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Online Therapy

Presentation Creative approaches to working online and use of online resources

-Bertus Swanepoel

Slide 1. Introduction

- My challenge was to creatively talk about creativity in the online therapeutic space which I wanted to apply to Acceptance and Commitment Therapy (ACT).
- To do the above I will introduce you to the processes used in Acceptance and Commitment Therapy.
- We will then explore creative approaches and online resources that can be used as tools in doing ACT online.
- In general, explore how smartphones can help with new creative measures in Mood and Behavioural Data.
- Conclude

Slide 2. Acceptance and Commitment Therapy (ACT)

ACT is based on the idea that psychological rigidity is a root cause of depression, anxiety and other forms of suffering (Hayes, Strosahl, Wilson, 2012). In my experience, many therapists feel comfortable to make use of ACT tools within their preferred therapeutic modalities.

There are mainly three Processes in Acceptance and Commitment Therapy to create Psychological Flexibility as Outcome.
- Being Open (Acceptance of Emotions and Sensations as well as Being Defused from Thoughts)
- Being Aware (Being Mindful and Present)
- Being Active (Discovering Values and Commit to valued based action)

Slide 3. Online Tools in Acceptance and Commitment Therapy

Being open and aware
This might be any process or tool that will help the client become more aware of his/her thoughts and feelings in the moment that he/she is experiencing it such as:
- Therapy through texting (email or chat) might already be a functional tool in creating distance between the experiencer of thought and feeling and typing the thoughts and feelings on a screen. (Dunn, 2012)
- Another option is to use role play through the chat option where you as therapist can assume different roles as another person, thought or emotion. An interesting dynamic between the self and certain thoughts or feelings might be discovered.
- The therapist can also send mindfulness exercises on Audio or make use of ACT Apps such as “actcompanion” (http://www.actcompanion.com/) or other mindfulness apps such as “Insight timer” (https://insighttimer.com/).
- ACT Metaphors (VIDEO). There are many ACT Metaphor Videos online and one can look at the animations and discuss the meaning of it with the client.
- According to Leigh (2015) Psychometric test can help to validate the efficiency of online therapy and within ACT the AAQ-II (Acceptance and Action Questionnaire) can measure the change in Psychological flexibility before and after therapeutic interventions although some discriminations might have to be considered (Tyndall, Waldeck, Pancani, Whelan, Roche & Dawson, 2019).

Slide 4. Online Tools in Acceptance and Commitment Therapy

Being active
Any process that will bring into focus the client’s values, followed by committed action towards living those values. These can be clarified and monitored via an app such as “actcompanion”.

What do you want your life to be about and how are you going to get it?
What do you want your friends to say about you at your 80th Birthday?

You can write your own Eulogy:
Bertus’s life was about being………………………………

Committed Action:
Behavioural goals can now be agreed upon with the client which can be put into the ACT app that periodically reminds the client of the goals.
Online Self-report in the experience of attempting the committed action can be tracked daily which could enhance therapeutic outcomes.

Slide 5. Unique creative approaches through smartphones

I realised through my reading that self-report and reminders aren’t the only way technology-based assessment can be used to track mood and behavioural data. Although not directly applicable to ACT, smart devices and apps can practically assist in saving lives (Bawden, 2018). Arean & Andersson (2016) highlight the following to track mood and behaviours: - Performance Measures (Game-like cognitive assessments) can be used to assess cognitive functioning through daily or weekly cycles. - Those collected from sensors (heart rate monitoring) can indirectly assess stress or anxiety levels. - Apps monitoring searches and social media usage to gauge social connectivity and possible psychopathology are considered to measure suicidal risk.

Slide 6 Conclusion

Although some of the ACT processes can be done in f2f as well as in online settings, the measurement of behavioural outcomes might be better measured and adapted for online work. In online work the ease with which mindfulness exercises can be accessed might encourage the client to practice mindful meditation more often.
There are only a few studies examining effectiveness of online ACT interventions compared to f2f research and I believe that more e-ACT research needs to be done in future to solidify its effectiveness alongside CBT. (McGuire, 2017) (Slattery et al, 2018)
Although the future of using apps as therapeutic tools looks bright, the use of these apps stays dependent on the participation of the client and more research is necessary to understand motivation of clients to actualise the potential. (Baigianti et al, 2017)


Areàn, P.A., Ly, K.H., Andersson, G. (2016), Mobile technology for mental health assessment. Dialogues in Neuroscience. Jun; 18(2): 163–169.
Bawden, A. (2018). How apps have the potential to save lives. In: The Guardian. 17 July 2018.
Biagianti,B., Hidalgo-Mazzei, D., Meyer, N. (2017). Developing digital interventions for people living with serious mental illness: perspectives from three mHealth studies. In: Evidence Based Mental Health. November 2017 Vol 20 No 4. 98-101.
Dunn, K. (2012). A qualitative investigation into the online counselling relationship: To meet or not to meet, that is the question. Counselling and Psychotherapy Research: Linking research with practice. 12:4, 316-326.
Leigh, S. & Flatt, S. (2015). App-based psychological interventions: friend or foe? In: Evidence Based Mental Health.
Hayes, S., Strosahl, K. Wilson, K.(2012). Acceptance and Commitment Therapy. The Process and Practice of Mindful Change. The Guilford Press.
McGuire, B., Henderson, E., McGrath, P. (2017) Translating e-pain research into patient care. Pain, 2017 journals.lww.com
Slattery, B., O’Connor, L.,Haugh, S., Barrett, K., Francis, K., Dwyer, C., O’Higgins, S., Caes, L. Egan, J., McGuire, B.(2016) Investigating the effectiveness of an online acceptance and commitment therapy (ACT) intervention versus a waiting list control condition on pain interference and quality of life in adults with chronic pain and multimorbidity: protocol for a randomised controlled trial. BMJ Journals. Vol9 issue 5.
Tyndall, I., Waldeck, D., Pancani, L., Whelan, R., Roche, B. Dawson, D. (2019). The Acceptance and Action Questionnaire-II (AAQ-II) as a measure of experiential avoidance: Concerns over discriminant validity. Journal of Contextual Behavioral Science, Volume 12, April 2019, 278-284

Futher Reading:

Why work online? The pros and cons for the therapist and for the client - by Bertus Swanepoel
Presentation notes : Creative approaches in working online and use of online resources - by Bertus Swanepoel
Article review: Telepsychology in a University Psychology Clinic Setting: A Pilot Project. Simpson, S.G, Guerrini, L, Rochford, S. (2015).- by Bertus Swanepoel

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