Empirical Research Evaluations of self-referential thoughts and their association with components of Acceptance and Commitment Therapy Hollie Duff a,n , Andreas Larsson b , Louise McHugh a a University College Dublin, Ireland b Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden article info Article history: Received 16 October 2013 Received in revised form 17 August 2015 Accepted 23 November 2015 Keywords: Thought relations Psychological flexibility Experiential avoidance Cognitive fusion Psychological distress abstract Limited research has been carried out with respect to relationships among how individuals relate to thoughts and levels of cognitive fusion, experiential avoidance, psychological distress and mindfulness. Recent third-wave cognitive behavioral therapies such as Acceptance and Commitment Therapy (ACT) use techniques that focus less on changing the content of thoughts, and place more emphasis on changing the client's relationship to thoughts. For this reason, it is important to consider initial relations between the client's thoughts and the factors that ACT focuses on. The current study investigated as- sociations among several ACT-consistent factors and how they relate to evaluations of positive and ne- gative self-relevant thoughts. Seventy-nine participants completed ACT-consistent psychological mea- sures and thought evaluation measures. The results indicated that ACT-consistent variables were asso- ciated with thought relations (i.e., believability, discomfort and willingness) rather than evaluations of content (i.e., negativity). Positive associations were observed among greater levels of psychological distress and psychological inflexibility (i.e., greater experiential avoidance and cognitive fusion). Med- iation analysis identified believability of negative thoughts as a partially mediating factor in the pre- dictive ability of mindfulness, experiential avoidance and cognitive fusion on psychological distress, with stronger negative thought believability positively associated with greater levels of psychological distress. The results are discussed in terms of the clinical implications of the relations observed. & 2015 Published by Elsevier Inc. on behalf of Association for Contextual Behavioral Science. 1. Introduction While traditional Cognitive Behavioral Therapy (CBT) methods endeavor to dispute, change and restructure the content of clients’ thoughts, more recent third-wave cognitive behavioral therapies have shifted their focus. Several contemporary CBTs share the view that it is not necessarily the content of private experiences that lead to psychological difficulties and distress, but rather, their function (i.e., the way in which the individual relates to them). For example, Dialectical Behavior Therapy (DBT; Linehan, 1993a;1993b) utilizes mindfulness-based strategies to aid the in- dividual in achieving acceptance of their thoughts and in altering their reactions to emotional stimuli (Koerner, 2012; Hofmann, Sawyer, & Fang, 2010). Mindfulness-Based Cognitive Therapy (MBCT; Teasdale et al., 2000) uses techniques that encourage the individual towards a more decentered view of their own thoughts. Similarly, according to Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), there is no requirement for the client to change‘ dysfunctional’ thoughts; rather, to try to ex- perience them as internal events distinct from the self (Hayes, Jacobson, Follette, & Dougher, 1994). ACT, the subject of the current study, aims to change the function of private experiences and in- dividuals’ relationships to these experiences through strategies such as mindfulness, acceptance of thoughts and cognitive defusion. 1.1. Acceptance and Commitment Therapy Acceptance and Commitment Therapy derives its theoretical basis from Relational Frame Theory (Hayes, Barnes-Holmes, & Roche, 2001), a framework for understanding the relationship between cognition and language (Hoffmann et al., 2010). Within ACT it is understood that suffering evolves as a result of language processes. Rigidly regarding self-referential thoughts as fact, known as fusing with these thoughts, has been found to correlate with self-reported levels of anxiety and depression (Hayes et al., 2004; Gillanders et al., 2014) and has been linked to the devel- opment and maintenance of a number of psychological disorders Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jcbs Journal of Contextual Behavioral Science http://dx.doi.org/10.1016/j.jcbs.2015.11.003 2212-1447/& 2015 Published by Elsevier Inc. on behalf of Association for Contextual Behavioral Science. n Correspondence to: School of Psychology, Newman, Building, University College Dublin, Belfield, Dublin 4, Ireland. E-mail address: duffhols@gmail.com (H. Duff). Please cite this article as: Duff, H., et al. Evaluations of self-referential thoughts and their association with components of Acceptance and Commitment Therapy. Journal of Contextual Behavioral Science (2015), http://dx.doi.org/10.1016/j.jcbs.2015.11.003i Journal of Contextual Behavioral Science ∎ (∎∎∎∎) ∎∎∎–∎∎∎