WARNING: There's some graphic violence, so it's not for the faint-hearted!
Watch the wide-screen version on YouTube.
Showing posts with label acceptance and commitment therapy. Show all posts
Showing posts with label acceptance and commitment therapy. Show all posts
Wednesday, August 10, 2011
ACT for Zombies
The Acceptance and Commitment Therapy people try not to take each other too seriously. Each year at the main ACT conference--the Association for Behavioral Contextual Science--they hold a "Follies night" where people poke fun aat ACT and some of the key ACT people. Created by Joe Oliver and Eric Morris, this video was unveiled at the most recent conference.
WARNING: There's some graphic violence, so it's not for the faint-hearted!
Watch the wide-screen version on YouTube.
WARNING: There's some graphic violence, so it's not for the faint-hearted!
Watch the wide-screen version on YouTube.
Thursday, April 21, 2011
Comparison of Motivational Interviewing with Acceptance and Commitment Therapy: A Conceptual and Clinical Review
Motivation Interviewing (MI) is not an a mindfulness and acceptance-based treatment; however, it is consistent with many of same principles and can be used in conjunction with a number of treatments. MI is a type therapy in which the primary aim is increasing motivation for change. It was originally developed for addiction but has since been adapted for all sorts of things, including health-related behaviors. Rooted in Carl Roger's person-centered approach, MI is not a stand alone therapy in itself, but a way to prepare someone for change. The therapist accepts the client where she is while helping to guide the individual towards talking about change.
Dr. Jonathan Bricker--who also piloted the telephone smoking cessation study I posted about last year--co-authored a recent article exploring the conceptual similarities and differences between MI and Acceptance and Commitment Therapy (ACT). The article highlights three ways in which both approaches overlap:
1. Both seek to increase commitment to changing behavior.
2. Both draw upon values to enhance commitment. In particular, MI and ACT therapists strive to help people contact long-term goals and life directions to increase the motivation for behavior change.
3. Both look at processes of language to help facilitate change. In MI, there's an emphasis on helping people engage in "change talk" (e.g., openly verbalizing what they want to do). By contrast, ACT seeks to undermine verbal self-rules (e.g., unhelpful ideas that keep people stuck) and help people make commitments towards valued goals and directions.
The article does a nice job summarizing both treatments. According to the Acknowledgments section, the authors received feedback on the manuscript from Drs. Bill Miller and Steve Hayes, core originators of MI and ACT, respectively. There's no new data, but the article provides a balanced view of MI and ACT and offers suggestions for how they may complement one another. Even if you've never heard of MI, the article provides a concise introduction.
The article hasn't been officially published yet but is available online. To download a copy click on the full citation below:
Bricker, J., & Tollison, S. (in press). Comparison of Motivational Interviewing with Acceptance and Commitment Therapy: A Conceptual and Clinical Review. Behavioural and Cognitive Psychotherapy.
If you'd like to read further about MI, I encourage you to check out the core MI book:
Miller, W.R., & Rollnick, S. (2002). Motivational Interview, Second Edition: Preparing People for Change. New York: Guilford Press.
For a book with chapters on an ACT approach to substance use, check out:
Hayes, S.C., & Strosahl, K. (Eds.) (2004). A Practical Guide to Acceptance and Commitment Therapy. New York: Springer.
Dr. Jonathan Bricker--who also piloted the telephone smoking cessation study I posted about last year--co-authored a recent article exploring the conceptual similarities and differences between MI and Acceptance and Commitment Therapy (ACT). The article highlights three ways in which both approaches overlap:
1. Both seek to increase commitment to changing behavior.
2. Both draw upon values to enhance commitment. In particular, MI and ACT therapists strive to help people contact long-term goals and life directions to increase the motivation for behavior change.
3. Both look at processes of language to help facilitate change. In MI, there's an emphasis on helping people engage in "change talk" (e.g., openly verbalizing what they want to do). By contrast, ACT seeks to undermine verbal self-rules (e.g., unhelpful ideas that keep people stuck) and help people make commitments towards valued goals and directions.
The article does a nice job summarizing both treatments. According to the Acknowledgments section, the authors received feedback on the manuscript from Drs. Bill Miller and Steve Hayes, core originators of MI and ACT, respectively. There's no new data, but the article provides a balanced view of MI and ACT and offers suggestions for how they may complement one another. Even if you've never heard of MI, the article provides a concise introduction.
The article hasn't been officially published yet but is available online. To download a copy click on the full citation below:
Bricker, J., & Tollison, S. (in press). Comparison of Motivational Interviewing with Acceptance and Commitment Therapy: A Conceptual and Clinical Review. Behavioural and Cognitive Psychotherapy.
If you'd like to read further about MI, I encourage you to check out the core MI book:
Miller, W.R., & Rollnick, S. (2002). Motivational Interview, Second Edition: Preparing People for Change. New York: Guilford Press.
For a book with chapters on an ACT approach to substance use, check out:
Hayes, S.C., & Strosahl, K. (Eds.) (2004). A Practical Guide to Acceptance and Commitment Therapy. New York: Springer.
Thursday, March 31, 2011
Open, Aware, and Active: Contextual Approaches as an Emerging Trend in the Behavioral and Cognitive Therapies
In recent post, I wrote about how Dr. Steven Hayes coined the term "third wave" to describe the recent crop of mindfulness and acceptance-based treatments. In a new paper, Dr. Hayes and his colleagues at the University of Nevada-Reno explore this notion further.
The article examines the theoretical underpinnings of the current generation of mindfulness and acceptance-based psychotherapies, and at the published empirical data supporting the theory. This article provides a fantastic overview of the current state and development of many of these treatments.
Towards the end of article, Hayes and colleagues suggest abandoning the term "third wave" in favor of what they call "contextual cognitive behavioral therapy" or contextual CBT. According to the authors, contextual CBT differs from traditional CBT in several important ways:
1. Contextual CBT emphasizes changing the context and function of psychological events (e.g., thoughts, emotions, physical sensation) rather than the content, accuracy, and frequency. For example, a contextual CBT therapist is more interest in changing how someone relates to self-critical thinking than in changing the thoughts themselves.
2. Contextual CBT focuses more on what the authors call a "transdiagnostic approach to mental health." What this means is that, rather than treat specific diagnoses (e.g., generalized anxiety disorder), contextual CBT therapists focus more on processes (e.g., emotion regulation).
3. Contexutal CBT therapists are encouraged to apply these methods to themselves. For example, leaders of Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy groups are encouraged--even required--to maintain their own mindfulness practices.
4. Contextual CBT is less about throwing away techinques and interventions from other treatments than in taking what is useful and applying it in ways that are consistent with the theories underlying contextual CBT.
5. In their final distinction, the authors suggest contextual CBT is being applied to a much broader and deeper range of problems within the human conditions, such as spirituality and values. (The authors admit that this point is more of a "judgment call" than an accepted fact.)
I highly recommend this article for readers of Scientific Mindfulness. It's a great review article for much of what we write about in this blog.
To download a copy of the article, click on the full citation below:
Hayes, S.C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, Aware, and Active: Contextual Approaches as an Emerging Trend in the Behavioral and Cognitive Therapies. Annual Review of Clinical Psychology, 7, 141-168.
The article examines the theoretical underpinnings of the current generation of mindfulness and acceptance-based psychotherapies, and at the published empirical data supporting the theory. This article provides a fantastic overview of the current state and development of many of these treatments.
