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The Future of ACT…
Brandon A. Gaudiano, Ph.D.Alpert Medical School of Brown
University & Butler HospitalACBS World Conference XII
June, 2014Minneapolis, MN
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Expand the technology
Expand the training of clinicians
Expand the role of behavioral intervention in the healthcare system
ACT Areas of Expansion
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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
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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
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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
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Exposure Behavioral Activation Skills Training Stimulus-Control Contingency Management Homework Cognitive Interventions (e.g., thought
records)
ACT-ifying CBT
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Self asContext
Contact with the Present Moment
Defusion
Acceptance
Committed Action
Values
Psychological Flexibility
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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
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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
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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.
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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
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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
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