acceptance & commitment therapy introductory workshop with ...€¦ · acceptance &...
TRANSCRIPT
Acceptance & Commitment Therapy
INTRODUCTORY Workshop with Russ Harris
Psychological
Flexibility
Contact With The
Present Moment
Defusion
Acceptance Values
Committed Action
Self-as-context
3
Workshop Aims
Theoretical overview
Experiential overview
Practical Tools
Personal Growth
Have Fun
Inspiration
C B T
5
About ACT
The origin
The name
The data
The paradox
The aim
12
Famous Quotes
Life is spelt H.A.S.S.L.E.—Albert Ellis
Life is difficult.—M. Scott Peck
Life is suffering.—Buddha
Most men lead lives of quiet desperation and
go to the grave with the song still in them. –
Henry Thoreau
Shit happens!—Anonymous
13
The Big Question:
Why is it so
hard to be happy?
14
Evolution of the human mind
Pain
From
The
Past
Fears
About
The
Future
Problems
In The
Present
1616
The Challenge We Face
I. Life is difficult
II. A full human life = the full
range of emotions
III. The normal, healthy human
mind naturally amplifies
pain
Psychological
Flexibility
Contact with the
Present Moment
Defusion
Acceptance Values
Committed Action
Self-as-context
17
Be Present
Open up Do What Matters
18
What Is Mindfulness?
Paying attention - with openness,
curiosity and flexibility
“Task-focused Attention”
Psychological
Flexibility
Contact with the
Present Moment
Defusion
Acceptance Values
Committed Action
Self-as-context
19
“WORKABILITY”
Is it working to give you
a rich, full and meaningful life?
If yes, keep doing it.
If not, would you consider
doing something different?
What works short term to get rid of unpleasant
thoughts & feelings, often does not work long term
to give us a rich and full life
Challenging Situation
‘HOOKS’
Thoughts, feelings, emotions
memories, urges, sensations
‘AWAY’ Acting ineffectively, behaving unlike the
person you want to be
‘TOWARDS’Acting effectively, behaving like the
person you want to be
CHOICE
POINT
‘HELPERS’
Values, strengths, skills
Especially mindfulness skills
INFORMED CONSENT
• ACT is a very active form of therapy/coaching – not just talking about problems.
• Learning skills to handle difficult thoughts and feelings more effectively, so they
have less impact and influence over you
• Clarifying your ‘values’: what kind of person you want to be, how you want to
treat yourself and others, what you want to stand for in life, what gives you a
sense of meaning or purpose
• Taking action: to solve problems, and do things that make life better
• Like playing a guitar – needs practice both in session and between sessions.
• NB Modify this as needs – e.g. in grief work, this would sound very different
21
2 Questions
Q: 1. What valued direction does the client want
to move in?
Q: 2: What is getting in the way?
22
So where do I start?
A: What’s the valued direction?
-Values clarification
-Goal Setting
-Committed Action
-Skills training
23
‘TOWARDS’Acting effectively, behaving like the
person you want to be
CHOICE
POINT
‘HELPERS’
Values, strengths, skills
B: What’s getting in the way?
-Fusion => Defusion
-Avoidance => Acceptance
-Automaticity => Awareness
24
‘HOOKS’
Thoughts, feelings, emotions
memories, urges, sensations
‘AWAY’ Acting ineffectively, behaving unlike the
person you want to be
CHOICE
POINT
‘HELPERS’
Mindfulness skills
Challenging Situation
‘HOOKS’
Thoughts, feelings, emotions
memories, urges, sensations
‘AWAY’ Acting ineffectively, behaving unlike the
person you want to be
‘TOWARDS’Acting effectively, behaving like the
person you want to be
CHOICE
POINT
‘HELPERS’
Values, strengths, skills
Especially mindfulness skills
Where to start?
For clients in crisis/panic/dissociative
states/overwhelmed by emotions: start with
grounding/centering
For clients with major grief/loss:
Start with self-compassion
For the poorly motivated:
Values
26
27
The Resilience Formula
4 approaches to any problem situation:
1. Leave
2. Stay & change what can be changed
3. Stay & accept what can’t be changed & live
by your values
4. Stay & give up & do stuff that makes it worse
28
Psychological
Flexibility
Contact With The
Present Moment
Defusion
Acceptance Values
Committed Action
Self-as-context
(Copy me) Imagine your hands are your thoughts and feelings
Imagine in front of you is everything that matters: the people, places, activities you love
etc (give examples). And also the problems/challenges you need to face/deal with,
and the important tasks you need to do. (give examples)
Now (copy me) see what happens when we get all caught up in our thoughts and
feelings
Notice 3 things: 1) How much are you missing out on? 2) How disconnected and
disengaged are you; how difficult to stay focused, keep your attention on the task?
