Transcript No Slide Title

VA Training in
Evidence-Based
Psychotherapies
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VAPTC EBP Presentation
Background
In recent years, health care policy has incorporated
evidence-based practice as a central tenet of health
care delivery (Institute of Medicine, 2001)
The VA developed a Mental Health Strategic Plan in
response to the President’s New Freedom
Commission on Mental Health report (2004)
The Mental Health Strategic Plan calls for the
implementation of EBPs at every VAMC in the
country
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VAPTC EBP Presentation
Goals of VA Training in EBPs
To train VA staff from multiple disciplines
in evidence-based psychotherapies
To augment psychotherapies already
being offered in VA medical centers
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VAPTC EBP Presentation
VA Dissemination and
Training in EBPs
Cognitive Behavioral Therapy (CBT) for Depression
Acceptance and Commitment Therapy (ACT) for
Depression
Cognitive Processing Therapy (CPT) for PTSD
Prolonged Exposure (PE) for PTSD
Social Skills Training (SST) for severe mental illness
(SMI)
Integrative Behavioral Couple Therapy (IBCT)
Family Psychoeducation (FPE)
• Behavioral Family Therapy (BFT)
• Multi-Family Group Therapy (MFGT)
VAPTC EBP Presentation
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EBP Presentations for Interns
and Postdoctoral Fellows
VA EBP rollout training has been
focused on staff
VA Psychology Training Council
(VAPTC) developed a workgroup in
2009 to focus on developing EBP
didactics for interns and postdoctoral
fellows
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VAPTC EBP Presentation
Goals of these EBP
Presentations
To provide a basic working knowledge
of each of the rollout EBPs
To provide the foundation for trainees
to seek out further training and
supervision in the EBPs they intend to
implement
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VAPTC EBP Presentation
Limitations
This presentation will not provide
equivalent training to the EBP rollouts
This presentation will not provide the
skills to implement the treatment
without further training and
supervision
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VAPTC EBP Presentation
Acceptance and Commitment
Therapy (ACT):
Research Overview
ACT slides are adapted from a
presentation by
Robyn D. Walser, Ph.D.
VAPTC EBP Presentation
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General Points
ACT is a principle based intervention
– It is a behavioral intervention
– The processes thought to work in ACT are believed
to transcend typical diagnostic categories
– ACT has been studied across a wide variety of
psychological symptoms
– The evidence from correlational, component, process
of change, and outcome comparisons relevant to the
model are broadly supportive
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VAPTC EBP Presentation
General Points
ACT can be used in conjunction with other
behavioral interventions
– ACT takes on the character of traditional behavior
therapy (e.g. functional analysis, behavioral targets)
– Virtually any behavior change technique is acceptable
within ACT (e.g., goal setting, behavioral activation)
– Behavior change is seen as a willingness exercise, to
be linked to chosen values
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VAPTC EBP Presentation
Research on ACT
Short summary:
– ACT is a principle-based intervention and has used to
treat a variety of disorders and cultural problems
– Over 46 RCT’s showing ACT as good as or better
than tx as usual – currently more studies under
review or under investigation
– 4 RCT’s, 4 open trials for depression supporting ACT
– Core processes targeted in ACT -- experiential
avoidance and acceptance --- mediate outcomes in
most studies
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VAPTC EBP Presentation
ACT Research Findings
History and state of the evidence:
– ACT evolved directly from basic research in human
cognition (see Relational Frame Theory:
http://contextualpsychology.org)
– ACT research and theory literatures continue to grow
– The literature is maturing and many questions
regarding ACT and its application are being
examined
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VAPTC EBP Presentation
ACT Training & Clinical Outcomes
Strosahl, Hayes, Burgan & Romano, et. al. (1998).
ACT field effectiveness trial in an outpatient clinic
– Most common diagnoses : Adjustment Disorder (16.4%),
Affective Disorders (12%), and Anxiety Disorders (7.4%)

Experienced therapists exposed to 30 hours of ACT training +
monthly supervision for 1 year produced better client outcomes
than outcomes of similar level therapists in the same agency
– Clients reported better coping
– Clients more likely to have completed treatment within 5
months of initiating treatment
– Client-rated higher levels of psychological acceptance
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VAPTC EBP Presentation
ACT and Depression
4 randomized controlled trials
All comparing ACT to Cognitive Therapy:
– CT provides a fairly stringent standard against which
to evaluate the efficacy of ACT
– CT is a clearly distinct theoretical model targeting
change of internal experience (rather than
acceptance)
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VAPTC EBP Presentation
ACT & Depression: RCTs
Zettle, R. D. & Rains, J. C. (1989).
