearly explained the theory. The article was aimed at describing the adoption of an integrated acceptance and commitment therapy (ACT) that can be used for handling any anxiety disorder as well as data results from three patients that were diagnosed with the anxiety disorder. The direction of the article is to offer several ways in which ACT can be employed to anxiety disorder victims. It was relevant to see how the researchers utilized literature from other scholars. As (Eifert & Forsyth, 2005) claim, there are two major goals of ACT which are enhancing acceptance of challenging feelings and thoughts that may not require control. The other goal is the action and devotion of an individual to live a life based on their values.
The methodology used in this study was qualitative research methods. This is due to the case studies of three patients suffering from generalized anxiety disorders that were used. The use of the case study provided an exploration of the effectiveness of ACT program and explained. The researchers focused on only recruiting participants from a clinical randomized outcome trial (Herzberg et al. 2009). The sample size comprised of three individuals and this was a small group to provide sufficient information in examining the effectiveness of ACT in treating anxiety disorder. There is a description of the participant’s age or gender. There was one woman of 52 years, a man of 51 years and another man of 31 years. Even in the selection of the three participants, it is noted that there were no criteria that were used. The patients who were visiting a therapist at the time of the study are the ones that were selected, although each one was diagnosed with a varied anxiety disorder. From the small population sample, it could be difficult to generalize the results and even the findings could not be accurate. The articles have appropriate measures such as anxiety sensitivity index and the ACT process measures that are suitable in examining the research topic.
The researcher s presented the results accurately by covering the case description of each patient suffering from an anxiety disorder. Data was presented in tables to illustrate the pre and post process measures acceptance, defusion, mindfulness and the life quality of the participants. Even if the article did not mention the research aims and hypotheses, it could be concluded that the case description results covered major aspects of the ACT program. There was a manual of ACT anxiety treatment clearly articulated and covered various clinical presentations of anxiety disorder among the patients. The article did not have statistical analyses and this is appropriate as the research study was a qualitative research method. The initial findings of the research are sufficient to create a single treatment manual that could be effective in treating anxiety-related illness through ACT. Due to this, it can be said that the results matched the aims and objective of a unified treatment protocol of an integrated acceptance and commitment therapy (ACT) that can be used for handling any anxiety disorder. It is worth to note that the ACT has focused on enhancing a living life and tackling the barriers that are in patients. The research indicated that ACT enhances a sense of empowerment for life when treating patients as they all claimed that it values living and enhances behaviors that are tied to an individual life’s goals.
Simon, E., & Verboon, P., (2016). Psychological inflexibility and child anxiety. Journal of child and family studies, 25(12), 3565-3573.
From the introduction, it is evident that the researchers clearly articulated the research aims and objectives. Simon & Verboon (2016) carried out a research study that made insights into the relevance of evaluating psychological flexibility as a means of studying the usefulness of acceptance commitment therapy (ACT) in children between the ages of 8-11 years. The article has identified the current research and appropriate theories utilized. The investigation was carried out on construct validity, factor structure and the reliability of fusion and avoidance questionnaire among the youth. The questionnaire for fusion and avoidance dealt with psychological inflexibility in adolescents and children. In the introduction, Simon & Verboon (2016) have provided an in-depth analysis concerning the topic of study by claiming that the role of Acceptance Commitment Therapy is to improve the quality of life of an individual instead of minimizing the symptomatology of the person. Also, when considering ACT, it focuses on the context of the behavior and thinking of the person who presents its main feature as psychological flexibility.
Based on the research method used to study the topic, it is evident that it was a quantitative type. In a quantitative study, it is important to obtain the consent of the participants before they engage in the questionnaire survey (Rector, 2013). This aspect was very well observed in the research study as the local ethical committee approved the cross-sectional study. The signing of consent is relevant to ensure privacy is put into consideration for the children who took part in the study. When determining the sample size in a quantitative study, it is important to consider the measures of the margin of error and confidence level. In this research study, it recruited 459 children from regular primary schools located in the Netherland, but 267 parents approved the informed agreements for their children. Having a sample size of 267 children with boys being 137, representing 51% and girls being 130 in number or 49% was good for the research study. The sample size was effective in providing appropriate results.
This study provided useful implications on the possibility of evaluating psychological flexibility, which enabled the understanding of the relevance of ACT in children. According to Greco et al. (2008), the level of psychological inflexibility will rise when children become anxious. This concept was evidenced in a study by Simon & Verboon (2016) as there is a good support of the questionnaire in the construct viability due to the positive association that existed from the anxiety symptoms in children and psychological inflexibility. Through applying ACT, it will be possible to help children suffering from an anxiety disorder when clinical experts when decide to review their psychological inflexibility.
