In this lesson you will get some background, the reason why ACT developed the way it did, and that will help to contextualise the roots of of this work.

ESSENTIAL: Click on this link to watch the video. This will take you to a platform called Media Hopper. The video can be made full screen, by clicking on the two diagonlal arros in the menu bar below the video. In addition, if you hover over the video with your mouse, two horizontal arros will appear on the right of the screen. By clicking on the two horizontal arrows you can switch between seeing the presenter or the slides as the larger of the two windows. You can also pick up the 'within picture' part of the video and move it around so that you can put the smaller picture window where you want it, for example if it is obscuring some text on a slide.

You can also choose to have the presenter and slide view equal in size or one smaller than the other, by clicking on the small TV picture icon just below the two horizontal arrows. Again this only appears when you hover over the video with your mouse.

ESSENTIAL: Respond to the question(s) using the comments function below

ADDITIONAL: Download and read the paper by Robert Zettle

In this session you will get an introduction to the ACT Hexaflex model of Psychological Flexiblity. The six core processes leading to inflexibility are described and explained, with brief examples: Experiential Avoidance, Cognitive Fusion, Being caught up in the past or future, Attachment to a narrowly defined conceptualised self, Lack of awareness of values, and Inaction. In addition you will learn about the six core Psychological Flexibility processes that are the flip side: Accetpance, Cognitive Defusion, Present Moment Awareness, Self as Context, Values and Comitted Action. 

As well as learning ACT conceptually, this lesson will also introduce these processes experientially. You will find below six audio recordings that each focus on one (or more) of the core processes, to give you a flavour of how they feel from the inside and to give you a chance to begin learning how to conduct experiential exercises that can evoke these processes.

A word about Experiential Learning

We are offering these audio exercises as an invite to step inside the ACT processes. They are typical of the kinds of exercises that you might use with clients. They can be powerful and meaningful. We would like you to gve them a try in a spirit of invitation. There is absolutely no coercion here. Only you can know what is happening in your life right now and whether any exercise is right for you. Download the guide and disclaimer document below, which will give you more of a feel for what each exercise is trying to do. Make a choice about your own level of willingness. Choose a time when you will be in a place that is comfortable for you and you are not likely to be interupted. Choose a place where you can give the exercises your full attention. Don't listen whilst driving and so on. We reccommend not doing them all at once, but spreading them out over a few days. After listening, journal about your experience of listening, connecting with the process. What did you notice? How did you respond? 

ESSENTIAL: Watch this Introduction Video Here

ESSENTIAL: Watch this narrated PowerPoint that describes the ACT model conceptually

ESSENTIAL (but invitational - you can say no): Download and read the guide and then listen to the six audio tracks below to explore psychological flexibility from the inside.

ESSENTIAL: (but invitational - you can decide what you feel safe enough to share): Use the comments below to share extracts from your journalling, as you encounter these processes from the inside.

ADDITIONAL: Download and read the paper by Mike Twohig

In this lesson we begin to look at how to apply the principles you have been learning with clients. The examples we use are in clinical or health settings, but the same model and principles apply if you are working in coaching, organisational psychology, education, social work or other fields. 

In our assessment we do use a lot of generic core skills and we ask very similar types of questions that you might already be familiar with. We ask our client to tell us about what has brought them for therapy, what their problems are, how they began and developed. We emphasise how they are responding to their issues and what the consequences of their responses are, perhaps more than many other models of therapy. We also ask them to talk about what they would most want in life if they weren't struggling with these issues. The learning activities for this lesson are:

 

ESSENTIAL: Watch this video presentation about assessment and case conceptualisation

ESSENTIAL: Watch these two videos of David working with John, a man with Irritable Bowel Syndrome. Video One   Video Two      Be sure to share reflections or ask questions about these videos in the comments on this page.

ESSENTIAL: Download and review this blank case conceptualisation form that is mentioned in the presentation. Also download this version of the form that has been completed for John (the client with IBS). 

