Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists

466 Pages·2017·8.97 MB·English

by  Jason B. Luoma

“In this authoritative text, Luoma, Hayes, and Walser present a clearly written and practical step-by-
step guide for therapists who are using acceptance and commitment therapy (ACT). Firmly rooted in
contextual behavioral science and derived from a well-articulated theory, this text clearly describes and
illustrates the concrete strategies to target a set of key processes that are critical to improve the lives of
people. Every clinician should be familiar with it. It is a masterful book. I highly recommend it.”
—Stefan G. Hofmann, PhD, professor of psychology at Boston University,
past president of the Association for Behavioral and Cognitive Therapies, and
author of Emotion in Therapy
“This second edition is an exceptional guide for the skillful and flexible implementation of ACT prin-
ciples. The chapters outline the six core flexible ACT processes and their methods, with case examples
and dialogues that bring the information to life. The book includes a unique and invaluable set of
training tools and tests of core competencies. This is a masterful ‘how to’ for ACT suitable for clini-
cians at any level of training and experience.”
—Michelle G. Craske, PhD, distinguished professor, and director of the Anxiety
and Depression Research Center at the University of California, Los Angeles
“Firmly grounded in contextual behavioral science (CBS), superbly organized with lucid and compre-
hensive explanation of all ACT concepts and competencies, and loaded with clinical pearls and pitfalls
to avoid, this book lives up to the title and then some, as one of the best books for learning ACT.
Further, the clinical vignettes and self-reflective exercises will deepen and advance the practice of more
seasoned practitioners of ACT. The updated text and the new inclusion of an excellent chapter on
culture and diversity make this edition more relevant and invaluable than ever in this diverse, global-
izing world. This book is simply a ‘must-have’ for any serious ACT practitioner!”
—Kenneth P. Fung, MD, FRCPC, MSc, associate professor in the department
of psychiatry at the University of Toronto; clinical director of the Asian Initiative
in Mental Health at the University Health Network; and president-elect of the
Society for the Study of Psychiatry and Culture
“ACT has been at the forefront of the pioneering third-wave cognitive behavioral therapies for many
years. Not only has it uniquely linked the human evolution of language and symbol formation to mental
processes that can cause suffering (relational frame theory [RFT]), but it has articulated six clear pro-
cesses for therapeutic intervention centered around developing psychological flexibility. For both
novice and expert therapists of any orientation, you could not want for a more clearly articulated, easily
accessible, and therapeutically wise approach than this by these leaders and pioneers in the field. Full
of therapeutic transcripts with clear, insightful descriptions of the therapeutic process, this beautifully
written book is an outstanding contribution to therapeutic literature that is bound to become a classic
and an essential text.”
—Paul Gilbert, professor at the University of Derby, creator of compassion-focused
therapy (CFT), founder of the Compassionate Mind Foundation, and author of
The Compassionate Mind
“The tremendous dedication of thought and care Luoma, Hayes, and Walser infused into this second
edition of Learning ACT is evident in the breadth and depth of every chapter. Their labor of love
resulted in a preeminent and indispensable guide for novice and advanced ACT practitioners alike.
Especially valuable are the fifty core competency exercises that stimulate experiential engagement. The
chapter on adapting ACT to cultural contexts makes this a cutting-edge treatment for individuals from
every walk of life who want to move in valued directions while welcoming all their thoughts and
feelings.”
—Mavis Tsai, PhD, coauthor of A Guide to Functional Analytic Psychotherapy,
and research scientist and clinical faculty at the University of Washington
L e a r n i n g
AC T
S E C O N D E D I T I O N
An Acceptance & Commitment Therapy
Skills Training Manual for Therapists
JASON B. LUOMA, P D
h
STEVEN C. HAYES, P D
h
ROBYN D. WALSER, P D
h
C P
ontext ress
An Imprint of New Harbinger Publications, Inc.
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It
is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other
professional services. If expert assistance or counseling is needed, the services of a competent professional should be
sought.
Distributed in Canada by Raincoast Books
Copyright © 2017 by Jason B. Luoma, Steven C. Hayes, and Robyn D. Walser
Context Press
An imprint of New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup
Acquired by Catharine Meyers
Edited by Jasmine Star
Indexed by James Minkin
All Rights Reserved
Library of Congress Cataloging-in-Publication Data on file
To my partner, Jenna LeJeune, for your support, your sacrifice, and your faith in me.
— JBL
I would like to dedicate this book to David H. Barlow, and to my fellow interns (Peter M. Monti,
Kelly D. Brownell, A. Toy Caldwell- Colbert, and Carol Heckerman Landau) who worked under
him in the first class of clinical psychology at Brown University, Department of Psychiatry and
Human Behavior, 1975– 1976 and who such showed patience and kindness in shaping up a wild
man (that would be me) to be able to work with people.
— SCH
I would like to dedicate this book to Susan L. Pickett. Thanks for the encouragement
over the years and for always having faith in me.
— RDW

