Stress Less Live More

7/30/2019 Stress Less Live More

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Stress Less, Live More: How

Acceptance and CommitmentTherapy Can Help You Lead a

Busy yet Balanced life

Dr. Richard Blonna


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What is Stress?

Stress means different things to different people

What stresses some people challenges others

Four classic ways to define stress : stimulus,

response, transaction, and holistic phenomenon


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Stress is a Stimulus

Stress is something in the external environment

Stress is defined by the stimuli that one isexposed to (stress is bills, work, taxes etc.)

Some stimuli are defined as life events(Holmes & Rahe)


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Stress is a Response

Stress is something in the internal environment

Stress is defined as the non-specific response ofthe body to any demand (Hans Selye)

The non-specific response include symptomssuch as increased muscle tension, breathingrate, hormonal release, metabolic rate etc.


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Stress is a Transaction

Stress is a transaction between a stimulus and aresponse (Lazarus & Folkman, 1987)

The transaction revolves around the appraisal ofa potential stressor based on two questions:

Is it a threat?

Can I cope?Stimulus (potential stressor) and Personality(the individual) factors mediate the transaction


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Stress as a Holistic Phenomenon

Stress is a response that that occurs when thedimensions of health (physical, social, spiritual,

emotional, intellectual, occupational andenvironmental) are out of balance.

Lack of balance causes the body to makeadjustments in order to regain and maintainhomeostasis


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All of these Definitions are PartiallyCorrect

In actuality, stress is all of these things(stimulus, response, transaction, holistic

phenomenon) combined.

Each of the classic ways of defining stressaccounts for a piece of the puzzle.


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A New Way of Defining Stress

Stress is a holistic transaction between anindividual and a potential stressor resulting in a

stress response (Blonna, 2006).

Blonnas definition combines elements of thefour classic definitions to form a more eclectic

picture of stress.


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What is ACT?

Acceptance and commitment therapy (ACT) is athird wave form of cognitive behavior therapy(CBT) grounded in relational frame theory (RFT

Numerous ACT studies support its efficacy intreating anxiety, schizophrenia, depression,workplace stress, and burnout, pain, drug use,

psychological adjustment to cancer, anddiabetes self-management (Ciarrochi & Bailey,2008).


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What is ACT?

An underlying premise of ACT is that mentalsuffering occurs when clients becomepsychologically-inflexible and get stuck

ACT helps clients become more psychologicallyflexible, get unstuck, and engage in values-congruent behavior


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Values-Congruent Behavior

The primary therapeutic outcome for ACT isgetting clients to behave in ways that are

congruent with their values

Two key aspects of this are helping clients clarifytheir values and setting behavioral goals that are

congruent with these values


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The Acceptance Component of ACT

Acceptance has three aspects :

1. Becoming more mindful of thoughts,emotions, and actions

2. Understanding how thoughts, emotions,and actions support or oppose values andgoals

3. Accepting that trying to control, avoid, oreliminate painful thoughts and feelings isimpossible and makes them worse


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The Commitment Component ofACT

Acceptance and Commitment work togetheracceptance is the cognitive part

commitment is the behavioral part

Commitment involves sticking to values-congruent behavior while coexisting with

troubling thoughts and painful emotions


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The Therapeutic Component of ACT

ACT does not focus on over-analyzing the pastor trying to change thoughts, personal scripts,mental images and emotions

ACT is based on RFT research that demonstratesthe effectiveness of accepting painful thoughtsand troubling emotions and focusing on values-

congruent behavior


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ACT and RFT

ACT is grounded in Relational Frame Theory(RFT), the language theory that underlies it

RFT proposes that current thoughts, personalscripts, mental images and emotions related tostress are linked to their original frames ofreference (what RFT refers to as relationalframes) from the past in which they wereinitially learned


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An RFT View of the Human Mind

RFT compares the mind to a 24/7 computer thatis running multiple programs simultaneously

The programs are thoughts, personal scripts,mental images, and emotions

At times, some of the programs get corruptedand cause the mind to freeze (get stuck) andcrash


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Relational Frame Theory

The mind uses information from previousrelational frames as the basis for assessing thethreat posed by current stressors

In addition, the mind can carry this one stepfurther and use the same previous information

to jump ahead and project an infinite number offuture situations involving this and similarstressors


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Thoughts

Thoughts do not occur in a vacuum, they areconnected to specific relational frames

An underlying principle of ACT is that allthoughts are not equally helpful or important

ACT evaluates thoughts in terms of whether ornot they are helpful in reaching goals and takingvalued action.


