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Vilardaga, Roger M

Positions:

Assistant Professor in Psychiatry and Behavioral Sciences

Psychiatry & Behavioral Sciences, Addictions
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 2012

Ph.D. — University of Nevada at Reno

Grants:

Duke Cancer Institute Application for Administrative Supplement for the P30 Cancer Center Support Grant to Develop Tobacco Cessation Treatment Capacity and Infrastructure for Cancer Patients

Administered By
Duke Cancer Institute
AwardedBy
National Institutes of Health
Role
Co Investigator
Start Date
January 01, 1997
End Date
December 31, 2019

Innovative Smartphone Application for Quitting Smoking among Seriously Mentally Ill

Administered By
Psychiatry & Behavioral Sciences, Addictions
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
August 15, 2016
End Date
July 31, 2019

PainTracker Sel-Manager: a web-based platform to promote and track chronic pain self-management and other treatment outcomes

Administered By
Psychiatry & Behavioral Sciences, Addictions
AwardedBy
University of Washington
Role
Principal Investigator
Start Date
August 01, 2016
End Date
September 15, 2017

Publications:

A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness.

The authors examined whether a contingency management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine whether contingency management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior.Seventy-nine (37% female, 44% nonwhite) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomly assigned to 12 weeks of contingency management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency management included the variable magnitude of reinforcement "prize draw" procedure contingent on EtG-negative samples (<150 ng/mL) three times a week and weekly gift cards for outpatient treatment attendance. Urine EtG, drug test, and self-report outcomes were assessed during the 12-week intervention and 3-month follow-up periods.Contingency management participants were 3.1 times (95% CI=2.2-4.5) more likely to submit an EtG-negative urine test during the 12-week intervention period, attaining nearly 1.5 weeks of additional alcohol abstinence compared with controls. Contingency management participants had significantly lower mean EtG levels, reported less drinking and fewer heavy drinking episodes, and were more likely to submit stimulant-negative urine and smoking-negative breath samples, compared with controls. Differences in self-reported alcohol use were maintained at the 3-month follow-up.This is the first randomized trial utilizing an accurate and validated biomarker (EtG) to demonstrate the efficacy of contingency management for alcohol dependence in outpatients with serious mental illness.

Authors
McDonell, MG; Leickly, E; McPherson, S; Skalisky, J; Srebnik, D; Angelo, F; Vilardaga, R; Nepom, JR; Roll, JM; Ries, RK
MLA Citation
McDonell, MG, Leickly, E, McPherson, S, Skalisky, J, Srebnik, D, Angelo, F, Vilardaga, R, Nepom, JR, Roll, JM, and Ries, RK. "A Randomized Controlled Trial of Ethyl Glucuronide-Based Contingency Management for Outpatients With Co-Occurring Alcohol Use Disorders and Serious Mental Illness." The American journal of psychiatry 174.4 (April 2017): 370-377.
PMID
28135843
Source
epmc
Published In
American Journal of Psychiatry
Volume
174
Issue
4
Publish Date
2017
Start Page
370
End Page
377
DOI
10.1176/appi.ajp.2016.16050627

Design and Real-World Evaluation of Eyes-Free Yoga: An Exergame for Blind and Low-Vision Exercise.

People who are blind or low vision may have a harder time participating in exercise due to inaccessibility or lack of encouragement. To address this, we developed Eyes-Free Yoga using the Microsoft Kinect that acts as a yoga instructor and has personalized auditory feedback based on skeletal tracking. We conducted two different studies on two different versions of Eyes-Free Yoga: (1) a controlled study with 16 people who are blind or low vision to evaluate the feasibility of a proof-of-concept and (2) an 8-week in-home deployment study with 4 people who are blind or low vision, with a fully functioning exergame containing four full workouts and motivational techniques. We found that participants preferred the personalized feedback for yoga postures during the laboratory study. Therefore, the personalized feedback was used as a means to build the core components of the system used in the deployment study and was included in both study conditions. From the deployment study, we found that the participants practiced Yoga consistently throughout the 8-week period (Average hours = 17; Average days of practice = 24), almost reaching the American Heart Association recommended exercise guidelines. On average, motivational techniques increased participant's user experience and their frequency and exercise time. The findings of this work have implications for eyes-free exergame design, including engaging domain experts, piloting with inexperienced users, using musical metaphors, and designing for in-home use cases.

Authors
Rector, K; Vilardaga, R; Lansky, L; Lu, K; Bennett, CL; Ladner, RE; Kientz, JA
MLA Citation
Rector, K, Vilardaga, R, Lansky, L, Lu, K, Bennett, CL, Ladner, RE, and Kientz, JA. "Design and Real-World Evaluation of Eyes-Free Yoga: An Exergame for Blind and Low-Vision Exercise." April 2017.
PMID
29104712
Source
epmc
Published In
ACM Transactions on Accessible Computing
Volume
9
Issue
4
Publish Date
2017
DOI
10.1145/3022729

User Experience Evaluation of a Smoking Cessation App in People With Serious Mental Illness.

