Acceptance-based behavioural therapy

Domain II · Behavioural & cognitive · Roemer, Orsillo · 2009

What it is

Acceptance-based behavioural therapy (ABBT) is an individual outpatient cognitive-behavioural therapy that adds acceptance, mindfulness and values-based practice to traditional behavioural methods. It was developed for GAD and is now presented by its authors as a flexible framework for anxiety and…

Format

• Format (trial version). 16 individual sessions over about 18 weeks. Sessions 1 to 4 last 90 minutes and are weekly. Later sessions last 60 minutes and are weekly, then taper to every two weeks across sessions 14 to 16. NREPP describes this as 14 weekly plus 2 biweekly sessions. Adaptations exist: a…
• Pre-treatment meeting(s) and case formulation (before session 1). Goals:

Evidence status, as the guide reports it

• Version followed: Roemer & Orsillo's individual ABBT for generalized anxiety disorder (GAD) as delivered in the 16-session randomised trial protocol (Hayes-Skelton, Roemer & Orsillo, 2013), organised by the chapter structure of their 2020 clinician text Acceptance-Based Behavioral Therapy: Treating…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Clients for whom imagery is hard. Offer a body-based anchor instead.
• Unreported changes that confound progress. Content of the official form not seen.
• Irritation at intrusive sounds. This is useful material on judging and resisting.
• The client doing mindful activities only on good days. Encourage practice on hard days too.
• Using imagery to push thoughts away ("I sent it off"). The task is to watch, not to dispatch.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.