Monthly Archives: August 2008

Mindfulness and psychosis

At the 2008 BABCP National Conference held in Edinburgh, Amy McArthur, Gordon Mitchell and I led a half-way workshop on “Acceptance and Commitment Therapy for Psychosis”.

The workshop represented a distillation of our understanding of the field currently, and some of the clinical methods that we use for running groups and doing individual therapy in our services.

A description of the workshop is below:

Acceptance and Commitment Therapy (ACT) is a contextual CBT that uses mindfulness and values-based behavioural activation strategies to help people develop a workable relationship with internal experiences as part of a direction of increasing life meaning and vitality. ACT involves an experiential approach to therapy, based upon empirical principles of behaviour change. Clients are guided through exercises and metaphors to develop a present moment focus, clarify personal values and explore the functional utility of coping strategies. There has been promising evidence to suggest ACT can help people who are distressed and/or disabled by psychosis to learn a mindful and accepting stance toward unusual experiences, reducing the impact of symptoms, and improving social functioning (Bach & Hayes 2002; Gaudiano & Herbert, 2006). This workshop will present an ACT approach to psychosis, including how the problems of psychosis are conceptualised in this model and modifications to mindfulness and acceptance techniques for this population.

We had excellent attendance for the workshop and it was obvious that a fair number of CBT therapists have an interest in mindfulness and ACT approaches for helping people distressed and disabled by psychosis.

There is a description of the workshop available here (on the contextualpsychology.org website). On the same page is the workshop handout, as well as the audiorecordings of the presentations.

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The great divisions in modern Britain

This week I have been reading the extracts (published in the Guardian) from Polly Toynbee & David Walker’s new book, Unjust Rewards. The book is a contemporary look at class divisions in British society.

The first extract “Meet the Rich” is based upon group interviews with City workers, and their views on disparities in wealth and opportunity in the UK. Predictably, the attitudes reported from these City workers were ill-informed, intolerant or full of self-serving justifications for their position and wealth:

One woman banker described escaping from a provincial town where the main employer was the public sector: “If you aspire to anything beyond that you’re not going to live [there] any more, and that’s the choice you make.”

They had chosen a life that would make them rich while others, making different and morally equivalent choices, had abdicated their right to complain. “Some of these are vocational, things like nurses . . . It’s accepted – they go into it knowing that that’s part of the deal.” Another said: “Many people, like teachers, don’t do things for the pay. But you won’t find a teacher that works as hard as we do.” This was categorical, evidence unnecessary. They spoke of heroic all-nighters drawing up contracts for clients in time zones on the other side of the globe, a Herculean effort that justified fat pay. But did they work 10 times as hard as a teacher on £30,000 a year or, in the case of some lawyers and bankers, 100 times as hard? Such disproportionality did not enter their scheme of things.

What is reported is almost a parody of itself, “Guardian journalist finds out that rich people think that money spent on poor people is wasted”, were there going to be any surprises?

The second extract “Breathless with Amazement” is more touching and in its way heartbreaking. It recounts a visit to Oxford University by a group of high-achieving high school students from a poor London borough, a number of the students from minority backgrounds and none of whom have had family members experience further education. For these kids the trip opens their eyes to the possibilities of what can happen with academic success, but as the article contends, without a change in the disparities of opportunity, the chances are slim that any of them will make it to Oxbridge.

They left the gleaming spires with a vision of university as a place of pleasure – a new thought and perhaps the most important one at this stage in their lives. Would any of them make it back to Oxford after their A-levels? Their teacher thought two of them were in with a chance as they were exceptionally clever. But it would depend on admissions tutors appreciating how much they had overcome in how short a time. Several were Afghan refugees, who in the course of the two days, had talked movingly of American gunships firing on their towns and villages. One boy was African-Caribbean, UK-born and in care for years. In year 9 he barely attended school and was shunted from pillar to post, but once settled in year 10 he had become pupil of the year and was now destined to do well, despite everything. Would an Oxbridge tutor ever hear these stories – and get to assess how their potential stacked up against the attainment of a young person who had no obstacles to overcome?