Smoking rates among people with serious mental illness are 3 to 4 times higher than the general population, yet currently there are no smoking cessation apps specifically designed to address this need. We report the results of a User Experience (UX) evaluation of a National Cancer Institute smoking cessation app, QuitPal, and provide user centered design data that can be used to tailor smoking cessation apps for this population.Two hundred forty hours of field experience with QuitPal, 10 hours of recorded interviews and task performances, usage logs and a self-reported usability scale, informed the results of our study. Participants were five individuals recruited from a community mental health clinic with a reported serious mental illness history. Performance, self-reports, usage logs and interview data were triangulated to identify critical usability errors and UX themes emerging from this population.Data suggests QuitPal has below average levels of usability, elevated time on task performances and required considerable amounts of guidance. UX themes provided critical information to tailor smoking cessation apps for this population, such as the importance of breaking down "cessation" into smaller steps and use of a reward system.This is the first study to examine the UX of a smoking cessation app among people with serious mental illness. Data from this study will inform future research efforts to expand the effectiveness and reach of smoking cessation apps for this highly nicotine dependent yet under-served population.Data from this study will inform future research efforts to expand the effectiveness and reach of smoking cessation apps for people with serious mental illness, a highly nicotine dependent yet under-served population.

Authors
Vilardaga, R; Rizo, J; Kientz, JA; McDonell, MG; Ries, RK; Sobel, K
MLA Citation
Vilardaga, R, Rizo, J, Kientz, JA, McDonell, MG, Ries, RK, and Sobel, K. "User Experience Evaluation of a Smoking Cessation App in People With Serious Mental Illness." Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 18.5 (May 2016): 1032-1038.
PMID
26581430
Source
epmc
Published In
Nicotine and Tobacco Research (OUP)
Volume
18
Issue
5
Publish Date
2016
Start Page
1032
End Page
1038
DOI
10.1093/ntr/ntv256

A framework for self-experimentation in personalized health.

To describe an interdisciplinary and methodological framework for applying single case study designs to self-experimentation in personalized health. The authors examine the framework's applicability to various health conditions and present an initial case study with irritable bowel syndrome (IBS).An in-depth literature review was performed to develop the framework and to identify absolute and desired health condition requirements for the application of this framework. The authors developed mobile application prototypes, storyboards, and process flows of the framework using IBS as the case study. The authors conducted three focus groups and an online survey using a human-centered design approach for assessing the framework's feasibility.All 6 focus group participants had a positive view about our framework and volunteered to participate in future studies. Most stated they would trust the results because it was their own data being analyzed. They were most concerned about confounds, nonmeaningful measures, and erroneous assumptions on the timing of trigger effects. Survey respondents (N = 60) were more likely to be adherent to an 8- vs 12-day study length even if it meant lower confidence results.Implementation of the self-experimentation framework in a mobile application appears to be feasible for people with IBS. This framework can likely be applied to other health conditions. Considerations include the learning curve for teaching self-experimentation to non-experts and the challenges involved in operationalizing and customizing study designs.Using mobile technology to guide people through self-experimentation to investigate health questions is a feasible and promising approach to advancing personalized health.

Authors
Karkar, R; Zia, J; Vilardaga, R; Mishra, SR; Fogarty, J; Munson, SA; Kientz, JA
MLA Citation
Karkar, R, Zia, J, Vilardaga, R, Mishra, SR, Fogarty, J, Munson, SA, and Kientz, JA. "A framework for self-experimentation in personalized health." Journal of the American Medical Informatics Association : JAMIA 23.3 (May 2016): 440-448.
PMID
26644399
Source
epmc
Published In
Journal of the American Medical Informatics Association
Volume
23
Issue
3
Publish Date
2016
Start Page
440
End Page
448
DOI
10.1093/jamia/ocv150

Examining the role of psychological inflexibility, perspective taking, and empathic concern in generalized prejudice

Authors
Levin, ME; Luoma, JB; Vilardaga, R; Lillis, J; Nobles, R; Hayes, SC
MLA Citation
Levin, ME, Luoma, JB, Vilardaga, R, Lillis, J, Nobles, R, and Hayes, SC. "Examining the role of psychological inflexibility, perspective taking, and empathic concern in generalized prejudice." Journal of Applied Social Psychology 46.3 (March 2016): 180-191.
Source
crossref
Published In
Journal of Applied Social Psychology
Volume
46
Issue
3
Publish Date
2016
Start Page
180
End Page
191
DOI
10.1111/jasp.12355

Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes.

A modular, transdiagnostic approach to treatment design and implementation may increase the public health impact of evidence-based psychosocial interventions. Such an approach relies on algorithms for selecting and implementing treatment components intended to have a specific therapeutic effect, yet there is little evidence for how components function independent of their treatment packages when employed in clinical service settings. This study aimed to demonstrate the specificity of treatment effects for two components of Acceptance and Commitment Therapy (ACT), a promising candidate for modularization. A randomized, nonconcurrent, multiple-baseline across participants design was used to examine component effects on treatment processes and outcomes in 15 adults seeking mental health treatment. The ACT OPEN module targeted acceptance and cognitive defusion; the ACT ENGAGED module targeted values-based activation and persistence. According to Tau-U analyses, both modules produced significant improvements in psychiatric symptoms, quality of life, and targeted therapeutic processes. ACT ENGAGED demonstrated greater improvements in quality of life and values-based activation. ACT OPEN showed greater improvements in symptom severity, acceptance, and defusion. Both modules improved awareness and non-reactivity, which were mutually targeted, though using distinct intervention procedures. Both interventions demonstrated high treatment acceptability, completion, and patient satisfaction. Treatment effects were maintained at 3-month follow up. ACT components should be considered for inclusion in a modular approach to implementing evidence-based psychosocial interventions for adults.

Authors
Villatte, JL; Vilardaga, R; Villatte, M; Plumb Vilardaga, JC; Atkins, DC; Hayes, SC
MLA Citation
Villatte, JL, Vilardaga, R, Villatte, M, Plumb Vilardaga, JC, Atkins, DC, and Hayes, SC. "Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes." Behaviour research and therapy 77 (February 2016): 52-61.
PMID
26716932
Source
epmc
Published In
Behaviour Research and Therapy
Volume
77
Publish Date
2016
Start Page
52
End Page
61
DOI
10.1016/j.brat.2015.12.001

Predictors of Utilization of a Novel Smoking Cessation Smartphone App.

