8/1/2015

Acceptance and

Commitment
Therapy
For Parents of Children with Autism

Dr. Mark R. Dixon

The Acronyms
• RFT: Relational Frame Theory
– Post-Skinnerian approach to language and
cognition
– Originated in late 80s and early 90s
– First full textbook in 2001

• Acceptance and Commitment Therapy

– Talk-therapy approach to psychological distress
which follows directly from the RFT basic
research
– Use of “mid-level” terms to gain buy in from
clients and non-behavioral community

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The Autism Applications

• RFT: PEAK Relational Training System
– Comprehensive assessment and curriculum for
running discrete trial training for children between 9
months and 18 years of age.
– Incorporates traditional Skinnerian techniques with
more complex cognitive and language processes
– More empirical evidence than ANY OTHER ABA
program

• Acceptance and Commitment Therapy

– Full 180 days of therapeutic techniques designed to
be delivered by parents, caregivers and behavior
analysts
– Implementation 1:1 or within a group setting.
– Basic introduction to how ACT relates to children
with autism is also provided.

HOW MUCH TIME DO YOU SPEND

IN YOUR HEAD?
Worrying, stressed, freaking out, sad, lonely, depressed?

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Which one is you?

The Mainstream

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A New(er) Clinical Approach*:

ACT Therapy

* As an alternative to traditional Cognitive Behavior Therapy

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Your Top 5
• Best things about being a parent?

• Worst things about being a parent?

C-B-T
• Step 1: Identify distortions in thinking
– Log of thoughts, and the triggers that caused them

• Step 2: Identify a replacement thought

– Analyze the distorted thought, and take control over it with a
new thought

• Step 3: Working through the necessary change

– Breaking down large problems into smaller steps

• Step 4: Positive reinforcement for making even small gains

– Rewarding along the way allows feeling accomplishments

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A-C-T
• Step 1: Acceptance
– Don’t run and hide from the problem

• Step 2: Defusion
– You are not your thoughts

• Step 3: Contact with the “Present Moment”

– Awareness of yourself right here right now

• Step 4: Values
– Are you living the type of life that you truly value

• Step 5: Committed Action

– How serious are you about changing your behavior?

What is ACT?
• Experiential behavioral psychotherapy based on
relational frame approach to human language
– Emphasizes role of experiential avoidance, cognitive
fusion, values absence/diminishment, and resulting
behavioral rigidity and ineffectiveness
• ACT is a comprehensive model of therapy
– NOT set of techniques
– However, it includes many many many techniques,
some used in other forms of therapy, that work
together to increase psychological flexibility

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What is ACT?
• ACT tries to:
– Reduce domination of literal, evaluative, temporal
language

– Connect instead with our VALUES

– Behave more FLEXIBLY + effectively focused on

values, NOT fear!

“The single most remarkable fact

about human existence is how
hard it is for humans to be
happy.”

(Hayes, Strosahl, & Wilson, 1999)

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ACT Model
• An alternative to the traditional CBT
treatment model

• Focus on feeling good instead of feeling

good

• Doesn’t try to change our thoughts or

feelings, instead it changes the way we
relate to them

ACT vs. CBT

• ACT • CBT
– Behavior Change – Behavior Change
– Environment determines – Environment + thoughts
behavior are casual
– Changes Context – Changes Content
– Acceptance of Private – Control and
Events restructuring
– Primary Goal = valued – Primary Goal = symptom
living reduction

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Contact with the

Present Moment

Acceptance Values

Psychological
Flexibility

Defusion Committed
Action

Self as
Context

Present Moment
• Contact with the present moment

• Focus on what is happening right now

• Out of your mind and into your life

• Alternative to living in a imagined future or a re-

imagined past

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Acceptance
• Willingness to experience thoughts and urges,
including unwanted and uncomfortable ones
• Acceptance is NOT an act of surrender or resignation
that you will “always be a pathological gambler”
• Rather, it is giving yourself permission to feel what you
are feeling – even if it is “I will always be a pathological
gambler”
• Alternative to attempting to control/eliminate
unwanted thoughts and urges to gamble

Defusion
• Fostering flexible responses to rigidly
held verbal relationships
• De-literalizing language
• Seeing things as what they are and not
what they say they are
• Alternative to tightly holding inflexible
and unworkable beliefs, stories,
associations.

