Harris, R. (August 2006). Embracing your demons: an overview of acceptance and commitment therapy. Psychotherapy in Australia, 12, 4, 2-8.
Acceptance and Commitment Therapy (ACT) is one of the "third-wave" behavioral therapies which emphasizes mindfulness and is intended to be used with a broad range of clinical conditions. The goal of ACT is to create a rich and meaningful life, while accepting the pain that inevitably goes with it. Western psychology has typically operated under the "healthy normality" assumption which states that by their nature, humans are psychologically healthy. That is, they will naturally be happy and content, and suffering is seen as abnormal. However, research shows that psychiatric disorders are exceedingly commonplace, as is nonclinical psyshological suffering, despite our high standards of living. ACT assumes, rather, that psychological processes of a normal human mind are often destructive. They posit that there is a dark side of language and cognition which sits at the root of this suffering. We often struggle with our thoughts and feelings, hoping to change them, avoid them, ameliorate them, and get rid of suffering. In doing so, ACT points at that some of these tactics often create extra suffering for ourselves. These "emotional control strategies" commonly become costly, life-distorting, or harmful. In ACT, there is no attempt to reduce, change, avoid, suppress, or control these private experiences. Instead, mindfulness is encouraged.
ACT commonly employs six techniques: (1) Cognitive Defusion: Learning to perceive thoughts, images, emotions, and memories as what they are, not what they appear to be. (2) Acceptance: Allowing them to come and go without struggling with them. (3) Contact with the present moment: Awareness to the here and now experience with openness, interest, and receptiveness. (4) Observing the self: Accessing a transcendent sense of self, a continuity of consciousness which is changing. (5) Values: Discovering what is most important to one's true self. (6) Committed Action: Setting goals according to values and carrying them out responsibly.
Tuesday, July 29, 2008
Sunday, July 27, 2008
Relapse Prevention for Alcohol and Drug Problems
Witkiewitz, K. & Marlatt, G.A. (2004). Relapse Prevention for Alcohol and Drug Problems. American Psychologist, 59, 4, 224-235.
Relapse prevention (RP) is a cognitive-behavioral approach with the goal of identifying and preventing high-risk situations such as substance abuse, obsessive-compulsive behavior, sexual offending, obesity, and depression. Relapse is seen as both an outcome and as a transgression in the process of behavior change. An initial setback (lapse) may either translate into a return to the previous problematic behavior (relapse) or into the individual turning again towards positive change (prolapse). That individuals commonly experience lapses, and even relapses, is not contested. However, an understanding of this phenomenon continues to evolve.
Relapse is thought to be multi-determined, especially by self-efficacy, outcome expectancies, craving, motivation, coping, emotional states, and interpersonal factors. High self-efficacy, negative outcome expectancies, potent availability of coping skills following treatment, positive affect, and functional social support are expected to predict positive outcome. Craving has not historically been shown to serve as a strong predictor.
The article proposes a new reconceptualization of relapse as a multidimensional, complex system. Such a nonlinear dynamical system is believed to be able to best predict the data witnessed, which commonly includes cases where small changes introduced into the equation seem to have large effects. The model also introduces concepts of self-organization, feedback loops, timing/context effects, and interplay between tonic and phasic processes. The effectiveness and efficacy of RP for various goals is also discussed in the article.
(I, Doug Girard, am the author of this article, Relapse Prevention, and I release its content under the terms of the GNU Free Documentation License, Version 1.2 and later.)
Relapse prevention (RP) is a cognitive-behavioral approach with the goal of identifying and preventing high-risk situations such as substance abuse, obsessive-compulsive behavior, sexual offending, obesity, and depression. Relapse is seen as both an outcome and as a transgression in the process of behavior change. An initial setback (lapse) may either translate into a return to the previous problematic behavior (relapse) or into the individual turning again towards positive change (prolapse). That individuals commonly experience lapses, and even relapses, is not contested. However, an understanding of this phenomenon continues to evolve.
Relapse is thought to be multi-determined, especially by self-efficacy, outcome expectancies, craving, motivation, coping, emotional states, and interpersonal factors. High self-efficacy, negative outcome expectancies, potent availability of coping skills following treatment, positive affect, and functional social support are expected to predict positive outcome. Craving has not historically been shown to serve as a strong predictor.
The article proposes a new reconceptualization of relapse as a multidimensional, complex system. Such a nonlinear dynamical system is believed to be able to best predict the data witnessed, which commonly includes cases where small changes introduced into the equation seem to have large effects. The model also introduces concepts of self-organization, feedback loops, timing/context effects, and interplay between tonic and phasic processes. The effectiveness and efficacy of RP for various goals is also discussed in the article.