Understanding the characteristics of high and low utilizers of smartphone applications (apps) for smoking cessation would inform development of more engaging and effective apps, yet no studies to date have addressed this critical question. Informed by prior research on predictors of cessation Web site utilization, this study examines the degree to which baseline demographic factors (gender, age, and education), smoking-related factors (smoking level and friends' smoking), and psychological factors (depression and anxiety) are predictive of utilization of a smartphone app for smoking cessation called SmartQuit.Data came from 98 participants randomized to SmartQuit as part of a pilot trial from March to May 2013. We used negative binomial count regressions to examine the relationship between user characteristics and utilization of the app over an 8-week treatment period.Lower education (risk ratio [RR]=0.492; p=0.021), heavier smoking (RR=0.613; p=0.033), and depression (RR=0.958; p=0.017) prospectively predicted lower app utilization. Women (RR=0.320; p=0.022), those with lower education (RR=0.491; p=0.013), and heavier smokers (RR=0.418; p=0.039) had lower utilization of app features known to predict smoking cessation.Many of the predictors of utilization of smoking cessation apps are the same as those of cessation Web sites. App-delivered smoking cessation treatment effectiveness could be enhanced by focusing on increasing engagement of women, those with lower education, heavy smokers, and those with current depressive symptoms.

Authors
Zeng, EY; Vilardaga, R; Heffner, JL; Mull, KE; Bricker, JB
MLA Citation
Zeng, EY, Vilardaga, R, Heffner, JL, Mull, KE, and Bricker, JB. "Predictors of Utilization of a Novel Smoking Cessation Smartphone App." Telemedicine journal and e-health : the official journal of the American Telemedicine Association 21.12 (December 2015): 998-1004.
PMID
26171733
Source
epmc
Published In
Telemedicine Journal and e-Health
Volume
21
Issue
12
Publish Date
2015
Start Page
998
End Page
1004
DOI
10.1089/tmj.2014.0232

Perspectives on the nature of being, becoming and reality from contextual behavioral science

Authors
Vilardaga, R; Trent Codd, R
MLA Citation
Vilardaga, R, and Trent Codd, R. "Perspectives on the nature of being, becoming and reality from contextual behavioral science." Journal of Contextual Behavioral Science 4.4 (October 2015): 213-214.
Source
crossref
Published In
Journal of Contextual Behavioral Science
Volume
4
Issue
4
Publish Date
2015
Start Page
213
End Page
214
DOI
10.1016/j.jcbs.2015.07.002

Opportunities and challenges for self-experimentation in self-tracking

Personal informatics applications support capture and access of data related to an increasing variety of dimensions of everyday life. However, such applications often fail to effectively support diagnostic self-tracking, wherein people seek to answer a specific question about themselves. Current approaches are therefore difficult, tedious, and error-prone. This workshop paper discusses our ongoing efforts to develop methods for self-experimentation in self-tracking. We examine how self-experimentation situates within existing models of personal informatics processes, discuss our current focus on personal food triggers in patients suffering from Irritable Bowel Syndrome, and highlight open challenges for self-experimentation more broadly.

Authors
Karkar, R; Fogarty, J; Kientz, JA; Munson, SA; Vilardaga, R; Zia, J
MLA Citation
Karkar, R, Fogarty, J, Kientz, JA, Munson, SA, Vilardaga, R, and Zia, J. "Opportunities and challenges for self-experimentation in self-tracking." September 7, 2015.
Source
scopus
Published In
UbiComp and ISWC 2015 - Proceedings of the 2015 ACM International Joint Conference on Pervasive and Ubiquitous Computing and the Proceedings of the 2015 ACM International Symposium on Wearable Computers
Publish Date
2015
Start Page
991
End Page
996
DOI
10.1145/2800835.2800949

Determining ethyl glucuronide cutoffs when detecting self-reported alcohol use in addiction treatment patients.

Ethyl glucuronide (EtG) is an alcohol biomarker with potential utility as a clinical research and alcohol treatment outcome. Debate exists regarding the appropriate cutoff level for determining alcohol use, particularly with the EtG immunoassay. This study determined the EtG immunoassay cutoff levels that most closely correspond to self-reported drinking in alcohol-dependent outpatients.Eighty adults with alcohol dependence and mental illness, taking part in an alcohol treatment study, provided urine samples 3 times per week for up to 16 weeks (1,589 samples). Self-reported drinking during 120 hours prior to each sample collection was assessed. Receiver operating characteristic analyses were conducted to assess the ability of the EtG immunoassay to detect self-reported alcohol use across 24- to 120-hour time periods. Sensitivity and specificity of EtG immunoassay cutoff levels was compared in 100 ng/ml increments (100 to 500 ng/ml) across 24 to 120 hours.Over half (57%) of the 1,589 samples indicated recent alcohol consumption. The EtG immunoassay closely corresponded to self-reported drinking from 24 (area under the curve [AUC] = 0.90, 95% confidence interval [CI]: 0.88, 0.92) to 120 hours (AUC = 0.88, 95% CI: 0.87, 0.90). When cutoff levels were compared across 24 to 120 hours, 100 ng/ml had the highest sensitivity (0.93 to 0.78) and lowest specificity (0.67 to 0.85). Relative to 100 ng/ml, the 200 ng/ml cutoff demonstrated a reduction in sensitivity (0.89 to 0.67), but improved specificity (0.78 to 0.94). The 300, 400, and 500 ng/ml cutoffs demonstrated the lowest sensitivity (0.86 to 0.33) and highest specificity (0.86 to 0.97) over 24 to 120 hours.For detecting alcohol use for >24 hours, the 200 ng/ml cutoff level is recommended for use as a research and clinical outcome.

