The 5-Minute Guide to ACT: A Visual ACT Elevator Pitch

The 5-Minute Guide to ACT: A Visual ACT Elevator Pitch

The challenge of explaining ACT

As an ACT trainer, one of the most challenging things for me is when someone who isn’t familiar with ACT says “What’s this whole ACT thing about?” Let’s just say my ACT elevator pitch needs some work! It’s tricky to try to describe something that is supposed to be an experiential therapy. And then there is the whole conundrum of trying to use language to explain a theory that holds that language is at the heart of the problem. But I find that “you just have to experience it” is the trainer equivalent to “because I said so” and is equally unsatisfying (and also not very helpful). So this week I was thrilled when I got another tool in my “what is ACT” arsenal thanks to ACBS member Dov Ben-Yaacov and the 5-minute Guide to ACT Pictogram he created.

The 5-Minute Guide to ACT Pictogram (click on picture to download)

This isn’t something I would necessarily share with clients. However, I do think this simple, yet surprisingly comprehensive pictogram could be very helpful in orienting students and those learning ACT to the general gestalt of how ACT, RFT, and Functional Contextualism fit together.

Another example of the generosity in the ACBS community

One of the things I most love about the Contextual Behavioral Science community is how incredibly generous the community is. I can’t imagine how much time it took Dov to create this. And then he just went ahead and posted it for anyone to use it for free. So it’s with much gratitude to Dov Ben-Yaacov that I pass this along to you. Please use it as it is helpful and also continue to credit Dov Ben-Yaacov as you do so.

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.

Tips for Therapists Making the Change to ICD-10

Tips for Therapists Making the Change to ICD-10

In case you didn’t know already, starting October 1st 2015, insurance companies will start using the ICD-10 system for diagnostic codes, rather than the ICD-9/DSM codes. For any Date of Service (not date of claim submission) Sept. 30th or before, clinicians will still need to use the DSM codes. But any claims submitted for dates of service Oct. 1st or later will be rejected if they are not ICD codes. If you are a clinician billing insurance, you need to make this change or else you will be soon running into a lot of problems with rejecte claims.

What’s the difference between the DSM and the ICD system? Do I still need both of them?

DSM is a diagnostic determination guide. It can be a resource in providing information needed to make an accurate diagnosis, but it is a ICD 10 diagnosis (not a DSM diagnosis) that we are to now assign clients. It should be noted that the DSM may not be the ONLY or definitive source in determining diagnosis. According to the APA, “Psychologists might access that content through the DSM or through other resources such as the professional literature, practice guidelines or other accepted sources [to determine appropriate diagnosis]”.

Can’t we just have a simple chart that converts our DSM codes to ICD 10 codes?

No. The DSM V is NOT synonymous with the ICD-10. There are MANY more codes in the ICD-10 than there are in either the ICD-9 (which is roughly equivalent to DSM-IV) or the DSM V. There are approximately 14,000 codes in the ICD-9 but more than 68,000 codes in the ICD-10 (though of course we mental health professionals will only use a small fraction of those codes). While most of the ICD-10 codes are in the DSM V, some of the more specific ones are not. So, psychologists can’t simply convert DSM codes to ICD-10 codes automatically. PTSD is a good example of why a simple conversion from DSM V to ICD-10 isn’t going to be accurate. The DSM-V only has a code for PTSD “unspecified” type, while the ICD-10 has diagnostic codes for both PTSD “Acute” and “Chronic” types that are not in the DSM-V.

How can I find the correct diagnosis?

In general, you can find the correct corresponding ICD 10 code for most of the DSM diagnoses listed in the back of the DSM V. However, there are some ICD10 codes that aren’t listed in the DSM V, as in the case mentioned above about PTSD. So you can’t just rely on the DSM. Instead, we suggest crosschecking your diagnosis using one of several “crosswalk” tools available online. Two such resources would be:

  1. ICD-10 Code Lookup
  2. ICD-10 Tabular List

Need for specificity, particular in relation to substance use disorders

One factor accounting for the increased number of codes in the ICD-10 pertains to the number of specifiers for the different diagnoses in the ICD 10. This is especially true for the substance use disorders. The increased use of specifiers is a main difference many clinicians will need to become familiar with as they move forward using the ICD-10 system starting Oct. 1st. It is important to be as specific as possible in selecting ICD-10-CM codes — that is, when known, use the code structure to indicate severity or other meaningful diagnostic information. Try to avoid “unspecified” diagnoses, as plans may not reimburse for them — plans are looking for increasing specificity in diagnosis.

