Increasing valued behaviors precedes reduction in suffering : Findings from a randomized controlled trial using ACT

Journal article

Gloster, Andrew T., Klotsche, Jens, Ciarrochi, Joseph, Eifert, Georg, Sonntag, Rainer, Wittchen, Hans-Ulrich and Hoyer, Jürgen. (2017). Increasing valued behaviors precedes reduction in suffering : Findings from a randomized controlled trial using ACT. Behaviour Research and Therapy. 91, pp. 64-71. https://doi.org/10.1016/j.brat.2017.01.013

Publication dates
Authors	Gloster, Andrew T., Klotsche, Jens, Ciarrochi, Joseph, Eifert, Georg, Sonntag, Rainer, Wittchen, Hans-Ulrich and Hoyer, Jürgen
Abstract	Background 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. Method 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. Results 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. Discussion 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.
Keywords	psychological flexibility; ACT; valued behavior; suffering; process; treatment resistance
Year	2017
Journal	Behaviour Research and Therapy
Journal citation	91, pp. 64-71
Publisher	Elsevier Ltd
ISSN	0005-7967
Digital Object Identifier (DOI)	https://doi.org/10.1016/j.brat.2017.01.013
Scopus EID	2-s2.0-85011074134
Open access	Published as green open access
Page range	64-71
Funder	Australian Research Council (ARC)
Research Group	Institute for Positive Psychology and Education
Author's accepted manuscript	AM_Gloster_2017_Increasing_Valued_behaviors_precedes_reduction_in.pdf License CC BY-NC-ND 4.0 File Access Level Open
Publisher's version	License All rights reserved File Access Level Controlled
Output status	Published
Online	24 Jan 2017
Publication process dates
Accepted	23 Jan 2017
ARC Funded Research	This output has been funded, wholly or partially, under the Australian Research Council Act 2001
Grant ID	DP140103874

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Marshall, Sarah, Parker, Philip D., Heaven, Patrick and Ciarrochi, Joseph. (2014). Is Self-Esteem a Cause or Consequence of Social Support? : A 4-Year Longitudinal Study. Child Development. 85(3), pp. 1275 - 1291. https://doi.org/10.1111/cdev.12176

Juxtaposing math self-efficacy and self-concept as predictors of long-term achievement outcomes

Parker, Philip David, Marsh, Herbert W., Ciarrochi, Joseph, Marshall, Sarah and Abduljabbar, Adel Salah. (2014). Juxtaposing math self-efficacy and self-concept as predictors of long-term achievement outcomes. Educational Psychology. 34(1), pp. 29-48. https://doi.org/10.1080/01443410.2013.797339

Agreeableness, conscientiousness, and psychoticism : Distinctive influences of three personality dimensions in adolescence

Heaven, Patrick C. L., Ciarrochi, Joseph, Leeson, Peter and Barkus, Emma. (2013). Agreeableness, conscientiousness, and psychoticism : Distinctive influences of three personality dimensions in adolescence. British Journal of Psychology. 104(4), pp. 481 - 494. https://doi.org/10.1111/bjop.12002

A preliminary exploration of the working alliance and real relationship in two coaching approaches with mental health workers

Sun, Belinda, Deane, Frank, Crowe, Trevor, Andresen, Retta, Oades, Lindsay and Ciarrochi, Joseph. (2013). A preliminary exploration of the working alliance and real relationship in two coaching approaches with mental health workers. International Coaching Psychology Review.

