Praxis Continuing Education & Training

FACT Summer Intensive

Kirk Strosahl, PhD, Patti Robinson, PhD, and Thomas Gustavsson, MSC

Earn up to 30 CE credits available
Please read the complete course information below prior to registering.

Target Audience

All of the sessions of this program are designed for behavioral health clinicians from all disciplines, beginners to advanced; psychiatrists; general healthcare providers, including nurses, physicians, physician assistants, occupational therapists, physiotherapists, physical therapists; medical specialists such as pain medicine, rehabilitation medicine, endocrinology, oncology, psychology, social work, etc. The workshop will be ideal for clinicians who want extensive hands-on practice in using the model to build fluency in their application.

Schedule (earn up to 30 CE hours)

  • Optional yoga at 8–8.30 a.m. (led by Dr. Robinson, a certified yoga teacher). There are no CE credits offered for this session.
  • Breakfast (continental buffet provided) 8:30–9:00 a.m.
  • Morning class 9:00 a.m.–12:15 p.m. with a 15-minute break (3 CE hours available)
  • Lunch break 12:15–1:15 p.m.
  • Afternoon class 1:15–4:30 p.m. with a 15-minute break (3 CE hours available)
  • Optional yoga at 5–5:45 p.m. (led by Dr. Robinson) OR optional discussion group (led by Dr. Strosahl and Dr. Gustavsson) 5–6 p.m.  There are no CE credits offered for these sessions.

Monday a.m. – Session #1

The FACT Pillars of Psychological Flexibility

Trainers: Strosahl, Robinson, Gustavsson

This session will explore the three process outcomes FACT therapists seek to promote in their clients in every session: being open to and accepting of inner experiences, being aware and mindful in the present moment, organizing and directing personal actions according to one’s values. Participants will also learn about the three destructive processes that clients typically bring into therapy: rule following, emotional avoidance, and behavioral avoidance. The group will examine the central dynamic of all FACT sessions: workability. This involves raising the client’s awareness of their choice to live according to their values or to prioritize efforts to control, eliminate, or avoid inner distress. The trainers will demonstrate via role play demonstration how the three core processes ebb and flow during any given FACT conversation. Participants will engage in dyadic role play practice to help build core FACT intervention skills.

Learning Objectives:

  1. Describe the core processes of the ACT model (open, aware, engaged).
  2. Describe the central role of workability in creating motivation for change.
  3. Demonstrate and practice core FACT strategies for enhancing psychological flexibility.

Workshop Agenda:

  • Three pillars of psychological flexibility as antidotes to rule following, emotional avoidance, and behavioral avoidance; language as a behavioral control system, workability as the measuring rod of successful living. 
  • “Dancing” with the pillars in practice; role play demonstration, supervised dyadic role playing using standard case vignettes; establish individual learning plan for the week.

References:

  1. Doorley, J., Goodman, F. Kelso, K., & Kashdan, T. (2020). Psychological flexibility: What we know, what we do not know, and what we think we know. Social and Personality Psychology Compass. 14. 10.1111/spc3.12566.
  2. Hayes, S. C., Hofmann, S. G., & Ciarrochi, J. (2023). The Idionomic Future of Cognitive Behavioral Therapy: What Stands Out From Criticisms of ACT Development. 
  3. Behavior Therapy, 54(6), 1036–1063. https://doi.org/10.1016/j.beth.2023.07.011
  4. Dochat, C., Wooldridge, J. S., Herbert, M. S., Lee, M. W., & Afari, N. (2021). Single-Session Acceptance and Commitment Therapy (ACT) Interventions for Patients with Chronic Health Conditions: A Systematic Review and Meta-Analysis. Journal of Contextual Behavioral Science, 20, 52-69. DOI: 10.1016/j.jcbs.2021.03.003

Monday p.m. – Session #2

Interviewing and Case Conceptualization

Trainers: Gustavsson & Strosahl

This workshop will examine the many nuances of the FACT change-oriented interview. Participants will learn the basic principles of functional analysis and contextual assessment, and how these differ from more traditional forms of mental health interviewing. The trainers will demonstrate, and have participants practice, the CARE framework for interviewing. Each letter of the CARE acronym represents a specific task the clinician will perform in a normal session. 1) Reveal the life context factors that are promoting dysfunction and avoidance in the context of the client’s values; 2) Assess and undermine emotional and behavioral avoidance, and the rules that promote these strategies; 3) Reformulate the client’s problem in value-based and acceptance terms, making it solvable and thus increasing motivation; 4) Engage the client in formulating between-session behavioral experiments that are values-based and promote behavioral variability. In addition, the trainers will demonstrate and have participants practice with two core FACT case conceptualization methods, the Four Square and the Patient Assessment Tool. 

Learning Objectives:

  1. Describe the core components of the FACT CARE algorithm for session organization.
  2. Demonstrate and practice FACT case conceptualization methods (Four Square, Pillars Assessment Tool).
  3. Discuss clinical issues related to balancing assessment, case conceptualization, and intervention activities in each session.

Workshop Agenda:

  • Introduction to CARE session organization model; contextual interviewing, workability assessment, eliciting avoidance behaviors, reformulation of the problem, building powerful behavioral experiments.
  • On the “fly” case conceptualization skills using Four Square and PAT; clinical demonstration and supervised dyadic role plays; reflect on learning experiences and update personal learning plan 

References:

  1. Ong, C. W., Hayes, S. C., & Hofmann, S. G. (2022). A process-based approach to cognitive behavioral therapy: A theory-based case illustration. Frontiers in Psychology, 13, 1002849. https://doi.org/10.3389/fpsyg.2022.1002849.
  2. Hayes, S. C., Ciarrochi, J., Hofmann, S. G., Chin, F., & Sahdra, B. (2022). Evolving an idionomic approach to processes of change: Towards a unified personalized science of human improvement. Behaviour Research and Therapy, 156, 104155. https://doi.org/10.1016/j.brat.2022.104155
  3. Kashdan, T. Disabato, D. Goodman, F. Doorley, J., & Mcknight, P. (2020). Understanding psychological flexibility: A multimethod exploration of pursuing valued goals despite the presence of distress. Psychological Assessment. 10.1037/pas0000834.