3) How difficult is it to take action, to do the things that make your life work? (give
examples)
Now (copy me) slowly separate from your thoughts & feelings
What’s your view of the room like now? How much easier is it to engage and connect;
to keep your attention focused on the task at hand? Move your arms around: how
much easier is it to to do the things that make your life work (give examples)
Notice these things (i.e. hands) haven’t disappeared. If you can use them, do so. Many
thoughts and feelings give us valuable information we can make good use of. But if
you can’t make use of them, just let them sit there.
29
3 Tricky Reactions
- I feel safe behind here
- How will that solve my problems?
- I can’t do that with my real thoughts &
feelings
30
31
32
33
34
35
37
NB. Leaves On A Stream
Non-visual version (e.g. black space)?
Let them come, stay and go as they please
It’s okay if the leaves hang around or the river stops flowing - just keep watching
Do this for all thoughts: positive and negative
Invite clients to creatively modify the exercise: e.g. conveyor belt, blackboard
Watch for avoidance: e.g. writing thoughts on blackboard then erasing them
38
‘Cognitive’ Defusion?
ACT is based on RFT, relational frame theory
RFT is a theory of symbolic behaviour: how we create, manipulate & respond to symbols
‘Cognition’ in ACT = symbolic behaviour
Symbolic behaviour is involved in all private experiences: thoughts, feelings, emotions, memories, sensations, etc.
So ‘cognition’ in ACT refers to the symbolic aspects of any/all of the above experiences.
39
‘Cognitive’ Defusion
ACT textbooks emphasise defusion from ‘thoughts’ – including assumptions, attitudes, beliefs, judgments, etc.
But ‘cognitive defusion’ means defusion from the symbolic aspects of any private experience:
thoughts, feelings, emotions, memories, images, physical sensations, hallucinations, urges, cravings, schemas, etc.
40
FEELINGS
THOUGHTSSMELL
TASTE
TOUCH
HEAR
SEE
PAINMEMORYFEELINGTHOUGHTSENSATIONURGECRAVINGEMOTIONHALLUCINATIONPAIN
FUSION
41
PAIN
SMELL
TASTE
TOUCH
HEAR
SEE
FEELINGS
THOUGHTS
SELF-COMPASSION
VALUES & ACTION
42
Change the context
Thoughts & feelings function differently in
different contexts
43
FEELINGS
THOUGHTSSMELL
TASTE
TOUCH
HEAR
SEE
PAINMEMORYFEELINGTHOUGHTSENSATIONURGECRAVINGEMOTIONHALLUCINATIONPAIN
Pain in a context of FUSION
44
PAIN
SMELL
TASTE
TOUCH
HEAR
SEE
FEELINGS
THOUGHTS
SELF-COMPASSION
VALUES & ACTION
Pain in a context of Mindfulness & Values
EXPANSIVE AWARENESS EXERCISE (Dropping anchor/grounding)
• I can see something very painful (e.g. thought/feeling/memory) has just shown up,
for you, and I want to help you handle it
• Push your feet hard into the floor
• Sit forward in your chair
• Push your hands hard together,
• As well as this painful thought/feeling/memory, notice your body in the chair – hands,
feet, back
• Also look around – notice 5 things you can see
• And notice 3 or 4 things you can hear
• And also notice you and I, working together
• So there is a painful thought/feeling/memory here
• And your body in the chair
• And a room around you
• And you and I working together
46
47
Dropping anchor - notes
Modify script – use anything present (other than the storm itself) – e.g. glass of water, stretching arms, breathing, sound of air con
Goes for as long as needed
Repeat as often as needed
If client is ready and able to talk, identify the elements of the storm first.
If client is too overwhelmed to speak, just go into the exercise.
Debrief it afterwards
48
Debrief
Do you notice any difference? Are you less caught up in the storm? Less swept away or pushed around?
Is it easier for you to engage with me, to be present, to focus?
Do you have more control over your actions? (Move your arms and legs – check it out.)
How could this be helpful outside the room?
Can we do more of this in our sessions?
Would you be willing to practise this?
49
Cognitive Defusion
What’s your “I’m not good enough story”?
How have you tried to get rid of it?
How did that work, long term?
Ready to try something different?
50
Beliefs?
A ‘belief’ is simply a thought held as ‘true’
ACT does not traditionally classify cognitions into types: attitudes, assumptions, schemas, core beliefs, automatic thoughts, categories of “dysfunctional thinking” etc..
