As we’ve discussed in earlier posts this month, college counseling centers (CCCs) have unique needs which influence what kinds of groups are offered and how groups are run. With limited resources and the need for a time-limited treatment model, coupled with increasingly severe and complex problems among the student population, effective short-term interventions are necessary. Because of the variety of presenting problems for which students seek help, it can be difficult to compose a group with members who share a common diagnosis. In fact, it is much more likely and common that group members will carry a variety of diagnoses.
All of the above factors make Acceptance and Commitment Therapy (ACT) groups a good fit for CCCs. ACT has shown efficacy as a short-term group intervention for a wide range of problems (Zettle & Raines, 1989; Bach & Hayes, 2002; Pearson, Heffner, & Folette, 2010) and, when applied in a group format, has been tested with high satisfaction ratings in busy, otherwise overwhelmed CCCs.
Facilitating ACT Groups: the Basics
Whether an ACT group should be composed of students who share a specific problem like procrastination, or students who present with a variety of problems depends on a number of factors:
- The pool of students willing to participate in the group
- The CCC’s resources
- Training and interests of the staff
Composing a group for a broader category of diagnoses, such as mood disorders, can be very effective. An ACT group composed entirely of students with anxiety disorders, for example, could focus exclusively on the dynamics of anxiety, including manifestations (panic, worry, and physiological arousal) and the behaviors that sustain them (like avoidance of anxiety-producing situations). And the existing 12-session ACT protocol for anxiety disorders would provide empirically-supported structure for the group.
Orienting Students to the Group
Interested students can be oriented in an individual meeting with one of the group leaders, who could provide the following description of the group:
This group is based on Acceptance and Commitment Therapy, or ACT. ACT assumes that pain is a normal part of living and that excessive efforts to avoid pain can lead to greater suffering. You will have the opportunity to explore how your painful thoughts and feelings affect your life, experiment with different ways of relating to them, and learn how to pursue your values more fully.
Individual group orientation meetings can also provide preliminary opportunities to explore the role of unworkable avoidance and control in students’ lives and introduce willingness as an alternative. It can be useful to facilitate a brief experiential exercise both to introduce potential group members to the experiential nature of ACT, and also to provide a window into what the group will be like. Flyers, given to students before or during an orientation meeting, can also be quite useful for communicating the nature of the group.
ACT groups usually include some combination of education, mindfulness exercises, experiential exercises, group discussions, and homework exercises. A typical ACT group might start with a mindfulness exercise to lay the groundwork for a present-focused and self-aware discussion. Next, the group might discuss homework given during the previous session, whether a worksheet, reading from an ACT self-help book, or a daily mindfulness exercise. The group leaders could then move on to a brief introduction of one of the six core processes of psychological flexibility, augmenting the instruction with interactive exercises to help students learn both intellectually and experientially. As the meeting professes, group members could reflect on how the topic being discussed applies to their lives. These conversations provide a good opportunity for members to provide feedback to one another, as well as for group leaders to facilitate discussions about present moment experiences. For example, group members might be encouraged to notice what their minds are saying about the discussion, observe what feelings are stirred up in response to their fellow group members, and consider what interpersonal behaviors might best serve their values. Facilitators may end the group by assigning a homework exercise based on the topic of the day.
ACT is brief, interactive, and effective, and thus a good fit for colleges and universities. But implementing new services in a CCC can be challenging, especially in light of limited resources and heightened concern on campuses about violence. Counselors who are interested in implementing ACT groups can point to ACT’s research base, short-term format, and broad applicability to make a case for adoption in CCCs. The wide availability of low-cost ACT resources can also be extremely helpful in reducing planning time and potential clinical hours lost to preparation.
ACT-naïve clinicians and administrators may express concern about “accepting thoughts and feelings,” wondering if this means all thoughts and feelings—including, for example, thoughts of suicide or violence against others. But acceptance means letting go of struggle with private experiences, not necessarily buying into their content: holding a spontaneous suicidal thought compassionately in one’s awareness while choosing to act in the service of one’s values, for example, is very different from giving in to a suicidal thought. Furthermore, ACT groups, like other outpatient groups, should uphold exclusion criteria to rule out participation of high-risk students who may harm themselves or others. To this end, assessment by a professional prior to joining the group is essential, and even once the group has begun meeting, each group member should have a counselor assigned to them who may provide individual support should a crisis arise.
Bach, P., & Hayes, S. C. (2002). The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial.Journal of Consulting and Clinical Psychology, 70(5), 1129-1139.
Pearson, A. N., Heffner, M., & Follette, V. M. (2010). Acceptance and commitment therapy for body image dissatisfaction: a practitioner’s guide to using mindfulness, acceptance, and values-based behavior change strategies. Oakland, CA: New Harbinger.