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Self as Context
• Transcendental sense of self
• The “you that is always you”
• Self as process and as context
• Alternative to the stories we well tell about ourselves
(self as content)

In this moment
The ACT Question Contact with the
are you
Present Moment

Willing to show
up to whatever
you are Acceptance Values
experiencing
Freely chose a
without defenses
direction you
Psychological want to head in
Flexibility
See things for
what they are,
and not what
Defusion Committed And gently
they say they are
Action return to that
direction when
you find yourself
Not the stories
Self as off track
you tell about
yourself, but you Context

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Number of ACT Empirical Publications

Cummulative Outcome Publications

70

60

Number of Publications
50
ACT
40

30

20

10

0
85 87 89 91 93 95 97 99 01 03 05 07
19 19 19 19 19 19 19 19 20 20 20 20

Number of ACT RCTs

102
Cummulative RCTs

25

20
Number of Publications

15

10

ACT
5

0
85
87
89
91
93
95

97
99
01
03
05

07

Total to Date
19
19
19
19
19
19

19
19
20
20
20

20

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ACT Outcomes

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., Lillis, J. (2006). Acceptance and Commitment Therapy: Model,
processes and outcome. Behaviour Research and Therapy, 44, 1-25.

Regular-Daily Classroom Behavior

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Mindfulness in the Pre-K

Classroom
• Participants: 3 full time Baseline
0.9
Mindfulness
staff members in Pre-K

Percentage of Positive / Total

room for typical and DD 0.8

Interactions with Kids

kids
• Procedures 0.7

– 5 minutes of mindfulness 0.6

exercises
– No instruction 0.5

whatsoever about what

experimenter was going 0.4

to record
– Experimenter was a mom 0.3
1 2 3
of a child in room that Staff Number
was there to observe

Getting Teachers/Staff on Board

• Participants: 5 full time educational staff for

children with autism or other developmental
disabilities
• What we did?:
– On the job feedback, definition of targeted skills,
training on implementation, performance tracking
– Addition of 5 hours of Mindfulness/ACT for the
STAFF!
• Did it work?:
– Percentage of observation interval displaying
“active treatment”

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Dependent Variable

– Active treatment definition: the staff member is

running a formal instructional program and/or
applying incidental teaching procedures with one or
more of their assigned kids

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Taking it SCHOOLWIDE

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Meditation for the Masses & Classes

• Decrease in anxiety
• Mood change
• Pre-frontal cortex activation
• Immune response

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Now to Practice

Contact with the

Present Moment

Acceptance Values

Defusion Committed
Action

Self as
Context

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Contact with the present moment

• Basic assumption
– Living on autopilot
– Mindless interaction with world within and
around us

• ABC’s of present moment awareness

– A wareness of what is here
– B eing with what is here
– C hoosing what to do

• Primary goal:
– Life is occurring RIGHT NOW
– Making contact with the here and now
– Experiencing both external and internal events
– Practice, practice, practice!

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• Clinical example:
– “I think I’ll change my behavior tomorrow”
– “I can’t allow myself to feel the pain, so I fight to
escape it”
– “I’m noticing that when you say the word
“autism”, I feel a rush of heat in my throat”

Becoming Mindful
• Sit
• Breath
• Notice the sounds of the room
• Notice your body sensations
• Notice your thoughts
• Why are you here?
• What are you wanting from today, and from
your life?

