Academic journal article International Journal of Clinical and Health Psychology

Long-Term Outcomes of Acceptance and Commitment Therapy in Drug-Dependent Female Inmates: A Randomized Controlled Trial

Academic journal article International Journal of Clinical and Health Psychology

Long-Term Outcomes of Acceptance and Commitment Therapy in Drug-Dependent Female Inmates: A Randomized Controlled Trial

Article excerpt

Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is the most representative therapy of the contextual therapies. ACT is philosophically based on functional contextualism and has his own model of psychopathology, the psychological inflexibility (Hayes, Levin, Plumb-Vilardaga, Villatte, & Pistorello, 2013; Hayes, Luoma, Bond, Masuda, & Lillis, 2006). Psychological inflexibility is a "transdiagnostic" alternative to the established classification systems. The new proposal is radically different and consists in identifying the common processes that are at the root of the different disorders and proposing a unified concept of the psychopathological condition (Pérez-Álvarez, 2012b).

ACT tries to dismantle the inflexible repertoire that characterizes the experiential avoidance, that is, the tendency to avoid or escape from aversive private events such as thoughts, emotions, memories and bodily sensations (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). One of the main goals of ACT is to increase psychological flexibility, which refers to an individual's ability to connect with the present moment more fully as a conscious human being, and to change or persist in behavior that serves one's valued ends (Hayes et al., 2006). Furthermore, ACT proposes acceptance of the feared private events when the attempt to control them is counterproductive in the long-term. Summing up, there are two principles in ACT intervention: first, to promote values clarification; second, to promote a commitment to act as a way to engage in the valued ends in the presence of the feared private events.

Two major meta-analyses have examined the efficacy of ACT (Öst, 2008; Powers, Zum, & Emmelkamp, 2009). Specifically, Powers et al. (2009) suggested comparing ACT with empirically supported treatments for specific disorders before its application in routine clinical care. However, ACT is now recognized as "empirically supported" by the United States Substance Abuse and Mental Health Service Administration (SAMHSA, 2012), in its national registry of evidence-based programs and practices. Even more, similar to CBT, ACT has showed its efficacy in several mental disorders, i.e. anxiety disorders (Arch et al., 2012; Roemer & Orsillo, 2012), depression (Zettle, Rains, & Hayes, 2011), and personality disorder (Morton, Snowdon, Gopold, & Guymer, 2012).

Currently, a certain degree of controversy remains about the empirical status of ACT in addictive behaviors. Few randomized controlled trials (RCT) have been published comparing ACT with other interventions: Twelve-step Facilitation, Pharmacotherapy, Cognitive Behavioral Therapy (CBT) and Counseling (Gifford et al., 2011; Hayes et al., 2004b; Smout et al., 2010; Stotts et al., 2012). The results are promising for ACT. In polysubstance-abusing opiate addicts, Hayes et al. (2004b) compared Methadone Maintenance (MM) alone to MM in combination with Intensive Twelve-step Facilitation (ITSF) or ACT. The results suggested that both ACT and ITSF may add to the benefits of MM in the reduction of drug use. However, there were differential effects between ACT and ITSF in drug use outcomes at follow-up. The ACT participants showed lower rates of drug use compared to the MM participants. In smoking cessation, Gifford et al. (2011) have compared ACT with a pharmacological treatment. In general, there were no differences between conditions at post-treatment; however, ACT participants had better long-term smoking outcomes at the 1-year follow-up.

Lastly, in methamphetamine abuse, Smout et al. (2010) randomized 104 treatment-seeking adults to receive ACT or CBT. There were no significant group differences in treatment attendance and methamphetamine-related outcomes. Methamphetamine use, negative consequences, and dependence severity significantly improved over time in both groups. However, serious methodological problems limit the conclusions of this study. …

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