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Systematic Review of Acceptance and Commitment Training Components in the Behavioral Intervention of Individuals with Autism and Developmental Disorders

Behavior Analysis in Practice volume 15, pages 126–140 (2022)Cite this article

Abstract

Acceptance and commitment therapy (ACT) is a contemporary approach to dealing with unhelpful private events and improving psychological flexibility (Hayes et al., 2006) that is often used in psychotherapy (Szabo, 2019). Nonpsychotherapeutic uses of ACT have been referred to as acceptance and commitment training (ACTraining; Moran, 2011, 2015; Szabo, 2019), which refers to the use of one or more of six processes—present moment attention or mindfulness, values clarification, committed action, self-as-context, defusion, and acceptance (Hayes et al., 2006)—implemented outside of psychotherapeutic settings. There has been a recent increase in interest in ACTraining within the behavior-analytic community, which has led behavior analysts to question whether ACTraining is useful to the field of applied behavior analysis (ABA) and whether it is within the scope of practice of behavior analysts. Tarbox et al. (2020) proposed that the use of ACTraining is within the scope of practice of behavior analysts and aligns with the seven dimensions of ABA as outlined by Baer et al. (1968). The purpose of the current study was to provide a systematic review of single-case research designs that measure the behavioral effects of ACTraining components conducted with individuals with autism spectrum disorder or developmental disorders, their parents, and their staff, and to inform clinicians and researchers about what variables have been evaluated and what gaps still exist.

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References

References marked with an asterisk indicate studies evaluated in the systematic review

  • *Adkins, A. D., Singh, A. N., Winton, A. S. W., McKeegan, G. F., & Singh, J. (2010). Using a mindfulness-based procedure in the community: Translating research to practice. Journal of Child and Family Studies, 19(2), 175–183. https://doi.org/10.1007/s10826-009-9348-9.

  • Association for Contextual Behavioral Science. (n.d.). List of meta-analyses conducted on ACT. Retrieved May 12, 2020, from bit.ly/ACTmetas

  • Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1(1), 91–97. https://doi.org/10.1901/jaba.1968.1-91.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bond, F. W., & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5(1), 156–163. https://doi.org/10.1037/1076-8998.5.1.156.

    Article  PubMed  Google Scholar 

  • *Brazeau, K., Rehfeldt, R. A., Mazo, A., Smalley, S., Krus, S., & Henson, L. (2017). On the efficacy of mindfulness, defusion, and behavioral skills training on job interviewing skills in dually-diagnosed adults with developmental disorders. Journal of Contextual Behavioral Science, 6(2), 145–151. https://doi.org/10.1016/j.jcbs.2017.04.002.

  • *Castro, M., Rehfeldt, R. A., & Root, W. B. (2016). On the role of values clarification and committed actions in enhancing the engagement of direct care workers with clients with severe developmental disorders. Journal of Contextual Behavioral Science, 5(4), 201–207. https://doi.org/10.1016/j.jcbs.2016.09.003.

  • *Chancey, C., Weihl, C., Root, W. B., Rehfeldt, R. A., McCauley, D., Takeguchi, K., & Pritchard, J. (2019). The impact of mindfulness skills on interactions between direct care staff and adults with developmental disabilities. Journal of Contextual Behavioral Science, 12, 160–169. https://doi.org/10.1016/j.jcbs.2018.07.004.

  • Cicoria, M. (Host). (2017-present). Russ Harris on ACT, Burnout, and Practitioner Well-Being (Session 41) [Audio podcast episode). Behavioral Observations. [Audio podcast]. https://www.behavioralobservations.com/session-41-russ-harris-act-burnout-practitioner-well/.

  • Dahl, J., Wilson, K. G., & Nilsson, A. (2004). Acceptance and commitment therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35(4), 785–801. https://doi.org/10.1016/s0005-7894(04)80020-0.

    Article  Google Scholar 

  • *Eilers, H. J., & Hayes, S. C. (2015). Exposure and response prevention therapy with cognitive defusion exercises to reduce repetitive and restrictive behaviors displayed by children with autism spectrum disorder [Special Issue on Derived Relational Responding]. Research in Autism Spectrum Disorders, 19, 18–31. https://doi.org/10.1016/j.rasd.2014.12.014.

  • Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31(6), 772–799. https://doi.org/10.1177/0145445507302202.

