Acceptance and Commitment Therapy - PowerPoint Presentation

Slide1

Acceptance and Commitment Therapy

Scott ClarkSlide2

1950-60s 1

st

wave: Behaviour Therapyfocus on direct behaviour change, classical and operant conditioning1970s 2nd wave: Cognitive Therapyfocus on changing content and frequency of cognitions1980s 3rd wave: focus on changing relationship with thoughts and feelings – using mindfulness and acceptance strategies Dialectical Behavior Therapy, Acceptance and Commitment Therapy, Functional Analytic Psychotherapy, Integrative Behavioral Couples Therapy, Mindfulness Based Cognitive Therapy (Hayes and De May, in press)

ACT

(Hayes, Masuda & De

Mey

, in press)Slide3

ACT

(

Morris & Oliver 2009)Psychotherapy technique that:Attempts to expand a person’s behavioural repertoire by increasing the ability to respond flexibly in response to the opportunities presented by each situation for valued living. Involves a degree of being in the present moment, connection with the direction given by values, and a letting go of or distancing from the rules and assumptions that can function as barriers to doing what matters.Some of these rules and assumptions are a by product of/ are inherent in the use of language as thinking and communication.Attempts to change the social and verbal contexts that link thoughts and feelings with overt actionRuss Harris intro videoSlide4

ACT

Developed by Stephen Hayes - 1984

Evolution from behaviourismClassical and Instrumental conditioningLearnt verbal and rule-governed behaviour Functional contextualism (Hayes, Masuda & De Mey, in press)“ACT conceptualizes psychological events as a set of ongoing actions of a whole organism interacting with historically and situationally defined contexts”. ……. Learning Theory…at mercy of learned associations…focusing on changing cognitions is not enough or can actually be counter productive by reinforcing dysfunctional thinking….. Slide5

Relational Frame Theory

(

www.contextualpsychology.org) Language allows humans to link neutral stimuli such as words/thoughts with events. Pairings/networks can generalise (derived relationships) with reinforcement to become relational frames applied in an arbitary fashion.Relational networks: If A = B and B = C then A = CA child experiences seasickness on a boat and then associates the word boat with seasickness.The child may then learn at school that a "Car Ferry" is a type of boat. Later, on hearing that she is going on a car ferry, the child may show signs of anxiety despite having had no direct experience with car ferries. Respondently acquired (conditioned) function of "boat" and the derived relation between "boat" and "car ferry". The child does not need to experience the possibly aversive consequences of traveling on a car ferry in rough seas, in order to show signs of anxiety. Slide6

ACT Core

Priniciples

(Harris 2006)Goal is psychological flexibility DefusionThoughts/language are not truth/rules/threatening events….person not fused with thoughts….able to observe them….”leaves in the stream” versus Fusion (Hayes et al. in press)Behavior is guided more by inflexible verbal networks than by the contingencies of reinforcement in the environment…..realityfocus on:Literality - treating symbols (e.g.“life is hopeless”) as one would their referents (i.e., a truly hopeless life)Reason-giving (i.e., basing action or inaction excessively on the constructed “causes” of ones own behavior, especially when these processes point to non-manipulable

“causes” such as conditioned private

events)

E

motional

control

(i.e., focusing on proper manipulation of emotional states as a primary goal and metric of successful living

)…..? In contrast to CBTSlide7

ACT Core

Priniciples

(Harris 2006)AcceptanceMoment by moment process of actively embracing the private events evoked in the moment without unnecessary attempts to change their frequency or form, especially when doing so would cause psychological harm (Vs avoidance)Contact with the present momentBringing full awareness to your here- and-now experience, with openness, interest, and receptiveness The “Observing Self”“A transcendent sense of self encourages clients to experience their own thoughts and feelings and to shift from identifying with the conceptualized self (“I am a bad person”, “I am depressed”)”. ValuesClarifying what is most important to you; what sort of person you want to beCommitted actionsetting goals, guided by your values, and taking effective action to achieve them Slide8

HEXAFLEX DIAGRAMSlide9

HEXAFLEX DIAGRAM

1. Given a distinction between Context you and the stuff you

are struggling with and trying to change …2. … are you willing to have that stuff, fully and without defense …

3. … as it is, and not as what it says it is …

4. … and do what takes you in the direction …

5. … of your chosen values …

6. … at this time, in this situation?

Acceptance and mindfulness

Commitment and

behaviour

changeSlide10

HEXAFLEX DIAGRAMSlide11

Techniques

(Harris 2006)

Less confrontational manner and less directive forms of verbal interaction, such as metaphor, paradoxes, and experiential exercises, to loosen the entanglement of language/thoughts and the self.Identify unworkable behaviours and develop suitable metaphorsHomework exercises that highlight the cost of unworkable solutions in respect to valued livingSlide12

Stages

(Hayes, Masuda, & De

Mey (in press))Creative hopelessness – explore current strategies in motivational interviewing style - bring client toward new options. Man in the hole metaphorControl is the problem, not the solutionPolygraph metaphorAcceptance as an alternative agendaTwo scales metaphorImagine an anxiety provoking situationNotice its effects on the bodyExamine these effects at a distance, “like a scientist”Allow it to be there regardless of its aversive natureHighlights the futility of struggle for control and undermines avoidanceRuss Harris exmplesAccepting emotionsDemons on a shipSlide13

