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

Acceptance & Commitment TherapyINTRODUCTORY Workshop with Russ Harris

PsychologicalFlexibility

Contact With The Present Moment

Defusion

Acceptance Values

Committed Action

Self-as-context

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Workshop Aims

Theoretical overview Experiential overview Practical Tools Personal Growth Have Fun Inspiration

C B T

BEHAVIOUR→ANTECEDENT → CONSEQUENCE

physical environment

cognitiveinterpersonal

development and learning history

emotionalphysiological

genetic and epigenetic

social and

cultural

Slide courtesy of Jennifer Villatte

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Famous Quotes

Life is spelt H.A.S.S.L.E.—Albert EllisLife is difficult.—M. Scott PeckLife is suffering.—BuddhaMost 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?

PainFrom The Past

FearsAboutThe Future

ProblemsIn ThePresent

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The Challenge We Face

I. Life is difficultII. A full human life = the full

range of emotionsIII. The normal, healthy human

mind naturally amplifies pain


Contact with thePresent Moment

Defusion

Acceptance Values

Committed Action

Self-as-context

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Be Present

Open up Do What Matters

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Defusion

Acceptance Values

Committed Action

Self-as-context

Distractibility, DisengagementDisconnection, Dissociation

Fusion with theconceptualised self

Fusion: past, future,reasons, rules, judgments

Experiential Avoidance

Unworkable action

Remoteness fromvalues

PsychologicalRigidity

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What Is Mindfulness?

Paying attention - with flexibility,openness, curiosity, kindness

Mindfulness is not …

MeditationDistractionRelaxationA way to get rid of unwanted thoughts and feelingsBuddhismReligion

How Do I “Sell” Mindfulness?

Don’t!

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Grounding, Centering, & Dropping anchor

Acceptance (expansion, opening up, making room,dropping the struggle)

Defusion

Self-compassion

Accessing the “observing self”

Savouring & appreciating

Observing thoughts

Engaging

Noticing &acknowledgingwhat is present

Narrowing & Broadening focus

Flexiblyshiftingfocus

Sustaining focus,Noticing you’re distracted & refocussing

What’s the point????

For any mindfulness skill, be clear: What is the purpose? Specifically, how will this help the client achieve

her therapy goals?

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Dodgy Language?

“Mindfulness”“Acceptance”“Values”“Self-compassion”

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Contact with thePresent Moment

Defusion

Acceptance Values

Committed Action

Self-as-context

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“WORKABILITY”

Is it working to give youa 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

Setting Up

Informed consent Press pause Teamwork Freedom to say no

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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• I want you to leave each session with an action plan – something you can do

between sessions to improve your life• NB Modify this as needs – e.g. in grief work, this would sound very different

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What I do that’s ineffective, behaving unlike the person I want to be

AWAY

Situation(s)Thoughts & Feelings

What I do (or want to do) that’s effective,behaving like the person I want to be

TOWARDS

Choice Point 2.0 © Russ Harris, 2016 adapted from the ‘Choice Point’ by Bailey Ciarrochi, Harris 2013

ooChoicePoint

Drawing it by hand …

oo

TowardsAway

Situation(s), Thoughts & Feelings


SituationThoughts & Feelings

AWAY TOWARDS

1. What is (are) the challenging situation(s), thoughts & feelings in your life today?

4. So is it okay if we take some time to explore what matters to you & who you care about – to help figure out your towards moves -and also develop some unhooking skills, so these thoughts and feelings no longer hold you back or pull you off track?

2. When you get hooked by your thoughts & feelings, what kind of “away moves” do you do: acting ineffectively, behaving unlike the person you want to be?

3. What kind of towards moves do you already make or would you like to start making – acting effectively, behaving like the person you want to be?


4 Areas To Explore

ooChoicePoint

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

Values, Goals, SkillsWhat matters to you? Who do you care about? What do you want to do differently? What skills, values, strengths can you use?

What I want to do that’s effective,behaving like the personI want to be

HELPERS

B: What’s getting in the way?-Fusion => Defusion-Avoidance => Acceptance-Automaticity => Awareness

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AWAYWhat I do that’s ineffective, behaving unlike the person I want to be

Unhooking Skills

Contacting the present momentDefusionAcceptanceSelf-compassionThe “noticing self”

Where to start?

For clients in crisis/panic/dissociative states/overwhelmed by emotions: start with grounding/centering (dropping anchor)For clients with major grief/loss: Start with self-compassionFor the poorly motivated:Values & defusion from hopelessnessFor clients fixated on feeling good and avoiding pain: creative hopelessness

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The Resilience Formula

4 approaches to any problem situation:1. Leave 2. Stay & change what can be changed3. Stay & accept what can’t be changed & live

by your values4. Stay & give up & do stuff that makes it worse

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Defusion

Acceptance Values

Committed Action

Self-as-context

(Copy me) Imagine your hands are your thoughts and feelingsImagine 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 & feelingsWhat’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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‘Cognitive’ Defusion

ACT textbooks emphasise defusion from ‘thoughts’ – including assumptions, attitudes, beliefs, judgments, etc.I personally tend to talk about defusion from ‘thoughts and feelings’ because cognition is such a huge ‘part’ of any emotional response.

