Presentation on theme: "Acceptance and Commitment Therapy"— Presentation transcript:
1 Acceptance and Commitment Therapy Steven C. HayesUniversity of Nevada
2 Acceptance and Commitment Therapy It is said as one word, not lettersA cognitive behavioral intervention that uses acceptance and mindfulness processes, and commitment and behavior change processes, to create psychological flexibility
3 Psychological Flexibility … is consciously contacting the present more fully, without needless defense, and based on what the situation affords, changing or persisting in behavior in the service of chosen values.
4 ACTIs transdiagnostic: focused on common core processes known to underlie many forms of psychopathology This makes it broadly applicable, and especially well suited to multi-problem patients
5 Expanding avoidanceAll animals escape and avoid aversive events
6 But only humans can readily bring aversive events into any setting “Car”CAR
7 So We Try to Avoid Pain Itself Experiential avoidance is built into human language and then amplified by the cultureExperiential avoidance is the tendency to attempt to alter the form, frequency, or situational sensitivity of historically produced negative private experience (emotions, thoughts, bodily sensations) even when attempts to do so cause psychological and behavioral harm
8 ACTThis is a logical step, but it tends to amplify pain or at least its impact, not decrease it Especially toxic for those with difficult histories or physiology Why toxic?
9 Self-Amplifying Don’t think of a white bear Don’t be anxious Consequences: artificial pain
10 Puts Life on Holdwhat can happen when we let the monster dictate how we live. Nobody wants to spend their time and energy on this roundabout, but it is so easy to do. In fact, this cartoon doesn’t even show how crowded this round about really is?
11 Increases Arousal and Stress And with that we respond not just psychologically but physically! Strongly!
12 Repertoire Narrowing And as aversive control increases, liberty leaves Organisms respond to aversive with repertoire narrowing
13 The ACT Model An ACT Model of Treatment/Health Psychological Flexibility
14 An ACT Model of Treatment OpenAn ACT Model of Treatment
15 An ACT Model of Treatment CenteredAn ACT Model of Treatment
16 An ACT Model of Treatment EngagedAn ACT Model of Treatment
17 EmpiricallyACT is recognized as an evidence-based therapy by APA and SAMSHA (areas so far: depression; chronic pain; coping with psychosis; worksite stress; OCD)40 RCTs42 component studies; 38 mediation studiesOver 150 studies on experiential avoidance and psychological flexibility
18 What is Remarkable about the ACT Literature The variety of problems it can help treatThe range of formats that can be usedSize and stability of outcomes in comparison to the extent of intervention
19 Controlled Studies in Mental Health Obsessive-compulsive disorder; generalized anxiety disorder; panic disorder; depression; polysubstance abuse; coping with psychosis; borderline personality disorder; trichotillomania; marijuana dependence; skin picking; eating disorders
20 Controlled Studies in Behavioral Medicine chronic pain; smoking; diabetes management; adjustment to cancer; epilepsy; whiplash associated disorders; chronic pediatric pain; weight-maintenance; exercise; work stress; adjustment to tinnitus;
25 ACT (etc) for BPD (Gratz et al 2006) Small RCT (N = 22); patients with at least 5/9 DSM BPD features (8 or more on the RDIB)History and current (last 6 mo) self- harmIn individual therapy (stayed in – the group was in addition)14 weekly groups; 90 minutes each
26 ACT (etc) for BPD (Gratz et al 2006) 1. Function of self-harm behavior2. Function of emotions3-4. Emotional awareness5. Primary vs. secondary emotions6. Clear vs. cloudy emotions7-8. Emotional avoidance vs. acceptance9. Nonavoidant emotion regulation strategies10. Impulse controlValued directionsCommitment to valued actions
29 ACT for BPD (Morton et al., in press) Small RCT (N = 41); patients with at least 4 DSM BPD featuresRegular individual treatment contact (stayed in – the group was in addition)12 weekly groups; 2 hours each
30 ACT for BPD (Morton et al in press) 1. Overview of ACT. Intro to mindfulness2. Cost of avoidance; beginning values3-4. Acceptance and defusion5. Mindfulness of pleasure6. Emotional awareness7-8. Health and relationship values9. Mindfulness in conflict10. Values and choice11. Mindfulness and acceptance12. Review and celebration
31 Borderline Severity TAU Mean Score ACT Phase 50 40 30 Pre Post 3 mo F-UpPhase
32 Hopelessness18TAU12Mean ScoreACT6PrePost3 mo F-UpPhase
33 Impact of ACT Self HelpSub-analysis of 46 depressed teachers in a wellness program8 weeks to read the bookThe treatment protocol consists of an 8-week trial period in which participants have access to 6 10-point quizzes completed online at will and at each participant's pace within that time. Standardized feedback is given between 1 and three days after each quiz completion. Feedback consists of a score, missed item numbers, and a 1-word score-contingent response such as Super for a 10, great for a 9, or good for an 8..33
34 Depressed Teacher Subsample Average for Hospitalized Depressed PatientsBookAnalysis of 0,2,6 month data: p eta sq = .25 (large effect size)Teacher SampleHow about clinical significance?% who get across that green lineBookODepressed Teacher Subsample