No More NOS – “Unspecified” versus “Other Specified” diagnoses.

When the DSM switched from IV to V, the NOS specifier was replaced with two options “Unspecified” and “Other Specified”. The ICD 10 also uses this distinction. “Other Specified Disorder” allows the clinician to specify the reason that the criteria for a specific disorder are not met (it is required to give reason(s) why the criteria are not met in the diagnosis field).  An example of this would be other specified depressive disorder, short-duration depressive episode, 9 days.

“Unspecified Disorder” allows the clinician the option to forgo specification.  This would be used instead of deferring a diagnosis when a client does not meet criteria AND the provider cannot specify due to inadequate info.  This will likely not be an acceptable reimbursable diagnosis.

It has been suggested that when you have the choice between an “Unspecified” and “Other Specified” diagnosis and both seem equally valid, choose the latter, and document in the chart what criteria were not met for you to use another diagnoses of this category.

How do I diagnose substance use disorders with the ICD-10?

This is probably the biggest category of changes from the DSM to ICD-10 system. The APA has created a very useful step-by-step guideline for diagnosing substance use problems using the ICD-10 system that can be accessed here.

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.

Creating a Peer-Led Acceptance and Commitment Therapy Consultation Group: The Portland Model

Creating a Peer-Led Acceptance and Commitment Therapy Consultation Group: The Portland Model

In 2005, the clinic directors (Jenna LeJeune, Ph.D. & Jason Luoma, Ph.D.) at Portland Psychotherapy helped found a peer-consultation group to provide a place for local therapists to learn and practice Acceptance and Commitment Therapy (ACT) and to build supportive community of like-minded practitioners.

The ACT peer consultation group underwent a number of iterations in the years that followed. It took several years for the group to find its feet, and there was process and evolution in creating a workable structure and set of roles to help guide the meetings.

Recently, several of us got together and wrote a paper describing the process of creating an ACT peer consultation group and the structure we created. We’d run some workshops demonstrating (e.g., role-playing) the model—we called “The Portland Model”—and found that clinicians around the world were very interested in learning how they could start their own ACT peer consultation group. After running some workshops, we agreed we were ready to write up our experiences in order to reach a larger audience. We each contributed a section of the paper, and I took on the role of editing and putting it all together.

And it’s finally available! The paper was published in a 2015 issue of the Journal for Contextual Behavioral Science (JCBS). If you’re a member of the Association of Contextual Behavioral Science (ACBS)—the core organization behind ACT—you can access and download the paper for free by logging into the ACBS website. Under the “Resources” tab, click on the “Journal for Contextual Behavioral Science” link. There is a list of issues. Our paper was published in “Volume 4 (2015) Issues 3-4.” The Science Direct link is here.

If you’d like to find out more about the Portland ACT peer consultation group, you can click on this page to find out about meeting times, as well as download copies of the mission statement, meeting structure, and a description of the roles.

The main point I’ve tried to emphasize to people in workshops is that our model is just one way of structuring the meetings—the most important thing is to have some sort of structure. Once you agree upon a structure, only then can you evaluate what is and is not working. Feel free to drop me a line if you’d like some consultation for how to get your own group started.

Article (Portland Psychotherapy authors bolded): Thompson, B. T., Luoma, J. B., Terry, C., LeJeune, J., Guinther, P., & Robb, H. (2015). Creating a Peer-Led Acceptance and Commitment Therapy Consultation Group: The Portland Model. Journal of Contextual Behavioral Science, 4(3), 144-150.

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.

