act for health
DESCRIPTION
Acceptance & Commitment Therapy for physical health problemsTRANSCRIPT
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Aims for the day
► Consider how core ACT processes relate to working with people who have physical health problems
► Look at specific problems related to Health, and useful ACT-based techniques E.g. living with uncertainty, altered sense of self,
carer burden, tolerating physical treatment, healthy behaviour change
► Reflect on own experience as clinician► Reflect on own experience as human being► Feedback suggests more experiences,
technique and clinical reflection, less literature survey All at contextualscience.org
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To begin with…
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Physical health
►Acute e.g. cancer with curative intent, recovery
from injury►Long-term / chronic
e.g. chronic pain, bowel disorders, neurological disorders, lung problems
►Palliative e.g. advanced cancer, late-stage MND
►Health Behaviour Change
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The ACT Model of PsychopathologyThe ACT Model of Psychopathology
Psychological inflexibility
Dominance of Conceptualised Past & Future
Experiential avoidance
Cognitive Fusion
Attachment to the conceptualised self
Lack of Values Clarity,
dominance of pliance and
avoidant tracking
Inaction, impulsivity or
avoidant persistence
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STUCK
UNFULFILLED
Experiential avoidance: basing your
actions on avoiding feeling
bad
Fusion: getting tangled up in
thoughts
Loss of contact with present moment : getting caught up in the past & the future
Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself
Loss of contact with Values: not recognising what matters to you in life
Lack of committed action: not acting effectively to live your life the way you want to
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Think of a client…
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The Positive Psychological The Positive Psychological
Processes ACT Seeks to StrengthenProcesses ACT Seeks to Strengthen
Psychological Flexibility
Being in the present moment /
mindfulness
Acceptance / Willingness
Defusion
Self as Context
Values
Committed Action
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MOVING FORWARD:
MORE FULFILLED
Acceptance / willingness to
experience: allowing
whatever shows up just to be
there.
Defusion: treating thoughts as thoughts (not
realities)
Present moment awareness / mindfulness: living in the Here-and-Now
Observing self / flexible perspective-taking: adopting a more flexible sense of self
Awareness of Values: recognising what matters to you in life
Committed action: doing the things that matter to you, even when it's difficult
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Think of a client…
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STUCK
UNFULFILLED
Experiential avoidance: basing your
actions on avoiding feeling
bad
Fusion: getting tangled up in
thoughts
Loss of contact with present moment : getting caught up in the past & the future
Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself
Loss of contact with Values: not recognising what matters to you in life
Lack of committed action: not acting effectively to live your life the way you want to
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Fusion and Avoidance
►On the buses►“Why does my mind hurt me that
way?”►Living with an uncertain future►Thoughts we should pay attention to
►What kind of feelings are we avoiding?
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Using the basics
►Another trip on the bus..►Not just an explanatory metaphor
Ongoing tool
►A landslide blocking the road
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While we’re on the bus…► Minds say unhelpful things► Take a minute..
Notice a passenger What are they saying What form they take Where’s that coming from What is the function of that passenger speaking up
► Actual► ‘intended’
► Mind is not usually our enemy► So why say these things?► Doing its job(s)
The stay alive machine (can become the EA machine) The Problem-solving machine (can become the worry-engine) The Learn From Experience machine (can become the dwell on
the past machine
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Default assumption
► My mind is not ‘out to get me’► It’s mostly trying to help by doing one of its jobs► Most of the time it’s pretty good at that► Sometimes in trying to be ‘helpful’ (protect you
from harm, from social victimisation, isolation etc etc) its suggestions end up being unhelpful
► Recognising this makes it easier to use ‘Thanks, mind’
► Why this helps in Health
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Uncertainty
►Back to your client How does uncertainty show up Potential impact on life Interaction with core processes
►?especially here-and-now, committed action?
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Many paths
►More of a raft than a walk►Originally used with denial-like behaviours►BenefitsBenefits
Defusion from thoughts about prognosisDefusion from thoughts about prognosis Observing selfObserving self Acceptance of feelings that ariseAcceptance of feelings that arise Ability to focus on Values-driven committed Ability to focus on Values-driven committed
action (not being frozen in face of uncertainty)action (not being frozen in face of uncertainty)
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But what about the thoughts we SHOULD attend to?
