Review of ‘A CBT practitioner’s guide to ACT’ by JV Giarrochi and A Bailey.
Book description and review: This book describes the usual ACT philosophy and approaches, such as defusing from thoughts, observing the self, being in the now, accepting thoughts and feelings, and acting flexibly in pursuit of values. It looks at how CBT differs from ACT, and acknowledges (correctly) that it may be acceptable to challenge thoughts, as opposed to defusing from them, depending on the context. The authors say that if a patient values being accurate then challenging may be best, but if a patient believes something to obtain help, or make sense of the world, or blame someone else, then less so. It encourages the CBT practitioner to be less verbal, and be open to creating a slowed down mindful space in the therapy hour, sitting with distress. There is an excellent section on values, and I have always found that helping patients identify and engage with what their philosophy in life is (be kind…be intelligent…) works well, especially with depression and chronic pain.
There are fantastic exercises in this book including ‘milk’, and ‘monsters on the bus’ that can be incorporated into therapy.
This is an excellent book more philosophically aligned to the ACT approach, but striving to be fair to both. It’s written more clearly than some ACT books, with even ‘relational frame’ theory made fairly understandable. Having used both therapy approaches, I find them fairly equally effective, but I personally find CBT more acceptable: it is more collaborative and, I think more sophisticated from a theoretical point of view. The ACT approach is more genuinely side by side, ‘we’re all in it together’, and aims to bring about a more philosophical change in the individual, as opposed to just reducing a dysfunctional emotion.
Clinical application: If you use a Beckian approach try using the ACT defusion exercises like milk and monsters on the bus. The first is done by getting the person to say milk and see what it brings up, then to repeatedly say it, which can lead to defusing from meanings of milk. One can then try this with the person’s beliefs e.g. I’m stupid’, saying it repeatedly, quietly, loudly, like Mickey Mouse, like an opera singer. This is a powerful and humorous exercise but crucially the person has to be reassured that he is not being laughed at.
The monsters exercise has the patient driving the bus to the destination despite the passengers (therapist) trying to distract them by mouthing the drivers negative thoughts. This is a fun exercise, which works well. The patient can be invited to see the various effects of ignoring, arguing with or accepting of the passengers’ comments.
Values work can be done by getting the patient to fill in the values questionnaire, and to rate their adherence to their values. Imaging your eulogy is a more emotionally powerful version of this. This strategy can enhance the Beckian mastery and pleasure approach by targeting the range of activities more thoughtfully.