Unique Processes of Change in ACT; Bringing Context into the - - PowerPoint PPT Presentation

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Feb 01, 2024 425 likes •641 views

Obstacles in Identifying the Unique Processes of Change in ACT; Bringing Context into the Conversation Jacqueline Stump Neil McLean Mitch Hart Private Practice PhD Candidate Lecturer School of Psychological Science School of Psychological

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Obstacles in Identifying the Unique Processes of Change in ACT; Bringing Context into the

Conversation

Neil McLean

Lecturer School of Psychological Science University of Western Australia Mitch Hart Private Practice

Jacqueline Stump

PhD Candidate School of Psychological Science University of Western Australia

Jacqueline. stump@research.uwa.edu.au

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ACT: New wave or old hat?

Ongoing conversation regarding the place that ACT holds in the therapeutic landscape, and its relationship to CBT

New wave
Third wave
Under CBT umbrella

Emerging conversation regarding what is ACT

Hexaflex of the six core processes
Psychological flexibility
Constantly growing/changing/evolving

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Hayes & Hofmann, October 2017

“In part because of its greater process focus, modern CBT and evidence‐based therapy is more open to the investigation of a wider range of approaches from humanistic, existential, analytic, and spiritual traditions. This promises over time to reduce the dominance within intervention science of walled off schools of thought, or trademarked intervention protocols, and to bring different wings of the field together in an evidence‐based search for coherent and powerful sets of change processes.”

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Expected Themes

CBT ACT Cognitive:

Loosening of unhelpful core beliefs
More realistic view of the world
Challenging automatic thoughts
Relationship between

events/thoughts/feelings Behavioural:

Activation
Goal Setting
Problem Solving
Testing out hypotheses
Defusion
Expansion
Connection
Self as context
Values
Committed action

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Putting it to the Test

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Outcomes: Stress Scores

N=62

0.00 5.00 10.00 15.00 20.00 25.00 Pre Post Follow up Mean Stress Scores ACT CBT

(DASS_Stress Subscale)

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Outcomes: General Health Scores

N=62

1 2 3 4 5 6 Pre Post Follow up Mean GHQ Score ACT CBT

GHQ

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Clinical Significance

Clinical Significant Change

Recovered Improved Unchanged Deteriorated

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Process Measures: AAQII

5 10 15 20 25 30 35 40 Pre Post Follow Up Mean AAQII SCore

AAQII

ACT CBT

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Process Measures: MAAS

10 20 30 40 50 60 70 Pre Post Follow Up Mean MAAS Score

MAAS

ACT CBT

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Process Measures: MCQ & DAS

20 40 60 80 100 120 140 160 Pre Post Follow Up Mean DAS Score

DAS

ACT CBT 10 20 30 40 50 60 70 80 Pre Post Follow Up Mean MCQ Score

MCQ

ACT CBT

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Client Diaries

Common therapeutic processes Shared CBT ‘umbrella processes’ ACT specific processes?

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An argument for general factors?

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Two possible explanations Is there a more helpful way of making sense of this?

There is no difference

Pathways of change between ACT and

CBT are more similar than you might expect

Unique processes in studies of this

magnitude are extremely well hidden…

There is a difference and we failed to identify it

Type II error
Measure selection
Measure frailty
Therapist factors
Insufficient treatment length
Timing/frequency of measure

administration

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Apply the filters

1. RFT principles 2. Adaptation into meaningful therapeutic processes 3. Interpretation of processes into ACT experiential exercises 4. Application of ACT based exercises into complete therapy protocol 5. Adaptation for a Stress-based focus 6. Incorporate necessary extra-therapeutic tasks

Consent
Psychoeducation
Homework review
Check-ins etc…

7. Add group processes

Interpersonal differences
Participant preference
Timing & pacing
Dealing with absences

8. Add therapist filter 9. Add contextual factors/individual differences

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A breakdown of feedback to the master copy?

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Future Directions

Ongoing dialogue between researchers and clinicians
Greater specificity in measures for both models
A more refined understanding of what it means to ‘ACT’ and how that is

similar/differs from the CBTers; even if this is a moving target

A more explicit relationship between RFT principles and ACT based

techniques

Applications for funding for bigger studies
Continuation of this conversation
An engaged, collaborative interaction at conferences, in books, in

publications, and in the lunch room Build bridges if you can ... they are far stronger than walls.

- Steve Hayes.

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Jacqueline.stump@research.uwa.edu.au

Jacqueline Stump

PhD Candidate School of Psychological Science University of Western Australia

Neil McLean

Lecturer School of Psychological Science University of Western Australia Mitch Hart Private Practice