Values: Clarity of Purpose, Crisis not Required

July was a heck of a month. Having just returned from a 5-month sabbatical, I was ready to get settled back into my life here in Portland when I got a phone call that stopped me in my tracks. We’ve all had those moments, when an unexpected event challenges us to consider what really matters, often with shocking, jarring clarity. Maybe it’s a phone call that a loved one is being rushed to the hospital. Or maybe it’s the day you lose your “dream job” or your physician gives you that unexpected diagnosis that will change the trajectory of your life. Or maybe it’s the moment your loved one looks into your eyes and says they are leaving you. These things can happen to any of us and if you’ve ever been confronted with one of these crises then I’m guessing it gave you pause to reflect.

Crisis and loss often have a way of clarifying what is most important to us. It often takes a crisis or significant loss to make us stop the autopilot of our lives and focus on what really matters. But what if it were possible to live with that kind of clarity of purpose and values without something terrible needing to happen? And what if your work could be about helping people do that?

At its heart, I think that’s what values work in ACT is all about. Living a values-based life is about living with intention, consciously choosing to live out a well-lived life, whatever that would mean for you personally. Values work in ACT is about creating a context where your clients are able to be connected with and live out their deepest values in a sustained and consistent way, not just when the crisis happens.

Our main tool in being able to help clients connect with what is most important to them (without the need for a crisis to shove that in their face!) is language. Although language often gets a bad rap in ACT, language is our ally when it comes to values work. Language and cognition are the very medium of meaning, purpose, and valuing, experiences which are central to what makes us human. Through various perspective taking exercises, for example, we can use language to enter into a remembered past or an imagined future to help us connect with what may be important to us in the grand scheme of things, beyond simply our immediate wants or preferences.

Over the next several months we’re going to be posting a series of pieces on this issue of values, how to have values guide your therapy and specific tools you can use to help your clients live with intention and clarity of purpose without the need for a preceding crisis. So if this is something you are interested in, stay tuned. Also, we’re currently working on a book on this topic called Values in Practice: A Clinician’s Guide to Helping Clients Develop Psychological Flexibility and Live a More Meaningful Life, to come out through New Harbinger Publications sometime next year. If you are interested in getting an announcement about when that will be released, feel free to send us an email and we’ll keep you posted about the publication date.

Jenna LeJeune, Ph.D

Author: Jenna LeJeune, Ph.D

Jenna is a clinical psychologist who specializes in working with people who struggle with relationship and intimacy difficulties and with those who have a trauma history. Her research focuses on developing compassion-based interventions targeting stigma, shame, and chronic self-criticism.

New books on Acceptance and Commitment Therapy in 2017


We do our best to update our Learning ACT Resource Guide with the newest resources on Acceptance and Commitment Therapy that come out each year.

You can download the newest version of the guide here.

As part of the guide, we’ve pulled together a comprehensive list of all the ACT that have ever been published.  Below are the 11 new books we discovered when wee revised the guide at the end of 2017:

Books for therapists:

ACT Books for the public:

We hope you find this new version of the Learning ACT Resource Guide useful in your practice. If you have any feedback, we’d love to hear it!

Disclosure: These links are affiliate links, meaning Portland Psychotherapy will be receive a small commission if you decide to buy something through Amazon after clicking on them. If you appreciate our work in putting this guide together (which we’ve done for free), then maybe you’ll be happy to have that happen, but if not, just buy the book without clicking on the link. It doesn’t cost you anything either way.

CEO of Portland Psychotherapy publishes second edition of “Learning ACT”

Our CEO, Jason Luoma, Ph.D., has just published the second edition of the book Learning ACT!

Learning ACT, Second Edition has been thoroughly rewritten with new exercises, references, and totally new chapters. It also pulls together resources on ACT from across the literature to guide therapists who are new to ACT.

In this fully revised and updated edition you’ll find exercises to help you practice, in the therapist role, ACT’s unique six process model. Numerous therapy vignettes illustrate how ACT actually looks in clinical practice and give you a chance to step into the role of therapist, to practice your skills before stepping into the room with an actual client. There are also downloadable extras that include role-played examples of the core ACT processes in action.