– 31 patients randomly assigned
– ACT and CT delivered in group format
– Participants in both conditions showed significant and
equivalent reductions in depression at post-treatment and
2-month follow-up for all patients
– Scores on the DAS suggested that ACT and CT mediate
change through different processes
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VAPTC EBP Presentation
ACT & Depression: RCTs
Zettle, R. D., & Hayes, S. C. (1986).
– 18 patients randomly assigned
– ACT and CT delivered in individual format
– Participants in both conditions showed significant
improvements from pre-treatment to end of a two-month
follow-up
– Independent, blind, evaluator rated ACT participants at
follow-up significantly less depressed than those who got CT
– ACT participants showed significant pre-to-post reduction in
attachment to thoughts as causes of dysfunctional behavior.
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VAPTC EBP Presentation
ACT & Depression: RCTs
Forman, E. M., Herbert, J. D., Moitra, E., Yeomans,
P. D. & Geller, P. A. (2007).
– 101 heterogeneous outpatients
– 23 junior therapists
– moderate to severe levels of anxiety or depression
– Results: Participants receiving CT and ACT evidenced large
and equivalent improvements in depression, anxiety,
functioning difficulties, quality of life, life satisfaction and
clinician-rated functioning.
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VAPTC EBP Presentation
ACT & Depression: RCTs
Lappalainen, R., Lehtonen, T., Skarp, E., Taubert, E.,
Ojanen, M., & Hayes, S. C. (2007).
– RCT: 28 patients randomly assigned to ACT model or a
traditional CBT model
– Larger within-group effect size of Pre-to-Post SCL-90 for ACT
(d = 1.11) than CBT (d = 0.36); also for Pre-to-Followup
– Statistically significant Pre-to-Post changes in depression for
the ACT group, also from Pre-to-Followup
– Nonparametric group comparisons showed BDI Pre-Post
improvements marginally greater for ACT than for CBT
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VAPTC EBP Presentation
ACT Studies that have Included
Measures of Depression
Study investigated the effectiveness of acceptance and
commitment therapy in the treatment of chronic pain. Results
indicated significant improvements for pain, depression, painrelated anxiety, disability, medical visits, work status, and
physical performance (Vowles, K. E. & McCracken, L. M.,
2008).
Study investigating whether exposure and acceptance could
increase function and life satisfaction found a significant
difference between treatment groups, as well as significant
improvements within the treatment groups for depression
(Wicksell, R. D. Ahlqvist, J., Bring, A., Melin, L. & Olsson, G.
L., 2008).
An RCT investigating worksite stress found improvements in
mental health and work-related variables for both the ACT
condition and active control. Analyses indicated that, in the
ACT condition, BDI scores decreased significantly from Time 2
to Time 3 (Bond, F. & Bunce, D., 2000).
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VAPTC EBP Presentation
ACT Studies that have Included
Measures of Depression
Study examining the efficacy of an acceptance-based behavioral
therapy (drawn from ACT) for GAD found statistically significant
reductions in clinician-rated and self-reported symptoms including
significant reductions in depressive symptoms (Roemer, L., Orsillo, S.
& Salters-Pedneault, K., 2008).
An ACT-based group intervention decreased depression for selfharming clients who had been diagnosed with borderline personality
disorder compared to a treatment-as-usual control (Gratz &
Gunderson, 2006).
Study investigating the effects of a brief ACT with unemployed
individuals on sick leave suffering from depression found that the
ACT group showed significantly lower levels of depression and higher
level of quality of life, general health, and perceived level of
functioning compared to the TAU group (Folke, F., & Parling, T.,
2004).
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VAPTC EBP Presentation
ACT Studies that have Included
Measures of Depression
Chronic pain patients, acting as their own controls
and receiving ACT-consistent interventions,
demonstrated reduced levels of depression that
were maintained at a 3-month follow-up
(McCracken, Vowles, & Eccleston, 2005).
A multiple baseline within-subject design
demonstrated reductions in depression among
obsessive-compulsive clients (Twohig, Hayes, &
Masuda, 2006).
A noncontrolled study reported reductions in
depression among parents of children who had
been diagnosed with autism given ACT-based group
support (Blackledge & Hayes, 2006).