Tuesday a.m. (Option 1) – Session #3

Chronic Pain

Trainer: Robinson

This workshop will offer strategies for formulating a plan to help people who suffer from chronic pain. It will include a description of a 4-session approach that may be offered individually or in a class format. Results from a small randomized controlled pilot study of this FACT approach to chronic included significant improvement in pain acceptance. Participants will have an opportunity to practice using a variety of tools associated with this encouraging approach to assisting people with chronic pain. 

Learning Objectives: 

  1. Discuss how to conceptualize chronic pain from a FACT perspective. 
  2. Identify strategies for addressing the problem of chronic pain as a member of a multidisciplinary team. 
  3. Apply a variety of tools that promote responding to pain with greater psychological flexibility.

Workshop Agenda:

  • FACT framework for understanding the processes underpinning chronic pain and chronic pain syndrome; strategies for “reframing” chronic pain; practicing empathy and compassion for the client
  • Using FACT tools in individual and group visits with patients with chronic pain; small group exercises and supervised dyadic role play skill development

References: 

  1. Kanzler, K. E., Robinson, P. J., McGeary, D. D., et al. (2022). Addressing chronic pain with Focused Acceptance and Commitment Therapy in integrated primary care: Findings from a mixed methods pilot randomized controlled trial. BMC Prim. Care 23, 77. https://doi.org/10.1186/s12875-022-01690-2
  2. Kanzler, K. E., Robinson, P. J., McGeary, D. D., Mintz, J., Potter, J. S., Munante, M., Lopez, E. J., Dougherty, D. M., Hale, W. J., & Villigan, D. I. (2018). Rationale and design of a pilot study examining Acceptance and Commitment Therapy for persistent pain in an integrated primary care clinic. Contemporary Clinical Trials, 66, 28-35. Doi: 10.1016/j.cct.2018.01.004. Epub 2018 Feb 4.
  3. Kanzler, K. E., Pugh, J. A., McGeary, D. D., Hale, W. J., Mathias, C. W., Kilpela, L. S., ... & McCracken, L. M. (2019). Mitigating the effect of pain severity on activity and disability in patients with chronic pain: The crucial context of acceptance. Pain Medicine, 20(8), 1509-1518. https://doi.org/10.1093/pm/pny197

Tuesday a.m. (Option 2) – Session #4

Anxiety and Depression

Trainers: Strosahl, Gustavsson

This workshop will examine process bases of depressive experiences from a FACT perspective. The trainers will describe a transdiagnostic model of mood disorders, in which depression and anxiety are part of the same continuum. The functional role of avoidance will be a central feature of understanding both depressive and anxiety experiences. Depression itself functions as an emotional avoidance behavior. Anhedonia, or the sense of diminished emotional responding to either positive or negative affective experiences, is a cardinal sign of emotional avoidance. And the loss of motivation, escape, passivity, and withdrawal seen in depression can easily be conceptualized as forms of behavioral avoidance. Participants will learn how to identify these processes in clinical conversations, to shift the perceived “problem to be solved” from eliminating or controlling common emotional experiences to accepting them as legitimate forms of human experience. Via role play demonstrations and dyadic skill-building practice, participants will learn how to “move” depressed and anxious clients to an accepting stance, so that they can develop adaptive responses that reflect their values.

Learning Objectives:

  1. Describe the FACT conceptualization of depressive experiences and associated intervention principles.
  2. Describe the FACT conceptualization of anxiety states and associated intervention principles.
  3. Demonstrate and practice core FACT intervention strategies for depressive experiences and anxiety states.

Workshop Agenda:

  • Rethinking the mechanisms of depression and anxiety; the role of emotional and behavioral avoidance in mood disorders, 
  • Role play demonstration of FACT intervention for depression/anxiety; supervised dyadic skill practice using standard case vignette.

References:

  1. Arroll , B., Frischtak, H., et al. (2021). FACT effectiveness in primary care: A single visit RCT for depressive symptoms. International Journal of Psychiatry in Medicine, 0, 1-12. DOI: 10.1177/00912174211010536 .
  2. Larsson, A., Hartley, S., & McHugh, L. (2022). A randomised controlled trial of brief web-based Acceptance and Commitment Therapy on the general mental health, depression, anxiety and stress of college students. Journal of Contextual Behavioral Science, 24, 10-17. doi.org/10.1016/j.jcbs.2022.02.005
  3. Muthu, A., & Revathy, A. (2023). Effectiveness of Acceptance and Commitment Therapy (ACT) for Anxiety, Depression, and Stress during COVID-19 Pandemic: A Narrative Review. International Journal of Psychology & Psychological Therapy, 23, 261-275.

Tuesday p.m. (Option 1) – Session #5

Crisis Integration

Trainers: Strosahl, Robinson

Dealing effectively with clients in crisis is an everyday challenge for helping professionals, yet there are few well-established clinical models that explain the psychological genesis of crisis and specify appropriate clinical interventions. Participants will learn a FACT basis model of both crisis instigation (i.e., how crises are produced by client coping strategies) and crisis integration (i.e., how to promote acceptance, mindfulness of the body, and value-based coping). The basic tenets of predictive coding theory will be used to highlight a different approach to crisis-level emotions. Crisis emotions are not the “enemy,” but rather are signals for adaptation. Thus, helping clients lean into their emotional discomfort, practice mindfulness of the body as the ultimate host for emotions, and change their prior mental models of the world to fit the “actual” world are the keys to crisis integration. Participants will be introduced to, and practice, a specific set of clinical interventions designed to promote new perspectives on the crisis event/situation, and increase value-based adaptation.