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Thoughts

Can organize thoughts in terms of theirhelpfulness:

helpful thoughts are consistent with

ones values and goals and facilitatevalues-congruent behavior

unhelpful thoughts - are inconsistent with

ones values and goals and interfere withvalues-congruent behavior.


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Personal Scripts

Personal scripts are like scenes in a play exceptthe play is ones life.

Each script has its own inner dialogue (self- talk)that represents how the scene

played out (old script)

is currently running (present script)will ultimately play out (future script).


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Personal Scripts

Each script is connected to a relational frame,the context that sets the stage for the inner-dialogue

Personal scripts often get outdated because therelational frame or the person changes

Outdated personal scripts are seldom helpful intaking valued action.


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Mental Images

Mental images are the visual images thataccompany the personal scripts

Think of the scripts as the dialogue and theimages as the moving pictures

As with personal scripts, mental images arelinked to relational frames that set their context


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Mental Images

Mental images, are similar to personal scripts inthat they can get outdated and no longerrepresent who the person is

Many adults still have images of themselves ashelpless or worthless children

Outdated mental images are seldom helpful intaking valued action.


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Emotions

ACT views emotions as something that cannotbe controlled and therefore should beacknowledged and accepted not analyzed orchanged

Emotions are also linked to past, present, orfuture relational frames

Even though emotions cannot be controlled, thebehavior associated with them can be


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RFT and Control

The minds ability to synthesize past and presentrelational frames and extrapolate into the futureis tremendously useful when planning for thingsit can control:

behavior

some aspects of the environment

These are known as external potential stressors


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RFT and Control

The same ability can also be a source ofemotional distress when dealing with things it

cannot control:thoughts

personal scripts

mental imagesemotions

These are known as internal potential stressors


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RFT and Control

RFT teaches us that the more people try tocontrol, avoid, or eliminate potential stressorsthat cannot be controlled, the worse they get

Learning how to manage them is the keybe mindful of them

accept them

be willing to act while coexisting with them


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Acceptance vs Control

Most people fail in their stress managementattempts because they try to control, avoid, oreliminate internal potential stressors

This is doomed to fail because more than half ofall stress is associated with internal potential

stressors that cannot be controlled


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ACT & Stress

Often clients who seek the services of therapistsand counselors do not have mental disordersthat meet the criteria established in the DSM lV

These clients, the worried well, are stuckbecause of their psychological inflexibility, and

suffer from stress, anxiety and worry that keepsthem from taking values-congruent action


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ACT & Stress

The worried well, like clients with more seriousmental disorders, also struggle with:

unhelpful thoughts, personal scripts, mentalimages, and emotions that contribute totheir psychological inflexibility and keep

them stressed and stuck in a rut


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ACT & Stress

ACT can help these clients develop greaterpsychological flexibility, get unstuck, takevalues-congruent action, and meet their goals

ACT can also help these clients keep their stress,anxiety, and worry from turning into more

serious mental disorders


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An ACT View of Stress

An ACT view of stress supports a transactionalway of defining stress

Thoughts, personal scripts, mental images, andemotions all come into play during the stressappraisal process


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An ACT View of Stress

All of the core process that contribute topsychological inflexibility also come into playduring stress transactions

All of the six therapeutic processes can beadapted to help clients manage their stress


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The Six Core Processes

There are six core processes, that contributeto psychological inflexibility and stress:

attachment to the conceptualized selfcognitive fusion

dominance of outmoded scripts and learning

experiential avoidancelack of clarity concerning values

inaction, impulsivity, and rigidity.


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Attachment to the ConceptualizedSelf The conceptualized self refers to the self-

descriptions clients to describe themselves:

Im a mother

Im of average height and buildIm a happily married man

Im an architect

Im a teacher

The mind creates stereotypes or shortcuts

around these descriptions


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Attachment to the ConceptualizedSelf

These statements sum up how people viewthemselves and measure up to societalstandards (IQ, SES, body image etc.)