In this article, ACT enhances psychological flexibility, but the existing problem is there lacks a validated measure of psychological inflexibility for children in the middle-age. The use of AFQ-Y8 in this research provided a good means in assessing psychological inflexibility considering the main problem in middle-aged children. It will be sufficient for all scientists and clinicians to be capable of evaluating the main outcome of ACT in children as this would lead to determining its effectiveness. Fergus et al. (2011) provided a good insight by suggesting that anxiety develops from a young age in children when compared to all psychiatric disorders apart from developmental disorders. By analyzing the study by Simon & Verboon (2016), it proved that in the middle-aged children, there is a positive correlation of the main outcomes of anxiety and psychological inflexibility from ACT. By conducting the study at a community level, it restricted the generalization of the outcomes. It was necessary to determine the clinical cut-offs by carrying out the research study for all children that were at a mental health center for anxiety treatment.
Ritzert, T. R., Forsyth, J. P., Sheppard, S. C., Boswell, J. F., Berghoff, C. R., & Eifert, G. H. (2016). Evaluating the effectiveness of ACT for anxiety disorders in a self-help context: Outcomes from a randomized wait-list controlled trial. Behavior therapy, 47(4), 444-459.
Ritzert et al. (2016) conducted a research study that examines the usefulness of an ACT (Acceptance and Commitment Therapy) workbook for all related concerns on anxiety without therapist consultation in the international sample. The introduction of the article has offered a vast explanation of the topic of study. The study was also significant in evaluating the effectiveness of Acceptance and Commitment Therapy (ACT) by using an international sample with no therapist contact to denote anxiety-related concerns. The article has not included any research questions, aims and hypotheses. To understand the purpose of the researchers, it was imperative for the readers to examine the entire introduction section. Nevertheless, the researchers made an effort to highlight how the study will highlight the effectiveness of ACT workbook of self-help for people suffering from an anxiety disorder.
This article employed a quantitative research method due to the need to obtain factual data that will answer the research question on providing an extensive assessment of the self-help books of anxiety disorder. It was important if the researchers could utilize a semi-structured interview, which is performed online. This would have been effective in enabling the participants in expressing their views. The materials used in the articled were appropriate and reliable in offering valid measures. It is noted that (Farrand & Woodford, 2013) have considered the self-help bibliotherapy as a system that will reduce the problems emerging from anxiety disorders by increasing the accessibility of evidence-based treatments. The evaluation of an ACT self-help workbook acted as a pragmatic and strategic means. The analysis from this article suggests that the ACT is a trans-diagnostic procedure with the capacity to examine wide behavioral outcomes, procedures and specific treatment components that are empirically supported.
The research utilized a wait-list treatment design, which is mainly effective during the early phases of treatment and distribution of research when assigning control to internal validity threats such as time and during self-help research. It was necessary for the study to select a sample size of 503 participants to provide a sample of the wait-list condition and immediate workshop condition. Having a wide range of sample size was effective in providing a wide range of a given self-reported diagnosis, application of outside therapy and demographic information. The research design guided in demonstrating how the face-to-face therapy has caused many anxiety disorder patients not to receive treatment through examining the effect of the workbook on any related symptoms of anxiety, life quality and processes of ACT treatment. This illustrates that there was a good assessment of the variables that were being examined.
There is a correlation of results of this study to those presented by Arch et al. (2012) on trials of ACT for anxiety disorders from therapist feedback as participants in the workbook group showed pre-post advancement in anxiety sensitivity, symptoms of anxiety and depression and life quality. In the results, there was no significance on the preliminary analyses among group differences on outcome, demographic and variable process. The few self-help workbooks which have empirical support have just examined on specific problems like social anxiety. Such work is important at the initial stages of treatment stages and dissemination. Nevertheless, this research has to widen the scope of work and examine trans-diagnostic processes that result in the high prevalence of anxiety disorder. Even if the findings by Ritzert et al. (2016) are promising, they need to be analyzed with regards to the potential limitations of the study. Moreover, the research study emphasized on an international sample on the effect of utilizing workbook on processes of ACT, which was in line with its development strategy. Another limitation was the high susceptibility of many confounds for wait-list design. Ritzert et al. (2016) managed to use a cross over design to mitigate the mistakes. It is recommended that different conditions such as self-help books or treatments to be used due to empirical support from various trans-diagnostic workbooks of self-help.
Codd III, R. T., Twohig, M. P., Crosby, J. M., & Enno, A. (2011). Treatment of three anxiety disorder cases with acceptance and commitment therapy in private practice. Journal of Cognitive Psychotherapy, 25(3), 203-217.