The psychological impact of anal cancer screening on HIV-infected men

Landstra, Jodie M. B., Ciarrochi, Joseph, Deane, Frank Patrick, Botes, Leon P. and Hillman, Richard J.. (2013). The psychological impact of anal cancer screening on HIV-infected men. Psycho-Oncology: journal of the psychological, social and behavioral dimensions of cancer. 33(3), pp. 614-620. https://doi.org/10.1002/pon.3040

The longitudinal relationships between adolescent religious values and personality

Huuskes, Lee, Ciarrochi, Joseph and Heaven, Patrick. (2013). The longitudinal relationships between adolescent religious values and personality. Journal of Research in Personality. https://doi.org/10.1016/j.jrp.2013.04.010

improving implementation of evidence-based practice in mental health service delivery : Protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions

Williams, Virginia, Oades, L, Deane, F, Crowe, T, Ciarrochi, Joseph and Andresen, R. (2013). improving implementation of evidence-based practice in mental health service delivery : Protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions. Implementation Science. https://doi.org/10.1186/1748-5908-8-75

Identifying and describing feelings and psychological flexibility predict mental health in men with HiV

Landstra, Jodie M. B., Ciarrochi, Joseph, Deane, Frank P. and Hillman, Richard J.. (2013). Identifying and describing feelings and psychological flexibility predict mental health in men with HiV. British Journal of Health Psychology. 18(4), pp. 844 - 857. https://doi.org/10.1111/bjhp.12026

A Comparison of Two Coaching Approaches to Enhance implementation of a Recovery-Oriented Service Model

Deane, Frank, Andresen, Retta, Crowe, Trevor, Oades, Lindsay, Ciarrochi, Joseph and Williams, Virginia. (2013). A Comparison of Two Coaching Approaches to Enhance implementation of a Recovery-Oriented Service Model. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-013-0514-4

Acceptance and Commitment Therapy (ACT) for improving the lives of cancer patients : A preliminary study

Feros, D, Lane, L, Ciarrochi, Joseph and Blackledge, J. (2013). Acceptance and Commitment Therapy (ACT) for improving the lives of cancer patients : A preliminary study. Psycho-Oncology: journal of the psychological, social and behavioral dimensions of cancer. https://doi.org/10.1002/pon.2083

The interrelations among the perception of parental styles and psychological well-being in adolescence : A longitudinal study

Shahimi, F, Heaven, Patrick and Ciarrochi, Joseph. (2013). The interrelations among the perception of parental styles and psychological well-being in adolescence : A longitudinal study. Iranian Journal of Public Health.

The self in cognitive-behavioral therapy

McLeod, Hamish J. and Ciarrochi, Joseph. (2012). The self in cognitive-behavioral therapy. In In McHugh, Louise (Ed.). The self and perspective taking : Contributions and applications from modern behavioral science pp. 161-180 New Harbinger Publications.

Acceptance and Commitment Therapy (ACT) for psychological adjustment after traumatic brain injury : Reporting the protocol for a randomised controlled trial

Whiting, Diane, Simpson, Grahame, McLeod, Hamish, Deane, Frank and Ciarrochi, Joseph. (2012). Acceptance and Commitment Therapy (ACT) for psychological adjustment after traumatic brain injury : Reporting the protocol for a randomised controlled trial. Brain Impairment. 13(3), pp. 360 - 376. https://doi.org/10.1017/BrImp.2012.28

Cognitive ability and health-related behaviors during adolescence : A prospective study across five years

Ciarrochi, Joseph, Heaven, Patrick C. L. and Skinner, Timothy. (2012). Cognitive ability and health-related behaviors during adolescence : A prospective study across five years. Intelligence. 40(4), pp. 317 - 324. https://doi.org/10.1016/j.intell.2012.03.003

Acceptance and Commitment Therapy (ACT) for psychological adjustment after traumatic brain injury : Reporting the protocol for a randomised controlled trial

Revisiting the link between low verbal intelligence and ideology

Leeson, Peter, Heaven, Patrick and Ciarrochi, Joseph. (2012). Revisiting the link between low verbal intelligence and ideology. Intelligence. 40(2), pp. 213 - 216. https://doi.org/10.1016/j.intell.2011.11.006

Psychosocial aspects of anal cancer screening : A review and recommendations

Landstra, J, Ciarrochi, Joseph and Deane, F. (2012). Psychosocial aspects of anal cancer screening : A review and recommendations. Sexual Health. 9(6), pp. 620 - 627. https://doi.org/10.1071/SH11169