ESSENTIAL: Take the time to work through the blank form thinking of a client that you know well. It can be someone you are curently working with or someone you have worked with in the past. Use this form to create a case conceptualisation for that client. In the live sessions you will be gven the option to roleplay being your client in a small group. Be aware of confidentiality and consider changing a few details if you need to to protect that. You will bring these case conceptualisations to the live sessions so keep the form somewhere safe. The idea is to give people a chance to have a practice, so its a good idea to choose someone who your peers in this workshop could work with (its not an opportuntity to show others how complex your caseload is!) That said, you also don't want it to be too easy, try and find a case where the person is stuck and has tried a lot of different things, but that is not so stuck that it will be hard to even get going with them. 

This form is to help you think it through, and isn't necessarily something you would share with the client or work with the client on, though you could have it as a guide as you engage in the collaborative process of assessment.

ESSENTIAL: Post in the comments below about the process of thinking through your client this way, and use the comments to ask any questions or clarify anything unclear.

As you saw in the work with John, we move through a process of assessment and 'workability analysis' in the early stage of intervention. This process is referred to as 'Creative Hopelessness' and it is one of the most challenging parts of the model for many therapists. We are actively and persistently walking into the stuckeness with our client to help them to contact the consequences of the things they have done to try and be rid of their problems. In so doing, we will likely encounter pain, frustration, disappointment and regret to name just a few. We want the client to be in touch with a feeling that 'the strategy I am using to control or get rid of this problem is not working and will be unlikely to work' - we wnt them to get hopeless about that strategy. We do this so that they will let go of responses (strategies) that don't work, to allow more creative, new strategies to be shaped.

It can be helpful in this stage to use a metaphor to illustrate how you are understanding the problem and what your work together will be about. There are many metaphors that serve this purpose of organising the work, in this lesson you will see david continuing to work with John and develop the Sailing Boat Metaphor.

This lesson's learning activities are:

ESSENTIAL: Watch this video of Intervention Strategies in ACT

ESSENTIAL: Watch this video of continuing the work with John

ESSENTIAL: Ask questions and provide your reflections in the comments below.

In this lesson we show you another commony used metaphor: The Passengers on the Bus. We also walk you through how metaphors work, giving a little glimpse into Relational Frame Theory. In the therapy video you will see I also weave into the basic metaphor other ACT interventions strategies - in particular the use of 'Physicalizing' thoughts, giving them a name, creating perspective on them. This metaphor has such broad use and it can very helpfully organise the work in any setting. 

ESSENTIAL: Watch this video of David working with Anne - a woman with social anxiety and low self esteem. 

ESSENTIAL: Watch this video of how metaphors work

Feel free to make reflections, comments and questions in the comments below.

ADDITIONAL: Download and read this paper on the RFT understanding of metaphor

 

And that is also the end of the pre workshop flipped classroom learning. We hope you have digested, reflected, assimilated and taken on some of these ideas, we look forward to seeing you live and helping you to use the skills and knowledge that you have been learning here to work with your clients, to address your own barriers to interventions and to deepen your practice of ACT.

The activities on this page are all optional, if you want to see more about how things went with John, the man with IBS, you can have a look at the following videos:

Willingness

From willingness to values

From values to action

These also give a sense of how the work might unfold. You dont see me doing a lot of defusion or self related work with John, its more about the processes described.

Further reading and links to other resources:

This is my developmentally paced reading list:

ACT Reading list May 2021

* indicates my recommended picks

Getting started gently (light reading)
*Twohig, M. P. (2012). Acceptance and Commitment Therapy. Cognitive and Behavioral Practice, 19(4), 499–507. doi:10.1016/j.cbpra.2012.04.003

*Batten, S. (2011) Essentials of Acceptance and Commitment Therapy, London, Sage Publications Ltd.

OK: so I see the idea, how do I know the evidence is up to scratch?
Graham, C. D., Gouick, J., Krahé, C., & Gillanders, D. (2016). A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clinical Psychology Review, 46, 46–58. http://doi.org/10.1016/j.cpr.2016.04.009

A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. a J., & Emmelkamp, P. M. G. (2014). A Meta-Analysis of the Efficacy of Acceptance and Commitment Therapy for Clinically Relevant Mental and Physical Health Problems. Psychotherapy and Psychosomatics, 84(1), 30–36. doi:10.1159/000365764