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Contact with the

Present Moment

Acceptance Values

Defusion Committed
Action

Self as
Context

Acceptance
• Basic assumption
– Human beings tend to engage in avoidance
behaviors
– When you’re not willing to have something, you
have it!
– Control is the problem and willingness is the
answer

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• Primary goal:
– Undermine experiential control by identifying
solution-focused behaviors
– Developing creative hopelessness
• Seeing the hopelessness of experiential avoidance
• Experiential exercise: Man in hole

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Primary goal cont:

– To help clients see willingness as an ALTERNATIVE
to control
– Willingness to experience distress

Willingness
• So what IS willingness?
– Openness towards WHOLE experience
– ALTERNATIVE to control
– Willingness to experience distress
• Easily embraced in the abstract, but how do you stay
committed during difficult experiences?
• Experiential exercise:
– Joe the Bum

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This is Joe the bum

You’re having a party, and he decides to show up

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You have 2 choices

Tell him he’s not allowed in, and Be willing to invite him in, even
make sure he never comes inside though you may feel uncomfortable

WHAT DO YOU DO?

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Passengers on the Bus

• Clinical example:
– “I don’t like the feeling I get when I get stressed”
• Unwilling to “be present” with physiological responses
to gambling
– “If I don’t have control over my thoughts, then I
know I will get a panic attack”
• Wanting control in life

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Contact with the

Present Moment

Acceptance Values

Defusion Committed
Action

Self as
Context

Defusion
• Basic assumption
– Human beings become FUSED to the CONTENT of
their thoughts
• Leading to escape/avoidance
– The problem is not WHAT we think, it is HOW we
relate to what we think

• Don’t believe me?

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• Experiential exercises
– Fill in the blank:
• Blondes have more ________
• Eeny, Meeny, Miny, ________
• Little Miss Muffet sat on her ________
– Milk, Milk, Milk
– I’m having the thought that…

• Primary goal:
– Interacting with thoughts as WHAT they are
– Attend to thinking + experiencing as ONGOING
process
– De-emphasizing literality of language

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• Clinical example
– “I can’t stop thinking about what dad did to me”
– “I want to stop but I know its not possible”
– “I need to fight somebody to feel important”
– Others?

Contact with the

Present Moment

Acceptance Values

Defusion Committed
Action

Self as
Context

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Values
• Basic assumption
– We put our life on hold while we try to control our
suffering
– We tend to behave in ways that go against what we value
• Avoidance behavior

• What are values?

– Chosen life directions
– Verbally constructed, globally desired life directions
– Ongoing PROCESS rather than outcome

(Hayes, Barnes-Holmes, & Roche, 2001)

• Primary goals:
– Clarifying chosen life directions
– Linking behavior change to those values
– Willingness to stay on valued path
– Acceptance and willingness of private events,
while remaining committed to values

• Experiential exercise
– Bulls eye

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Living
Bulls Eye exercise
inconsistently with
your values

Living a
value-driven
life

Bulls Eye exercise Personal

growth/health
Work/Education

Relationships Leisure

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• How do you know you’re not already living a

valued life?

• Experiential Exercise:
– If you died today, what would your tombstone to
read?
• Would would you WANT it to read
• How are these two different?
• How can you begin to lead a life, where your
tombstone would reflect what you WANT?

• Clinical example
– Identifying values
– “I value my family, but I don’t know how to do
things for them”
– “I can’t stop cutting myself, and if my family can’t
accept it, then maybe I don’t need them after all”

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Contact with the

Present Moment

Acceptance Values

Defusion Committed
Action

Self as
Context

Committed Action
• Basic assumption
– We know what we want to be about, yet we avoid
things that may bring pain or suffering to us
– “If I do not care, I will not be hurt”

• Are you willing to accept whatever discomfort

your mind provides you AND commit to your
values?

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• Focus on building patterns of committed

action
• Primary goal:
– Work for behavior change
– Making room for automatic reactions and
experiences
– Taking responsibility for ALL patterns of action

• Difference between values and GOALS

– Values
• Verbally constructed and never achieved as an object
– Goals
• Values-consistent AND can be achieved

• Patterns of effective action

– action linked to chosen values.
– Similar to traditional behavior therapy

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• Experiential exercise
– Eye contact exercise
– Swamp metaphor
– SMART goals

• Clinical example
– Valuing education, yet keeping child at home
because of friction with school staff
– “I want to stop fighting with spouse, but when I
see him do something wrong, I cant help myself”
– “I value my child, so I have to put up with all the
problem behaviors because that is just part of his
disability.”

