Blended care in the treatment of subthreshold symptoms of depression and psychosis in emerging adults:A randomised controlled trial of Acceptance and Commitment Therapy in Daily-Life (ACT-DL)

In this study, the feasibility and efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), ACT augmented with a daily life application, was investigated in 55 emerging adults (age 16 to 25) with subthreshold depressive and/or psychotic complaints. Participants were randomized to ACT-DL (n = 27) or to active control (n = 28), with assessments completed at pre- and post-measurement and 6- and 12-months follow-up. It took up to five (ACT-DL) and 11 (control) months to start group-based interventions. Participants attended on average 4.32 out of 5 ACT-DL sessions. On the app, they filled in on average 69 (48%) of signal-contingent beep-questionnaires, agreed to 15 (41%) of offered beep-exercises, initiated 19 on-demand exercises, and rated ACT-DL metaphors moderately useful. Relative to active control, interviewer-rated depression scores decreased significantly in ACT-DL participants (p =.027). Decreases in self-reported depression, psychotic-related distress, anxiety, and general psychopathology did not differ between conditions. ACT-DL participants reported increased mean NA (p =.011), relative to active controls. Mean PA did not change in either group, nor did psychological flexibility. ACT-DL is a feasible intervention, although adaptations in future research may improve delivery of and compliance with the intervention. There were mixed findings for its efficacy in reducing subthreshold psychopathology in emerging adults. Dutch Trial Register no.: NTR3808

Acceptance and Commitment Therapy and white matter plasticity in individuals with subclinical depression and psychotic experiences: A Randomised Controlled Trial

Background: Research indicates that Acceptance and Commitment Therapy in Daily Life (ACT-DL) is effective in reducing symptoms of depression, anxiety and psychosis. During adolescence, vulnerability to psychopathology peaks, creating a window for early interventions, while white matter development is ongoing. This study aims to examine microstructural white matter after ACT-DL intervention in youngsters with mild psychopathology. Methods: Forty-five individuals with mild psychopathology were randomly allocated to ACT-DL (n=20) or topic discussion control (TD, n=25). Symptomatology was assessed with the Community Assessment of Psychic Experiences (CAPE), Montgomery–Åsberg Depression Rating Scale (MADRS) and the Experience Sampling Method (ESM). Diffusion Weighted Imaging (DWI) and network-connectivity parameters were obtained and compared before and after the intervention/control condition. Interactions between microstructural white matter change and condition were examined in models of CAPE positive symptoms and ESM subclinical psychotic experiences (PE) and negative affect (NA) levels. Results: ACT-DL, compared to TD, was associated with changes on subclinical depressive and psychotic symptom levels. There was no significant change in DWI or network connectivity in either condition and no significant difference between both conditions. In the model of NA, several regional interactions between condition and network measures were significant, but stratification per condition provided no significant associations. There were no significant interactions between DWI or network connectivity parameters and condition in the models of the CAPE positive symptoms, MADRS and PE. Conclusions: The findings suggest that behavioral (symptom) changes are more sensitive to a five-week psychological training than microstructural white matter changes which did not show significant changes over time

Third wave behaviour therapy: process measures and contextual interventions

Acceptance and commitment therapy (ACT) is a form of behavioural therapy that focuses on developing psychological flexibility (resilience). The first part of this dissertation describes the measurement tools currently available and focuses on the development of a new valid and reliable questionnaire – the Flexibility Index Test (FIT-60)* – to identify psychological flexibility. The second part describes the application of ACT in the daily life of clients using an mHealth intervention. The initial results in the field of feasibility and acceptability are positive; follow-up research on its effectiveness is currently on-going. * Available for free at www.hoeflexibelbenjij.n

Early maladaptive schemas and their relation to personality disorders:a correlational examination in a clinical population

Personality Disorder (PD) pathology has been linked to Early Maladaptive Schemas (EMSs; Young, 1999). Because of a large heterogeneity in study populations, sample size, statistical analyses and conceptualizations in the literature, the exact relationships between PDs and EMSs are still unclear. The current study examined the relationship between borderline, dependent, avoidant and obsessive-compulsive PDs, represented dimensionally as number of traits, and 15 different EMSs as measured by the YSQ. A total of N = 130 inpatients took part in the study (Mage = 43.6, gender = 51.5% female). Stepwise regressions indicated that borderline, dependent, avoidant and obsessive-compulsive PD traits were partly characterized by specific EMSs and EMSs grouped as domains (i.e. other-directedness domain for dependent PD and overvigilance for obsessive-compulsive PD), and that relations with a variety of domains and EMSs were overlapping for the PD dimensions (i.e. disconnection and rejection for both borderline and avoidant PD). This suggests that PDs are reflected by a hybrid model of EMSs, with some EMSs and domains that relate to a broader vulnerability factor for PDs, and other domains that differentially relate to the independent PDs. Findings are informative for clinicians, as various EMSs per PD may be targeted in therapy

