Kirk Strosahl

Measuring experiential avoidance: A preliminary test of a working model

The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items. A fully confirmatory factor analysis upheld this same 9-item factor in an independent clinical sample. The operational characteristics of the Acceptance and Action Questionnaire (AAQ) were then examined in 8 additional samples. All totaled, over 2,400 participants were studied. As expected, higher levels of experiential avoidance were associated with higher levels of general psychopathology, depression, anxiety, a variety of specific fears, trauma, and a lower quality of life. The AAQ related to more specific measures of avoidant coping and to self-deceptive positivity, but the relation to psychopathology could not be fully accounted for by these alternative measures. The data provide some initial support for the model of experiential avoidance based on Relational Frame Theory that is incorporated into Acceptance and Commitment Therapy, and provides researchers with a preliminary measure for use in population-based studies on experiential avoidance.

A practical guide to acceptance and commitment therapy.

An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT Case Formulation. Steven C. Hayes, Kirk D. Strosahl, Jayson Luoma, Alethea A. Smith, and Kelly G. Wilson ACT with Behavior Problems Chapter 4. ACT with Affective Disorders. Robert D. Zettle Chapter 5. ACT with Anxiety Disorders. Susan M. Orsillo, Lizabeth Roemer, Jennifer Block-Lerner, Chad LeJeune, and James D. Herbert Chapter 6. ACT with Posttraumatic Stress Disorder. Alethea A. Smith and Victoria M. Follette Chapter 7. ACT for Substance Abuse and Dependence. Kelly G. Wilson and Michelle R. Byrd Chapter 8. ACT with the Seriously Mentally Ill. Patricia Bach Chapter 9. ACT with the Multi-Problem Patient. Kirk D. Strosahl ACT with Special Populations, Settings, and Methods Chapter 10. ACT with Children, Adolescents, and their Parents. Amy R. Murrell, Lisa W. Coyne, & Kelly G. Wilson Chapter 11. ACT for Stress. Frank Bond. Chapter 12. ACT in Medical Settings. Patricia Robinson, Jennifer Gregg, JoAnne Dahl, & Tobias Lundgren Chapter 13. ACT with Chronic Pain Patients. Patricia Robinson, Rikard K. Wicksell, Gunnar L. Olsson Chapter 14. ACT in Group Format. Robyn D. Walser and Jacqueline Pistorello

What Is Acceptance and Commitment Therapy

ACT is an example of a third wave behavior therapy that saves direct change strategies for overt behaviors and utilizes contextual and experiential methods such as mindfulness and acceptance to address cognitive process that hinder and limit overt behavioral change. The treatment is informed by RFT and is based on the philosophical position of functional contextualism. ACT seeks to undermine the literal grip of language (relational framing) that fosters experiential avoidance, cognitive fusion, and behavioral inflexibility, through the application of six core psychological techniques: acceptance, defusion, contact with the present moment, self-as as-context, values, and commitment to behavior change. Homework can play an integral role in the application of these techniques, by supporting the in-session therapy. Homework can be especially useful because it allows the client to utilize these principles in situations that cannot be created in the therapy sessions, such as public situation for someone who struggles with anxiety. As with most therapies, ACT has its own homework assignments, but therapists often create new techniques to serve the clients needs.

Confessions of a behavior therapist in primary care: The odyssey and the ecstasy.

As the pressures surrounding health care reform continue to mount, there has been a corresponding emphasis on re-integrating health and behavioral health services. This trend promises to provide behaviorally trained clinicians with numerous opportunities to practice in medical settings. The de facto mental health system in the United States is the primary care system; yet, there are few behavioral health practitioners practicing “on site” in primary care practice groups. This is unfortunate, because research studies and clinical experience suggest that physicians have very favorable attitudes toward behavioral procedures and use them regularly in medical practice. This article attempts to summarize key learning experiences from a 5-year primary care integration project at Group Health Cooperative, organized by three behaviorally trained psychologists. The major principles underpinning effective health and behavioral health integration will be examined. Main sources of organizational and disciplinary resistance, along with some “tried and true” strategies for countering that resistance, are highlighted. The concept of primary mental health care is introduced, as a distinctive form of behavioral health service that shares many of the philosophies of primary medical care. Changes in the structure of clinical practice are inevitable in primary care and, accordingly, moving to a consultation model is a more viable method for delivering services. The defining characteristics of the consultant, versus therapist, model will be highlighted, as will the core clinical services that are most valued in primary care settings. Finally, key practice style adjustments will be discussed to highlight how much the practice of behavior therapy must change to accommodate the demands of the primary care setting.

Entering the new frontier of managed mental health care: Gold mines and land mines

This article examines issues that behavior therapists must address as they adapt to the new and complex trends of managed mental health care. The origins of the managed health care movement are reviewed. Major shifts in clinical practice will occur in four primary areas: viewing both the client and payer as “customers”, accepting accountability for clinical outcomes, providing efficient, empirically based care, and accepting the technical and ethical challenges of being both cost conscious and quality focused. Behaviorally trained clinicians and researchers will have many potential advantages working in the era of managed care. To capitalize on their background strengths, behavior therapists must learn to work with and not against managed care systems, learn the language necessary to have constructive, change-oriented dialogues with managed care executives, and learn to conduct “field based” research to answer important questions about the clinical efficacy and cost efficiency of behavioral interventions. Finally, the behaviorally trained clinician should try to find the right “fit” between practice style preferences and choice of managed care setting.

An ACT Primer

The purpose of this chapter is to present a consolidated overview of ACT treatment interventions and therapy processes. In Chapter 1 we described the philosophy, basic theory, applied theory and the theoretical processes that collectively define ACT as a clinical system. In this chapter we will examine the concrete clinical steps used in implementing this model.

A Look to the Past, Directions for the Future

This article represents the history of primary care and behavioral health integration at Group Health Cooperative (GHC) over the last decade, and foreshadows probable futures for this work into the next decade. To build from a logical progression, the article responds to a series of questions: 1. Why integrate primary care and behavioral health? 2. What has been done so far and how well has it worked? 3. Keeping the end in mind, whats the idealized picture of integration for the future? 4. How to get from here to there? What will help or hinder the effort? and 5. Again, why make these efforts to integrate?

Quality and customers: Type 2 change in mental health delivery within health care reform

The traditional separation of mental health and medical programs is problematic because mental health issues are inseparable from the larger medical system. By contrast, a collaborative primary care model of mental health care, augmented and supported by secondary specialty mental health services, has the potential to optimize quality and cost goals while reinforcing health care reform principles. The flexibility of mental health treatment in this delivery structure provides opportunities to customize services according to patient and purchaser expectations.

ACT Case Formulation

Because ACT is a contextual treatment, your attempts to conceptualize a presenting problem might be different from traditional case conceptualization models. The most important principle in contextual analysis is that you are not just assessing a particular symptom with a particular topography; you are also attempting to understand the functional impact of the presenting complaint. The same clinical complaint can function in dramatically different ways for clients. Thus, your case conceptualization and associated treatment plan may differ for clients with seemingly similar problems. For example, many patients are diagnosed with major depression, single episode (a categorical formulation) based on the number and severity of symptoms described by the patient (a topographical assessment). In clinical practice however, it is fair to say that no two depressed patients are alike. Each is unique in how their life space is organized, how depression affects their functioning (and vice versa) and how depressive beliefs and behaviors define the individual’s sense of self and external world.