ACT is an orientation to psychotherapy that is based on functional contextualism as a philosophy and RFT as a theory. As such, it is not a specific set of techniques. ACT protocols target the processes of language that are hypothesized to be involved in psychopathology and its amelioration, such as:
and other such processes. Technological, ACT uses both traditional behavior therapy techniques (defined broadly to include everything from cognitive therapy to behavior analysis), as well as others that are more recent or that have largely emerged from outside the behavior tradition, such as cognitive defusion, acceptance, mindfulness, values, and commitment methods.
ACT protocols are thus instances of a strategy. ACT protocols can vary from very short interventions done in minutes or hours, to those that take many sessions. When an ACT strategy is aplied to a given problem it will include specific interventions designed to help with that specific difficulty, and thus every population will lead to different ACT protocols ... and there will be variation even with specific populations based on the creativity of the researcher/clinician and relative emphasis on various ACT/RFT-sensible processes. For all of these reasons and many more, the world ACT community has chosen not to ossify the treatment through processes of centralization, certification and the like, preferring to trust its development to open scientific processes. These include sharing of protocols, identification of processes of change, outcome research, basic research, and so on.
Protocols cited or displayed here are not the ACT approach to any given problem, but an ACT approach in the eyes of the serious researchers who post them. They are not "official" or "recognized" or approved by anyone by virtue of their posting here, but are offered as a resource to the world ACT community so that development of the approach can be accelerated. Clinical use of the protocols is the responsibility of those who choose to use them. If you plan to use these protocols in research, you should of course interact with the listed authors.
Site Members: If you have an ACT treatment protocol you would like listed here, click on the "add child page" link at the bottom of this page. When adding your content, remember that you can attach relevant files and documents.
Experimental tests to date:
None Published
For further information contact: Amy Murrell (amurrell@unt.edu) or Kelly Wilson (kwilson@olemiss.edu), University of Mississippi.
Author's note: We are posting this protocol in the hope that they will provide useful information in helping clients and spark further interest and research in ACT with children and adolescents. Please, recognize that we consider the treatment technology to be evolving in nature. These protocols, therefore, should be viewed as works in progress. The underlying principles should be adhered to, but the protocols can (and indeed should) be used with flexibility.
An ACT protocol designed for use with agoraphobia.
Experimental tests to date:
Hayes, S. C., Wilson, K. G., Afari, N., & McCurry, S. (November 1990). The use of Acceptance and Commitment therapy in the treatment of agoraphobia. Paper presented at meeting of the Association for the Advancement of Behavior Therapy, San Francisco.
This is a very early anxiety protocol, written about 18 years ago. There has been a lot of work since on ACT for anxiety and though it is still recognizably the same kind of protocol, it has gotten better as we've gone along. For an excellent and detailed ACT anxiety protocol see the book by Eifert and Forsyth, 2005. Acceptance and Commitment Therapy for anxiety disorders. Oakland: New Harbinger.
For further information contact: Steve Hayes (hayes@unr.edu), Department of Psychology, University of Nevada, Reno, NV 89557-0062.
Acceptance and Commitment Training for Substance Abuse Counselors protocol.
Experimental tests to date:
Varra, A. A., Hayes, S. C., Roget, N., & Fisher, G. (in press). Using Acceptance and Commitment Training to Increase the Effectiveness of Continuing Education in Pharmacotherapy for Substance Use. Journal of Consulting and Clinical Psychology.
This protocol was developed by Lindsay Fletcher at the University of Nevada, Reno. Contact Lindsay for more information.
Attached is a more developed version of the Togus one-week protocol. Kevin Polk presented the sketch of this at ACT SI III. Dr. Hambright has developed it further. Email Kevin if you have questions. polkkev@gmail.com.
Click here for the newest version of the protocol
Additional materials are routinely updated on Kevin Polk's blog
This page includes treatment outlines that were used in the Forman and colleagues (2007) effectiveness study comparing ACT and CT for anxiety and depression.
Experimental tests to date:
Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of Acceptance and Commitment Therapy and Cognitive Therapy for anxiety and depression. Behavior Modification, 31(6), 772-799.
