Skip to main content
Log in

Evaluation of mediators of change in the treatment of epilepsy with acceptance and commitment therapy

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

The present study examined the mediators of change accounting for outcomes of a previously published study on acceptance and commitment therapy for the self-management of epilepsy and its life restricting impact. Conducted with 27 poor South Africans, a 9-h ACT protocol that included seizure management methods was shown to greatly reduce epileptic seizures and to increase quality of life over the next year as compared to an attention placebo control. A series of bootstrapped non-parametric multiple mediator tests showed that pre to follow-up changes in: seizures, quality of life, and well-being outcomes were mediated to a degree by ACT process measures of epilepsy-related acceptance or defusion, values attainment, persistence in the face of barriers, or their combination. The results of this study contribute to the understanding of the contextual conditioning mechanisms at work for those suffering from epilepsy and may show that helping people live vital lives may also help to reduce seizures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alsaadi, T. M., & Vinter-Marquez, A. (2005). Psychogenic nonepileptic seizures. American Family Physician, 72(5), 849–856.

    PubMed  Google Scholar 

  • Amir, M., Marcelo, F., Herrman, H., et al. (2000). Reliability, validity and reproducibility of the WHOQOL.BREF in six countries. http://www.hrainc.net/pdf/ISOQOL_2000_Vancouver_BREF.pdf.

  • Austin, J. K. (1989). Comparison of child adaptation to epilepsy and asthma. Journal of Child and Adolescent Psychiatric and Mental Health Nursing, 2, 139–144.

    Article  PubMed  Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Article  PubMed  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, 156–163.

    Article  PubMed  Google Scholar 

  • Cohen J. (1992). A power primer. Psychological Bulletin, 112, 155–159.

    Article  Google Scholar 

  • Cummins, R. A. (1991). The comprehensive quality of life scale—Intellectual disability: An initial report. Australia and New Zealand Journal of Developmental Disabilities, 17, 259–264.

    Google Scholar 

  • Cummins, R. A. (1997). Assessing quality of life for people with disabilities. In R. I. Brown (Ed.), Quality of life for handicapped people (pp. 116–150). Cheltenham, England: Stanley Thomas.

    Google Scholar 

  • Dahl, J., Brorson, L. O., & Melin, L. (1992). Effects of a broad-spectrum behavioural medicine treatment program on children with refractory epileptic seizures: An 8 year follow-up. Epilepsia, 33(1), 98–102.

    Article  PubMed  Google Scholar 

  • Dahl, J., Melin, L., Brorson, L. O, et al. (1985). Effects of a broad-spectrum behavior modification treatment program on children with refractory epileptic seizures, Epilepsia, 26(4), 303–309.

    Article  PubMed  Google Scholar 

  • Dahl, J., Melin, L., & Lund, L. (1987). Effects of a contingent relaxation treatment program on adults with refractory epileptic seizures. Epilepsia, 28, 125–132.

    Article  PubMed  Google Scholar 

  • Dahl, J. (1992). Epilepsy: A behavior medicine approach to assessment and treatment in children. Göttingen: Hogref & Huber.

    Google Scholar 

  • Diener, E., Emmons, R. A., Larsen, R. J., et al. (1985). The satisfaction with life scale. Journal of Personality and Social Psychology, 49, 71–75.

    Google Scholar 

  • Forman, E. M., Hoffman, K. L., McGrath, K. B., et al. (2007). A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study. Behaviour Research and Therapy, 45, 2372–2386.

    Article  PubMed  Google Scholar 

  • Forman, E. M., Herbert, J. D., Moitra, E., et al. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31, 772–799.

    Article  PubMed  Google Scholar 

  • Fried, R., Rubin, S., Carton, R., et al. (1984). Behavioral control of intractable seizures: Self regulation of end tidal carbon dioxide. Psychosomatic Medicine, 46, 315–331.

    PubMed  Google Scholar 

  • Gaudiano, B. A., & Herbert, J. D. (2006). Believability of hallucinations as a potential mediator of their frequency and associated distress in psychotic inpatients. Behavioural and Cognitive Psychotherapy, 34, 497–502.

    Article  Google Scholar 

  • Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., et al. (2004). Acceptance theory-based treatment for smoking cessation: An initial trial of acceptance and commitment therapy. Behavior Therapy, 35, 689–705.

    Article  Google Scholar 

  • Gregg, J. A., Callaghan, G. M., Hayes, S. C., et al. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(2), 336–343.

    Article  PubMed  Google Scholar 

  • Haut, S. R., Vouyiouklis, M., & Shinnar, S. (2003). Stress and epilepsy: A patient perception survey. Epilepsy and Behavior, 4(5), 511–514.

    Article  PubMed  Google Scholar 

  • Hayes, S. C., Bissett, R., Korn, Z., et al. (1999). The impact of acceptance versus control rationales on pain tolerance. The Psychological Record, 49, 33–47.

    Google Scholar 

  • Hayes, S. C., Bissett, R., Roget, N., et al. (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, 821–835.

    Article  Google Scholar 

  • Hayes, S. C., Luoma, J., Bond, F., et al. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44, 1–25.

    Article  PubMed  Google Scholar 

  • Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.

    Google Scholar 

  • Hayes, S. C., Strosahl, K. D., Wilson, K. G., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553–578.

    Google Scholar 

  • Hitiris, N., Suratman, S., Kelly, K., et al. (2007). Sudden unexpected death in epilepsy: A search for risk factors. Epilepsy and Behavior, 10, 138–141.

    Article  PubMed  Google Scholar 

  • Johnson, E. K., Jones, J. E., Seidenberg, M., et al. (2004). The relative impact of anxiety, depression, and clinical seizure features on health-related qulity of life in epilepsy. Epilepsia, 45, 544.

