ACT, Clinical RFT, and ERP: Getting Under the Hood of Exposure-Based Treatment
Epidemiological studies have estimated a lifetime prevalence rate of 28.8% for anxiety disorders (Kessler et al, 2005), and a recent meta-analysis of 87 studies across 44 countries estimated the global current prevalence of anxiety disorders at 7.3% (4.8–10.9%, adjusted for methodological differences across studies; Baxter, Scott, Vos, & Whiteford, 2013). While exposure-based treatment for anxiety and OCD in youth and adult populations has robust empirical support, there is room for improvement. In terms of outcomes, intent-to-treat analyses suggest that approximately 1 in 5 individuals drop out of exposure treatment (Hofmann and Smits, 2008; Ong et al. 2016), and a significant proportion either do not improve or relapse (eg Ginsburg et al., 2014; 2018). Moreover, clinicians are unlikely to use exposure-based treatment even when it is needed (Freihart et al, 2004; Deacon et al., 2013; Sars & Van Minnen, 2015), due to their own experiential avoidance (Meyer et al., 2014; Scher, Herbert & Forman 2015). To complicate matters, simply adding ACT to ERP does not lead to demonstrably improved outcomes (Twohig et al., 2018). So, while exposure works, it could work better, and clinicians could get much more skilled and flexible in its use. Very likely, this will take a patient-centered “microanalytic approach” (Twohig et al., 2018) to improve outcomes of exposure-based approaches.
That is the focus of this 2-day workshop: we hope to get “under the hood” of how exposure-based treatments work at the level of basic learning processes; to explore clinicians’ common myths and barriers to offering and “flexibly persisting” in using exposure-based treatment; and to demonstrate how to use ACT and clinical RFT to help enhance exposure-based treatment in developmentally sensitive ways for youths and adults. Acceptance and Commitment Therapy (ACT), and more specifically, clinical RFT, may be used to design and implement individualized exposure-based treatment across anxiety and OCD. Thus, this two-day workshop will teach how clinicians may use ACT and clinical RFT to enhance exposure-based treatment through supporting curiosity, willingness, and flexibility with individual cases across anxiety disorders and OCD. Specifically, the presenters will a) discuss behavioral (inhibitory learning) and neurobiological models of fear and uncertainty and exposure-based treatment; b) teach how to conduct exposure-based treatment with various presentations of anxiety and OCD; c) give an overview of ACT and its evidence-base; and c) demonstrate how to incorporate specific ACT interventions into flexible exposure to strengthen and contextualize inhibitory learning, d) address clinicians’ own barriers to consistently and effectively offer exposure-based treatments (knowledge, clinician psychological flexibility, myths about ERP). Participants will be given opportunities to engage in experiential exercises, role- and real-plays, and case discussions in which to practice the principles taught. Clinical examples will be used to illustrate therapeutic techniques, in addition to the workshop’s didactic content.
References
Baxter, A. J., Scott, K. M., Vos, T., & Whiteford, H. A. (2013). Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological Medicine, 43(5), 897-910.
Deacon, B. J., Farrell, N. R., Kemp, J. J., Dixon, L. J., Sy, J. T., Zhang, A. R., & McGrath, P. B. (2013). Assessing therapist reservations about exposure therapy for anxiety disorders: The Therapist Beliefs about Exposure Scale. Journal of Anxiety Disorders, 27(8), 772–80.
Freiheit, S. R., Vye, C., Swan, R., & Cady, M. (2004). Cognitive-Behavioral Therapy for Anxiety: Is Dissemination Working? the Behavior Therapist, 27(2), 25-32.
Ginsburg, G. S., Becker, E. M., Keeton, C. P., Sakolsky, D., Piacentini, J., Albano, A. M., Compton, S. N., Iyengar, S.,Sullivan, K., Caporino, N., Peris, T., Birmaher, B., Rynn, M., March, J., Kendall, P. C., (2014). Naturalistic follow-up of youths treated for pediatric anxiety disorders. Journal of the American Medical Association Psychiatry, 71(3),310-318.
Ginsburg, G. S., Becker-Haimes, E. M., Keeton, C., Kendall, P. C., Iyengar, S., Sakolsky, D., Albano, A. M., Peris, T., Compton, S. N., Piacentini, J. (2018) Results from the child/adolescent anxiety multimodal extended long-term study (CAMELS): primary anxiety outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 57 (7), 471-480.
Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69(4), 621-632.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication, Archives of General Psychiatry, 62(6), 593-602.
Meyer, J. M., Farrell, N. R., Kemp, J. J., Blakey, S. M., & Deacon, B. J. (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy, 54(1), 49–53.