Learning Objectives:

  1. Describe the FACT model of crisis instigation and crisis integration.
  2. Discuss the important role of present-moment awareness and mindfulness of the body in crisis integration.
  3. Demonstrate and practice a FACT crisis intervention protocol.

Workshop Agenda:

  • FACT model of crisis instigation and crisis integration; the role of emotions in predictive coding theory; crisis as a response to predictive coding gaps.
  • Clinical demonstration of FACT for crisis integration and the crisis workers task checklist; supervised dyadic role plays of crisis case vignettes.

References:

  1. Mohi, S., Deane, F., Mooney-Reh, D., Baily, A., & Ciaglia, D. (2021). Experiential avoidance and depression predict values engagement among people in treatment for borderline personality disorder, Journal of Contextual Behavior Science, 20, 94-100. https://doi.org/10.1016/j.jcbs.2021.03.002
  2. Barnes, S., Borges, L., Smith, G., Walser, R., Forster, J., & Bahraini, N. (2021). Acceptance and Commitment Therapy to promote recovery from suicidal crises: A randomized controlled acceptability and feasibility trial of ACT for life. Journal of Contextual Behavioral Science, 20, 35-45. https://doi.org/10.1016/j.jcbs.2021.02.003
  3. Arroll, B., Frischtak, H., et al. (2021). FACT effectiveness in primary care: A single visit RCT for depressive symptoms. International Journal of Psychiatry in Medicine, 0, 1-12. DOI: 10.1177/00912174211010536 .

Tuesday p.m. (Option 2) – Session #6

Self-Harming Behavior

Trainer: Gustavsson

Interest in non-suicidal self-injury (NSSI) has steadily increased over the last decade. This class of self-destructive behavior spans an enormous spectrum, from infrequent “experimental” attempts at NSSI to the development of chronic, high-intensity, high-risk behaviors. This workshop will introduce participants to a FACT conceptualization of NSSI and focus on how to treat the most serious forms of this behavior.  Participants will examine NSSI as a rapidly reinforced function of very short-term emotional avoidance that requires repeated administrations to regulate distressing unwanted inner experiences. The phenomenology of NSSI often involves a harsh, self-critical inner narrative that leads to intense feelings of alienation from self and others. As such, mindfulness and self-compassion have an important role to play in fostering observational distance from self-loathing narratives and help with perspective taking on alternate ways of relating to the self. Participants will observe a role play demonstrating core FACT intervention strategies for NSSI and then engage in supervised dyadic skills-building role plays using structured case vignettes.

Learning Objectives:

  1. Describe the spectrum, prevalence, and clinical risks of self-harming behaviors.
  2. Analyze self-harming behaviors from a FACT perspective.
  3. Examine clinical strategies to reframe and alter the functions of self-harming behaviors.

Workshop Agenda:

  • Forms and functions of NSSI; a FACT model of NSSI; core phenomenological features of NSSI; Utility of mindfulness and self-compassion in reframing self-loathing and alienation. 
  • Role play demonstration of self-compassion, perspective taking and reframing; dyadic skill practice simulations of structured case vignettes.

References:

  1. Angelakis, I., & Gooding, P. (2021). Experiential avoidance in non-suicidal self-injury and suicide experiences: A systematic review and meta-analysis. Suicide and Life Threatening Behavior, 51, 978-992. doi.org/10.1111/sltb.12784
  2. Haywood, S., Hasking, P., & Bayes, M. (2023). Associations between experiential avoidance and non-suicidal self-injury: A systematic review and robust bayesian meta-analysis. Journal of Affective Disorders, 325, 470-479. https://doi.org/10.1016/j.jad.2023.01.027
  3. Per, M., Smundic, A., Argento, A., Khoury, B., & Heath, N. (2022). Examining the relationship between mindfulness, self-compassion and emotion regulation in self-injury. Archives of Suicide Research, 26, 1286-1301. DOI: 10.1080/13811118.2021.1885534

Wednesday a.m. (Option 1) – Session #7

Primary Care Applications

Trainer: Robinson

This workshop will expose participants to an innovative integration model for delivering FACT in the primary care or general practice setting. This model is known as the Primary Care Behavioral Health (PCBH) model, and it has been demonstrated to provide a strong platform for providing FACT services to children, adolescents, families, and adults. In New Zealand, results of an evaluation of PCBH and FACT included improvements in quality of life, high levels of patient satisfaction, and health equity. Participants will receive a core competency tool that provides details about the many new skills that behavioral health providers master as they practice this innovative and growing approach that supports the dream of healthcare services for all people. Participants will observe a role play demonstration showing how FACT strategies can be applied in a 20–25 minute initial visit with a behavioral health consultant in primary care.

Learning Objectives:

  1. Describe the Primary Care Behavioral Health (PCBH) approach to the delivery of team-based healthcare services in the general practice or primary care setting. 
  2. Review the core competencies of a Behavioral Health Consultant (BHC) who works in PCBH clinics.
  3. Discuss the application of a FACT approach at the consultant level as well as the primary care team level. 

