Mindfulness- and Acceptance-Based Behavioral Therapies in Practice (Guides to Individualized Evidence-Based Treatment)

257 Pages·2009·2.26 MB·English

by  Lizabeth Roemer

Mindfulness- and acceptance-Based
Behavioral therapies in practice
Guides to individualized evidence-Based treatment
Jacqueline B. Persons, Series Editor
Providing road maps for managing real-world cases, volumes in this series help the clinician develop
treatment plans using interventions of proven effectiveness. With an emphasis on systematic yet flexible
case formulation, these hands-on guides provide powerful alternatives to one-size-fits-all approaches.
Each book addresses a particular disorder or presents cutting-edge intervention strategies that can be
used across a range of clinical problems.
Cognitive Therapy of Schizophrenia
David G. Kingdon and Douglas Turkington
Treating Bipolar Disorder:
A Clinician’s Guide to Interpersonal and Social Rhythm Therapy
Ellen Frank
Modular Cognitive-Behavioral Therapy for Childhood Anxiety Disorders
Bruce F. Chorpita
Cognitive-Behavioral Therapy for PTSD: A Case Formulation Approach
Claudia Zayfert and Carolyn Black Becker
Cognitive-Behavioral Therapy for Adult Asperger Syndrome
Valerie L. Gaus
Cognitive-Behavioral Therapy for Anxiety Disorders:
Mastering Clinical Challenges
Gillian Butler, Melanie Fennell, and Ann Hackmann
The Case Formulation Approach to Cognitive-Behavior Therapy
Jacqueline B. Persons
Mindfulness- and Acceptance-Based Behavioral Therapies in Practice
Lizabeth Roemer and Susan M. Orsillo
Mindfulness- and Acceptance-
Based Behavioral Therapies
in Practice
Lizabeth Roemer
Susan M. Orsillo
Series Editor’s Note by Jacqueline B. Persons
THE GUILFORD PRESS
New York London
To Josh, Paul, Sarah, and Sam
with love and gratitude
© 2009 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
www.guilford.com
All rights reserved
Except as noted, no part of this book may be reproduced, translated, stored in a retrieval system,
or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher.
Printed in the United States of America
This book is printed on acid-free paper.
Last digit is print number: 9 8 7 6 5 4 3 2 1
LIMITED PHOTOCOPY LICENSE
These materials are intended for use only by qualified mental health professionals.
The Publisher grants to individual purchasers of this book nonassignable permission to
reproduce all materials for which photocopying permission is specifically granted in a
footnote. This license is limited to you, the individual purchaser only, for use with your
own clients and patients. Purchase by an institution does not constitute a site license. This
license does not grant the right to reproduce these materials for resale, redistribution, or any
other purposes (including but not limited to books and handouts or slides for lectures or
workshops). Permission to reproduce these materials for these and any other purposes must
be obtained in writing from The Guilford Press.
Library of Congress Cataloging-in-Publication Data
Roemer, Lizabeth, 1967–
Mindfulness- and acceptance-based behavioral therapies in practice / by Lizabeth Roemer,
Susan M. Orsillo.
p. ; cm.—(Guides to individualized evidence-based treatment)
Includes bibliographical references and index.
ISBN 978-1-59385-997-8 (hardcover: alk. paper)
1. Acceptance and commitment therapy. I. Orsillo, Susan M., 1964– II. Title. III. Series.
[DNLM: 1. Behavior Therapy—methods. 2. Awareness. 3. Patient Acceptance of Health Care—
psychology. WM 425 R715m 2009]
RC489.C62R64 2009
616.89′142—dc22
2008016226
About the Authors
Lizabeth Roemer, PhD, is Professor of Psychology at the University of Massachusetts–
Boston, where she is actively involved in research and clinical training of doctoral stu-
dents in clinical psychology. Her research examines basic processes that may under-
lie clinical problems, such as the role of emotional acceptance, emotional suppression,
emotion regulatory strategies, and mindfulness in a range of clinical presentations.
Dr. Roemer has published over 60 journal articles and book chapters and has coedited
two books.
Susan M. Orsillo, PhD, is Associate Professor of Psychology at Suffolk University in
Boston, Massachusetts. Her current research focuses on the role of emotional response
styles, most notably experiential avoidance, in potentially maintaining psychological
difficulties. In collaboration with her doctoral students in clinical psychology, she has
developed and tested a number of prevention and treatment programs that integrate
acceptance and mindfulness with evidence-based behavioral approaches. Dr. Orsillo
has published over 60 journal articles and book chapters and has coedited two books.
Together, Drs. Roemer and Orsillo have developed an acceptance-based behavioral
therapy for generalized anxiety disorder. They are currently examining its efficacy as
well as mediators and moderators of change in a study funded by the National Institute
of Mental Health.
v

