Evaluation of implicit self-referential thoughts of people with depression and their association with cognitive fusion, self-esteem and psychological distress

Background: Acceptance Commitment Therapy (ACT) provides interventions on increasing psychological flexibility. Within ACT, a process known as fusion, suggests that individuals attach to the content of their thoughts. Limited research has assessed this process. Aim: To assess whether people who fuse with their thoughts are more likely to experience psychological distress displayed through symptoms of depression, psychological inflexibility, and have difficulties with self-esteem. A secondary aim is to assess whether the Implicit Relational Assessment Procedure (I RAP) can help to account for more variance of severity of depression than self-report measures alone. Method: Thirty-seven participants who were accessing mental health services for symptoms of depression, completed the study. Five self-report measures and one I RAP task that was designed to assess implicit repertoires of responding to co-ordination and containment statements were completed. Results: Lower levels of self-esteem and psychological flexibility and greater fusion were associated with experiencing a higher level of depression as measured by the DASS-21. However, the I RAP was unable to account for more of the variance of depression than self-report measures alone. Conclusion: By addressing the limitations highlighted, the IRAP may be enhanced to become a tool that can increase understanding about the functional processes underlying fusion