Swain, J., Hancock, K., Dixon, A., & Bowman, J. (2015). Acceptance and commitment therapy for children: A systematic review of intervention studies. Journal of Contextual Behavioral Science, 1–13. doi:10.1016/j.jcbs.2015.02.001

Levin, M. E., Hildebrandt, M. J., Lillis, J., & Hayes, S. C. (2012). The impact of treatment components suggested by the psychological flexibility model: a meta-analysis of laboratory-based component studies. Behavior therapy, 43(4), 741–56. doi:10.1016/j.beth.2012.05.003

Ost, L.-G. (2014). The efficacy of Acceptance and Commitment Therapy: an updated systematic review and meta-analysis. Behaviour Research and Therapy, 61, 105–21. http://doi.org/10.1016/j.brat.2014.07.018

Atkins, P. W. B., Ciarrochi, J., Gaudiano, B. A., Bricker, J. B., Donald, J., Rovner, G., … Hayes, S. C. (2017). Departing from the essential features of a high quality systematic review of psychotherapy: A response to Öst (2014) and recommendations for improvement. Behaviour Research and Therapy. http://doi.org/10.1016/j.brat.2017.05.016

Ost, L. G. (2017). Rebuttal of Atkins et al . ( 2017 ) critique of the Ost (2014) metaanalysis of ACT. Behaviour Research and Therapy, 97, 273–281. https://doi.org/10.1016/j.brat.2017.08.008
See the editor’s note and all three articles here: https://www.sciencedirect.com/science/article/pii/S0005796717302486

Stockton, D., Kellett, S., Berrios, R., Sirois, F., Wilkinson, N., & Miles, G. (2019). Identifying the underlying mechanisms of change during acceptance and commitment therapy (ACT): A systematic review of contemporary mediation studies. Behavioural and Cognitive Psychotherapy, 47(3), 332–362. https://doi.org/10.1017/S1352465818000553

Gloster, A. T., Walder, N., Levin, M., Twohig, M., & Karekla, M. (2020). The Empirical Status of Acceptance and Commitment Therapy: A Review of Meta-Analyses. Journal of Contextual Behavioral Science, 18(September), 181–192. https://doi.org/10.1016/j.jcbs.2020.09.009

WOW: There seems to be something in here, so how do I learn how to do it?
*Join the Association for Contextual Behavioural Science (ACBS) at www.contextualscience.org Minimum fee is $15 and you can download lots of articles, therapy materials, measures etc. You can see my training page there with lots of goodies, including mp3 audio files of exercises: http://contextualscience.org/david_gillanders_training_page

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and Commitment Therapy (2nd Edition): The Process and Practice of Mindful Change (2nd ed.). New York: Guilford Press.

Harris, R. (2009). ACT made simple : an easy-to-read primer on acceptance and commitment therapy. Oakland: New Harbinger. (You can even download the first two chapters for free along with lots of other goodies at: http://www.thehappinesstrap.com/free_resources )

Stoddard, J. A., Afari, N. A., Hayes, S. C. (2014) The Big Book of ACT Metaphors: A Practitioner’s Guide to Experiential Exercises and Metaphors in Acceptance and Commitment Therapy. Oakland CA: New Harbinger

Luoma, J., Hayes, S., & Walser, R. Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual (2nd Edition). New Harbinger, 2018. 

*Villatte, M., Villatte, J. L., & Hayes, S. C. (2016). Mastering the Clinical Conversation: Language as Intervention. New York: Guilford Press. (also a website to support this work with videos: https://languageasintervention.com

Westrup, D. (2014). Advanced Acceptance & Commitment Therapy. Oakland, CA: New Harbinger Publications.

I’m hooked: give me more!
*Wilson, K. G., & Dufrene, T. (2008). Mindfulness for Two: An acceptance and commitment therapy approach to mindfulness in psychotherapy. New Harbinger, Oakland. Its also supported by a website http://www.onelifellc.com/Workshop_Goodies.html

Tirch, D., Schoendorff, B., & Silberstein, L. R. (2014). The ACT Practitioner’s Guide to the Science of Compassion: Tools for Fostering Psychological Flexibility. Oakland CA: New Harbinger.

Polk, K. L., Schoendorf, B., Webster, M., & Olaz, F. O. (2016). The Essential Guide to the ACT Matrix: A step by step approach to using the ACT Matrix model in clinical practice. Oakland, CA: New Harbinger Publications.

