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.

Harnessing the Power of the Therapeutic Relationship

“Dealing with others is dealing with ourselves, dealing with others.”

–Norman Fischer

Creating intense and curative therapeutic relationships is a fundamental skill for meaningful therapy. Strong relationships like this can engage people in ways that challenge and can perhaps even frighten them.  This means that therapy can involve exposure to avoided thoughts, emotions and sensations for the client AND the therapist.

“Exposure therapy typically elicits a temporary increase in patients’ negative affect in order to facilitate new learning. This may in turn increase therapist discomfort as therapists interact with the patient and are confronted with their own uncomfortable subjective experiences.” (Scherr, Herbert and Foreman, 2015).

The authors of this study found that therapists with high levels of avoidance tended to avoid doing exposure therapy. Powerful therapy requires us choosing to lean into risking vulnerability instead of leaning back and doing therapy to the client.   Easier said than done. Doing therapy can be disturbing and we rarely receive explicit training on what to do when we are struggling. When we find the courage to open up about our challenges in consultation, we might hear solutions, be given articles to read, or have our behaviors analyzed by the other clinician. Rarely do we hear, “Yeah, me too. As a matter of fact, about an hour ago.”

Thankfully, two third wave behavioral therapies (Functional Analytic Psychotherapy and Acceptance and Commitment Therapy) blend quite nicely and give us clear guidance on how to continue to move toward that vulnerable edge of growth.  With them, we can accept our own human urge to avoid distress and stay the course, especially when deep pain arises in the therapy.

Functional Analytic Psychotherapy (FAP)

Bob Kohlenberg and Mavis Tsai, at the University of Washington developed FAP. As behavior analysts, they noticed some clients improved much more than others.  They found that in sessions where the client experienced great change, the relationship was pivotal. FAP focuses on interpersonal flexibility.  The power of FAP is responding to our client’s behaviors moment-to-moment in session. To do this, we need to consider our clients in the context of their lives and their histories.  For example, consider a client with a pervasive and persistent pattern of complaining which affects his relationships. Telling us that they don’t like something about the therapy could be an instance of that unworkable behavior.  For another client, it might be a risky move toward intimacy.  FAP terms these ‘clinically relevant behaviors’ or CRB for short.

FAP gives a framework for how to be most effective with our clients through a set of rules or guidelines. When we follow FAP rules with our clients, we can find ourselves risking and challenging ourselves to engage in an honest and undefended way.

Here’s a simplified version of those rules:  Be aware, courageous and loving with our clients. Again, easier said than done.

Acceptance and Commitment Therapy (ACT)

ACT was developed by Steve Hayes at the University of Reno, and focuses on intrapersonal flexibility. Humans don’t like risk, so we need something to help us when we are in that shaky ambiguity of pushing our comfort zones.  ACT helps us find our ground as we engage in emotionally vulnerable ways with the people we serve.  As human beings with our own histories, it’s certain that we will have painful reactions in the therapy session.  Accepting this as normal, staying in the present moment with those reactions, touching into our values and taking action allows us to follow the FAP rules of engagement.   ACT helps us hold a stance of open curiosity, so that we can engage in the messy work of human intimacy.

Doing effective and meaningful work as a therapist is not easy. Thankfully, Steve Hayes, Bob Kohlenberg and Mavis Tsai have given us tools that provide a scaffold for us to create transformation with our clients.   I’m excited to share how you can get the most out of these two therapies and make your work more powerful.  We’ll be working in depth on blending these two powerful therapies and applying them to your most challenging clients.  Come join us.

 

Harnessing the Power of the Therapeutic Ralationship Using ACT & FAP

  • 2-day workshop led by Joanne Steinwachs, LCSW
  • March 4 – 5, 2016, from 8:30 am – 4:30 pm
  • sponsored by Portland Psychotherapy


Joanne Steinwachs LCSWJoanne Steinwachs LCSW is a social worker in private practice in Denver, CO. She is a peer reviewed ACT trainer and a recognized FAP trainer. To learn more about her training and therapy practice, go to www.joannesteinwachslcsw.com.

 

 

ACT for Social Anxiety – A Great Self-Help Book and Treasure Trove of Resources

ACT for Social Anxiety – A Great Self-Help Book and Treasure Trove of Resources

I’ll make a confession here: I’m a failure at bibliotherapy. By bibliotherapy, I mean assigning a self-help book to a client and following it along with the client in order to guide treatment. For clients who are interested in self-help resources, I’ll make recommendations for books that clients can read on their own as a complement to treatment, but I feel stifled at the idea of using the book to guide treatment.

The authors of Mindfulness and Acceptance Workbook for Social Anxiety & Shyness have made things much easier for therapists like me. The book is based on a group treatment for social anxiety that has been studied in two published research studies—an initial pilot followed by a randomized controlled trial.