Towards the end of article, Hayes and colleagues suggest abandoning the term "third wave" in favor of what they call "contextual cognitive behavioral therapy" or contextual CBT. According to the authors, contextual CBT differs from traditional CBT in several important ways:
1. Contextual CBT emphasizes changing the context and function of psychological events (e.g., thoughts, emotions, physical sensation) rather than the content, accuracy, and frequency. For example, a contextual CBT therapist is more interest in changing how someone relates to self-critical thinking than in changing the thoughts themselves.
2. Contextual CBT focuses more on what the authors call a "transdiagnostic approach to mental health." What this means is that, rather than treat specific diagnoses (e.g., generalized anxiety disorder), contextual CBT therapists focus more on processes (e.g., emotion regulation).
3. Contexutal CBT therapists are encouraged to apply these methods to themselves. For example, leaders of Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy groups are encouraged--even required--to maintain their own mindfulness practices.
4. Contextual CBT is less about throwing away techinques and interventions from other treatments than in taking what is useful and applying it in ways that are consistent with the theories underlying contextual CBT.
5. In their final distinction, the authors suggest contextual CBT is being applied to a much broader and deeper range of problems within the human conditions, such as spirituality and values. (The authors admit that this point is more of a "judgment call" than an accepted fact.)
I highly recommend this article for readers of Scientific Mindfulness. It's a great review article for much of what we write about in this blog.
To download a copy of the article, click on the full citation below:
Hayes, S.C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, Aware, and Active: Contextual Approaches as an Emerging Trend in the Behavioral and Cognitive Therapies. Annual Review of Clinical Psychology, 7, 141-168.
Friday, March 11, 2011
Psychology Today: Bringing ACT to Sierra Leone
In a blog post today on the Psychology Today website, Dr. D.J. Moran, author of ACT in Practice, writes of a recent trip to war-torn Sierra Leone with two other psychologists. Together, they taught two workshops on Acceptance and Commitment Therapy (ACT) to local mental health practitioners. Dr. Moran writes:
In January 2011, my colleagues Beate Ebert and JoAnne Dahl and I set out to present two workshops in evidence-based behavior therapy and Acceptance and Commitment Therapy (ACT). Beate is a dedicated psychologist and the founder of Commit + Act, the non-governmental agency that planned this trip. JoAnne has extensive understanding of using ACT with the chronic pain population, but also has experience with bringing ACT to populations that have limited access to mental health care. Our first five (5) day workshop was in Freetown, S.L. and the second three (3) day workshop was in Serabu, S.L.. Each workshop had over 30 mental health practitioners in attendance. They were very eager to hear how they could address Post-Traumatic Stress Disorder with behavior therapy and ACT.
Dr. Moran offers a touching sketch of their efforts to bring an evidence-based mindfulness and acceptance-based treatment to therapists in a country that has witnessed unimaginable horror. I can't do it justice to through summary; to read the full post, click here.
In January 2011, my colleagues Beate Ebert and JoAnne Dahl and I set out to present two workshops in evidence-based behavior therapy and Acceptance and Commitment Therapy (ACT). Beate is a dedicated psychologist and the founder of Commit + Act, the non-governmental agency that planned this trip. JoAnne has extensive understanding of using ACT with the chronic pain population, but also has experience with bringing ACT to populations that have limited access to mental health care. Our first five (5) day workshop was in Freetown, S.L. and the second three (3) day workshop was in Serabu, S.L.. Each workshop had over 30 mental health practitioners in attendance. They were very eager to hear how they could address Post-Traumatic Stress Disorder with behavior therapy and ACT.
Dr. Moran offers a touching sketch of their efforts to bring an evidence-based mindfulness and acceptance-based treatment to therapists in a country that has witnessed unimaginable horror. I can't do it justice to through summary; to read the full post, click here.
Friday, March 4, 2011
The U.S. Government Lists Acceptance and Commitment Therapy as an Evidence-Based Treatment
This is exciting news within the Acceptance and Commitment Therapy (ACT) community! The Substance Abuse and Mental Health Services Administration (SAMHSA), a major department within the U.S. government, now lists ACT as an empirically supported treatment. This is part of its National Registry of Evidence-based Programs and Practices (NREPP).
ACT received high scores across a number of different dimensions, including quality of research and efforts at dissemination (e.g., getting ACT out there to professional and the public). This is a great victory for mindfulness and acceptance-based treatments, and for ACT in particular!
Read about it yourself here.
ACT received high scores across a number of different dimensions, including quality of research and efforts at dissemination (e.g., getting ACT out there to professional and the public). This is a great victory for mindfulness and acceptance-based treatments, and for ACT in particular!
Read about it yourself here.
Thursday, March 3, 2011
Investigating the Similarities and Differences Between Practitioners of Second- and Third-Wave Cognitive Behavioral Therapies
In 2004, Dr. Steven Hayes published an influential paper in which he coined the term "third wave." Third wave refers to the mindfulness and acceptance-based cognitive behavioral therapies we focus on in Scientific Mindfulness: Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Cognitive Therapy (MBCT), among others.
In calling these third wave treatments, Dr. Hayes distinguished them from the first wave of treatments that came out of behaviorism, and from the second wave of therapies that came out of cognitive therapy. Traditional cognitive behavioral therapy (CBT), which focuses on changing maladaptive thoughts, is a second wave treatment. The mindfulness and acceptance-based treatments of the third wave differ from the second wave, according to Dr. Hayes, in their focus on changing how people relate to thinking, not the thoughts themselves. (You can download a copy of this seminal article at the bottom of this post.)
A group of researchers affiliated with Brown University took some data from a larger study to examine similarities and differences between second and third wave therapists. Out of a sample of 176 clinicians who completed an Internet survey, 55 identified as second wave and 33 identified as third wave. The terms second and third wave weren't actually used in the Internet survey: rather, therapists who identified as "cognitive or cognitive behavioral" (i.e., second wave) or "acceptance-based behavioral/cognitive" (i.e., third wave) were included in the two categories.
In general, the researchers found that second and third wavers are more similar than different. For example, both were equally likely to endorse using social skills training and homework. The main differences the authors found were related to techniques and treatment strategies. Second wavers were more likely to use traditional cognitive techniques such as cognitive restructuring and relaxation training; by contrast, third wavers were--as you might imagine--more likely to use mindfulness and acceptance techniques.
Curiously, third wavers were also more likely to report using existential/humanistic and family systems techniques. The authors offers explanations for these findings. For one, they suggest the emphasis in values clarification in ACT may explain the endorsement of existential/humanistic techniques. This is a reasonable assumption but, by no means, an clear-cut interpretation. What seems a little more far afield is the authors' suggestion that the endorsement of family systems techniques reflects a greater inclusiveness in the use of techniques by third wavers. Again, this assumption is not unreasonable, but it seems like a stretch in the absence of any additional data. That said, I don't know how to explain these findings either!
What I found most interesting is that third wavers reported greater use of exposure. Exposure is a decades old behavioral intervention that has been widely successful in treating anxiety disorders (e.g., anxiety, phobias, obsessive-compulsive disorder, and posttraumatic stress disorder). In my view, exposure is an extremely useful intervention when appropriate applied. As it's also been incorporated into traditional CBT and interpreted according to cognitive models, I find it really interesting that second wavers are significant less likely to use exposure than third wavers because it is frequently a component of empirically-supported CBT treatments for anxiety disorders.