But you can do this, if desired, for defusion:
‘There’s my schema showing up.’
‘I’m noticing my core belief’
‘There’s my mind making an assumption’
‘I’m noticing “black and white thinking” again’
51
Believability versus Fusion
Defusion usually leads to decreases in believability, but not always.
But we can defuse from thoughts even if we continue to believe them 100%, and even if they can never be disputed (e.g. ‘One day I will die’; ‘The plane might crash’)
We can also fuse with thoughts we don’t believe (e.g. fantasising)
52
3 steps to defusion – mix & match
Notice
Name
Neutralise
53
Psycho-education Exercises
Pop-up thoughts
Lift your arm
Delete a memory
Make your leg go numb
Don’t think about …
“Falling in love” metaphor
“Polygraph” metaphor
Lemons, lemons, lemons
54
Psychological
Flexibility
Contact With The
Present Moment
Defusion
Acceptance Values
Committed Action
Self-as-context
55
Values
‘Desired qualities of ongoing action’
Heart’s deepest desires for how you want to behave
How you want to treat anyone or anything
What kind of person do you want to be?
Can usually be said in one or two words
57
Goals or Values?
Nurturing, maintaining and caring for my body
Lose 10 kg
Get a great job
Being helpful, friendly and responsible
58
Goals or Values?
Buy a house
Being supportive, protective, caring for my family
Get good grades
Curiosity, learning, persistence
59
Goals or Values?
Being sensual and intimate
Have an orgasm
Have children
Being caring, kind, loving
60
Goals or Values?
Win the match
Playing enthusiastically, fairly, skillfully
Being creative
Write a book
Why does this distinction matter?
61
Trickier: Goals or Values?
Be respected
Be respectful
Be loved
Be loving
62
Needs & Values
‘Needs’ = ‘very important goals’
Values are:
how I want to behave as I try to get my needs met
how I want to behave when I don’t get my needs met
how I want to behave when I do get my needs met
63
Mind-Reading Machine-What you stand for
-Your personal strengths and qualities
-The role you have played in their life
Bull’s Eye: Values To Goals
Pick a quadrant on the Bull’s Eye & identify 2 or 3 key values
Then set a values-guided SMART goal for the next week
Specific,
Meaningful,
Adaptive,
Realistic,
Time-framed
A “live person’s goal”
0-10: How realistic? If <7, make it smaller/easier
64
Bull’s Eye: Values To Goals
In pairs, stand up and share your goals
Begin with: “Here is my commitment …”
Notice what thoughts and feelings show up
Afterwards share:
a) What unhelpful things did your mind say?
b) What uncomfortable feelings showed up in your body?
65
I can’t do
it because
…
I shouldn’t
have to do
it because
…
I shouldn’t
do it
because …
67
The Resilience Formula
4 approaches to any problem situation:
1. Leave
2. Stay & change what can be changed
3. Stay & accept what can’t be changed & live
by your values
4. Stay & give up & do stuff that makes it worse
68
Psychological
Flexibility
Contact With The
Present Moment
Defusion
Acceptance Values
Committed Action
Self-as-context
The Alternative to Self-Esteem?
“I've missed more than 9000 shots in
my career.
I’ve lost almost 300 games.
26 times I've been trusted to take the
game winning shot ... and missed.
I've failed over and over and over
again in my life.
That is why I succeed.”
75
Self-Acceptance
You are not who you think you are!
79
Which Is The Real you?
Take 30 seconds to tell your partner as much as possible about who you are as a human being – just positive stuff
Take 30 seconds to tell your partner as much as possible about who you are as a human being – just negative stuff
80
Self-Acceptance
You are not who you think you are!
If your mind tells you a negative story …
‘Thanks, mind!’
And if it’s a positive story …
‘Thanks, mind!’
=>The ‘Good self/Bad Self’ exercise
81
Self-AcceptanceShe was so caring,
loving, kind.
Always there for
me when I needed
her!
She had a really
high opinion of
herself!
82
The Conceptualised Self
Your ‘conceptualised self’ is important and often useful. You wouldn’t want to get rid of it
You may even want to work on developing it
But hold it lightly – it is not you!
