ACT As A Brief Intervention Model

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ACT As A Brief Intervention Model

• Kirk Strosahl Ph.D.
• Patricia Robinson Ph.D.
• www.behavioral-health-integration.com
• mconsultinggrp_at_embarq.mail.com

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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

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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

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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

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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

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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 doesnt work
• Small change builds self-efficacy or the
  conviction that one can make changes
• Basis of many evidence based treatments

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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 patients problems
• Generally requires longer and more frequent
  contacts
• Runs the risk of engendering dependence,
  passivity, low motivation for change and
  non-adherence

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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
  providers office
• Leads to greater motivation, adherence and better
  delineation of boundaries

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Basic Brief Intervention Theory

• Gain a single point of entry into the problem
• This allows you to work with more concentration
  in one area without consuming more time
• If you try to do too many different
  interventions, you will automatically require
  additional sessions
• Remember the 80-20 rule Most of the gain comes
  from the first best guess intervention

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Basic Brief Intervention Theory

• Change the frame of reference
• A basic principle of brief strategic therapy
• When you recast the problem in a different

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Basic Brief Intervention Theory

• The problem is not the problem the solution
  is the problem

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Basic Brief Intervention Theory

• Emphasize acceptance of the ongoing stream of
  experience while behaving differently

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Basic Brief Intervention Theory

• Get the patient to own the need for and ability
  to change

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Basic Brief Intervention Theory

• Focus on increasing positive behaviors, rather
  than on eliminating negative behaviors

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Basic Brief Intervention Theory

• Focus on picking one small behavior change

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ACT Brief Intervention Principles

• Normalize and validate toxic private events
  that are the natural sequalae 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

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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 dont have to do this perfectlyjust get from
  point A to point B.

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ACT Brief Intervention Strategies

• What do you think life is trying to teach you
  here?
• Is there anything about how youre 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 youve 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 doesnt 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?