Increasing valued behaviors precedes reduction in suffering: Findings from a randomized controlled trial using ACT.
Psychological flexibility theory (PFT) suggests three key processes of change: increases in value-directed behaviors, reduction in struggle with symptoms, and reduction in suffering. We hypothesized that Acceptance and Commitment Therapy (ACT) would change these processes and that increases in valued action and decreases in struggle would precede change in suffering.



Data were derived from a randomized clinical trial testing ACT (vs. waitlist) for treatment-resistant patients with primary panic disorder with/without agoraphobia (n = 41). Valued behavior, struggle, and suffering were assessed at each of eight sessions.



Valued actions, struggle, and suffering all changed over the course of therapy. Overall changes in struggle and suffering were interdependent whereas changes in valued behavior were largely independent. Levels of valued behaviors influenced subsequent suffering, but the other two variables did not influence subsequent levels of valued action.



This finding supports a central tenet of PFT that increased (re-)engagement in valued behaviors precedes reductions in suffering. Possible implications for a better understanding of response and non-response to psychotherapy are discussed.
University of Basel, Department of Psychology, Division of Clinical Psychology and Intervention Science, Missionsstrasse 62A, CH-4055 Basel, Switzerland; Technische Universität Dresden, Department of Psychology, Institute for Clinical Psychology and Psychotherapy, Chemnitzer Straße 46, 01187 Dresden, Germany. Electronic address: andrew.gloster@unibas.ch.
Andrew T
AT
Gloster
German Rheumatism Research Centre Berlin, Leibniz Institute, Epidemiology Unit, Charitéplatz 1, 10117 Berlin, Germany; Charité Universitätsmedizin Berlin; Institute for Social Medicine, Epidemiology and Health Economics, Luisenstraße 57, 10117 Berlin, Germany.
Jens
J
Klotsche
Institute of Positive Psychology and Education, Australian Catholic University, 25A Barker Road, Strathfield NSW 2135, Australia.
Joseph
J
Ciarrochi
Chapman University, 1 University Dr, Orange, CA 92866, USA.
Georg
G
Eifert
Private Practice, In der Wüste 18, 7462 Olpe, Germany.
Rainer
R
Sonntag
Technische Universität Dresden, Department of Psychology, Institute for Clinical Psychology and Psychotherapy, Chemnitzer Straße 46, 01187 Dresden, Germany.
Hans-Ulrich
HU
Wittchen
Technische Universität Dresden, Department of Psychology, Institute for Clinical Psychology and Psychotherapy, Chemnitzer Straße 46, 01187 Dresden, Germany.
Jürgen
J
Hoyer
D064869:Acceptance and Commitment Therapy; D000328:Adult; D000379:Agoraphobia / Q000150:complications / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D016584:Panic Disorder / Q000150:complications / Q000523:psychology* / Q000628:therapy; D011582:Psychological Theory; D013315:Stress, Psychological; D055815:Young Adult
ACT; Process; Psychological flexibility; Suffering; Treatment resistance; Valued behavior