Authors
Lowe, JM; McDonell, MG; Leickly, E; Angelo, FA; Vilardaga, R; McPherson, S; Srebnik, D; Roll, J; Ries, RK
MLA Citation
Lowe, JM, McDonell, MG, Leickly, E, Angelo, FA, Vilardaga, R, McPherson, S, Srebnik, D, Roll, J, and Ries, RK. "Determining ethyl glucuronide cutoffs when detecting self-reported alcohol use in addiction treatment patients." Alcoholism, clinical and experimental research 39.5 (May 2015): 905-910.
PMID
25866234
Source
epmc
Published In
Alcoholism: Clinical and Experimental Research
Volume
39
Issue
5
Publish Date
2015
Start Page
905
End Page
910
DOI
10.1111/acer.12699

High levels of agreement between clinic-based ethyl glucuronide (EtG) immunoassays and laboratory-based mass spectrometry.

Immunoassay urine drug screening cups that detect use for two or more days are commonly used in addiction treatment settings. Until recently, there has been no comparable immunoassay test for alcohol use in these settings.The aim of this study was to assess the agreement of a commercially available ethyl glucuronide immunoassay (EtG-I) test conducted at an outpatient addiction clinic and lab-based EtG mass spectrometry (EtG-MS) conducted at a drug testing laboratory at three cut-off levels. High agreement between these two measures would support the usefulness of EtG-I as a clinical tool for monitoring alcohol use.Forty adults with co-occurring alcohol dependence and serious mental illnesses submitted 1068 urine samples over a 16-week alcohol treatment study. All samples were tested using EtG-I on a benchtop analyzer and 149 were randomly selected for EtG-MS analysis at a local laboratory. Agreement was defined as the number of samples where EtG-I and EtG-MS were both above or below a specific cut-off level. Agreement was calculated at low cut-off levels (100 and 250 ng/ml), as well as at a higher cut-off level (500 ng/ml) recommended by most by commercial drug testing laboratories.Agreement between EtG-I and EtG-MS was high across all cut-off levels (90.6% at 100 ng/ml, and 96.6% at 250 and 500 ng/ml).EtG immunoassays conducted at low cut-off levels in point-of-care testing settings have high agreement with lab-based EtG-MS. EtG-I can be considered a useful clinical monitoring tool for alcohol use in community-based addiction treatment settings.

Authors
Leickly, E; McDonell, MG; Vilardaga, R; Angelo, FA; Lowe, JM; McPherson, S; Srebnik, D; Roll, JM; Ries, RK
MLA Citation
Leickly, E, McDonell, MG, Vilardaga, R, Angelo, FA, Lowe, JM, McPherson, S, Srebnik, D, Roll, JM, and Ries, RK. "High levels of agreement between clinic-based ethyl glucuronide (EtG) immunoassays and laboratory-based mass spectrometry." The American journal of drug and alcohol abuse 41.3 (May 2015): 246-250.
PMID
25695340
Source
epmc
Published In
The American Journal of Drug and Alcohol Abuse (Informa)
Volume
41
Issue
3
Publish Date
2015
Start Page
246
End Page
250
DOI
10.3109/00952990.2015.1011743

Web-based acceptance and commitment therapy smoking cessation treatment for smokers with depressive symptoms.

Smokers with depressive symptoms have more difficulty quitting smoking than the general population of smokers. The present study examines a web-based treatment using acceptance and commitment therapy (ACT) for smokers with depressive symptoms. The study aimed to determine participant receptivity to the intervention and its effects on smoking cessation, acceptance of internal cues, and depressive symptoms.Smokers who had positive screening results for depressive symptoms at baseline (n = 94) were selected from a randomized controlled trial (N = 222) comparing web-based ACT for smoking cessation (WebQuit.org) with Smokefree.gov. Forty-five participants (48%) completed the three-month follow-up.Compared to Smokefree.gov, WebQuit participants spent significantly more time on site (p =.001) and had higher acceptance of physical cravings (p =.033). While not significant, WebQuit participants were more engaged and satisfied with their program and were more accepting of internal cues overall. There was preliminary evidence that WebQuit participants had higher quit rates (20% versus 12%) and lower depressive symptoms at follow-up (45% versus 56%) than those in Smokefree.gov.This was the first study of web-based ACT for smoking cessation among smokers with depressive symptoms, with promising evidence of receptivity, efficacy, impact on a theory-based change process, and possible secondary effects on depression. A fully powered trial of the ACT WebQuit.org intervention specifically for depressed smokers is needed. This was part of a clinical trial registered as NCT#01166334 at www.clinicaltrials.gov .

Authors
Jones, HA; Heffner, JL; Mercer, L; Wyszynski, CM; Vilardaga, R; Bricker, JB
MLA Citation
Jones, HA, Heffner, JL, Mercer, L, Wyszynski, CM, Vilardaga, R, and Bricker, JB. "Web-based acceptance and commitment therapy smoking cessation treatment for smokers with depressive symptoms." Journal of dual diagnosis 11.1 (January 2015): 56-62.
PMID
25671683
Source
epmc
Published In
Journal of Dual Diagnosis
Volume
11
Issue
1
Publish Date
2015
Start Page
56
End Page
62
DOI
10.1080/15504263.2014.992588

Feature-level analysis of a novel smartphone application for smoking cessation.

