1. Acceptance & Commitment Therapy: Applications with ID/DD Clients
Judith Hill-Weld, M.S., LMFT
NADD Annual Conference 2018

2. Acceptance & Commitment Therapy: Concepts
ACT is based on Relational Frame Theory (RFT):
“Human behavior is governed largely through networks of mutual relations called relational frames.”
(Hayes & Smith, Get Out of Your Mind and Into Your Life, 2005)
Acceptance & Commitment Therapy: Concepts
J. Hill-Weld, NADD 2018

3. Acceptance & Commitment Therapy: Concepts
“The aim of ACT, in lay terms, is to create a rich, full, and meaningful life while accepting the pain that inevitably goes with it.”
(Harris, ACT Made Simple, 2009)
Acceptance & Commitment Therapy: Concepts
J. Hill-Weld, NADD 2018

4. Acceptance & Commitment Therapy: Concepts
Six Core Therapeutic Processes
Present Moment Awareness
Defusion
Acceptance
Self as Context
Values
Committed Action
Acceptance & Commitment Therapy: Concepts
J. Hill-Weld, NADD 2018

5. Acceptance & Commitment Therapy: Concepts
Six Core Processes Combined = Psychological Flexibility
A = Accept your thoughts & feelings & be present with them
C = Choose a valued direction
T = Take action
Acceptance & Commitment Therapy: Concepts
J. Hill-Weld, NADD 2018

6. Acceptance & Commitment Therapy: Concepts
Cognitive fusion + experiential avoidance vs. Psychological flexibility
Acceptance & Commitment Therapy: Concepts
J. Hill-Weld, NADD 2018

7. Acceptance & Commitment Therapy: Research
Not much research available on ACT in ID/DD populations for dual diagnosis tx
More research focused on parents or support staff participating in ACT therapy or psychotherapeutic education
Or, on ACT targeting core disability regardless of dual diagnosis status
Acceptance & Commitment Therapy: Research
J. Hill-Weld, NADD 2018

8. Acceptance & Commitment Therapy: Research
Acceptance and Commitment Therapy with Dually Diagnosed Individuals
Dissertation by Julieann Pankey at University of Nevada, Reno, 2008
She developed a 4 session ACT protocol for people with Borderline Intellectual Functioning, Mild Intellectual Disability, and Moderate Intellectual Disability
Acceptance & Commitment Therapy: Research
J. Hill-Weld, NADD 2018

9. Acceptance & Commitment Therapy: Research
Three articles that specifically mention dual diagnosis and ACT:
Brown, F. J., & Hooper, S. (2009). Acceptance and Commitment Therapy (ACT) with a learning disabled young person experiencing anxious and obsessive thoughts. Journal of Intellectual Disabilities, 13(3),
Kangas, M., & McDonald, K. (2011). Is it time to act? The potential of acceptance and commitment therapy for psychological problems following acquired brain injury. Neuropsychological Rehabilitation, 21,
Rostami, M., Veisi, N, Dehkordi, F. J., & Alkasir, E. (2014). Social anxiety in students with learning disability: Benefits of Acceptance and Commitment Therapy. Practice in Clinical Psychology, 2,
Acceptance & Commitment Therapy: Research
J. Hill-Weld, NADD 2018

10. Acceptance & Commitment Therapy: Six Core Processes
J. Hill-Weld, NADD 2018

11. Acceptance & Commitment Therapy: Strengths & Challenges
Why do I like using ACT with children and adults with intellectual and developmental disabilities?
Values focus can be person-centered, client directed
Emphasizes living a meaningful life, not just compliant one
Mindfulness skills reduce reactivity, increase emotional regulation
Psychological flexibility addresses dual dx and core disability
Experiential, humorous, metaphorical, novel
Acceptance & Commitment Therapy: Strengths & Challenges
J. Hill-Weld, NADD 2018

12. Acceptance & Commitment Therapy: Strengths & Challenges
What are some dangers or drawbacks in using ACT with persons with ID/DD?
“Acceptance” can be interpreted as “be quiet, don’t protest or say no”
Difficult to teach when to “accept” and when to take action
When presented as “training” it can lose the emphasis on living a meaningful life
System (families, DSPs, peers, etc..) may resist
Cognitive deficits may restrict work in some of 6 processes
Difficulty separating private & public experiences may inhibit effectiveness
Acceptance & Commitment Therapy: Strengths & Challenges
J. Hill-Weld, NADD 2018

13. Acceptance & Commitment Therapy: The Therapist
In ACT, the therapist use her own psychological flexibility in a psychologically flexible manner, to help increase the client’s psychological flexibility
Our therapeutic work must be guided by our own effort to live a meaningful life
Our best work with clients will happen when we monitor our own willingness to stay flexible, present, and values-congruent
We have to be willing to move toward emotional pain with acceptance first, before we can help people change
Acceptance & Commitment Therapy: The Therapist
J. Hill-Weld, NADD 2018

14. Judith Hill-Weld, M.S. Licensed Marriage & Family Therapist PO Box 1891 Nevada City, CA
Contact Information
J. Hill-Weld, NADD 2018