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Contact with the

Present Moment

Acceptance Values

Defusion Committed
Action

Self as
Context

Self as context
• Basic assumption:
– Taking thoughts out of context
– Thought become entangled as evaluations and
self-conceptualizations
• Taken as literal truth

• Focus on distinguishing conceptualized self

from self as context

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• Experiential exercise:
– Fill in the blank
• I am a person who _____________
• I am a person who does not _____________
• My favorite thing about me is _____________
• My least favorite thing about me is _____________

• Are you really those things? Could it be your

mind telling you that you are?

• Primary goal:
– Making contact with self that is continuous and
consistent
– Differentiate between self as CONTEXT from self
as CONTENT
– Understand the self as distinct from private events

• What is the “self”?

– Continuity of consciousness itself (Hayes, 1984)

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• Experiential exercise:
– House and furniture exercise

• Clinical example:
– “I am a rotten person for what I have done to my
family”
– “I am unlovable”
– “Nobody likes me”
– “Although I have struggled in the past, I see that
my family will always be there for me”
– “I’m noticing that my mind is telling me that my
life will never be the same because of X”

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180 Days of Activities

• 5 Years in
Development
• Over 300 kids
statewide have had
the curriculum
• Research
undergoing across
the country
• Often done with
both parent and
child together

Day 1: Everyone feels bad! Sometimes our friends seem to: A

o Have cooler clothes or toys than we do.

o Have better parents or friends than we do.
o Be smarter or funnier than we are.
o Have less pain or don’t feel bad like we do.
Want to know a secret?
EVERYONE YOU KNOW HAS PAINFUL EXPERIENCES!
Even your mom, dad, and Your mom, dad, best friend, We all experience pain.
friends feel bad sometimes. and every other person you Everyone you have ever met
What is it like to know you have ever met feels bad has felt or will feel both
are just like them? sometimes. How does it feel emotional and physical pain.
knowing you are just like This means you are not
everyone else? alone! How do you feel,
knowing that you are not
_______________________ alone with your struggle
with pain? ____________
_______________________ _______________________
_______________________
_______________________ _______________________
_______________________
_______________________ ______________________. ______________________.
Grades K-4 Intermediate Middle/High School

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Day 1: Everyone gets sad or has pain! A

If your sadness/pain was an animal, which one would it be? Draw it below.
Share with the class you animal. Was it like or different than other’s in the
class?

Day 2: Sad/ Painful Experiences A

Sad/Painful Experiences
Sad or painful experiences are a normal part of life, one that every person
experiences at some point. These may include things that happen at home, at
school, with your friends or family, or anything else that is difficult for you.

Some things that make me Write down a list of some Write down a list of some
feel bad: memories, feelings, or painful memories, feelings,
thoughts that make you feel or thoughts that you
bad. experience during your day.
_______________________
_______________________ _______________________
_______________________
_______________________ _______________________
_______________________
_______________________ How long have you
experienced them?
_______________________ _______________________
_______________________
_______________________ _______________________ _______________________
Grades K-4 Intermediate Grades Middle/High School

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Day 2: Painful Experiences A

Painful Experiences

Put the things that make you feel bad in order based on how they have changed your
life. Next, draw arrows between things that happen together.

D Day 5: Everything Can Be

Related!
Words can be tricky! In school, teachers make you
learn how to read them, write them, and use them
properly. By learning all we can about language, we
learn how to RELATE anything with anything else!

What is your favorite

line from a song?
What word do you like
What word do you like
the most?
the most? What is your least
favorite line from a
song? (maybe your
What word do you like
What word do you like parent’s music)
the least?
the least?
How are the two sets of
How is your favorite lyrics the same? How
word like your least are they the opposite?
favorite word? How are they both like
a lawn mower?
Grades K-4 Intermediate Grades Middle/High School

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Day 5: Everything Can Be

Related! D

Circle your favorite animal.

Circle your favorite food.