The authors conclude both second and third wavers emphasize evidence-based practice. Where they differ is that, although third wavers use both first and second wave interventions, they are less likely to use traditional cognitive techniques (e.g., cognitive restructuring). One important potential bias the authors note is that, as they recruited from an ACT listserv, among other listservs, ACT therapists may be over-represented in their sample compared to other third wave therapies such as DBT and MBCT. Consequently, the results may be more reflective of ACT therapists than to the broader community of third wave therapists.
The full citations are below. Only members of ACBS can download the main article I covered. However, everyone can click on the second citation to download a copy of Dr. Hayes seminal 2004 article:
Brown, L.A., Gaudiano, B.A., & Miller, I.W., (2011). Investigating the Similarities and Differences Between Practitioners of Second- and Third-Wave Cognitive Behavioral Therapies. Behavior Modification, 35(2), 187-200.
Hayes, S.C. (2004). Acceptance and Commitment Therapy, Relational Frame Theory, and the Third Wave of Behavior Therapy. Behavior Therapy, 35, 639-665.
In calling these third wave treatments, Dr. Hayes distinguished them from the first wave of treatments that came out of behaviorism, and from the second wave of therapies that came out of cognitive therapy. Traditional cognitive behavioral therapy (CBT), which focuses on changing maladaptive thoughts, is a second wave treatment. The mindfulness and acceptance-based treatments of the third wave differ from the second wave, according to Dr. Hayes, in their focus on changing how people relate to thinking, not the thoughts themselves. (You can download a copy of this seminal article at the bottom of this post.)
A group of researchers affiliated with Brown University took some data from a larger study to examine similarities and differences between second and third wave therapists. Out of a sample of 176 clinicians who completed an Internet survey, 55 identified as second wave and 33 identified as third wave. The terms second and third wave weren't actually used in the Internet survey: rather, therapists who identified as "cognitive or cognitive behavioral" (i.e., second wave) or "acceptance-based behavioral/cognitive" (i.e., third wave) were included in the two categories.
In general, the researchers found that second and third wavers are more similar than different. For example, both were equally likely to endorse using social skills training and homework. The main differences the authors found were related to techniques and treatment strategies. Second wavers were more likely to use traditional cognitive techniques such as cognitive restructuring and relaxation training; by contrast, third wavers were--as you might imagine--more likely to use mindfulness and acceptance techniques.
Curiously, third wavers were also more likely to report using existential/humanistic and family systems techniques. The authors offers explanations for these findings. For one, they suggest the emphasis in values clarification in ACT may explain the endorsement of existential/humanistic techniques. This is a reasonable assumption but, by no means, an clear-cut interpretation. What seems a little more far afield is the authors' suggestion that the endorsement of family systems techniques reflects a greater inclusiveness in the use of techniques by third wavers. Again, this assumption is not unreasonable, but it seems like a stretch in the absence of any additional data. That said, I don't know how to explain these findings either!
What I found most interesting is that third wavers reported greater use of exposure. Exposure is a decades old behavioral intervention that has been widely successful in treating anxiety disorders (e.g., anxiety, phobias, obsessive-compulsive disorder, and posttraumatic stress disorder). In my view, exposure is an extremely useful intervention when appropriate applied. As it's also been incorporated into traditional CBT and interpreted according to cognitive models, I find it really interesting that second wavers are significant less likely to use exposure than third wavers because it is frequently a component of empirically-supported CBT treatments for anxiety disorders.
The authors conclude both second and third wavers emphasize evidence-based practice. Where they differ is that, although third wavers use both first and second wave interventions, they are less likely to use traditional cognitive techniques (e.g., cognitive restructuring). One important potential bias the authors note is that, as they recruited from an ACT listserv, among other listservs, ACT therapists may be over-represented in their sample compared to other third wave therapies such as DBT and MBCT. Consequently, the results may be more reflective of ACT therapists than to the broader community of third wave therapists.
The full citations are below. Only members of ACBS can download the main article I covered. However, everyone can click on the second citation to download a copy of Dr. Hayes seminal 2004 article:
Brown, L.A., Gaudiano, B.A., & Miller, I.W., (2011). Investigating the Similarities and Differences Between Practitioners of Second- and Third-Wave Cognitive Behavioral Therapies. Behavior Modification, 35(2), 187-200.
Hayes, S.C. (2004). Acceptance and Commitment Therapy, Relational Frame Theory, and the Third Wave of Behavior Therapy. Behavior Therapy, 35, 639-665.
Wednesday, February 16, 2011
The Unwelcome Party Guest
This animated short by Joe Oliver illustrates a popular metaphor from the Acceptance and Commitment Therapy literature. I've heard the metaphor called "Joe the Bum" and "Aunt Edna"--here the uninvited guest is "Brian." (Also, my name!--there are any number of self-deprecatory comments I can insert here.)
The metaphor is used to illustrate the practice of acceptance or (in ACT terms) willingness.
The metaphor is used to illustrate the practice of acceptance or (in ACT terms) willingness.
Monday, January 31, 2011
In Opening Monologue, Jay Leno Refers to Dr. Twohig's Study of Acceptance and Commitment Therapy for OCD
Back in October, I posted about a study by Dr. Michael Twohig of Utah State. The study focused on the use of Acceptance and Commitment Therapy (ACT) in the treatment of obsessive-compulsive disorder.
I haven't seen it myself, but apparently Jay Leno made a joke about the study in a recent Tonight Show monologue. According to The Utah Statesman:
A few weeks ago, Jay Leno's opening monologue mentioned a study that recently began here at USU focusing on scrupulosity. He joked that researchers are looking into people obsessed with morals and religion and the punch line was, "Yeah, we call those people parents."
While this is probably a footnote in Dr. Twohig's career, I still think it's really neat that the study is well-known enough to catch the attention of Leno or his cadre of joke writers.
The title of the article is "Leno-Featured Prof Sudies [SIC] Moral Obsessions." (That's a pretty glaring typo in the title!--I presume the writer meant "studies," not "sudies." College newspapers...)
To read the Utah Statesman article, click here.
To read my post of the actual study, click here.
I haven't seen it myself, but apparently Jay Leno made a joke about the study in a recent Tonight Show monologue. According to The Utah Statesman:
A few weeks ago, Jay Leno's opening monologue mentioned a study that recently began here at USU focusing on scrupulosity. He joked that researchers are looking into people obsessed with morals and religion and the punch line was, "Yeah, we call those people parents."
While this is probably a footnote in Dr. Twohig's career, I still think it's really neat that the study is well-known enough to catch the attention of Leno or his cadre of joke writers.
The title of the article is "Leno-Featured Prof Sudies [SIC] Moral Obsessions." (That's a pretty glaring typo in the title!--I presume the writer meant "studies," not "sudies." College newspapers...)
To read the Utah Statesman article, click here.
To read my post of the actual study, click here.
Friday, January 28, 2011
A Novel Application of Acceptance and Commitment Therapy for Psychosocial Problems Associated with Multiple Sclerosis
In a previous post, I wrote about an 8-week mindfulness-based intervention for multiple sclerosis. Here's one that's even shorter: it's a one-shot 5-hour workshop.
