1. Wisconsin Public Psychiatry Network Teleconference (WPPNT)
This teleconference is brought to you by the Wisconsin Department of Health Services (DHS) Bureau of Prevention, Treatment, and Recovery and the University of Wisconsin-Madison, Department of Psychiatry.
The Department of Health Services makes no representations or warranty as to the accuracy, reliability, timeliness, quality, suitability or completeness of or results of the materials in this presentation. Use of information contained in this presentation may require express authority from a third party.

2. Acceptance & Commitment Therapy
An Exciting New Treatment Approach
Intro: ACT intro seminars are usually a minimum of 3 hours; likely to leave with more questions than when you started; many references at the end to help you continue your learning
Amanda Krupp, MFT

3. Acknowledgements THANK YOU
Steven Hayes, Kirk Strosahl, Kelly Wilson, and others
for developing this amazing therapy model
ACT community for being open and generously sharing there materials
Ciarrochi, Blackledge & Mercer (2006) for providing
the images related to ACT processes

4. Acceptance & Commitment Therapy (ACT)
“ACT is a therapeutic approach that uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility.”
Hayes, Wilson, Strosahl, 1999

5. Goal of ACT
Live a rich, full,
meaningful life with
less struggle

6. The Serenity Prayer (Reinhold Neibuhr)
God grant me the
Serenity to accept the
Things I cannot change,
Courage to change
The things I can,
And wisdom to know the difference
ACT gives you the skills
But How???

7. Acceptance & Commitment Therapy (ACT)
So What is ACT?
A behavioral & experiential model of therapy
Based on a new model of why humans suffer
So what is this model of human suffering?
Provides a model of how one might respond more
effectively to suffering
Aims to help people live a vital and meaningful life

8. Traditional Perspective of Suffering
Humans, given the right circumstances, are naturally
psychologically healthy, happy and content
Psychological pain is abnormal, meaning something
is wrong that needs to be fixed
If we are suffering due to difficult thoughts, feelings, or
emotions, then we should (and can) avoid, reduce, alter,
or eliminate them

9. ACT Perspective on Suffering
ACT assumes that the normal psychological processes of the human mind (thoughts, feelings, memories) are often destructive, and create psychological suffering for all of us at some point
If we are suffering, that means we are stuck, not broken or sick

10. ACT Perspective on Suffering
Look to your experience. Have you met anyone
who has never experienced . . .
Sadness
Fear
Anxiety
Negative thoughts
Scary dreams
Bad memories
Are these experiences really indicative of pathology if we’ve all had them? Or are they normal parts of being human?
These are normal human experiences
Our suffering is due to our use of language
and our attempts to control our internal experiences

11. Philosophical & Theoretical Foundations
Relational Frame Theory
Our mind makes arbitrary connections between things.
Connections are based on history and context
Tastes
Yummy
Apple
Healthy
If I polled the audience, we’d likely get a lot of answers – likely most would be positive, but some might be negative
If I say “Sand,” what shows up for you?

12. Philosophical & Theoretical Foundations: RFT
It’s futile and frustrating to control the uncontrollable (Our Mind)
Example: Whatever you do, don’t think about a
PINK ELEPHANT
Our mind has made associations between things and your body will react accordingly, but it doesn’t mean your mind is right.
Example: Tornado Siren

13. “Language has created the word “loneliness” to express the pain of being alone. And it has created the word “solitude” to express the glory of being alone.
Paul Tillich
Psychopathology evolves in part because
We let our mental activity dictate our behavior

14. Brief Example A girl is riding a horse outside. It is windy.
The horse at one point bucks and she falls off.
She forms relations in her mind between riding, falling, and the wind.
She later rides the horse and the wind starts to blow. Even though
she and the horse are fine, her heart starts racing , she starts to feel
the sensations she had when falling, and has images of falling.
Although the horse did not buck and she did not fall, her psychological
pain is the same.
She may choose to never ride outside again – not because it is
inherently dangerous, but because she is wrapped up in the psychological
pain (fear, anxiety, stress, worry, memories) when it’s windy and letting
the content of her mind dictate her behavior

