Table 1:
ACT-ED Session Content and Timing
| Session Title | General Tasks | ACT Principles & Tasks |
|---|---|---|
| Session 1: The Fork in the Road- The Choice of a Vital Life: An Introduction to ACT-ED | 1. Introduction to treatment & review of treatment time line and goals 2. Psycho-education on side effects and recovery after radical prostatectomy 3. Emphasis on the benefits of adherence to sexual medicine protocol 4. Introduction to erectile dysfunction (ED) and potential impact |
1. Introduce core concepts of ACT-ED: “The Acceptance and Commitment Cycle & Avoidance Cycle” 2. Acceptance and commitment are more effective strategies than avoidance and control to reduce distress. 3. Goal to decrease avoidance of and engage in activities related to penile rehabilitation regardless of discomfort or distress 4. Sexual Values Assessment 5. Conceptualize recovery in terms of maintaining valued activities and goals |
| Session 2: It’s Your Life: Story of Recovery and Making a Commitment | 1. Update on injection therapy training and reactions 2. Review current side effects of urinary incontinence and ED 3. Injection Therapy: Discuss behavior aspects to help in use of injections |
1. Articulate Story around ED & recovery 2. Discuss psychological impact of ED 3. How negative thinking impairs ability to move forward towards goals 4. Integration into Sexual Activity/Intimate Relationship 5. Barriers Assessment: Identify potential barriers and obstacles that might get in the way of acting consistently with these values 6. Fork in the Road Handout: Living a valued life vs. living a life in avoidance 7. Life Bus Handout: Having a thought vs. buying a thought: Cognitive Defusion 8. Make a commitment to taking purposeful action step |
| Session 3 (2 weeks post Session 2): Get Out of Your Mind Get into Your… Acceptance, Willingness and Mindfulness | 1. Update on injection therapy training and reactions 2. Verbal Bullseye Exercise: How many times a week have you injected? 3. Introduce and explain Injection Log |
1. Acceptance and willingness vs. avoidance and control 2. Acceptance of what cannot be changed (thoughts and feelings) and changing what can be changed. 3. Discuss concept of “willfulness” 4. Self-Awareness (Mindfulness) a. Applications to injection therapy and sexual intimacy |
| Phone Sessions (4, 6, & 9 weeks post session 2): How Do We Keep It Up! Monitoring our Progress and Maintaining Valued Actions and Goals | 1. Update on injection use and quality of erections. 2. What is the patient’s “story” around recovery now? 3. Review Injection Log 4. Review progress with sexual functioning |
1. Review patient’s values related to sexual functioning, Acceptance, Willingness & Diffusion 2. Importance of persistence 3. Commit to moving in directions consistent with goals |
| Session 4 (13 weeks post session 2): Just Do It! Taking Effective Action | 1. Update on injection use and quality of erections. 2. What is the patient’s “story” around recovery now? 3. Review Injection Log 4. What are the current obstacles and barriers 5. Strategies to address ongoing barriers 6. Discussion of future expectations and fears |
1. Review core concepts of ACT-ED: “The Acceptance Cycle & Avoidance Cycle” 2. Use of acceptance training to address difficult thoughts and feelings about erectile dysfunction a. Focus on the ability to act in a valued direction while maintaining awareness of difficult experiences. b. Mindfulness applications to sexual intimacy 3. Review long term goals and “Fork in the road” diagram 4. Remake a commitment to treatment and adherence to injection therapy protocol and achieving identified goals |