1. ACT II: Specific Examples from an ACT Trial
Jon Abramowitz, Laura Fabricant, & Ryan Jacoby
Clinical Lunch Spring 2014

2. Overview ACT principles Our study on exposure therapy and ACT
Techniques to foster acceptance
Techniques to foster defusion
Techniques to pursue values
Discussion (applying ACT to other problems)

3. ACT Principles

4. I constantly struggle with my thoughts and feelings I spend
My thoughts tell me how things really are, and determine what I do next
I constantly struggle with my thoughts and feelings
I spend
most of my time lost in thought about the past or future
I don’t know what I want from life
I don‘t manage to act on the things I care about
Deep down, my thoughts and feelings are the real me
I spend most of my time paying attention to what is happening in the present moment
I am clear about what I choose to value in life
I work out what I need to do about the things I care about, and
I see it through
My thoughts and feelings come and go, but deep down the real me doesn’t change
I see each of my thoughts as just one of many ways to think about things – what I do next is up to me
I willingly accept my thoughts and feelings even when I don’t like them
ACCEPTANCE SCALE
ATTENTION TO PRESENT SCALE
VALUES IDENTIFICATION SCALE
COMMITMENT & TAKING ACTION SCALE
DEFUSION
SCALE
SELF AS OBSERVER SCALE 10 9 8 7 6 5 4 3 2 1

5. Our study: Exposure + ACT

6. Our Study How did we get interested in ACT? Our study
An ACT perspective on OCD: 3 parts
Exposure from an ACT framework
Similarities and differences (SUDS vs. willingness)
Exposure therapy to facilitate the ACT processes

7. ACT Techniques

8. Acceptance Willingness to experience internal events
Examples from OCD patients
Metaphors and techniques
“Jerk at the door”
Chessboard
Exposure
Habituation vs. fear tolerance

9. Defusion Distancing and disconnecting from thoughts
Seeing thoughts and feelings for what they are, not what they say they are
Examples from OCD patients
Metaphors and techniques
Milk, Milk, Milk
Passengers on the bus
Imaginal exposure

10. Passengers on the Bus Metaphor
You’re the driver and the passengers are your OCD related thoughts, feelings, physiological sensations, etc.
The passengers try to direct where the bus goes
They are loud and bossy about what you do
They quiet down when you do what they want
If you drive the bus where you want to go, what will happen?
You can allow them to shout and keep your attention focused on where you want to go

11. Values
Choosing what direction one wants life to take (not letting OCD choose the direction life goes)
Examples from OCD patients
Metaphors and techniques
Bull's-eye
Moving through a swamp
Exposure

12. What do you value?
What do you want your life to be about?
What do each of these categories mean to you?
In what ways has OCD been getting in the way of living life in the direction of your values?

13. Moving through a swamp
Swamp = OCD-related inner experiences and triggers
Exposure = learning how to handle whatever comes up while still moving forward through swamp
Willingness to go into the swamp without resisting (avoiding or using compulsive rituals)
Why are we doing this?
Getting dirty and muddy but for a purpose
Not wallowing in the swamp
Things you value are on the other side of the swamp (only way is through it!)

14. Exposures and values Emotional moves vs. values moves Motivation
Anxiety reduction is not an explicit goal
Successful outcome = you doing something important to you despite having anxiety

15. Discussion

16. Discussion How could we apply these techniques to other problems?
Similarities and differences with other therapies?
Questions?

17. Thank you!