Thursday, June 21, 2012

ACT therapists help war survivors in Sierra Leone

Sierra Leone, a small country on the Western coast of Africa is in recovery after a brutally violent and lengthy civil war, and therapists are lending help with Acceptance and Commitment Therapy (ACT). One Association for Contextual Behavioral Science (ACBS) member, Beate Ebert from Germany, and her friends have founded a non-profit organization "commit and act e.V.", with the intention to bring therapy training, especially ACT, to conflict or post-conflict areas, starting in Sierra Leone. As a result of that, Leonean therapists have attended several ACBS World Conferences to learn ACT. ACBS has established the Developing Nations Training Fund to support these efforts, has declared therapeutic support of developing countries as one of its main goals in the future.

Several ACBS members, such as JoAnne Dahl, D. J. Moran and Ross White have taken on a more personal involvement -- visiting Sierra Leone together with Beate to give ACT trainings.  Beate was gracious enough to answer some questions about her recent experiences with ACT in Sierra Leone.

Doug: The people of Sierra Leone have been through so much. How are they coping?
Beate: It is a complicated situation. When I visited Sierra Leone for the first time in 2010 , I  met Aminata – in the picture below. She lives in one of the amputee-camps, the rebels cut her arm in the war when she was 12; she is around 30 now, has 3 children and she cooks palm oil on the fire to sell it.  Like human beings often do, people in Sierra Leone try to forget all the cruel events, for example they pray to forget - and these people in the amputee camps are very much left alone with no support by the government, and not much possibility to earn their own living, only supported by inhabitants of the close village who do not have much for their own families.

Survivors of the conflict must find ways to cope.
Aminata is one of the victims we hope to support through the therapists we train in the workshops. This year, Hannah Bockarie, many of you met her at the World Conference in Parma, organized an ACT training with 35  local counselors in Bo, the second biggest city in the country. So, Ross White, Jennifer Nardozzi and I traveled around and did a few workshops this year.

Doug: What was your experience like with these workshops?
Beate: This was my third visit to Sierra Leone, and my experience is that we are building a solid basis here. People are awake, and very quick in adapting the ACT approach to their therapy skills. I never experienced such gratefulness before. It worked really well. These participants hardly wanted to take the breaks, even though we have this hot and moist climate. They are not only eager to learn, but so quick in understanding and adapting what we give to them. We had social workers in the workshop who work with street kids, and they adapted the life line exercise to teach their boys the difference between the "easy way", this is going to the street, avoiding the father who beats them or avoiding school problems, and the "best way", the valued way, this could be asking for professional support for their families. 


Therapists practice the ACT life line exercise.
Doug: Those therapists sound really talented and motivated.
Beate: There is a lot of experience there, some of them with 10-15 years as counsellors. Their willingness to support each other, and their experience of community is immense. Therapists shared, how hard it is sometimes, to end their workday. One woman said, “ all these girls who have been raped are coming to see me, they are stigmatized, their families don’t want them any more, so I take them to the police, outside my working hours, I give them money for food, even if I have no money myself.”

Doug: Does it seem like ACT has something to offer?
Beate: At the end of the workshop, many came personally to shake our hands and thank us for the blessing we bring with our method. We met some people who we had trained previously, and you can see how valuable ACT is for them. People reported that they used ACT successfully in their daily practice and  that they share the tools they got with their colleagues. They used ACT for taking care of themselves as caregivers and this was so needed. They do an incredible amount of work and there are hardly any capacities for their support, like supervision. 

Participants are proud of what they have learned.
Doug: It sounds like some really good work is happening there. What’s next?
Beate: It was so fulfilling to be there, and to see how local therapists are building up what we started. This is our goal, that people like Hannah take it on, that they train their people in the future and we can go to other places. Hannah showed me a proposal she wrote for opening an ACT center with an experienced colleague who participated in last years and this years training. We also have requests from other parts of the country, Makeni for example, where the rate of domestic violence and sexual violence against women is the highest in the country. 

Doug: Anything else you would like ACBS members to know?
Beate: I could go on and on, this project is so close to my heart. It´s such a gift for me, to be connected to my friends and colleagues in Sierra Leone and to learn from them about community, friendliness and caring. If you want to consider coming as a trainer, please visit our SIG Meeting at the ACBS World Conference in Washington, D.C. or contact me.

Thank you for taking the time to read this. Thank you for supporting this with your contribution to ACBS and the fund. Thanks for being this visionary community, empowering so many people around the world.

Left to right: Beate Ebert, Hannah Bockarie, Ross White

Article by ACBS Staff Member Douglas M. Long

New meta-analysis highlights CBS laboratory research

The utility and importance of laboratory studies within Contextual Behavioral Science (CBS) has recently been highlighted in a new paper by Levin, Hildebrandt, Lillis, and Hayes. The psychological flexibility model – which underlies Acceptance and Commitment Therapy -- was evaluated in this meta-analysis of 66 laboratory studies. This unique meta-analysis evaluates components and processes such as acceptance, defusion, present moment, values, mixed mindfulness components, and more. Significant positive effects were found. In this interview, author Michael Levin answers a few questions, and provides recommendations for future research. 

Doug: How does this paper fit into the big picture of CBS?
Michael: There is a large and growing number of lab-based component studies relevant to ACT and this is the first meta-analysis we know of that has reviewed this literature within the framework of the psychological flexibility model.

Doug: What is unique and special about this meta-analysis?
Michael: In addition to providing an overall summary of the effect sizes for each component, there are enough varied studies now that we could  explore important theoretical questions such as whether they impact outcomes in ways consistent with our theory and whether there are differences between rationale-alone vs. more experiential interventions.This paper also gave us a chance to discuss the CBS approach and outline how lab-based studies can fit within theory/treatment development and testing.

Doug: What were some challenges that you faced?
Michael: Early into the meta-analysis we realized that, due to different approaches taken by authors and the varied audiences they were speaking to, the interventions were not necessarily labeled in a way that consistently reflected the psychological flexibility model. Many were labeled as "acceptance" or "mindfulness", the meaning of which varied somewhat across articles. However, we were able to reliably code these interventions ourselves for the meta-analysis and found a number of studies testing each component in isolation as well as combined. 

Doug: What sorts of component studies do you hope to see in the future?
Michael: We didn't find any lab-based studies testing self-as-context alone and there is a clear need for research in this area. Also, more careful comparisons are needed to examine the impact of combining specific components (i.e., acceptance vs. acceptance + values). We also recommend generally not using rationale-alone manipulations, unless there is a specific theoretical question, given our finding that such interventions are fairly inert. As we begin to build upon and expand our research questions with lab-based studies a broader range of behavioral measures (i.e., implicit measures, behavioral flexibility, delayed discounting) and measures with more applied relevance to the participant are needed.


Article by ACBS Staff Member Douglas M. Long