Inside This Moment: A Clinician’s Guide to Promoting Radical Change Using Acceptance and Commitment Therapy

Book Title: Inside This Moment: A Clinician’s Guide to Promoting Radical Change Using Acceptance and Commitment Therapy

Authors: Kirk D. Strosahl, Patricia J. Robinson, and Thomas Gustavsson

Publication Information: Oakland, CA, Context Press, 2015, 232 pp., $49.95. paperback

Inside This Moment is a step-by-step manual for clinicians who want to help their patients enact radical change in their lives via the use of present moment awareness and mindfulness. The book walks the clinician through the critical steps they must take with their patients to change behavior patterns and break harmful cognition loops. The theory behind the work seems to draw on a mix of mindfulness, cognitive behavioral practice, and neuropsychology. The authors are well qualified to present this new approach to therapy, as they are the same clinicians who brought us acceptance and commitment therapy (ACT).^1,2 As a primary care physician and a human being, I found this book a worthwhile read. However, in a busy generalists’ practice, it is questionable whether one would have time to actually enact these techniques with patients in the 10 to 15-minute time constraint.

The book is divided into three parts: “The Present Moment Inside Out”, “The Five Processes of Present-Moment Awareness Interventions”, and “Using Present Moment in Common Clinical Problems”. The first part gives context to the theory and practice, and encourages clinicians to heal themselves and pay attention to their own issues, as this is the first step in helping others. The second part goes through the five steps that clinicians must take with their patients: Noticing, Naming, Letting Go, Softening, and Expanding. The final part gives practical examples of using theory with a handful of common mental health disorders encountered in practice including depression, anxiety and panic, post traumatic stress, addictive behaviors, and self harm. It also includes a section on behavior change. Throughout the text are sample clinical vignettes that are very useful for the clinician envisioning how the authors recommend putting theory into practice. The authors also frequently use neuroscience and discuss functioning of different neuroanatomical pathways to support their theories.

The specific examples of application of techniques to common mental health conditions in the last part seem especially useful for therapists who see a majority of patients with one or two of these problems (eg, the PTSD example may be useful for the practitioner working in a VA clinic, and the substance abuse example may be useful for the practitioner working in a combined primary care/suboxone clinic, etc).

An excellent use of this book would be as a teaching supplement for residents or medical students in a course led by a therapist or clinical psychologist. The bottom line is that this is a practical guide that presents a user-friendly approach to helping patients enact radical change and acceptance through mindfulness in their personal lives. Although mostly helpful to therapists and psychologists, for those primary care providers who have the time to practice and use this method in their clinics, it could also potentially be a very powerful tool. Overall it is interesting and useful to understand the theory and practice, even for physicians not using it themselves on a daily basis with patients.