ACT: Acceptance & Commitment Therapy Thérapie de version finale Thomas  · ACT: Acceptance

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  • ACT: Acceptance & Commitment

    Therapy Thrapie de l acceptat ion et de

    l engagement

    Yes, its possible to facilitate recovery, empowerment, belonging, with a flexible approach that is also evidence based!

    Oui, cest possible de faciliter le rtablissement, la prise de pouvoir, le sentiment dappartenance par une approche flexible

    base sur des donnes probantes!

    Thomas Holmes, 18 fvrier 2014


    15 Years as case manager for clients with severe mental illness 4 Years at a community follow up, about a year at an assertive community

    treatment program, 10 years at PEPP Interested in mindfulness approaches since even before starting in social

    work but knew that bringing these directly into practice would be difficult for many reasons

    Wanted to find something that was evidence based but also wise, flexible and applicable to almost any situation and based in bringing out the best in people

    Came across ACT in 2005 while at PEPP, impressed by empirical findings Evidence based practice does not have to be opposed to recovery-based


  • Goals of presentation / Objectifs de la presentation

    1. To present a brief overview of ACT

    2. Connect ACT to recovery 3. To initiate to ACT

    processes of psychological flexibility

    4. Do a short experience of one process of ACT

    1. Prsenter un bref survol de lapproche ACT

    2. Faire le lien ACT et le rtablissement

    3. Distinguer les processus de flexibilit psychologique de lapproche ACT

    4. Offrir un aperu exprientiel de lapproche.

  • ACT: WHAT IT IS NOT.. ACT : CE QUE CE NEST PAS Not assertive community

    treatment, although it could be used there

    Not just Accept your meds and engage in treatment although it can help for both

    Not anti-psychiatry Not the usual CBT, Not just a bunch of therapy


    ACT nest pas un suivi intensif dans la communaut mais peut tre utilis dans ce contexte

    Pas seulement accepter vos mdicaments , le diagnostic, ni engage toi dans le suivi psychiatrique mais ACT aide le client sengager

    Pas anti-psychiatrie Pas le TCC habituel Pas seulement un paquet de

    techniques thrapeutiques

  • ACT- WHAT IT IS / ACT CEST QUOI Called ACT, as in action, not eh-

    siy-tiy Although not typical CBT, it is from

    the behavioral and cognitive behavioral tradition but also integrates humanist/existential, mindfulness approaches and more

    An evidence based form of treatment psychotherapy

    It is a psychological science to better understand and change the human condition- of suffering and its transformation

    Set of interacting principles and processes of suffering & change that is trans-diagnostic, sub-diagnostic

    Based in a behavioral theory of language and cognition call Relational Frame Theory

    On dit ACT pas ai- si-t Mme si ce nest pas du TCC habituel,

    ACT vient de la tradition comportementale cognitive, en intgrant les approches humanistes, existentiels, motivationnelles et de pleine conscience.

    Un forme de thrapie en mergence au Qubec, base sur des donnes probantes.

    Un champ de la psychologie qui vise mieux comprendre la condition humaine et transformer la souffrance.

    Un ensemble intgr de principes et de processus trans-diagnostique qui permet comprendre la souffrance en soi, diagnostique ou pas et la transformer

    Bas sur la science du langage et de la cognition, thorie des cadres relationnels .

  • Todays presentation: give you a taste of act so that we can Aujourd,hui cest un avant got de ce que ACT peut apporter.

    More effectively hold, care for, recognize and respect the wise, courageous suffering persons we all serve (clients, their families) and that we are (ourselves and our colleagues)

    Offrir plus efficacement, aux usagers, nous-mmes et aux collgues, un vaste contenant incluant le prendre soin , le reconnatre, le respect de la vulnrabilit, la sagesse, et le courage que lon porte.

  • Recovery- rtablissement Moving from avoidance based

    goals, e.g. not (only, mainly) get rid of symptoms & dysfunctional behaviors (e.g. substance use...),

    to approach-based, positive, personal values based actions, effectiveness in the world, according to the persons own intrinsic values (trust theyre pro-social

    N/B. Dead-man rule: dont set a goal that a dead man could do better

    Activate, mobilize the persons strengths

    Broaden the persons repertoire of approach behaviors based on their values

    Partir de l vitement, pas seulement dbarrasser des symptmes et comportements dysfonctionnels (ex. Abus de substance)..