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VAPTC EBP Presentation
ACT Resources
VA ACT Treatment and Consultant Manuals
ACT EBP SharePoint website
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ACT information and training process
Assessments
Discussion Forum
Useful Links
https://vaww.portal.va.gov/sites/act_community/ACT%20Rollout/default.a
spx
ACT Training Website (TBA): ACT in action
video sessions
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VAPTC EBP Presentation
ACT Resources
Association for Contextual and Behavioral Science
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Handouts
Power Points
Articles
RFT tutorial
http://www.contextualpyschology.org
Broader VA community site

•
Rich set of materials
https://vaww.portal.va.gov/sites/act_community/default.aspx
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VAPTC EBP Presentation
Acceptance and
Commitment Therapy:
Treatment Overview
ACT slides are adapted from a
presentation by
Robyn D. Walser, Ph.D.
VAPTC EBP Presentation
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“The single most remarkable fact of
human existence is how hard it is for
human beings to be happy.”
- Steven C. Hayes
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VAPTC EBP Presentation
The Situation
Most humans are hurting
- It is hard for humans to be happy – we have
shelter, warmth, food, yet we have misery,
suicide, alcohol, etc.
- Every day of every year –
suicide/alcohol/checking
- It is easy to sink into a psychological struggle
- Suffering is pervasive
This is not happening in non-humans
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VAPTC EBP Presentation
The Issue
To sensitize you to the role that
language plays in human suffering
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VAPTC EBP Presentation
The Target of ACT
To make experiential contact with
previously avoided private events
without excessive verbal involvement
and control – and to make powerful
life enhancing choices.
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VAPTC EBP Presentation
Verbal Knowledge: Language
We have knowledge:
Relational Frame Theory
Theory of human language and cognition
Based on principles of learning
What we are doing with our minds: describing categorizing,
relating, evaluating, talking about, writing, reading, thinking
Generalized operant
Relating as a class of behavior
www.contextualpsychology.org/rft
http://www.contextualpsychology.org/node/2979 (RFT)

Verbal knowledge is our blessing and our burden
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VAPTC EBP Presentation
Knowledge and the Assumption
of Healthy Normality
Underlying assumptions of psychological mainstream
Psychological health is the natural homeostatic state
This state is disturbed by illness or distress – problematic
By dividing the world into normal and healthy versus
abnormal and disturbed
We have narrowed the range of human experience
We have failed to see that humans suffer
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VAPTC EBP Presentation
Good……
Language is useful:
–
–
–
–
–
Communicate
Predict and plan
Solve complex problems
Develop rules to regulate behavior
Learn from people and cultures that no
longer exist
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VAPTC EBP Presentation
…….and Bad
Only species aware of our own death
Create an idealized future
Evaluation: form negative opinions about ourselves
and others
Obsess or relive traumatic events
Develop rules for acting that are harmful and
ineffective
Excessive use of language makes it difficult to
maintain contact with the present moment
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VAPTC EBP Presentation
Our “Minds” Do Not Always Know
What is Good for Us
As noted, we can verbally construct needs,
dangers, and futures and take action based
on these constructions
We struggle for no reason and hold on when
we should let go
We live in a derived, verbally regulated reality
rather than to experience the world as it
unfolds in the here and now
Language is overemphasized as a means to
achieving well-being
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VAPTC EBP Presentation
Our Relationship With Private Events
People become identified with the content of
their mental life to a large extent:
Example: Vietnam Era Veteran
Disentangling people from their “minds” is
one of the main goals of ACT
Helping people get back in contact with
another way of knowing the world
Verbal knowledge vs. experiential knowledge
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VAPTC EBP Presentation
How are we entangled?
F.E.A.R.:
Fusion, Evaluation, Avoidance, &
Reason-giving
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VAPTC EBP Presentation
Fusion and Evaluation:
Literality: cognitive fusion occurs
when a person holds their thoughts to
be literally true.
Exercise: Lemon
ACT aims to alter the context in which
thoughts occur so as to decrease the
impact and importance of difficult
private events
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VAPTC EBP Presentation
Avoidance:
Social training of cognitive and
emotional control
–
–
Avoid that which should be avoided nonhappiness
“Just forget about X”, “Get on with it”, “I
can’t control my depression”
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VAPTC EBP Presentation
Reason-giving:
Believing one’s stories: refers to verbal
explanations and justifications that
clients give for their actions.
