Kirk Strosahl

University of Washington Seattle | UW · Department of Family Medicine

This article provides an overview of 20 years of professional experiences with developing and implementing a model for integrating behavioral health services into primary care. The Primary Care Behavioral Health (PCBH) model is designed to provide immediate access to behavioral care for a large number of primary care patients by positioning a behav...

Research findings consistently suggest that most people receive behavioral health (BH) services in the primary care setting. The annual rate of onset of mental and addictive disorders hovers in the vicinity of 27%, and the vast majority of those afflicted by these problems seek care from primary care providers (PCPs). People present to primary care...

●Suicidal and self-destructive behavior is one of the most common clinical problems encountered in both out-patient and in-patient behavioral health settings. Studies suggest that as many as 20% of out-patients and 50% of in-patients report suicidal behavior as a significant clinical issue (Crosby, Cheltenham & Sacks, 1999; Chiles & Strosahl 2004)....

Reviews the videotape, Drug and Alcohol Abuse (2002) with William Miller, who, with colleagues, developed and refined "motivational interviewing" (MI), a pioneering approach designed to impact motivational readiness. Although it is a widely accepted feature of an effective chemical dependency intervention package, MI is not exactly a treatment for...

Manual-based, empirically validated psychotherapies potentially have a very important role to play in building quality managed care delivery systems. Unfortunately, managed care systems have been slow to endorse or implement such models of care on a widespread basis. The essence of the problem is that manual-based procedures have been developed pri...

The present study describes the development of a short, general measure of experiential avoidance, based on a specific theoretical approach to this process. A theoretically driven iterative exploratory analysis using structural equation modeling on data from a clinical sample yielded a single factor comprising 9 items, A fully confirmatory factor a...

The purpose of this chapter is to present a consolidated overview of ACT treatment interventions and therapy processes. In Chapter 1 we described the philosophy, basic theory, applied theory and the theoretical processes that collectively define ACT as a clinical system. In this chapter we will examine the concrete clinical steps used in implementi...

Because ACT is a contextual treatment, your attempts to conceptualize a presenting problem might be different from traditional case conceptualization models. The most important principle in contextual analysis is that you are not just assessing a particular symptom with a particular topography; you are also attempting to understand the functional i...

This chapter attempts to explain the economic pressures facing contemporary healthcare systems as well as the potential economic benefits of integrating primary care and behavioral health services. In order to achieve this objective, the authors first review trends in the financing of general health care, as well as the impact which behavioral heal...

This article represents the history of primary care and behavioral health integration at Group Health Cooperative (GHC) over the last decade, and foreshadows probable futures for this work into the next decade. To build from a logical progression, the article responds to a series of questions: 1. Why integrate primary care and behavioral health? 2....

Human beings use language to shape their world: to structure it and give it meaning. Language builds our skyscrapers, imparts the strength to our steel, creates the elegance of our mathematics, and forms our art’s depiction of beauty. Language has been the source of so much human achievement that it is only natural that we look to it first to ident...

An ACT Approach Chapter 1. What is Acceptance and Commitment Therapy? Steven C. Hayes, Kirk D. Strosahl, Kara Bunting, Michael Twohig, and Kelly G. Wilson Chapter 2. An ACT Primer: Core Therapy Processes, Intervention Strategies, and Therapist Competencies. Kirk D. Strosahl, Steven C. Hayes, Kelly G. Wilson and Elizabeth V. Gifford Chapter 3. ACT C...

Health care reform and managed care have produced a growing emphasis on field effectiveness research. The present paper proposes a simple methodological model for conducting such research that can assimilate all of the setting features of effectiveness questions while not requiring that researchers abandon experimental controls in favor of survey m...

Introduces the primary mental health care services delivery model, a population-based approach to integrating medical and behavioral health care. To understand this new paradigm of behavioral health care, it is first necessary to appreciate the primacy of mental disorders and psychosocial stresses as determinants of medical utilization and health c...

This chapter details a specific model of behavioral health in primary care integration. The authors describe the Group Health Cooperative model of integrated care developed over many years of research and field testing. They conclude with a nine-part differentiation of the characteristics of specialty mental health care vs primary mental health car...

Syndromal classification is a well-developed diagnostic system but has failed to deliver on its promise of the identification of functional pathological processes. Functional analysis is tightly connected to treatment but has failed to develop testable, replicable classification systems. Functional diagnostic dimensions are suggested as a way to de...

Primary mental healthcare is different from consultation-liaison psychiatry and behavioral medicine yet has elements of both. This approach calls for complete integration of behavioral health services within the primary care and general medical setting. Primary care providers, rather than mental health specialists, retain direction of patient care....

As the pressures surrounding health care reform continue to mount, there has been a corresponding emphasis on re-integrating health and behavioral health services. This trend promises to provide behaviorally trained clinicians with numerous opportunities to practice in medical settings. The de facto mental health system in the United States is the...

The traditional separation of mental health and medical programs is problematic because mental health issues are inseparable from the larger medical system. By contrast, a collaborative primary care model of mental health care, augmented and supported by secondary specialty mental health services, has the potential to optimize quality and cost goal...

