Acceptance & Commitment Therapy INTRODUCTORY Workshop with ...€¦ · Acceptance & Commitment Therapy INTRODUCTORY Workshop with Russ Harris ... assumptions, schemas, core beliefs,

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

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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

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The Big Question:

Why is it so

hard to be happy?

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Evolution of the human mind

Pain

From

The

Past

Fears

About

The

Future

Problems

In The

Present

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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

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Be Present

Open up Do What Matters

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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

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“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

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2 Questions

Q: 1. What valued direction does the client want

to move in?

Q: 2: What is getting in the way?

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So where do I start?

A: What’s the valued direction?

-Values clarification

-Goal Setting

-Committed Action

-Skills training

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‘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

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‘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

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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

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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.

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3 Tricky Reactions

- I feel safe behind here

- How will that solve my problems?

- I can’t do that with my real thoughts &

feelings

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35

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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

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‘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.

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‘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.

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FEELINGS

THOUGHTSSMELL

TASTE

TOUCH

HEAR

SEE

PAINMEMORYFEELINGTHOUGHTSENSATIONURGECRAVINGEMOTIONHALLUCINATIONPAIN

FUSION

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PAIN

SMELL

TASTE

TOUCH

HEAR

SEE

FEELINGS

THOUGHTS

SELF-COMPASSION

VALUES & ACTION

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Change the context

Thoughts & feelings function differently in

different contexts

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FEELINGS

THOUGHTSSMELL

TASTE

TOUCH

HEAR

SEE

PAINMEMORYFEELINGTHOUGHTSENSATIONURGECRAVINGEMOTIONHALLUCINATIONPAIN

Pain in a context of FUSION

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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

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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

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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?

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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?

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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’

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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)

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3 steps to defusion – mix & match

Notice

Name

Neutralise

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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

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Psychological

Flexibility

Contact With The

Present Moment

Defusion

Acceptance Values

Committed Action

Self-as-context

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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

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Goals or Values?

Nurturing, maintaining and caring for my body

Lose 10 kg

Get a great job

Being helpful, friendly and responsible

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Goals or Values?

Buy a house

Being supportive, protective, caring for my family

Get good grades

Curiosity, learning, persistence

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Goals or Values?

Being sensual and intimate

Have an orgasm

Have children

Being caring, kind, loving

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Goals or Values?

Win the match

Playing enthusiastically, fairly, skillfully

Being creative

Write a book

Why does this distinction matter?

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Trickier: Goals or Values?

Be respected

Be respectful

Be loved

Be loving

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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

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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

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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?

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I can’t do

it because

…

I shouldn’t

have to do

it because

…

I shouldn’t

do it

because …

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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

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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.”

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Self-Acceptance

You are not who you think you are!

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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

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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

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Self-AcceptanceShe was so caring,

loving, kind.

Always there for

me when I needed

her!

She had a really

high opinion of

herself!

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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

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ACT

RFT

ABA

Functional Contextualism

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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’

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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

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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

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(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.

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Creative Hopelessness

What have you tried?

How has it worked, long term?

What has it cost you?

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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

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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

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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?

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Values Are Not:

Goals

What you want or need from others

Rules or commandments, codes of conduct

‘Shoulds’, ‘musts’, obligations

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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.

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Properties of Values

Here and now

Freely chosen

Dynamic

Evolving

Never completed

Intrinsically rewarding

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Properties of Values

Often need prioritising

Never need justifying

Values ,Virtues & Strengths

Pursue vigorously, but hold lightly

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What Prevents Action?

FEAR

Fusion

Excessive goals

Avoidance of discomfort

Remoteness from values

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The Antidote

DARE

Defusion

Acceptance of discomfort

Realistic goals

Embracing values

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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