A single-session Acceptance and Commitment Therapy intervention targeting shame in people experiencing homelessness: A randomized multiple baseline design

Background and Objectives: Individuals experiencing homelessness are frequently discriminated against, such as through reduced employment opportunities and interpersonal rejection, creating a vicious cycle that sustains homelessness. These external conditions of stigma often result in individuals developing an internal sense of self-stigma and intense shame, which can result in negative psychological and behavioral consequences. Psychological intervention may contribute to disrupting this vicious cycle. Acceptance and Commitment Therapy (ACT) has been demonstrated to treat shame and self-stigma in other domains, but never homelessness. Methods: We developed a single-session intervention suitable for this population, and tested it within a randomized multiple-baseline Single Case Experimental Design (SCED). Shame and experiential avoidance were measured daily via SMS messages for eighty-nine days in 9 individuals experiencing homelessness. Results: SCED analysis and meta-analysis across participants indicated that the intervention showed significant improvements in experiential avoidance and shame both within and between participants. Limitations: Limitations include a lack of assessment of overt behavior change and the results of single case studies may have limited generalizability. Conclusions: Results demonstrate the efficacy of a brief ACT intervention in reducing shame and experiential avoidance in a homeless population, as well as the general benefits of single case design methodologies when working with populations that are difficult to reach or recruit from.