Brandon A. Gaudiano, Ph.D. Alpert Medical School of Brown University & Butler Hospital ACBS World Conference XII June, 2014 Minneapolis, MN

 Expand the technology  Expand the training of clinicians  Expand the role of behavioral intervention in the healthcare system

Exposure with response prevention Beck’s Cognitive Therapy Dialectical Behavior Therapy Mindfulness Based Cognitive Therapy Rational Emotive Behavior Therapy Acceptance and Commitment Therapy Schema Therapy Barlow’s Unified Protocol Cognitive Therapy for OCD Functional Analytic Psychotherapy Metacognitive Therapy Many others Prolonged Exposure Mindfulness Based Stress Reduction C B T Motivational Interviewing

 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

 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

 Exposure  Behavioral Activation  Skills Training  Stimulus-Control  Contingency Management  Homework  Cognitive Interventions (e.g., thought records)

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

 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

Treatment1998, %2007, %AOR (95% CI) Psychotherapy only (0.48 – 0.90) Both together (0.59 – 0.90) Psychotropics only (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:

 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

 Possible Solutions: ◦ Steadfastly pursue functional contextual neuroscience to take back biology ◦ Advocate strongly for the role of behavioral interventions and influence public policy