Effectiveness of acceptance and commitment therapy for worry and rumination
Creators: name: Slevison, Monique
Publisher: name: RMIT University
Year: 2024

description: Research on psychological interventions for worry and rumination is limited, in spite of the prevalence of these cognitive processes across clinical disorders, and their role in the onset and maintenance of depressive and anxiety disorders in particular. The two studies which comprise this research programme sought to explore the effectiveness of Acceptance and Commitment Therapy in the treatment of worry and rumination as transdiagnostic psychological processes. <br>In Study One, a case study design was used to explore the outcomes of a group ACT intervention delivered in a community setting for one individual experiencing worry and rumination in the context of anxiety and minor depression. The intervention involved seven 2-hour sessions and one 4-hour session. The participant completed quantitative outcome measures assessing worry, rumination, psychological symptomatology, ACT-related variables, and functional impairment at baseline, post-treatment, and 3-month follow-up. An interview was also conducted with the participant following the completion of the intervention. Data indicated that following the intervention the participant experienced significant reductions anxiety and rumination, which were maintained at 3-month follow-up. There were also improvements in mindfulness and functionality, however these were not maintained. There was no significant change in the participant’s worry, nor was change observed in the ACT constructs of experiential avoidance and valued living. The interview data revealed that the mindfulness and values aspects of the ACT intervention had the strongest and most lasting impact on the participant, and that she used mindfulness to manage her rumination. Furthermore, the interview data highlighted potential differences between worry and rumination, and suggested that an individual’s engagement with ACT may be mediated by their prior experience with CBT. <br>In order to expand on the findings observed in Study One and to explore the effectiveness of ACT for worry and rumination with a larger sample, Study Two utilised a within-subjects repeated measures design to explore the research questions amongst individuals with a range of transdiagnostic psychological problems. The intervention was delivered through the outpatient service of a private psychiatric hospital, and consisted of 10 sessions which were 4.5 hours each in duration. Forty individuals (11 male, 29 female; M = 42.58, SD = 11.45) completed baseline measures of worry, rumination, psychological symptomatology, ACT-related variables, and quality of life. Eighteen of these participants (6 male, 12 female) completed the same measures at post-treatment, and 4 completed the measures for a third time at 1-month follow-up (1 male, 3 female). <br>Data revealed that following the intervention there were significant reductions in participants’ worry, rumination, depression, anxiety and stress, experiential avoidance and cognitive fusion, and improvements in participants’ mindfulness, valued living, life satisfaction, personal wellbeing, and functionality. Follow-up data indicated that changes in worry, ACT constructs, and personal wellbeing were maintained, however depression, anxiety and stress increased at 1-month follow-up (although scores remained reduced from baseline levels). <br>The present research provides preliminary support for the effectiveness of ACT for worry and rumination. Explanations of the clinical implications of the findings in addition to the discrepancies between the two studies are discussed. The author proposes a theoretical model of ACT for worry and rumination along with an intervention framework to better target the application of ACT in the treatment of these cognitive processes.<br><br>