This article presents personality assessment as valuable in expediting favorable outcomes in mental health service delivery. The unique role of the examining psychologist is discussed with respect to assessment paradigms, behavior sampling, and eliciting patient "ownership" of solutions. Solution-oriented therapy is presented as promoting client ad...

The case is made for the integration of primary care and behavioral health services in the HMO. Key features of a successfully integrated behavioral health service are offered, along with brief reports of integration efforts at a number of HMOs across the United States. The author believes that better value and cost efficiencies result from integra...

This article examines issues that behavior therapists must address as they adapt to the new and complex trends of managed mental health care. The origins of the managed health care movement are reviewed. Major shifts in clinical practice will occur in four primary areas: viewing both the client and payer as “customers”, accepting accountability for...

Mental health service delivery is both a health care and business arrangement, and is accordingly impacted by national changes in both areas. HMO mental health services in the current health reform zeitgeist are being called on to provide more efficient, comprehensive integrated care. A planning effort is presented which is organized around (1) a q...

This study examined the risk prediction efficiency of the Reasons for Living Inventory Survival and Coping Beliefs Scale, Beck Hopelessness Scale, Beck Depression Inventory, and the Life Experiences Survey with a sample of 51 newly hospitalized parasuicides. The index of suicidal potential chosen for this study was suicide intent as measured by Bec...

Reliability and validity data are provided for pre- and posttreatment administrations of a structured interview version of the Hamilton Rating Scale for Depression (HRSD) integrated with the National Institute of Mental Health Diagnostic Interview Schedule (DIS). Ss were 70 adult patients requesting therapy for depression. Results indicate excellen...

Reliability and validity data are provided for pre- and posttreatment administrations of a structured interview version of the Hamilton Rating Scale for Depression (HRSD) integrated with the National Institute of Mental Health Diagnostic Interview Schedule (DIS). Ss were 70 adult patients requesting therapy for depression. Results indicate excellen...

The authors compared 37 patients in the People's Republic of China and 46 patients in the United States who were having difficulty with suicidal thinking or behavior. Hopelessness, reasons for living, and suicidal efficacy showed none of the expected relationships with suicidal intent among the Chinese patients, but the two groups were similar on m...

This study examined the relationship between interpersonal problem solving and suicidal behavior among psychiatric patients. Subjects were 123 psychiatric inpatients, admitted for current parasuicide, serious suicide ideation, or non-suicide-related complaints. A group of 16 orthopedic surgery patients was included to control for hospitalization tr...

Fifty-nine psychiatric inpatients were interviewed concerning the psychological and environmental events that occurred in the 24 hours prior to their hospitalization. Independent raters then performed a content evaluation of these accounts, allowing for comparisons among patients admitted for a suicide attempt, suicide ideation, or non-suicide-rela...

Two studies examined the theory that emotive-abstract, sensory modality, and control imagery are functionally distinct abilities and that emotive-abstract imagery and image control are directly related to the quality of intherapy imagery. In Study One, 199 subjects completed self-report measures of sensory modality, molar imagery, and image control...

This chapter outlines our views of the training and supervision process from a behavioral perspective. One of the major issues for a behavioral training program is the unification of assessment and treatment. The importance of technology also separates behavioral training and supervision programs from others, and the very power of this technology c...

Knowledge of suicidal behavior, i.e., psychiatric patients indicating that they have an acquaintance or relative who has attempted or committed suicide, has been cited as a risk factor in the assessment of suicide potential. The authors evaluated psychiatric patients hospitalized for a suicide attempt (N = 30), serious suicidal ideation (N = 26), o...

Articles by the 2nd author and S. Nielsen have examined and debated the clinical significance of the negative relationship between the Hopelessness Scale and the social desirability (SD) response style. K. Petrie and K. Chamberlain found that the Marlowe-Crowne Social Desirability Scale had no influence on the prediction of suicidal behavior. The p...

Suggests that the growing use of mental imagery in clinical settings has been hampered by major theoretical deficits, notably the virtual absence of interdisciplinary models not constrained by a specific therapeutic orientation. Information-processing data pertaining to the functional and structural properties of imagery are reviewed to illustrate...

The previous decade has witnessed a rapid proliferation of imagery-based psychotherapies, ranging from psychodynamic techniques such as psycho-imagination therapy (Shorr, 1974) to more structured and focused behavior modification procedures (Cautela, 1967; Wolpe, 1958). Despite the promise of imagery as a psychotherapeutic tool, a host of issues re...

The hypothesis was proposed that gains in self-concept as the result of systematic desensitization could be determined by active coping imagery. In a study of the effects of coping imagery on self-concept, subjects high in test anxiety were assigned to one of four groups: coping imagery, systematic desensitization, combined coping imagery and syste...

The purpose of this chapter is to provide the reader with an overall framework that addresses the important dimensions involved in developing and evaluating behavioral health in primary care integrated service programs. First, a population-based care framework is introduced to help articulate the mission of integrated services. Two required, comple...

Examines the empirical literature that supports the integration of behavioral services into primary care medicine and proposes an overall framework that addresses various dimensions involved in developing, implementing, and evaluating integrated primary care behavioral health programs. It is noted that this model of care has been shown empirically...