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FEELINGS

THOUGHTS SMELL

TASTE

TOUCHHEAR

SEE

PAINMEMORYFEELINGTHOUGHTSENSATIONURGECRAVINGEMOTIONHALLUCINATIONPAIN

FUSION

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PAIN

SMELL

TASTE

TOUCHHEAR

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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Defusion

Acceptance Values

Committed Action

Self-as-context

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 fingertips 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

Indication: if and when client is so fused that he is unable to effectively engage/participate in the session

If client wants to learn a valuable skill for dealing with dissociation or overwhelm

NB: If therapist uses dropping anchor to try to stop the client crying/ to distract her/ to reduce her anxiety etc, this is a misuse.

The aim is to help the client be present, regain control of his actions, engage, focus.

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Dropping anchor – notes – cont.

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’)

In 2 RCTs of ACT versus CBT, defusionlead to significantly faster reductions of believability than disputation

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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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Defusion

Acceptance Values

Committed Action

Self-as-context

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?

These are NOT useful goals:

‘reduce depression’‘reduce anxiety’ ‘increase self-worth or build self-esteem’‘recover from DSM disorder X’‘get over what happened’‘get my old self back’‘feel happy’, ‘feel good’, ‘stop feeling like shit’‘have more confidence/ regain my confidence/ stop doubting myself’‘feel calmer’

(copyright) Russ Harris 2015 www.ImlearningACT.com


AWAY



TOWARDS


ooChoicePoint

To turn them into useful goals….

If I could wave a magic wand so your difficult thoughts and feelings are no longer an issue, like water off a duck’s back…..What would you stop doing or start doing, do more of or less of? How would you treat yourself, others, life, the world, differently? What goals would you pursue? What activities would you start or resume? What people, places, events, activities, challenges, would you approach, start, resume or contact - rather than avoid or withdraw?


Naming What Matters

What matters to the client: people, places, activities, events, aspects of life, goals, values, desires, needs, and so on; anything the client cares about, considers important? Basically anything that triggers a strong negative reaction in the client – whether that be a person, a place, a problem, an event, a situation, a domain of life, a goal, a desire – is likely to be important.


Naming What Matters

So as we take the history and validate the client’s suffering, we can repeatedly name the things that seem to matter most to the client. For example, if the client is worrying/stressing/complaining about her marriage we might say, “So your marriage really matters to you”


Naming Who Matters?

Who, in your life today, matters to you most? Who is important to you? Who do you care about? Who do you look after, or take care of?Who would you like to care about more? Are there any relationships you’d like to improve, or conflicts you’d like to resolve? Are there any relationships you’d like to start?If our work here could improve just one relationship in your life, who would you pick? How would that relationship improve?


From “What I’ll Stop” to “What I’ll Do Instead”


From “What I can’t do” to “What I can do”If people keep talking about what they can't do any more …"So would you like to be able to do that again?“If “yes”: "Okay. So two things we need to look at then:a) if it's possible to start doing it again and b) if it's not possible to do exactly the same, to find out what was meaningful in doing that and find out if there are other ways to get that same sense of meaning.”


From “What I don’t want to feel” to “Learning to handle feelings more effectively”

If people keep talking about what they DON’T want to feel? “So seems like it’s important to you to learn better ways of handling these difficult thoughts/ feelings/ emotions/ memories?”


“What I DO want to feel”What if people keep talking about what they DO want to feel (e.g. happy, confident, high self-esteem, calm, in love)?“So right now, you don’t feel the way you want to? Can you tell me what kind of difficult thoughts and feelings are showing up for you?”“So seems like it’s important to you to learn better ways of handling these difficult thoughts & feelings?”


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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

‘Stepping Stones’ to Values‘Good friend’, ‘Good mother’ etc.StrengthRole modelInspiring Mateship, friendshipHappiness

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Bull’s Eye: Values To GoalsPick a quadrant on the Bull’s Eye & identify 2 or 3 key valuesThen set a values-guided SMART goal for the next weekSpecific, Motivated by values, Adaptive, Realistic, Time-framedA “live person’s goal”0-10: How realistic? If <7, make it smaller/easier

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Bull’s Eye: Values To GoalsIn pairs, stand up and share your goalsBegin with: “Here is my commitment …”Notice what thoughts and feelings show upAfterwards 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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Defusion

Acceptance Values

Committed Action

Self-as-context

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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 itBut hold it lightly – it is not you!=>The ‘I am’ exercise

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http://www.actmindfully.com.au/

ACT

RFT

BA

Functional Contextualism

BEHAVIOUR→ANTECEDENT → CONSEQUENCE

physical environment

cognitiveinterpersonal

development and learning history

emotionalphysiological

genetic and epigenetic

social and

cultural

Slide courtesy of Jennifer Villatte

118

A – Antecedents B – Behaviour C- Consequences

C

Situation Thoughts Feelings

Immediate outcomesthat either increase ordecrease the behaviour

If consequences => lNCREASE in behaviour, they are ‘REINFORCING’