    Article  PubMed  Google Scholar 

  • Lambert, M. V., & Robertson, M. M. (1999). Depression in epilepsy: Etiology, phenomenology, and treatment. Epilepsia, 40, 21–47.

    Article  Google Scholar 

  • Lappalainen, R., Lehtonen, T., Skarp, E., et al. (2007). The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial. Behavior Modification, 31, 488–511.

    Article  PubMed  Google Scholar 

  • Levitt, J. T., Brown, T. A., Orsillo, S. M., et al. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35, 747–766.

    Article  Google Scholar 

  • Lillis, J. (2007). Acceptance and Commitment Therapy for the treatment of obesity-related stigma and sustained weight loss. Unpublished doctoral dissertation, University of Nevada, Reno.

  • Lindsay, W., & Baty, F. (1986). Behavioral relaxation training: Exploration with adults who are mentally handicapped. Mental Handicap, 15, 159–162.

    Google Scholar 

  • Longmore, R. J., & Worrell, M. (2007). Do we need to challenge thoughts in cognitive behavior therapy? Clinical Psychology Review, 27, 173–187.

    Article  PubMed  Google Scholar 

  • Lundgren, T. (August 2006). Validation and reliability data of the Bull’s-Eye. Presentation at the second world conference on ACT/RFT. London.

  • Lundgren, A. T., Dahl, J., Melin, L., et al. (2006). Evaluation of acceptance and commitment therapy for drug refractory epilepsy: A randomized controlled trial in South Africa. Epilepsia, 47, 2173–2179.

    Article  PubMed  Google Scholar 

  • MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007). Mediation analysis. Annual Review of Psychology, 58, 593–614.

    Article  PubMed  Google Scholar 

  • MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., et al. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104.

    Article  PubMed  Google Scholar 

  • MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39(1), 99–128.

    Article  Google Scholar 

  • Masedoa, A. I., & Esteve. M. R. (2006). Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress. Behaviour Research and Therapy, 45, 199–209.

    Article  Google Scholar 

  • Masuda, A., Hayes, S. C., Sackett, C. F., et al. (2004). Cognitive defusion and self-relevant negative thoughts: Examining the impact of a ninety year old technique. Behaviour Research and Therapy, 42, 477–485.

    Article  PubMed  Google Scholar 

  • Montgomery, J., & Epsie, C. (1986). Behavioral management of hysterical pseudo seizures. Behavioral Psychotherapy, 143, 34–40.

    Google Scholar 

  • Newson, D., Goldstein, L., & Fitzpatrick, D. (1998). Fear of seizures: An investigation and treatment. Seizure, 7, 101–106.

    Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers, 36, 717–731.

    PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Contemporary approaches to assessing mediation in communication research. In A. F. Hayes, M. D. Slater, & L.B. Synder (Eds.), The SAGE sourcebook of advanced data analysis methods for communication reseach (pp. 13–54). Thousand Oaks, CA: Sage Publications.

  • Ramaratnam, S., Baker, G. A., & Goldstein, L. H. (2004). Psychological treatments for epilepsy. (Cochran Review). The Cochran Library, Issue 1. Chichester, UK: Wiley.

    Google Scholar 

  • Rosseau, A., Hermann, B., & Whitman, S. (1985). Effects of progressive relaxation on epilepsy: Analysis of a series of cases. Psychological Reports, 57, 1203–1212.

    Google Scholar 

  • Spector, S., Goldstein, L., Cull, C., et al. (1994). Precipitating and inhibiting epileptic seizures: A survey of adults with poorly controlled epilepsy. London: International League against Epilepsy.

    Google Scholar 

  • Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equations models. In S. Leinhart (Ed.), Sociological methodology, 1982 (pp. 290–312). Washington, DC: American Sociological Association.

    Google Scholar 

  • Tan, S., & Bruni, J. (1986). Cognitive-behavior therapy with adult patients with epilepsy: A controlled outcome study. Epilepsia, 27, 255–263.

    Article  Google Scholar 

  • Tomson, T., Beghi, E., Sundqvist, A., et al. (2004). Medical risks in epilepsy: A review with focus on physical injuries, mortality, traffic accidents and prevention. Epilepsy Research, 60, 1–16.

    Article  PubMed  Google Scholar 

  • Vowles, K. E., McNeil, D. W., Gross, R. T., et al. (2007). Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain. Behavior Therapy, 38, 412–425.

    Article  PubMed  Google Scholar 

  • Wolf, P. (2005). From precipitation to inhibition of seizures: Rationale of a therapeutic paradigm. Epilepsia, 46, 15–16.

    Article  PubMed  Google Scholar 

  • World Health Organization. (1996). WHOQOL-BREF: Introduction, administration and generic version of the assessment. Geneva, Switzerland: WHO Programme on Mental Health.

    Google Scholar 

  • Zettle, R. D. (2003). Acceptance and commitment therapy (ACT) versus systematic desensitization in treatment of mathematics anxiety. The Psychological Record, 53, 197–215.

    Google Scholar 

  • Zettle, R. D., & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: The context of reason giving. The Analysis of Verbal Behavior, 4, 30–38.

    Google Scholar 

  • Zettle, R. D., & Rains, J. C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45, 438–445.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tobias Lundgren.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lundgren, T., Dahl, J. & Hayes, S.C. Evaluation of mediators of change in the treatment of epilepsy with acceptance and commitment therapy. J Behav Med 31, 225–235 (2008). https://doi.org/10.1007/s10865-008-9151-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-008-9151-x

Keywords

Navigation