Category Archives: Acceptance and Commitment Therapy

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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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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Acceptance…. like learning to ride a bike

I found a nice little video on youtube recently of Kevin Polk describing the contingency-shaped nature of Acceptance and Commitment Therapy (or Acceptance & Commitment Training, as they call it in the program at the regional centre of the Veteran Affairs in Togus, Maine USA). A nice metaphor that ACT is like learning to ride a bike, no amount of instruction can replace actually being shaped by doing it. This rule-governed vs contigency-shaped distinction gets to the heart of what ACT is about (I have previously discussed this here, in relation to therapy supervision).

Dr Polk and his colleagues treat veterans for PTSD using ACT and have a program that makes the approach more accessible by describing the skills as “Let Go, Show Up and Get Moving” in valued directions. They presented their work at the recent ACT Summer Institute IV in Chicago, and I was impressed by how simple and elegant the approach was, while still being consistent to the model. It was also impressive how many groups they had run in just a couple of years. Here is a potted description of their program:

The Intensive Outpatient PTSD Program (IOP) – ACT is presented to a cohort of veterans in a “workshop” format across 14 classes (groups) in five days. All aspects of ACT (Let Go, Show Up, and Get Moving) are experienced in the 14 sessions. Veterans who have graduated from a week-long cohort are offered unlimited follow-ups in the form of additional groups or individual “coaching” via the phone or in person. The program conducts 26 cohorts per year.

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Acceptance and Commitment Therapy in Early Psychosis

Recently, with my colleague Joe Oliver, we presented our work (at the ACT Summer Institute IV) on developing acceptance and commitment therapy to help young people recovering from a first episode of psychosis. We titled our presentation “ACT Early”, and described the work we have been doing in developing groups and individual therapy for this population.

Conference Abstract:

The stance of acceptance and committed action may allow for flexibility in response to persisting psychotic experiences, as has been suggested in ACT studies with the seriously mentally ill (Bach & Hayes, 2002; Gaudiano & Herbert, 2006). There is also the exciting potential for researching the impact of ACT in the early phase of psychosis – helping first episode clients to recover from psychosis through the development of a more mindful approach toward unusual experiences and critical appraisals, and committing to values-based actions.

More specifically, the use of ACT may:

[1] foster the development of a psychologically flexible stance toward anomalous experiences,

[2] enable a “values-based” recovery,

[3] reduce the impact of “fear of recurrence” of psychosis through development of mindfulness and self as context,

[4] enable individuals to notice the process of self-stigmatisation, contexts where this operates as a barrier, and commit to valued directions in the face of these appraisals, and

[5] improve relapse prevention plans through the use of mindfulness and committed action.

We describe a group program we have developed, as well as individual work with young people who have experienced a first episode of psychosis. In addition there is discussion about a pilot ACT/mindfulness group for people experiencing at risk mental states, who may be in a prodromal phase of psychosis.

The .pdf of this workshop is here: act-early-morris-oliver-2008 and the audio recording of our presentation is here (.mp3 format, 30MB download)

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Acceptance and Commitment Therapy in the United Kingdom

For the past 6 months or so I have been working on a committee to set up a Special Interest Branch of the BABCP that focuses on Acceptance and Commitment Therapy (ACT). It has been good to get involved again in organising training and the promotion of evidence-based psychological therapy, something that I used to do when I lived in Perth (when I was in the West Australian branch of the AACBT). Aside from the appeal of letting others know about ACT, I’ve enjoyed having contact with other therapists and researchers who are keen about the science and therapeutic stance that ACT takes.

In my experience, the ACT community has been welcoming and inspiring, living the values of the approach, which includes emphasising the key role of science in developing methods to help people: the hard graft of research, open to skepticism and debate, and remaining linked to basic research and philosophical assumptions. It has seemed a good fit for me with my background training as a scientist-practitioner in clinical psychology.

I hope that the work of the ACT Special Interest Branch in the UK will continue this trend. For those who are curious, the link to the homepage of the ACTSIB is here.

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