Introducing ACT With Compassion

Dear reader,

We feel a bit like a rude guest, who has forgotten to introduce you to their friend. If you’re reading this post, you’re probably a therapist looking for resources to learn and grow professionally. We think you might be interested in meeting this friend, “ACT With Compassion,” a website dedicated to helping therapists who are interested in bringing more compassion and effectiveness to their work with clients struggling with self-criticism and shame. Actwithcompassion.com is created by therapists at Portland Psychotherapy and is a place where we:

  • List all the latest training events for therapists that we can find that relate to things like self-compassion, compassion-focused therapy, and working with shame prone clients
  • Publish original resources for therapists (e.g. handouts, and exercises) that we’ve created that therapists can use in their practices to help clients with self-criticism and shame
  • Write blog posts about research and resources related to shame, self-criticism and self-compassion.

In our free time, we travel around the web, curating content (e.g. readings, videos, and measures) on self-compassion, shame and self-criticism. It’s possible that actwithcompassion.com might just become your go-to place for book and audio recommendations on these topics.

We apologize for the tardy introduction, but do hope you will become acquainted soon.

Sincerely,
Portland Psychotherapy

Written by Christina Chwyl, B.A.

Newest Data on Shame and Drinking Published at Western Psychological Association Conference

Newest Data on Shame and Drinking Published at Western Psychological Association Conference

Last Friday, Portland Psychotherapy research assistants Monica Bahan, Megan Cheslock, and Jackie Potter presented a research poster at the annual Western Psychological Association convention, which took place in Portland. Their poster detailed findings from one of our ongoing studies exploring the relationship between shame, guilt, and drinking behavior. The findings were based on the first 88 participants in the study, all volunteers from the Portland area.

Congratulations to Monica, Megan, and Jackie on their first presentation!

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.

Reducing Shame in Addictions: Slow and Steady Wins the Race

Reducing Shame in Addictions: Slow and Steady Wins the Race

I’m pretty excited about publishing the 51st randomized clinical trial on Acceptance and Commitment Therapy (in The Journal of Consulting and Clinical Psychology). Our study is the first randomized trial ever published to test the effectiveness of an intervention targeting shame in substance use disorders. Authors have been writing about the importance of shame in addiction for decades, but no one has spent the time and money to actually test an intervention. It’s pretty cool to be the first.

This study adds to the rapidly growing database on ACT

The number of randomized clinical trials on ACT is growing rapidly, with most studies published in just the last four years (see graph below of the number of published randomized clinical trials on ACT, by year, courtesy of Steve Hayes  – the graph is missing the five most recently published randomized trials).

 

Those who follow this blog are going to get a sneak peak at what will be in the manuscript. Below, I’ll snip out a few findings and the abstract. I’m pretty excited about this work and where our research on shame and self-stigma is leading. Keep tuned to this blog for more about where this work goes. You can find past publications on the topic on our Portland Psychotherapy publications page.

 

First, the abstract:

Objective: Shame has long been seen as relevant to substance use disorders, but interventions have not been tested in randomized trials. This study examined a group-based intervention for shame based on the principles of Acceptance and Commitment Therapy (ACT) in patients (N = 133; 61% female; M = 34 years old; 86% Caucasian) in a 28-day residential addictions treatment program. Method: Consecutive cohort pairs were assigned in a pair-wise random fashion to receive treatment as usual (TAU) or the ACT intervention in place of six hours of treatment that would have occurred at that same time. The ACT intervention consisted of three, two-hour group sessions scheduled during asingle week. Results: Intent-to-treat analyses demonstrated that the ACT intervention resulted in smaller immediate gains in shame, but larger reductions at four month follow up. Those attending the ACT group also evidenced fewer days of substance use and higher treatment attendance at follow up. Effects of the ACT intervention on treatment utilization at follow up were statistically mediated by post treatment levels of shame, in that those evidencing higher levels of shame at post treatment were more likely to be attending treatment at follow up. Intervention effects on substance use at follow up were mediated by treatment utilization at follow up, suggesting that the intervention may have had its effects, at least in part, through improving treatment attendance. Conclusions: These results demonstrate that an approach to shame based on mindfulness and acceptance appears to produce better treatment attendance and reduced substance use. 