Something an organism does

- Public- Private

If consequences => DECREASE in behaviour, they are ‘PUNISHING’

DIFFERENTIAL REINFORCEMENT

POSITIVE REINFORCEMENT – ‘access something you want’NEGATIVE REINFORCEMENT – ‘avoid something you don’t want’

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A – Antecedents B – Behaviour C- Consequences (reinforcing)


immediate outcomesthat maintain the behaviour

Situation: alone in house at night, tired

Thoughts & Feelings: ‘I have no friends’ ‘I wish I had a social life’Sadness, loneliness,Anxiety, boredomUrge to smoke dope

Feeling of relief; painful thoughts, feelings, urges disappear

Costs:Addiction worsens; stays home more & social isolation increases; more feelings of loneliness and sadness

Smokes marijuana

Present Moment,Defusion,Acceptance

Values & Committed action

Workability


- Public- Private

‘TRIGGERS’ ‘PAYOFFS’

DIFFERENTIAL REINFORCEMENTOF A MORE WORKABLE BEHAVIOUR

payoffs VS costs

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Situation: alone in house at night, tired

Thoughts & Feelings: ‘I have no friends’ ‘I wish I had a social life’Sadness, loneliness,Anxiety, boredomUrge to smoke dope

Painful thoughts, feelings, urges lose some of their impact and influence; switch off ‘automatic pilot’ & get present; experience a sense of greater self-control, more freedom to choose behaviour

Mindfulness(Defusion, acceptance contacting the present)


- Public- Private



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Situation: Alone in house at night, tired, and mindfully responding to painful thoughts, feelings, urges – defusing & accepting – surfing urges– dropping anchor

Sense of clarity and self-awareness; sense of purpose; making sense of this pain

Connects with values. “This painful loneliness reminds me that what I really want is to be engaging and connecting with my friends.”


- Public- Private



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Situation: Alone in house at night, tired, and mindfully responding to thoughts and feelings – and in touch with values of engaging and connecting

Feeling of vitality or satisfaction; sense of living by values & moving in a positive life direction; sense of self-empowerment or personal growth

Committed actionPicks up phone, calls a friend, arranges to go over to her house.


- Public- Private



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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 itMake room for it/ give it spaceExpand around itOpen upLet it flow through youHold it gently/lightly/softly/kindlyBreathe into itLet it be/Allow itSit with itSoften up/loosen up around itWilling to have itLean into 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 feelingsImagine 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 canNotice 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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NAME your feelings

Notice Acknowledge Make room Expand awareness

Self-compassion: 6 Elements1. 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-talk4. Acceptance: open up and make room for painful thoughts

and feelings5. Validation: validate your pain as a normal & natural part of

being human6. 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

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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

Useful Questions For Crisis/Loss

What do you want to stand for in the face of this?

10 years from now, if you were to look back at the way you dealt with this issue, what would you like to say about the way you behaved, the way you handled it, what you stood for?

NB – if client is terminally ill, might be ‘ten weeks’ or ‘ten days’ from now

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More Useful Questions

You are 80 years old, looking back on your life today; complete these sentences:

I spent too much time worrying about ….I did not spend enough time doing things such

as …If I could go back in time to today, what I’d do

differently from today onwards is …

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A Common Reply To Questions About Values:

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I DON’T KNOW!Consider the function of this behaviour

Is it a request for help, due to lack of knowledge?

If so, do briefpsychoeducation, give some examples of values, then do an experiential exercise

A far more common function of ‘I don’t know’:

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Situation: therapy/coaching session – being asked about valuesThoughts & Feelings Oh shit!’ ‘I don’t know!’Anxiety, confusion. Urge to change the topic

Says ‘I don’t know’



Workability


- Public- Private



payoffs VS costs

Costs:Fail to clarify values, Fail to set meaningfulGoalsRemain stuck –nothing changes

Conversation endsFeeling of relief; anxiety/confusion disappears

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Situation: therapy/coaching session – being asked about valuesThoughts & Feelings Oh shit!’ ‘I don’t know!’Anxiety, confusion. Urge to change the topic

Says ‘I don’t know’



Workability


- Public- Private



payoffs VS costs

Costs:Fail to clarify values, Fail to set meaningfulGoalsRemain stuck –nothing changes

Conversation endsFeeling of relief; anxiety/confusion disappears

Validate: yes, right now, you don’t know. So would you be willing to: Sit with the question a bit longer?Do an exercise? Fill in a worksheet? Do a card sort?

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Clues: Important Domains of Life

What does the client: Complain about? Worry about? Feel strongly about: e.g. feelings of guilt,

sadness, anger, fear, love, joy? Want to have, get, or achieve (i.e. goals)?

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Clues: Important Domains of Life

Explore pain in all its forms: what does this pain tell you really matters?

For suicidal clients: What has stopped you from killing yourself?

If these painful thoughts/feelings/memories were no longer a problem, what would you do differently?

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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


AWAY



TOWARDS


ooChoicePoint

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The Resilience Formula

4 approaches to any problem situation:1. Leave 2. Stay & change what can be changed3. Stay & accept what can’t be changed & live

by your values4. Stay & give up & do stuff that makes it worse

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

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