This study is from Dr. John Forsyth's lab at the University of Albany - SUNY. His lab is also currently investigating the effectiveness of Dr. Forsyth's self-help book, from which some preliminary data looking at mindfulness and self-compassion was recently published.
Dr. Forsyth and another psychologist led a 5-hour Acceptance and Commitment Therapy (ACT) workshop for people with multiple sclerosis (MS). At the end of the workshop, participants were given a CD of various mindfulness exercises and a bunch of worksheets and exercises from the workshop. They also received daily practice logs to track what they did following the workshop. Fifteen people with MS completed a battery as part of the workshop, and 11 completed the battery again 12 weeks later.
According to the authors, MS is the most common cause of neurologic disability in the US. MS is incurable and associated with pain, fatigue, depression, and anxiety.
For a one-short 5-hour workshop, the results are very promising. Depression decreased over time, showing a large effect. (Depression went from the moderate-severe range down to the mild-moderate range.) Although the effect of pain itself did not change, the impact of pain on behavior and mood decreased at follow-up. Mindfulness did not improve, but people reported a reduced tendency to suppress thoughts, which suggests increased mindful acceptance. Lastly, overall quality of life improved at the follow-up. Participants reported practicing exercises from the workshop or listening to the mindfulness CD nearly 3 hours per week, which is pretty good.
Because of the design of the study, the findings are preliminary. With only 15 people, 4 of whom dropped out, it's difficult to know how representative the sample is; however, with such a small sample size, it's impressive the researchers found significant results at all, as the results had to be very strong to be detected. Also, without a comparison group, it's impossible to know if ACT was the active ingredient. The authors acknowledged these weaknesses and others in the paper.
Limitations aside, the results are extremely promising. If a 5-hour group could lead to some pretty strong improvements for people with a painful, incurable disease, this is well worth exploring further. According to the authors, traditional cognitive behavioral treatments have shown mixed results for people with MS, and even the positive results weren't all that impressive. By contrast, this is a short, inexpensive group intervention that may have made a real different in the lives of people with MS.
To download a pdf of the article, click on the citation below:
Sheppard, S.C., Forsyth, J.P., Hickling, E.J., & Bianchi, J.M. (2010). A Novel Application of Acceptance and Commitment Therapy for Psychosocial Problems Associated with Multiple Sclerosis: Results from a Half-Day Workshop Intervention. International Journal of MS Care, 12, 200-206.
This study is from Dr. John Forsyth's lab at the University of Albany - SUNY. His lab is also currently investigating the effectiveness of Dr. Forsyth's self-help book, from which some preliminary data looking at mindfulness and self-compassion was recently published.
Dr. Forsyth and another psychologist led a 5-hour Acceptance and Commitment Therapy (ACT) workshop for people with multiple sclerosis (MS). At the end of the workshop, participants were given a CD of various mindfulness exercises and a bunch of worksheets and exercises from the workshop. They also received daily practice logs to track what they did following the workshop. Fifteen people with MS completed a battery as part of the workshop, and 11 completed the battery again 12 weeks later.
According to the authors, MS is the most common cause of neurologic disability in the US. MS is incurable and associated with pain, fatigue, depression, and anxiety.
For a one-short 5-hour workshop, the results are very promising. Depression decreased over time, showing a large effect. (Depression went from the moderate-severe range down to the mild-moderate range.) Although the effect of pain itself did not change, the impact of pain on behavior and mood decreased at follow-up. Mindfulness did not improve, but people reported a reduced tendency to suppress thoughts, which suggests increased mindful acceptance. Lastly, overall quality of life improved at the follow-up. Participants reported practicing exercises from the workshop or listening to the mindfulness CD nearly 3 hours per week, which is pretty good.
Because of the design of the study, the findings are preliminary. With only 15 people, 4 of whom dropped out, it's difficult to know how representative the sample is; however, with such a small sample size, it's impressive the researchers found significant results at all, as the results had to be very strong to be detected. Also, without a comparison group, it's impossible to know if ACT was the active ingredient. The authors acknowledged these weaknesses and others in the paper.
Limitations aside, the results are extremely promising. If a 5-hour group could lead to some pretty strong improvements for people with a painful, incurable disease, this is well worth exploring further. According to the authors, traditional cognitive behavioral treatments have shown mixed results for people with MS, and even the positive results weren't all that impressive. By contrast, this is a short, inexpensive group intervention that may have made a real different in the lives of people with MS.
To download a pdf of the article, click on the citation below:
Sheppard, S.C., Forsyth, J.P., Hickling, E.J., & Bianchi, J.M. (2010). A Novel Application of Acceptance and Commitment Therapy for Psychosocial Problems Associated with Multiple Sclerosis: Results from a Half-Day Workshop Intervention. International Journal of MS Care, 12, 200-206.
Friday, January 21, 2011
Mental Health Promotion as a New Goal in Public Mental Health Care: A Randomized Controlled Trial of an Intervention Enhancing Psychological Flexibility
Within the past few years, I've been coming across more and more studies of time-limited, group interventions of mindfulness and acceptance-based treatments. Recently, a group of Dutch researchers designed and implemented a brief Acceptance and Commitment Therapy (ACT) intervention for people with mild to moderate distress.
From an initial pool of 140, 93 people were randomly assigned to either an ACT and mindfulness intervention (n = 49) or a wait list (n = 44). They completed measures before the intervention, immediately after the intervention, and 3 months after the intervention.
The ACT and mindfulness intervention consisted of eight 2-hour groups with about 7 people each. Facilitators taught each of the 6 core ACT processes, and mindfulness exercises were woven in each session. After the study ended, the wait list participants were allowed to take part in the intervention.
The researchers found that emotional and psychological well-being improved following the intervention. There was no change in social well-being. Psychological flexibility--defined as the ability to move towards meaningful change in the present moment--did not increase immediately after the intervention but showed improvement at the 3-month follow-up. I always find these sort of delayed effects interesting, as it suggests an active intervention beyond the basic group effects. Moreover, improvements in psychological flexibility appeared to impact improvements in mental health.
As the authors acknowledge, a wait list control group is not ideal, as it doesn't eliminate the possibility that improvements were related to the fact that people received eight session of something; that is, it's hard to tell if improvements are unique to the particular intervention. This caveat aside, the study joins a growing body of literature suggesting that comparatively brief, mindfulness-based intervention can have a significant impact on people.
Member of the Association for Contextual Behavioral Science can download the article here.
See below for the full citation:
Fledderus, M., Bohlmeijer, E.T., Smit, F., & Westerhof, G.J. (2010). Mental Health Promotion as a New Goal in Public Mental Health Care: A Randomized Controlled Trial of an Intervention Enhancing Psychological Flexibility. American Journal of Public Health, 100(12), 2372-2378.
From an initial pool of 140, 93 people were randomly assigned to either an ACT and mindfulness intervention (n = 49) or a wait list (n = 44). They completed measures before the intervention, immediately after the intervention, and 3 months after the intervention.
The ACT and mindfulness intervention consisted of eight 2-hour groups with about 7 people each. Facilitators taught each of the 6 core ACT processes, and mindfulness exercises were woven in each session. After the study ended, the wait list participants were allowed to take part in the intervention.
