Comparing of Clinical Efficacy of ACT Matrix with ACT Focused on Compassion and Hofmann's CBT on Social Anxiety Disorder

Document Type : Scientific-research

Authors

1 Ph.D. Student Clinical Psychology, Department of Clinical Psychology, College of Economy & Management, Shiraz Branch, Islamic Azad University, Shiraz, Iran.

2 Assistant Professor, Department of Clinical psychology, College of Economy & Management, Shiraz Branch, Islamic Azad University, Shiraz, Iran.

Abstract

Aim: The empirical and theoretical evidence suggest that Cognitive-Behavioral Interventions lack stable efficacy. This study aimed to compare the clinical efficacy of ACT Matrix, ACT Focused on Compassion, and Hofmann's CBT in treating social anxiety disorder.
 
Method: A single-blinded clinical trial with a single-case experimental design, employing a non-concurrent multiple baseline approach, was conducted on 9 students with social anxiety disorder, selected through purposive random sampling. The treatment comprised 12 sessions (60 minutes each) with a two-month follow-up. Liebowitz Social Anxiety Scale (Heimberg & et al., 1999), Self-Compassion Scale-Short Form (Raes & et al., 2011), Acceptance and Action Questionnaire (Second Version, Bond & et al., 2011), and the Valued Living Questionnaire (Wilson & et al., 2010) were used for outcome assessment. Data analysis involved visual drawing, recovery percentage, stable change index, and six indicators of clinical efficiency.
 
Results: All three intervention methods significantly reduced social anxiety (Z<-2.58) and enhanced flexibility (Z>2.58). However, Hofmann's CBT exhibited limited clinical effectiveness in increasing self-compassion and valued living (Z<1.96). These results were sustained at the 2-month follow-up.
 
Conclusion: The ACT Matrix and ACT focused on compassion demonstrated superior clinical efficacy in terms of magnitude of change, stability, total change, and safety compared to Hoffmann's CBT. Nevertheless, all three interventions exhibited similarities in acceptance and generality of change.

