Assessing acceptance and commitment therapy for adolescent mental health: Single-case A-B design with high temporal density assessments

Abstract

Using a single-case A-B design with high temporal density assessments, the present study examined the impact of a ten-session group-based acceptance and commitment therapy (ACT) intervention on adolescents’ distress, psychological inflexibility, cognitive fusion, generalized pliance, and perceived ply workability. Six participants aged 16 to 19 years were invited to (i) attend a weekly ACT group, submit ecological momentary assessments daily for 69-days, and (iii) complete standardized questionnaires pre- and post-intervention. Data were analyzed using Hussey’s (2019) R Package for Robust Visualization, Analysis, and Meta Analysis of A-B Designs. In terms of the ecological momentary assessments, avoidance and pliance ratings significantly decreased across time for most participants. Findings regarding perceived ply workability were less consistent (i.e., although ply workability ratings significantly decreased for three participants, the overall effect was not statistically significant). In terms of the standardized questionnaires, across participants, there were overall negligible changes in distress and pliance, while avoidance and fusion ratings decreased from pre- to post-intervention. Results are discussed with explicit reference to the need for future research that identifies the key mechanisms/processes of change underlying intervention effectiveness.

Chatbot-delivered acceptance and commitment therapy with adolescents: A pilot randomized controlled trial

“…However, our findings also deviate from those of Levin et al (2014), since unlike them, we observed no significant improvements in psychological flexibility post-intervention. Finally, our findings regarding the effects of ACT on pliance and tracking (as per the standardized measures) depart from extant research evidencing that ACT reduces problematic rule-following (Ruiz et al, 2020b;Salazar et al, 2020;Stapleton et al, 2022b).…”

“…Second, the present study is one of few to explicitly target problematic rule-following (Ruiz et al, 2020b;Salazar et al, 2020;Stapleton et al, 2022b), and is the only study to measure both pliance and tracking. Third, we collected both quantitative and qualitative intervention satisfaction data, the latter of which is often overlooked in acceptability trials (Lavelle et al, 2022).…”

“…Supporting this, research has observed negative correlations between generalized pliance and hexaflex components (Stapleton et al, 2022a;Waldeck et al, 2019), in addition to positive correlations between tracking and hexaflex components (Ruiz et al, 2020a). Although few empirical studies have directly examined the effects of ACT on pliant rule-following, available studies report that ACT was associated with lesser problematic pliance post-intervention (Ruiz et al, 2020b;Salazar et al, 2020;Stapleton et al, 2022b). Notably, to date, no studies have examined the effects of ACT on tracking.…”

“…Second, relative to the use of ACT with adults, there are fewer empirical studies examining the effectiveness of ACT with young people (Swain et al, 2015), with no published RCTs evaluating chatbot-delivered ACT for youth (Zhou et al, 2021). Third, few studies have explicitly targeted problematic rule-following (Ruiz et al, 2020b; PILOT RCT: CHATBOT-DELIVERED ACT WITH ADOLESCENTS 8 2020; Stapleton et al, 2022b), with none measuring both pliance and tracking. Finally, as per Feeley et al (2009), conducting a pilot RCT would allow us to assess the feasibility and acceptability of our design, procedure, and the chatbot intervention itself (i.e., both participants' satisfaction and intervention effectiveness), in addition to facilitating estimates of effect sizes yielded from our intervention (if any) for use in future sample-size calculations.…”