    Article  PubMed  Google Scholar 

  • Fryling, M. J., Wallace, M. D., & Yassine, J. N. (2012). Impact of treatment integrity on intervention effectiveness. Journal of Applied Behavior Analysis, 45(2), 449–453. https://doi.org/10.1901/jaba.2012.45-449.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M., Rasmussen-Hall, M. L., & Palm, K. M. (2004). Acceptance-based treatment for smoking cessation. Behavior Therapy, 35(4), 689–705. https://doi.org/10.1016/s0005-7894(04)80015-7.

    Article  Google Scholar 

  • *Gould, E. R., Tarbox, J., & Coyne, L. (2017). Evaluating the effects of acceptance and commitment training on the overt behavior of parents of children with autism. Journal of Contextual Behavioral Science, 7, 81–88. https://doi.org/10.1016/j.jcbs.2017.06.003.

  • Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., Masuda, A., Pistorello, J., Rye, A. K., Berry, K., & Niccolls, R. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35(4), 821–835. https://doi.org/10.1016/s0005-7894(04)80022-4.

    Article  Google Scholar 

  • 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. https://doi.org/10.1016/j.brat.2005.06.006.

    Article  PubMed  Google Scholar 

  • Hayes, S. C., Wilson, K. G., Gifford, E. V., Bissett, R., Piasecki, M., Batten, S. V., Byrd, M., & Gregg, J. (2004). A preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance-abusing methadone-maintained opiate addicts. Behavior Therapy, 35(4), 667–688. https://doi.org/10.1016/s0005-7894(04)80014-5.

    Article  Google Scholar 

  • Kazdin, A. E. (2011). Single-case research designs: Methods for clinical and applied settings (2nd ed.). Oxford University Press.

  • *Little, A., Tarbox, J., & Alzaabi, K. (2020). Using acceptance and commitment training to enhance the effectiveness of behavioral skills training. Journal of Contextual Behavioral Science, 16, 9–16. https://doi.org/10.1016/j.jcbs.2020.02.002.

  • Luoma, J. B., Hayes, S. C., & Walser, R. D. (2017). Learning ACT: An acceptance & commitment therapy skills-training manual for therapists (2nd ed.). New Harbinger Publications.

  • Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Prisma Group. (2009). Reprint—preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Physical therapy, 89(9), 873–880. https://doi.org/10.1093/ptj/89.9.873.

  • Moran, D. J. (2011). ACT for leadership: Using acceptance and commitment training to develop crisis-resilient change managers. International Journal of Behavioral Consultation and Therapy, 7(1), 66–75. https://doi.org/10.1037/h0100928.

    Article  Google Scholar 

  • Moran, D. J. (2015). Acceptance and commitment training in the workplace. Current Opinion in Anxiety, 2, 26–31. https://doi.org/10.1016/j.copsyc.2014.12.031.

    Article  Google Scholar 

  • National Autism Center. (2015). Findings and conclusions: National standards project, phase 2. https://www.nationalautismcenter.org/national-standards-project/phase-2/.

  • Parry-Cruwys, D., Parry-Cruwys, R., & MacDonald, J (Hosts). (2016-present). Mark Dixon on Acceptance and Commitment Therapy for Children with Autism and Emotional Challenges (Episode 14) [Audio podcast episode]. In ABA Inside Track. [Audio podcast]. https://behavioralobservations.com/session-13-mark-dixon-acceptance-commitment-therapy-children-autism-emotional-challenges/.

  • *Pingo, J. C., Dixon, M. R., & Paliliunas, D. (2019). Intervention enhancing effects of acceptance and commitment training on performance feedback for direct support professional work performance, stress, and job satisfaction. Behavior Analysis in Practice, 13, 1–10. https://doi.org/10.1007/s40617-019-00333-w.

  • *Raulston, T. J., Zemantic, P. K., Machalicek, W., Hieneman, M., Kurtz-Nelson, E., Barton, H., Hansen, S. G., & Frantz, R. J. (2019). Effects of a brief mindfulness-infused behavioral parent training for mothers of children with autism spectrum disorder. Journal of Contextual Behavioral Science, 13, 42–51. https://doi.org/10.1016/j.jcbs.2019.05.001.

  • Scruggs, T. E., & Mastropieri, M. A. (1998). Summarizing single-subject research: Issues and applications. Behavior modification, 22(3), 221–242. https://doi.org/10.1177/01454455980223001.