New resource: a dictionary of terms commonly used in transgender and gender nonconforming communities

New resource: a dictionary of terms commonly used in transgender and gender nonconforming communities

APA has a new set of guidelines for psychologists working with transgender and gender nonconforming people (TGNC). In an appendix to those guidelines, APA included a very useful index defining many of the terms used within the TGNC community. Terminology of this sort is rapidly evolving and it can be difficult to stay abreast of it all. The index APA included in its guidelines is a helpful resource as psychologists strive towards treating others in a respectful and culturally competent way. For example, the term “transgender” has rapidly become part of American lexicon, especially since Caitlyn Jenner told her story in Vanity Fair magazine earlier this summer. However, although I’m familiar with the term, I’ve never heard the term “cisgender” used in the popular media. The APA terminology index defines “cisgender” as “An adjective used to describe a person whose gender identity and gender expression align with sex assigned at birth; a person who is not TGNC.” Only using a term to describe one experience/group implies that those in that group are “not the norm”; you’re either transgender or you’re “normal.” By knowing and using terms like cisgender to describe people whose experience isn’t that of those in the TGNC community, we make a small but important statement affirming the equality of all experiences of gender identity. If you’re interested in updating your knowledge of terms commonly used in the TGNC community, go to the appendix of the APA document.

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.

Top 5 Mindfulness Resources

Top 5 Mindfulness Resources

The science of mindfulness is a very hot topic these days.  In agreement with the research, we find mindfulness to be a very helpful skill to have that is effective for a variety of problems that come with everyday life, such as distractibility, emotional reactivity, and impulsive decision making.

If you’d like to learn this skill, we have one one simple piece of advice – practice!  Any skill that you want to get better at (gardening, sports, playing an instrument) requires practice, and plenty of it.

In order to help you to learn how to train your mind in this way, we’ve put together a list of our top 5 resources for learning mindfulness. Some of these applications and websites are also helpful for providing a sense of community around mindfulness, which helps with both accountability and feelings of connection. For example, the insight timer shows you how many other people across the world are using the insight timer at the same time.

2 Minute Beginner’s Guide Animation

Free

Why We Like It: Having a very quick, to-the-point, and accurate explanation can often be more helpful than a big, comprehensive tool.  We also like this explanation because it clarifies some of the common misperceptions of what mindfulness practice is.

Headspace

iPhone

Android

10 day free trial, subscription following trial

Why We Like It: This is a great app because the creators paid lots of attention to the interface.  This is the current industry leader, and it shows in the quality.  When you first begin to use it, the app has you watch a series of short and fun animations to quickly orient you to what mindfulness is and what it is not (the videos are worth watching).

Another reason why this app made our list is because the developers made it in a way that will have a higher likelihood of keeping you engaged over time.  Instead of moving on to something else once the initial motivation has passed, there is a greater chance you’ll stick with Headspace because each day has a different guided file, it gives you clear goals, and you get to choose to practice on specific issues (a series on anxiety, depression, pain, etc).

Insight Timer

iPhone

Android

iPad

Free for iPhone and Android with option of purchasing upgrades, $2.99 for iPad

Why We Like It: This app is worth acquiring for the Tibetan bells alone, but in the past year or so, the app has expanded to include a wide variety of meditation practices of varying lengths.

Stop, Breathe & Think

Web

iPhone

Android

Free

Why We Like It: This is a great app that works either on the computer or a smartphone.  It provides a great introduction and resources for taking your practice deeper, as well.  One thing it also does that the others don’t do is offer a check-in that will ask you questions about how you are feeling in order to suggest some useful types of mindfulness practice.

Tara Brach’s Guided Meditations

Free

Why We Like It: Tara Brach is most widely known for her book Radical Acceptance.  On her website she regularly posts guided meditations to follow along with.  Every meditation instructor has their own style, and Tara has an easy style that many people tend to like.  Additionally, we’d highly recommend listening to her her 2-part introduction to meditation talk:

Part 1 – Do You Make Regular Visits to Yourself (57 min)

Part 2 – Do You Make Regular Visits to Yourself? (55 min)

If you’d like to see our full list, please visit

Resources for Learning Mindfulness Meditation in Portland, Oregon

UPCOMING TRAINING EVENTS