15. ACT Response to Example
. . . Help the girl develop Psychological Flexibility
Contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values (what’s most important to you)

16. Psychological Flexibility
Means not holding on too tightly (or totally buying into) our own
thoughts and emotions, and acting on longer term values rather
than short term impulses, thoughts, and feelings
Why Important
Thoughts & emotions are not good indicators of long term value
Our minds are not always right
We have no control over thoughts and emotions
If we buy into and act on them, we may overlook the more important,
sustained patterns of action which bring true meaning, vitality and
richness to our lives (i.e horseback rides in the wind with no incident)

17. Psychological Inflexibility
Preoccupation with the past or future and
Loss of awareness of the present
Rumination, worry, depression, anxiety
Avoidance of
Sensations, feelings,
Thoughts, or memories
Loss of contact with
Or clarity of
Personal values
Suffering
Escapism, AODA
Not in touch with, or not
Using what matters as
Your guide
Inaction,
Impulsivity,
Or persistent avoidance
Entanglement in thoughts;
Listening to our mind
And ignoring experience
Reactive, lacking
direction
Restrictive sense of self
(Believing that we are what our thoughts say we are)
Anxiety, OCT
“You can’t do it,” “You’re not worthy”

18. Psychological Inflexibility
Dominance of Conceptualizations
Preoccupation with past or future and
Loss of awareness of the present
Lack of Values Clarity
Or Contact
Experiential Avoidance
Avoidance of
Sensations, feelings,
Thoughts, or memories
Loss of contact with
Or clarity of
Personal values
Suffering
Inactivity or Disorganized
Activity
Cognitive Fusion
Entanglement in thoughts;
Listening to our mind
And ignoring experience
Inaction,
Impulsivity,
Or persistent avoidance
Self As Content (descriptions)
Holding tightly to identity descriptions
Believing that we are what our thoughts say we are

19. Preoccupation with the Past or Imagined Future
“If you aren’t in the moment, you are either looking forward to uncertainty, or back to pain and regret.”
Jim Carrey

20. When we are not fully present in the moment, we miss opportunities to discover what works
Loss of Contact With Present Moment

21. Dominance of the Conceptualized Past/Future
Borrowed from presentation by Ron Kimball

22. We also miss enjoyment of what’s in front of us
Example:
Man forgets key and he and dog are stuck outside in the cold rain for 2 hours
Wife comes home and lets them in
Man spends an hour ruminating and complaining about what an awful
experience it was
The dog goes and gets a drink
And snuggles up and enjoys the
Warmth of the home

23. Experiential Avoidance
When faced with two options to turn, you may decide to avoid the left turn and steer clear of the scary thoughts residing there

24. It seems like your thoughts are blocking your way, but really they’re just along for the ride
Our thoughts can be very intimidating and convincing sometimes, but can they really hurt you?

25. Cognitive Fusion When are we fused or stuck:
“Buying into” our thoughts
Following rules about how to behave rather than
responding to the present circumstances
Attachment to the “Conceptualized Self”
Rigid ideas about who we are and who we ought to be

26. Cognitive Fusion
Entanglement with our thoughts limits and shapes what we see

27. Cognitive Fusion
Our thoughts are like passengers on a bus. Some give helpful advice, some not so helpful. Just because they’re on the bus and in our mind doesn’t mean we have to listen to them or follow their directions. Who’s driving your life?