Religious values and the development of trait hope and self-esteem in adolescents

Ciarrochi, Joseph and Heaven, Patrick C. L.. (2012). Religious values and the development of trait hope and self-esteem in adolescents. Journal for the Scientific Study of Religion. 51(4), pp. 676 - 688. https://doi.org/10.1111/j.1468-5906.2012.01675.x

Reflection impulsivity in adolescent cannabis users: a comparison with alcohol-using and non-substance-using adolescents

Solowij, Nadia, Jones, Katy A., Rozman, Megan E., Davis, Sasha M., Ciarrochi, Joseph, Heaven, Patrick C. L., Pesa, Nicole, Lubman, Dan I. and Yücel, Murat. (2012). Reflection impulsivity in adolescent cannabis users: a comparison with alcohol-using and non-substance-using adolescents. Psychopharmacology. 219(2), pp. 575 - 586. https://doi.org/10.1007/s00213-011-2486-y

When IQ is not everything : Intelligence, personality and academic performance at school

Heaven, Patrick C. L. and Ciarrochi, Joseph. (2012). When IQ is not everything : Intelligence, personality and academic performance at school. Personality and Individual Differences. 53(4), pp. 518 - 522. https://doi.org/10.1016/j.paid.2012.04.024

Inflexible Parents. Inflexible Kids : A 6-Year Longitudinal Study of Parenting Style and the Development of Psychological Flexibility in Adolescents

Williams, Kathryn, Ciarrochi, Joseph and Heaven, Patrick. (2012). Inflexible Parents. Inflexible Kids : A 6-Year Longitudinal Study of Parenting Style and the Development of Psychological Flexibility in Adolescents. Journal of Youth Adolescence. 41(8), pp. 1053 - 1066. https://doi.org/10.1007/s10964-012-9744-0

Heterogeneity Among Potential Foster Carers: An investigation of Reasons for Not Foster Caring

Randle, Melanie, Miller, Leonie, Dolnicar, Sara and Ciarrochi, Joseph. (2012). Heterogeneity Among Potential Foster Carers: An investigation of Reasons for Not Foster Caring. Australian Social Work. 65(3), pp. 382 - 397. https://doi.org/10.1080/0312407X.2011.574229

Hope for the future: identifying the individual difference characteristics of people who are interested in and intend to foster-care

Ciarrochi, Joseph, Randle, Melanie, Miller, Leonie and Dolnicar, Sara. (2012). Hope for the future: identifying the individual difference characteristics of people who are interested in and intend to foster-care. The British Journal of Social Work. 42(1), pp. 7 - 25. https://doi.org/10.1093/bjsw/bcr052

Cognitive ability, right-wing authoritarianism, and social dominance orientation :a five-year longitudinal study amongst adolescents

Heaven, Patrick Charles Lionel, Ciarrochi, Joseph and Leeson, Peter. (2011). Cognitive ability, right-wing authoritarianism, and social dominance orientation :a five-year longitudinal study amongst adolescents. Intelligence. 39(1), pp. 15 - 21. https://doi.org/10.1016/j.intell.2010.12.001

Verbal learning and memory in adolescent cannabis users, alcohol users and non-users

Solowij, Nadia, Jones, Katy, Rozman, Megan, Davis, Sasha, Ciarrochi, Joseph, Heaven, Patrick Charles Lionel, Lubman, Dan and Yucel, Murat. (2011). Verbal learning and memory in adolescent cannabis users, alcohol users and non-users. Psychopharmacology. 216, pp. 131 - 144. https://doi.org/10.1007/s00213-011-2203-x

On being aware and accepting :a one-year longitudinal study into adolescent well-being