This is not actaully a protocol as such, but this page seemed like the most logical place on the website to locate it. It is a powerpoint presentation from a half-day workshop I have given a few times, on the use of ACT with couples. I have a book on this coming out in early 2009 (called 'ACT With Love' - published by New Harbinger) The link below allows you to download it from my website: www.actmindfully.com.au
http://www.actmindfully.com.au/upimages/ACT_with_Couples_-_Russ_Harris.ppt
An eight session protocol for chronic pain intended for use in outpatient settings. Includes preface, therapist guide, patient manual, and references.
Experimental tests to date:
Vowles, K. E., Wetherell, J. L., & Sorrell, J. T. (2009). Targeting acceptance, mindfulness, and values-based action in chronic pain: Findings of two preliminary trials of an outpatient group-based intervention. Cognitive and Behavioral Practice, 16, 49-58.
Authors note: The co-morbidity of psychosis in individuals with developmental disabilities may exacerbate the financial strain, emotional turmoil, and difficulties in adaptive functioning that these individuals experience. Given the salience of distress across domains of functioning, there exists a pressing need for more effective interventions to address this population. I am posting this protocol in the hope that it will assist treatment practitioners working with the developmentally disabled. It is an attempt to create more "physicalized" ACT metaphors for clients who think more concretely. Please understand that ACT work with this population is evolving and that this protocol is a work in progress. An small single case study using this protocol was discussed in Pankey and Hayes, 2003. (see publications list).
The ACT for diabetes management protocol is available in book form in
Gregg, J., Callaghan, G., & Hayes, S. C. (2007). The diabetes lifestyle book: Facing your fears and making changes for a long and healthy life. Oakland, CA: New Harbinger.
Experimental tests to date:
Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(2) , 336–343.
Attached is the dissertation by Lundgren (2004) that includes the ACT for epilepsy treatment protocol.
Experimental tests to date:
Lundgren, T. (2004). Psychological treatment of epilepsy. Unpublished dissertation, Uppsala University, Uppsala, Sweden.
Lundgren, A. T., Dahl, J., Melin, L., & Kies, B. (2006). Evaluation of Acceptance and
Commitment Therapy for drug refractory epilepsy: A randomized controlled trial in South Africa. Epilepsia, 47, 2173-2179.
Lundgren, T., Dahl, J., & Hayes, S. C. (in press). Evaluation of mediators of change in the
treatment of epilepsy with Acceptance and Commitment Therapy. Journal of Behavioral Medicine
Louise Hayes and Julie Rowse. (2008). Acceptance and Commitment Therapy: Experiential Adolescent Group Program. Available from l.hayes@ballarat.edu.au
The program is an 8 week group program for adolescents. The aim of the program is to use experiential mediums, for example painting or clay, to facilitate teenagers’ experience of the ACT concepts. Art allows them to explore their own experiences, without getting caught up in language processes. The group program also makes use of role play and other forms of experience.
Initial outcome data is positive and will be available from the first author early 2009.
Artwork is shown in this document for training purposes only and should not be reproduced in anyway. All participant artwork has been used with written consent from the participants.
Note: The manual attached below follows guidelines for the implementation of ACT derived from Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change (1999) by Hayes, Strosahl, and Wilson. As such, it is meant to supplement rather than serve as a replacement for this book in the implementation of ACT. Accordingly, users of this manual should be familiar with the principles of ACT outlined in this book as well as additional techniques and procedures covered within it that are not explicitly contained in this manual.
(Thanks for this manual Rob Zettle!)
Experimental tests to date:
Zettle, R. D., & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: The context of reason giving. The Analysis of Verbal Behavior, 4, 30-38.
Zettle, R. D., & Hayes, S. C. (1987). A component and process analysis of cognitive therapy. Psychological Reports, 61, 939-953.
Zettle, R. D., & Raines, J. C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45, 438-445.
For further information contact: Robert Zettle (robert.zettle@wichita.edu), Wichita State University, Department of Psychology, 1845 N. Fairmount, Wichita, KS 67260-0034
Select this link to access the HEAT (Honorably Experiencing Anger and Threat) group treatment protocol developed by Andy Santanello and Sharon Kelly.