    ..Pour aller vers louverture et la vie, travers des actions efficaces bases sur les valeurs personnelles que les personnes ont choisies.

    nb: la rgle de lhomme mort: ne pas fixer des buts quun homme mort peut faire mieux

    Activer, mobiliser les forces de la personne

    Augmenter le rpertoire de comportements daller vers bass sur les valeurs personnelles de lindividu.

  • Steps for Recovery tapes du rtablissement

    Frequency of Approach and Avoidance Goals for Stages of Psychological Recovery

    Avoidance n (%)

    Approach n (%)

    Moratorium Characterized by denial of illness, identity confusion, social withdrawal and feelings of hopelessness.

    12 (13) 6 (6)

    Awareness Awareness there is the possibility of a more hopeful future, a self not defined by illness.

    5 (5) 7 (7)

    Preparation Starts to take steps towards recovery and focus on identifying values/strengths and connecting with peers.

    10 (11) 14 (15)

    Rebuilding Actively working toward a positive identity. Focus on goals and taking responsibility for ones life.

    6 (6) 16 (15)

    Growth Living a full and meaningful life and positive sense of self despite illness. They are resilient and able to manage illness despite setbacks. This stage is highly reflective of psychological well-being.

    7 (7) 19 (20)

    Clarke, S., Oades, L. G. Crowe, T. P. (2012) Recovery in Mental Health: A Movement Towards Well-being and Meaning in Contrast to an Avoidance of Symptoms. Psychiatric Rehabilitation Journal, V. 35, n. 4, 297304

  • But some questions ???? Mais quelques questions????? Is this shift from avoidance to

    approach only for later stages, once someone has accepted their diagnosis, & our treatment?

    Do they have to be rid of symptoms?

    Do they have to have good insight?

    Is it not also appropriate for acute moments of crises?

    Is recovery only for those with better functioning, more strengths?

    Est-ce que ce changement dvitement vers louverture et la vie est seulement pour les stades plus avancs du rtablissement? seulement quand la personne a accept le diagnostic pos et le traitement?

    Est-ce quil faut ne plus avoir de symptmes?

    Est-ce que ACT et cette approche de rtablissement est approprie pour des moments de crises aigu?

    Est-ce que le rtablissement est seulement pour ceux qui fonctionnent mieux ou qui ont plus dhabilits ?

  • Initial Studies For Act With Clients With Acute Psychosis Bach, P.; Hayes, S.C. (2002) The Use Of Acceptance And Commitment Therapy To Prevent The Rehospitalization Of Psychotic Patients: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 70(5), 1129-1139

    Niveau defficacit ACT versus TCC, mta-analyses et preuves scientifiques.

  • ACT and Diagnosis of personality disorders ACT et diagnostic troubles de la personnalit

    ACT, and behaviorist tradition it

    comes from, are not strong supporters of DSM categories of personality disorders, and object also to the possible stigmatizing effects of such labels.

    Less interested in the particular forms of internal and external behavior, than their functions,

    Rticence dans lapproche ACT classer les problmes de sant mentale selon les catgories du DSM-V parce que :

    encourage stigmatisation ACT est plus intress par

    la fonction dun comportement que sa forme

    Ex. Fonction dvitement.

  • Principles of act Principes de ACT

    Why do we as humans suffer, all of us, with diagnosis or not:

    Pain, of physical and emotional pain (loss, painful emotions themselves) & how we react to pain- inflexibly, avoiding, rejecting..

    Rigidity Suffering of unlived life, untrue

    to ourselves, qualities and values

    We work with ourselves to better help others stuck in similar processes if not the same places or contents or to the same degree

    Tous les tres humains souffrent quils aient ou non un diagnostic de problme de SM ou pas.

    ( douleurs physiques, motionnels, perte etc.

    Ractions ces douleurs = mcanismes multiples: rigidit, vitement, rejet etc.

    Souffrance dune vie manque ou mal vcue,

    Souffrance de ne pas tre vrai avec soi-mme

    Nous intervenants on travaille sur nous-mme pour mieux aider dautres qui sont coincs dans des processus similaires mais qui peuvent diffrer en termes de contenu ou dintensit.

  • Les six Processus dACT

    Rigit psycho-logique

    Perdu dans le

    future ou le pass


    Inaction, impulsivit

    Soi -contenu

    Fusion Cognitive

    Rejet/ vitement experientiel

    Flexibilit psycho-logique

    Contact moment present


    Action engag

    Soi -perspective

    Defusion cognitive

    Acceuil, ouverture

  • Facilitating these processes for our cli