Contains Video 1 Brief Acceptance and Commitment Therapy and Exposure for Panic Disorder: A Pilot Study Alicia E. Meuret, Southern Methodist University Michael P. Twohig, Utah State University David Rosenfield, Southern Methodist University Steven C. Hayes, University of Nevada Michelle G. Craske, University of California, Los Angeles Cognitive and biobehavioral coping skills are central to psychosocial therapies and are taught to facilitate and improve exposure therapy. While traditional coping skills are aimed at controlling maladaptive thoughts or dysregulations in physiology, newer approaches that explore acceptance, defusion, and values-based direction have been gaining interest. Acceptance and Commitment Therapy (ACT) involves creating an open, nonjudgmental stance toward whatever thoughts, feelings, and bodily sensations arise in a given moment, experiencing them for what they are, and moving toward them while inner experiences such as anxiety are present. This approach can be seen as consistent with exposure therapies and may be utilized to organize and facilitate engagement in exposure exercises. This study examines the feasibility and efficacy for combining a brief ACT protocol with traditional exposure therapy. Eleven patients with panic disorder with or without agoraphobia received 4 sessions of ACT followed by 6 sessions of exposure therapy, with data collected on a weekly basis. Acquisition of ACT skills and their application during exposure was monitored using a novel “think-aloud” technology. Treatment was associated with clinically significant improvements in panic symptom severity, willingness to allow inner experiences to occur, and reductions in avoidant behavior. Although preliminary, results suggest that our brief training in ACT only (as assessed prior to exposure exercises) and in combination with exposure therapy was acceptable to patients and offered benefits on the order of large effect sizes. Clinical and research implications are discussed. C OGNITIVE and biobehavioral coping skills are central to psychosocial therapies for anxiety disorders and are taught to facilitate and improve exposure therapy. These control-based coping skills typically aim to change catastrophic appraisals or change somatic symptoms. While traditional coping skills are aimed at controlling maladaptive thoughts or dysregulations in physiology, newer approaches that explore acceptance or willingness to experience such states have been gaining interest. One specific cognitive behavioral modality that is receiving increased attention is Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 2011). ACT is part of the cognitive behavioral tradition, but it focuses more heavily on acceptance and mindfulness processes as ways of responding to internal experiences (i.e., thoughts, feelings, bodily sensations) than more traditional CBT protocols. To this end, ACT is more similar to other acceptance- and mindfulness-based interventions, such as Mindfulness-Based Cognitive Therapy (Segal, Williams, & Teasdale, 2002), that focus on the function of internal experiences rather than their form or content. With the focus shifting away from the question of whether “CBT works” to “why it works” (i.e., mediators) and “for whom” (i.e., moderators), the examination of novel approaches seems particularly vital (Kazdin, 2007; McNally, 2007; Meuret, Wolitzky-Taylor, Twohig, & Craske, 2012). While the combination of therapeutic components that make up traditional CBT is generally effective for patients suffering from an anxiety disorder (Norton & Price, 2007; Westen & Morrison, 2001), there is considerable room for improvement. This seems particularly true for patients suffering from panic disorder with or without agoraphobia (PD/A). Here, effect sizes for CBT are the smallest among the anxiety disorders (Andrews, Cuijpers, Craske, McEvoy, & Titov, Keywords: Acceptance and Commitment Therapy; exposure; behav- ioral; panic; efficacy 1077-7229/12/606-618$1.00/0 © 2012 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved. 1 Video patients/clients are portrayed by actors. www.elsevier.com/locate/cabp Available online at www.sciencedirect.com Cognitive and Behavioral Practice 19 (2012) 606-618