acceptance and commitment therapy steven c. hayes university of nevada
TRANSCRIPT
Acceptance and Commitment
Therapy
Steven C. HayesUniversity of Nevada
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
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.
ACTIs 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
Expanding avoidance
All animals escape and avoid aversive events
CAR
But only humans can readily bring aversive events into any setting
“Car”
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
ACTThis 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?
Don’t be anxious
Don’t think of a white bear
Self-Amplifying
Puts Life on Hold
Increases Arousal and
Stress
Rep
erto
ire
Nar
row
ing
Self asContext
Contact with the Present Moment
Defusion
Acceptance
Committed Action
Values
Psychological Flexibility
The ACT Model
Defusion
Acceptance
EssentialComponents
of ACT
Open
Self asContext
Contact with the Present Moment
Defusion
Acceptance
EssentialComponents
of ACT
Centered
Self asContext
Contact with the Present Moment
Defusion
Acceptance
Committed Action
Values
EssentialComponents
of ACT
Engaged
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
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
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
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;
ACT for Depression
ACT for COD
ACT / CBT Comparisons
• 8 ACT better
• 1 CBT better
• 3 Both are the same
• Change processes so far always different
ACT for Psychosis
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
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. acceptance9. Nonavoidant emotion regulation strategies 10. Impulse control11-12. Valued directions 13-14. Commitment to valued actions
Self Harm
Pre Post
30M
ean
Sco
re
Phase
20
ACT etcACT etc
TAUTAU
10
Depression
Pre Post
30M
ean
Sco
re
Phase
20
ACT etcACT etc
TAUTAU
10
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
ACT for BPD(Morton et al in press)
1. Overview of ACT. Intro to mindfulness2. Cost of avoidance; beginning values3-4. Acceptance and defusion5. Mindfulness of pleasure6. Emotional awareness7-8. Health and relationship values9. Mindfulness in conflict10. Values and choice11. Mindfulness and acceptance12. Review and celebration
Borderline Severity
Pre Post
50M
ean
Sco
re
Phase
40
ACT ACT
TAUTAU
30
3 mo F-Up
Hopelessness
Pre Post
18M
ean
Sco
re
Phase
12
ACT ACT
TAUTAU
6
3 mo F-Up
Impact of ACT Self Help
Sub-analysis of 46 depressed teachers in a wellness program
8 weeks to read the book
Depressed Teacher Subsample
0
5
10
15
20
25
30
35
40
45
0 2 6
0
5
10
15
20
25
30
35
40
45
0 2 6 8
Months
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
Book
O 2 6 8
Depressed Teacher Subsample
0%
10%
20%
30%
40%
50%
60%
0 2 6 8
Percentage Clinically Improved
Book
56.5%
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.