Workshop Agenda:

  • Rationale for primary care behavioral health integration; Essential features of the PCBH model and its’ confluence with FACT philosophies of care; clinical practice style modifications needed to work in primary care. 
  • Structure of the initial and follow-up visits in the PCBH approach; role play demonstration of initial consult visit; dyadic skill building role plays

References:

  1. Hunter, C., Funderburk, J., et al. (2018). Primary Care Behavioral Health (PCBH) Model Research: Current State of the Science and a Call to Action. Journal of Clinical Psychology in Medical Settings. DOI 10.1007/s10880-017-9512-0 
  2. Petts, R., Lewis, R., Brooks, K., McGill, S., Lovelady, T., Galvez, M., & Davis, E. (2021). Examining patient and provider experiences with integrated care at a community health clinic. The Journal of Behavioral Health Services & Research, 1-18. 
  3. Reiter, J., Dobmeyer, A., & Hunter, C. (2018). The primary care behavioral health (PCBH) model: An overview and operational definition. Journal of Clinical Psychology in Medical Settings, 25(2), 109-126. 

Wednesday a.m. (Option 2) – Session #8

Psychiatric and Specialty Mental Health Settings

Trainer: Gustavsson

This session will introduce participants to a model for applying FACT to more impaired clients in psychiatric and specialty mental health settings. We will discuss the many ways that FACT principles can be integrated into residential, day treatment, or long-term care programs where clients typically have numerous global impairments, health morbidities, housing and food insecurities, and limited social support. The focus will be on clinical skills such as making a hypothesis-driven change agenda in a barrier-filled social and life context, how to prioritize and target FACT interventions, and where to start interventions when multiple impairments exist. The basic framework for using FACT will be the three pillars of psychological flexibility, taking into account both the number and severity of impairments as well as the potential for early gains in treatment. Even clients with long-standing, serious impairments have been shown to benefit from brief FACT interventions. Another important area will be how to cooperate and integrate FACT interventions with teams, psychiatrists, and resources outside the clinic. This session will blend modalities for training and learning such as role play in a dyadic format as well as small and large group exercises.

Course Objectives:

  1. Describe the core processes of the FACT model (Open, Aware, Engaged) as they pertain to clients with chronic mental health or addiction issues.
  2. Describe the challenges and possibilities of using FACT with more psychologically impaired clients.
  3. Demonstrate and practice core FACT strategies for hypothesis-driven interventions, while having to prioritize treatment targets in clients with multiple impairments.

Workshop Agenda:

  • Focused interventions for chronic clients: possibilities and challenges; principles of hypothesis-driven treatment planning; focusing brief interventions when there are many possible targets; dealing with systemic, social, and institutional barriers. Using the pillars of flexibility to create transformative change opportunities. 
  • Rapid response is possible! Role play demonstration with chronic, multi-problem client; Small group and dyadic skills-building exercises

References:

  1. Muñoz González-Deleito, C., McCracken, L., & Tyrberg, M. (2024): Ultra-brief acceptance & commitment therapy for inpatients with psychosis: A single-case experimental design investigating processes of change, Cognitive Behaviour Therapy, 1-15. DOI: 10.1080/16506073.2023.2300369 
  2. Tyrberg, M., & Klintwall, L. (2022). Transdiagnostic ultra-brief behaviour therapy for psychiatric inpatients: A multiple-baseline single-case design. Journal of Psychiatric Intensive Care, 18, 83–94. https://doi.org/10.20299/jpi.2022.013 
  3. Reyes-Ortega, M.., Miranda, E., Fresán, A., Vargas, A., Barragán, S., Robles García, R., & Arango, I. (2020). Clinical efficacy of a combined acceptance and commitment therapy, dialectical behavioural therapy, and functional analytic psychotherapy intervention in patients with borderline personality disorder. Psychology and Psychotherapy, 93, 474–489. https://doi.org/10.1111/papt.1224

Wednesday p.m. (Option 1) – Session #9

Suicidality

Trainers: Strosahl & Gustavsson

Addressing suicidal behavior, in all of its forms, is one of the most daunting aspects of clinical practice. This workshop will provide participants with a FACT model of suicidality. Suicidality will be recast as an extreme form of emotional and behavioral avoidance. Thus, it can be analyzed and assessed using functional analysis and the workability criterion. Participants will learn a straightforward protocol designed to defuse suicidal crises and promote value-based problem solving. The main components of this approach are to: 1) validate the client’s sense of desperation and desire to be “heard”; 2) reframe the client’s suicidal behaviors as a form of problem solving; and 3) create a positive, value-based, short-term behavior plan. Role play demonstrations and dyadic practice will be used to help participants internalize these three intervention components.

Learning Objectives:  

  1. Describe the FACT model for understanding and treating suicidality.
  2. Describe the basic therapeutic themes and associated conversations that determine the success of an intervention for suicidality.
  3. Demonstrate and practice the “1, 2, 3” model of intervention with a suicidal or self-harming client.

Workshop Agenda:

  • FACT model of suicidality; suicidality as an extreme form of emotional avoidance; the three “I” approaches to understanding suicidal crisis; the 1-2-3 approach to managing acute suicidal crisis.
  • Clinical demonstration of FACT with a suicidal client; supervised dyadic role plays using standard scripts to allow practice in the 1-2-3 management approach.

References:

  1. Barnes, S., Borges, L., Smith, G., Walser, R., Forster, J., & Bahraini, N. (2021). Acceptance and commitment therapy to promote recovery from suicidal crises: A randomized controlled acceptability and feasibility trial of ACT for life. Journal of Contextual Behavioral Science, 20, 35-45. https://doi.org/10.1016/j.jcbs.2021.02.003
  2. El-Sayed, M., Elhay, E., Taha, S., et al. (2023). Efficacy of acceptance and commitment therapy on impulsivity and suicidality among clients with bipolar disorders: a randomized control trial. BMC Nursing, 22, 271. https://doi.org/10.1186/s12912-023-01443-1
  3. Ducasse, D., Jaussent, I., Arpon-Brand, V., Vienot, M., Laglaoui, C., Béziat, S., et al. (2018). Acceptance and commitment therapy for managing suicidal patients: A randomized controlled trial. Psychotherapy and Psychosomatics, 87, 211–22. https://doi.org/10.1159/000488715

Wednesday p.m. (Option 2) – Session #10

Teaching FACT to Health Workers

Trainer: Robinson

There is growing recognition that health disparities exist in both mental health and addiction treatment service use. In large part, this is due to a lack of qualified mental health providers knowledgeable in evidence-based treatments. The most likely solution is to “extend” the reach of mental health by “task shifting” responsibility to non-mental-health-trained lay health workers. In this workshop, participants will examine one such initiative that involves training mono-lingual Hispanic lay health workers in FACT. Participants will be introduced to the FACT Competency Assessment Tool (FACT CAT) which allows the FACT clinician to focus on teaching core FACT skills and measure learner progress over time. 