Experimental tests to date:
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.
For further information contact: Patty Bach (pattybach@earthlink.net), Department of Psychology, Illinois Institute of Technology, 3300 South Federal Street, Chicago, IL 60616
Below is the ACT for math anxiety protocol developed by Zettle (2003).
Experimental tests to date:
Zettle, R. D. (2003). Acceptance and commitment therapy (ACT) vs. systematic desensitization
in the treatment of mathematics anxiety. The Psychological Record, 53, 197–215.
An eight session ACT for OCD protocol.
Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and Commitment Therapy as a treatment for obsessive compulsive disorder. Behavior Therapy, 37(1), 3-13.
For further information contact: Mike Twohig (michael.twohig@usu.edu), Assistant Professor, Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, Utah 84322-2810, www.twohig.usu.edu.
Étude pilote de prise en charge en groupe par l’ACT de patients TOC rechutés et/ou résistants et souffrant de comorbidité et suivi à 1 an.
B. SCHOENDORFF (1), B. PUTOIS (2), C. BARNEL (3), E. MOLLARD (4)
(1) Université Claude Bernard, Lyon
(2) Université Louis Lumière, Lyon
(3) Hôpital cardiologique Louis Pradel, Lyon
(4) Hôpital neurologique Pierre Wertheimer, Lyon
Communicant : Benjamin PUTOIS bputois@gmail.com
Problématique :
En proportion non négligeable, des patients souffrant de TOC ne répondent pas aux meilleurs traitements validés (TCC et/ou ISRS). Cette population souffre souvent de comorbidités tels des troubles de la personnalité. Cette étude pilote évalue l’efficacité potentielle d’un traitement ACT en groupe chez cette population.
Méthode :
Étude pilote sous forme de groupe fermé (11 séances d’intervention manuélisées et 3 séances de suivi) à l’hôpital Wertheimer de Lyon, N=9. 6 participants présentaient une comorbidité, dont 5 troubles de la personnalité. YBOCS moyen 28,7. 11 groupes hebdomadaires de 3 heures pendant 11 semaines puis suivi à 3 mois, 6 mois et 1 an. Mesures principales : Y-BOCS, et mesures autoévaluées de handicap, temps passé et malaise dû aux obsessions/compulsions. Nombreuses autres mesures dont AAQ (Hayes), MAAS (Brown&Ryan) et de qualité de vie (Marks).
Résultats :
Les 9 participants ont complété l’étude, mais seulement 7 ont participé aux séances de suivi.
L’acceptabilité du traitement était bonne chez tous les participants, et haute à très haute chez 6.
L’amélioration pré-post du score Y-BOCS était significative pour le groupe de 9 (z=2,67, p<,01 ; d=2,13) et
maintenue à tous les points de suivi (3 mois, 6 mois et 1 an) pour les 7 participants présents aux séances de suivi (suivi 1an : z=2,34 ; p=,02 ; d=1,92).
L’effet du traitement était également significatif sur la dimension handicap (à 1 an : p<,05 ; d = 0,91), et tendanciel sur la dimension malaise (à 1 an : p= 07 ; d=0,99).
Discussion :
Cette étude pilote de type « preuve de concept » suggère que l’ACT peut présenter une intervention adaptée et acceptable chez les patients « difficiles » souffrant de TOC résistants et/ou rechutés et souffrant d’importantes comorbidités. On peut faire l’hypothèse que les interventions de défusion cognitive, visant à distancer radicalement des pensées sont particulièrement bien adaptées à un trouble dont les victimes souffrent au premier chef de la tyrannie de pensées qui se « collent à eux » et contre lesquelles ils combattent en vain. On remarquera aussi la forte acceptabilité du traitement chez cette population réputée difficile.
An ACT protocol designed for use with postpartum depression.
Experimental tests to date:
None
For further information contact: Espen Klausen (eklausen@hotmail.com), M. S., Department of Psychology, University of Wisconsin-Milwaukee.
An individual outpatient psychotherapy protocol for use with methamphetamine dependence. It combines motivational interviewing techniques and cognitive therapy relapse prevention techniques within an ACT framework.
An Individual ACT protocol designed for use in severe substance abuse problems.