 

And the overall summary of the findings from the discussion:

A six-hour group using an ACT approach to shame as a small part of a 28-day residential program led to slower immediate gains in shame, but better long term progress….Results indicated that reductions in shame during active treatment predicted higher levels of substance use at follow up. Mediational analyses suggested that the more gradual reductions in shame found in the ACT group protected against the pattern seen in TAU for shame reductions to be associated with subsequent higher levels of substance use. As predicted, the ACT intervention led to higher levels of outpatient treatment attendance during follow up, which in turn was functionally related to lower levels of substance use. Across the board, participants in the ACT condition showed a pattern of continuous treatment gains, especially on psychosocial measures, rather than the boom and bust cycles seen in treatment as usual.

 Our explanation for this pattern of results:

… something in the six hours spent in the ACT group changed the overall effect of this residential program. Unhealthy suppression of shame may be involved in the “treatment high” sometimes seen in early recovery in which sobriety can lead to unrealistic treatment gains, only to be followed by urges to use, relapse, or depression … It seems plausible that these six hours [of the intervention] kept participants from interacting with the overall treatment program in a way that produced illusory short term gains, perhaps by helping them experience shame in a more open and  mindful fashion, thereby allowing the emotion to perform its regulatory function of warning against or punishing violations of personal values or social norms and of helping to repair strained social roles. The resulting improvement in functioning and reintegration into healthy social networks, such as those found in a recovery community, led to less shame over time.

At the end of our article we summed up our hopes for how this research might help people with addiction:

Many people with substance use disorders experience shame as a result of the stigma of substance abuse, failure to control their substance use, and failures in role functioning. Understandably, people are motivated to avoid or reduce this extremely painful affect. Unfortunately, when the emotion of shame itself becomes the target of avoidance, this may exacerbate shame in the long run, even though it may provide some relief in the short-term. In a similar way, while negative self-conceptions are painful, direct change efforts can paradoxically increase the frequency and regulatory power of negative self-conceptions. Results of this study suggest that acceptance and mindfulness based interventions may help people to step out of a cycle of avoidance and shame and move toward a path of successful recovery that leads to more stable reductions in shame and to more functional ways of living. 

 

Citation:

Luoma, J. B., & Kohlenberg, B.S., Hayes, S. C., & Fletcher, L. (in press). Slow and Steady Wins the Race: A Randomized Clinical Trial of Acceptance and Commitment Therapy Targeting Shame in Substance Use Disorders. Journal of Consulting and Clinical Psychology.

The full study should be available shortly on the journal’s website.

UPCOMING TRAINING EVENTS


Acceptance & Commitment Therapy – An Experiential & Practical Introduction

Jason Luoma, PhD and Jenna LeJeune, PhD
November 13th and 14th, 2021 from 8:30am-4:30pm
at Hilton Garden Inn Portland Airport
This two-day in-person workshop provides a thorough overview of the theory, principles, and techniques of Acceptance and Commitment Therapy. It is intended for those who are relatively new to ACT and for those who have done some reading on their own about ACT but who may not have had the opportunity to participate in more experiential learning, observe models, or receive feedback while using the ACT model. Read More.


Ethical & Legal Considerations in Psychedelic Integration Therapy

Brian Pilecki, PhD and Jason Luoma, PhD
November 19th, 2021 from 9am-11am

There is an increasing demand from clients seeking therapeutic support in their personal use of psychedelics. However, many clinicians interested in psychedelic preparation and integration are unsure as to how to provide these services as psychedelics mostly remain illegal. In this workshop, we will outline legal and ethical frameworks relevant to providing therapy to clients around their personal use of psychedelics, as well as describe how harm reduction approaches are suitable for this developing clinical area. Read More.