  • *Singh, N. N., Chan, J., Karazsia, B. T., McPherson, C. L., & Jackman, M. M. (2017). Telehealth training of teachers to teach a mindfulness-based procedure for self-management of aggressive behavior to students with intellectual and developmental disabilities. International Journal of Developmental Disabilities, 63(4), 195–203. https://doi.org/10.1080/20473869.2016.1277841.

  • *Singh, N. N., Lancioni, E., Singh, N. A., Winton, S. W., Singh, D. A., & Singh, J. (2011c). A mindfulness-based health wellness program for individuals with Prader–Willi syndrome. Journal of Mental Health Research in Intellectual Disabilities, 4(2), 90–106. https://doi.org/10.1080/19315864.2011.583489.

  • *Singh, N. N., Lancioni, G. E., Karazsia, B. T., Myers, R. E., Kim, E., Chan, J., Jackman, M. M., McPherson, C. L., & Janson, M. (2018). Surfing the urge: An informal mindfulness practice for the self-management of aggression by adolescents with autism spectrum disorder. Journal of Contextual Behavioral Science, 12, 170–177. https://doi.org/10.1016/j.jcbs.2018.10.003.

  • *Singh, N. N., Lancioni, G. E., Manikam, R., Winton, A. S. W., Singh, A. N. A., Singh, J., & Singh, A. D. A. (2011). A mindfulness-based strategy for self-management of aggressive behavior in adolescents with autism. Research in Autism Spectrum Disorders, 5(3), 1153–1158. https://doi.org/10.1016/j.rasd.2010.12.012.

  • *Singh, N. N., Lancioni, G. E., Singh, A. D. A., Winton, A. S. W., Singh, A. N. A., & Singh, J. (2011b). Adolescents with Asperger syndrome can use a mindfulness-based strategy to control their aggressive behavior. Research in Autism Spectrum Disorders, 5(3), 1103–1109. https://doi.org/10.1016/j.rasd.2010.12.006.

  • *Singh, N. N., Lancioni, G. E., Winton, A. S., Adkins, A. D., Singh, J., & Singh, A. N. (2007). Mindfulness training assists individuals with moderate mental retardation to maintain their community placements. Behavior Modification, 31(6), 800–814. https://doi.org/10.1177/0145445507300925.

  • *Singh, N. N., Lancioni, G. E., Winton, A. S., Singh, A. N., Singh, J., & Singh, A. D. (2011d). Effects of a mindfulness-based smoking cessation program for an adult with mild intellectual disability. Research in Developmental Disabilities, 32(3), 1180–1185. https://doi.org/10.1016/j.ridd.2011.01.003.

  • *Singh, N. N., Lancioni, G. E., Winton, A. S. W., Curtis, W. J., Wahler, R. G., Sabaawi, M., Singh, J., & McAleavey, K. (2006). Mindful staff increase learning and reduce aggression in adults with developmental disabilities. Research in Developmental Disabilities, 27(5), 545–558. https://doi.org/10.1016/j.ridd.2005.07.002.

  • *Singh, N. N., Lancioni, G. E., Winton, A. S. W., Fisher, B. C., Wahler, R. G., McAleavey, K., Singh, J., & Sabaawi, M. (2006). Mindful parenting decreases aggression, noncompliance, and self-injury in children with autism. Journal of Emotional and Behavioral Disorders, 14(3), 169–177. https://doi.org/10.1177/10634266060140030401.

  • *Singh, N. N., Lancioni, G. E., Winton, A. S. W., Karazsia, B. T., Myers, R. E., Latham, L. L., & Singh, J. (2014). Mindfulness-based positive behavior support (MBPBS) for mothers of adolescents with autism spectrum disorder: Effects on adolescents’ behavior and parental stress. Mindfulness, 5(6), 646–657. https://doi.org/10.1007/s12671-014-0321-3.

  • *Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, A. N., Adkins, A. D., & Singh, J. (2008). Clinical and benefit-cost outcomes of teaching mindfulness-based procedure to adult offenders with intellectual disabilities. Behavior Modification, 32(5), 622–638. https://doi.org/10.1177/0145445508315854.

  • *Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, A. N., Adkins, A. D., & Singh, J. (2009). Mindful staff can reduce the use of physical restraints when providing care to individuals with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 22, 194–202. https://doi.org/10.1111/j.1468-3148.2008.00488.x.

