1. Acceptance and Commitment Therapy
Steven C. Hayes
University of Nevada

2. Acceptance and Commitment Therapy
It is said as one word, not letters
A 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. ACT
Is 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 avoidance
All 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 culture
Experiential 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. ACT
This 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 Hold
what 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
Open
An ACT Model of Treatment

15. An ACT Model of Treatment
Centered
An ACT Model of Treatment

16. An ACT Model of Treatment
Engaged
An ACT Model of Treatment

17. Empirically
ACT is recognized as an evidence-based therapy by APA and SAMSHA (areas so far: depression; chronic pain; coping with psychosis; worksite stress; OCD)
40 RCTs
42 component studies; 38 mediation studies
Over 150 studies on experiential avoidance and psychological flexibility

18. What is Remarkable about the ACT Literature
The variety of problems it can help treat
The range of formats that can be used
Size 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;

21. ACT for Depression

22. ACT for COD

23. ACT / CBT Comparisons 8 ACT better 1 CBT better 3 Both are the same
Change processes so far always different

24. ACT for Psychosis

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- harm
In 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 behavior
2. Function of emotions
3-4. Emotional awareness
5. Primary vs. secondary emotions
6. Clear vs. cloudy emotions
7-8. Emotional avoidance vs. acceptance
9. Nonavoidant emotion regulation strategies
10. Impulse control
Valued directions
Commitment to valued actions

27. Self Harm 30 20
TAU
Mean Score
ACT etc 10
Pre
Post
Phase

28. Depression 30 20
TAU
Mean Score
ACT etc 10
Pre
Post
Phase

29. ACT for BPD (Morton et al., in press)
Small RCT (N = 41); patients with at least 4 DSM BPD features
Regular 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 mindfulness
2. Cost of avoidance; beginning values
3-4. Acceptance and defusion
5. Mindfulness of pleasure
6. Emotional awareness
7-8. Health and relationship values
9. Mindfulness in conflict
10. Values and choice
11. Mindfulness and acceptance
12. Review and celebration

31. Borderline Severity TAU Mean Score ACT Phase 50 40 30 Pre Post
3 mo F-Up
Phase

32. Hopelessness 18
TAU 12
Mean Score
ACT 6
Pre
Post
3 mo F-Up
Phase

33. Impact of ACT Self Help
Sub-analysis of 46 depressed teachers in a wellness program
8 weeks to read the book
The 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 Patients
Book
Analysis of 0,2,6 month data: p eta sq = .25 (large effect size)
Teacher Sample
How about clinical significance?
% who get across that green line
Book O
Depressed Teacher Subsample

35. Depressed Teacher Subsample
Percentage Clinically Improved
56.5%
Book
Depressed Teacher Subsample

36. ACT
Good books now available in Dutch, for example Rokx, T.A.J.J. (2011). Het Leven is geen Feest; de mythe van het maakbare geluk. Amsterdam, Hogrefe.