In this research study, Codd III et al. (2011) examined the treatment of three consecutive referrals under ACT sessions in private practice for anxiety disorder. The introduction of the article provided an in-depth examination of Acceptance and Commitment Therapy (ACT) for anxiety disorder that aimed at reducing the behavior control of anxiety and mainly deals with the change of behavior that is experienced with patient value. In the introduction, the researchers have clearly defined the theory. The article indicates that anxiety disorder has evolved to be a prevalent psychological disturbance that has caused many individuals to look for mental health services. It is difficult for the reader to determine the aims and research questions of the study. The researchers could have stated the research aims and objectives after concluding the introduction. With a clear indication of the research objectives, it is easier to understand what the researchers will cover in the entire research study. The study made a clear identification of the current research by examining the model of ACT to give an insight that they are eager and willing to offer strategies of controlling anxiety. The study from Stewart & Chambless (2009) suggests that ACT will change the practical effects of inner involvements with fewer considerations on the frequency, form, or probability of any group of inner experiences like panic, worry and anxiety sensations. In such a way, this article aids in explaining the effectiveness of ACT for generalized anxiety disorder.
In this study, quantitative method of research was utilized as evidenced by the Anxiety Disorders Interview Schedule conducted on all participants who had DSM-IV. Apart from this, the participants also filled a standardized severity measure on every diagnosis. There has to be a procedural collection of data when using quantitative research. In this research study, ACT in private practice was utilized to treat various cases of anxiety disorder. The article also used statistical analysis and standardized measures to analyze the collected data and provide results and findings. The sample size comprised of three participants, which were not appropriate in giving adequate validation about the treatment of anxiety disorder using ACT. According to Kelly & Forsyth (2009), the treatment of a bigger population sample would be appropriate and reasonable due to the similarities and differences that would be noted in the process. Nevertheless, when viewing from another perspective, the use of three participants was to increase accuracy and make the various stages of treatment easier as they ranged from 8 to 17 months.
It was relevant to how Codd III et al. (2011) utilized different measures in the research study. The weekly avoidance and anxiety measure enabled the participants to report about their average anxiety during a day. From this study, it was evident that there were clinical and experimental implications. The study acted as the first to use ACT for monitoring changes in anxiety disorder and evaded the application of time series design. Also, the data is noted to be not definitive, although it has demonstrated consistency. It is noticed that the findings support the change procedures that entailed changing the role of anxiety over the severity. The implication is that there can be a successful treatment of anxiety disorder by examining the functional effect of anxiety on behavior over the anxiety level. One of the limitations was that the study was carried out by a full-time practitioner, which proved to have insufficient experimental controls in the results. The lack of control participants also showed that there was no understanding of how the outcomes were affected by nonspecific treatment factors. Nevertheless, this study offered a good appraisal of unified ACT protocol for anxiety disorder that would be supported by exposure procedures.
Swain, J., Hancock, K., Dixon, A., Koo, S., & Bowman, J. (2013). Acceptance and Commitment Therapy for anxious children and adolescents: study protocol for a randomized controlled trial. Trials, 14(1), 140.
In this research study, Swain et al. (2013) provide a procedure of randomized controlled trial whereby it investigates the effectiveness of Acceptance and Commitment Therapy program for children and adolescents having a primary diagnosis of anxiety disorder. The article is well presented as there is an abstract that describes the main topics to be covered. It is easier for the reader to learn about the background of the study of the research topic by examining the abstract. The introduction has shown how the researchers have used the current research and theories to describe the effectiveness of ACT in the treatment of anxiety disorder. Ciarrocchi et al. (2010) supported the topic of study by suggesting that young people suffering from anxiety are mainly unrepresented in clinical research and health professionals are suitable for minimizing anxiety in children. The structuring of the research paper is well coordinated and the reader can easily the various sections like methodology, research, introduction and abstract. The aims of the study have been clearly articulated at the end of the introduction section. This has made it clear for the readers to understand and make good relation with the literature review.
By examining the research study, it was evident that it used various hypotheses which have been clearly described. The first was that ACT would guarantee effectiveness in anxiety disorder treatment in the selected children and adolescents. Another hypothesis was that ACT would be highly effective in anxiety disorders treatment in the population about the control condition at the post-treatment and 3-month follow up on the measures of outcomes. Despite the use of a randomized controlled trial as study design, the research study was mainly quantitative. The method used in this study was very complicated, but it could be described as experimental research. The sample size was enough to support the research aims. According to the researchers, the participants were recruited through referrals to the hospital for children. The use of inclusion criteria by the researchers was relevant in identifying the recommended target audience. The experiment was supported by 150 children aged 7-17 years with a diagnosis of DSM-IV anxiety disorder who acted as the participants. It is understood that through a baseline evaluation, the participants were randomized to any of the condition of waitlist control or acceptance and commitment therapy.