Learning Objectives:

  1. Describe the FACT Competency Assessment Tool.
  2. Discuss strategies for teaching FACT.
  3. Detail supervision practices helpful to clinicians experimenting with the use of FACT.

Workshop Agenda:

  • The need for task shifting to care extenders; the process of co-creating FACT interventions with care extenders in their native language and culture. 
  • Lessons learned from supporting Promotores in using FACT in phone interventions with people with diabetes; review of pragmatics of community-based delivery of FACT; practice core supervision and co-development skills.

References:

  1. Stewart, C., White, R. G., Ebert, B., Mays, I., Nardozzi, J., & Bockarie, H. (2016). A preliminary evaluation of Acceptance and Commitment Therapy (ACT) training in Sierra Leone. Journal of Contextual Behavioral Science, 5(1), 16-22. 
  2. White, R. G., Gregg, J., Batten, S., Hayes, L. L., & Kasujja, R. (2017). Contextual behavioral science and global mental health: Synergies and opportunities. Journal of Contextual Behavioral Science, 6(3), 245-251
  3. Verhey, I., Ryan, G., Scherer, N., et al. (2020). Implementation outcomes of cognitive behavioural therapy delivered by non-specialists for common mental disorders and substance-use disorders in low- and middle-income countries: A systematic review. International Journal of Mental Health Systems, 14, 40. https://doi.org/10.1186/s13033-020-00372-9
  4. Kazdin, A. E., & Blase, S. L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6(1), 21-37. 
  5. Robinson, P. J., & Mundy, B. (2014). In pursuit of excellence: Developing competencies for delivery of brief interventions. In M. Boone (Ed.), Mindfulness and Acceptance in Social Work, Oakland, New Harbinger. 
  6. Lundgren, T., Luoma, J. B., Dahl, J., Strosahl, K., Robinson, P., & Melin, L. (2012). The Bull's-Eye Values Survey: A psychometric evaluation. Cognitive and Behavioral Practice, 19, 518-526.
  7. Robinson, P. J., Gould, D., & Strosahl, K. D. (2010). Real Behavior Change in Primary Care. Strategies and Tools for Improving Outcomes and Increasing Job Satisfaction. Oakland: New Harbinger.

Thursday a.m. (Option 1) – Session #11

Life Path Intervention for Groups 

Trainer: Robinson

For a variety of reasons, clinicians are seeking to improve their skills for using FACT in groups. Whether to better meet the needs of the many people who wait for care (often for long periods of time), to improve the general well-being of a community, or to provide a context for care that adds the possibility of better meeting the social needs of people, groups are of interest to many. In this workshop, participants will analyze the benefits and challenges of conducting FACT in a group or classroom format. They will receive “tips” on determining group composition, meeting frequency, open- versus closed-ended groups, among other issues. Participants will be introduced to The Life Path Class protocol, which offers a structure for clinicians to use in starting a 3–4 session FACT-oriented group or class. In addition, they will be able to experiment with co-leading a Life Path Class, using the class manual to support their work. 

Learning Objectives:

  1. Describe the benefits of and logistical considerations in delivering FACT in a group or classroom format. 
  2. Summarize The Life Path Class manual as a way to organize and deliver a FACT class. 
  3. Demonstrate delivering a Life Path Class, using a small group role play. 

Workshop Agenda:

  • Benefits and technical steps associated with delivering FACT in groups or classes; introduce the Life Path Intervention; describe elements of pre-class orientation visit
  • The Life Path Class Manual; small group role play practice of core skills

References:

  1. Glover, N., Sylvers, P., Shearer, E., Kane, M., Clasen, P., Epler, A., Plumb-Vilardaga, J., Bonow, J., & Jakupcak, M. (2016). The efficacy of Focused Acceptance and Commitment Therapy in VA primary care. Psychological Services, 13(2), 156–161. https://doi.org/10.1037/ser0000062
  2. Ferreira, M., Luciano, I., Vieira de Rezende, J., Caramelli, P., & Kishita, N. (2022). Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. Journal of Affective Disorders, 309, 297-308. https://doi.org/10.1016/j.jad.2022.04.134.
  3. Robinson, P. J. (unpublished). The Life Path Class Manual. 
  4. Robinson, P. J. (2020). Basics of Behavior Change in Primary Care. NY: Springer. 

Thursday a.m. (Option 2) – Session #12

Addictive Behaviors

Trainers: Strosahl, Gustavsson

Addictive behaviors include the unworkable use of drugs and alcohol, but also a myriad of other dysfunctions, including eating behaviors, sex, gambling, pornography, or social media use, to name but a few examples. Indeed, armed with the right functions, almost any behavior can become an addiction. The formula for developing an addiction starts with the attempt to avoid distressing, unwanted inner experiences, coupled with discovering a behavior, or set of behaviors, that allow the individual to “get out of the skin” very quickly. The rapidity of relief from, followed by the reappearance of, feared and avoided inner experiences requires the individual to engage in the avoidance behavior more and more frequently. In this workshop, participants will examine addictive behaviors from the FACT perspective to highlight psychological processes that are shared in all addictions. The trainers will also discuss and demonstrate FACT-consistent dialogues and intervention strategies. Participants will also engage in supervised skills-building role plays to hone their FACT skills for clients suffering from addictive behaviors.

