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Acceptance and Commitment Therapy

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Hannah Pritchett

on 8 June 2011

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Transcript of Acceptance and Commitment Therapy

Outcome Finding Values and Meaning in
Acceptance and Commitment Therapy By Kayla Carson,
Hannah Pritchett,
Kyoko Tsuzuki,
and Carey Cramer What is ACT? Issues with Traditional Therapy: Basis on the Medical Model Happiness is the "normal" state
Suffering is a result of an upset of happiness
Ultimate goal:
elimination How does ACT differ? First Difference:
Suffering is basic and should be accepted
Right or wrong is not important, instead what is useful is important GERIATRIC GENERALIZED ANXIETY DISORDER Insomnia Obsessive Compulsive Disorder Variety of contexts in which ACT has been used?

Research has indicated the effectiveness of ACT in treating: (Wetherell, Afari, Ayers, Stoddard, Ruberg, Sorrell & Patterson, 2011) (Dalrymple, Fiorentino, Politi, & Posner, 2010) (Twohig, Hayes, Plumb, Pruitt, Collins, Hazlett-Stevens, & Woidneck, 2010) TOURETTE’S SYNDROME (Franklin, Best, Wilson, Loew, & Compton, 2011) MARITAL PROBLEMS (Peterson, Eifert, Feingold, & Davidson, 2009) EPILEPSY (Lundgren, Dahl, Yardi, & Melin, 2008) and a number of other issues We will discuss the unique and fundamental role of VALUES in two different ACT interventions... Murrell, Rogers, and Johnson (2009) explored how ACT helped an Asian-Indian overcome CROSS-CULTURAL PROBLEMS. Introducing Jaya, a 32 year old mother of 2 who immigrated to the US from India nine years prior Discussion of presenting problems. ACT intervention with Jaya General interview Valued Living Questionnaire Jaya’s values Valued action plan Consequences of not taking valued actions Value journal Diffusion exercise The importance of values in cross-cultural interventions What does act entail? Patient vs. Therapist Thoughts and statements are neither correct or incorrect
Must be willing to change and accept new ways of thinking
No changes in daily life required Patient's Role Therapist’s Role Exposes patient to his or her fear
Tries to help the patient focus more on the present moment
Focuses on 2 main principles:
Control issues
Living in accordance with new
values Control Issues include: creative hopelessness, values clarification, and willingness to experience events that can cause stress Creative Hopelessness Exploring new possibilities
Engaging in life to find solutions to seemingly hopeless situations Values Clarification Discovering values by assessing, exploring, and determining what those personal values are
Discuss how values affect personal decision-making Willingness to Experience Events that can Cause Stress Patient’s willingness to allow therapist to expose him or her to the fear that is causing stress
Therapist ensures there is a controlled setting Living in accordance with new values include: cognitive diffusion and experiencing the self as a context Cognitive Diffusion Negative, anxious, etc. thoughts and ideas can be thought of or experienced as real life
Cognitive diffusion helps the patient recognize that those thoughts are separate from the events they refer to (break bad associations) Experiencing the Self as a Context This is the transcendent self that is always observing and experiencing, but distinct from one’s thoughts, feelings, sensations, and memories
The therapist helps the patient realize that he or she is not the content of his or her experience : we are not our thoughts, our feelings, our experienced sensations, the things we see, or the images that pass through our heads ...and listen to your thoughts and ask yourself these 2 questions:
Am I the thoughts that are going through my head?
Or, am I the one who is aware of these thoughts that are going through my head? Typical ACT Intervention includes:
Four sessions of educating the patients on problem and ACT
Two sessions focusing on helping the patients identify a control strategy (undermining control problems)
Two sessions focusing on mindfulness skills to help patients tolerate negative private events
Three sessions focusing on accepting unpleasantness and exposure too fearful situations
Four sessions focusing on patients’ values
One session focusing on therapy termination and how to apply ACT to life
Two optional sessions focusing on helping family members cope with situation
(Berman, Boutelle, & Crow, 2009, p. 429). Creating Your Own ACT Purse! Incorporation of a wide range of beliefs and therapies Philosophical Foundation Discussion What do you think the benefits or drawbacks of ACT are?
Do you think the acceptance of negative thought processes could be taken too far?
How do you think meaning making differs in ACT as opposed to traditional therapy? Discussion What are your impressions of
ACT as a theraputic technique?
Cognitive diffusion exercise
Eulogy exercise stop THe END Eastern Traditions
Humanistic Therapy
Behavioral Therapy Functional contextualism and Relational Frame Theory
Vase Example
Bigger or Smaller? Comprehensive Distancing: The Early Version of ACT Mental illness and boxing people into required criteria
But, what about comorbidity and unique cases? Second Difference:
Concerned with specific contexts
Diverse, broad and dynamic First Issue: Second Issue Berman, Boutelle, & Crow (2009) explore an ACT intervention with 3 patients with Anorexia Nervosa (AN) AN: a serious, complex disorder affects mostly girls and young women
no efficacious treatments known
may affect mental and physical condition to extent that hospitalization is inevitable
high mortality rates