(I, Doug Girard, am the author of this article, Relapse Prevention, and I release its content under the terms of the GNU Free Documentation License, Version 1.2 and later.)
Thursday, July 10, 2008
Theory-based research for understanding dynamic psychotherapy
Luborsky, L., Barber, J.P., & Crits-Christoph, P. (1990). Theory-based research for understanding the process of dynamic psychotherapy. Journal of Consulting and Clinical Psychology, 58, 3, 281-287.
This article reviews empirical support for 6 basic theoretical assumptions central to psychodynamic psychotherapy. (1) A therapeutic alliance must develop. The strength of therapeutic alliance (the collaborative and affective bond between therapist and client) is shown to predictive of positive outcomes. (2) Patients display transference. Trends from existing studies show central relationship patterns exist which are largely consistent over time and may be projected onto the therapist. (3) Accurate interpretations of transference by the clinician lead to increased benefits for the client. Findings are inconsistent on this point, specifically on the relation between increased number of transference interpretations and outcomes. Mediators may exist, such as how the patient responds to the interpretation. (4) The patient will benefit more from more accurate interpretations. Accurate interpretations correlate with "better" sessions. Accuracy of interpersonal aspects of interpretation predicted outcomes best. (5) Increased insight about themselves and their relationships with others leads to better outcomes. Gaining an understanding about the therapist and others is associated with outcomes. An understanding of self and parents does not seem to be as well correlated. (6) Improved patients show greater change in their transference patterns. Results are consistent with the theory that transference still exists but is under better control and mastery. Patients' expectations of how others will respond becomes less negative and their mental health improves.
This article reviews empirical support for 6 basic theoretical assumptions central to psychodynamic psychotherapy. (1) A therapeutic alliance must develop. The strength of therapeutic alliance (the collaborative and affective bond between therapist and client) is shown to predictive of positive outcomes. (2) Patients display transference. Trends from existing studies show central relationship patterns exist which are largely consistent over time and may be projected onto the therapist. (3) Accurate interpretations of transference by the clinician lead to increased benefits for the client. Findings are inconsistent on this point, specifically on the relation between increased number of transference interpretations and outcomes. Mediators may exist, such as how the patient responds to the interpretation. (4) The patient will benefit more from more accurate interpretations. Accurate interpretations correlate with "better" sessions. Accuracy of interpersonal aspects of interpretation predicted outcomes best. (5) Increased insight about themselves and their relationships with others leads to better outcomes. Gaining an understanding about the therapist and others is associated with outcomes. An understanding of self and parents does not seem to be as well correlated. (6) Improved patients show greater change in their transference patterns. Results are consistent with the theory that transference still exists but is under better control and mastery. Patients' expectations of how others will respond becomes less negative and their mental health improves.
Prolonged Exposure Treatment for PTSD following 9/11
Kazi, A., Freund, B., & Ironson, G. (2008). Prolonged Exposure Treatment for Posttraumatic Stress Disorder following the 9/11 attack with a person who escaped from the Twin Towers. Clinical Case Studies, 7, 100-116.
This article chronicles the progress of one 9/11 survivor through the cognitive-behavioral therapy intervention of prolonged exposure (PE) therapy to address her PTSD and depressive symptomatology. This treatment consists of (1) imaginal exposure, and (2) in vivo exposure. It is designed to elicit emotional processing until the detrimental traumatic memories and avoidances have habituated (desensitized). After 15 sessions this client improved 75% as measured by a composite index. However, there was residual symptomatology 6 months after therapy ended but measures remained sub-clinical. Progress through treatment can be seen as waxing and waning, but trending towards improvement. Still, in this type of therapy clients must be stressed before they are to feel better. With the prevalence of PTSD at 8% in the US population, clinicians are calling more and more for effective treatment regimes. PE may be a promising candidate.
This article chronicles the progress of one 9/11 survivor through the cognitive-behavioral therapy intervention of prolonged exposure (PE) therapy to address her PTSD and depressive symptomatology. This treatment consists of (1) imaginal exposure, and (2) in vivo exposure. It is designed to elicit emotional processing until the detrimental traumatic memories and avoidances have habituated (desensitized). After 15 sessions this client improved 75% as measured by a composite index. However, there was residual symptomatology 6 months after therapy ended but measures remained sub-clinical. Progress through treatment can be seen as waxing and waning, but trending towards improvement. Still, in this type of therapy clients must be stressed before they are to feel better. With the prevalence of PTSD at 8% in the US population, clinicians are calling more and more for effective treatment regimes. PE may be a promising candidate.
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