ACT II: Specific Examples from an ACT Trial

1. ACT II:Specific Examples from an ACT Trial Jon Abramowitz, Laura Fabricant, & Ryan Jacoby Clinical Lunch Spring 2014

2. Overview • ACT principles • Our study on exposure therapy and ACT • Techniques to foster acceptance • Techniques to foster defusion • Techniques to pursue values • Discussion (applying ACT to other problems)

3. ACT Principles

4. I spend most of my time paying attention to what is happening in the present moment 10 9 8 7 6 5 4 3 2 1 ATTENTION TO PRESENT SCALE I willingly accept my thoughts and feelings even when I don’t like them I am clear about what I choose to value in life ACCEPTANCE SCALE I spend most of my time lost in thought about the past or future 10 10 9 9 8 8 7 7 6 6 5 5 4 4 3 3 2 2 1 I constantly struggle with my thoughts and feelings 1 I don’t know what I want from life VALUES IDENTIFICATION SCALE My thoughts tell me how things really are, and determine what I do next I don‘t manage to act on the things I care about DEFUSION SCALE Deep down, my thoughts and feelings are the real me 1 1 2 2 3 3 4 I see each of my thoughts as just one of many ways to think about things – what I do next is up to me 4 5 5 6 I work out what I need to do about the things I care about, and I see it through 6 7 7 8 8 9 9 10 COMMITMENT & TAKING ACTION SCALE 10 1 2 3 4 5 6 7 8 9 10 SELF AS OBSERVER SCALE My thoughts and feelings come and go, but deep down the real me doesn’t change

5. Our study: Exposure + ACT

6. Our Study • How did we get interested in ACT? • Our study • An ACT perspective on OCD: 3 parts • Exposure from an ACT framework • Similarities and differences (SUDS vs. willingness) • Exposure therapy to facilitate the ACT processes

7. ACT Techniques

8. Acceptance • Willingness to experience internal events • Examples from OCD patients • Metaphors and techniques • “Jerk at the door” • Chessboard • Exposure • Habituation vs. fear tolerance

9. Defusion • Distancing and disconnecting from thoughts • Seeing thoughts and feelings for what they are, not what they say they are • Examples from OCD patients • Metaphors and techniques • Milk, Milk, Milk • Passengers on the bus • Imaginal exposure

10. Passengers on the Bus Metaphor • You’re the driver and the passengers are your OCD related thoughts, feelings, physiological sensations, etc. • The passengers try to direct where the bus goes • They are loud and bossy about what you do • They quiet down when you do what they want • If you drive the bus where you want to go, what will happen? • You can allow them to shout and keep your attention focused on where you want to go

11. Values • Choosing what direction one wants life to take (not letting OCD choose the direction life goes) • Examples from OCD patients • Metaphors and techniques • Bull's-eye • Moving through a swamp • Exposure

12. What do you value? • What do you want your life to be about? • What do each of these categories mean to you? • In what ways has OCD been getting in the way of living life in the direction of your values?

13. Moving through a swamp • Swamp = OCD-related inner experiences and triggers • Exposure = learning how to handle whatever comes up while still moving forward through swamp • Willingness to go into the swamp without resisting (avoiding or using compulsive rituals) • Why are we doing this? • Getting dirty and muddy but for a purpose • Not wallowing in the swamp • Things you value are on the other side of the swamp (only way is through it!)

14. Exposures and values • Emotional moves vs. values moves • Motivation • Anxiety reduction is not an explicit goal • Successful outcome = you doing something important to you despite having anxiety

15. Discussion

16. Discussion • How could we apply these techniques to other problems? • Similarities and differences with other therapies? • Questions?

17. Thank you!