Ciarrochi, Joseph, Kashdan, Todd, Leeson, Peter, Heaven, Patrick Charles Lionel and Jordan, Carlie. (2011). On being aware and accepting :a one-year longitudinal study into adolescent well-being. Journal of Adolescence. 34, pp. 695 - 703. https://doi.org/10.1016/j.adolescence.2010.09.003

The link between value motives, value success, and well-being among people diagnosed with cancer

Ciarrochi, Joseph, Fisher, Darrell and Lane, Lisbeth. (2011). The link between value motives, value success, and well-being among people diagnosed with cancer. Psycho-Oncology: journal of the psychological, social and behavioral dimensions of cancer. 20(11), pp. 1184 - 1192. https://doi.org/10.1002/pon.1832

Importance, pressure, and success :dimensions of values and their links to personality

Veage, Stephanie, Ciarrochi, Joseph and Heaven, Patrick Charles Lionel. (2011). Importance, pressure, and success :dimensions of values and their links to personality. Personality and Individual Differences. 50(3), pp. 1180 - 1185. https://doi.org/10.1016/j.paid.2011.01.028

On being mindful, emotionally aware, and more resilient : Longitudinal pilot study of police recruits

Williams, Virginia, Ciarrochi, Joseph and Deane, Frank. (2010). On being mindful, emotionally aware, and more resilient : Longitudinal pilot study of police recruits. Australian Psychologist. 45(4), pp. 274 - 282. https://doi.org/10.1080/00050060903573197

Parental styles and religious values among teenagers : A 3-year prospective analysis

Heaven, Patrick, Ciarrochi, Joseph and Leeson, Peter. (2010). Parental styles and religious values among teenagers : A 3-year prospective analysis. The Journal of Genetic Psychology. 171(1), pp. 93 - 99. https://doi.org/10.1080/00221320903500861

On being mindful, emotionally aware, and more resilient : Longitudinal pilot study of police recruits

Motivation for and commitment to social values : The roles of age and gender

Ferssizidis, Patty, Adams, Leah, Kashdan, Todd, Plummer, Christine, Mishra, Anjali and Ciarrochi, Joseph. (2010). Motivation for and commitment to social values : The roles of age and gender. Motivation and Emotion. 34(4), pp. 354 - 362. https://doi.org/10.1007/s11031-010-9187-4

The distinctiveness and utility of a brief measure of alexithymia for adolescents

Heaven, Patrick, Ciarrochi, Joseph and Hurrell, Katherine. (2010). The distinctiveness and utility of a brief measure of alexithymia for adolescents. Personality and Individual Differences. 49(3), pp. 222 - 227. https://doi.org/10.1016/j.paid.2010.03.039

The distinctiveness and utility of a brief measure of alexithymia for adolescents

Substance abusers report being more alexithymic than others but do not show emotional processing deficits on a performance measure of alexithymia

Lindsay, Julie and Ciarrochi, Joseph. (2009). Substance abusers report being more alexithymic than others but do not show emotional processing deficits on a performance measure of alexithymia. Addiction Research and Theory. 17(3), pp. 315 - 321. https://doi.org/10.1080/16066350802472056

Personality development at school: Assessing a reciprocal influence model of teachers' evaluations and students' personality

Heaven, Patrick, Leeson, Peter and Ciarrochi, Joseph. (2009). Personality development at school: Assessing a reciprocal influence model of teachers' evaluations and students' personality. Journal of Research in Personality. 43(5), pp. 815 - 821. https://doi.org/10.1016/j.jrp.2009.06.009

A longitudinal study into the link between adolescent personality and peer-rated likeability and adjustment: Evidence of gender differences

Ciarrochi, Joseph and Heaven, Patrick Charles Lionel. (2009). A longitudinal study into the link between adolescent personality and peer-rated likeability and adjustment: Evidence of gender differences. Journal of Research in Personality. 43(6), pp. 978 - 986. https://doi.org/10.1016/j.jrp.2009.08.006

A longitudinal study into the interplay between problem orientation and adolescent well-being