– Behavior is caused
– Reasons are causes
– Thoughts and feelings are good reasons
– Thoughts and feelings become accepted as
legitimate causes for dysfunctional actions
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VAPTC EBP Presentation
Reason-Giving
Why this might not be so
– We don’t have access to all variables
– We can’t formulate it even if we did
– Even if true, too small a part of the real
picture
– This is not the function of reasons
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VAPTC EBP Presentation
The usual agenda for therapy:
FEEL GOOD
MORE, BETTER, DIFFERENT
If a client comes to us they have generally not found the
right way to fix their problem:
They say, “Why am I failing?”
–
“I am failing because I need more _______”
Self-esteem, emotional control, confidence
–
Or “less _________”
depression, anxiety, worry
VAPTC EBP Presentation
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Is there another way?
In the place of literal meaning, there are
multiple meanings (your thinking, what is
present, context, history, feelings)
In the place of evaluations – “own” your
evaluations and do what works
In the place of reason-giving – honest
ignorance and commitment to a course
In the place of emotional control –
emotional acceptance
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VAPTC EBP Presentation
Accept and Commit
The Acceptance and Commitment Therapy
approach assumes the position that clients can
learn to accept their own emotions and
deliteralize their own thoughts such that they
do not have a significant negative psychological
impact, even if these emotions and thoughts
continue to occur. Rather than change the form
or frequency of the thought/feeling– ACT seeks
to change the function.
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VAPTC EBP Presentation
Six Core Processes
1.
2.
3.
Foster acceptance and willingness while
undermining the dominance of emotional
control and avoidance (Acceptance).
Undermine the language-based processes
that promote fusion, needless reason-giving,
and unhelpful evaluation (these can cause
private experiences to function as
psychological barriers to life promoting
activities) (Defusion).
Live more in the present moment, contacting
more fully the ongoing flow of experience as
it occurs (Present Moment).
VAPTC EBP Presentation
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Core Processes Continued
4.
5.
6.
Make experiential contact with the distinction
between self-as-context versus the
conceptualized self to provide a position from
which acceptance of private events is less
threatening (Self-as-Context).
Identify valued outcomes in living that will
legitimize confronting previously avoided
psychological barriers (Values).
Build larger and larger patterns of committed
action that are consistent with valued life
ends (Committed Action).
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VAPTC EBP Presentation
OR….

Using a unique set of experiential and
mindfulness exercises that promote
acceptance of self and others, while
working to define personal values and
also to support efforts at making and
keeping commitments related to those
values.
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VAPTC EBP Presentation
The Model
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VAPTC EBP Presentation
Pathological
Processes
Living in the past; worrying about future;
Limited self knowledge
Experiential
avoidance
Lack of values
clarity/contact
Psychological
In-flexibility
Cognitive
fusion
Inaction, Impulsivity, or
Avoidance
Attachment to the
conceptualized self
VAPTC EBP Presentation
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Acceptance and
Commitment
Therapy
Contact with the
Present Moment
Acceptance
Values
Psychological
Flexibility
Defusion
Committed
Action
Self as
Context
VAPTC EBP Presentation
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ACT Model
Target Problem
ACT Intervention
Experiential avoidance: running away or
escaping from emotions and thoughts
Fusion with the mind; arguing with mind;
believing mind
Living in the past or worrying about the
future
Attachment to the conceptualized self
A life focused on emotion, thought and
symptom elimination
Inaction and remaining stuck
Psychological Inflexibility
Acceptance
Defusion
Contact with the present moment
Self-as-context: Conscious awareness;
Experiencer vs. the experienced
Values-focused life
Committed action: making and keeping
behavioral commitments that exemplify
personal values
Psychological Flexibility
VAPTC EBP Presentation
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Psychological Flexibility
Psychological flexibility is
contacting the present moment
fully as a conscious human being,
experiencing what is there to be
experienced and working to
change behavior such that it is in
the service of chosen values.
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VAPTC EBP Presentation
Tools of the Trade
Difficulty with giving verbal rules to
instruct experiential material
Use of metaphors, stories, and
experiential exercises
Distinction between mind and
experience
Functional analysis of behavior
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VAPTC EBP Presentation
The Application and Technique Part
Six Main Goals of ACT:
1. Creative hopelessness
2. Control of private events as the problem
3. Willingness/Letting go of the struggle
4. Self as context rather than content
5. Values Clarificaitn
6. Commitment and behavior change
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VAPTC EBP Presentation
“When suffering knocks at your door and you say
there is no seat for him, he tells you not to worry
because he has brought his own stool.”