Keywords

References

Abbasi, E., Fti, L., Molodi, R., & Zarabi, H. (2012). Psychometric properties of Persian Version of Acceptance and Action Questionnaire–II. Psychological Methods and Models, 3(Vol.2/No.10/Winter 2013), 65-80.  [Link]
Akbari M, Roshan R, Shabani A, Fata L, Shairi M R, Zarghami F.(2015) The Comparison of the Efficacy of Transdiagnostic Therapy Based on Repetitive Negative Thoughts with Unified Transdiagnostic Therapy in Treatment of Patients with Co-occurrence Anxiety and Depressive Disorders: A Randomized Clinical Trial . IJPCP; 21 (2) :88-107. [Link]
Akbari, Mehdi. (2019). Examining the validity and reliability of the Persian version of the Valuable Life Questionnaire: based on the commitment and acceptance approach. Clinical psychology and personality, 16(1), 239-249. doi: 10.22070/cpap.2020.2851.[Link]
Ahmadbeigi, N., Hashemi, T., Parvaz, S., & Karimishahabi, R. (2015). The Role of Attachment Style in Social Phobia Regarding the Mediating Effects of Self Esteem. Psychological Achievements, 22(1), 47-66. [Link]
Alladin, A. (2015). Integrative CBT for anxiety disorders: An evidence-based approach to enhancing cognitive behavioural therapy with mindfulness and hypnotherapy. John Wiley & Sons. [Link]
Allen, A., & Leary, M. R. (2010). Self-compassion, stress, and coping. Social and Personality Psychology Compass, 4(2), 107-118. [Link]
Ayyash-Abdo, H., Tayara, R., & Sasagawa, S. (2016). “Social anxiety symptoms: A cross-cultural study between Lebanon and the UK”. Personality and Individua Differences, 96, 100-105. [Link]
Azadeh, S. M., Kazemi-Zahrani, H., & Besharat, M. A. (2016). Effectiveness of acceptance and commitment therapy on interpersonal problemsand psychological flexibility in female high school students with social anxiety disorder. Global journal of health science, 8(3), 131.‏  [Link]
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in clinical neuroscience, 17(3), 327. [Link]
Bandelow, B., Charimo Torrente, A., Wedekind, D., Broocks, A., Hajak, G., & Ruther, E.  (2004). Early traumatic life events, parental rearing styles, family history of mental disorders, and birth risk factors in patients with social anxiety disorder. European Archives of Psychiatry and Clinical Neuroscience, 254(6), 397-405. [Link]
Boersma, K., Håkanson, A., Salomonsson, E., & Johansson, I. (2015). Compassion focused therapy to counteract shame, self-criticism and isolation. A replicated single case experimental study for individuals with social anxiety. Journal of Contemporary Psychotherapy, 45(2), 89-98. [Link]
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K, M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R., D. (2011). Preliminary Psychometric Properties of the Acceptance and Action Questionnaire-II: A Revised Measure OF Psychological Inflexibility and Experiential Avoidance. Behavior Therapy. [Link]
Boisseau, C. L., Farchione, T. J., Fairholme, C. P., Ellard, K. K., & Barlow, D. H. (2010). The development of the unified protocol for the transdiagnostic treatment of emotional disorders: A case study. Cognitive and Behavioral Practice, 17(1), 102–13. [Link]
Callaghan, G.M., & Darrow, S.M. (2015). "The role of functional assessment in third wave behavioral interventions: foundations and future directions for a fourth wave", Current Opinion in Psychology, 2: 60–64. [Link]
Craske Michelle G., Niles Andrea N., Burkland Lisa J., Wolitzky-Talor Kate B., Vilardaga Jennifer C. Plumb, Arch Jonna G., Saxbe Darby E., Lieberman Mattew D.(2014). Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators. J Consult Clin Psychol.;74(4):658-7. [Link]
Demir, T., Karacetin, G., Demir, D. E., & Uysal, O. (2013). Prevalence and some psychosocial characteristics of social anxiety disorder in an urban population of Turkish children and adolescents. European Psychiatry, 28(1), 64-69. [Link]
Dixon, M. L., Moodie, C. A., Goldin, P. R., Farb, N., Heimberg, R. G., & Gross, J. J. (2020). Emotion regulation in social anxiety disorder: reappraisal and acceptance of negative self-beliefs. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 5(1), 119-129. [Link]
Dryman, M. T., Gardner, S., Weeks, J. W. and Heimberg, R. G. (2016). Social anxiety disorder and quality of life: How fears of negative and positive evaluation relate to specific domains of life satisfaction. Journal of Anxiety Disorders, 38(3): 1-8. [Link]
Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety disorders: A practitioner's treatment guide to using mindfulness, acceptance, and values-based behavior change. New Harbinger Publications. [Link]
Esmaeili, L., amiri, S., Reza Abedi, M., & Molavi, H. (2018). The Effect of Acceptance and Commitment Therapy Focused on Self -Compassion on Social Anxiety of Adolescent Girls. Clinical Psychology Studies, 8(30), 117-137. doi: 10.22054/jcps.2018.8605. [Link]