De-Mystifying Self-As-Context in ACT: Practical Strategies for Clients

Brian Pilecki, PhD and Kati Lear, PhD
December 3rd, 2021 from 12pm-1:30pm

This workshop will outline how self-as-context can be used to conceptualize commonly discussed topics in therapy such as self-esteem, confidence, identity, and inner conflict. Participants will learn how to flexibly practice practical self-as-context interventions that can be used with clients, as well as have a chance to practice newly learned skills through structured role-play exercises in breakout groups. Read More.


Values in Therapy: An Intro to Working with Values from an ACT Perspective

Jenna LeJeune, PhD
January 21, 2022 from 12pm-2:00pm

This workshop will provide a theoretical and conceptual overview of values from a contextual behavioral science perspective. We will cover the “what”, “why”, “when”, and “how” of values within ACT. While we will also provide an overview of various values exercises and measures that can be used with clients, the emphasis in this workshop will be on providing a foundational framework that will help clinicians approach values work from a functional perspective rather than a primarily technique-focused approach. Read More.



Culturally Responsive Therapy: How to Apply Anti-Racist Values in Session

Christy Tadros, LPCC and RaQuel Neal, LCSW
February 4th, 2022 from 1:30pm-4:45pm
and February 5th from 9:00am-12:00pm

This 2 day 6-hour training will help therapists develop their ability to support clients from a different racial background than them, with a particular focus on Black, Indigenous and People of Color. Through a multicultural social justice framework, it will integrate research and clinical experience to teach a therapeutic model for rapport building, assessment, and treatment. This model is not a rigid therapeutic modality, but provides a contextual lens to build a strong, culturally grounded therapeutic relationship. It is a flexible model and can align with many therapeutic modalities, including a contextual behavioral approach to therapy. Read More.


Truffle Hunting: Bringing Values to Life in the Therapy Room

Jenna LeJeune, PhD
February 25, 2022 from 12pm-2:00pm

This brief workshop is designed to help clinicians deepen their values work with clients by shifting the focus from the content of values conversations to the quality of those conversation. By listening for and deepening the qualities of effective values conversations participants will get a taste for how more experiential and relationally-based values work can supercharge therapy. Participants will have opportunities to both observe demonstrations and practice in small groups with the benefit of feedback. Read More.


Values Prototyping: Using Action to Help Clients Explore Their Values

Jenna LeJeune, PhD
March 18, 2022 from 12pm-2:00pm

This workshop will focus on one specific experiential tool called “values prototyping” that helps clients learn more about their values through engaging in intentional valuing. As participants will hopefully already have a solid foundation of some of the core concepts of the values process in ACT, this workshop will dive right in on how to use values prototyping to help clients learn more about what they would choose to value in their life. You will have the chance to practice developing a values prototype in small groups with the benefit of feedback, so that by the end of the workshop you will be able to use this tool in your work with clients. Read More.


The Invitation to Change Approach: Helping Families Affected by Addiction

Jeff Foote, PhD and Cordelia Kraus, LPC, CADC 1, certified CRAFT clinician
May 13th and 14th, 2022 from 9:00am-5:00pm
at University of Portland, Terrace Room
This two-day in-person workshop will provide skills training for professionals focused on the process of working with clients who have a loved one struggling with substance use issues. The Invitation to Change Approach draws on CRAFT (Community Reinforcement and Family Training), MI (Motivational Interviewing), and ACT (Acceptance and Commitment Therapy) to provide a compassionate and collaborative way of working with the families and concerned significant others of people who struggle with substance use. 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.

November 12th, 2021Psychedelic Research: Implications for Palliative Care and End-of-Life Existential Distress with Anthony Bossis, Ph.D.

December 10th, 2021Implementing Culturally-Attuned & Anti-Racist Psychedelic Therapy: Impact over Intention with Jamilah R. George, M.Div., M.S.

January 14th, 2022Psilocybin-Assisted Therapy of Major Depressive Disorder using Acceptance and Commitment Therapy as a Therapeutic Frame with Jordan Sloshower, MD, MSc

February 11th, 2022 – Drug-Drug Interactions Between Psychiatric Medications and MDMA or Psilocybin with Aryan Sarparast, MD