Methods Participants Initially, 380 vocational and high school students (304 males) participated at the pre-intervention assessment phase. Of these, 48 smokers age years (29 males) participated in the intervention phase. The intervention phase consisted of a series of 8 (90 min) sessions, each facilitated by 2 trained graduate psychology students. Of these 45 smokers participated at the post treatment assessment after the completion of the smoking cessation program. Procedure The manual used for the intervention program was based on the ACT Protocol (Gifford et al., 2002; Hayes, Wilson, & Strosahl, 2000). The intervention program was an 8-week program. At the beginning of the intervention program, an awareness and motivational session took place during class time. Students who had obtained parental permission to do so attended this 40 minute session, during which trained graduate psychology students facilitated a psycho educational and motivation raising presentation. This was preceded by completion of a questionnaire about their smoking-related experiences and behavior. Students who reported interest to participate in smoking cessation groups also participated in the second phase, which consisted of a series of 8 intervention group sessions, facilitated by trained graduate psychology students. Participants completed a packet of questionnaires assessing their smoking related behavior, thoughts and acceptance related measures before the intervention and upon completion. Also various measures were collected at the beginning of each session. Measures  Demographic background information  Accepntance and Action Questionnaire (AAQ-II; Bond et al.,2011; Monestes et al., manuscript in preparation). The AAQ is a 10 item measure of experiential avoidance and psychological flexibility.  Avoidance and Inflexibility Scale (AIS; Gifford et al., 2002). The AIS is a 13 item measure designed to evaluate the (a) inflexibility of the smokers´ responses to internal stimuli associated with smoking and (b) participants´ endorsement of avoidance or control strategies related to these internal stimuli, as a mean for smoking cessation.  Avoidance and Fusion Questionnaire for Youth (AFQ-Y). The AFQ-Y is a short form of the original AFQ-Y child report measure, that is used to assess psychological inflexibility engendered by cognitive fusion, experiential avoidance, and behavioral ineffectiveness in the presence of negatively evaluated private events.Methods Participants Initially, 380 vocational and high school students (304 males) participated at the pre-intervention assessment phase. Of these, 48 smokers age years (29 males) participated in the intervention phase. The intervention phase consisted of a series of 8 (90 min) sessions, each facilitated by 2 trained graduate psychology students. Of these 45 smokers participated at the post treatment assessment after the completion of the smoking cessation program. Procedure The manual used for the intervention program was based on the ACT Protocol (Gifford et al., 2002; Hayes, Wilson, & Strosahl, 2000). The intervention program was an 8-week program. At the beginning of the intervention program, an awareness and motivational session took place during class time. Students who had obtained parental permission to do so attended this 40 minute session, during which trained graduate psychology students facilitated a psycho educational and motivation raising presentation. This was preceded by completion of a questionnaire about their smoking-related experiences and behavior. Students who reported interest to participate in smoking cessation groups also participated in the second phase, which consisted of a series of 8 intervention group sessions, facilitated by trained graduate psychology students. Participants completed a packet of questionnaires assessing their smoking related behavior, thoughts and acceptance related measures before the intervention and upon completion. Also various measures were collected at the beginning of each session. Measures  Demographic background information  Accepntance and Action Questionnaire (AAQ-II; Bond et al.,2011; Monestes et al., manuscript in preparation). The AAQ is a 10 item measure of experiential avoidance and psychological flexibility.  Avoidance and Inflexibility Scale (AIS; Gifford et al., 2002). The AIS is a 13 item measure designed to evaluate the (a) inflexibility of the smokers´ responses to internal stimuli associated with smoking and (b) participants´ endorsement of avoidance or control strategies related to these internal stimuli, as a mean for smoking cessation.  Avoidance and Fusion Questionnaire for Youth (AFQ-Y). The AFQ-Y is a short form of the original AFQ-Y child report measure, that is used to assess psychological inflexibility engendered by cognitive fusion, experiential avoidance, and behavioral ineffectiveness in the presence of negatively evaluated private events. Introduction Defusion in one of the techniques utilized in ACT and aims for a person to be able to watch a thought dispassionately thus, see it for what it is, i.e. just a thought and nothing more. Although this technique is a major focus of ACT, it is not yet clear how to assess when the client has achieved defusion. Therefore new defusion measures are needed, especially treatment process measures. Lock and colleagues (2001) utilize a technique where a therapist asks the client to measure her progress using Venn diagram figures (two circles, one represents anorexic thinking and the other the person) to illustrate how much of herself remains preoccupied with Anorexia Nevrosa. Initially a fused client with anorexic thoughts draws the two circles on top of each other as she believes that her thoughts is who she is. The goal of Lock´s treatment is for the client to be able to draw two circles next to each other, thus acknowledge that the thoughts related to anorexia are there but these thoughts do not define who she is as a person. This technique may be used as a fusion/defusion measure and it is appealing given that it is more of a visual representation rather than a verbal one. In the current study the purpose is to use this figurative measurement of fusion with thoughts in an ACT study of smoking cessation in adolescents. The aim is to examine whether this technique may be used as a valid and reliable measure of defusion. Results will be discussed in terms of whether this technique can be used as a process measure of defusion in clinical practice.Introduction Defusion in one of the techniques utilized in ACT and aims for a person to be able to watch a thought dispassionately thus, see it for what it is, i.e. just a thought and nothing more. Although this technique is a major focus of ACT, it is not yet clear how to assess when the client has achieved defusion. Therefore