Currently, there are over 400 smoking cessation smartphone apps available, downloaded an estimated 780,000 times per month. No prior studies have examined how individuals engage with specific features of cessation apps and whether use of these features is associated with quitting.Using data from a pilot trial of a novel smoking cessation app, we examined: (i) the 10 most-used app features, and (ii) prospective associations between feature usage and quitting.Participants (n = 76) were from the experimental arm of a randomized, controlled pilot trial of an app for smoking cessation called "SmartQuit," which includes elements of both Acceptance and Commitment Therapy (ACT) and traditional cognitive behavioral therapy (CBT). Utilization data were automatically tracked during the 8-week treatment phase. Thirty-day point prevalence smoking abstinence was assessed at 60-day follow-up.The most-used features - quit plan, tracking, progress, and sharing - were mostly CBT. Only two of the 10 most-used features were prospectively associated with quitting: viewing the quit plan (p = 0.03) and tracking practice of letting urges pass (p = 0.03). Tracking ACT skill practice was used by fewer participants (n = 43) but was associated with cessation (p = 0.01).In this exploratory analysis without control for multiple comparisons, viewing a quit plan (CBT) as well as tracking practice of letting urges pass (ACT) were both appealing to app users and associated with successful quitting. Aside from these features, there was little overlap between a feature's popularity and its prospective association with quitting. Tests of causal associations between feature usage and smoking cessation are now needed.

Authors
Heffner, JL; Vilardaga, R; Mercer, LD; Kientz, JA; Bricker, JB
MLA Citation
Heffner, JL, Vilardaga, R, Mercer, LD, Kientz, JA, and Bricker, JB. "Feature-level analysis of a novel smartphone application for smoking cessation." The American journal of drug and alcohol abuse 41.1 (January 2015): 68-73.
PMID
25397860
Source
epmc
Published In
The American Journal of Drug and Alcohol Abuse (Informa)
Volume
41
Issue
1
Publish Date
2015
Start Page
68
End Page
73
DOI
10.3109/00952990.2014.977486

Using Acceptance and Commitment Therapy to Increase Self-Compassion: A Randomized Controlled Trial.

Self-compassion has been shown to be related to several types of psychopathology, including traumatic stress, and has been shown to improve in response to various kinds of interventions. Current conceptualizations of self-compassion fit well with the psychological flexibility model, which underlies acceptance and commitment therapy (ACT). However, there has been no research on ACT interventions specifically aimed at self-compassion. This randomized trial therefore compared a 6-hour ACT-based workshop targeting self-compassion to a wait-list control. From pretreatment to 2-month follow-up, ACT was significantly superior to the control condition in self-compassion, general psychological distress, and anxiety. Process analyses revealed psychological flexibility to be a significant mediator of changes in self-compassion, general psychological distress, depression, anxiety, and stress. Exploratory moderation analyses revealed the intervention to be of more benefit in terms of depression, anxiety, and stress to those with greater trauma history.

Authors
Yadavaia, JE; Hayes, SC; Vilardaga, R
MLA Citation
Yadavaia, JE, Hayes, SC, and Vilardaga, R. "Using Acceptance and Commitment Therapy to Increase Self-Compassion: A Randomized Controlled Trial." Journal of contextual behavioral science 3.4 (October 2014): 248-257.
PMID
25506545
Source
epmc
Published In
Journal of Contextual Behavioral Science
Volume
3
Issue
4
Publish Date
2014
Start Page
248
End Page
257
DOI
10.1016/j.jcbs.2014.09.002

Practical considerations in the design and development of smartphone apps for behavior change.

The fast adoption of smartphone applications (apps) by behavioral scientists pose a new host of opportunities as well as knowledge and interdisciplinary challenges. Therefore, this brief report will discuss the lessons we have learned during the development and testing of smartphone apps for behavior change, and provide the reader with guidance and recommendations about this design and development process. We hope that the guidance and perspectives presented in this brief report will empower behavioral scientists to test the efficacy of smartphone apps for behavior change, further advance the contextual behavioral etiology of behavioral disorders and help move the field towards personalized behavior change technologies.

Authors
Roth, WR; Vilardaga, R; Wolfe, N; Bricker, JB; McDonell, MG
MLA Citation
Roth, WR, Vilardaga, R, Wolfe, N, Bricker, JB, and McDonell, MG. "Practical considerations in the design and development of smartphone apps for behavior change." Journal of contextual behavioral science 3.4 (October 2014): 269-272.
PMID
25485231
Source
epmc
Published In
Journal of Contextual Behavioral Science
Volume
3
Issue
4
Publish Date
2014
Start Page
269
End Page
272
DOI
10.1016/j.jcbs.2014.08.006

Randomized, controlled pilot trial of a smartphone app for smoking cessation using acceptance and commitment therapy.

There is a dual need for (1) innovative theory-based smartphone applications for smoking cessation and (2) controlled trials to evaluate their efficacy. Accordingly, this study tested the feasibility, acceptability, preliminary efficacy, and mechanism of behavioral change of an innovative smartphone-delivered acceptance and commitment therapy (ACT) application for smoking cessation vs. an application following US Clinical Practice Guidelines.Adult participants were recruited nationally into the double-blind randomized controlled pilot trial (n=196) that compared smartphone-delivered ACT for smoking cessation application (SmartQuit) with the National Cancer Institute's application for smoking cessation (QuitGuide).We recruited 196 participants in two months. SmartQuit participants opened their application an average of 37.2 times, as compared to 15.2 times for QuitGuide participants (p<0001). The overall quit rates were 13% in SmartQuit vs. 8% in QuitGuide (OR=2.7; 95% CI=0.8-10.3). Consistent with ACT's theory of change, among those scoring low (below the median) on acceptance of cravings at baseline (n=88), the quit rates were 15% in SmartQuit vs. 8% in QuitGuide (OR=2.9; 95% CI=0.6-20.7).ACT is feasible to deliver by smartphone application and shows higher engagement and promising quit rates compared to an application that follows US Clinical Practice Guidelines. As results were limited by the pilot design (e.g., small sample), a full-scale efficacy trial is now needed.

