ACT II Specific Examples from an ACT Trial

ACT II: Specific Examples from an ACT Trial Jon Abramowitz, Laura Fabricant, & Ryan Jacoby Clinical Lunch Spring 2014

Overview � ACT principles � Our study on exposure therapy and ACT � Techniques to foster acceptance � Techniques to foster defusion � Techniques to pursue values � Discussion (applying ACT to other problems)

ACT Principles

I spend most of my time paying attention to what is happening in the present moment I willingly accept my thoughts and feelings even when I don’t like them 10 9 8 7 6 5 4 3 2 1 109 8 76 ACCEPTANCE SCALE 54 32 1 DEFUSION SCALE I see each of my thoughts as just one of many ways to think about things – what I do next is up to me 10 9 87 ATTENTION TO PRESENT SCALE 4 65 32 1 I am clear about what I choose to value in life I spend 10 89 most of my time 67 5 4 3 lost in thought 12 I constantly about the past or I don’t struggle future VALUES know what with my IDENTIFICATION I want SCALE thoughts from life and feelings My thoughts tell I don‘t me how things manage to really are, and act on the determine what I Deep down, my things I care do next 12 34 thoughts and about 56 I work out what I 78 feelings are the 9 10 COMMITMENT need to do about the real me & TAKING things I care about, ACTION 1 and SCALE 2 I see it through 3 SELF AS 4 OBSERVER 5 6 SCALE 7 8 9 10 My thoughts and feelings come and go, but deep down the real me doesn’t change

Our study: Exposure + ACT

Our Study � How � Our � An did we get interested in ACT? study ACT perspective on OCD: 3 parts � Exposure from an ACT framework � Similarities and differences (SUDS vs. willingness) � Exposure therapy to facilitate the ACT processes

ACT Techniques

Acceptance � Willingness � Examples to experience internal events from OCD patients � Metaphors and techniques � “Jerk at the door” � Chessboard � Exposure � Habituation vs. fear tolerance

Defusion � Distancing and disconnecting from thoughts � Seeing thoughts and feelings for what they are, not what they say they are � Examples from OCD patients � Metaphors � Milk, and techniques Milk, Milk � Passengers on the bus � Imaginal exposure

Passengers on the Bus Metaphor � You’re the driver and the passengers are your OCD related thoughts, feelings, physiological sensations, etc. � The passengers try to direct where the bus goes � They are loud and bossy about what you do � They quiet down when you do what they want � If you drive the bus where you want to go, what will happen? � You can allow them to shout and keep your attention focused on where you want to go

Values � Choosing what direction one wants life to take (not letting OCD choose the direction life goes) � Examples from OCD patients � Metaphors and techniques � Bull's-eye � Moving through a swamp � Exposure

� What do you value? � What do you want your life to be about? � What do each of these categories mean to you? � In what ways has OCD been getting in the way of living life in the direction of your values?

Moving through a swamp � Swamp = OCD-related inner experiences and triggers � Exposure = learning how to handle whatever comes up while still moving forward through swamp � Willingness to go into the swamp without resisting (avoiding or using compulsive rituals) � Why are we doing this? � Getting dirty and muddy but for a purpose � Not wallowing in the swamp � Things you value are on the other side of the swamp (only way is through it!)

Exposures and values � Emotional moves vs. values moves � Motivation � Anxiety reduction is not an explicit goal � Successful outcome = you doing something important to you despite having anxiety

Discussion

Discussion � How could we apply these techniques to other problems? � Similarities � Questions? and differences with otherapies?

Thank you!