An Introduction To And Commitment Therapy BY DR. E. ADRIANA WILSON & K. RYAN WILSON GRAND ROUNDS DEPARTMENT OF PSYCHIATRY DALHOUSIE UNIVERSITY APRIL 24, 2013 Participants will be able to: OBJECTIVES Discuss the core concepts of ACT Compare and contrast ACT from other forms of therapy Recognize and discuss its use in a number of disorders as established by RCT s Examine how ACT principals may be helpful in their own practice WHY LISTEN? What is ACT? Who here has a 100% success rate with their patients? What have you heard? What do you want to know? Our 10 second summary The Russ Harris 10 second summary Third Wave Behavior Therapy Informed by CBT, BT, Mindfulness, Motivational Interviewing and Relational Frame Theory Established in the literature as an Evidence Based practice through over 60 RCTs to date ACT core message: to accept what is out of your personal control, while committing to action that will improve your quality of life The aim of ACT is to help people create a rich full and meaningful life, while effectively handling the pain and stress that life inevitably brings. Accomplished by: a) Teaching psychological skills to deal with painful thoughts and feelings effectively in such a way that they have much less impact and influence over you. (mindfulness skills) b) Helping patients clarify what is truly important and meaningful to them - ie their values - then use that knowledge to guide, inspire and motivate them to change their life for the better. Russ Harris, http://www.thehappinesstrap.com/about_act 1
70" 60" 50" 40" 30" 20" 10" Active area of ongoing research June%2012:%62%ACT%RCT s% 0" 1985" 1990" 1995" 2000" 2005" 2010" This graph contains a cumulative record of the randomized clinical trial on and Commitment Therapy through June 20, 2012 (including articles in press). from ACBS website Steven Hayes on October 3, 2011 Indicated for Considered an empirically supported treatment on the American Association Division 12 list of empirically-based treatments Strong support for Pain Moderate support for Depression Modest for multiple Anxiety disorders, Psychosis, Substance Abuse, smoking cessation Chambless (1988) WHO can do ACT & WHERE? HOW can it be delivered? Psychiatrists Psychologists Social Workers Counselors Physicians Used in hospitals Private practice offices Clinics Social service organizations How is ACT similar and different than other models? CBT ACT Dynamic Six Core Processes DBT BT 2
The Hexaflex and Mindfulness Processes Commitment and Behavior Change Processes Let Go Get Moving Show Up 1. UNWORKABLE ACTION: What is the patient doing that makes their life worse or keeps them stuck? (ie.avoidance, self damaging behaviors etc) 3
2. FUSION: What are the problematic thoughts and feelings the patient is fusing with? (ie. reasons, rules, judgments, self descriptions, past, future, processes- like I can t do this, worrying, ruminating etc) 3. EXPERIENTIAL AVOIDANCE: What is the patient avoiding internally? (ie. thoughts, feelings, memories, urges, sensations, emotions that they are trying to avoid, to get rid of or are unwilling to have?) ACT Targets 4. MOTIVATION FOR CHANGE: What is it COSTING the patient to remain stuck? Fusion Evaluation Avoidance Reason-giving Accept your reactions and be present Choose a valued direction Take action BEING PRESENT VALUES I am living very inconsistently with my values Notice who is noticing I am living fully by my values Russ Harris, ACT made Simple (2009) 4
COMMITTED ACTION ACCEPTANCE 3+44)'5)(4&'$6)7.48&(946))$ Specific Meaningful, measurable able by you Realistic Time oriented 2+*.)0 "#$%&'()*+$),$&-&.( /+*.)0 From: ACT for Life- Group Intervention for Psychosis Manual Institute of Psychiatry, at The Maudsley, South London 42 DEFUSION Our thoughts and feelings SELF AS CONTEXT Conceptualized self Ongoing self awareness DEFUSION Self Our thoughts and feelings In short ACT uses acceptance and mindfulness processes, commitment and behavior change processes, to produce greater PSYCHOLOGICAL FLEXIBILITY Observer stance 5
Relevance? Thanks What is one thing you learned today? How might that be helpful in your practice? Members of the Association for Contextual Behavioral Science (ACBS) for their open source attitude toward research, presentations, materials, information 6