Authors
Bricker, JB; Mull, KE; Kientz, JA; Vilardaga, R; Mercer, LD; Akioka, KJ; Heffner, JL
MLA Citation
Bricker, JB, Mull, KE, Kientz, JA, Vilardaga, R, Mercer, LD, Akioka, KJ, and Heffner, JL. "Randomized, controlled pilot trial of a smartphone app for smoking cessation using acceptance and commitment therapy." Drug and alcohol dependence 143 (October 2014): 87-94.
PMID
25085225
Source
epmc
Published In
Drug and Alcohol Dependence
Volume
143
Publish Date
2014
Start Page
87
End Page
94
DOI
10.1016/j.drugalcdep.2014.07.006

Do counselor techniques predict quitting during smoking cessation treatment? A component analysis of telephone-delivered Acceptance and Commitment Therapy.

No studies to date have examined the effect of counselor techniques on smoking cessation over the course of treatment. To address this gap, we examined the degree to which the use of specific Acceptance and Commitment Therapy (ACT) counseling techniques in a given session predicted smoking cessation reported at the next session. The data came from the ACT arm of a randomized controlled trial of a telephone-delivered smoking cessation intervention. Trained raters coded 139 counseling sessions across 44 participants. The openness, awareness and activation components of the ACT model were rated for each telephone counseling session. Multilevel logistic regression models were used to estimate the predictive relationship between each component during any given telephone session and smoking cessation at the following telephone session. For every 1-unit increase in counselors' use of openness and awareness techniques there were 42% and 52% decreases in the odds of smoking at the next counseling session, respectively. However, there was no significant predictive relationship between counselors' use of activation techniques and smoking cessation. Overall, results highlight the theoretical and clinical value of examining therapists' techniques as predictors of outcome during the course of treatment.

Authors
Vilardaga, R; Heffner, JL; Mercer, LD; Bricker, JB
MLA Citation
Vilardaga, R, Heffner, JL, Mercer, LD, and Bricker, JB. "Do counselor techniques predict quitting during smoking cessation treatment? A component analysis of telephone-delivered Acceptance and Commitment Therapy." Behaviour research and therapy 61 (October 2014): 89-95.
PMID
25156397
Source
epmc
Published In
Behaviour Research and Therapy
Volume
61
Publish Date
2014
Start Page
89
End Page
95
DOI
10.1016/j.brat.2014.07.008

Preliminary findings: Contingency management targeting psycho-stimulant use results in secondary decreases in smoking for severely mentally ill adults.

Treatments for drug addiction and smoking in severely mentally ill (SMI) adults are needed.To investigate the effect of a contingency management (CM) intervention targeting psycho-stimulant on cigarette smoking.126 stimulant dependent SMI smokers were assigned to CM or a non-contingent control condition. Rates of smoking-negative (<3 ppm) carbon monoxide breath-samples were compared.Individuals who received CM targeting psycho-stimulants were 79% more likely to submit a smoking-negative breath-sample relative to controls.This study provides initial evidence that a behavioral treatment for drug use results in reductions in cigarette smoking in SMI adults.

Authors
McDonell, M; McPherson, S; Vilardaga, R; Srebnik, D; Angelo, FN; Leickly, E; Saxon, AJ; Roll, J; Ries, R
MLA Citation
McDonell, M, McPherson, S, Vilardaga, R, Srebnik, D, Angelo, FN, Leickly, E, Saxon, AJ, Roll, J, and Ries, R. "Preliminary findings: Contingency management targeting psycho-stimulant use results in secondary decreases in smoking for severely mentally ill adults." The American journal on addictions 23.4 (July 2014): 407-410.
PMID
24961363
Source
epmc
Published In
The American Journal on Addictions
Volume
23
Issue
4
Publish Date
2014
Start Page
407
End Page
410
DOI
10.1111/j.1521-0391.2013.12114.x

The promise of mobile technologies and single case designs for the study of individuals in their natural environment.

Mobile technologies are growing rapidly around the world to broad demographics of society. These technologies hold great promise for their integration with Single Case Designs (SCDs) and the study of individuals in their natural environment. This paper discusses the theoretical, methodological and analytic implications of these tools for the advancement of the contextual behavioral etiology of behavioral disorders, and their remediation. We hope this paper will highlight the scientific advantages of combining mobile technologies and SCDs and encourage their adoption among CBS scientists.

Authors
Vilardaga, R; Bricker, J; McDonell, M
MLA Citation
Vilardaga, R, Bricker, J, and McDonell, M. "The promise of mobile technologies and single case designs for the study of individuals in their natural environment." Journal of contextual behavioral science 3.2 (April 2014): 148-153.
PMID
24949285
Source
epmc
Published In
Journal of Contextual Behavioral Science
Volume
3
Issue
2
Publish Date
2014
Start Page
148
End Page
153
DOI
10.1016/j.jcbs.2014.03.003

Technical, practical and analytic innovations in single case designs for contextual behavioral scientists

Authors
Vilardaga, R
MLA Citation
Vilardaga, R. "Technical, practical and analytic innovations in single case designs for contextual behavioral scientists." Journal of Contextual Behavioral Science 3.2 (April 2014): 136-137.
Source
crossref
Published In
Journal of Contextual Behavioral Science
Volume
3
Issue
2
Publish Date
2014
Start Page
136
End Page
137
DOI
10.1016/j.jcbs.2014.05.002

The Acceptance and Action Questionnaire - Stigma (AAQ-S): Developing a measure of psychological flexibility with stigmatizing thoughts.