Learning Objectives:

  1. Describe the interaction between addictive behaviors and emotional and behavioral avoidance.
  2. Explore the role that value-based choice plays in reshaping the functional meaning of addictive behaviors.
  3. Develop skills for using metaphors as a powerful form of intervention for addictive behaviors.

Workshop Agenda:

  • A functional contextual analysis of addictive behaviors and why they are so common; FACT framework for undermining avoidance moves in addiction; useful metaphors for addictive reinforcement cycles
  • Role play demonstration of FACT for addictive behaviors; supervised dyadic skill building role plays using scripted case vignettes.

References:

  1. Shorey, R., Gawrysiak, M., Elmquist, J., Brem, M., Anderson, S., & Stuart, G. (2017). Experiential avoidance, distress tolerance, and substance use cravings among adults in residential treatment for substance use disorders. Journal of Addictive Diseases, 36, 151–157. https://doi.org/10.1080/10550887.2017.1302661
  2. Serowik, K., & Orsillo, S. (2019). The relationship between substance use, experiential avoidance, and personally meaningful experiences. Substance Use & Misuse, 54, 1834–1844. https://doi.org/10.1080/10826084.2019.1618329
  3. Osaji, J., Ojimba, C., & Ahmed, S. (2020). The use of Acceptance and Commitment Therapy in substance use disorders: A review of literature. Journal of Clinical Medicine Research, 12(10), 629–633. https://doi.org/10.14740/jocmr4311

Thursday p.m. (Option 1) – Session #13

Trauma

Trainer: Gustavsson

Most clients with mental health addiction issues have trauma in their past or have recently experienced a traumatic event. Learning to incorporate the psychological impacts of trauma into FACT treatment is a prerequisite for successful outcomes. Participants will learn a FACT model of trauma, in which the challenge is not to eliminate the vestiges of trauma, but rather to accept them so that they don’t function as barriers to achieving valued life directions. The trainer will demonstrate ways to talk about “trauma” in a way that allows the client to step back from traumatic memories, emotions, and sensations and allow these experiences to be what they are rather than what they appear to be. Participants will also see a demonstration of using core FACT metaphors and experiential exercises for trauma, followed by dyadic skills-building exercises.

Learning Objectives:

  1. Describe the core tenets of the FACT approach to understanding and intervening with trauma.
  2. Explain the principles of applying present-moment awareness to reformulate the meaning of trauma.
  3. Demonstrate and practice strategies for increasing non-reactivity to inner experiences of trauma and increasing self-compassion.

Workshop Agenda:

  • Discuss the FACT conceptualization of trauma; trauma and sense-making operations; “carrying trauma” while living according to personal values; uncovering the cost of trauma avoidance
  • Clinical demonstration of FACT with a trauma client; supervised dyadic role plays using pre-scripted cases.

References:

  1. Kelly, M. M., Reilly, E. D., Ameral, V., Richter, S., & Fukuda, S. (2022). A Randomized Pilot Study of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD. Journal of Clinical Medicine, 11, 3482. https://doi.org/10.3390/jcm11123482
  2. Bean, R., Ong, C., Lee, J., & Twohig, M., (2017). Acceptance and commitment therapy for PTSD and trauma: An empirical review. The Behavior Therapist, 40, 145-150 
  3. McLean, C., & Follette, V. (2016) Acceptance and commitment therapy as a nonpathologizing intervention approach for survivors of trauma. Journal of Trauma & Dissociation, 17, 138-150, DOI: 10.1080/15299732.2016.1103111.

Thursday p.m. (Option 2) – Session #14

Present-Moment Power Moves

Trainer: Strosahl

Being aware is often referred to as the “center pillar” of psychological flexibility, and rightly so. Without the ability to pay attention in a sustained, flexible way in the present moment, people fall prey to the regulatory influence of automatic rule following. But the present moment is full of hazardous private material, which tends to appear uninvited when we enter the present moment. Thus, contact with the present moment is the venue for life-changing emotional processing experiences, but it is also a place where all hell can break loose. This learning session will focus on how to cultivate and sustain present-moment awareness in the presence of feared and avoided inner experiences. This requires the clinician and client to constructively share the “space” created by shifting attention to what is here, right now. Participants will examine the application of the Five Facet Model of Mindfulness as a heuristic for evolving a present-moment intervention in therapy. The trainer will demonstrate a present-moment intervention in a “real play” or “role play.” Participants will have the opportunity to practice “being present” in dyadic interactions and appreciate the distinction between self-focused present-moment awareness and “shared” present-moment awareness.

Course Objectives

  1. Discuss the central role that present-moment awareness plays in promoting both openness to inner experiences, perspective taking, and value-driven life engagement.
  2. Analyze the application of the Five Facet Model of Mindfulness as a heuristic for evolving a present-moment intervention in therapy.
  3. Demonstrate the skills needed to elicit and sustain a robust, transformative present-moment intervention.