Early maladaptive schemas and their relation to personality disorders: a correlational examination in a clinical population

Personality Disorder (PD) pathology has been linked to Early Maladaptive Schemas (EMSs; Young, 1999). Because of a large heterogeneity in study populations, sample size, statistical analyses and conceptualizations in the literature, the exact relationships between PDs and EMSs are still unclear. The current study examined the relationship between borderline, dependent, avoidant and obsessive-compulsive PDs, represented dimensionally as number of traits, and 15 different EMSs as measured by the YSQ. A total of N = 130 inpatients took part in the study (Mage = 43.6, gender = 51.5% female). Stepwise regressions indicated that borderline, dependent, avoidant and obsessive-compulsive PD traits were partly characterized by specific EMSs and EMSs grouped as domains (i.e. other-directedness domain for dependent PD and overvigilance for obsessive-compulsive PD), and that relations with a variety of domains and EMSs were overlapping for the PD dimensions (i.e. disconnection and rejection for both borderline and avoidant PD). This suggests that PDs are reflected by a hybrid model of EMSs, with some EMSs and domains that relate to a broader vulnerability factor for PDs, and other domains that differentially relate to the independent PDs. Findings are informative for clinicians, as various EMSs per PD may be targeted in therapy

ImpACT study: feasibility, effectiveness and evaluation of an online ACT training for students

The mental health of students in higher education is increasingly a concern for society (Campbell et al, 2022). It is therefore urgently needed that higher education develops an approach aimed at prevention and support for students facing high levels of stress, performance pressure, and loneliness, as well as promoting mental well-being (Rijksoverheid, 2021). Inspiration for this can be drawn from Acceptance and Commitment Therapy (ACT), a widely accessible form of behavior therapy (Gloster et al., 2020; Hayes et al., 2006). ACT aims to increase resilience, which means being able to deal flexibly with thoughts, feelings, and situations while also investing in things that are important (values). This is referred to as psychological flexibility. Preliminary research within student populations shows that ACT not only promotes mental health but also has positive effects on student engagement and academic progress (Asikainen et al., 2018). The aim of this research is to investigate whether students benefit from taking the online training 'ImpACT: studying with resilience', based on ACT. The training is not specifically aimed at complaints, but provides tools to develop personal resilience and take an active role in life. Thus, the training can contribute to dealing with obstacles (such as stress and performance pressure) during studies and personal development into a powerful professional. References: - Asikainen, H., Hailikari, T., & Mattsson, M. (2018). The interplay between academic emotions, psychological flexibility and self-regulation as predictors of academic achievement. Journal of Further and Higher Education, 42(4), 439–453. doi.org/10.1080/0309877X.2017.1281889 - Campbell, F., Blank, L., Cantrell, A., Baxter, S., Blackmore, C., Dixon, J., & Goyder, E. (2022). Factors that influence mental health of university and college students in the UK: a systematic review. BMC Public Health, 22(1), 1778. doi.org/10.1186/s12889-022-13943-x - Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192. doi.org/10.1016/j.jcbs.2020.09.009 - Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. doi.org/10.1016/j.brat.2005.06.006 - Rijksoverheid. (11 november 2021). Mentale gezondheid studenten onder druk. Geraadpleegd op 18 mei 2023, van rijksoverheid.nl/actueel/nieuws/2021/11/11/mentale-gezondheid-studenten-onder-druk * This project also includes a qualitative evaluation of students’ experiences with the ACT training. A separate preregistration for the qualitative study will be added once the protocol is finalized (expected: November 2025)

ImpACT study: feasibility, effectiveness and evaluation of an online ACT training for students

