cbt to act
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Transitioning from CBT to ACT:
Challenges and Triumphs
Jeff Szymanski, PhDPresident, ACBS New England ChapterExecutive Director, International OCD
Foundation
From CBT to DBT to ACT
My Own Journey
Where you are in relation to your current treatment model?•What feels like it’s working and what isn’t?•Where are you in relation to the ACT model?•What do you find yourself agreeing with and what are you still pushing against (if anything)?
• What do you do well as an ACT therapist?•What would you like to get better at?•As you try to incorporate more ACT into your work (assuming you are), where are you getting tripped up?
Goal for this Workshop:A Self-Assessment
What did you come up with?
What did you notice as you were reflecting on this?
One of my own stumbling blocks…
Pre-therapy Aim of CBT Aim of ACT
Comparison of CBT and ACT Goals
“Okay those are definitely different goals”
My Initial Response to this Slide
“Actually, they are opposite goals”“What do I do with my clients?”
Confusion
“Wait a minute, is a client really going to buy into this basic goal of ACT?”
Mild alarm
“This surely must be an exaggeration of what they really mean…”
“Seriously…what the F*@K?!?”
Annoyed“So, I basically need to learn a completelydifferent approach…”
“Or do I?”
Confusion with a goal ofreducing confusion
Panic
After Some Contemplation….
So, why do I continue to move away from CBT toward ACT?
•CBT does focus on symptom reduction (this is actually in a CBT treatment contract –successful CBT treatment is defined as a decrease in frequency and intensity of sx’s)
•As a result, CBT is taught and CBT therapists inadvertently encourage emotional avoidance strategies
•Even when you use emotional approach strategies like Exposure therapy (why else are you asking about SUDS going down and teaching about habituation?)
•It may also even strengthen the belief the client has about: “If I can get rid of or decrease x, then I can have a life”.
•A “symptom reduction” model seems to get into predictable stuck places (i.e., endless, exhausting attempts at making internal, unwanted processes go away).•Unless you find a way to address: “If I get rid of x, then I will get a life”, CBT strategies can end up being ineffective or short-lasting.•Research by Craske and others is showing some of the flaws and problems in the traditional CBT approach - and her findings are lining up better with ACT principles than traditional CBT principles in some cases (i.e., there is no way of getting “rid of” unwanted internal experiences)!
Current Conclusions
But, I’m not sure I have drunk the Kool-Aid quite yet…
Session 1
As you watch this video, try to determine:
which interventions seem CBT-informed?which interventions seem ACT-informed?whether the client response to the various interventions seemed to move her forward or not?what seemed to work and not work in this session?how similar is this to what you currently do in session with similar clients?what would you have done differently?
Session 2
As you watch this video, try to determine:
which interventions seem CBT-informed?which interventions seem ACT-informed?whether the client response to the various interventions seemed to move her forward or not?what seemed to work and not work in this session?how similar is this to what you currently do in session with similar clients?what would you have done differently?
Session 3
As you watch this video, try to determine:
which interventions seem CBT-informed?which interventions seem ACT-informed?whether the client response to the various interventions seemed to move her forward or not?what seemed to work and not work in this session?how similar is this to what you currently do in session with similar clients?what would you have done differently?
Where Are You in Your Journey?
•Are you finding yourself running up against obstacles and challenges as you work to either incorporate ACT into your work or try to transition fully into an ACT model?•If so, what are they? •How are you addressing them?
•What would you say your strengths and weaknesses are as a: •CBT therapist?•ACT therapist? •Therapist in general?
My Own Self-Assessment
•For me, CBT and ACT are different and overlapping approaches.
•My strategy has been to increasingly transitioning from a CBT emphasis on “symptom reduction” to an ACT empahsis on “psychological flexibility” and “emotional experiencing”.
•I have been doing this by taking what I know from CBT and seeing what still works (with or without some tweaking) and what needs to be completely overhauled?
My Own Self-Assessment
•I continue to emphasize skills training•Though the skills I teach now are a little different
• I still target cognitive flexibility•But my interventions look increasingly like defusion (I was never a cognitive restructuring fan).
•I still use behavioral activation (this seems like a direct translation of committed action to me) •However, I spend a lot more time getting the client better connected to their values
My Own Self-Assessment
•I have always used metaphors and analogies•Though ACT helps me understand better why I use these and why they work when they do
•I modify the language I use when I use exposure therapy•They will get more “bang for their buck” if they use willingness and acceptance during exposure
•I strongly believe that ACT has a better response to: “If I feel less x, then I can go have a life”•I struggle with pushing that agenda too hard and am still clumsy (over explaining) about helping the client get to this same wisdom on their own without encouraging them to “get it”
My Own Self-Assessment
•Though I’m an exposure therapist and have trained in DBT (which encourages in session exercises), I struggle to incorporate ACT exercises into my sessions preferring explanation over demonstration.
My Journey: Part 2
What I personally/professionally continue to find difficult and challenging: •I still find myself being too verbal and “explainy”•Though even when I catch myself I still have a hard time switching gears
•I am still pretty invested in the client “figuring it out” and “getting” the “right answer”•I realize that workability is the bottom line in ACT. That said, I still feel there is a stronger emphasis on “never focus on emotional control” than I seem to be comfortable with.