Workshop Agenda:

  • Attributes of present moment awareness and why they are so important to developing psychological flexibility; difficulties experienced by FACT therapists in eliciting and sustaining present moment awareness in therapy. 
  • Five facet model of mindfulness as a heuristic; importance of phrasing to elicit present moment space; experiential exercise for practicing being present alone, and in a shared interpersonal space; Role play demonstration of a present moment intervention; small group practice of phrasing skills

References:

  1. Fan, J., Li, W., Lin, M., Li, X., & Deng, X. (2023). Effects of mindfulness and fatigue on emotional processing: An event-related potentials study. Frontiers in Behavioral Neuroscience, 17,  https://doi.org/10.3389/fnbeh.2023.1175067
  2. Wu, R., Liu, L., Zhu, H., Su, W., Cao, Z., Zhong, S., Liu, X., & Jiang, C. (2019). Brief mindfulness meditation improves emotion processing. Frontiers in Neuroscience, 13, 1074. https://doi.org/10.3389/fnins.2019.01074
  3. Kiken, L., Lundberg, K., & Fredrickson, B. (2017). Being present and enjoying it: Dispositional mindfulness and savoring the moment are distinct, interactive predictors of positive emotions and psychological health. Mindfulness, 8(5), 1280–1290. https://doi.org/10.1007/s12671-017-0704-3.
  4. Don, B., Algoe, S., & Fredrickson, B. (2020). Does meditation training influence social approach and avoidance goals? Evidence from a randomized intervention study of midlife adults. Mindfulness. 12: 582-593. DOI: 10.1007/s12671-020-01517-0 
  5. Gu, J., Strauss, C., Crane, C., Barnhofer, T., Karl, A., Cavanagh, K., & Kuyken, W. (2016). Examining the factor structure of the 39-item and 15-item versions of the Five Facet Mindfulness Questionnaire before and after mindfulness-based cognitive therapy for people with recurrent depression. Psychological Assessment, 28, 791. doi: 10.1037/pas0000263 

Friday a.m. (Option 1) – Session #15

Challenging Moments in Therapy 

Trainers: Strosahl and Gustavsson

Since therapy involves the interaction of two or more people, there are bound to be moments in which communication does not go well. The trainers will propose that there is no such thing as a “difficult client,” only “difficult interactions.” Participants will learn a new way to think about clients with chronic dysfunction using a functional contextual perspective. Participants will also examine their own “hot buttons,” and how to use mindful awareness to create observational distance from judgmental thinking that is likely to create a therapeutic impasse. Participants will practice responding in a FACT-consistent way to a set of “problematic” client statements that might otherwise induce conflict, defensiveness, blaming, termination, or drop-out.

Learning Objectives:

  1. Describe the FACT interactional perspective on challenging moments in therapy.
  2. Discuss the core components that define chronically dysfunctional behaviors (pervasive, persistent, resistant, self-defeating).
  3. Demonstrate and practice FACT interaction strategies designed to engage clients and decrease the likelihood of therapeutic impasse.

Workshop Agenda:

  • FACT approach to managing difficult interactions; importance of therapist non-judgment and acceptance; seeing the “functions” rather than the “form” of difficult behaviors; self-exploration of clients that “set you off.”
  • Role play demonstration of difficult patient interaction; supervised dyadic role playing, small group exercise “Dealing with Downers.”

References:

  1. Gloster, A. T., Haller, E., Villanueva, J., et al. (2023). Psychotherapy for chronic in- and outpatients with common mental disorders: the “Choose Change” effectiveness trial. Psychotherapy and Psychosomatics. 94, 122-134. doi:10.1159/00052941  
  2. Reyes-Ortega, M., Miranda, E., Fresan, A., Vargas, A., Barragan, S., Robles-Garcia, R., & Arango, I. (2019). Clinical efficacy of a combined acceptance and commitment therapy, dialectical behavioural therapy, and functional analytic psychotherapy intervention in patients with borderline personality disorder. Psychology and Psychotherapy: Theory Research and Practice. 1-16. DOI:10.1111/papt.12240 
  3. Mohi, S., Deane, F., Mooney-Reh, D., Baily, A., & Ciaglia, D. (2021). Experiential avoidance and depression predict values engagement among people in treatment for borderline personality disorder. Journal of Contextual Behavior Science, 20, 94-100. https://doi.org/10.1016/j.jcbs.2021.03.002

Friday a.m. (Option 2) – Session #16

FACT With Children and Teens 

Trainer: Robinson

This workshop provides an introduction to the use of FACT with children, teens, and their families. Through cultivating psychological flexibility in parents, we can hope to create better physical health and psychological well-being in children and teens. Participants will consider ways to assess the psychological flexibility of children and teens using the FACT tools, including the Four Square Tool and the Pillars Assessment Tool. Additionally, participants will view a demonstration of the Family Matrix intervention, and then practice this intervention in small groups. 

Learning Objectives:

  1. Discuss how to adapt FACT to use with children, youth, and families.
  2. Name measures of psychological flexibility for children, youth, and parents.
  3. Describe the evidence for the use of FACT and brief ACT with children, youth, and parents.
  4. Use the Four Square Tool to use contextual interview information to formulate a plan for enhancing psychological flexibility in children, youth, and families.
  5. Describe and practice the Family Matrix. 

Workshop Agenda:

  • Overview of psychological flexibility in children and young people; measurement and conceptualization strategies. Review of evidence for using FACT or brief ACT with children, adolescents, and families. Preview FACT tools for working with children, adolescents, and families.
  • Demonstration of the Family Matrix intervention. Skill practice.

References:

  1. Fergus, T. A., Valentiner, D. P., Gillen, M. J., Hiraoka, R., Twohig, M. P., Abramowitz, J. S., & McGrath, P. B. (2012). Assessing psychological inflexibility: The psychometric properties of the Avoidance and Fusion Questionnaire for Youth in two adult samples. Psychological Assessment, 24(2), 402–408. https://doi.org/10.1037/a0025776
  2. Greco, L. A., Lambert, W., & Baer, R. A. (2008). Psychological inflexibility in childhood and adolescence: Development and evaluation of the Avoidance and Fusion Questionnaire for Youth. Psychological Assessment, 20(2):93-102. doi: 10.1037/1040-3590.20.2.93. PMID: 18557686.
  3. Harris, E., & Samuel, V. (2020). Acceptance and Commitment Therapy: A systematic literature review of prevention and intervention programs for mental health difficulties in children and young people. Journal of Cognitive Psychotherapy, 1;34(4):280-305. doi: 10.1891/JCPSY-D-20-00001. PMID: 33372124.
  4. Simon, E., & Verboon, P. (2016). Psychological inflexibility and child anxiety. Journal of Child and Family Studies, 25(12), 3565–3573. https://doi.org/10.1007/s10826-016-0522-6 
  5. Swain, J., Hancock, K., Dixon, A., & Bowman, J. (2015). Acceptance and Commitment Therapy for children: A systematic review of intervention studies. Journal of Contextual Behavioral Science. 4. 10.1016/j.jcbs.2015.02.001.

