Category: Treatment - ACT

PS8- #B61 - Effect of Exposure to Distressing and Encouraging Beliefs Over Time: A Multilevel Modeling Analysis

Saturday, Nov 18
8:30 AM – 9:30 AM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: ACT (Acceptance & Commitment Therapy) | CBT | Ecological Momentary Assessment

In both clinical and community settings, people handle distressing thoughts about themselves in different ways.  This study evaluates the relative efficacy of two opposing strategies to responding to distressing thoughts.  First, when confronted by distressing thoughts, people often make greater attempts to think more encouraging thoughts (i.e., to counter distressing thoughts with positive thoughts). However, an alternative approach has been proposed by third-wave behavioral treatments such as acceptance and commitment therapy (ACT), reflecting a core process of exposure therapy as well. Here, the aim is to remove the behavioral influence that the content of a distressing thought has over an individual by withholding any attempts to change the form, frequency, or severity of the thought itself. This represents a directly opposite approach to encouragement as individuals allow thoughts to exist without engaging in behaviors meant to avoid the distress itself.


 To date, no known research has looked at these respective processes in naturalistic contexts and without therapeutic oversight. In addition, no known studies have directly compared the use of exposure strategies aimed specifically at distressing self-statements versus encouraging self-statements in terms of psychological and behavioral outcomes. Finally, given that exposure to self-statements occurs over time and within individuals, an analytic approach that allows for investigation of both the time-variant and time-invariant variables affecting these outcomes is necessary.


The present study uses ecological momentary assessment (EMA) to determine the effects of recurring exposure to self-reported distress statements compared to self-reported encouraging statements. Undergraduate participants across two universities were recruited and randomized to one of three groups: distress, encouragement, or control. Participants received five text messages per day for a period of 10 days. Each text provided a link to a mobile Qualtrics survey consisting of multiple brief items assessing current mood and behavior. Then, participants in the distress group read a self-tailored distressing statement whereas participants in the encouragement group read a self-tailored encouraging statement; both groups then rate subjective distress after reading the statement, believability of the statement, and extent to which the thought of this statement interferes with the course of their day. Participants in the control group received no self-statements and instead only tracked mood and behavior. Post-experimental and one-month follow-up outcomes focus on EMA reactions to distressing thoughts (i.e., distress, believability, interference) as well as change on broader measures of experiential avoidance, cognitive defusion, believability of anxious feelings and thoughts, and rumination. Preliminary data shows that individuals who received distressing self-statements showed significant improvement in both distress levels in response to self-tailored distress statements and believability concerning anxious thoughts relative to the two other groups. Further analytic detail on multilevel analyses will be included in the final poster.

Dane C. Hilton

Graduate Student
The University of Alabama
Northport, Alabama

Alex Kirk

Doctoral Student
The University of Colorado at Boulder
Broomfield, Colorado

Michael Wefelmeyer

The University of Alabama

Joanna Arch

Assistant Professor
The University of Colorado at Boulder
Boulder, Colorado

Matthew Jarrett

The University of Alabama