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 w

ith re

spon

se pr

even

tion

Beck

’s Co

gnitiv

e Th

erap

y

Dialectical Behavior Therapy

Mind

fulne

ss B

ased

Cog

nitive

The

rapy R

ational Emotive Behavior Therapy

Acceptance and Com

mitm

ent Therapy

Schema Therapy

Barlow’s U

nified Protocol Cog

nitive

The

rapy

for O

CDFu

nctio

nal A

nalyt

ic Ps

ycho

ther

apy

Met

acog

nitiv

e Th

erap

y

Many othersProlonged Exposure

Mindfulness Based Stress R

eduction

C B T

Motiva

tiona

l Inter

viewing

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