Experimental tests to date:
Hayes, S. C., Wilson, K. G., Gifford, E. V., Bissett, R., Piasecki, M., Batten, S. V., Byrd, M., & Gregg, J. (2004). A randomized controlled trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance abusing methadone maintained opiate addicts. Behavior Therapy, 35, 667-688.
The treatment protocol for the ACT for skin picking study is exactly the same as the one for the OCD study by the same authors. All you need to do is change the word "obsession" to "urge to pick" and it will fit nicely.
Twohig, M. P., Hayes, S. C., & Masuda, A. (in press). A preliminary investigation of ACT for chronic skin picking. Behaviour Research and Therapy.
Below is a protocol for a two and a half hour workshop on ACT for stigma toward people with psychological disorders developed by Akihiko Masuda, Kara Bunting and Steven Hayes. The psychoeducation control protocol used in Masuda et al. (2007) is also included.
Experimental tests to date:
Masuda, A., Hayes, S. C., Fletcher, L. B., Seignourel, P. J., Bunting, K., Herbst, S. A., Twohig, M. P., & Lillis, J. (2007). The impact of Acceptance and Commitment Therapy versus education on stigma toward people with psychological disorders. Behaviour Research and Therapy, 45(11), 2764-2772.
The protocol is available in book form in
Woods, D. W., & Twohig, M. P. (2008). Trichotillomania: An ACT-enhanced Behavior Therapy Approach Therapist Guide. Oxford University Press.
The accompanying client workbook is available in
Woods, D. W., & Twohig, M. P. (2008). Trichotillomania: An ACT-enhanced Behavior Therapy Approach Workbook. Oxford University Press.
Experimental tests to date:
Woods, D. W., Wetterneck, C. T., & Flessner, C. A. (2006). A controlled evaluation of Acceptance and Commitment Therapy plus habit reversal for trichotillomania. Behaviour Research and Therapy, 44(5), 639-656.
Below is a protocol for a 1-day workshop for weight-related stigma and weight maintenance based on Acceptance and Commitment Therapy developed by Jason Lillis, Steven Hayes, and Kara Bunting.
This is a protocol designed to reduce entanglement with stigmatizing thoughts about clients and through that reduction in burnout and stress at work.
Experimental tests:
Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., Masuda, A., Pistorello, J., Rye, A. K., Berry, K. & Niccolls, R. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35, 821-835.
The protcol is for a 6 hour group workshop. It is not very detailed -- refering in a single line to exercises that might take 40 minutes. For those familiar with experiential ACT workshops, this should be enough. You will see most of these exercises at major ACT / RFT conventions such as the World Conferences or the Summer Institutes.
This protocol is currently being revised for a large new grant (which will run from 2005 to 2008) that will replicate and extend the study above. It is our sense that we can do better than the protocol that is here, so don't feel bound by it. Use it as a starting point.
The adherence manual include both ACT and Multicultural Training items since that was the comparision in the study (and in this new grant ... which will include an ACT and MT combination group as well as ACT alone and MT alone and a control).
For more information contact Steve Hayes (hayes@unr.edu), Department of Psychology, University of Nevada, Reno, NV 89557-0062
Experimental tests to date:
Bond, F. W., & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156-163.
The protocol itself can be found in Bond, F., & Hayes, S. C. (2002). ACT at work. In F. Bond & W. Dryden (Eds.), Handbook of Brief Cognitive Behaviour Therapy (pp. 117-140). Chichester, England: Wiley.
For further information contact: Frank Bond (f.bond@gold.ac.uk), Department of Psychology, Goldsmiths College, University of London, New Cross, London SE14 6NW
Experimental tests to date:
None Published
For further information contact: Amy Murrell (amurrell@unt.edu) or Kelly Wilson (kwilson@olemiss.edu), University of Mississippi.
Author's note: We are posting this protocol in the hope that they will provide useful information in helping clients and spark further interest and research in ACT with children and adolescents. Please, recognize that we consider the treatment technology to be evolving in nature. These protocols, therefore, should be viewed as works in progress. The underlying principles should be adhered to, but the protocols can (and indeed should) be used with flexibility.