Stages

(Hayes, Masuda, & De

Mey (in press))A transcendent sense of selfSafe to expose yourself to fearsChessboard metaphor – separated self and avoided psychological contentDefusing language and cognitionMindfulness exercises: locate self in here and now“AND” not “BUT” (which implies something is wrong)Dealing with an unpleasant thoughtSimply observe it with detachmentRepeat it over and over, out aloud, until it just becomes a meaningless soundImagine it in the voice of a cartoon characterSing it to the tune of ‘Happy Birthday’Silently say ‘Thanks, mind’ in gratitude for such an interesting thoughtExercise: Think of a negative self-judgement “(x)” – notice its effect. Compare to “I am having the thought (x)”Slide14

Stages (Hayes, Masuda, & De

Mey

(in press))ValuesChoose life directions in various domains (e.g. family, career, spirituality) while undermining verbal processes that might lead to choices based on avoidance, social compliance, or fusion (e.g. “I should value X” or “A good person would value Y” or “My mother wants me to values x”) (Hayes et al. in press). The “Bulls eye” (Tobias Lundgren)Formal assessment of ability to live life according to ones values in:Work/educationLeisurePersonal Growth/HealthRelationshipsAssessment of barriers in each areaValued action plan addressing each areaSlide15
Slide16

Stages

(Hayes, Masuda, & De

Mey (in press))Willingness and commitmentDevelopment of larger and larger patterns of effective action linked to chosen values. Identify barriers to achieving valuesSimilar to traditional behavior therapySelect the appropriate components:exposure skills acquisitionshaping methodsgoal setting, The ACT therapeutic relationship Two mountains metaphorSlide17

Studies of

efficacy

(Powers et al. (2009))Metanalysis of 18 (n = 917) randomized controlled ACT trials Range of conditions:Psychosis, worksite stress, chronic pain, anxiety and depression, smoking, borderline personality disorder, diabetes self management, polysubstance abuse, weight, drug refractory epilepsy, trichotillomania, math anxiety.Mixed comparators and outcome measuresACT better than control (effect size = 0.42). The average ACT-treated participant was more improved than 66% of the participants in the control conditions. ACT was superior to:Waiting lists and psychological placebos (effect size = 0.68) Treatment

as usual (effect size = 0.42

)

ACT

was not

more

effective

than:

Established treatments -

e.g

CBT (

effect size = 0.18, p = 0.13). Slide18

Studies of efficacy

Cohen’s convention of small (0.2), medium (0.5), and large (0.8) effectsSlide19

Studies of

efficacy

(Powers et al. (2009))When viewed individually only 4 studies had confidence intervals not crossing 0:Smoking cessationSupplementation of TAU for borderline PDTreatment resistant epilepsyTrichotillomaniaStudy quality poorJadad Scale 0-50=1; 1 = 7; 2 = 5; 3 = 5Slide20

Studies of efficacy Since 2008

(

Smout et al. 2012)Improved coherence and competence montoringGood studies provide Level II RCT evidence for chronic pain, obsessive–compulsive disorder, and a subset of other anxiety disorders (panic disorder, social phobia, and generalised anxiety disorder) The majority of studies demonstrated that ACT significantly improved primary outcomes but used comparison conditions that did not rule out therapy-unspecific factors, including use of concurrent treatments, as explanations for the improvements. Use of treatment as usual unmatched for contact and unmonitored for competence, and unmonitored use of concurrent treatments are the primary factors preventing the attribution of better outcomes for ACT recipients to therapy-specific effects Slide21

References

Chris

Cullen (2008) Acceptance and Commitment Therapy (ACT): A Third Wave Behaviour Therapy Behavioural and Cognitive Psychotherapy, 36, 667–673. Fletcher L, Hayes S (in press) Relational Frame Theory, Acceptance and Commitment Therapy, and a Functional Analytic Definition of Mindfulness Harris R (2006) Embracing Your Demons: an Overview of Acceptance and Commitment Therapy. Psychotherapy in Australia 12 (4): 2-8.Hayes S, Luoma, J, Bond S, Masuda A, and Lillis J (in press) Acceptance and Commitment Therapy: Model, Processes and Outcomes.Hayes S, Masuda A, and De May (in press) Acceptance and Commitment Therapy and the Third Wave of Behavior TherapyRelational Frame Theory, Acceptance and Commitment Therapy, and a Functional Analytic Definition of Mindfulness Morris E & Oliver J (2009)ACT Early: Acceptance and Commitment Therapy in early intervention. Power point

presentation

Powers M,

Vörding

M,

Emmelkamp

P (2009)

Acceptance and Commitment Therapy: A Meta-Analytic

Review.

Psychother

Psychosom

78

:73–

80.

Webster, M. (2011) Introduction to Acceptance and Commitment Therapy. Advances in Psychiatric Treatment 17:309-316.

Wilson, K. G. & Murrell, A. R. (In Preparation). Values-Centered Interventions: Setting a Course for Behavioral Treatment. In S. C. Hayes, V. M..

Follette

, & M.

Linehan

(Eds.) (in preparation). The new behavior therapies: Expanding the cognitive behavioral tradition. New York: Guilford Press.

The empirically supported status of acceptance and commitment therapy: An update

Smout

, M, Louise Hayes, Atkins, PWB, Klausen, J and

Duguid, J E (2012) The empirically supported status of acceptance and commitment therapy: An update. Clinical Psychologist 16 (2012) 97–109 www.contextualpsychology.orgRelational frame theory simplified

Bulls eye values assessment