Integrating nature into acceptance and commitment therapy for anxiety and comorbid medical diagnosis: Two case studies

The effectiveness of integrating nature-based interventions into acceptance and commitment therapy (ACT) for individuals with anxiety and comorbid medical diagnosis was examined. Participants experienced a 5-minute nature-based exercise before every session and were asked to spend at least 15 minutes in nature every day between sessions. These nature-based interventions were integrated with an adapted eight-week protocol for ACT. Relying on a quasi-experimental single subject design involving two participants from the Pacific Northwest, this study found clinically significant changes in anxiety, mindfulness, and experiential avoidance for participant one but clinically non-significant change in these areas for participant two. Although change in general health was found to not be clinically significant at post-treatment for both participants, it was at 3-month follow-up for participant one. Common journal themes for the two participants included an increased sense of calmness and increased present moment awareness with insight. Limitations included absence of a control group, an untested protocol, restricted generalizability, and the use of self-report measures. This was the first study to use a combination of nature-based intervention and ACT to treat this population. The potential effectiveness of using nature-based interventions was supported. Future research is needed to test whether a true difference exists between treatment using ACT with a nature-based component and ACT alone through randomly-controlled study. Also, future research should compare the effects of this treatment with PTSD versus GAD, as well as its impact on individuals with and without a comorbid medical diagnosis. Other research could explore ways to maximize the effectiveness of nature-based interventions and help individuals overcome barriers to spending time in nature. Further research could investigate more extensive long-term effects. Degree Type Dissertation Rights Terms of use for work posted in CommonKnowledge. Comments Library Use: LIH This dissertation is available at CommonKnowledge: http://commons.pacificu.edu/spp/1121 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use. If you have received this document through an interlibrary loan/document delivery service, the following terms of use apply: Copyright in this work is held by the author(s). You may download or print any portion of this document for personal use only, or for any use that is allowed by fair use (Title 17, §107 U.S.C.). Except for personal or fair use, you or your borrowing library may not reproduce, remix, republish, post, transmit, or distribute this document, or any portion thereof, without the permission of the copyright owner. [Note: If this document is licensed under a Creative Commons license (see “Rights” on the previous page) which allows broader usage rights, your use is governed by the terms of that license. ] Inquiries regarding further use of these materials should be addressed to: CommonKnowledge Rights, Pacific University Library, 2043 College Way, Forest Grove, OR 97116, (503) 352-7209. Email inquiries may be directed to:. copyright@pacificu.edu This dissertation is available at CommonKnowledge: http://commons.pacificu.edu/spp/1121 INTEGRATING NATURE INTO ACCEPTANCE AND COMMITMENT THERAPY FOR ANXIETY AND COMORBID MEDICAL DIAGNOSIS: TWO CASE STUDIES A DISSERTATION SUBMITTED TO THE FACULTY OF SCHOOL OF PROFESSIONAL PSYCHOLOGY PACIFIC UNIVERSITY HILLSBORO, OREGON BY KEITH M. INGULLI IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PSYCHOLOGY JUNE, 5, 2014 APPROVED BY THE COMMITTEE: Michael Christopher, PhD, Chair Paul Michael, PhD, Reader PROFESSOR AND DEAN: Christiane Brems, PhD, Dean