Ciarrochi, Joseph, Leeson, Peter and Heaven, Patrick Charles Lionel. (2009). A longitudinal study into the interplay between problem orientation and adolescent well-being. Journal of Counseling Psychology. 56(3), pp. 441 - 449. https://doi.org/10.1037/a0015765

The longitudinal links between shame and increasing hostility during adolescence

Heaven, Patrick, Ciarrochi, Joseph and Leeson, Peter. (2009). The longitudinal links between shame and increasing hostility during adolescence. Personality and Individual Differences. 47(8), pp. 841 - 844. https://doi.org/10.1016/j.paid.2009.07.002

Promoting social intelligence using the experiential role-play method

Bilich, Linda L. and Ciarrochi, Joseph. (2009). Promoting social intelligence using the experiential role-play method. In In J.T. Blackledge, J. Ciarrochi and F.P. Deane (Ed.). Acceptance and commitment therapy pp. 247 - 262 Australian Academic Press.

The stability and change of trait emotional intelligence, conflict communication patterns, and relationship satisfaction: A one-year longitudinal study

Smith, Lynne, Ciarrochi, Joseph and Heaven, Patrick Charles Lionel. (2008). The stability and change of trait emotional intelligence, conflict communication patterns, and relationship satisfaction: A one-year longitudinal study. Personality and Individual Differences. 45(8), pp. 738 - 743. https://doi.org/10.1016/j.paid.2008.07.023

Self-nominated peer crowds, school achievement, and psychological adjustment in adolescents: Longitudinal analysis

Heaven, Patrick, Ciarrochi, Joseph and Vialle, Wilma J.. (2008). Self-nominated peer crowds, school achievement, and psychological adjustment in adolescents: Longitudinal analysis. Personality and Individual Differences. 44(4), pp. 977 - 988. https://doi.org/10.1016/j.paid.2007.10.031

A CBT Practitioners Guide to ACT - How to bridge the gap between cognitive behavioral therapy and acceptance and commitment therapy

Ciarrochi, Joseph and Bailey, Anne. (2008). A CBT Practitioners Guide to ACT - How to bridge the gap between cognitive behavioral therapy and acceptance and commitment therapy New Harbinger Publications.

Cognitive ability, personality, and academic performance in adolescence

Leeson, Peter, Ciarrochi, Joseph and Heaven, Patrick Charles Lionel. (2008). Cognitive ability, personality, and academic performance in adolescence. Personality and Individual Differences. 45(7), pp. 630 - 635. https://doi.org/10.1016/j.paid.2008.07.006

Parental styles, conscientiousness, and academic performance in high school: A three-wave longitudinal study

Heaven, Patrick and Ciarrochi, Joseph. (2008). Parental styles, conscientiousness, and academic performance in high school: A three-wave longitudinal study. Personality and Social Psychology Bulletin. 34(4), pp. 451 - 461. https://doi.org/10.1177/0146167207311909

The link between emotion identification skills and socio-emotional functioning in early adolescence: A 1-year longitudinal study

Ciarrochi, Joseph, Heaven, Patrick Charles Lionel and Supavadeeprasit, Sunila. (2008). The link between emotion identification skills and socio-emotional functioning in early adolescence: A 1-year longitudinal study. Journal of Adolescence. 31(5), pp. 565 - 582. https://doi.org/10.1016/j.adolescence.2007.10.004

Parental styles, conscientiousness, and academic performance in high school: A three-wave longitudinal study

Trait emotional intelligence, conflict communication patterns, and relationship satisfaction

Smith, Lynne, Heaven, Patrick and Ciarrochi, Joseph. (2008). Trait emotional intelligence, conflict communication patterns, and relationship satisfaction. Personality and Individual Differences. 44(6), pp. 1314 - 1325. https://doi.org/10.1016/j.paid.2007.11.024

Learned social hopelessness: The role of explanatory style in predicting social support during adolescence