Ong, C. W., Clyde, J. W., Bluett, E. J., Levin, M. E., & Twohig, M. P. (2016). Dropout rates in exposure with response prevention for obsessive-compulsive disorder: What do the data really say? Journal of Anxiety Disorders, 40(1), 8 – 17.
Sars, D., & Van Minnen, A. (2015). On the use of exposure therapy in the treatment of anxiety disorders: a survey among cognitive behavioural therapists in the Netherlands, BMC Psychol 3 (1), 26.
Scher, Herbert & Forman 2015 Scherr, S. R., Herbert, J. D., & Forman, E. M. (2015). The role of therapist experiential avoidance in predicting therapist preference for exposure treatment for OCD. Journal of Contextual Behavioral Science, 4(1), 21-29.
Twohig, M. P.; Abramowitz, J. S.; Smith, B. M.; Fabricant, L. E.; Jacoby, R. J.; Morrison, K. L.; Bluett, E. J.; Reuman, L.; Blakey, S. M.; and Ledermann, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: a randomized controlled trial, Psychology Faculty Publications. Paper 1755. https://digitalcommons.usu.edu/psych_facpub/1755
About Lisa Coyne, Ph.D.:
Lisa W. Coyne, Ph.D. is a licensed clinical psychologist who has worked to improve the psychological well-being of children, teens and families for nearly 20 years. After teaching as a tenured professor in the APA-Accredited Clinical Psychology at Suffolk University for 9 years, she is an Assistant Professor at Harvard Medical School/McLean Hospital in the Division of Child and Adolescent Psychiatry, where she founded the McLean Child and Adolescent OCD Institute (OCDI Jr.). She has also founded the New England Center for OCD and Anxiety (NECOA), a specialty clinic serving children, adolescents, and adults with anxiety and OCD. She is a peer-reviewed Acceptance and Commitment Therapy (ACT) Trainer, and a Faculty member of the Behavior Therapy Training Institute (BTTI) of the International OCD Foundation (IOCDF). She has published numerous peer-reviewed articles and chapters on anxiety, OCD, and parenting and is the author of The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years.
About Eric Morris, Ph.D.:
Eric Morris is the Director of the La Trobe University Psychology Clinic. He is a clinical psychologist and researcher based in Melbourne, registered to practice in Australia. He has been practising Acceptance and Commitment Therapy (ACT) for nearly 20 years, including supervising and training therapists using contextual cognitive behavioural therapies. He is a founding member and a former chair of the Acceptance and Commitment Therapy Special Interest Group (ACTSIG) of the British Association for Behavioural and Cognitive Psychotherapies. Dr. Morris has also served as a Board member and President of the Australia & New Zealand Chapter of the Association for Contextual Behavioral Science. He is a co-editor of a book on ACT and mindfulness therapies for psychosis (published by Wiley-Blackwell in April 2013), co-author of a self-help guide, ACTivate Your Life: Using Acceptance and Mindfulness to Build a Life that is Rich, Fulfilling and Fun (published by Constable & Robinson in March 2015) and co-author of a groups manual ACT for Psychosis Recovery (published by New Harbinger in March 2018).
Learning Objectives:
Following this workshop participants will be able to:
- Describe how an approach to exposure based on ACT and clinical RFT differs from exposure conducted from a traditional habituation rationale
- Engage in useful discussion around common exposure myths and have ways to engage clients, colleagues and services in supporting evidence-based use of exposure
- Engage clients and their caregivers in effective rationales for exposure-based therapy, based on a psychological flexibility paradigm, and with attention to developmental differences across children, adolescents, and adults
- Prepare and utilize the process of a functional behavioural assessment and case conceptualization to develop a collaborative exposure plan with clients
- Demonstrate how to develop therapeutic relationship characterized by acceptance, values, compassion and commitment, that supports the client in engaging in exposure-based treatment
- Apply various methods suggested by the inhibitory learning paradigm to enhance exposure-based treatment, including using multiple contextual cues, stimulus variability. exposure menus, affect labelling, etc.
- Engage clients using valuing as action and direction to “contextualise” exposure and place exposure-based tasks under appetitive control
- Use clinical RFT methods to enhance tracking and contact with contingencies to usefully explore expectancy violation
- Use clinical RFT methods to foster flexible perspective-taking to enhance engagement in exposure tasks and promote functional senses of self
- Assess progress in exposure-based treatment using within-task and across-session methods
Target Audience: Beginner, Intermediate, Advanced, Clinical
Components: Conceptual analysis, Literature review, Original data, Experiential exercises, Didactic presentation, Case presentation, Role play
Package Includes: A general certificate of attendance, lunch, and twice daily coffee/tea break on site.