Adria N. Pearson, PhD. Richard Tingey, PhD. Department of Medicine National Jewish Health. Department of Psychology VA Long Beach Healthcare System

Transcription

1 Adria N. Pearson, PhD Department of Medicine National Jewish Health Richard Tingey, PhD Department of Psychology VA Long Beach Healthcare System

2 Clinical Population US Veterans with psychotic spectrum disorders and bipolar disorder Also includes co-morbid diagnoses such as PTSD, depression and those in substance abuse recovery. Psychosocial Rehab/Recovery Center (PRRC) Long Beach VA Based on the recovery model of treatment Offers longer term daily treatment (i.e.3 mos-several years) Includes group and individual therapy, recreational therapy, vocational rehabilitation Interdisciplinary team Client community involved in program development (steering committee)

3 Need for Evidence Based Treatment for psychosis within the PRRC ACT is consistent with the recovery model utilized within the PRRC Initial use of ACT in the PRRC (1 yr) Unstructured Development of a 18 session protocol Application of the protocol with clinical consultation

4 Order of core processes Use of an orienting therapist Employing client pairs for exercises and homework Selection of metaphors and exercises Physically Active, Simple, Few (built upon throughout) Conceptualizing hallucinations and delusions Frequent mention of psychotic symptoms--voices

5 Structured using the six core processes Present moment focus Defusion Acceptance Self as content & context Values Clarification Committed Action Progressive integration of core processes Utilizes the hexaflex, enhancing psychological flexibility Provides flexibility within a structured protocol Addresses individual patient needs in a group setting

6 OBJECTIVES: Noticing external experience; Noticing & distinguishing types of internal experience w/o excessive judgment --Orienting Bell/Chime --Bag/Backpack to carry thoughts --Fire in the room/false alarms

7 OBJECTIVES: Introduce the concept of the mind & its thoughts; Distinguish thoughts from experiences; Recognize the mind is easily trained & repeats verbal material. --The Bell: Thoughts about it & Origin of Thoughts --The Mind as Co-pilot take yours for a flight --Sensory experience w/food (mindful eating) & Co-pilot s response --Passengers on your plane Take them for a flight

8 OBJECTIVES: Recognize the struggle to get rid of unwanted thoughts and emotions (experiential avoidance); Realize the ineffectiveness of this (creative hopelessness); Introduce acceptance as an alternative. --Willingness Check --Tossing furniture/tossing thoughts--don t think of --Co-pilot s scary/sad thoughts on a card --Stand with Yourself: feelings on posters --Tug of war: dropping the rope

9 OBJECTIVES: Introduce the content self to provide a reality foothold, yet notice it s impermanence; Introduce the constant self as permanent & with this realization increase willingness to accept difficult current and future experiences. --Notice/Share who I Am I am a/used to be a..., I like/don t like --Acting 101: Interview an assumed character --Wisdom with Age images from youth --I have survived recalling a difficult experience

10 OBJECTIVES: Identify thoughts of lost hope; Identify meaningful valued domains in life; Define specific behavioral goals aligned with values; Identify barriers to valued-based living; Doing--homework --Interview Your Passengers --The Best Part of My Day --Flying South: The Concept of Meaningful/Valued Directions --Chain Analysis of Choosing Valued Domains & Defining Goals

11 OBJECTIVES: Further clarify value-based goals & specific barriers; Build a pattern of committed action via goal completion; Encourage continued committed action beyond the protocol. --Barriers: How to Hold Them (barriers in a bag) --Flying with Turbulence: Are You Willing? (barriers as passengers) --Public Commitment Statements