Behavioral Medicine/Primary Care
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I would like to connect with "fellow travelers" who are using ACT in a Behavioral Medicine or Primary Care setting. I'm a chaplain in a medical center and also a Licensed Professional Counselor. I've been using ACT principles in group settings for our Diabetes Education and Cardiac Rehab outpatient programs. It seems to me that using ACT in this setting has virtually unlimited possibilities, including chronic pain, fibromyalgia, CFS, and many other chronic "medical" illnesses. There is a growing body of ACT literature, both popular and professional, that specifically addresses these disorders. I would like to hear from other professionals who might be using ACT in a similar setting with "medical" patients.
ACT with Illness and Injury
I use ACT with chronic pain and recovery from injury including brain injury. I did run a pain group for awhile, it was over six weeks, 2-3 hours each week. Hope to get one running again in the new year. I have run short one of workshops for different groups like the ME group, but not a real treatment groups for them. I run my individual clients much the same way as a group. I try to use as many experiential exercises as possible.
I usually start with values – funeral exercise followed by looking at and rating particular values and barriers to activity.
Then I move in to Monsters on the Bus as an experiential exercise, not a metaphor. This is my favorite exercise.
I like mindfulness/noticing behavioral exercises, exposure - introspective exposure through extreme mindfulness, or minute descriptions of pain for example, and exposure to feared activity.
That type of thing. Also use Tug of War with the Monster as an exercise, and “ Your right” with fairly stuck people.
I haven't read the pain workbook,although I have it. I think JoAnne Dahl's first pain book is a good template for most ACT interventions.
I am interested to hear what other people do. Any ideas would be helpful.
Jim Hegarty PhD PgDipClinPsych FNZCCP
Consultant Clinical Psychologist
diabetic interventions
I mostly see diabetic folks for short-term (1-3 sessions) individual work, and actually often include their significant other in the sessions, as well, since they're part of the context of eating and exercising and remembering to check blood sugar, take insulin, etc. Plenty of time spent examining how much they've accepted diabetes as a condition they have whether they like it or not, and also ways they've reacted and coped.
Depending on where they are in terms of acceptance and willingness to do something different, I might either proceed to spend more time on values work (if they're not so accepting) or to conceptualizing valuing behaviorally and starting to look at awareness and intentionality of actions as related to self-care and any other values they come up with. From that point we can look at goals and/or choices and how those are working - start building some new behavior history...
I haven't ever used the standardized workshop, but I do sometimes facilitate the diabetic education group here at the hospital. Not a whole lot to say there in terms of clever ACT stuff - I mostly just normalize frustration, empower them with choice, lightly touch on values (often, spouses are present for these classes), and encourage self-referrals for behavioral health help as needed.
Hi, I'm interested in
Hi, I'm interested in hearing about experiences folks have had using ACT with diabetes. Has anyone used the 1-day workshop which showed promising results in terms of blood glucose being in the target range 3 months later? Anyone using the Diabetes Lifestyle Book? Are you using individual therapy sessions with diabetic patients, workshops, or something else?
In primary care work, I'm finding the "passenger on the bus" and the thoughts as "leaves traveling downstream" or thoughts as "people walking by with placards" metaphors really helpful. We talk about how the person is so much more than these thoughts and feelings, that they can watch them come and watch them go...
Kimberly Montgomery, Ph.D. HSPP
Clinical Manager of Behavioral Medicine and Health Psychology
Community Health Network
ACT in a Behavioral Medicine/Primary Care setting
Michael Lalic,LCSW,LMFT
Don,
I absolutely agree that ACT has limitless possibilities in work with "medical" patients. I began using ACT with patients in Cardiac rehab, Diabetes classes, oncology and most recently with bariatric weight loss surgery patients, all with great success. I am now developing a program of Behavioral Neuroscience interventions for patients with neurological disorders. This is an exciting time for being an ACT therapist and while we are still behind here in Indiana (I am one of only 5 ACT therapists in the whole state), the future appears quite bright. Keep in touch and hope to see you all in Reno come June. Be well.
Mike
primary care ACT & RFT
Hey Marc - representin the VA! It's a beautiful thing to do this work in primary care, in part because it doesn't always take the form of "therapy." The average person who agrees to a same-day, doctor's office, referral (e.g., after getting a flu shot), either does so reluctantly or just wants to talk and make sense of things. So working in primary care has taught me to respect (AND take lightly) people's urges to "understand" as a part of trusting in the therapeutic process enough to be willing to consider anything but holding back and someday-ing. To borrow the tug-of-war metaphor, I have learned that clients in primary care will sometimes stop working on stuff if I as the therapist drop the rope too often.
Favorite primary care contextual intervention: reality TV show. For example, What if your life were a reality TV show? What was yesterday's episode about? What would the little description in the TV guide say about yesterday's episode? What about today's?
ACT in Primary Care
Howdy,
I just started a position in Primary Care within the VA. Hi John Agee! Anyway, would love materials, thoughts, insights as to providing ACT-consistent care within a very brief model.
Marc Houck, Psy.D.
Behavioral Medicine/Primary Care
I work as a psychologist in a VA primary care setting and ACT plays a huge role in the work I do, including more traditional "mental health" referrals as well as the behavioral medicine stuff. Diabetes is our number one referral issue for the latter. Working in primary care has been a good lesson in psychological flexibility in that sometimes "ACT consistent" interventions end up being "unworkable," or so says my experience. So eclecticism with a large dose of functional contextualism is really the bread and butter for my setting. Good to see this topic on the board!
ACT in medical settings
I have been enjoying using ACT in primary care settings and finding it very useful to help focus patients on meaningful and productive action. I'm exploring ways to use this in other medical specialty settings.
Kimberly Montgomery, Ph.D. HSPP
Clinical Manager of Behavioral Medicine and Health Psychology
Community Health Network
Behavioral medicine - diabetes care
Ullet E. Bydairk - reply to Don Hubbard
I am writing my final master thesis in psychology at Linköping University, Sweden. We're doing a smaller study on type 1 diabetics to see if there are any relationships between acceptance/E.A, self care and HbA1c-values. I hope, in the future, to continue with extended ACT-studies in this medical field. I would very much like to hear more about your experiences and knowledge. If you want to you can e-mail me at: ulrby378@student.liu.se
/Ullet E. Bydairk