new defusion measures are needed, especially treatment process measures. Lock and colleagues (2001) utilize a technique where a therapist asks the client to measure her progress using Venn diagram figures (two circles, one represents anorexic thinking and the other the person) to illustrate how much of herself remains preoccupied with Anorexia Nevrosa. Initially a fused client with anorexic thoughts draws the two circles on top of each other as she believes that her thoughts is who she is. The goal of Lock´s treatment is for the client to be able to draw two circles next to each other, thus acknowledge that the thoughts related to anorexia are there but these thoughts do not define who she is as a person. This technique may be used as a fusion/defusion measure and it is appealing given that it is more of a visual representation rather than a verbal one. In the current study the purpose is to use this figurative measurement of fusion with thoughts in an ACT study of smoking cessation in adolescents. The aim is to examine whether this technique may be used as a valid and reliable measure of defusion. Results will be discussed in terms of whether this technique can be used as a process measure of defusion in clinical practice. Results Further analysis was conducted to assess whether the figurative fusion measure was correlated to other defusion measures. Correlations from the questionnaires at the pre-treatment phase were conducted with Week 1 mean distance of how close the participants felt to be in relation to smoking related thoughts and to smoking related thoughts about quitting. The same correlations were re-run using the post-treatment measures in association with week 8 stamps. Correlations from the questionnaires at the pre-treatment phase Correlations from the questionnaires at the post-treatment phase. Results Results Discussion This study examined whether a figurative measurement of fusion may be used as a valid and reliable measure of defusion. The results indicated that from Week 1 to Week 8 of the intervention program the mean distance of how close the participants felt to be in relation to smoking related thoughts and thoughts about quitting increased mostly in a linear trend upwards. The figurative demonstration of the stamps being placed further away from smoking related thoughts and thoughts about quiting indicates that the participants have managed to see smoking related thoughts for what they are, just thoughts. Unfortunately no significant correlations were found between the figurative measurement and one of the other verbal measures of defusion, (i.e. AAQ-II, AIS, and AFQ-Y). This might be due to the specific nature of the measures, i.e. verbal vs. figurative measures. Also the sample size of individuals completing all 8 weeks and being available for the post treatment completion of the stamps/figurative measure of defusion was small and this affected the power for this study. Further analysis and investigation is required. Future studies with larger Ns should be included to see the effect of using such a figurative representation as a valid measure of defusion. References Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (in press).Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (in press). Preliminary psychometric properties of the Acceptance and Action Questionniare - II: A revised measure of psychological flexibility and experiential avoidance. Behavior Therapy Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M., Rasmussen-Hall, M. L., et al. (2004). Acceptance based treatment for smoking cessation. Behavior Therapy, 35, (AIS) Greco, L. A., Lambert, W., & Baer, R. A. (2008). Psychological inflexibility among children and adolescence: Development and validation of the Avoidance and Fusion Questionnaire for Youth. Psychological Assessment, 20, (AFQ) Lock, J., Grange, D., Agras, W., S. & Dare, C. (2001). Treatment manual for anorexia nervosa; A family based approach. The Guilfrord Press, New York. Existing Stamp Methods cont.  Evaluations rating: At the end of each session, participants rated their satisfaction with the session, the effectiveness of the facilitators and their perceived quality of the session on a scaled from 0 (none) to 10 excellent.  Visual Representation Measure of Defusion The participants´ used a circular stamp to show where they consider themselves to be in relation to an existing stamp which represented smoking related thoughts (i.e. How fused they are with smoking thoughts). Also,the participants used a circular stamp to show where they consider themselves to be in relation to an existing stamp which represented smoking related behavior (i.e. How fused they are with thoughts about their ability to act to quit smoking). The distance between the middles of the two circles are measured in mm and the longer the distance between the two circles the more defused the client is in relation to smoking thoughts. The figurative measure is demonstrated below. Where they Smoking related thoughts Where they consider themselves to be in relation to smoking thoughts AAQAISAFYQVisual Measure Behavior Visual Measure Thought AIS.516**. AFQY.500**529** Visual Measure- Thought Visual Measure- Behavior ** AAQAISAFYQVisual Measure Behavior Visual Measure Thought AIS.129. AFQY.267*641** Visual Measure- Thought Visual Measure- Behavior **.988* High levels of fusion Low levels of fusion Figure 1: The mean distance between the 2 circles in relation to fusion with smoking related thoughts Figure 2: The mean distance between the 2 circles in relation to fusion with smoking related thoughts about acting to quit smoking To examine defusion throughout the weekly smoking cessation program; a preliminary analysis of the data was conducted using participants´ reports on the figurative fusion measure before each session. The mean distance between the centers of the circles (the existing in relation to the one the participant placed) was measured for the 2 exercises: 1) smoking related thoughts about smoking, 2) smoking related thoughts about acting to quit smoking. A repeated measures ANOVA was used to examine whether there were any significant changes to the means from week to week. Results suggest that there was a significant linear trend, F (1,7)= 5.84, p<.05 for fusion with smoking related thoughts. Week 1 ratings were not found to significantly differ from week 8 ratings. Regarding fusion with smoking related thoughts about acting to quit smoking, there was again a significant linear trend F (1,7)= 5.95, p<.05. Week 1 was also found to significantly differ from week 8 ratings, with an increase in the distance between the two circled from week 1 (M=57.63, SD=10.41) to week 8 (M=81.25, SD=15.49). N= 55 N= 63 N= 66 N= 61N= 57 N= 51N= 31N= 14 N= 64 N= 57N= 51 N= 31N= 65 N= 14