-
Chinua Achebe, from Arrow of God (1967, p. 84)
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VAPTC EBP Presentation
Creative Hopelessness
The therapist is working to bring the
patient into experiential contact with
what hasn’t worked – the more better,
better, different problem
– Tried, but problem remains
– The problem is not one of specific tactics
– The problem is not like other areas of life

quicksand
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VAPTC EBP Presentation
Summary: Creative Hopelessness
The culture instructs the patient that:
Psychological problems can be defined as the presence of
unpleasant feelings, thoughts, etc.
These undesirable experiences are viewed as “signals”
that something is wrong; something has to change
Healthy living cannot occur until these experiences are
eliminated/reduced
The client needs to get rid of them by correcting the
deficits that are causing them (e.g. lack of confidence,
thoughts of not being worthy)
From the ACT perspective this agenda- excessive and
misapplied control - may not be very workable
VAPTC EBP Presentation
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“I used to think that the brain was the most
wonderful organ in my body. Then I realized
who was telling me this.”
-
Emo Philips
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VAPTC EBP Presentation
Control Is the Problem
Giving a name to the unworkable agenda
identified in creative hopelessness
Validation of efforts to try to control painful
experiences
•
•
•
•
•
Works outside of the skin
Taught that it should work
Appears to work for others
Sometimes works
Should work if we try hard enough
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VAPTC EBP Presentation
Control Is the Problem
The client’s change efforts are really efforts
at controlling private events
The culture, through language, engrains
control strategies
Manifestations of control are emotional
avoidance and escape
The more control is applied, the more
negative experiences escalate and take
control of life
Alternative to control: Willingness
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VAPTC EBP Presentation
Summary: Control as the Problem
Change the context in which culturally
conditioned rule systems operate (loosening
rule governed behavior)
Aim is to disrupt unworkable rules and lay
the groundwork for more workable ones
As patient makes direct contact with unworkability of control strategies, he or she
becomes more susceptible to direct
contingencies
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VAPTC EBP Presentation
Willingness
An openness to experience the
avoided thoughts, feelings, bodily
sensations, etc
Learn that internal emotion and
thought stimuli are
judgment
not dangerous
Suffering
Natural
response
Pain
evaluation
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VAPTC EBP Presentation
Natural
response
judgment
Pain
Suffering
evaluation
Internal experience flows like a river
Decrease suffering by showing up to the natural response and
letting it be what it is: a thought, a feeling, a sensation, a
memory (be mindfully aware of experience). This must be done
compassionately…it is not a diminishing of experience, but a
presence to and acknowledgment of it – a gentle observing.
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VAPTC EBP Presentation
Willingness
Willingness is not wanting negative
experience
Willingness is not a concession
Willingness is not liking negative experience
It is a stance taken/an action
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VAPTC EBP Presentation
Establishing Willingness
Through Defusion
Humans “fuse” with the content of their
mind’s
Defusion helps to make the distinction
between the process of language versus the
product of language:
– Looking from rather than looking at
– Evaluation is not in the object evaluated
– The arrogance of words
Reason-giving
Separate thought and thinker, emotion from feeler
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VAPTC EBP Presentation
Summary: Willingness
Language versus “languaging”
Undermine evaluation
Teach healthy observing
Teach non-judgmental awareness
Continue to establish willingness:
Self-as-Context
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VAPTC EBP Presentation
Establishing Willingness
Through Self-as-Context
Distinguishing the Self from Experiential
Phenomena
Connect to self as experiencer
 What is “Programming?”
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VAPTC EBP Presentation
Distinguishing the Self from
Experiential Phenomena
Our histories are not controllable
Self as Context vs. Content
The Experiencer, not the experienced
In chess – it is being the board that
holds the pieces (thoughts, feelings,
sensation).
Increased awareness of this sense of self lessons the
perceived danger of one’s emotional reactions
Liberates action
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VAPTC EBP Presentation
Summary: Self-As-Context
The client is not defined by private
experience; rather the client is a conscious
vessel that contains private experience
Observing self is beyond evaluation
Observing self is found in experience not
logic
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VAPTC EBP Presentation
“If we don’t decide where we’re going,
we’re bound to end up where we’re
headed.”
- Chinese Saying
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VAPTC EBP Presentation
Values
Discovering valued living




What stands between you and living life you
value?
What do you value?
What are specific goals related to those values?
What are the barriers (thoughts, feelings, other
experiences) to living out those goals?