multiple studies (Berman, Boutelle & Crow, 2009; Higbed & Fox, 2010) suggest psychotherapy for long-term success WHY? Meet: Samia, Kate, and Jessie 24 years old
Caucasian
female dance instructor
12 year history of AN,
hospitalized 4 times for low weight complications
also diagnosed/treated for PTSD from chronic childhood sexual abuse by non-familial perpetrator 56 years old
language education specialist
BMI= 18.6 at baseline, 14.6 at onset
experienced AN since onset during mid-30s following a divorce
also experienced sexual abuse during childhood
claims to have been succesfully treated for depression as well but AN symptoms don't go away 24 years old
Caucasian female dental hygienist
outpatient multidisciplinary treatment for 1 year prior to enrollment in study
history of physical abuse by father, no PTSD General methodology clinical interview
physical indices procedure 6 phases of treatment:
education about AN and ACT
identifying the role of dieting
mindfulness skills training
acceptance and exposure, including in-session exposure to feared foods and observing one's body in a mirror
identifying values and committing to pursuing valued life directions
therapy termination: how to take ACT with you
optional family sessions Value Identification Exercises Examples of Values:
leisure
citizenship
health
education
career
spirituality "Think of your own life" The Dead Man's Goal Funeral Meditation: using the inevitability of death to help identify values How do you want to be remembered? Were weight and looks important? "When you focus on your physical appearance, you are investing in a part of life that will not survive beyond your years on this planet" (Heffner & Eifert, 2004). Back to samia, kate, and jessie... Outcomes Samia showed improvement on most psychological measures
was in functional range of all scales and remained there at 1-year follow up
first time since the onset of her disorder that she maintained weight after treatment instead of losing weight
no additional hospitalizations, psychological, or psychiatrical treatments since
maintained a job and romantic relationship
accepted into MSW program at an Ivy League University
reported at the follow up interview that ACT therapy had "changed her life" (Berman, Boutelle & Crow, 2009). Jessie in functional range on all scores by 1-year follow up
total weight gain of almost 1 BMI point
no further treatment Kate more modest improvements on scales
actually deteriorated in hostility and body image scores between baseline and post-treatment
thought ACT treatment was 'making her worse' (Berman, Boutelle & Crow, 2009)
physical evidence did not agree: weight did not change (no loss), began writing a book with colleagues, all career issues improved "In ACT, weight gain is not the main focus of treatment. Eating is merely a means to a valued end. It is not THE end or goal" (Hefner & Eifert, 2004). Commitment to valued lifestyle
is the final step Example Eulogies:

"You were my only sister, and you were my best friend. I will always remember your bright smile. I feel that you are with me whenever I laugh because I have shared so much laughter with you. When I meet you in heaven, I want to give you a big hug, hear you laugh, and see your smile. That is how I will always remember you."

"Whenever I walk past your locker at school, I think of how much you meant to me. I think of you every day, and senior year is going to be difficult without you. I know you will be looking down from heaven to be with me and the rest of your class when we walk across the stage at graduation."

(Heffner & Eifert, 2004) References
Bach, P.A., & Moran, D.J. (2008). ACT in Practice: Case Conceptualization in Acceptance & Commitment Therapy. California: New Harbinger Publications, Inc.

Berman, M.I., Boutelle, K.N., & Crow. S.J. (2009). A case series investigating Acceptance and Commitment Therapy as a treatment for previously treated, unremitted patients with anorexia nervosa. European Eating Disorders Review, 17, p. 426-434. doi: 10.1002/erv.962.

