Using Session-by-Session Measurement to Compare Mechanisms of Action for Acceptance and Commitment Therapy and Cognitive Therapy
Using Session-by-Session Measurement to Compare Mechanisms of Action for Acceptance and Commitment Therapy and Cognitive Therapy
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DOI：
10.1016/j.beth.2011.07.004
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发表时间：
2012-06-01
期刊：
影响因子：
3.7
通讯作者：
Moitra, Ethan
中科院分区：
文献类型：
--
作者：
Forman, Evan M.;Chapman, Jason E.;Moitra, Ethan
关于认知行为疗法（CBT），包括标准CBT（即，Beckian认知疗法[CT]）和接受与承诺疗法（ACT）得到中介分析的支持。此外，CT和ACT的独特性也受到质疑。在这一竞技场中，造成持续不确定性的一个因素是缺乏随时间变化的过程数据。在这项研究中，174名患有焦虑或抑郁症的大学诊所患者被随机分配接受ACT或CT治疗，并在每次治疗前完成了对理论介质和结果的评估。分层线性模型的会话数据显示，增加利用认知和情感的变化策略相对于利用心理接受策略介导的结果CT，而ACT的调解效果是在相反的方向。自我报告的功能失调性思维，认知“去融合”（将自己的想法视为精神事件而非现实表征的能力）以及尽管有不愉快的想法或情绪仍愿意参与行为活动的减少是治疗中的等效介质。这些结果有潜在的影响，背后的理论论据，和独特性，CT和ACT。
Debate continues about the extent to which postulated mechanisms of action of cognitive behavior therapies (CBT), including standard CBT (i.e., Beckian cognitive therapy [CT]) and acceptance and commitment therapy (ACT) are supported by mediational analyses. Moreover, the distinctiveness of CT and ACT has been called into question. One contributor to ongoing uncertainty in this arena is the lack of time-varying process data. In this study, 174 patients presenting to a university clinic with anxiety or depression who had been randomly assigned to receive either ACT or CT completed an assessment of theorized mediators and outcomes before each session. Hierarchical linear modeling of session-by-session data revealed that increased utilization of cognitive and affective change strategies relative to utilization of psychological acceptance strategies mediated outcome for CT, whereas for ACT the mediation effect was in the opposite direction. Decreases in self-reported dysfunctional thinking, cognitive "defusion" (the ability to see one's thoughts as mental events rather than necessarily as representations of reality), and willingness to engage in behavioral activity despite unpleasant thoughts or emotions were equivalent mediators across treatments. These results have potential implications for the theoretical arguments behind, and distinctiveness of, CT and ACT.