Farchione, T.J., Fairholme, C.P., Ellard, K.K., Boisseau, C.L., Thompson-Hollands, J., Carl, J.R. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: A randomized controlled trial. Behaviour Therapy, 43(3), 666-78. [Link]
First, M. B., Williams, J. B., Karg, R. S., & Spitzer, R. L. (2016). User's guide for the SCID-5-CV Structured Clinical Interview for DSM-5® disorders: Clinical version. American Psychiatric Publishing, Inc. [Link]
Gadermann, A., Alonso, J., Vilagut, G., Zaslavsky, A., & Kessler, R. (2012). Comorbidity and disease burden in the national comorbidity survey replication (NCS-R). Depression and Anxiety, 29, 797-806. [Link]
Gerhart JI, Baker CN, Hoerger M, Ronan GF. (2014). Experiential avoidance and interpersonal problems: A moderated mediation model. J Contextual Behav Sci.;3(4):291-8. [Link]
Gentili, C., Rickardsson, J., Zetterqvist, V., Simons, L., Lekander, M., & Wicksell, R. K. (2019). Psychological flexibility as a resilience factor in individuals with chronic pain. Frontiers in psychology, 10, 1-11. [Link]
Gilbert P. (2005).Compassion ،conceptualisations, research and use in psychotherapy .Routledge . page 387. [Link]
Gilbert, P. (2009). Introducing compassion focused therapy. Advances in Psychiatric Treatment, 15, 199– 208. [Link]
Gilbert P. (2010). Training Our Minds in, with and for Compassion. An Introduction to Concepts and Compassion-Focused Exercises.
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6-41. [Link]
Ghorbani, N., Watson, P. J., Zhuo, C., & Norballa, F. (2012). Self-Compassion in Iranian Muslims: Relationships with Integrative Self-Knowledge, Mental Health, and Religious Orientation. The International Journal for the Psychology of Religion, 22,106-118. [Link]
Hacker, T., Stone, P., & MacBeth, A. (2016). Acceptance and commitment therapy–do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials. Journal of affective disorders, 190, 551-565. [Link]
Hamidpoor, Hassan. (2007). The importance of methodology in behavioral-cognitive research. Reflection of knowledge, a journal about cognition, brain and behavior. Third period, number 10.
Hasni, Jafar, Fayazi, Morteza, Akbari, Elias. (2015). Validity, validity and confirmatory factor structure of the Farsi version of Leibovitz's social anxiety scale. Social Psychology Research, 6(24). [Link]
Hayes, S. C., & Strosahl, K. D. (2005). A practical guide to acceptance and commitment therapy. Springer Science+ Business Media. [Link]
Hayes, S.C. (2008). The roots of compassion. Keynote speech delivered at the      International ACT Conference, Chicago. [Link]
Hayes SC, Strosahl KD, Wilson KG. (2011). Acceptance and commitment therapy: The process and practice of mindful change: Guilford Press. [Link]
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (2015). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. In The Act in Context (pp. 197-230). Routledge. [Link]
Heimberg, R.G., Brozovich, F.A., & Rapee, R.M.(2010).A cognitive-behavioral model of social anxiety disorder: Update and extension. In S.G. Hofmann & P.M. DiBartolo (Eds.), Social anxiety: Clinical, Developmental, and Social perspectives (2nd ed., pp.395-422). New york: Academic Press. [Link]
Heimberg, R. G., Horner, K. J., Juster, H. R., Safren, S. A., Brown, E. J., Schneier, F. R. & Liebowitz, M. R. (1999). Psychometric properties of the Liebowitz Social Anxiety Scale. Psychological Medicine 29, 199- 212. [Link]
Hezavei, & Rabat Milli. (2019). The effect of "acceptance and commitment therapy" on psychological flexibility and behavioral inhibition of adolescents with social anxiety disorder. Health Promotion Management, 8(6), 18-29. [Link]
Hofmann, S. G., & Hayes, S. C. (2019). The future of intervention science: Process-based therapy. Clinical Psychological Science, 7(1), 37-50. [Link]
Ingram RE, Hayes A, Scott W.( 2000). Empirically supported treatments: A critical analysis. In Snyder CR, Ingram RE (Eds.). Handbook of psychological change: Psychotherapy processes and practices for the 21st century. New York: Wiley; 41-60. [Link]
Kennedy, A.E., Whiting, S.W., Dixon, M.R.(2014). Improving novel food choices in preschool children using acceptance and commitment therapy. Journal of Contextual Behavioral Science, 3(4), 228-235. [Link]
Khoram Nia; Taheri, Amir Abbas; Mohammadpour, Mohsen; Foroughi and Karimzadeh. (2021). The effectiveness of acceptance and commitment therapy on interpersonal sensitivity and psychological flexibility in students with social anxiety disorder: a clinical trial study. Cognition Scientific Research Quarterly, 8(1), 15-27.  [Link]