Ciarrochi, Joseph and Heaven, Patrick Charles Lionel. (2008). Learned social hopelessness: The role of explanatory style in predicting social support during adolescence. Journal of Child Psychology and Psychiatry. 49(12), pp. 1279 - 1286. https://doi.org/10.1111/j.1469-7610.2008.01950.x

Parental styles, gender and the development of hope and self-esteem

Heaven, Patrick and Ciarrochi, Joseph. (2008). Parental styles, gender and the development of hope and self-esteem. European Journal of Personality. 22(8), pp. 707 - 724. https://doi.org/10.1002/per.699

Conscientiousness and Eysenckian psychoticism as predictors of school grades: A one-year longitudinal study

Heaven, Patrick, Ciarrochi, Joseph and Vialle, Wilma J.. (2007). Conscientiousness and Eysenckian psychoticism as predictors of school grades: A one-year longitudinal study. Personality and Individual Differences. 42(3), pp. 535 - 546. https://doi.org/10.1016/j.paid.2006.07.028

The impact of hope, self-esteem, and attributional style on adolescents' school grades and emotional well-being: A longitudinal study

Ciarrochi, Joseph, Heaven, Patrick and Davies, Fiona. (2007). The impact of hope, self-esteem, and attributional style on adolescents' school grades and emotional well-being: A longitudinal study. Journal of Research in Personality. 41(6), pp. 1161 - 1178. https://doi.org/10.1016/j.jrp.2007.02.001

Longitudinal examination of the impact of Eysenck's psychoticism dimension on emotional well-being in teenagers

Ciarrochi, Joseph and Heaven, Patrick. (2007). Longitudinal examination of the impact of Eysenck's psychoticism dimension on emotional well-being in teenagers. Personality and Individual Differences. 42(3), pp. 597 - 608. https://doi.org/10.1016/j.paid.2006.07.022

Psychological acceptance and quality of life in the elderly

Butler, Jodie and Ciarrochi, Joseph. (2007). Psychological acceptance and quality of life in the elderly. Quality of Life Research. 16(4), pp. 607 - 615. https://doi.org/10.1007/s11136-006-9149-1

On being gifted, but sad and misunderstood: Social, emotional, and academic outcomes of gifted students in the Wollongong Youth Study

Vialle, Wilma J., Heaven, Patrick and Ciarrochi, Joseph. (2007). On being gifted, but sad and misunderstood: Social, emotional, and academic outcomes of gifted students in the Wollongong Youth Study. Educational Research and Evaluation: an international journal on theory and practice. 13(6), pp. 569 - 586. https://doi.org/10.1080/13803610701786046

Personality and religious values among adolescents: A three-wave longitudinal analysis

Heaven, Patrick and Ciarrochi, Joseph. (2007). Personality and religious values among adolescents: A three-wave longitudinal analysis. British Journal of Psychology. 98(4), pp. 681 - 694. https://doi.org/10.1348/000712607X187777

Emotional expression, perceptions of therapy, and help-seeking intentions in men attending therapy services

Cusack, Jason, Deane, Frank P., Wilson, Coralie J. and Ciarrochi, Joseph. (2006). Emotional expression, perceptions of therapy, and help-seeking intentions in men attending therapy services. Psychology of Men and Masculinity. 7(2), pp. 69 - 82. https://doi.org/10.1037/1524-9220.7.2.69

The link between emotional competence and well-being: A longitudinal study

Ciarrochi, Joseph and Scott, Greg. (2006). The link between emotional competence and well-being: A longitudinal study. British Journal of Guidance and Counselling. 34(2), pp. 231 - 243. https://doi.org/10.1080/03069880600583287

Perceptions of parental styles and Eysenckian psychoticism in youth: A prospective analysis

Heaven, Patrick and Ciarrochi, Joseph. (2006). Perceptions of parental styles and Eysenckian psychoticism in youth: A prospective analysis. Personality and Individual Differences. 41(1), pp. 61 - 70. https://doi.org/10.1016/j.paid.2005.12.011