Young ACBS researcher wins grant for ACT with OCD

Michael Twohig, Assistant Professor at Utah State University, and his colleague Jon Abramowitz have recently been awarded $50,000 from the International OCD Foundation. The grant was awarded for their proposal to investigate the combination of Acceptance and Commitment Therapy (ACT) and Exposure and Response Prevention (ERP) for the treatment of Obsessive Compulsive Disorder (OCD).

Taking a break from some writing over the winter holiday season, Michael agreed to an interview with ACBS. In it, he explains his new study, and shares some useful insights from his experiences as a young psychologist. 

DOUG: Thanks for taking the time to answer some questions, Mike. First, tell us, what do you hope to find in your new study? 

MIKE: Jon Abramowitz and I want to see whether conducting exposures from and ACT model increases acceptability and engagement in the exposures compared to those conducted from a more traditional fear reduction model. Of course I would be pleased if we had positive findings. Exposure exercises are useful, when done in the right way, but they are very hard for some people to do. If casting the exercises from and ACT model helps people do them more often and more fully, we would likely see better outcomes with a larger sample. Still, it is research and we will just have to see how things turn out. Like, my old mentor Alan Baron used to say, "the rats don't lie." 

DOUG: What do you think ACT can add to ERP?

MIKE: I think ACT offers a different procedures from which to do exposures. The exposures are about fostering willingness and the sessions involve doing what we can to foster that. It has a unique process of change. ACT tries to foster psychological flexibility--which is not the main goal when exposure is done from other models. Also, ACT seeks a different main outcome: increased functioning. I see these three things as the big differences from exposures done from a fear reduction model. 

  

DOUG: What inspires you? What is it that you find meaningful about your work?

MIKE: All and all, my overarching value in this work is to help our clients receive the best psychological treatments possible. This has been my focus since my undergraduate days in Milwaukee. This shows up in many ways in my lab, from running outcome studies to training students. 

It is great to be making a difference. There is an odd pressure with having people listen to what I say, but I am also pleased that I get to push the field around a little. Sometimes I do miss being a grad student and having all criticisms aimed at my advisor.

I try and make sure my work does some good for our clients. Sometimes it is easy to see--as in an outcome study--but other times the good comes years later--as in a review paper that organizes research. I think keeping my focus on doing work that matters has been really useful to me. It has also made my work seem meaningful and I don't really tire of it.

DOUG: What difficulties have you faced in pursuit of a psychology career? 

MIKE: That is a tough question. It is a long road and it feels like it never ends. I only got licensed 2 years ago and I am currently going up for tenure, so it feels like the evaluation part of grad school never ends. I will admit, the pay is better now. 

DOUG: Is there anything you wish you had known before you started on this path?

MIKE: You will never, ever, be caught up. I learned that towards the end of grad school and have slept better ever since. 

DOUG: Looking ahead at the years to come, what sort of impact do you hope your lab will have? 

MIKE: I think besides putting great students out in the world, we will help find a way for behavioral and ACBS values to be integrated into the field of psychology. 

DOUG: What other research topics do you hope to explore?

MIKE: My lab is getting into translational work with basic behavior analysts. We have rat and pigeon researchers on all our thesis and dissertation committees.

DOUG: Any final thoughts?

MIKE: It is a little freaky if I am really at a point I get interviewed. But if I am really here I want to thank a few of my mentors: Drs. Woods, Friman, Hayes, and Whittal. All I really do as a mentor is repeat things you four said to me. Thanks!    

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Interview by Douglas M. Long

University of Nevada, Reno

ACBS Staff Writer

ACT has "strong research support" for chronic pain says Society of Clinical Psychology

The Society of Clinical Psychology (APA’s Division 12) has recently listed ACT as having “strong research support” for the treatment of chronic pain. ACT’s new status reflects the number and quality of randomized control trials for this problem area. The key studies cited there in support of ACT reflect enormous efforts from several research teams. Congratulations to all those who lent a hand! 

ACBS member-at-large Rikard Wicksell, is one such researcher. Rikard K. Wicksell, Ph.D., is a licensed clinical psychologist, and a clinical researcher at the Behavioral Medicine Pain Treatment Service, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institutet, in Stockholm, Sweden. Since 2001, he has, in collaboration with colleagues, developed a treatment approach based on ACT for children, adolescents, and adults with chronic pain. Rikard sat down for an extensive interview – offering advice to young researchers and chronic pain clients, and sharing his hopes for ACBS.

DOUG: The Society of Clinical Psychology recently rated ACT has having strong research support for chronic pain. Given all your work with this population, this must be really nice to see. What are your thoughts?