The current study sought to develop and test the Acceptance and Action Questionnaire - Stigma (AAQ-S), a measure of psychological flexibility with stigmatizing thoughts. A sample of 604 undergraduate students completed an online survey, which included an initial pool of 43 AAQ-S items as well as measures related to psychological flexibility and stigma. Expert judge ratings and factor analysis were used to identify and refine two distinct subscales; psychological flexibility and psychological inflexibility relating to stigmatizing thoughts. Analyses indicated that the AAQ-S psychological flexibility and inflexibility subscales, as well as a combined total score, correlate with other measures of psychological flexibility and stigma in expected ways, and are more predictive of stigma than a general measure of psychological flexibility. Overall, the results suggest that the AAQ-S could be a useful measure in conducting future stigma research.

Authors
Levin, ME; Luoma, JB; Lillis, J; Hayes, SC; Vilardaga, R
MLA Citation
Levin, ME, Luoma, JB, Lillis, J, Hayes, SC, and Vilardaga, R. "The Acceptance and Action Questionnaire - Stigma (AAQ-S): Developing a measure of psychological flexibility with stigmatizing thoughts." Journal of contextual behavioral science 3.1 (January 2014): 21-26.
PMID
25485230
Source
epmc
Published In
Journal of Contextual Behavioral Science
Volume
3
Issue
1
Publish Date
2014
Start Page
21
End Page
26
DOI
10.1016/j.jcbs.2013.11.003

Preliminary Findings: Contingency Management Targeting Psycho-Stimulant Use Results in Secondary Decreases in Smoking for Severely Mentally Ill Adults

Authors
McDonell, M; McPherson, S; Vilardaga, R; Srebnik, D; Angelo, FN; Leickly, E; Saxon, AJ; Roll, J; Ries, R
MLA Citation
McDonell, M, McPherson, S, Vilardaga, R, Srebnik, D, Angelo, FN, Leickly, E, Saxon, AJ, Roll, J, and Ries, R. "Preliminary Findings: Contingency Management Targeting Psycho-Stimulant Use Results in Secondary Decreases in Smoking for Severely Mentally Ill Adults." AMERICAN JOURNAL ON ADDICTIONS 23.4 (2014): 407-410.
Source
wos-lite
Published In
The American Journal on Addictions
Volume
23
Issue
4
Publish Date
2014
Start Page
407
End Page
410
DOI
10.1111/j.1521-0391.2014.12114.x

Comparing experiential acceptance and cognitive reappraisal as predictors of functional outcome in individuals with serious mental illness.

Two psychological regulation strategies to cope with psychotic symptoms proposed by the cognitive behavioral tradition were examined in this study: cognitive reappraisal and experiential acceptance. Although cognitive behavior therapy for psychosis has increasing empirical support, little is known about the role of these two strategies using methods of known ecological validity.Intensive longitudinal data was gathered from 25 individuals diagnosed with a psychiatric disorder with psychotic features. During the course of six days we measured contextual factors, psychotic and stressful events, psychological regulation strategies and functional outcome.Positive psychotic symptoms and stressful events had negative associations with quality of life and affect, whereas experiential acceptance had positive associations with them. Cognitive reappraisal had inconsistent associations with quality of life and no association with affect. Social interactions and engagement in activities had a positive association with quality of life. Results were supported by additional and exploratory analyses.Across measures of functional outcome, experiential acceptance appears to be an effective coping strategy for individuals facing psychotic and stressful experiences, whereas cognitive reappraisal does not. In order to inform treatment development efforts, results suggest the need to further investigate the role of these psychological regulation strategies using ecologically valid methods.

Authors
Vilardaga, R; Hayes, SC; Atkins, DC; Bresee, C; Kambiz, A
MLA Citation
Vilardaga, R, Hayes, SC, Atkins, DC, Bresee, C, and Kambiz, A. "Comparing experiential acceptance and cognitive reappraisal as predictors of functional outcome in individuals with serious mental illness." Behaviour research and therapy 51.8 (August 2013): 425-433.
PMID
23747581
Source
epmc
Published In
Behaviour Research and Therapy
Volume
51
Issue
8
Publish Date
2013
Start Page
425
End Page
433
DOI
10.1016/j.brat.2013.04.003

Deictic Relational Responding, Empathy, and Experiential Avoidance as Predictors of Social Anhedonia: Further Contributions From Relational Frame Theory

Authors
Vilardaga, R; Estévez, A; Levin, ME; Hayes, SC
MLA Citation
Vilardaga, R, Estévez, A, Levin, ME, and Hayes, SC. "Deictic Relational Responding, Empathy, and Experiential Avoidance as Predictors of Social Anhedonia: Further Contributions From Relational Frame Theory." The Psychological Record 62.3 (July 2012): 409-432.
Source
crossref
Published In
The Psychological record
Volume
62
Issue
3
Publish Date
2012
Start Page
409
End Page
432
DOI
10.1007/BF03395811

A Contextual Behavioral Approach to Pathological Altruism

© Oxford University Press, 2014. This chapter argues that maladaptive patterns of behavior, such as pathological altruism, can be explained by the influence of the verbal/cultural context. Once established, those maladaptive patterns can be very pervasive, regardless of their lack of apparent benefit. The chapter presents an evolutionarily consistent approach to language and cognition in which the cultural environment precisely selects certain patterns of behavior that, although useful for the survival of the species, can also keep the individual in a vicious cycle of behavior that can damage himself as well as others. The chapter describes four processes that may be key to pathological altruism: experiential avoidance, perspectivetaking, values-based actions, and conceptualized self. The human species is characterized by high levels of adaptability. However, it is crucial not to underestimate the complexity of verbal and cultural influences, and to create models that allow us not only to understand, but to modify them.