  • *Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, J., Curtis, W. J., Wahler, R. G., & McAleavey, K. M. (2007). Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities. Behavior Modification, 31(6), 749–771. https://doi.org/10.1177/0145445507300924.

  • *Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, J., Singh, A. N. A., & Singh, A. D. A. (2011e). Peer with intellectual disabilities as a mindfulness-based anger and aggression management therapist. Research in Developmental Disabilities, 32(6), 2690–2696. https://doi.org/10.1016/j.ridd.2011.06.003.

  • *Singh, N. N., Lancioni, G. E., Winton, A. S. W., Wahler, R. G., Singh, J., & Sage, M. (2004). Mindful caregiving increases happiness among individuals with profound multiple disabilities. Research in Developmental Disabilities, 25(2), 207–218. https://doi.org/10.1016/j.ridd.2003.05.001.

  • *Singh, N. N., Singh, A. N., Lancioni, G. E., Singh, J., Winton, A. S. W., & Adkins, A. D. (2010). Mindfulness training for parents and their children with ADHD increases the children’s compliance. Journal of Child and Family Studies, 19, 157–166. https://doi.org/10.1007/s10826-009-9272-z.

  • *Singh, N. N., Wahler, R. G., Adkins, A. D., & Myers, R. E. (2003). Soles of the feet: A mindfulness-based self-control intervention for aggression by an individual with mild mental retardation and mental illness. Research in Developmental Disabilities, 24(3), 158–169. https://doi.org/10.1016/S0891-4222(03)00026-X.

  • *Singh, N. N., Lancioni, G. E., Winton, A. S. W., Karazsia, B. T., Singh, A. D. A., Singh, A. N. A., & Singh, J. (2013). A mindfulness-based smoking cessation program for individuals with mild intellectual disability. Mindfulness, 4(2), 148–157. https://doi.org/10.1007/s12671-012-0148-8.

  • *Singh, N. N., Lancioni, G. E., Karazsia, B. T., Myers, R. E., Winton, A. S. W., Latham, L. L., & Nugent, K. (2015). Effects of training staff in MBPBS on the use of physical restraints, staff stress and turnover, staff and peer injuries, and cost effectiveness in developmental disabilities. Mindfulness, 6(4), 926–937. https://doi-org.lib.pepperdine.edu/10.1007/s12671-014-0369-0.

  • *Szabo, T. G. (2019). Acceptance and commitment training for reducing inflexible behaviors in children with autism. Journal of Contextual Behavioral Science, 12, 178–188. https://doi.org/10.1016/j.jcbs.2019.03.001.

  • Tarbox, J., Szabo, T., & Aclan, M. (2020). Acceptance and commitment training within the scope of practice of applied behavior analysis. Behavior Analysis in Practice. Advance online publication. https://doi.org/10.1007/s40617-020-00466-3.

  • Twohig, M. P., & Woods, D. W. (2004). A preliminary investigation of acceptance and commitment therapy and habit reversal as a treatment for trichotillomania. Behavior Therapy, 35(4), 803–820. https://doi.org/10.1016/s0005-7894(04)80021-2.

    Article  Google Scholar 

  • Zettle, R. D. (2003). Acceptance and commitment therapy (ACT) vs. systematic desensitization in treatment of mathematics anxiety. The Psychological Record, 53(2), 197–215. https://doi.org/10.1007/bf03395440.

    Article  Google Scholar 

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Acknowledgments

We thank Justin Leaf for his assistance with previous versions of this manuscript. We thank Bryan Acuña for his assistance with this project.

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Authors and Affiliations

  1. Applied Behavior Analysis Program, Endicott College, Beverly, MA, USA

    Victoria D. Suarez

  2. Graduate School of Education and Psychology, Pepperdine University, Malibu, CA, USA

    Emma I. Moon & Adel C. Najdowski

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  1. Victoria D. Suarez
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Correspondence to Adel C. Najdowski.

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Suarez, V.D., Moon, E.I. & Najdowski, A.C. Systematic Review of Acceptance and Commitment Training Components in the Behavioral Intervention of Individuals with Autism and Developmental Disorders. Behav Analysis Practice 15, 126–140 (2022). https://doi.org/10.1007/s40617-021-00567-7

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Keywords

  • Acceptance and commitment training
  • Applied behavior analysis
  • Autism
  • Difusion
  • Mindfulness
  • Psychological flexibility
  • Self-as-context
  • Values