How is the animal like your favorite food? ___________________________________

How is the animal better than the food? _____________________________________

How is the animal the PARENT of the food? __________________________________

Day 6: The Language Game D

Language has advantages and disadvantages. Let’s play a

game to understand them. See If you can notice what
your mind does when you do this.

Twinkle, twinkle______ Eney, Meeny, Miny ______ Eney, Meeny, Miny

______________________
Hickory Dickory __________ Hickory Dickory __________ Hickory Dickory
______________________
Clean up, clean up, Little Miss Muffit sat on her Little Miss Muffit sat on her
everybody______________ ______________________
_________ _______________________ Was it hard to fill these in?
Do you know what a tuffet
Did you know the answers Was it hard to fill these in? is? ____________________
before I got to the end? Do you know what a tuffet What did your mind do as
is? you filled these in? _______
_______________________ ______________________
_______________________ ______________________
Grades K-4 Intermediate Grades Middle/High School

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Day 6: The Language Game

A good thing about words is it lets us talk about our experiences. But, what happens
when the sentences are more important to you?
D

The worst thing about me is that I’m _________________________

_______________________________________________________

I’m not a good person, I’m ________________________________

_______________________________________________________

Deep down, I’m afraid I’m ________________________________

_______________________________________________________
Notice how much harder these were for you. Why do you think that is?

_____________________________________________________________________

Day 7: Getting Rid of Our

Thoughts What happens when you don’t want to have an
upsetting thought? Sometimes when you are not willing
to experience something, you do. Let’s play a game to
see if we can get rid of our thoughts. See if you can
D
imagine a bright purple airplane. For 3 minutes try as
hard as you can NOT to think about the purple plane.

Did you think about the How many times did you Did you think about a purple
purple plane? think about the purple plane last week?
plane? _______________________
How did you try to not think How many times did you
about the plane? _______________________ think about a purple plane?
For 3 minutes, think about _______________________
whatever you want. How For 3 minutes, think about
Did it work? many times did you think whatever you want. How
about the plane? many times did you think
about that plane?
_______________________ _______________________
Yikes! We thought a lot Yikes! We thought a lot
about that purple plane, about that purple plane,
didn’t we?! didn’t we?!
Grades K-4 Intermediate Grades Middle/High School

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Day 7: Getting Rid of Our Right down a word or a thought of something you do
Thoughts not like to think about usually. Like monsters, someone
who is mean to you, a food that makes you sick.

Now write down how you

usually try and get rid of that
thought in your head?
Say the word / thought to
yourself 5 times fast, then 5
times slow, and then 5 times
really slow. Does that
word/thought seem as bad
anymore?

Day 34. Hamburger Mind V

Picture a hamburger in your mind. Picture each layer of

it—the meat, cheese, onions, lettuce, tomato, pickles.
What if your mind was like this hamburger and stacked
full of thoughts? Some good and some bad.

What would each layer of What would each layer of

your hamburger be? your hamburger be?
_______________________
______________________ _______________________
_______________________
______________________ _______________________
_______________________
______________________ _______________________
_______________________
______________________ _______________________
_______________________
______________________ _______________________
Draw what each layer of _______________________
your hamburger would be. ______________________ _______________________
Grades K-4 Intermediate Grades Middle/High School

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Day 34: Hamburger Mind

D
Draw your mind hamburger on various colored sheets of paper. Glue them
together below to complete the burger!

P
Day 35: Mindfulness Silence

Let’s play the silent game for the next 10 minutes.

Breathe in your nose and out of your mouth. Take deep
long breaths. Stay quiet and notice your body for as long
as you can.
Ready, set, go…
What did you notice in your What did you notice feeling What did you notice feeling
body? Did your thoughts in your body? Was it in your body? Was it difficult
wander sometimes? difficult to keep your mind to keep your mind on your
on your body? body? What thoughts did
you have?
______________________ _______________________
_______________________
______________________ _______________________
_______________________
______________________ _______________________
_______________________
______________________ _______________________
_______________________
______________________ _______________________
Grades K-4 Intermediate Grades Middle/High School

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Day 35: Mindfulness Silence P

Write down a thought you have that is something you don’t like to have.

