An Introduction to Acceptance and Commitment Therapy ACT

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An Introduction to Acceptance and Commitment
Therapy (ACT)

• Kimberly Nylen
• April 23, 2007

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Outline

• Brief history
• Third wave therapies
• Introduction to ACT
• Research

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History

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

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Behavior Therapy

• Interventions derived from conditioning
  principles
• Exposure
• Behavioral Activation

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Cognitive Therapy

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

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Third Wave Therapies

• Integrate mindfulness and acceptance

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Examples

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

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What is mindfulness?

• Consciously bringing awareness to your
  here-and-now experience with openness, interest,
  and receptiveness. (Harris, 2006)

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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).

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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 dont have to like something to accept it

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Acceptance and Commitment Therapy

• Pronounced ACT, not A.C.T.

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ACT

• Developed by Steven Hayes and colleagues in the
  1980s

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Framework

• Western psychology is founded on the assumption
  of healthy normality
• Psychological disorders are viewed as abnormal

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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

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Why not symptom reduction?

• Humans natural tendency is to avoid problems
• Problem something we dont 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 cant get rid of, but can
  avoid.

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Avoidance can be bad.

• Problem-solving approaches (avoiding, getting rid
  of) work really well when it comes to certain
  types of problems.
• They dont work so well when it comes to
  thoughts, feelings, sensations, memories

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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)

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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

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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)

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Example

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

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Psychological Flexibility
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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).

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Psychological Flexibility
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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
  persons individual values

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Values domains

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

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Why is this important?

• Clients often come to therapy because they arent
  living the kind of life they want to be living.
• Increasing psychological flexibility is important
  so that clients can live according to their values

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Stages of values work

• Defining life values
• Defining life activities
• Dealing with barriers to valued living

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Life Compass Worksheet
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Example

• A woman diagnosed with Panic Disorder with
  Agoraphobia
• Important value is parenting
• Womans 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

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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
  daughters graduation, in spite of panic attacks
  (exposure ? psychological flexibility)

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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

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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)

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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.

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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.