Kohlenberg, R. J., Tsai, M., Kuczynski, A. M., Rae, J. R., Lagbas, E., Lo, J., & Kanter, J. W. (2015). A brief, interpersonally oriented mindfulness intervention incorporating Functional Analytic Psychotherapy׳ s model of awareness, courage and love. Journal of Contextual Behavioral Science, 4(2), 107-111. [Link]
Kuckertz, J. M., Gildebrant, E., Liliequist, B., Karlström, P., Väppling, C., Bodlund, O., ... & Carlbring, P. (2014). Moderation and mediation of the effect of attention training in social anxiety disorder. Behaviour Research and Therapy, 53, 30-40. [Link]
Liebowitz, M. R., Heimberg, R. G., Fresco, D. M., Travers, J., & Stein, M. B. (2000). Social phobia or social anxiety disorder: what's in a name?. Archives of general Psychiatry, 57(2), 191-192. [Link]
Leichsenring, F. and Leweke, F. (2017). Social anxiety disorder. New England Journal of Medicine, 376(23): 2255-2264.
Lev, A., & McKay, M. (2017). Acceptance and Commitment Therapy for Couples: A clinician's guide to using mindfulness, values, and schema awareness to rebuild relationships. New Harbinger Publications. [Link]
Lutz, A., Slagter, H. A., Dunne, J. D., & Davidson, R. J. (2008). Attention regulation and monitoring in     meditation. Trends in Cognitive Sciences, 12, 163–169. [Link]
Johnson, S. U., Hoffarta, a., Nordahlc, H. M., Wampold B. E. (2017). Metacognitive therapy versus disorderspecific CBT for comorbid anxiety disorders: A randomized controlled trial. Journal of Anxiety Disorders, 50, 103-112. [Link]
Mirsharifa, S. M., Mirzaian, B., & Dousti, Y. (2019). The Efficacy of Acceptance and Commitment Therapy (ACT) Matrix on Anxiety and Quality of Life of Patients with Irritable Bowel Syndrome. International Journal of Medical Investigation, 8(1), 19-30. [Link]
Neff, K. D. (2003b). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85-102. [Link]
Nelson, C. (2020). University student anxiety and stress–exploring the feasibility, suitability, and benefits of ACT matrix group workshops for university students experiencing anxiety and stress (Doctoral dissertation, Laurentian University of  Sudbury). [Link]
Ostadian Khani Z, Fadie Moghadam M. (2017). Effect of Acceptance and Commitment Group Therapy on Social Adjustment and Social Phobia Among Physically-Disabled Persons. jrehab; 18 (1) :63-72. [Link]
Peyamannia, B. (2021). The Effectiveness of ACT Matrix with compassion on cognitive emotion regulation strategy in Students with Test Anxiety Disorders. The Journal of New Thoughts on Education, 16(4), 217-236. doi: 10.22051/jontoe.2020.24026.2494. [Link]
Polk, K. L., Schoendorff, B., Webster, M., & Olaz, F. O. (2016). The essential guide to the ACT Matrix: A step-by-step approach to using the ACT Matrix model in clinical practice. New Harbinger Publications. [Link]
Polk, K. L., Schoendorff, B.(2014).The ACT Matrix, A New Approach to Building Psychological Flexibility Across Settings & Populations. An Imprint of New Harbinger Publications, Inc. [Link]
poursaleh, A., Hamid, N., & Davodi, I. (2020). The effectiveness of Compassion Mind Training (CMT) on social anxiety Symptoms & psychological capitals among female students with social anxiety disorder of Shahid Chamran University of Ahvaz. Thoughts and Behavior in Clinical Psychology, 15(56), 83-94.  [Link]
Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology & Psychotherapy. 18, 250-255. [Link]
Roeen Fard, M., Share, H., & Haghi, E. (2014). The Effectiveness of Heimberg and Becker Cognitive Behavioral Group Therapy in Improving Female Adolescents Social Anxiety and Cognitive Flexibility. Journal of Sabzevar University of Medical Sciences, 21(2), 226-240. [Link]
Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: evaluation in a randomized controlled trial. Journal of consulting and clinical psychology, 76(6), 1083. [Link]
Roohi, R., Soltani, A. A., Zinedine Meimand, Z., & Razavi Nematollahi, V. (2019). The effect of acceptance and commitment therapy (act) on increasing the self-compassion, distress tolerance, and emotion regulation in students with social anxiety disorder. Quarterly Journal of Child Mental Health, 6(3), 173-187. [Link]
Rose, G. M., & Tadi, P. (2021). Social Anxiety Disorder. StatPearls [Internet]. [Link]
Rostami, M., Veisi, N., Jafarian Dehkordi, F., & Alkasir, E. (2014). Social anxiety in students with learning disability: Benefits of acceptance and commitment therapy. Practice in Clinical Psychology, 2(4), 277-284. [Link]
Rubin, K. H., Coplan, R. J., & Bowker, J. C. (2009). Social withdrawal in childhood. Annual Review of Psychology, 60, 141‐171. [Link]
Sabze Arai Langroudi, Milad (2012). The relationship between desires and dependencies of self-worth with self-compassion, unhealthy narcissism, coherent self-knowledge and self-respect. Master's Thesis in Psychology, Faculty of Psychology and Educational Sciences, University of Tehran.  [Link]
 
