An Introduction to Acceptance and Commitment Therapy (ACT)

1. An Introduction to Acceptance and Commitment Therapy (ACT) Kimberly Nylen April 23, 2007

2. Outline • Brief history • “Third wave” therapies • Introduction to ACT • Research

3. History • 1950’s – Behavior therapy • 1970’s – Cognitive therapy • 1980’s to present – 3rd wave cognitive behavioral therapies

4. Behavior Therapy Interventions derived from conditioning principles • Exposure • Behavioral Activation

5. Cognitive Therapy Focus on social learning, language, information processing, cognitive styles • Irrational thoughts • Cognitive distortions

6. “Third Wave” Therapies • Integrate mindfulness and acceptance

7. Examples • Acceptance and Commitment Therapy (ACT) • Dialectical Behavior Therapy (DBT) • Functional Analytic Psychotherapy (FAP) • Integrative Behavioral Couples Therapy (IBCT) • Mindfulness-Based Cognitive Therapy (MBCT)

8. What is mindfulness? • “Consciously bringing awareness to your here-and-now experience with openness, interest, and receptiveness.” (Harris, 2006)

9. Mindfulness is… • Living in the present moment • Engaging fully in what you are doing rather than “getting lost” in your thoughts • Noticing as your feelings to come and go (without attempts to control them).

10. What is acceptance? • Making room for unpleasant sensations, feelings, urges, thoughts, etc. • Allowing them to come and go without trying to change them • Acceptance is NOT resignation or tolerance • You don’t have to like something to accept it

11. Pronounced “ACT,” not A.C.T. Acceptance and Commitment Therapy

12. Developed by Steven Hayes and colleagues in the 1980’s ACT

13. Framework • Western psychology is founded on the assumption of “healthy normality” • Psychological disorders are viewed as “abnormal”

14. Framework • ACT does not subscribe to this assumption • Rather, ACT assumes that psychological processes of the normal mind naturally lead to suffering/distress • Attempting to control/get rid of this distress is part of the problem

15. Why not symptom reduction? • Humans’ natural tendency is to avoid problems • Problem: something we don’t want • Solution: figure out how to get rid of it or avoid it • Example: Bear outside your window: get rid of it – throw rocks, shoot, call authorities • Example: snow, rain – can’t get rid of, but can avoid.

16. Avoidance can be bad. • Problem-solving approaches (avoiding, getting rid of) work really well when it comes to certain types of problems. • They don’t work so well when it comes to thoughts, feelings, sensations, memories

17. Example • Everyone has anxiety, but people are diagnosed with anxiety disorders when their lives revolve around controlling anxiety. • Panic disorder (anxiety about anxiety – avoid places that could lead to panic attack) • OCD (elaborate rituals to get rid of anxiety)

18. Goals • The goal of ACT is not symptom reduction, but it is a by-product • The goal IS to create a rich and meaningful life, while accepting the pain that goes with it • A specific type of behavior change that leads to psychological flexibility

19. Psychological Flexibility • “the ability to contact the present moment more fully as a conscious human being and to change or persist in behavior when doing so serves valued ends.” (Hayes et al., 2005)

20. Example • Snake phobia • When person is placed in presence of snake, 3 effects • Tension & arousal • Avoidance • Suppression of other responding

21. Psychological Flexibility

22. Psychological Flexibility • After exposure, the person who is afraid of snakes will display a range of behaviors in its presence (depending on the context of course. For example, happening upon a rattle snake would probably lead to narrow responding again).

23. Psychological Flexibility

24. Values • Another important component of ACT • The goal is to help the client live a rich and meaningful life, which is defined based on the person’s individual values

25. Values domains • Family relationships • Friendships/social relationships • Couples/romantic relationships • Work/career • Education • Recreation/Leisure • Spirituality/Religion • Community/Citizenship • Health/Physical Well-being

26. Why is this important? • Clients often come to therapy because they aren’t living the kind of life they want to be living. • Increasing psychological flexibility is important so that clients can live according to their values

27. Stages of values work • Defining life values • Defining life activities • Dealing with barriers to valued living

28. Life Compass Worksheet

29. Example • A woman diagnosed with Panic Disorder with Agoraphobia • Important value is parenting • Woman’s daughter will graduate from high school soon, and she would very much like to attend graduation...but… • She is afraid of having a panic attack in the large auditorium where commencement is held

30. Example • If she does not attend the graduation to avoid a panic attack, she is not living in accordance with her parenting value • Instead of making therapy about how to get rid of panic attacks, therapy is about how to be at her daughter’s graduation, in spite of panic attacks (exposure  psychological flexibility)

31. Research – does it work? • ACT shown to be effective for a number of conditions • Depression • OCD • Chronic pain & other health conditions • PTSD • Substance abuse • Psychosis

32. Schizophrenia • Patients with schizophrenia who received 4 hours of ACT showed a 50% decrease in hospital readmissions in a 6 month follow-up (Bach & Hayes, 2002)

33. Research • Even short interventions lead to significant improvements for a wide variety of conditions • Not yet an “empirically supported treatment,” but ACT has spurred a great deal of research since the publication of the manual in 1999.

34. Summary • ACT is a 3rd wave cognitive-behavioral therapy that integrates acceptance and mindfulness • Goals of ACT include behavior change and living a valued, meaningful life • The data support the efficacy of ACT interventions for a wide variety of disorders.