Series Editor’s Note
This volume is the latest in the series Guides to Individualized Evidence-Based Treat-
ment, which aims to facilitate the transportation of evidence-based therapies from
research and academic communities to the frontlines of clinical settings.
Lizabeth Roemer and Susan M. Orsillo aid the busy clinician by providing in this
volume a thoughtful synthesis of several of the important and increasingly popular
mindfulness- and acceptance-based behavioral therapies, including acceptance and
commitment therapy, mindfulness-based cognitive therapy, mindfulness-based relapse
prevention, integrative behavioral couple therapy, and dialectical behavior therapy. The
authors offer us their distillation of the essential principles and elements of this new
group of behavioral therapies.
Drs. Roemer and Orsillo present a general model that proposes that many prob-
lems and disorders for which our patients seek treatment result from three related
mechanisms: a maladaptive relationship to internal experience (such as fusion, judg-
ment, and/or lack of awareness), experiential avoidance, and behavioral constriction.
The authors show the clinician how to use the general model as the foundation for an
individualized case formulation and treatment plan that addresses the unique details
of each patient’s symptoms and problems. They show the therapist how to use the indi-
vidualized case formulation to understand the relationships among a patient’s multiple
disorders and problems and to select treatment targets and interventions. They describe
and offer numerous examples of interventions that are designed to help individuals
accomplish their treatment goals by altering their relationship to their internal experi-
ence, reducing experiential avoidance, and promoting valued action. The authors also
describe how to integrate other evidence-based therapies into this therapy and how to
account for cultural factors. The result is a therapy that clinicians can use in a flexible
way to address a wide range of clinical phenomena.
The approach to acceptance-based behavioral therapy described in this book is sup-
ported by data from randomized controlled trials showing that the therapies on which
the approach is based provide effective treatment for individuals and couples who have
vii
viii Series Editor’s Note
a wide range of clinical disorders and problems. The approach presented here is also
evidence based in the sense that the clinician collects data to monitor the progress of
every client.
This volume provides a wonderful balance of hands-on clinical detail, conceptual
clarity, scholarship, and reliance on the empirical literature. I am delighted to include
this book in the Guides to Individualized Evidence-Based Treatment.
Jacqueline B. Persons, PhD
San Francisco Bay Area Center
for Cognitive Therapy
Acknowledgments
This book is a culmination of our collaborative work over the past 14 years, and we are
grateful to the large number of people who have facilitated and supported its develop-
ment in a wide range of ways. We thank Kitty Moore and Jacquelyn Persons for their
invitation to write the book, their encouragement and support throughout the process,
and their valuable editorial feedback, which led to this final product. We also thank
Hillary Brown for her diligent and careful copyediting, and everyone at The Guilford
Press for their help in getting the book to its final form. We are deeply grateful to Laura
Allen and Sarah Hayes for their skill and care in overseeing our treatment grants, with-
out which we could not have written this book. The insights that they and the other
therapists we have supervised over the years have shared with us have shaped our
understanding in significant ways, all of which is reflected in these pages. We have had
the privilege of working directly with clients and supervising therapy with clients who
have continually taught and inspired us with their willingness to open up to their pain
and their courage to make changes in order to live more meaningful lives. We thank
them for all they have taught us as psychologists and as human beings. As we mention
in the Introduction, our work has been inspired and influenced by a number of clinical
psychologists and Buddhist writers; we are grateful to each of them for their efforts and
their wisdom. In particular, we thank our postdoctoral mentor, Brett Litz, for personally
and intellectually challenging us, for kindling our interest in emotion, and for introduc-
ing us to one another. We are grateful to David Barlow, Bonnie Brown, and the faculty,
students, and staff of the Center for Anxiety and Related Disorders for generously sup-
porting our work, and to the National Institute of Mental Health for supporting our
work and this book with Grants Nos. MH63208 and MH074589.
In addition, I (Lizabeth Roemer) want to thank Sue, first and foremost. There are
no words to describe the ways that our collaboration and friendship has strengthened,
expanded, and nourished me and my work throughout these past 14 years. Her wis-
dom, kindness, conscientiousness, insightfulness, and care create and enrich our shared
work and continually inspire me. With her steadfast support, I am far more able to
engage my life in ways that matter to me. I am also eternally grateful to my graduate
school mentor, Thomas Borkovec, for all of his teachings, his continuing guidance and
nurturance, and the model he provided of integrating science and practice, to which I
ix