The researchers found that emotional and psychological well-being improved following the intervention. There was no change in social well-being. Psychological flexibility--defined as the ability to move towards meaningful change in the present moment--did not increase immediately after the intervention but showed improvement at the 3-month follow-up. I always find these sort of delayed effects interesting, as it suggests an active intervention beyond the basic group effects. Moreover, improvements in psychological flexibility appeared to impact improvements in mental health.
As the authors acknowledge, a wait list control group is not ideal, as it doesn't eliminate the possibility that improvements were related to the fact that people received eight session of something; that is, it's hard to tell if improvements are unique to the particular intervention. This caveat aside, the study joins a growing body of literature suggesting that comparatively brief, mindfulness-based intervention can have a significant impact on people.
Member of the Association for Contextual Behavioral Science can download the article here.
See below for the full citation:
Fledderus, M., Bohlmeijer, E.T., Smit, F., & Westerhof, G.J. (2010). Mental Health Promotion as a New Goal in Public Mental Health Care: A Randomized Controlled Trial of an Intervention Enhancing Psychological Flexibility. American Journal of Public Health, 100(12), 2372-2378.
Tuesday, January 4, 2011
The Wall Street Journal Article on Mindfulness-Based Treatments
The 01/02/2011 issue of the The Wall Street Journal features an article by Melinda Beck on mindfulness-based treatments. The article quotes Dr. Steven Hayes, the prime originator of Acceptance and Commitment Therapy (ACT), Dr. Zindel Segal, one of the developers of Mindfulness-Based Cognitive Therapy (MBCT), and Dr. Marsha Linehan, the prime originator of Dialectical Behavior Therapy (DBT). According to the article:
This new psychology movement centers on mindfulness—the increasing popular emphasis on paying attention to the present moment. One of its key tenets is that urging people to stop thinking negative thoughts only tightens their grip—"like struggling with quicksand," Dr. Hayes says. But simply observing them like passing clouds can diffuse their emotional power, proponents say, and open up more options. ("Here's that old fat feeling again. You know, this happens every time I look at fashion magazines. I am sure judging myself harshly. Do I want to go to the gym? Or I could go to a movie. Or I could stop reading magazines.")
To read the full article, click here.
This new psychology movement centers on mindfulness—the increasing popular emphasis on paying attention to the present moment. One of its key tenets is that urging people to stop thinking negative thoughts only tightens their grip—"like struggling with quicksand," Dr. Hayes says. But simply observing them like passing clouds can diffuse their emotional power, proponents say, and open up more options. ("Here's that old fat feeling again. You know, this happens every time I look at fashion magazines. I am sure judging myself harshly. Do I want to go to the gym? Or I could go to a movie. Or I could stop reading magazines.")
To read the full article, click here.
Tuesday, December 21, 2010
Podcast: The Art & Science of Valuing in Psychotherapy
A crucial component in Acceptance and Commitment Therapy (ACT) is helping people connect with values, important life directions. Work in ACT is always connected to the larger picture.
For those interested in learning more about values from an ACT perspective, ACT in Practice author D.J. Moran, posted a podcast of a workshop focused specifically on values. The workshop was presented at a conference in the Netherlands a few years ago. The presenters are Joanne Dahl, Jennifer Plumb, Ian Stewart, and Tobias Lundgren, who all also authored a recent book on values called The Art and Science of Valuing in Psychotherapy.
Dr. Moran's blog is Functionally Speaking, and the workshop podcast is broken down into two parts:
For part one, click here.
For part two, click here.
Citation for the book on which the workshop was based:
Dahl, J.C., Plumb, J.C., Stewart, I., & Lundgren, T. (2009) The Art and Science of Valuing in Psychotherapy: Helping Clients Discover, Explore, and Commit to Valued Actions Using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
For those interested in learning more about values from an ACT perspective, ACT in Practice author D.J. Moran, posted a podcast of a workshop focused specifically on values. The workshop was presented at a conference in the Netherlands a few years ago. The presenters are Joanne Dahl, Jennifer Plumb, Ian Stewart, and Tobias Lundgren, who all also authored a recent book on values called The Art and Science of Valuing in Psychotherapy.
Dr. Moran's blog is Functionally Speaking, and the workshop podcast is broken down into two parts:
For part one, click here.
For part two, click here.
Citation for the book on which the workshop was based:
Dahl, J.C., Plumb, J.C., Stewart, I., & Lundgren, T. (2009) The Art and Science of Valuing in Psychotherapy: Helping Clients Discover, Explore, and Commit to Valued Actions Using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger.
Tuesday, December 7, 2010
A Podcast Interview with Steven Hayes, PhD, on BehaviorTherapist.com
Following fast on the heels of his interview with Dr. Zettle, Dr. Trent Codd has posted a podcast interview with Steven Hayes, PhD, on BehaviorTherapist.com. Dr. Hayes is the core originator of Acceptance and Commitment Therapy (ACT). An enormously influential professor and psychologist, Dr. Hayes has authored 32 books and over 400 scientific articles, as well as the popular self-help book Get Out of Your Mind and Into Your Life.
Dr. Hayes discusses the importance of defining the philosophical underpinnings of psychological theories, and how Functional Contextualism guides ACT.
You can listen to the interview at BehaviorTherapist.com here.
Dr. Hayes discusses the importance of defining the philosophical underpinnings of psychological theories, and how Functional Contextualism guides ACT.
You can listen to the interview at BehaviorTherapist.com here.
Monday, December 6, 2010
Interview with Rob Zettle, PhD, on Acceptance and Commitment Therapy for Depression
BehaviorTherapist.com has an interview with Rob Zettle, PhD, who, as the first graduate student of Steven Hayes, PhD, was involved in the development of what would eventually become Acceptance and Commitment Therapy (ACT). Dr. Zettle is also the author of the book, ACT for Depression.
Dr. Trent Codd interviews Dr. Zettle about his early work in developing ACT and his work on using ACT to treat depression. (The American Psychological Association Division 12 officially recognized ACT as a research-supported treatment for depression.) The interview may a little technical for people unfamiliar ACT but provides a fascinating window into its early development.
The interview can be found on BehaviorTherapist.com here.
If you're interested in Dr. Zettle's book, the citation is below:
Zettle, R. D. (2007). ACT for Depression: A Clinician's Guide to Using Acceptance and Commitment Therapy in Treating Depression. Oakland, CA: New Harbinger.
Dr. Trent Codd interviews Dr. Zettle about his early work in developing ACT and his work on using ACT to treat depression. (The American Psychological Association Division 12 officially recognized ACT as a research-supported treatment for depression.) The interview may a little technical for people unfamiliar ACT but provides a fascinating window into its early development.
The interview can be found on BehaviorTherapist.com here.
If you're interested in Dr. Zettle's book, the citation is below:
Zettle, R. D. (2007). ACT for Depression: A Clinician's Guide to Using Acceptance and Commitment Therapy in Treating Depression. Oakland, CA: New Harbinger.
Thursday, December 2, 2010
Telephone-Delivered Acceptance and Commitment Therapy for Adult Smoking Cessation: A Feasibility Study
In an efforts to make psychotherapy more accessible to people, researchers have been experimenting with ways of offering treatment to people who cannot come in to see a therapist regularly, perhaps for financial reasons or geographic (e.g., rural areas).
Dr. Bricker and colleagues at the University of Washington and Fred Hutchinson Cancer Research Center did a pilot study on using a smoking cessation Acceptance and Commitment Therapy (ACT) intervention delivered over the telephone.