► “I’m sure that lump wasn’t here last week..”► In ACT, we’re interested in the behaviour in
context Behaviour here includes internal behaviour eg
thoughts Need to know context and function
► ‘Defuse and move on’ vs ‘pay attention to and act upon’ nb anyway more able to evaluate and act from
defused position► Old vs New thoughts► Risk-related
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Approaches other than classic defusion
►Safe review period (if still here by… then I’ll..)
►Checking out with others►If new, evaluation / challenge►Looking at impact►Worry Time
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Avoiding feeling bad
► Emotions► Physical sensations – emotion related► Physical sensations – health related
When distinct, when overlap When is it safe to accept?
►E.g. aching in fibromyalgia vs crushing chest pain in heart disease
In a war vs living with the enemy Narrowing lives in battle with symptom For highly intrusive symptoms, look at ACT for
chronic pain literature (Vowles, McCracken, Dahl)
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STUCK
UNFULFILLED
Experiential avoidance: basing your
actions on avoiding feeling
bad
Fusion: getting tangled up in
thoughts
Loss of contact with present moment : getting caught up in the past & the future
Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself
Loss of contact with Values: not recognising what matters to you in life
Lack of committed action: not acting effectively to live your life the way you want to
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The self
►Over-attachment to the conceptualised self
►Self-as-content, self-as-process, self-as-context
►Flexible perspective-taking►Development of key relational frames
►What’s your mind telling you right now?
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How your (conceptualised) Self gets in the way..
► Stuck in a story ‘still the person I used to be’
►Someone who never gives up►The strong one►Carer
‘lost the person I used to be’► ‘shadow of my old self’►No use any more►That was the real me
Adjustment► I’m a burden
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Versions► Version 1► Version 1.1► ...Version 1.5► …Version 1.6► Version 2.0► …Version 2.1► Version 2.1.1► Version 2.1.2► ..Version 2.2► ..Version 2.3► Version 3.0► Version 4.0► Version 4.0.4► Version 4.1► Version 4.4► etc
► Alpha► Beta► Cupcake► Donut► Eclair► ►
►
► Froyo► Gingerbread► Honeycomb► Ice cream sandwich►
► Jelly Bean► KitKat
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I THEN, I NOW.. For you► At primary
school► Young adult ► Now► characteristics
► Psychological► Physical► Social
► A personality trait
► An ambition► A friendship► A talent
► ‘positive’ or ‘negative’
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I THEN, I NOW.. For client(nb. tailored appropriately for their history)
► Young adult ► Pre-illness ► Now► characteristics
► Psychological► Physical► Social
► A personality trait
► An ambition► A friendship► A talent
► ‘positive’ or ‘negative’
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Old me new me exercise
► Elicits ‘stories’ about self► Allows us to notice balance of them► How firmly held?
Can challenge if appropriate (new thought / insight)
► Doing the exercise is act of defusion► Mourn the past, accept the present► Are they fixed (e.g. ‘less sociable’)► Reinforces transitions over time
‘this too will pass’
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STUCK
UNFULFILLED
Experiential avoidance: basing your
actions on avoiding feeling
bad
Fusion: getting tangled up in
thoughts
Loss of contact with present moment : getting caught up in the past & the future
Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself
Loss of contact with Values: not recognising what matters to you in life
Lack of committed action: not acting effectively to live your life the way you want to
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►Doing treatment►Hopelessness►Carer burden►Making a choice
Values & Goals
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Treatment
► Originally from cancer treatments (chemotherapy & radiotherapy), however..
► ‘doing’ not ‘having’► “Why did you choose to have treatment?”
“no choice” What hoping to achieve “not dying” vs “what do with more/better quality
life” Acknowledge cost of having Price you are willing to pay in order to increase your
chances of … e.g. being close to your children Fast initial way into Values (often session 1) Emphasises active role vs victim story
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CHOICE POINT
AWAY FROM VALUES
TOWARDS VALUES
HOOKS, e.g.
Urge to avoid discomfort
Desire for short-term gains
Old habits
Hooked by thoughts
Stuck in a story
etc
HELPERS, e.g.
Awareness of Values
Skills:
-Present moment awareness
-Defusion
-Acceptance
-Flexible perspective taking
Effective goal-setting
etc
Adapted from Ciarrochi, Bailey & Harris 2013
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Finally..
► The same core processes of ACT apply in living well with physical health problems as with any other adversity
► Same interventions can work► Some tailored/tweaked/specific ones too► True whether aiming to
Make healthy behaviour change Cope with an more acute health crisis ‘facing the
storm’ or live a fulfilling life despite chronic health
problem, where aim is ‘living with the enemy’
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