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VAPTC EBP Presentation
Values and Choice
Choice
Valuing as an activity
Skiing down hill: the experience is in the
process not the outcome
Moment by moment choosing
Values Assessment
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VAPTC EBP Presentation
Summary: Values
Learn how values create a sense of life
meaning and direction
Define how values suggest specific life
goals
Define actions to achieve goals
Defined by behavior, not by private
content
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VAPTC EBP Presentation
“Try not. Do, or do not. There is no try.”
- Yoda
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VAPTC EBP Presentation
Commitment
And do what takes you in the
direction….of your values
Specific behavioral actions that the client
engages with willingness to experience and
movement in a valued direction
ACT
Accept
Choose
Take a direction
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VAPTC EBP Presentation
Summary: Commitment
Willingness is a primary condition of
committed action
Committed action inevitably invites
unwanted experience
Barriers can be identified with F.E.A.R.
Commitment is funded by ongoing process
of valuing
Goal: building larger and larger patterns of
behavior that are values consistent
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VAPTC EBP Presentation
The Question?
Out of the place from which there is a
distinction between you and the things
you have been struggling with and
trying to change, are you willing to
experience those things, fully and
without defense, as they are and not as
what they say they are, AND do what
works for you in this situation according
to what you value?
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VAPTC EBP Presentation
ACT Question
Contact with the
Present Moment
(6) at this time, in
this situation?
(2) are you willing to
have that stuff, fully
and without defense
Acceptance
If the answer is
“yes,” that is
what builds...
Psychological
& Behavioral
Flexibility
Defusion
(4) AND do what
takes you in the
direction
Committed
Action
(3) as it is, and not as
what it says it is,
Self as
Context
VAPTC EBP Presentation
Values
(5) of your chosen
values
(1) Given a distinction between
you and the stuff you are
struggling with and trying to
change
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References
Blackledge, J. T., & Hayes, S. C. (2006). "Using Acceptance and Commitment Training
in the Support of Parents of Children Diagnosed with Autism." Child & Family
Behavior Therapy, 28(1), 1-18.
Bond, Frank W. 1,2; Bunce, David 1 Mediators of Change in Emotion-Focused and
Problem-Focused Worksite Stress Management Interventions. Journal of
Occupational Health Psychology. 5(1):156-163, January 2000.
Folke, F., & Parling, T. (2004). Acceptance and Commitment Therapy in group format
for individuals who are unemployed and on sick leave suffering from depression: A
Randomized Controlled Trial. Unpublished Paper. Uppsala, Sweden: Uppsala
University.
Gratz, K. L., & Gunderson, J. G. (2006). "Preliminary data on an acceptance-based
emotion regulation group intervention for deliberate self-harm among women with
borderline personality disorder." Behavior Therapy, 37(1), 25-35.
Lappalainen, R., Lehtonen, T., Skarp, E., Taubert, E., Ojanen, M., & Hayes, S. C.
(2007). The impact of CBT and ACT models using psychology trainee therapists: A
preliminary controlled effectiveness trial. Behavior Modification. 31(4), 488-511.
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References Continued
Roemer, Lizabeth1; Orsillo, Susan M.2,3; Salters-Pedneault, Kristalyn (2008).
Efficacy of an Acceptance-Based behavior therapy for generalized anxiety
disorder: Evaluation in a randomized controlled trial. Journal of Consulting
and Clinical Psychology, 76, 1083–1089.
Strosahl, Hayes, Burgan & Romano et al. (1998). Assessing the Field
Effectiveness of Acceptance and Commitment Therapy: An Example of the
Manipulated Training Research Method. Behavior Therapy, 29, 35-64.
Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). "A preliminary investigation of
acceptance and commitment therapy as a treatment for chronic skin picking."
Behaviour Research and Therapy, 44(10), 1513-1522.
Vowles, Kevin E. 1,2; McCracken, Lance M. 1,2 Acceptance and Values-Based
Action in Chronic Pain: A Study of Treatment Effectiveness and Process.
Journal of Consulting & Clinical Psychology. 76(3):397-407, June 2008.
Wicksell, R. D. Ahlqvist, J., Bring, A., Melin, L. & Olsson, G. L. (2008). Can
exposure and acceptance strategies improve functioning and life satisfaction
in people with chronic pain and whiplash-associated disorders (WAD)? A
randomized controlled trial. Cognitive Behavior Therapy, 37, 169-182.
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References Continued
Wicksell, R. K., Melin, L., Lekander, M., & Olsson, G. L. (in press). Evaluating the
effectiveness of exposure and acceptance strategies to improve functioning
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VAPTC EBP Presentation