Of the 74 people screened, 14 participated in the study. Although small, the sample was pretty diverse: 57% were African American and 64% were low-income. Participants had to be a daily smoker for the past 30 days, and 64% reported smoking half a pack a day.
A licensed psychologist delivered up to 5 telephone sessions: the first was about 30 minutes, and the remaining averaged 15 minutes per call. The components of intervention involved learning skills to: 1.) increase willingness to experience smoking-related urges; 2.) alter the function of these urges; 3.) change how they respond to the urges (e.g., notice without acting on them).
The study had 20-day and 12-month follow-ups. At 12-months, 29% of the participants were no longer smoking. Although this may not seem like a great outcome, it's pretty impressive when compared to other smoking intervention outcomes. According the authors, success rates are 4% for those quitting on their own, 12% for other telephone interventions, and 30-35% for face-to-face ACT interventions. What this means is that the success rate for this intervention was more than twice that of other telephone interventions and comparable to face-to-face interventions.
Because this was a small sample with no comparison control group, further research is necessary. Nonetheless, this study offers some really promising evidence that a brief ACT-based telephone intervention for smoking cessation may be pretty effective. That it's brief and delivered by phone means that it may offer more bang for the buck compared to face-to-face interventions. Additionally, participants rated the intervention really positively.
For the full citation:
Bricker, J.B., Mann, S.L., Marek, P.M., Liu, J., & Peterson, A.V. (2010). Telephone-Delivered Acceptance and Commitment Therapy for Adult Smoking Cessation: A Feasibility Study. Nicotine & Tobacco Research, 12(4), 454-458.
Dr. Bricker and colleagues at the University of Washington and Fred Hutchinson Cancer Research Center did a pilot study on using a smoking cessation Acceptance and Commitment Therapy (ACT) intervention delivered over the telephone.
Of the 74 people screened, 14 participated in the study. Although small, the sample was pretty diverse: 57% were African American and 64% were low-income. Participants had to be a daily smoker for the past 30 days, and 64% reported smoking half a pack a day.
A licensed psychologist delivered up to 5 telephone sessions: the first was about 30 minutes, and the remaining averaged 15 minutes per call. The components of intervention involved learning skills to: 1.) increase willingness to experience smoking-related urges; 2.) alter the function of these urges; 3.) change how they respond to the urges (e.g., notice without acting on them).
The study had 20-day and 12-month follow-ups. At 12-months, 29% of the participants were no longer smoking. Although this may not seem like a great outcome, it's pretty impressive when compared to other smoking intervention outcomes. According the authors, success rates are 4% for those quitting on their own, 12% for other telephone interventions, and 30-35% for face-to-face ACT interventions. What this means is that the success rate for this intervention was more than twice that of other telephone interventions and comparable to face-to-face interventions.
Because this was a small sample with no comparison control group, further research is necessary. Nonetheless, this study offers some really promising evidence that a brief ACT-based telephone intervention for smoking cessation may be pretty effective. That it's brief and delivered by phone means that it may offer more bang for the buck compared to face-to-face interventions. Additionally, participants rated the intervention really positively.
For the full citation:
Bricker, J.B., Mann, S.L., Marek, P.M., Liu, J., & Peterson, A.V. (2010). Telephone-Delivered Acceptance and Commitment Therapy for Adult Smoking Cessation: A Feasibility Study. Nicotine & Tobacco Research, 12(4), 454-458.
Wednesday, October 27, 2010
Acceptance and Commitment Therapy Vs. Cognitive Therapy for the Treatment of Comorbid Eating Pathology
Recently, a group of researchers at Drexel University--including Dr. James Herbert, who we interviewed about mindfulness over the summer--conducted a study comparing Acceptance and Commitment Therapy (ACT) and Cognitive Therapy (CT) for disordered eating. Juarascio and colleagues looked at people in treatment with "subclinical eating pathology"--meaning that most people identified problematic eating behavior but didn't qualify for an official eating disorder diagnosis.
Although CBT is considered the gold-standard for eating disorder treatment, some research indicates only 30-50% of people completely stop binging and purging, according to research cited by the authors. Consequently, there seems to be some room for improvement.
This study appears to have been culled from the leftovers from a previous study of ACT and CT treatment for anxiety and depression (Foreman et al., 2007), that it was pulled from the same data set. It looks like the authors found that a number of participants (N = 55) from the data set reported eating disordered behavior and ran additional analyses on these individuals.
This study is what is known as an effectiveness study. It doesn't have the control of an efficacy study, but it plays out closer to what happens in real life. This makes it more naturalistic. (Click here for a quick explanation of efficacy vs. effectiveness.)
Participants agreed to the study and were randomly assigned to either an ACT or a CT therapist. These were students at a post-baccalaureate institution who received treatment from one of 23 doctoral students trained in both ACT and CT. Therapy was not conducted through a manual or protocol, as would happen in an efficacy study.
The researchers predicted people who received ACT would show greater improvements than those who received CT, and analyses supported this hypothesis. Although CT lead to small improvements in eating disorder behavior, ACT led to very large improvements.
Because treatment wasn't manualized, we don't know exactly what components of CT and ACT were drawn upon in therapy. In addition, CT participants didn't necessarily receive gold-standard CT protocols for eating disordered behavior. In fact, as they note, the researchers are not certain if eating disordered behavior was a focus. And, as was noted, the eating disordered problems were generally subclinical. For these reasons, this study cannot be considered a test of a gold-standard cognitive behavioral treatment for eating disorders against ACT.
That said, this study has wonderful real world validity. If someone with eating disordered problems walked into a CT or an ACT therapist's office, this is the kind of treatment he or she may be likely to receive. Fewer clinicians use the kind of manualized treatments that are used in more controlled studies (e.g., RCT's), although knowledge of manualized treatments can be very useful in real world practice.
This study provides pretty good evidence for the effectiveness of ACT in addressing eating disordered behavior. ACT promotes greater mindfulness, acceptance, and movement towards valued directions; by contrast, CT focuses on changing the content of one's thinking. Results suggest ACT processes of change may be more appropriate for individuals with eating disordered problems than CT processes.
Drs. Forman and Herbert have large collection of their research available as PDF's on their Drexel research lab page. Click here to download a copy of the article.
For the full citation:
Juarascio, A. S., Forman, E. M., & Herbert, J. D. (2010). Acceptance and Commitment Therapy versus Cognitive Therapy for the treatment of comorbid eating pathology. Behavior Modification, 34(2), 175-190.
Although CBT is considered the gold-standard for eating disorder treatment, some research indicates only 30-50% of people completely stop binging and purging, according to research cited by the authors. Consequently, there seems to be some room for improvement.
This study appears to have been culled from the leftovers from a previous study of ACT and CT treatment for anxiety and depression (Foreman et al., 2007), that it was pulled from the same data set. It looks like the authors found that a number of participants (N = 55) from the data set reported eating disordered behavior and ran additional analyses on these individuals.
This study is what is known as an effectiveness study. It doesn't have the control of an efficacy study, but it plays out closer to what happens in real life. This makes it more naturalistic. (Click here for a quick explanation of efficacy vs. effectiveness.)
Participants agreed to the study and were randomly assigned to either an ACT or a CT therapist. These were students at a post-baccalaureate institution who received treatment from one of 23 doctoral students trained in both ACT and CT. Therapy was not conducted through a manual or protocol, as would happen in an efficacy study.
