(PS9-3) Acceptability of ACT and CBT Exposure Therapy Descriptions: A Vignette Study

Background

Exposure therapy (ET) is an effective treatment for fear and anxiety. Integrating consumer perspectives can improve sustainable access and engagement to evidence-based treatment. Consumers may prefer acceptance and commitment therapy (ACT)- informed ET descriptions over CBT/habituation-informed ET. Using a new comprehensive framework of acceptability, we tested associations of acceptability components with mental health, attitudes, and demographics. Then we tested multivariate change in acceptability and acceptability components after viewing a general definition and then randomly viewing a subsequent CBT or ACT-informed description. We predicted improvements in acceptability with the added psychoeducation of either ET description, and higher acceptability for the ACT-informed depiction.

Methods

Participants (n=115) volunteered to participate. The study was advertised by email to all students at a mid-size northeastern US public university. Constructs were assessed by validated measures of anxiety, depression, OCD symptoms, anxiety sensitivity, distress tolerance, psychological flexibility and attitudes towards seeking professional help, and questions about their views and experiences with therapy and ET.

Participants viewed a brief overall definition of ET, and then either an ACT or CBT/habituation-informed description. They rated acceptability after each component. Participants had an average age of 27 (SD = 9.16). Most (82%) had completed at least 1-3 months of therapy, and 17% had prior experience with ET. They were mostly white (85%), female (73%), and heterosexual (59%). Acceptability was measured with 7 component items and a global rating from Sekhon et al. (2017, 2022).

Results

Global acceptability and some acceptability components had small-moderate associations with OCD and depression (negative) and psychological flexibility (positive). There was a significant difference in acceptability components according to a binary conceptualization of sexual orientation (heterosexual or not) [Pillai’s trace =.165, F(8,106)=2.62, p=.012]. There was a significant multivariate within-subjects effect of definition progression [Pillai’s trace=.35, F(8,106)=7.23, p< .001]. There were significant changes in 5 acceptability components from a basic definition of ET to a CBT or ACT framing. Partial η2 ranged from .06 to .23 and p < .01.  There was a non-significant difference in acceptability between ACT and CBT definitions.

Conclusions

Receiving more psychoeducation about ET decreased perceived effort and increased perceived comfort in engaging in ET, belief it would help, agreement it was clear how it would help, and confidence in engaging in it.

Limitations include the possibility of Type I and Type II errors, a potential lack of ecological validity and the presence of carryover effects, and limited generalizability to clinical samples.

Future studies should explore differences in perceptions of acceptability of ET, including more recent updates on ET, such as justice-based ET while accounting for intersecting identities and assessing acceptability measure psychometrics. This work can improve outreach and training about ET to improve demand and uptake of this effective treatment.