Academic journal article International Journal of Psychology and Psychological Therapy

Acceptance and Commitment Therapy (ACT) in the Treatment of Panic Disorder: Some Considerations from the Research on Basic Processes

Academic journal article International Journal of Psychology and Psychological Therapy

Acceptance and Commitment Therapy (ACT) in the Treatment of Panic Disorder: Some Considerations from the Research on Basic Processes

Article excerpt

Panic disorder (PD) is traditionally defined by the occurrence of unexpected and intense episodes of fear accompanied by physical and cognitive symptoms (American Psychiatric Association, 1994). Some of the most salient characteristics of PD are: 1) Panic attacks are accompanied by worries about future attacks, the consequences of attacks, or behavioral changes related to the attacks; and 2) it usually involves the avoidance of situations, behaviors or events that may produce similar somatic symptoms to those experienced during a panic attack. Individuals with PD usually present an early learning history in which the potential dangers of physical sensations have been emphasized. Also, those individuals are most likely to have observed panic symptoms or chronic illnesses in their family members, and to have received parental encouragement for sick-role behavior during their own experiences of panic-like symptoms (Orsillo, Roemer, Block-Lerner, LeJeune, & Herbert, 2004).

The first choice treatments for such disorders are the diverse variations of exposure techniques and cognitive restructuring (e.g., Barlow, Raffa & Cohen, 2002; Task Force on Promotion and Dissemination of Psychological Procedures, 1995). As quoted by Orsillo et al. (2004), cognitive-behavioral treatment (CBT) for PD has yielded large effect sizes (.68 to .88; Gould, Otto & Pollack, 1995), estimating that between 41% and 100% of clients are panic free 12 months following the termination of treatment (Barlow, 2002). It is assumed, thus, that treatments for anxiety disorders that retain and enhance the exposure component are most likely to produce clinically significant and meaningful results.

Nonetheless, there are a number of gaps in the literature on the efficacy, effectiveness, and efficiency of those treatments. First, between 20% and 30% of the clients who are administered behavior therapy and CBT do not improve. Second, a percentage of clients (between 5% and 15% depending on the source) quit treatment before it is completed. Third, there is little knowledge about the behavioral processes underlying the changes observed with the application of CBT (Eifert & Forsyth, 2005). These data along with the research on the paradoxical effects of thought suppression first developed by D. M Wegner and colleagues in the 90's (e.g., Wegner, 1994; Wenzlaff & Wegner, 2000), and extended by several authors at present, motivated researchers and clinicians to explore alternative approaches to therapy.

In the process, the research on 1) stimulus equivalence, 2) insensitivity to the change in the contingencies observed in rule-governed behavior, and 3) behavior-behavior arbitrary relations, was specially considered (Hayes, Strosahl, & Wilson, 1999). The result was what has been termed as Third Wave Behavior Therapy (Hayes, 2004), out of which we will focus in the Acceptance and Commitment Therapy as the most complete of the therapies included in this tradition. The three main descriptors of ACT according to Hayes, Strosahl, Bunting, Twohig and Wilson (2004) are the following. First, its basic foundations stem from the Relational Frame Theory (RFT; Hayes, Barnes- Holmes, & Roche, 2001); second, ACT assumes the basic principles of the Functional Contextualism (Gifford & Hayes, 1999; Hayes, Strosahl, & Wilson, 1999); and third, it proposes a functional model of psychopathology with the Experiential Avoidance Disorder as the functional diagnostic dimension present across several diagnostic categories included in the DSM-IV (Hayes, Wilson, Gifford, Follette & Strosahl, 1996; Luciano & Hayes, 2001). Furthermore, there is a special emphasis in the research on processes of change for the development and improvement of the methods and techniques included in ACT, as well as in the strictly functional nature of psychopathology and therapy. This turns ACT into a flexible conceptual and therapeutic model that may be used with multiple and varied problems, as it is being noted across several, but all coherent, treatment manuals (e. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.