Friday p.m. – Session #17

Understanding and Preventing Burnout

Trainers: Robinson, Gustavsson, Strosahl

This workshop provides a brief introduction to the use of FACT to address the public health emergency of chronic stress among healthcare workers. The Life Path Manual will help guide structured practice in using tools to promote ongoing assessment and attention to the development of psychological flexibility while working in stressful environments. The Life Path approach is practical and non-stigmatizing, and, with the aid of a manual, the goal will be to prepare participants to teach this approach to others in their community. 

Learning Objectives:

  1. Describe current information about the prevalence of symptoms of chronic work stress.
  2. Describe the evidence for using psychological flexibility interventions to enhance the resilience of people working in highly stressful contexts. 
  3. Describe a demonstration of a Life Path initial visit and then practice conducting an initial visit. 

Workshop Agenda:

  • Scope of the problem, self-assessment, introduction of Life Now manual
  • View demonstrations of initial and follow-up visits and practice with core materials

References:

  1. Ramaci, T., Bellini, D., Presti, G., & Santisi, G. (2019). Psychological flexibility and mindfulness as predictors of individual outcomes in hospital health workers. Frontiers of Psychology, 10, 1302. doi:10.3389/fpsyg.2019.01302
  2. Aronsson, G., Theorell, T., Grape, T., Hammarström, A., Hogstedt C., Marteinsdottir, I., Skoog, I., Träskman-Bendz, L., & Hall, C. (2017). A systematic review including meta-analysis of work environment and burnout symptoms. BMC Public Health, 17, 264. doi: 10.1186/s12889-017-4153-7.
  3. Harker, R., Pidgeon, A., Klaasen, F., & King, S. (2016). Exploring resilience and mindfulness as preventative factors for psychological distress burnout and secondary traumatic stress among human service professionals. Work, 54, 631 – 637. DOI: 10.3233/WOR-162311
  4. Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health, 39(5), 341–352. https://doi.org/10.1007/s10488-011-0352-1
  5. Maslach, C., Schaufeli, W. B., Leiter, M. P. (2001). Job burnout. Annual Review of  Psychology, 53, 397–422.
  6. Bond, F. W., Lloyd, J., & Guenole, N. (2013). The work-related acceptance and action questionnaire: Initial psychometric findings and their implications for measuring psychological flexibility in specific contexts. Journal of Occupational and Organizational Psychology, 86:331–347.
  7. Flaxman, P. E., Bond, F. W., & Livheim, F. (2013). The Mindful and Effective Employee: An Acceptance and Commitment Therapy Training Manual for Improving Well-Being and Performance. Oakland, CA: New Harbinger.

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Should a participant in the course be unsatisfied with the course, the participant should immediately contact our customer support team to file a grievance. Within five days, a customer support team member will contact the participant by email and/or phone and attempt to resolve the issue.

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Contact Information:

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Praxis Continuing Education
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CE Information:

This live in-person course is sponsored by Praxis Continuing Education and Training and is approved for up to 30 CE Hours by the organizations listed below. Praxis Continuing Education and Training, Inc maintains responsibility for the program with the CE approvals outlined below:

Joint Accreditation: In support of improving patient care, Praxis Continuing Education and Training, Inc is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

IPCE: This activity was planned by and for the healthcare team, and learners will receive 1 Interprofessional Continuing Education (IPCE) credit for learning and change for every hour attended.

Nursing: Praxis Continuing Education and Training, Inc designates this activity for a maximum of 1 ANCC contact hours per hour attended.

Physicians: Praxis Continuing Education and Training, Inc designates this live activity for a maximum of 1 AMA PRA Category 1 Credits™ per hour attended. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Psychologists: Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs.

Social Workers: As a Jointly Accredited Organization, Praxis Continuing Education and Training, Inc. is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. Regulatory boards are the final authority on courses accepted for continuing education credit. Social workers completing this course receive 1 clinical continuing education credits per hour attended. 

Drug and Alcohol Counselors: This course has been approved by Praxis Continuing Education and Training, Inc, as a NAADAC Approved Education Provider, for 1 CE hours per hour attended. NAADAC Provider #165310, Praxis Continuing Education and Training, Inc, is responsible for all aspects of its programming.

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Disclosure of Relevant Financial Relationships

Praxis Continuing Education and Training is responsible for the content, quality, and scientific integrity of all CE activities certified for credit. When an educational activity is offered for medical (CME), Nursing (ANCC), and/or Psychology (APA) continuing education credit, participants must be informed as to the source, amount, nature, and disposition of any funding used to support the activity, whether in the form of educational grants, cash contributions, or in-kind contributions. Individuals in a position to influence course content must also disclose whether they have one or more relevant financial relationships with ineligible companies.

We define ineligible companies as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. There is no minimum financial threshold; individuals must disclose all financial relationships, regardless of the amount, with ineligible companies. We ask that disclosures be made regardless of whether the individual views the financial relationships as relevant to the education. For more information on the Standards for Integrity and Independence in Accredited Continuing Education, please visit accme.org/standards.

All those in a position to control the content of an education activity are asked to disclose any relevant financial relationships they have with any ineligible companies.

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None of the planners or presenters for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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