The two most novel parts of the book (outlined here in more detail) and based on recent changes in contextual behavioral science are:

  • A thoroughly rewritten chapter on flexible perspective taking/self-as-context that makes this often confusing process much more accessible and useful
  • A new chapter on how to tailor ACT to take into account different cultural contexts and identities

Read more on the New Harbinger website

Learning ACT second edition

Praise for Learning ACT:

“In this authoritative text, Luoma, Hayes, and Walser present a clearly written and practical step-by-step guide for therapists who are using acceptance and commitment therapy (ACT). Firmly rooted in contextual behavioral science and derived from a well-articulated theory, this text clearly describes and illustrates the concrete strategies to target a set of key processes that are critical to improve the lives of people. Every clinician should be familiar with it. It is a masterful book. I highly recommend it.”
—Stefan G. Hofmann, PhD, professor of psychology at Boston University, past president of the Association for Behavioral and Cognitive Therapies, and author of Emotion in Therapy

“This second edition is an exceptional guide for the skillful and flexible implementation of ACT principles. The chapters outline the six core flexible ACT processes and their methods, with case examples and dialogues that bring the information to life. The book includes a unique and invaluable set of training tools and tests of core competencies. This is a masterful ‘how to’ for ACT suitable for clinicians at any level of training and experience.”
—Michelle G. Craske, PhD, distinguished professor, and director of the Anxiety and Depression Research Center at the University of California, Los Angeles

“Firmly grounded in contextual behavioral science (CBS), superbly organized with lucid and comprehensive explanation of all ACT concepts and competencies, and loaded with clinical pearls and pitfalls to avoid, this book lives up to the title and then some, as one of the best books for learning ACT. Further, the clinical vignettes and self-reflective exercises will deepen and advance the practice of more seasoned practitioners of ACT. The updated text and the new inclusion of an excellent chapter on culture and diversity make this edition more relevant and invaluable than ever in this diverse, globalizing world. This book is simply a ‘must-have’ for any serious ACT practitioner!”
—Kenneth P. Fung, MD, FRCPC, MSc, associate professor in the department of psychiatry at the University of Toronto; clinical director of the Asian Initiative in Mental Health at the University Health Network; and president-elect of the Society for the Study of Psychiatry and Culture

“ACT has been at the forefront of the pioneering third-wave cognitive behavioral therapies for many years. Not only has it uniquely linked the human evolution of language and symbol formation to mental processes that can cause suffering (relational frame theory [RFT]), but it has articulated six clear processes for therapeutic intervention centered around developing psychological flexibility. For both novice and expert therapists of any orientation, you could not want for a more clearly articulated, easily accessible, and therapeutically wise approach than this by these leaders and pioneers in the field. Full of therapeutic transcripts with clear, insightful descriptions of the therapeutic process, this beautifully written book is an outstanding contribution to therapeutic literature that is bound to become a classic and an essential text.”
—Paul Gilbert, professor at the University of Derby, creator of compassion-focused therapy (CFT), founder of the Compassionate Mind Foundation, and author of The Compassionate Mind

“The tremendous dedication of thought and care Luoma, Hayes, and Walser infused into this second edition of Learning ACT is evident in the breadth and depth of every chapter. Their labor of love resulted in a preeminent and indispensable guide for novice and advanced ACT practitioners alike. Especially valuable are the fifty core competency exercises that stimulate experiential engagement. The chapter on adapting ACT to cultural contexts makes this a cutting-edge treatment for individuals from every walk of life who want to move in valued directions while welcoming all their thoughts and feelings.”
—Mavis Tsai, PhD, coauthor of A Guide to Functional Analytic Psychotherapy, and research scientist and clinical faculty at the University of Washington

 

A look at the future of Acceptance and Commitment Therapy

After many hours of work, the second edition of Learning ACT is out! I’m so thankful to all those who helped in its revision, putting in many hours of work and making fantastic suggestions for how to improve it. Thanks so much to those who resulted in this much improved book.

Here’s a list of the key changes in the second edition:

  • Most of the core competency exercises were updated based on reader feedback
  • Experiential exercises added or updated
  • The case conceptualization process and form was updated
  • The flexible perspective taking/self-as-context chapter was completely rewritten
  • A new chapter on considering culture in using ACT
  • A new appendix on using ACT in different settings
  • New audio recordings of exercises
  • New videos
  • Updated recommendations on resources for further learning based on all the new resources in the ACT universe
  • Inclusion of new theory based on evolution science and social extensions of the model
  • Updates to the core competencies of ACT

In addition to the book, I wrote a blog post about what I believe are some of the key changes happening in the world of ACT and how these are reflected in the book. The ACBS world is constantly learning more about the therapy based on practice and research, and we tried our best to incorporate the most important changes. If you buy the book, I hope you find it useful.

Jason Luoma, Ph.D.

Author: Jason Luoma, Ph.D.

Jason is a psychologist who researches ways to help people with chronic shame and stigma and also works clinically with people struggling with those same problems.

 

SUDS vs. Willingness: Values-Based ACT Exposure for OCD

Throughout the years, I’ve written a series of blogs posts on exposure therapy, including the use of exposure therapy in Acceptance and Commitment Therapy. In the absence of much guidance on using exposure in ACT, I co-authored a theoretical paper on its use in treating PTSD.

Recently I read an excellent paper outlining the use of ACT and exposure for OCD.