RIKARD: I’m pleased to see that an independent organization has concluded that the empirical support is rather solid. And, we shouldn’t be worried that ACT “just made the cut”. Several RCT’s with promising preliminary findings will be published within a year or so that will likely provide further support. We are now working on a systematic review on ACT and pain that will include treatment evaluations, lab-studies, cross-sectional, and longitudinal data – perhaps 90 studies in total. For members not aware of the research on ACT and chronic pain, I want to point out the great contributions by Lance McCracken and Kevin Vowles.

From a clinical perspective I am still a bit worried that some people may think of ACT as a method (“just another”) for helping people to reduce pain and distress rather than a fundamentally different approach to human suffering. I’m concerned that core aspects of the model are not fully getting across to regular clinicians working with pain patients. The shift in perspective from symptom alleviation to vital living (in the presence of treatment resistant pain and distress) is difficult, to say the least, for patients as well as for clinicians.

DOUG: How did you become interested in the treatment of chronic pain?

RIKARD: The behavioral medicine field has fascinated me for a long time. During my final year in school, I conducted a behavioral intervention with an adolescent suffering from a severe form of myoclonic epilepsy. With a relatively brief intervention, his functioning improved substantially. His ability to stand up increased from a few seconds to several minutes. When I got in touch with Gunnar L Olsson, a pediatric anesthesiologist interested in developing a CBT-oriented approach for chronic pain, I found this to be an irresistible challenge with enormous potential.

In a sense, I guess I could say that I’m not really interested in chronic pain per se. I am interested in the individual and his/her suffering. Chronic pain just represents one of several areas where people, and clinicians, appear to be involved in a commonly unsuccessful struggle for cure and relief, possibly with a paradoxical increase in disability as the result of this process.

DOUG: What is it like working with this population?

RIKARD: The vast majority of our patients are rather ordinary individuals, easy to relate to. One may think that working with chronic treatment resistant pain is frustrating and emotionally challenging. A more traditional approach focused on symptom management probably is. In contrast, an ACT-oriented approach focuses on variables we can influence (behaviors) and is orientated towards something inherently positive (valued living). As a result, although we are sometimes disappointed and frustrated, a positive and optimistic spirit normally characterizes the collaborations with patients.

DOUG: If you were to offer advice to someone dealing with chronic pain, what would you say?

RIKARD: I don’t find it strange or inadequate to try to minimize the pain experience. I am sure this would intuitively be my primary focus, if I were in their shoes. I would point out though two related yet different problems: the presence of pain and the absence of a vital life. I would ask the person: What has the quest for pain relief cost? What has been reduced or left out of life in the service of living a life with as little pain as possible? And, what would you be willing to pay (in terms of pain and distress) to be able to do the things you value the most? I then would suggest taking a deep breath and start to dream about what life could be like, if pain reduction was no longer allowed to guide actions.

When asked about particularly relevant parts of the treatment program our patients commonly emphasize the values work and the creative hopelessness process. When working through this part of the treatment program, we explicitly state that therapy is not about making someone move in this or that direction. Rather, it is an opportunity to collaboratively explore the available options. The decision about where to head in life is, then, up to the patient.

DOUG: What are some of the challenges which you and your colleagues have faced in conducting your research? Any advice for new researchers?

RIKARD: This is a complicated and complex process with lots of struggles and frustration along the road. So, my first advice is to identify the value in it, and make sure that some reinforcing aspects are present throughout the process.

I think less extensive studies with a relatively simple design have some clear advantages. You can, for example, make changes based on previous studies, and thereby correct the things you were unpleased with. Also, relevant data can be analyzed and presented more quickly.

Getting input – especially from more senior researchers -- is essential. Kelly Wilson once passed along some words of advice that I try to hold on to: “if you only have one good idea, guard it with your life.” Although the academic world sometimes appears to be highly competitive, research is fundamentally about sharing and collaborating.

DOUG: What do you value about ACBS? What is your hope for the organization? Where would you like to see it go?

RIKARD: The quote about sharing good ideas leads back to the invaluable openness and collaborative spirit within ACBS. Especially, I value the wonderful combination of a scientific orientation and a friendly, supportive atmosphere.

The future of both ACBS and contextual behavioral science is about research. Unfortunately, it is not always obvious what the relevant research questions are or how they may be explored. Possibly the organization can play an even more active role when it comes to initiating and coordinating research activities -- especially with studies that may be difficult to conduct but are potentially groundbreaking. As commonly said in ACBS; it takes a village. If we can find a way to optimize the research activities that occur within the organization, that village may accomplish even more and better research in the future. Interdisciplinary research networks, and a “most wanted” list of research hypothesis are a couple of ideas.

There are many clinicians and researchers around the world capable of accomplishing great things but who lack a supportive environment. For all of us, but particularly for them, I think ACBS makes a critical difference. These are exciting times, and as a community we are in a position to make real difference. I appreciate being part of this work and look forward to see what we can accomplish together.

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Interview by Douglas M. Long
University of Nevada, Reno
ACBS Staff Writer