=>The ‘I am’ exercise
The Observing Self
84
ACT
RFT
ABA
Functional Contextualism
88
Fusion with thoughts & feelings =>
manifests in various ways
‘Overwhelmed’, ‘Pushed around’ ,‘Lost in’, ‘Wallowing in’, ‘Consumed by’, ‘Dwelling on’, ‘Controlled by’, ‘Entangled in’, ‘Jerked around by’, ‘In the grip of’, ‘Ruled by’, ‘Dominated by’, ‘Held back’, ‘Pulled down’
Often we try to avoid/ get rid of them:
‘Experiental avoidance’
89
Higher Experiential Avoidance
–Higher anxiety levels
–More depression
–Drug and alcohol addiction
–More overall pathology
–Poorer work performance
–Inability to learn
–Lower quality of life
–Long term disability
90
Drop the struggle with it
Make room for it/ give it space
Expand around it
Open up
Let it flow through you
Hold it gently/lightly/softly/kindly
Breathe into it
Let it be/Allow it
Sit with it
Soften up/loosen up around it
Willing to have it
“Acceptance” – not a good word!
But why accept pain?
Pushing Away Paper
91
(Copy me) Imagine this paper is all your difficult thoughts and feelings
Imagine in front of you is everything that matters: the people, places, activities you love
etc. And also all the problems/challenges you need to solve/tackle, and the
important tasks you need to do
Now push these thoughts and feelings away from you, hard as you can
Notice 3 things: 1) How tiring is it? 2) How distracting is it; how difficult is it to fully
engage or connect; to stay focused, keep your attention on the task? 3) How
difficult is it to take action, to do the things that make your life work? (give
examples)
Now rest it on your lap.
How much less effort is that? How much easier is it to engage and connect; stay
focused; keep your attention on the task? Move your arms around: how much
easier is it now to take action?
Notice your thoughts and feelings (i.e. the paper) haven’t disappeared. But you have a
new way of responding to them, so they don’t hold you back or tie you down or stop
you engaging in your life. If there’s something useful you can do with them, use
them; (thoughts and feelings often give you useful information). But if not, just let
them sit there.
92
Creative Hopelessness
What have you tried?
How has it worked, long term?
What has it cost you?
95
An Important Close Relationship
What is painful or difficult in this relationship?
Tap into a painful emotion – e.g. fear, sadness, anger, guilt – so you can work with it
96
NAME your feelings
Notice
Acknowledge
Make room
Expand awareness
Self-compassion: 6 Elements
1. Contact the present moment: notice & acknowledge your painful thoughts & feelings
2. Kindness: pursue the value of kindness towards yourself –(in words, thoughts, imagery & action)
3. Defusion: defuse from harsh judgmental self-talk
4. Acceptance: open up and make room for painful thoughts and feelings
5. Validation: validate your pain as a normal & natural part of being human
6. Connectedness with others: acknowledging and empathizing with pain of others; recognizing your commonality; sharing your pain with others
Kindness To Self
Kind self-talk (in both content and tone)
Kind imagery
Kind self-touch
Kind deeds
Establish Goals For Therapy
How will we know this is working?
What will you be doing differently?
What will you start/stop, do more/less?
How will you treat yourself, others, the world differently?
What areas of life do you want to work on improving?
What relationships would you like to improve?
Empowerment: Locus of Control
The more you focus on what is out of your control the more disempowered you are.
You have more control over your actions -what you say and do – than anything else
You can use your actions to influence others and the world around you
You can’t control others; only influence them.
You can’t control the world; only influence it.
So we need to look at you – at what you can do differently – with your words and actions
102
What kind of ….?
Pick an important role – e.g. mother, father, son, daughter, therapist, coach
T: What kind of ___ do you want to be?
T: Suppose we interviewed one of the people you interact with in that role, live on national TV, and we say ‘What was he/she like? What were his/her three greatest qualities? How did he/she treat you?’ – if magic could happen, if dreams could come true - what would you like them to answer?
103
Values Are Not:
Goals
What you want or need from others
Rules or commandments, codes of conduct
‘Shoulds’, ‘musts’, obligations
104
Are These My Real Values?
The proof of the pudding is in the eating
You won’t find out by analyzing and pondering if these are your real values
You will only find out by acting on them, and noticing what happens when you do so.
105
Properties of Values
Here and now
Freely chosen
Dynamic
Evolving
Never completed
Intrinsically rewarding
106
Properties of Values
Often need prioritising
Never need justifying
Values ,Virtues & Strengths
Pursue vigorously, but hold lightly
108
What Prevents Action?
FEAR
Fusion
Excessive goals
Avoidance of discomfort
Remoteness from values
109
The Antidote
DARE
Defusion
Acceptance of discomfort
Realistic goals
Embracing values
111
The Resilience Formula
4 approaches to any problem situation:
1. Leave
2. Stay & change what can be changed
3. Stay & accept what can’t be changed & live
by your values
4. Stay & give up & do stuff that makes it worse