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

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)

ACT Principles

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

Our study: Exposure + ACT

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

ACT Techniques

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

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

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

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

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?

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!)

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

Discussion

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

Thank you!