The mental health of students in higher education is increasingly a concern for society (Campbell et al, 2022). It is therefore urgently needed that higher education develops an approach aimed at prevention and support for students facing high levels of stress, performance pressure, and loneliness, as well as promoting mental well-being (Rijksoverheid, 2021). Inspiration for this can be drawn from Acceptance and Commitment Therapy (ACT), a widely accessible form of behavior therapy (Gloster et al., 2020; Hayes et al., 2006). ACT aims to increase resilience, which means being able to deal flexibly with thoughts, feelings, and situations while also investing in things that are important (values). This is referred to as psychological flexibility. Preliminary research within student populations shows that ACT not only promotes mental health but also has positive effects on student engagement and academic progress (Asikainen et al., 2018). The aim of this research is to investigate whether students benefit from taking the online training 'ImpACT: studying with resilience', based on ACT. The training is not specifically aimed at complaints, but provides tools to develop personal resilience and take an active role in life. Thus, the training can contribute to dealing with obstacles (such as stress and performance pressure) during studies and personal development into a powerful professional. References: - Asikainen, H., Hailikari, T., & Mattsson, M. (2018). The interplay between academic emotions, psychological flexibility and self-regulation as predictors of academic achievement. Journal of Further and Higher Education, 42(4), 439–453. doi.org/10.1080/0309877X.2017.1281889 - Campbell, F., Blank, L., Cantrell, A., Baxter, S., Blackmore, C., Dixon, J., & Goyder, E. (2022). Factors that influence mental health of university and college students in the UK: a systematic review. BMC Public Health, 22(1), 1778. doi.org/10.1186/s12889-022-13943-x - Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192. doi.org/10.1016/j.jcbs.2020.09.009 - Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. doi.org/10.1016/j.brat.2005.06.006 - Rijksoverheid. (11 november 2021). Mentale gezondheid studenten onder druk. Geraadpleegd op 18 mei 2023, van rijksoverheid.nl/actueel/nieuws/2021/11/11/mentale-gezondheid-studenten-onder-druk * This project also includes a qualitative evaluation of students’ experiences with the ACT training. A separate preregistration for the qualitative study will be added once the protocol is finalized (expected: November 2025)

ImpACT: effects of an online ACT-training on students' mental health

The mental health of students in higher education is increasingly a concern for society (Campbell et al, 2022). It is therefore urgently needed that higher education develops an approach aimed at prevention and support for students facing high levels of stress, performance pressure, and loneliness, as well as promoting mental well-being (Rijksoverheid, 2021). Inspiration for this can be drawn from Acceptance and Commitment Therapy (ACT), a widely accessible form of behavior therapy (Gloster et al., 2020; Hayes et al., 2006). ACT aims to increase resilience, which means being able to deal flexibly with thoughts, feelings, and situations while also investing in things that are important (values). This is referred to as psychological flexibility. Preliminary research within student populations shows that ACT not only promotes mental health but also has positive effects on student engagement and academic progress (Asikainen et al., 2018). The aim of this research is to investigate whether students benefit from taking the online training 'ImpACT: studying with resilience', based on ACT. The training is not specifically aimed at complaints, but provides tools to develop personal resilience and take an active role in life. Thus, the training can contribute to dealing with obstacles (such as stress and performance pressure) during studies and personal development into a powerful professional. References: - Asikainen, H., Hailikari, T., & Mattsson, M. (2018). The interplay between academic emotions, psychological flexibility and self-regulation as predictors of academic achievement. Journal of Further and Higher Education, 42(4), 439–453. doi.org/10.1080/0309877X.2017.1281889 - Campbell, F., Blank, L., Cantrell, A., Baxter, S., Blackmore, C., Dixon, J., & Goyder, E. (2022). Factors that influence mental health of university and college students in the UK: a systematic review. BMC Public Health, 22(1), 1778. doi.org/10.1186/s12889-022-13943-x - Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192. doi.org/10.1016/j.jcbs.2020.09.009 - Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. doi.org/10.1016/j.brat.2005.06.006 - Rijksoverheid. (11 november 2021). Mentale gezondheid studenten onder druk. Geraadpleegd op 18 mei 2023, van rijksoverheid.nl/actueel/nieuws/2021/11/11/mentale-gezondheid-studenten-onder-druk * This project also includes a qualitative evaluation of students’ experiences with the ACT training. A separate preregistration for the qualitative study will be added once the protocol is finalized (expected: November 2025)

Loneliness and Mental Health during the COVID-19 pandemic in the Dutch general population: the moderating role of Psychological Flexibility

Previous studies conducted during the COVID-19 pandemic found an increased risk of loneliness due to measurements taken by governments to limit social interaction. The current study addresses the relationship between loneliness and both positive and negative mental health in times of the COVID-19 pandemic and the role of psychological flexibility. Data was collected in the Dutch general population (18+) with two online questionnaires (T1-T2), with an interval of four weeks. A sample of 340 participants varying in age from 18 to 83 years (Mage(SD): 52.83 (13) and 61.8% female, filled in both questionnaires. Loneliness and (the six core processes of) psychological flexibility were measured at T1 and negative mental health (depression, anxiety and stress) and positive mental health (psychological, emotional and social well-being) at T2. Regression analyses indicated a positive prospective relation between loneliness and negative mental health and a negative prospective relation between loneliness and well-being. Psychological flexibility had a moderating effect on the relation between loneliness and negative mental health but not on the relation between loneliness and well-being. Looking at the six core processes of psychological flexibility, only acceptance was a significant moderator of the relation between negative mental health and loneliness. We conclude that while it has yet to be determined whether the moderating relationships found in this study hold beyond COVID-19 conditions, the findings do provide support for the benefits of psychological flexibility to intervene in situations where external circumstances or psychological challenges are beyond one's control