Using ACT to target internalized homophobia and self-stigma

Using ACT to target internalized homophobia and self-stigma

Many of our clients struggle with shame and stigma. Despite its prevalence in the therapy room, there are few clinical interventions that specifically target self stigma,  defined here as “negative thoughts and feelings (e.g., shame, negative self-evaluative thoughts, fear) that emerge from identification with a stigmatized group” (p. 48, Luoma, O’Hair, Kohlenberg, Hayes, & Fletcher, 2010). This is an issue that we at Portland Psychotherapy are exploring, both in our clinical work and in the research we are conducting. We currently have several research projects underway, looking at various aspects of stigma and shame, how they impact functioning, and ways to target stigma and shame inside and outside the therapy office.

For these reasons, I was very interested in a recent article in Cognitive and Behavioral Practice by Yadavaia & Hayestitled “Acceptance and Commitment Therapy for Self-Stigma Around Sexual Orientation: A Multiple Baseline Evaluation.”  In the article, the authors report on the effectiveness of a brief (6-10 session) ACT intervention for self stigma in those who experience same sex attraction– sometimes referred to as internalized homophobia. While the ACT intervention in the study was individualized to each participant, similar to standard clinical practice, all 6 of the basic ACT processes were covered and expert ratings of treatment integrity were high.

The study found that participants evidenced positive changes on a variety of factors including self stigma/internalized homophobia, depression, anxiety, quality of life, perceived social support, and overall psychological flexibility. What I found to be most significant was that while participants reported a decrease in the believability of same-sex thoughts, the frequency of those thoughts did not change. This finding is consistent with previous studies using ACT to target other psychological difficulties (e.g. Bach & Hayes, 2002) and appears to support an ACT-consistent mechanism of change. In ACT, it is the workability of a thought in terms of valued action, rather than the form of the thought that is targeted. As such, we would expect, and this study did indeed find, that the frequency or even the form, of particular thoughts would not necessarily change significantly, but rather that change is found in the function that thought serves. It other words, after the intervention, participants continued to still have the same same-sex thoughts, but they were much less troubled by the thought.

Previous studies have supported the use ACT to target other forms of self-stigma, including those who struggle with substance use problems (Luoma, Kohlenberg, Hayes, Bunting, & Rye, 2008) and obesity (Lillis, Hayes, & Bunting, 2009). Although power was limited because of the small sample size  (n=5), the pattern of findings in this study were consistent with previous findings and suggests that ACT may be an effective intervention for individuals who struggle with self-stigma related to sexual attraction and sexual orientation.

UPCOMING TRAINING EVENTS

Ethical & Legal Considerations in Psychedelic Integration Therapy

Jason Luoma, Ph.D. and Brian Pilecki, Ph.D.
May 7, 2021 from 12-2pm

This workshop is based on extensive research and writing we have conducted into the legal and ethical issues of working with psychedelics in the current regulatory climate, as well as clinical practice doing harm reduction and integration therapy with psychedelics. It is informed by consultation with multiple experts on harm reduction, as well as attorneys knowledgeable about criminal and civil matters relating to drug use and professional practice. We will share with you all we know so that you can be more informed in the decisions you are making in your practice and be better able to decide whether to jump into this kind of work if you are considering it. Read More.


Case Conceptualization in Acceptance and Commitment Therapy

Jason Luoma, Ph.D. and Brian Pilecki, Ph.D.
May 21, 2021 from 12-2pm

This workshop provides a chance to learn concrete methods for conceptualizing cases from the perspective of Acceptance and Commitment Therapy. Formulating a useful case conceptualization is a foundational clinical skill that is essential in delivering effective treatment, and one that can be often overlooked in the process of working with clients. Participants will learn several formats for doing formal case conceptualization outside of session as a means to further develop knowledge and skill with ACT theory, as well as to learn a means to enhance treatment planning. The importance of ongoing case conceptualization throughout a course of treatment will be emphasized, as well as common pitfalls in conceptualizing client problems. Participants will also have a chance to practice newly learned skills with a case in breakout groups. Read More.


Lunchtime Panel Discussion: Psilocybin Therapy and Mental Health Care in Oregon: What is Happening and Where do We Need to Go from Here?

Moderated by Brian Pilecki, Ph.D. with Ingmar Gorman, Ph.D, Kelly Sykes, Ph.D, Alan Davis, Ph.D, Aja Molinar, and Sam Chapman
May 28, 2021 from 12-1pm

Oregon Voters have recently approved a measure that will pave the way for the legal administration of psilocybin by state credentialed providers to begin in 2023. In this panel discussion, leading advocates, psychedelic therapy researchers, and psychedelic therapist training providers will elaborate on the implications during a moderated panel discussion and answer audience questions. Presenters will give an update on the status of the Oregon Psilocybin initiative, particularly as it relates to the training of facilitators, and will describe ways local therapists can get training in the practice of psilocybin-assisted therapy. Read More.


ACT Precision Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Help You be Focused and Strategic in Your Interventions

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
June 18, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop focuses on helping you use ACT theory & in-session clinical markers to make more precise and strategic interventions. The main goal of this workshop is to help you become more adept at identifying in-session client behaviors that are indicators for particular ACT processes that are likely to be most relevant. The workshop uses a process we call ACT Circuit Training, which involves intensive analysis of a video of an ACT session and intentional practice in conceptualizing client behavior and generating possible ACT responses, followed by discussion and feedback. Read More.


ACT Agility Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Increase Flexible Responding

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
July 16, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop is intended to help therapists be more flexible and nimble in their use of ACT processes, strengthening their ability to fluidly shift as needed between processes within sessions. Therapist learning ACT often develop tunnel vision, focusing too much on particular processes or responding rigidly when more flexibility is needed. Read More.


Therapy and Research in Psychedelic Science (TRIPS) Seminar Series

Second Friday of each month from 12:00 PM – 1:00 PM (PT)

TRIPS is an online seminar series that hosts speakers discussing science-informed presentations and discussions about psychedelics to educate healthcare professionals. This series was created to guide healthcare providers and students preparing to be professionals towards the most relevant, pragmatic, and essential information about psychedelic-assisted therapy, changing legal statuses, and harm reduction approaches in order to better serve clients and communities. This seminar series is a fundraiser for our clinical trial of MDMA-assisted psychotherapy for social anxiety disorder that Portland Psychotherapy investigators are preparing for and starting in the Fall of 2021. All proceeds after presenter remuneration will go to fund this clinical trial. Read more.

May 14th, 2021  Research on MDMA and Psychedelic-Assisted Therapy: An Overview of the Evidence for Clinicians with Jason Luoma, Ph.D.
June 11th, 2021 Becoming a Psychedelic-Informed Therapist: Toward Developing Your Own Practice with Nathan Gates, M.A., LCPC