______________________________

Now, for the next 5 minutes, think about this thought, stare at it written above,
and notice all the body sensations you have as you sit and notice this thought.
Watch how your mind comes and goes from this thought over the next 5
minutes.

Day 36: Purple Dinosaur

D

Picture that famous purple dinosaur in your

head. What does he look like? What does his
voice sound like? Now repeat his name over
and over again for 2-3 minutes.

What happened to the What happened to the What happened to the

picture of him when you picture of him when you picture of him when you
were saying the word? were saying the word? were saying the word?

Did he get more or less Did he get more or less

present in your head? present in your head?

Can you still hear his creepy Can you still hear his creepy
song? song?

Grades K-4 Intermediate Grades Middle/High School

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Day 36: Purple Dinosaur

D
Draw the purple dinosaur below, but….attach to him a pizza for a head, a bird for
one foot, a TV for one of his feet, and a lamp for one of his arms. See how he
still is a dinosaur, but drawing him differently makes you think about him
differently!

P
Day 37: Mindful eating

Often times we just eat and don’t even think about what we are eating.
Maybe that is sometimes why we eat too much some times and feel
sick. Eat your snack and think about the food you are eating. Where did
it come from? How far did it travel? How many people touched it
before it reached your hands?
Take ½ of your snack and eat Take ½ of your snack and eat
Eat ½ of your snack now? it like you always do. Write it like you always do. Write
Was it good? 2 things about your snack 2 things about your snack
_______________________ (taste, smell, etc.) (taste, smell, etc.)
______________________ ______________________
Eat the other ½ of your ______________________ ______________________
snack really slow. Count to Eat your next ½ of your Eat your next ½ of your
10 before every chew you snack very slowly. So slow snack very slowly. So slow
make. Which part of your you have to stare at every you have to stare at every
snack tasted better? piece for 1 minute before piece for 1 minute before
you eat it. Then, you need you eat it. Then, you need
to keep each piece in your to keep each piece in your
_______________________ mouth for 1 minute before mouth for 1 minute before
you swallow. you swallow.
Grades K-4 Intermediate Grades Middle/High School

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Day 37: Mindful Eating P

Get on the computer and become a snack detective. Find out where your
favorite snack came from. Where did it come from (city and state)? How far did it
travel (miles to your table)? How many people touched it before it reached your
hands (guess)? Was it grown in the earth or made by chemicals and machines?
Draw the path of your food from its “birthplace” to your mouth below.

Day 38: Paper Dragon D

The word “dragon” makes people think of very big scary fire breathing
beasts that are powerful. Some of your thoughts are like dragons. These
dragon-thoughts control you and have lots of power. Yet, not all dragons
are powerful. Putting the word “paper” in front of dragon makes this
mean powerful beast seem a bit silly. He has no more power.
What are two dragon What are two dragon
What is a dragon thought thoughts you have that thoughts you have that
you have? control you? control you?
_______________________ ______________________ ______________________
______________________ ______________________
How can you make this
dragon into a “paper” Rename these thoughts so Rename these thoughts so
dragon? Can you call this they seem almost as weak they seem almost as weak
thought another silly name? as a paper dragon. as a paper dragon.

_______________________ _______________________

_______________________
_______________________ _______________________
Grades K-4 Intermediate Grades Middle/High School

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History of Journeys
• 2010-2012
– ACT for Children with Autism and Emotional Challenges was piloted in ED/BD classrooms for students to
difficult for typical school settings to handle. Population was made up of multiple-district students that
were combined into an intensive self-contained learning environment.
• 2012
– Commitment of an entire school building by Jerseyville, IL school district to hold a larger-scale program for
children 5-12th grade.
– K-4 would remain in prior locations
– ACT would be delivered every day at the start of the day. 30 minutes group setting. Each of the 180 days
found in Dixon’s book was delivered in order
– Educational coursework done via PSI (computerized self-paced; target at level of each individual learner).
Teachers served as coaches, facilitators, and therapists throughout the day.
• 2013
– Outcome study of 9 students that attended program from day 1-180.
– Control group of matched disability and SES level which remained in “typical” district classrooms
– Disabilities included autism, emotional disorder, conduct disorder, and behavioral disorder
• 2012-15
– Population growth from 14 to 40 students
– Graduation rate 100 percent of seniors
– Doubling of GPA
– Increased attendance
– Decrease in psychological inflexibility
– Multiple replication sites have been developed statewide