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ACT in the UK symposium, BABCP National Conference Edinburgh 2008

Acceptance and Commitment Therapy had more of a presence at the British Association for Behavioural and Cognitive Psychotherapies National Conference this year, with pre-conference and half-day workshops, and several symposia on ACT and ACT-related research. Also, for those interested in the broader contextual approach to CBT there were workshops and symposia on Behavioural Activation, as well as a keynote speech by Christopher Martell on “Twenty Years of Behavior Therapy: Trends and Counter Trends”. It seemed that, compared to recent BABCP conferences, there was much more on offer for the behaviour analytically inclined clinician.

I participated in the ACT in the UK symposium, which was held on Saturday morning. The details of the presenters are below. Unfortunately Frank Bond was unable to present at the symposium as scheduled; similarly so for Tom Ricketts, although Giselle Brook presented in his place. The powerpoint presentations as well as audio are available for each presenter.

Saturday 19th July 2008, BABCP National Conference Edinburgh

Acceptance & Commitment Therapy: ACT in the UK
Convenor: Simon Houghton, Sheffield Care Trust, UK

Chair: Joe Curran, Sheffield Care Trust, UK

Group ACT for OCD: Development of the approach and initial findings

Tom Ricketts, Sheffield Care Trust, UK. Presenter: Giselle Brook  [Presentation (.ppt)  Audio (.mp3) ]

Abstract:

A significant proportion of clients with OCD are known not to respond to traditional exposure and response prevention (ERP) with alternative treatments such as cognitive therapy pr medication seeming to offer little additional benefit. A group treatment based on ACT was developed and delivered to a number of clients that had failed to respond to ERP. This presentation will describe the group process and report the initial clinical outcomes of this approach.

Measuring psychological flexibility and mindfulness skills with people who hear distressing voices

Eric Morris, Institute of Psychiatry, King’s College London & South London & Maudsley NHS Foundation Trust, UK  [Presentation (.ppt)  Audio (.mp3) ]

Abstract:

This study involved validating the Acceptance and Action Questionnaire-II (AAQ-II) with a sample of people who hear distressing and disabling voices. The relationships of psychological flexibility and mindfulness skills with general distress, social functioning, topography of voices, symptom distress, beliefs about voices, and thought control strategies are explored.

Living successfully with pain: The role of illness representations, catastrophising and acceptance in chronic pain functioning

Sujata Bose & Tammy Spencer, NHS Tayside, UK; David Gillanders, University of Edinburgh, UK (presenter)    [Presentation (.ppt)  Audio (.mp3) ]

Abstract:

Background: Psychological factors are known to influence adjustment to chronic pain. Beliefs or appraisals relating to pain, as well as catastrophising responses to pain have both been found to influence adjustment. Recent research has shown the importance of acceptance in living successfully with pain. Acceptance is a behavioural construct defined as willingness to experience pain whilst continuing to engage in important activities. The present study examined how appraisals relating to chronic pain interact with the processes of catastrophising and acceptance to influence physical and emotional functioning.

Method: 153 individuals attending NHS pain clinics and pain support groups completed validated questionnaires measuring appraisals of chronic pain, catastrophising, acceptance and emotional and physical function. Path analyses were conducted to investigate direct and moderated relationships between pain related appraisals, catastrophising, acceptance and emotional and physical functioning.

Results: A range of direct and moderated relationships are described, with important differences between the psychological variables associated with emotional dysfunction and physical dysfunction. Whist some direct relationships between appraisals and both emotional and physical functioning were observed, catastrophising moderated the relationship between appraisals, acceptance and emotional functioning. By contrast, acceptance moderated the relationship between appraisals, catastrophising, and physical functioning.

Discussion: The findings suggest that different psychological processes many underlie successful emotional and physical functioning in chronic pain. Interestingly, appraisals relating to the controllability of pain do not show significant relationships with either emotional or physical functioning. The clinical and theoretical implications of the results are discussed, as are directions for further research.

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