The researchers predicted people who received ACT would show greater improvements than those who received CT, and analyses supported this hypothesis. Although CT lead to small improvements in eating disorder behavior, ACT led to very large improvements.
Because treatment wasn't manualized, we don't know exactly what components of CT and ACT were drawn upon in therapy. In addition, CT participants didn't necessarily receive gold-standard CT protocols for eating disordered behavior. In fact, as they note, the researchers are not certain if eating disordered behavior was a focus. And, as was noted, the eating disordered problems were generally subclinical. For these reasons, this study cannot be considered a test of a gold-standard cognitive behavioral treatment for eating disorders against ACT.
That said, this study has wonderful real world validity. If someone with eating disordered problems walked into a CT or an ACT therapist's office, this is the kind of treatment he or she may be likely to receive. Fewer clinicians use the kind of manualized treatments that are used in more controlled studies (e.g., RCT's), although knowledge of manualized treatments can be very useful in real world practice.
This study provides pretty good evidence for the effectiveness of ACT in addressing eating disordered behavior. ACT promotes greater mindfulness, acceptance, and movement towards valued directions; by contrast, CT focuses on changing the content of one's thinking. Results suggest ACT processes of change may be more appropriate for individuals with eating disordered problems than CT processes.
Drs. Forman and Herbert have large collection of their research available as PDF's on their Drexel research lab page. Click here to download a copy of the article.
For the full citation:
Juarascio, A. S., Forman, E. M., & Herbert, J. D. (2010). Acceptance and Commitment Therapy versus Cognitive Therapy for the treatment of comorbid eating pathology. Behavior Modification, 34(2), 175-190.
Friday, October 15, 2010
A RCT of Acceptance and Commitment Therapy vs. Progressive Relaxation Training for Obsessive-Compulsive Disorder
In a previous post about the use of Acceptance and Commitment Therapy (ACT) for problematic pornography viewing, I mentioned researcher Dr. Michael Twohig’s work with ACT for obsessive-compulsive disorder (Twohig, Hayes, &; Masuda, 2006; Twohig, 2009; Twohig &; Whittal, 2009). Well, it looks like Dr. Twohig is on a hot streak as Journal of Consulting and Clinical Psychology (JCCP) has just published another study by Dr. Twohig: the first randomized controlled trial (RCT) of ACT for OCD.
OCD is a condition characterized by frequent, unwanted thoughts (obsessions) and/or reliance on repetitive or ritualized behavior (compulsions) in order to get rid of obsessions and reduce anxiety. The gold standard of treatment is what’s called Exposure with Ritual Prevention (ERP; sometimes called Exposure and Response Prevention), which is often used in the context of cognitive behavioral treatment. ERP involves having people sit for extended periods of time with distressing stimuli related to obsessions without engaging in the compulsions they typically use to alleviate distress. For example, someone with a fear of germs who compulsively hand washes might be asked to smear dirt on his hands and spend a half hour sitting with dirty hands without washing them. For someone who spends hours a day compulsively washing his hands even when they are not observably dirty, this can be extremely stressful. Perhaps because of this, there is a high drop out rate for people using ERP—about 25% according to the article. Also, even though ERP is the most effective treatment for OCD, most clinicians are reluctant to use it. (Clinicians can be uncomfortable sitting with distress, too!)
Although exposure can be and often is incorporated into ACT treatment, Dr. Twohig specifically did not include ERP in his ACT protocol. This move is shrewd yet bold. Given the widespread research support for the use of ERP in OCD treatment, adding it to ACT would leave the study vulnerable to serious questions about whether ACT contributes anything new to OCD treatment.
Although exposure can be and often is incorporated into ACT treatment, Dr. Twohig specifically did not include ERP in his ACT protocol. This move is shrewd yet bold. Given the widespread research support for the use of ERP in OCD treatment, adding it to ACT would leave the study vulnerable to serious questions about whether ACT contributes anything new to OCD treatment.
It’s worth noting, however, that the study does not directly compare ACT to ERP. Instead ACT is compared to progressive relaxation training (PRT), in which people are systematically taught ways of relaxing, beginning with their muscles. PRT has some support in OCD treatment but is considered less effective than ERP. I’ll address the researchers' reasons for using PRT over ERP at the end of this blog.
Approximately 80 people were randomly assigned to receive either 8-weeks of ACT or 8-weeks of PRT delivered in 1-hour sessions. The protocol is striking in its brevity--eight 1-hour sessions is not a lot of time. Participants were assessed 1 week before treatment, 1 week, after treatment, and 3-months later.
Instead of ERP, ACT treatment focused on typical ACT processes. Participants learned to notice how attempts at controlling obsessions made them worse over time, respond to obsessions more flexibly, and make behavioral commitment to things that were important to them. The behavioral commitments may resemble in vivo or real-world exposure exercises often found in ERP treatments. However, emphasis was placed less on deliberate exposure as in traditional ERP. Instead, the emphasis was placed on moving towards something important and responding to any distress that showed up.
Results indicted greater improvement in OCD symptoms at the end of treatment and at follow-up for ACT participants compared to those assigned to PRT. Participants rated the acceptability of ACT very highly—more so than PRT. Additionally, dropout rates were lower for ACT than is common for ERP.
This study provides evidence that ACT is a useful treatment for OCD worth further study. ACT has several things going for it: 1.) ACT was well-tolerated by participants, which is extremely important given the high dropout rate associated with ERP; 2.) The ACT protocol was remarkably brief—eight 1-hour sessions—which is much shorter than average for ERP treatments; 3.) Although not directly compared, reductions in OCD were similar to those indicated in a review of ERP treatment for OCD.
The researchers caution that they believe the ACT protocol for OCD would benefit from more tinkering before it is compared to ERP. However, I expect we’ll see a direct comparison in the near future. ACT has the potential to be a treatment that is better tolerated but as effective as ERP, or it may be a treatment for people who cannot tolerate direct exposure as emphasized in ERP. Regardless, it’s off to a promising start.
For members of the Association for Contextual Behavioral Science, the article may be downloaded here. For full citation:
Twohig, M.P., Hayes, S.C., Plumb, J.C., Pruitt, L.D., Collins, A.B., et al. (2010). A Randomized Controlled Trial of Acceptance and Commitment Therapy vs. Progressive Relaxation Training for Obsessive-Compulsive Disorder. Journal of Consulting and Clinical Psychology, 78(5), 705-716.
Tuesday, October 12, 2010
ACT for Pornography Interview with Dr. Michael Twohig
We previously posted about recent data on a mindfulness-based therapy, Acceptance and Commitment Therapy, as a treatment for pornography addiction. For those who like interviews, I just recently discovered a podcast by Dr. Twohig where he talks about his research. Check it out.
Tuesday, September 28, 2010
Acceptance and Commitment Therapy as a Treatment for Problematic Internet Pornography Viewing
In a post a few weeks ago, I blogged about a blog post by Dr. Steven Hayes on a study using Acceptance and Commitment Therapy (ACT), a mindfulness- and acceptance-based treatment, for problematic Internet pornography viewing. I’ve since had a chance to track down and read the study, and I thought I’d write about it today.
Dr. Michael Twohig, a professor at Utah State University, is a pioneer in the use of ACT for obsessive-compulsive disorder. In a talk I saw him give on OCD at a conference in June, I recall him saying he expanded into problematic pornography viewing after he moved to Utah and found it was a big problem there.
