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Acceptance and Commitment Therapy Steven C. Hayes University of Nevada

Acceptance and Commitment Therapy Steven C. Hayes University of Nevada

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Acceptance and Commitment Therapy Steven C. Hayes University of Nevada Slide 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 Slide 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. Slide 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 Slide 5 Expanding avoidance All animals escape and avoid aversive events Slide 6 CAR But only humans can readily bring aversive events into any setting Car Slide 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 Slide 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? Slide 9 Dont be anxious Dont think of a white bear Self-Amplifying Slide 10 Puts Life on Hold Slide 11 Increases Arousal and Stress Slide 12 Repertoire Narrowing Slide 13 Psychological Flexibility The ACT Model Slide 14 Open Slide 15 Centered Slide 16 Engaged Slide 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 Slide 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 Slide 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 Slide 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; Slide 21 ACT for Depression Slide 22 ACT for COD Slide 23 ACT / CBT Comparisons 8 ACT better 1 CBT better 3 Both are the same Change processes so far always different Slide 24 ACT for Psychosis Slide 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 Slide 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 11-12. Valued directions 13-14. Commitment to valued actions Slide 27 Self Harm PrePost 30 Mean Score Phase 20 ACT etc TAU 10 Slide 28 Depression PrePost 30 Mean Score Phase 20 ACT etc TAU 10 Slide 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 Slide 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 Slide 31 Borderline Severity PrePost 50 Mean Score Phase 40 ACT TAU 30 3 mo F-Up Slide 32 Hopelessness PrePost 18 Mean Score Phase 12 ACT TAU 6 3 mo F-Up Slide 33 Impact of ACT Self Help Sub-analysis of 46 depressed teachers in a wellness program 8 weeks to read the book Slide 34 Depressed Teacher Subsample Analysis of 0,2,6 month data: p eta sq =.25 (large effect size) How about clinical significance? % who get across that green line Average for Hospitalized Depressed Patients Teacher Sample Book O 2 6 8 Slide 35 Depressed Teacher Subsample Percentage Clinically Improved Book 56.5% Slide 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.