On their website (www.actonsocialanxiety.com), the authors offer a downloadable treatment manual based on their book. The manual is an adaption of the group treatment manual they (Jan Fleming, MD and Nancy Kocovski, PhD) used in their research studies. It includes copies of the handouts, so you don’t have to press your book against the photocopier—which I find a bit of pain to do in the digital age.

If you visit the publisher page on the New Harbinger website and register, you can also download audio files of the exercises (e.g., mindfulness exercises) and a separate collection of the handouts.

I’ve not had a chance to use the book in therapy yet, but I’ve read through it and am very impressed with it. The book is engagingly written, includes interesting exercises, and is relatively concise (I prefer brevity in a self-help book).

For all these reasons, I highly recommend Mindfulness and Acceptance Workbook for Social Anxiety & Shyness. You can find additional resources at the authors’ website and on the publisher’s website (under the “Accessories” tab—but you must register). Check it out—it’s one of the better self-help books I’ve read and the resources the authors provide are extremely generous.

Treating Skin Picking with Acceptance-Enhanced Behavior Therapy

Treating Skin Picking with Acceptance-Enhanced Behavior Therapy

Excoriation or skin picking has often been in the shadow of its nearest relative, trichotillomania or repetitive hair pulling. One good thing to come out of the DSM-5 was that it finally made skin picking disorder an official diagnosis—excoriation. Prior to the DSM-5, there was no official diagnosis for this condition. I suspect the lack of official diagnosis slowed research into skin picking disorder. As a consequence, there are few published treatment studies for excoriation.

A recent study looked at the use of an acceptance-based protocol that was originally created for trichotillomania. The protocol is Woods & Twohig’s Trichotillomania: An ACT-enhanced Behavior Therapy Approach therapist guide, part of the respected Treatments That Work series of treatment manuals published by Oxford Press. The protocol combines Habit Reversal Training (HRT) with Acceptance and Commitment Therapy (ACT). From the study description, the protocol remains largely the same as the published trichotillomania version, except that information about hair pulling is swapped out for skin picking.

The study

Four people with excoriation completed courses of AEBT. Three of the four completed treatment in 10-sessions—the standard protocol length—whereas the 4th completed 25 sessions of treatment. All four responded to treatment, although the individual who completed 25 sessions (“Rose”) struggled with periodic lapses (sudden increases in picking) during treatment. Of note: one of the primary treatment responders (“Amy”) completed all but the initial session through web-based video-conferencing. Treatment appeared to successfully address both skin picking as well as co-occurring problems including anxiety, depression, and life stress.

Because this is a small, uncontrolled study, results should be interpreted cautiously. However, it provides some additional evidence that the AEBT protocol is as effective for skin picking as it is for hair pulling. One prior multiple baseline study of AEBT included 2 participants with skin picking and also found reductions in pulling.

For therapists interested in treatment excoriation and trichotillomania, the AEBT protocol is a commercially available and flexible treatment manual with very good research support for hair pulling and some very promising evidence for its use in treating excoriation. Additionally, this study provides some evidence that treatment produces changes in conditions that are co-morbid with picking such as anxiety and mood problems. I draw from the treatment manual in my own practice and have found the handouts and treatment framework particularly helpful.

If you’re interested in reading the full study, you can download a pre-publication copy here.

An Alternative to Exposure and Response Prevention for OCD

An Alternative to Exposure and Response Prevention for OCD

Numerous studies have now shown that Exposure and Response (or Ritual) Prevention (ERP) remains  our most effective treatment for obsessive-compulsive disorder (OCD).  In ERP, clients deliberately confront feared stimuli while learning to refrain from engaging in compulsions.

Even with the effectiveness of ERP, the search continues for how to get even better results, as not everyone benefits from ERP and some clients are resistant to it. Recent research on Acceptance and Commitment Therapy (ACT) suggests that other approaches—such as learning to observe obsessions without engaging or “buying into” the content of the obsessions—can supplement ERP. One of the core ideas of ACT is helping clients to mindfully observe obsessions with greater distance.

I recently came across a new paper that focuses on these newer approaches to OCD and thought it might be helpful for clinicians working with OCD. The authors provide a nice summary of recent research on the use of ACT, Dialectical Behavior Therapy, mindfulness-based approaches, and Metacognitive Therapy in the treatment of OCD.  They also provide some background on the roots of ERP in behaviorism and (later) cognitive therapy. The authors summarize what makes these approaches unique in the treatment of OCD:

In general we agree that most approaches to OCD address the function of inner experiences to some degree; in addition arguing that what makes the approaches covered here unique is the greater or complete shift toward addressing the function of inner experiences and a substantial reduction in categorizations of types or styles of inner experiences. (p. 34)

I would like to emphasize that none of these newer strategies are incompatible with ERP. I often find they are a useful complement to exposure work in my clinical work. My sense is that these strategies can help us expand our range of effective treatment interventions for OCD to help prepare clients for exposure work or as an alternative for those who are not willing to engage in ERP.

If you’d like to read the paper, you can currently download a pdf for free here. For a list of other blog posts I’ve written about exposure, click on this link.

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