Although this study has a small sample—six men—it’s a big step in that it’s not only the first controlled study of the treatment of Internet pornography viewing using ACT, but it’s the first controlled study of any treatment for Internet pornography viewing! According to Twohig and his co-author Jesse Crosby, there are studies of problematic sexual behaviors with treatments such as cognitive behavior therapy and motivational interviewing, but none of these are experimental.
It’s worth noting that although the media uses terms such as “sex addiction” or “porn addiction,” these aren’t technical diagnostic terms. There’s no official diagnosis for someone engaging in excessive pornography viewing. In fact there’s no consensus on how to classify it: some see it as a compulsion similar to OCD, whereas others see it as akin to substance abuse. Twohig and Crosby define “problematic pornography viewing” as: 1.) “viewing pornography more than 3 times per week on some weeks; and 2.) “the viewing causes difficulty in general life functioning.” Although we could quibble with this criteria—why 3 times a week?—it serves the purpose of the study.
Serving as the therapist for all six men, Dr. Twohig treated each with a flexible protocol of 8 weekly, 1.5 hour sessions. Sessions addressed the major ACT processes. Participants practiced mindful awareness and acceptance of inner experiences such as urges and arousal. Between sessions, they committed to engaging in activities in accordance with their values.
At the end of the last treatment session, five of the six showed significant reductions in viewing pornography. At a follow-up three months after treatment ended, two people weren’t viewing pornography at all and three were viewing at significantly reduced levels. (It’s worth noting that the goal of some was abstinence and that of others was reduced viewing.) Only one of the six participants was viewing pornography as often as he was prior to treatment. Overall, participants exhibited an increase in quality of life and decrease in obsessive features and religious-based obsessive thoughts.
One thing I really like about this article is the modesty around some of the conclusions. The authors humbly note although the study did not use behavior therapy or contingency managements, nor did it draw from some of the other interventions that have been associated with pornography viewing (e.g., CBT, MI), these may also be useful. (A major reason the researchers did not draw upon other tools was that they wanted to rely on ACT-specific processes--a bold move in my opinion.) Results do suggest that focusing on mindful acceptance of urges and movement towards meaningful activity may be helpful in reducing pornography viewing. This is the really cool part--rather than focusing not looking at pornography, treatment focused on mindful acceptance of urges and engagement in meaningful activities outside session.
Although larger randomized controlled trials are a next step towards examining the efficacy of ACT in treating problematic pornography viewing, this study is a really important first step in two ways: 1) It's the first controlled experimental study of a treatment for viewing; 2) It suggests that mindful acceptance of one’s experiences may be more helpful in changing behavior than trying to control one’s urges.
For those who are a member of ACBS, the main umbrella organization for ACT, a pre-publication PDF of the article can be downloaded here.
For the full citation:
Twohig, M. P., & Crosby, J. M. (2010). Acceptance and Commitment Therapy as a Treatment for Problematic Internet Pornography Viewing. Behavior Therapy, 41(3), 285-295.
Dr. Michael Twohig, a professor at Utah State University, is a pioneer in the use of ACT for obsessive-compulsive disorder. In a talk I saw him give on OCD at a conference in June, I recall him saying he expanded into problematic pornography viewing after he moved to Utah and found it was a big problem there.
Although this study has a small sample—six men—it’s a big step in that it’s not only the first controlled study of the treatment of Internet pornography viewing using ACT, but it’s the first controlled study of any treatment for Internet pornography viewing! According to Twohig and his co-author Jesse Crosby, there are studies of problematic sexual behaviors with treatments such as cognitive behavior therapy and motivational interviewing, but none of these are experimental.
It’s worth noting that although the media uses terms such as “sex addiction” or “porn addiction,” these aren’t technical diagnostic terms. There’s no official diagnosis for someone engaging in excessive pornography viewing. In fact there’s no consensus on how to classify it: some see it as a compulsion similar to OCD, whereas others see it as akin to substance abuse. Twohig and Crosby define “problematic pornography viewing” as: 1.) “viewing pornography more than 3 times per week on some weeks; and 2.) “the viewing causes difficulty in general life functioning.” Although we could quibble with this criteria—why 3 times a week?—it serves the purpose of the study.
Serving as the therapist for all six men, Dr. Twohig treated each with a flexible protocol of 8 weekly, 1.5 hour sessions. Sessions addressed the major ACT processes. Participants practiced mindful awareness and acceptance of inner experiences such as urges and arousal. Between sessions, they committed to engaging in activities in accordance with their values.
At the end of the last treatment session, five of the six showed significant reductions in viewing pornography. At a follow-up three months after treatment ended, two people weren’t viewing pornography at all and three were viewing at significantly reduced levels. (It’s worth noting that the goal of some was abstinence and that of others was reduced viewing.) Only one of the six participants was viewing pornography as often as he was prior to treatment. Overall, participants exhibited an increase in quality of life and decrease in obsessive features and religious-based obsessive thoughts.
One thing I really like about this article is the modesty around some of the conclusions. The authors humbly note although the study did not use behavior therapy or contingency managements, nor did it draw from some of the other interventions that have been associated with pornography viewing (e.g., CBT, MI), these may also be useful. (A major reason the researchers did not draw upon other tools was that they wanted to rely on ACT-specific processes--a bold move in my opinion.) Results do suggest that focusing on mindful acceptance of urges and movement towards meaningful activity may be helpful in reducing pornography viewing. This is the really cool part--rather than focusing not looking at pornography, treatment focused on mindful acceptance of urges and engagement in meaningful activities outside session.
Although larger randomized controlled trials are a next step towards examining the efficacy of ACT in treating problematic pornography viewing, this study is a really important first step in two ways: 1) It's the first controlled experimental study of a treatment for viewing; 2) It suggests that mindful acceptance of one’s experiences may be more helpful in changing behavior than trying to control one’s urges.
For those who are a member of ACBS, the main umbrella organization for ACT, a pre-publication PDF of the article can be downloaded here.
For the full citation:
Twohig, M. P., & Crosby, J. M. (2010). Acceptance and Commitment Therapy as a Treatment for Problematic Internet Pornography Viewing. Behavior Therapy, 41(3), 285-295.
Friday, September 24, 2010
From Psychology Today: Dr. Kelly Wilson on Acceptance and Depression
Dr. Kelly Wilson, a professor at the University of Mississippi, and one of the early developers of Acceptance and Commitment Therapy (ACT) posted a blog on Psychology Today yesterday. The blog offers vivid illustrations of some basic ACT priniciples rooted in how Dr. Wilson himself came to experience these principles in his own life.
"For me, acceptance was the birthplace of possibility. It was a place where the stories that imprisoned me could ease enough for me to see a way forward or to see a hand outstretched towards me, ready to guide me along the path. An odd fact about word prisons is that the harder we struggle to be free of them, the tighter the confinement they impose. "
Read the full blog post here.
"For me, acceptance was the birthplace of possibility. It was a place where the stories that imprisoned me could ease enough for me to see a way forward or to see a hand outstretched towards me, ready to guide me along the path. An odd fact about word prisons is that the harder we struggle to be free of them, the tighter the confinement they impose. "
Read the full blog post here.
Subscribe to:
Posts (Atom)
Posts