Dalrymple, K. L., Fiorentino, L., Politi, M. C., & Posner, D. (2010). Incorporating principles from acceptance and commitment therapy into cognitive-behavioral therapy for insomnia: A case example. Journal of Contemporary
Psychotherapy, 40(4), 209-217.
doi:10.1007/s10879-010-9145-1

Franklin, M. E., Best, S. H., Wilson, M. A., Loew, B., & Compton, S. N. (2011). Habit reversal training and acceptance and commitment therapy for Tourette syndrome:A pilot project. Journal of Developmental and Physical Disabilities, 23(1), 49-60.
doi:10.1007/s10882-010-9221-1

Forman, E.M. & Herbert, J.D. (2009). New directions in cognitive behavior therapy: Acceptance-based therapies. In General Principles and Empirically Supported Techniques of Cognitive Behavior Therapy (77-101). New Jersey: John Wiley & Sons.

Hayes, S.C. (2008). Climbing our hills: A beginning Conversation on the comparison of acceptance and commitment therapy and traditional cognitive behavioral therapy. Clinical Psychology: Science & Practice, 15(4), 286-295.

Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (1999) Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: The Guilford Press.

Heffner, M. & Eifert, G. (2004). The Anorexia Workbook: How to Accept Yourself, Heal Your Suffering, and Reclaim Your Life (New Harbinger Self-Help Workbook). Oakland, CA: New Harbinger Publications, Inc.

Hernández-López, M., Luciano, M., Bricker, J. B., Roales-Nieto, J. G., & Montesinos, F. (2009). Acceptance and commitment therapy for smoking cessation: A
preliminary study of its effectiveness in comparison with cognitive behavioral therapy. Psychology of Addictive Behaviors, 23(4), 723-730. doi:10.1037/a0017632

Higbed, L. & Fox, J.R.E. (2010). Illness perceptions in anorexia nervosa: A qualitative investigation. British Journal of Clinical Psychology, 49, p. 307-325.
doi: 10.1348/014466509X454598.

Hofmann, S.G. (2008). Acceptance and commitment therapy: New wave or morita therapy. Clinical Psychology: Science and Practice, 15(4), 280-285.

Kazantzis, N., Reinecke, M.A., & Freeman, A. (2010). Acceptance and commitment therapy. In Cognitive and Behavioral Theories in Clinical Practice (148-192). New York: Guilford Press.

Lundgren, T., Dahl, J., Yardi, N., & Melin, L. (2008). Acceptance and commitment therapy and yoga for drug-refractory epilepsy: A randomized controlled trial.
Epilepsy & Behavior, 13(1), 102-108. doi:10.1016/j.yebeh.2008.02.009

Murrell, A. R., Rogers, L. J., & Johnson, L. (2009). From shy lamb to roaring lion: An Acceptance and Commitment Therapy (ACT) case study. Behavior and Social
Issues, 18(1), 1-18.

Peterson, B. D., Eifert, G. H., Feingold, T., & Davidson, S. (2009). Using acceptance and commitment therapy to treat distressed couples: A case study with two couples.
Cognitive and Behavioral Practice, 16(4), 430-442. doi:10.1016/j.cbpra.2008.12.009

Ruiz, F. J. (2010). A review of acceptance and commitment therapy (act) empirical evidence: correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10(1).

Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and
commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705-716.
doi:10.1037/a0020508

Ruiz, F. J. (2010). A review of acceptance and commitment therapy (act) empirical evidence: correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10(1), Retrieved from http://xa.yimg.com/kq/groups/8446968/1695767363/name/A+reveiw+of+ACT+evidence+2010.pdfan Ommen, J., Meerwick, E.L., Kars, M., van Elburg, A., & van Meijel, B. (2009). Effective nursing care of adolescents diagnosed with Anorexia Nervosa: The Patients' Perspective. Journal of Clinical Nursing, 18, p. 2801-2808. doi: 10.1111/j.1365-2702.2009.02821.x.

Wetherell, J., Afari, N., Ayers, C. R., Stoddard, J. A., Ruberg, J., Sorrell, J. T., & ...Patterson, T. L. (2011). Acceptance and Commitment Therapy for generalized
anxiety disorder in older adults: A preliminary report. Behavior Therapy, 42(1),
127-134. doi:10.1016/j.beth.2010.07.002

Wicksell, R. K., Olsson, G. L., & Hayes, S. C. (2010). Psychological flexibility as a mediator of improvement in Acceptance and Commitment Therapy for patients
with chronic pain following whiplash. European Journal of Pain, 14(10), e1-e11. doi:10.1016/j.ejpain.2010.05.001
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