Mmmm, maybe I need more background in behaviour analysis…

*Ramnero, J., & Torneke, N. (2008). The ABC’s of Human Behavior: Behavioural Principles for the Practicing Clinician. New Harbinger, Oakland, CA.

http://www.tastybehaviorism.com/Welcome.html

I am a psychology geek and I want to know everything…
Zettle, R. D. (2005). The Evolution of a Contextual Approach to Therapy : From Comprehensive Distancing to ACT. International Journal, 1(2), 77-89.

Wilson, K. G. (2001). Some Notes On Theoretical Constructs: Types and Validation from a Contextual Behavioral Perspective. International Journal of Psychology and Psychological Therapy, 1(2), 205-215.

My brain is exploding but I need more – give me the strongest stuff you’ve got!!!!!!
Torneke, N. (2010). Learning RFT: An Introduction to Relational Frame Theory and its Clinical Application. Context Press, Reno, NV.

Foody, M., Barnes-Holmes, Y., Barnes-Holmes, D., Törneke, N., Luciano, C., Stewart, I., & McEnteggart, C. (2014). RFT for clinical use: The example of metaphor. Journal of Contextual Behavioral Science, 1–9. doi:10.1016/j.jcbs.2014.08.001

Foody, M., Barnes-Holmes, Y., Barnes-Holmes, D., & Luciano, C. (2013). An empirical investigation of hierarchical versus distinction relations in a self-based ACT exercise. International Journal of Psychology and Psychological Therapy, 13(3), 373–385.

Barnes-Holmes, Y., Boorman, J., Oliver, J. E., & Thompson, M. (2018). Using conceptual developments in RFT to direct case formulation and clinical intervention : Two case summaries. Journal of Contextual Behavioral Science, 7(November 2017), 89–96. https://doi.org/10.1016/j.jcbs.2017.11.005

This is more than just a therapy – this is a vision of a different kind of psychology, tell me more…
Hayes, S. C., Barnes-Holmes, D., & Wilson, K. G. (2012). Contextual Behavioral Science: Creating a science more adequate to the challenge of the human condition. Journal of Contextual Behavioral Science, 1(1-2), 1–16. doi:10.1016/j.jcbs.2012.09.004

Wilson, D. S., Hayes, S. C., Biglan, A., & Embry, D. D. (2014). Evolving the future: Toward a science of intentional change. Behavioral and Brain Sciences, 37(4), 395–416. http://doi.org/10.1017/S0140525X13001593

Biglan, A. (2015). The Nurture Effect: How the science of human behavior can improve our lives and our world. Oakland, CA: New Harbinger Publications.

I don’t like reading too much, isn’t there an easier way?
Russ Harris’s YouTube Channel: https://www.youtube.com/channel/UC-sMFszAaa7C9poytIAmBvA/videos

Online Learning Courses from Russ Harris: Psychwire

Free Videos from ACBS: https://contextualscience.org/free_videos

Arthurs Place: A resource for young people with Juvenile idiopathic arthritis. I  (David) made three short films for them about using ACT strategies to live well with persistent health problems:

https://www.youtube.com/watch?v=wK_RKnSGYdU
https://www.youtube.com/watch?v=Wl046560jno&t=2s
https://www.youtube.com/watch?v=11sCEJI7hCI

Acting out the Passengers on the Bus Metaphor in Group Therapy
https://www.youtube.com/watch?v=hdeA-FKDLLc

Purchase the ACT in Action DVD’s (Steven Hayes) to stream:
https://www.psychotherapy.net/video/steven-hayes-act

Online and in person training (Primarily US based) (including some free videos and webinars)
https://www.praxiscet.com/

The ACT Matrix Academy
https://www.theactmatrixacademy.com/

Dr Kevin Polk
http://www.drkevinpolk.com/learn-about-act/

Podcasts

People Soup - a podcast by Ross McIntosh about psychological flexibility in teams, organisations and life in general

Psychologists Off the Clock - a podcast about the science and practice of living well

Cocktails & Courageous Conversations - webinar / conversations by Rikke Kjelgard

The original ACT in Context Podcast