The Future of ACT…

Brandon A. Gaudiano, Ph.D.Alpert Medical School of Brown

University & Butler HospitalACBS World Conference XII

June, 2014Minneapolis, MN

Expand the technology

Expand the training of clinicians

Expand the role of behavioral intervention in the healthcare system

ACT Areas of Expansion

Expos

ure

with re

spon

se p

reve

ntio

nB

eck’

s C

ogni

tive

Ther

apy

Dialectical B

ehavior Therapy

Min

dful

ness

Bas

ed C

ogni

tive

Ther

apy R

ational Em

otive Behavior T

herapyA

cceptance and Com

mitm

ent Therapy

Schem

a Therapy

Barlow

’s Unified P

rotocol Cog

nitiv

e Th

erap

y fo

r OCD

Func

tiona

l Ana

lytic

Psy

chot

hera

py

Met

acog

nitiv

e Th

erap

y

Many othersP

rolonged Exposure

Mindfulness B

ased Stress R

eduction

C B T

Mot

ivatio

nal I

nter

viewin

g

Potential Problem:◦ ACT’s distinctive techniques (metaphors/

exercises) can get in the way of the work

Related Problem:◦ Therapists forget to use traditional behavioral

strategies that may be useful/essential

Enhancing ACT Technology

Possible Solutions:

◦ Better integrate standard cognitive/behavioral techniques that work well into ACT

◦ Train therapists to conceptualize/employ CBT strategies in an ACT-consistent way linked to the model

Enhancing ACT Technology

Exposure Behavioral Activation Skills Training Stimulus-Control Contingency Management Homework Cognitive Interventions (e.g., thought

records)

ACT-ifying CBT

Self asContext

Contact with the Present Moment

Defusion

Acceptance

Committed Action

Values

Psychological Flexibility

Potential Problem: ◦ The complete ACT model can be too

complicated for novice/less advanced therapists to learn at first

Related Problem: ◦ Traditional CBT is easier to learn (at least

initially at a superficial level) than ACT and so may achieve better “uptake” in community settings

Enhancing ACT Training

Possible Solutions:

◦ Develop a multi-tiered training system that can build from beginner to advanced knowledge over time

◦ Meet therapists where they are at with ACT training just like we adapt our interventions to meet clients in need

Enhancing ACT Training

Outpatient Treatment Use at Mental Care Facilities

Treatment 1998, % 2007, % AOR (95% CI)

Psychotherapy only

15.9 10.5 0.66 (0.48 – 0.90)

Both together 40.0 32.1 0.73 (0.59 – 0.90)

Psychotropics only

44.1 57.4 1.63 (1.32 – 2.00)

“National Trends in Outpatient Psychotherapy” Mark Olfson, M.D., M.P.H. & Steven C. Marcus, Ph.D. Am J Psychiatry 2010;167:1456-1463.

Potential Problem: ◦ The Biomedical Model is

growing stronger and stronger in mental health treatment settings

Related Problem: ◦ Biological reductionism is

becoming the dominant way of thinking about behavioral problems and their solutions

Enhancing ACT Impact/Reach

Possible Solutions:

◦ Steadfastly pursue functional contextual neuroscience to take back biology

◦ Advocate strongly for the role of behavioral interventions and influence public policy

Enhancing ACT Impact/Reach