28. ACT Model of Effective Living
Contact with the Present Moment
Preoccupation with Past or Future
Be in the moment, mindful, engaged with
The here-and-now
Acceptance &
Willingness
Lack of Contact With
And Clarity of Values
Values, Purpose
And Meaning
Experiential Avoidance
Psychological
Flexibility
Active openness to
Experience without
Defense or judgment
Not goals, but how you
Want to live your life, what you want it to be about
Cognitive Defusion
Inactivity or Disorganized
Activity
Committed Action
Cognitive Fusion
See our thoughts for what
they are – products of the mind
Content remains, but no longer
Controls your behavior
Moving towards what’s
Most important to you
Self as Context
Self as Content
Transcendent sense of self
We are not our thoughts, feelings, images

29. ACT Model of Effective Living
Contact with the Present Moment
Be in the moment, mindful, engaged with
The here-and-now
Acceptance &
Willingness
Values, Purpose
And Meaning
Psychological
Flexibility
Active openness to
Experience without
Defense or judgment
Not goals, but how you
Want to live your life, what you want it to be about
Cognitive Defusion
Committed Action
See our thoughts for what
they are – products of the mind
Content remains, but no longer
Controls your behavior
Moving towards what’s
Most important to you
Self as Context
Transcendent sense of self
We are not our thoughts, feelings, images

30. “Hexaflex”

31. Acceptance & Willingness
Given the distinction between you and the stuff you struggle with, are you willing to have that stuff, as it is and not as what it says it is, and do what works in this situation?

32. Acceptance & Willingness
“Today I choose life. Every morning when I wake up I can choose joy, happiness, negativity, pain To feel the freedom that comes from being able to continue to make mistakes and choices – today I choose to feel life, not to deny my humanity but to embrace it.”
Kevyn Aucoin

33. Experiential Avoidance Acceptance & Willingness
Actively open to and contacting psychological experiences without defense or judgment
Exercises:
Bothersome thoughts on paper
Passengers on a bus

34. Cognitive Defusion
Exercises:
Leaves on a stream
Watching a movie

35. Cognitive Fusion

36. What happens if you stop struggling?
The monster might still follow you around, but now
You are free to live 36

37. Self as Context
A sense of self that is a consistent perspective from which to observe and accept all changing experiences
Exercises:
What are you
Chessboard or house metaphor

38. Values: What you want your life to be about
Imagine you can plan your own eulogy
How do you want to be remembered?
What would you want people to say about you?
Values are not goals or feelings – they are choices about how to live

39. Case Example 48 year old male Raised in Missouri
Lost job two years ago, wants to return to work
Previous diagnoses of Generalized Anxiety & Depression
Moved to WI a year ago and is living with his girlfriend
Presenting concerns: depression

40. Case Example Experiential Avoidance Cognitive Fusion
Ongoing effort to avoid negative self-evaluations
Avoids any situations where could be judged
Cognitive Fusion
Attached to idea that can’t move forward until negative self-evaluations are gone
Fused with idea that because he became depressed and was fired, he is no longer hireable
Loss of contact w/ Present Moment
Frequent rumination about past (events, identity)
Regular worries about what could go wrong if he takes a step forward
Self as Content
Attached to self-as-content:
A failure, weak, scared, “I am depressed”
Lack of contact with Values
No long has idea of what’s important
No guiding values – reactive to internal experiences
Lack of Committed Action
No participation in work, social life
Procrastination

41. Case Example: What did I do
Start with values – develop a sense of hope and direction
Defusion and self-as-context exercises
You’re not your thoughts, feelings, memories
You aren’t your identity descriptions
Document avoidance activities
What are the costs of avoidance?
Mindfulness exercises –
be in the moment
notice and accept whatever shows up

42. The ACT Question Given a distinction between you and
the stuff you are struggling with and trying to change,
are you willing to have that stuff, fully and without defense, as it is, and not as what it says it is,
AND do what takes you in the direction of your chosen values at this time, in this situation?

43. Research
As of March 2012, there are over 60 randomized controlled trials
Considered “empirically-based” by the American Psychological
Association for depression and chronic pain
Approaching empirically-based status for anxiety, psychosis,
substance abuse, and worksite stress
See for specifics

44. Resources