Exposure therapy for OCD from an Acceptance and Commitment Therapy framework

The article is a collaboration of 2 major research labs: Utah State professor Michael Twohig, a pioneer in the use ACT for OCD, and Jonathan Abramowitz, a professor at the University of North Carolina – Chapel Hill, and an incredibly prolific researcher in the field of anxiety.

The article walks through how exposure in an ACT context is different from traditional exposure and includes an example case, Monica, to illustrate treatment.

The authors provide helpful examples of values-based exposure exercises that emphasize willingness (i.e., acceptance) towards uncomfortable thoughts and feelings over traditional reduction in discomfort (e.g., habituation). As I’ve written about previously, difficulty with acceptance may maintain and exacerbate OCD symptoms. The authors note an overlap between an ACT approach and newer inhibitory learning approaches to exposure.

As the article is very readable and straightforward, there’s not much for me to say about it. I thought I’d expand upon and share my experiences with a few of the authors suggestions about relinquishing the traditional use of SUDS scores (i.e., discomfort) in favor of tracking the ACT process willingness, and of some of the difficulties in creating values-based exposure exercises.

SUDS vs. Willingness

In place of a traditional SUDS scale, the authors recommend a Willingness Scale, defined as the degree to which clients are will to be open and accepting of inner experiences (i.e., thoughts, feelings, bodily sensations) during exposure in service of their values (i.e., qualities of living that are important to them).

As the authors note, when you ask a client for a Willingness score, you often receive an inverse SUDS score rather than willingness in a strict ACT sense. More simply, clients are typically more willing to accept lower distress and less willing to accept higher distress.

The authors describe how in these instances they help the client separate “one’s openness to the experience from the severity of the experience.” In my experience this can be tricky. Some clients take right away to the concept of willingness and it can be very powerful for them. Other clients I’ve worked with successfully complete treatment but (I suspect) may not quite understand willingness in the ACT sense.

I would also note that SUDS scores can be used as part of ACT for exposure. What would be inconsistent with an ACT approach would be to use SUDS to emphasize habituation to discomfort. I want to be clear that the article authors are not explicitly anti-SUDS—I only mention this because I have heard some people express the view that ACT-based exposure is incompatible with tracking SUDS. This is a misunderstanding.

For these reasons, I still ask about SUDS scores and Willingness scores when conducting exposure. For one, SUDS scores help me catch when Willingness score are simply an inverse of SUDS. Secondly, it provides a view into the client’s experience, as it’s often hard to gauge a client’s distress from the outside. Lastly, I see value in clients tracking distress—especially in people with OCD. Many people with OCD do not believe their obsessions 100%, but they fear their anxiety will spiral out of control if they don’t engage in their compulsions. SUDS scores can help clients observe if their actual experience matches what their minds tell them. Some notice distress doesn’t become overwhelming as predicted, or that it passes more quickly than expected.

Values-based exposure

I also want to comment on the authors’ discussion of values-based exposure. They have a really useful table (Table 2) in the article listing how exposure exercises were linked to values in the example case. Values can help motivate clients to engage in exposure and bring more meaning to the process. In my experience, though, it is not always easy to clearly link exposure exercises to values. This paper helps provide guidance.

Sometimes I’ve found it useful to start with a more basic exposure exercise that can be easily conducted in session even if it is less directly connected to values This can serve as an introduction and help orient clients to exposure work. When I was first experimenting with values-based exposure, I could spend entire sessions trying to identify one ERP exercise that a client really valued! Instead, I’ve found it simpler to come to session with some ideas and ask, “Would you be willing to start with X or Y?” to get started. As clients start to understand exposure work through experience, they can offer more precise guidance and feedback.

When asked about valued activity, additionally, some clients will tell you they are engaged in valued living but that dealing with obsessions is exhausting and interferes with connecting with joy. In these instances, the value may simply be learning to be more present with their experiences of activities in which they are already engaged.

Summary

This collaborative article `from two major OCD/anxiety research labs provides one of the best illustrations of using ACT and ERP for OCD that I’ve read. I highly recommend it to anyone interested in ACT and exposure, and even non-ACT people who are interested in advancing models for exposure. I’ve offered a few opinions based on my experience conducting exposure in an ACT context that I hope readers find helpful.

If you’d like to read the article and, like me, don’t have access to journals behind paywalls, you can download an uncorrected proof from the authors’ ResearchGate page. You’ll notice a few typos in the proof such as “fiend” instead of ”friend.” 🙂

Brian Thompson Ph.D.

Author: Brian Thompson Ph.D.

Brian is a licensed psychologist and Director of the Portland Psychotherapy Anxiety Clinic. His specialties include generalized anxiety, OCD, hair pulling, and skin picking.

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