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Transcript of Brandon A. Gaudiano, Ph.D. Alpert Medical School of Brown University & Butler Hospital ACBS World...
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
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
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