Siegel, A.N., & Kocovski, N. L. (2020). Effectiveness of Self-Compassion Inductions Among Individuals with Elevated Social Anxiety. Mindfulness, 1-9. [Link]
Spence, S. H., Donovan, C. L., March, S., Kenardy, J. A., & Hearn, C. S. (2017). Generic versus disorder specific cognitive behavior therapy for social anxiety disorder in youth: A randomized controlled trial using internet delivery. Behaviour research and therapy, 90, 41-57. [Link]
Stephen G., Hoffmann, Michael, Otto (2022). Cognitive-behavioral treatment of social anxiety disorder. Cheini Foroshen, Masoud and Agashte, Mansour, 3rd edition, Tehran, Arjmand Publications.  [Link]
Trich D, Sandrov B, RL, Silbrastin A. (2015). Compassion-focused therapy for ACT therapists. Translation: Daneshmandi S, Ezdi R, Abedi M. First Edition. Kavashiar Publications.  [Link]
Valizadeh, Shahrokh; Makundi, Behnam; Bakhtiarpour, Saeed; and Hafiz (2019). The effectiveness of cognitive behavioral therapy on the cognitive flexibility of prisoners. Journal of Psychiatry, 8(4), 1-9.  [Link]
Weeks, J. W., Howell, A. N., Srivastav, A., & Goldin, P. R. (2019). “Fear guides the eyes of the beholder”: Assessing gaze avoidance in social anxiety disorder via covert eye tracking of dynamic social stimuli. Journal of anxiety disorders, 65, 56-63. [Link]
Wernre, K. H., Jazaieri, H., Goldin, P. R., Ziv, M., Heimberg R. G., & Gross, J.J. (2012). Self compassion and social anxiety disorder. Anxiety, Stress, & Coping. 25(5), 543-558. [Link]
Wilson, K. G. (2009). Mindfulness for two: An acceptance and commitment therapy approach to mindfulness in psychotherapy. New Harbinger Publications. [Link]
Wilson KG, Sandoz EK, Kitchens J, Roberts M. (2010). The valued living questionnaire: defining and measuring valued action within a behavioral framework. Psychological Record. 60: PP. 249-272. [Link]
Yabandeh, M. R., Bagholi, H., Sarvghad, S., & Kouroshnia, M. (2019). Comparing the Effectiveness of Cognitive Behavioral Therapy with Acceptance and Commitment Therapy on Reduction of Social Anxiety Disorder Symptoms. Psychological Methods and Models, 10(36), 177-196. DOR:20.1001.1.22285516.1398.10.36.10.7  [Link]
Zare, H. (2017). Effectiveness of Acceptance and Commitment Therapy (ACT) on Improving the Flexibility and Cognitive Fusion. Social Cognition, 6(1), 125-134. [Link]

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