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

An Introduction to Exposure Therapy for Anxiety Disorders: Traditional and Inhibitory Learning Approaches

Dr. Brian Pilecki
January 29, 2021 from 12:00pm-1:30pm PST
Exposure therapy is the gold-standard treatment for anxiety and obsessive compulsive and related disorders. The aim of this workshop is to provide a solid foundation in theory and knowledge for those newer to exposure therapy. This workshop will include a brief history of exposure therapy, including a description of its roots in classical and operant conditioning. Read More.


Using Acceptance and Commitment Therapy to Guide Flexible Exposure

Dr. Brian Thompson
February 26, 2021 from 1-2:30pm

Drawing from the ACT model, participants will learn to conceptualize and create exposure exercises to maximize flexibility. We will explore common pitfalls in using ACT as a context for exposure and how to create ACT-consistent exposure exercises for clients who are skeptical of “acceptance” and appear disinterested when you try to engage them about values. The presenter will use practice-based data to support these principles (Thompson, Twohig, & Luoma, in press). Read More.


An Introduction to Psychedelic-Assisted Psychotherapy for Clinicians

Dr. Brian Pilecki and Jason Luoma, Ph.D.
March 26, 2021 from 9am-12:10pm

Psychedelic assisted therapy is emerging as a highly effective form of mental health treatment. This workshop will provide health care professionals an overview of this new clinical area. The workshop will highlight the importance of preparation and integration in therapy using a harm reduction approach. The current legal status of psychedelics will be reviewed, including Oregon’s recent passing of an initiative to legalize psilocybin-assisted therapy. Finally, diversity issues around lack of access for underserved and non-majority populations will be explored. Read More.


How to be Experiential in Acceptance and Commitment Therapy

Jason Luoma, Ph.D.
April 23, 2021 from 12-1pm

Acceptance and commitment therapy (ACT) is, at its core, an experiential treatment, but is frequently delivered in a non-experiential way. Experiential learning involves going beyond verbal discussion, insight, and explanations of experience. But how do we do this in ACT and how do we know when we are spending too much time engaged in non-experiential modes of learning? This workshop will outline a simple model you can use to identify when you are in less or more experiential modes during therapy and easy methods to switch to more experiential modes. You will then have a chance to practice it in breakout groups and get feedback. Read More.


Case Conceptualization in Acceptance and Commitment Therapy

Jason Luoma, Ph.D. and Dr. Brian Pilecki
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.


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.

December 11th, 2020 – Ethical and Legal Considerations in Providing Psychedelic Integration Therapy with Brian Pilecki, Ph.D. & Jason Luoma, Ph.D.
January 8th, 2021 – What’s it Like to Trip? The Patient Experience in Psychedelic-Assisted Therapy with Brian Pilecki, Ph.D.
February 12th, 2021 – 5-MEO-DMT with Rafael Lancelotta, M.S.
March 12th, 2021 – What does Psilocybin-Assisted Therapy for Depression Look Like? A Clinical Case Presentation based on a Recent Clinical Trial from Johns Hopkins with Alan K. Davis, Ph.D.
April 9th, 2021 – Gregory Wells, Ph.D.
May 14th, 2021  Research on MDMA and Psychedelic-Assisted Therapy: An Overview of the Evidence for Clinicians with Jason Luoma, Ph.D.