Authors
Vilardaga, R; Hayes, SC
MLA Citation
Vilardaga, R, and Hayes, SC. "A Contextual Behavioral Approach to Pathological Altruism." Pathological Altruism. January 19, 2012.
Source
scopus
Publish Date
2012
DOI
10.1093/acprof:oso/9780199738571.003.0033

Burnout among the addiction counseling workforce: the differential roles of mindfulness and values-based processes and work-site factors.

Although work-site factors have been shown to be a consistent predictor of burnout, the importance of mindfulness and values-based processes among addiction counselors has been little examined. In this study, we explored how strongly experiential avoidance, cognitive fusion, and values commitment related to burnout after controlling for well-established work-site factors (job control, coworker support, supervisor support, salary, workload, and tenure). We conducted a cross-sectional survey among 699 addiction counselors working for urban substance abuse treatment providers in six states of the United States. Results corroborated the importance of work-site factors for burnout reduction in this specific population, but we found that mindfulness and values-based processes had a stronger and more consistent relationship with burnout as compared with work-site factors. We conclude that interventions that target experiential avoidance, cognitive fusion, and values commitment may provide a possible new direction for the reduction of burnout among addiction counselors.

Authors
Vilardaga, R; Luoma, JB; Hayes, SC; Pistorello, J; Levin, ME; Hildebrandt, MJ; Kohlenberg, B; Roget, NA; Bond, F
MLA Citation
Vilardaga, R, Luoma, JB, Hayes, SC, Pistorello, J, Levin, ME, Hildebrandt, MJ, Kohlenberg, B, Roget, NA, and Bond, F. "Burnout among the addiction counseling workforce: the differential roles of mindfulness and values-based processes and work-site factors." Journal of substance abuse treatment 40.4 (June 2011): 323-335.
PMID
21257281
Source
epmc
Published In
Journal of Substance Abuse Treatment
Volume
40
Issue
4
Publish Date
2011
Start Page
323
End Page
335
DOI
10.1016/j.jsat.2010.11.015

Creating a strategy for progress: a contextual behavioral science approach.

Behavior analysis is a field dedicated to the development and application of behavioral principles to the understanding and modification of the psychological actions of organisms. As such, behavior analysis was committed from the beginning to a comprehensive account of behavior, stretching from animal learning to complex human behavior. Despite that lofty goal, basic behavior analysis is having a generally harder time finding academic support, and applied behavior analysis has narrowed its focus. In the present paper we argue that both of these trends relate to the challenge of human language and cognition, and that developments within clinical behavior analysis and the analysis of derived relational responding are providing a way forward. To take full advantage of these developments, however, we argue that behavior analysts need to articulate their unique approach to theory, to develop more flexible language systems for applied workers, and to expand their methodological flexibility. This approach, which we term contextual behavioral science, is meant as an evolutionary step that will allow behavior analysis to better capture the center of modern psychological concerns in both the basic and applied areas. Clinical behavior analysis is showing a way forward for behavior analysis to regain its vision as a comprehensive approach to behavior.

Authors
Vilardaga, R; Hayes, SC; Levin, ME; Muto, T
MLA Citation
Vilardaga, R, Hayes, SC, Levin, ME, and Muto, T. "Creating a strategy for progress: a contextual behavioral science approach." The Behavior analyst 32.1 (January 2009): 105-133.
PMID
22478516
Source
epmc
Published In
The Behavior analyst / MABA
Volume
32
Issue
1
Publish Date
2009
Start Page
105
End Page
133
DOI
10.1007/bf03392178

Philosophical, theoretical and empirical foundations of Acceptance and Commitment Therapy

This article has two main purposes. The first one is to present the philosophical, theoretical, and empirical underpinnings of Acceptance and Commitment Therapy (ACT). The second is to outline the importance of philosophy and theory in order to build an empirical clinical psychology that copes progressively with the needs of the field. To accomplish these purposes, we have structured the article in three distinct sections. In the first one, we will explore the philosophical assumptions of ACT, known as Functional Contextualism. In the second section, we will offer a brief history of the applied and theoretical tradition of ACT, Behavior Analysis, and Relational Frame Theory (RFT), a modern account of human language and cognition. Finally, we will present some clinical outcomes that, although preliminary, exemplify the broad range of health problems and psychological disorders for which the ACT model has shown to have positive results. Overall we will offer a unified version of the ACT/RFT model that interconnects its multiple dimensions. © 2007, Facultat de Psicologia Universitat de Barcelona.

Authors
Vilardaga, R; Hayes, SC; Schelin, L
MLA Citation
Vilardaga, R, Hayes, SC, and Schelin, L. "Philosophical, theoretical and empirical foundations of Acceptance and Commitment Therapy." Anuario de Psicologia 38.1 (April 1, 2007): 117-128. (Review)
Source
scopus
Published In
Anuario de Psicologia
Volume
38
Issue
1
Publish Date
2007
Start Page
117
End Page
128
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