Brief Acceptance and Commitment Therapy for Shame Among Adults With Experience of Mental Health Difficulties Using a Randomized Multiple Baseline, Single Case Experimental Design (SCED)

Shame and self-stigma are particularly prevalent among people with experience of mental health difficulties adding to psychological distress and negatively impacting on psychosocial functioning. This study employed a randomized, multiple baseline, single case experimental design (SCED) to evaluate a brief, online intervention to address shame and experiential avoidance among this population using acceptance and commitment therapy and compassion-focused exercises. Audio exercises and a workbook were provided to support practice. Participants were seven Clubhouse members in Ireland with experience of mental health difficulties, three identifying as male, four as female, two in the 40-49 age category, four were 60-69, and one participant over 70. Participants submitted ecological momentary assessment (EMA) data for 74 days reporting on shame and experiential avoidance. Standardized questionnaires were used to evaluate impacts on shame and psychological flexibility. EMA shame data suggested that two participants significantly improved (P(A < B) = .65, p = .009; P(A < B) = .67, p = .001), one disimproved (P(A < B) = .15, p < .0001) while remaining participants experienced no significant change. EMA experiential avoidance scores showed one participant improving (P(A < B) = .72, p = .000), another disimproving (P(A < B) = .34, p = .006) and the remainder experiencing no significant change. Standardized measures suggested that two participants experienced reliable improvement and clinical change in relation to shame, preintervention to follow-up. Two participants reliably improved preintervention to follow-up in terms of psychological flexibility and one participant deteriorated preintervention to postintervention. Overall, the results suggest that the intervention was insufficient to achieve the aims among these participants. Future research may consider lengthier and perhaps group-based interventions.