ACT II:
Specific Examples from an ACT Trial
Jon Abramowitz, Laura Fabricant, & Ryan Jacoby
Clinical Lunch Spring 2014
Overview
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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)
ACT Principles
I spend most of my time paying
attention to what is happening in the
present moment
I willingly accept my
thoughts and feelings
even when I don’t like
them
10
9
8
7
6
5
4
3
2
1
10 9
ACCEPTANCE
SCALE
87
65
43
DEFUSION
SCALE
I see each of my thoughts
as just one of many ways
to think about things –
what I do next is up to me
10 9
21
21
43
5
6
87
I constantly
struggle with
my thoughts
and feelings
ATTENTION
TO PRESENT
SCALE
I spend
most of my time lost
in thought about the
past or future
My thoughts tell me
how things really are,
and determine what I
do next
Deep down, my
thoughts and
feelings are the
real me
SELF AS
OBSERVER
SCALE
3
1 2
I don’t know
what I want
from life
I don‘t manage
to act on the
things I care
about
1
2
3
4
5
6
7
8
9
10
My thoughts and feelings
come and go, but deep down
the real me doesn’t change
8
67
45
9 10
I am clear about
what I choose to
value in life
VALUES
IDENTIFICATION
SCALE
12
34
56
COMMITMENT &
TAKING ACTION
SCALE
78
9 10
I work out what I need to
do about the things I care
about, and
I see it through
Our study: Exposure + ACT
Our Study
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How did we get interested in ACT?
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Our study
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An ACT perspective on OCD: 3 parts
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Exposure from an ACT framework
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Similarities and differences (SUDS vs. willingness)
Exposure therapy to facilitate the ACT processes
ACT Techniques
Acceptance
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Willingness to experience internal events
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Examples from OCD patients
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Metaphors and techniques
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“Jerk at the door”
Chessboard
Exposure
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Habituation vs. fear tolerance
Defusion
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Distancing and disconnecting from thoughts
Seeing thoughts and feelings for what they are, not what
they say they are
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Examples from OCD patients
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Metaphors and techniques
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Milk, Milk, Milk
Passengers on the bus
Imaginal exposure
Passengers on the Bus Metaphor
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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
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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?
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You can allow them to shout and keep your attention focused
on where you want to go
Values
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Choosing what direction one wants life to take (not
letting OCD choose the direction life goes)
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Examples from OCD patients
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Metaphors and techniques
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Bull's-eye
Moving through a swamp
Exposure
B U L L ’S E Y E IL L U S T R A T IO N
M y life is just as I
w ant it to be
W o rk/
E d u ca tio n
P erson al g row th/
H ealth
M y life is far from
how I w ant it to be
beifrån d et jag
önskar
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What do you value?
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What do you want
your life to be
about?
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What do each of
these categories
mean to you?
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In what ways has
OCD been getting
in the way of living
life in the direction
of your values?
L eisu re
R ela tio n ships
Moving through a swamp
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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?
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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!)
Exposures and values
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Emotional moves vs. values moves
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Motivation
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Anxiety reduction is not an explicit goal
Successful outcome = you doing something important to
you despite having anxiety
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Discussion
Discussion
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How could we apply these techniques to other problems?
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Similarities and differences with other therapies?
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Questions?
Thank you!