Acceptance and Commitment Therapy with Treatment Resistant PTSD Clients. Michael P. Twohig, Ph.D. Associate Professor of Psychology

Transcription

1 Acceptance and Commitment Therapy with Treatment Resistant PTSD Clients Michael P. Twohig, Ph.D. Associate Professor of Psychology

2 C B T

3 How did ACT develop? 1 2 3

4 Rule Governed Behavior Verbal humans are insensitive to environmental contingencies Non-verbal ones are not How does this happen?

5 Relational Frame Theory Stimuli Three-term contingency Meaning vs function

6 Language: The two-edged sword Useful and interfering effects of this ability Grocery store My wife and our children, getting older We can apply this to our own thinking and emotions

7 Experiential Avoidance Experiential avoidance is the tendency to attempt to alter the form, frequency, or situational sensitivity of historically produced negative private experience (emotions, thoughts, bodily sensations) even when attempts to do so cause psychological and behavioral harm

8 Psychological Inflexibility The ability to contact the present moment more fully as a conscious human being, and based on what the situation affords, to change or persist in behavior in order to serve valued ends

9 AAQ-II Below you will find a list of statements. Please rate how true each statement is for you by circling a number next to it. Use the scale below to make your choice never true very seldom true seldom true sometimes true frequently true almost always true always true 1. My painful experiences and memories make it difficult for me to live a life that I would value I m afraid of my feelings I worry about not being able to control my worries and feelings My painful memories prevent me from having a fulfilling life Emotions cause problems in my life It seems like most people are handling their lives better than I am Worries get in the way of my success

10 AAQ Scores Are Associated With All anxiety disorders More depression More overall pathology Poorer work performance Inability to learn Substance abuse Lower quality of life Trichotillomania War related stress Poor weight management Eating disorder Hoarding Decreased functioning after returning from combat Maternal dysphoria Delusional distress History of sexual abuse High risk sexual behavior BPD symptomatology and depression Thought suppression Alexithymia Anxiety sensitivity Long term disability Worry Pain tolerance Health Anxiety More chronic pain Self-injury Increased pornography use Distress tolerance

11 Currently 130 Randomized Controlled Trials *=work with children too Anger Aggression Adjusting to end-stage cancer Borderline Personality disorder Chronic pain* Chronic headache Coping with Cancer Diagnosis Depression* Diabetes management Disordered eating Epilepsy Hyperactivity in Children* Generalized Anxiety Disorder Mixed Anxiety Disorders Methamphetamine use Methadone detoxification Multicultural competency OCD * Polysubstance abuse Panic Disorder Psychosis Stress of parents with children diagnosed with DD or MR Social anxiety Smoking cessation Shame in substance abusers Stigma against mental illnesses Tinnitus distress Trichotillomania Use of ESTs Weight loss Workplace stress and innovation Willingness to use ESTs Workplace burnout

12 63 studies, sig. r =.45 with anxiety 13 studies, sig. r =.40 with PTSD severity 3 case studies and one small trial Multiple trials ongoing at VAs

13 The Primary ACT Model of Treatment Contact with the Present Moment Acceptance Values Psychological Flexibility Defusion Committed Action Self as Context

14 The Primary ACT Model of Psychopathology

15 Effect size by component relative to inactive conditions Large effect Effect size Medium effect Levin et al., 2012 Behavior Therapy

16 Acceptance vs. Avoidance When is this seen in a client? Targeted moment by moment Therapist being OK with difficult topics Therapist being personally open

17 Acceptance vs. Avoidance Formal exercises Quicksand Playing a rigged game Feeding a tiger to make it quiet Giving into your kid at the grocery store Tug of war with rope Chinese handcuffs

18 Defusion vs Cognitive Fusion Oh, this is what you were talking about

19 Defusion vs. Cognitive Fusion When does this show up? Simple responses in session Has that thought helped you? How old is that thought? Thank your mind for that There it is again? Does this sound like your mind?

20 Defusion vs. Cognitive Fusion Additional options Repeat word Limitations of language Try not to evaluate Do opposite of a thought Difference between knowing about and knowing how

21 Being Present vs. Not Present

22 Being Present vs. Not Present Example Leaves on a stream Additional examples Slowing speech Bring client back to the room Labeling inner experience Widening View

23 Self as Context vs. Self as Content

24 Self as Context vs. Self as Content Quick responses in session Are you saying that or is your mind saying that? Are you the same as your thoughts? Is it OK to just have that thought? Formal exercises Watching thoughts Listen to music in car

25 Following Values vs. Unclear Values

26 Following Values vs. Unclear Values What are values? As described in therapy Values exercise Bulls eye Quick responses What is that in the service of? If that thought wasn t In the way

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28 Behavioral Commitment vs. Inaction Commitment tied to values Can be any already supported behavioral procedure But must be from ACT framework Parameters to behavioral commitments Time/event not emotional intensity No clock watching Practice other ACT processes while doing it

29 If you are interested in learning more about ACT Contextualscience.org Listserves on contextualscience.org New Harbinger books and Videos Professional Consultation You always welcome to contact me