Have you heard of:

Mindfulness therapies?
Avoiding avoidance
behaviors?
Dialectical Behavior
Therapy (DBT)?
 Acceptance-Based Behavioral
Therapy for Generalized Anxiety
Disorder
By: Ganit Gray & Abbey Gloyd
Let’s start with GAD
diagnostic criteria:
Generalized Anxiety Disorder 300.02 (F41.1)

A. Excessive anxiety and

worry,
>6mos,
in multiple situations
Generalized Anxiety Disorder 300.02 (F41.1)

B. The individual
finds it difficult to
control the worry.
Generalized Anxiety Disorder 300.02 (F41.1)

C. The anxiety/worry are associated with specific

symptoms,
 Generalized Anxiety Disorder 300.02 (F41.1)

D. Symptoms cause significant distress or impairment,

Generalized Anxiety Disorder 300.02 (F41.1)

E. Not attributable to effects of a substance.

Generalized Anxiety Disorder 300.02 (F41.1)

F. Not better explained by another

mental disorder.
Acceptance-Based Behavioral Therapy
● Need for treatment development
● Broad class of therapies
● Acceptance of internal experiences
● Grounded in behavioral
learning theory
Behavior is acquired
through conditioning
● Three learned behaviors:
○ Ways of relating to
internal experiences
○ Avoiding internal distress
○ Avoidance of meaningful
activities
○ Awareness & positive stance toward
internal experiences
○ Increase acceptance/willingness to have
internal experiences
○ Engage personally meaningful behaviors
Phases of Intervention
There are many therapies within ABBT: “third wave”
cognitive therapies that build upon and/or reframe CBT.

● Acceptance and Commitment Therapy (ACT) << will

describe the phases of this
● Dialectical Behavior Therapy (DBT)
● Mindfulness Based Cognitive Therapy (MBCT)
● Integrative Behavioral Couples Therapy (IBCT)
Phases of Intervention: ACT
There are six core phases of ACT: generally lasts 12 sessions.

1. Acceptance
2. Cognitive defusion
3. Being present
4. Self as context
5. Values
6. Committed action
1. Acceptance
Avoiding avoidance.

Accepting and struggling with avoidant thoughts and

experiences, rather than running away from them.
2. Cognitive Defusion
Using techniques that reduce the meaning and intensity of
anxiety-inducing events and thoughts, such as

● Labeling thoughts
● “Watching” thoughts dispassionately
● Repeating thoughts until their meaning/power reduces
3. Being Present
Experiencing events in the moment, as they are, and
describing rather than predicting.
4. Self as Context
Use exercises to adopt a spiritual, transcendent locus of
perspective:

1. Mindfulness exercises,
2. metaphors, and
3. experiential processes
5. Values
Encouraging clients to first identify their core values, and
then to think about what it would mean to live a life
motivated by those values, rather than on avoidance
behaviors.
6. Committed Action
Take what was discussed in #5 and make it happen.
Assignments
● Review psychoeducational materials
● Self-monitoring forms
● Practice mindfulness daily
○ Formal
○ Informal
● Engage in valuable actions
Research Support
SAMHSA National Registry of Evidence-based Programs and Practices: “ACT is
evidence based” (2011)

● Peer-reviewed research

American Psychological Association, Society of Clinical Psychology: “Modest

research support” for ACT and mixed anxiety

● Meta-analyses and clinical trials

Class Exercise
❖ Mindfulness-Based Progressive
Muscle Relaxation

❖ Discussion
https://www.guilford.com/companion-site/The-Mindful-Way-through-Anxiety/9781606234648#stream
References
Association for Contextual Behavioral Science (Ed.). (2011, July 6). 'ACT is evidence-Based' says U.S. government
agency. Retrieved January 27, 2019, from
https://contextualscience.org/news/act_is_evidencebased_says_us_government_agency

Barlow, D. H. (2014). Clinical handbook of psychological disorders: a step-by-step treatment manual. Fifth edition.
New York: The Guilford Press.

Guilford Press. (2016). Supplemental Materials for the mindful way through anxiety [Audio files].
Retrieved from https://www.guilford.com/companion-site/The-Mindful-Way-through-Anxiety/
9781606234648#stream

Hofmann, S. G., & Asmundson, G. J. G. (2008). Acceptance and mindfulness-based therapy: New wave or old hat?
Clinical Psychology Review, 28(1), 1–16. https://doi.org/10.1016/j.cpr.2007.09.003

Noel, N., & Imel, Z. (n.d.). Acceptance and commitment therapy for mixed anxiety disorders | Society for Clinical
Psychology. Retrieved January 27, 2019, from
http://www.div12.org/treatment/acceptance-and-commitment-therapy-for-mixed-anxiety-disorders/