Contents
Acknowlegments vii
Introduction 1
1 The Focus of ACT and Its Six Aspects 13
2 Developing Willingness and Acceptance 37
3 Undermining Cognitive Fusion 88
4 Getting in Contact with the Present Moment 132
5 Building Flexible Perspective Taking Through Self- as- Context 163
6 Defining Valued Directions 197
7 Building Patterns of Committed Action 238
8 Conceptualizing Cases Using ACT 272
9 The ACT Therapeutic Stance 316
10 Adapting ACT to Cultural Contexts 349
11 Bringing It All Together 371
Appendix A: The ACT Core Competency Rating Form 413
Appendix B: Resources for Further Development 420
Appendix C: Using ACT in Different Settings 422
Glossary 425
References 429
Index 443

Acknowledgments
This book was a team effort. To all those who read and provided feedback on drafts of these chapters,
thank you. The exercises were particularly improved by those who piloted chapters of this book, includ-
ing Mary Englert, Anne Shankar, Lianna Evans, Ross Leonard, Brendan Sillifant, Kevin Handley,
Laura Meyers, Joanne Hersh, Jennifer Boulanger, and Jennifer Plumb. Thanks to the Portland ACT
peer consultation group for their ideas about how to organize the book, exercises, and videos. Thanks
to Joe Parsons for discussions about shaping therapist behavior, which influenced the exercises in this
book. Thanks to those who provided feedback on the first edition including Donna Read, Ana Gallego,
Miguel Lewis, Hiba Giacoletto, Brady Henderson, Petra Berg, Andrea Sieg, Kathleen Thorndike, Fred
Kane, Magda Permut, Kaylin Jones, Sonia Combs, and the therapists at Lutheran Community Services
of Spokane. Your input resulted in some large improvements in this edition, and your efforts will touch
the lives of thousands of future readers and their hundreds of thousands of clients. All those people will
never know that they should thank you for the time you put into improving the book.
To all of our clients who have honored us with their presence, trust, and courage. Without all of
you, this book would not have been possible.
Thanks to those students and professionals who allowed themselves to be supervised by us and who
taught their supervisors so much. Thanks to our editors, Jude Berman and Jasmine Star, for smoothing
out our language and making our jargon more understandable.
Acknowledgment from individual authors:
Thank you to all those who helped me (JBL) learn ACT. When I first began studying ACT, I was
blown away by the rigor and scope of the theory and was thoroughly confused by the technical lan-
guage. I was rapidly able to utilize many of the metaphors and exercises, but didn’t really understand
how it all tied together. I needed a book about the in between moments. This is my attempt to write
that book.
I (SCH) would like to thank my wife, Jacqueline Pistorello, for her support, advice, and patience
throughout, and to thank my lab for their input and encouragement.
I (RDW) would like to thank my mom for providing some of the illustrations in this book. They look
great, Mom! We appreciate your willingness and action on short notice. I love and miss you. And thank
you to my brothers for being there in times of need and as well times of joy, much love to you and your
families.