In the research study, there was scarcity in investigating the effectiveness of ACT among children suffering from anxiety disorder despite ACT being supportive in the anxiety treatment among adults. After reviewing the ideas of the researchers, it can be concluded that the controlled trial was the first investigating the usefulness of ACT in children with an anxiety disorder. The research failed to justify the aims and hypothesis presented as there was no evidence of any results for the research. Due to this, several implications and recommendations had to be raised to support the study. It is necessary that this research is performed in clinical practice to evaluate the psychological interventions that are vital for effecting in a wider psychological setting. By being successful in clinical practice, the randomized controlled trial will aid in creating ACT treatment protocols that will be utilized in the private and public setting by clinicians. The study experienced limitations of the trial as recruitment and retention of adolescents. The problem was caused by the strict exclusion and inclusion criteria that needed a primary analysis of anxiety disorder and the lack of complex situations like suicidality and ability of the adolescent to manage a full-time commitment to the sessions. It is important that the researchers provide results of the controlled trial to show how well the study design enhanced the effectiveness of ACT for anxiety disorders in children.
Petkus, A. J., & Wetherell, J. L. (2013). Acceptance and commitment therapy with older adults: Rationale and considerations. Cognitive and behavioral practice, 20(1), 47-56.
The article by Petkus & Wetherell, (2013) examined the older adults as a growing population who have assisted in the provision of a system that uses ACT for research and gerontological theory. The article has also focused on the related processes of ACT that are employed among older adults. This research has provided an abstract that has communicated clear and succinct information about the rationale and considerations of ACT in treating older adults. One problem about this research study is that there are no topics to clarify the abstract, introduction, research design and results. The main advantage is that the theory and current research has been discussed extensively. Research about the older adults on anxiety is connected to various outcomes such as greater impairment functional, higher risks of home nursing placement, higher utilization levels on health care and reduced quality of life (Juncos & Markman, 2016).
There is no identification of the research aims and hypotheses. The researchers have provided a broad research theory at the start of the study without indicating which part is the introduction and where does the literature review begin. There is a big problem in identifying the research aims as the reader is expected to first few topics to get an overview of the key purpose of the study. There is extensive literature which has supported that the Acceptance and Commitment Therapy (ACT) is a new approach for treating anxiety disorder based on the aging of adults, development, emotion regulation and vast knowledge on anxiety disorder. The organization of the article is very poor as a recommendation topic about the treatment of older adults is provided before carrying out the research design and analyzing the results.
The research method in this article is mainly qualitative due to the use of a case study to examine the anxiety problems of a 69 years old man. It would be necessary to have a woman as a participant in the study to have a representation of both sexes and also allow comparing and contrasting the results of ACT. The sample size in this study is not enough due to the use of one participant. Petkus & Wetherell, (2013) could have included at least ten participants of various age, sex and all suffering from anxiety disorder to ensure they collect vast data that will support the research aims and hypotheses. Despite using one participant, the measures and variables used have been reliable and good in providing the correct data. The use of 12 sessions in the treatment plan for Joe indicated all the measures that the researchers aimed at testing. The selection criteria of the participant are also not described. Even if the participant suffered from an anxiety disorder, it was imperative for the researchers to provide reasons for selecting one individual, particularly a man and not a woman.
The results were clearly articulated and supported the purpose of the study, as indicated in the abstract of the research. There were no statistical analyses for the results because it was a qualitative study. The results proved that the use of ACT in treating people with an anxiety disorder is effective as the participant was active to take part in valued behaviors like contacting the friends and making job applications. The research outcomes were merged with the discussions and findings. It is recommended that the results could have been presented in a specific section and then the discussions to follow. The findings could have addressed how the older adults have been underrepresented and there is a need to conduct gerontological studies to champion the use of ACT among the old.
Conclusion
In this study, different peer-reviewed articles have mentioned the effectiveness of ACT for Anxiety disorder over different demographics groups and therapy delivery methods. The Acceptances and Commitment Therapy in private practice examined the problem regarding generalized anxiety disorder and self-help context has provided solution of improving the quality living of an individual. Three case studies of exemplifying a unified treatment protocol have critique regarding anxiety problems which has hampered and destroyed those from the individuals’ life along with the people the patients surround those. On the contrary, Acceptance and Commitment Therapy (ACT) For Generalized Anxiety Disorder’ highlighted those social policies that might that would lead to affecting the future generations by the issues regarding it. Therefore only a pre and post treatment observation is not enough to find a solution of anxiety disorder. It is recommended that to solve the anxiety disorder problems; there is a need to focus on the core problems behind the issue rather than other factors. There should be a manual of ACT for anxiety treatment that is clearly articulated and covers various clinical presentations of anxiety disorder among the patients. In the middle-aged children, there is a positive correlation of the main outcomes of anxiety and psychological inflexibility from ACT and this calls for a determination of the clinical cut-offs by carrying out the research study for all children that were at a mental health center for anxiety treatment. The randomized controlled trial will aid in creating ACT treatment protocols that will be utilized in the private and public setting by clinicians when it is successful in such practice.
