1. ACT As A Brief Intervention Model
Kirk Strosahl Ph.D.
ACT World Con III

2. Why Brief Interventions?
Average number of therapy sessions: 4-6
Modal number of sessions: 1
Dose effect analyses fail to show linear trend between session number and outcome
50% of therapy gain within first 4-8 sessions
Rapid response literature growing
Increased pressure from payers to complete therapy in fewer sessions
Increasing number of contexts where brief encounters are the norm (i.e., primary care, schools)
New models for delivering behavioral health services, i.e., primary care consultation

3. Toxic Assumptions
That you have to build “rapport” in a particular way to be effective
That therapy “drives” behavior change, ergo, the more therapy the better
The one hour therapy session is the only way to create change
That chronic suffering can only be address with long term therapy
That small changes don’t make a difference when people have big problems
That the patient’s descriptions of symptoms, suffering and causes are scientifically accurate

4. Basic Issues in Brief Intervention
Competing Theories of Human Suffering
Bio-Medical model
Emphasizes pathology, symptoms and syndromes, disease concepts, and a focus on somatic treatment
Less weight attached to person and environment interactions, context for behavior and the role of language in shaping dysfunctional behavior
Many syndromes share the same symptoms and respond to the same treatments
Emphasizes treatment over time

5. Basic Issues in Brief Intervention
Competing Theories of Human Suffering
Stress-coping-vulnerability models
Emphasis on delicate relationship between stress and coping responses
“Symptoms” occur when coping responses are insufficient to manage stress over time
Emphasis on building positive coping responses and/or decreasing stress
Interventions tend to be more situation specific and time limited

6. Basic Issues in Brief Intervention
Competing Theories of Change
Theory of big change (“cure”)
People are “broken” and need to be fixed
Success if defined by the elimination of symptoms and eliminating underlying causes
Treatments tend to be staged and longer
Goal setting often emphasizes large changes in behavioral, cognitive and emotional functioning
Historically has been very ineffective with more complicated patients

7. Basic Issues in Brief Intervention
Competing Theories of Change
Theory of strategic change (function)
From a person-environment perspective, small behavior change can have a domino like effect
Evidence shows that small changes are easier to make than big changes
Focus on using coping skills that work and stopping what doesn’t work
Small change builds “self-efficacy” or the conviction that one can make changes
Basis of many evidence based treatments

8. Basic Issues in Brief Intervention
Competing Theories of Agency
Provider driven change (therapist in charge)
Places patient in subordinate role
Provider assumes more responsibility for solving the patient’s problems
Generally requires longer and more frequent contacts
Runs the risk of engendering dependence, passivity, low motivation for change and non-adherence

9. Basic Issues In Brief Intervention
Competing Theories of Agency
Patient driven change (patient is in charge)
Places patient in co-equal role with provider
Responsibility for behavior change shifted to patient
Emphasis on patient education, basic goal setting with consultation from provider
Change occurs in real life settings, not in the provider’s office
Leads to greater motivation, adherence and better delineation of “boundaries”

10. Basic Brief Intervention Theory
Establish a single entry point
Pull the patient outside the normal frame of reference
The “problem” is not the problem; the “solution” is the problem
Emphasize acceptance of the ongoing stream of experience while behaving differently
Get the patient to “own” the need for and ability to change from negative to positive momentum
Focus on increasing positive behaviors, rather than on eliminating negative behaviors
Encourage limited, specific behavior change

11. ACT Brief Intervention Principles
Normalize and validate “toxic” private events that are the natural sequelae of being alive
Reframe the issue from “whether to” to “how to” experience what is there to be experienced
Emphasize approach toward rather than retreat from response ableness
Use spontaneous contact with mindfulness to help patient see an alternative
Get the patient to “stand for something”
Focus on small, value consistent actions

12. ACT Brief Intervention Strategies
Is there anything in front of you here that you are not big enough to have?
What if the goal were not to feel good, but to feel it good?
Are you having this? Or is it having you?
Looks like the more you try to control this thing, the more uncontrollable it becomes. What about just letting it be what it is?
What would make what you are going through here honorable, legitimate and purposeful?
You don’t have to do this perfectly—just get from point A to point B.

13. ACT Brief Intervention Strategies
What do you think life is trying to teach you here?
Is there anything about how you’re feeling, right here, right now that you would not be willing to feel?
What do you want to stand for here?
What will make you feel like you’ve grown as a human being when this situation is done?
It sounds like your mind is telling you to do things that your experience says doesn’t work.
If you were free to choose how to respond here, what would you like to do?
Is there anything standing in the way of you and what you want to be about here?

14. Video and Exercise: Patient With Multiple Family Stresses/Depression
Two Teams:
One: Focus on content level, client level of analysis, insight into causes, the client’s story, “therapist bait”
Two: Focus on function of symptoms, core ACT processes and ACT relationship factors
Debrief: Was this ACT consistent? Not? Mixed?
Other intervention strategies you might use?