Control/Treatment Group AAQ-2 Comparison

25

20

15
AAQ Score

Treatment
10 Control

0
1st 4th
Quarter

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Control/Treatment Group Attendance Comparison

100%

90%

80%
Percentage in Attendance

70%

60%

50%
Treatment
Control
40%

30%

20%

10%

0%
11-12 12-13
Year

Control/Treatment GPA
4 Comparison
Grade Point Average

2
Treatment
Control
1

0
11-12 Year 12-13

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The Flow of the Behavioral Event

Antecedent or • Awareness of how the
Student failed to maintain
Trigger flexibility.

• Communicate the ACT

Behavior language in response to
the behavior.

• Treat the student

for more flexibility
Consequence of responding as
they move
forward.

ACT within ABC

Awareness Communicate Treat
( ) Reactive ACT
( ) Not present in
- Let’s get back in the
current moment present
( ) Acknowledge current
- It’s ok that did not environment
( ) Fused to thoughts work out. We need to
accept it. ( ) Stepping back from
- Is this the real you current verbalizations
( ) choosing non- that is here right now?
values - Did this get you closer ( ) Reminding of prior
to your values?
( ) Proactive ACT
stated values
( ) Losing - Can you tell me what
commitment your values are today? ( ) Encouraging
- Stop, pause, and come commitment
back to the present.
( ) Wrong self - Let’s commit to doing ( ) Refocus to self-as-
better from this point context
( ) Difficulty with forward
- I like the real you I see
acceptance ( ) Acceptance of the
right now
entire event (good/bad)

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Kelly, was a 12 year- old girl who was diagnosed with autism at age 5 and since her diagnosis
has been receiving home-based behavioral intervention. She currently receives home based
ABA therapy once a week for 2 hours. The focus of these sessions is teaching social and
independence skills. Kelly is in an integrated grade 7 class and has a personal education
assistant for 20% of her school day. Kelly’s extracurricular actives include Girl Guides, piano
lessons, youth group at her church, and swimming. Kelly’s parents
17are concerned about her low self-esteem which is exhibited through Kelly saying negative
things about herself. Often these negative self comments take the form of statements such as
“I’m so stupid,” “I’m fat,” or “I’m an idiot.” Kelly found out within the last year that she has
autism, and her parents report that she is sensitive about her diagnosis.

Jake, a 8-year-old boy who was diagnosed with autism at age 5 and since then has been
receiving home-based behavioral intervention services. Jake is in an integrated grade 2 class
and has a personal education assistant for 100% of his school day. Jake’s extra-curricular
activities includes being part of a bowling league. Based on his school’s academic assessments
Jake has been diagnosed with being gifted and is above grade level in all subjects except
English which he is currently functioning at a grade level. The behavior that is of concern to
Jake’s mother is the tantrums that he displays in her presence following having something not
go his way. Jake’s parents describe him as a “perfectionist.” The tantrums that Jake has are
operationally defined as any of the following behaviors in isolation or combination: yelling,
throwing items, running away, dropping to the floor and/or crying. In order to be considered
more than one tantrum, Jake must be calm (e.g., no yelling, throwing items, running away,
dropping to the floor and/or crying) for 5 five minutes between the two tantrums. If Jake has
a tantrum at home following not being able to get his way the consequences that are
provided by Jake’s mother are one or some combination of loss of computer time (a highly
preferred activity), a time-out, or being required to finish the task he wants to escape (e.g.,
homework).

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Acceptance and

Commitment
Therapy
For Parents of Children with Autism

Dr. Mark R. Dixon

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