ACT refers to this way of describing the self as aself-as-content view (you are the sum total of

all of the things contained within you)

People get attachedto their self-statements


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Attachment to the ConceptualizedSelf and Stress

Stress clients often take a self-as-content viewof themselves

They use labels and past diagnoses to describethemselves and their problems (social phobic,asthmatic, dyslexic, etc.)

Often these labels limit their psychologicalflexibility and coping options resulting in stress


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Cognitive Fusion

Cognitive Fusionis the process offusingwith anaspect of the conceptualized self

Can fuse with positive or negative attributes:I am a runner (positive)

I am a loser (negative)

In a sense, cognitive fusion is over-attachmentto one aspect of the conceptualized self


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Cognitive Fusion & Stress

Stress clients often fuse with elements of theirconceptualized self and create stereotypes thatlimit their potential

A common occurrence with cognitive fusion isthe person becoming the problem:

I am an asthmatic

vs.

I am someone who has asthma


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Dominance of Outmoded PersonalScripts & Stress

Stress clients often fuse with personal scriptsand prior learning that are outmoded and nolonger represent who they are as individuals

The relational frames these scripts are based onrelate to failed attempts to cope with potential

stressors that were similar in nature to the onesbeing appraised in the present moment


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Lack of Clarity of Values & Stress

Stress clients often feel unable to cope withpotential stressors that threaten their values

Sometimes the threat is due to being unclearabout the underlying values

Stress clients often adhere to values that arebased on outmoded personal scripts that nolonger represent who they are


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Experiential Avoidance & Stress

Stress clients often avoid experiences thatexpose them to potential stressors that theyvepreviously found stressful

Their 24/7 thinking and feeling machines (theirminds) project into the future and extrapolate a

limitless number of threatening and failed copingscenarios based on past relational frames


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Inaction, Impulsivity, Rigidity, &Stress

Experiential avoidance contributes to stressclients inaction and rigidity due to a lack ofunderstanding of the relationship betweenaction and personal values

They often act impulsively because their

behavior is not congruent with their values(often due to lack of clarity regarding theirvalues)


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Psychological Inflexibility andUnhelpful Thinking Traps

Psychological inflexibility often results in fallinginto common thinking traps

Blonna (2010), synthesized 10 common thinkingtraps that contribute to getting stuck

ACT refers to the process of falling into thesethinking traps as getting hooked


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The Thoughts Are Reality Trap

This is based on the belief that the thoughtsclients have about events represent theobjective reality of the events

In fact, unless they are experiencing eventsfirst-hand, their thoughts are just that; whatthey think aboutthe event

Clients fall into the trap when they think theirthoughts are the actualevents instead of justtheir thoughtsabout them


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The Thoughts are True Trap

The thoughts are true trap is based on thebelief that just because clients think ofsomething that these thoughts must be true.

Many of the thoughts clients have are reallyjudgments or evaluations and not really truthsbased on evidence

Clients fall into the thoughts are true trap

when they fail to realize that these truthsarereally their personal judgments or evaluations.


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The All Thoughts Are EquallyImportant Trap

The all thoughts are equally important trapgives equal weight to all thoughts

Clients fall into this trap when they take all oftheir thoughts too seriously (after all, they areonly thoughts) and assign them the same high

importance.


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The Thoughts Are Orders Trap

The thoughts are orders trap revolves aroundthe belief that just because clients thinkaboutdoing something they feel that they have to act

on it.

Clients fall into the thoughts are orders trapwhen they mindlessly act in response tounhelpful thoughts because they took them asmarching orders.


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The Thoughts Are Threats Trap

Thinking that something can harm you isdifferent from actually beingin harms way.

Sticks and stones will break your clients bones,but words (or thoughts) will never hurt them,unless they allow them to.

Clients fall into this trap when they believe theirthoughts can actually cause themselves harm.


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The Outdated Personal ScriptsTrap

Based on the belief that outdated personalscripts are still valid

In reality, outdated scripts are like faded oldnewspaper clippings from the past

Clients fall into this trap when they think theseold scripts are still valid even though they standin the way of creating newer, more helpful ones


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The Scary Pictures are Real Trap

Based on the belief that the frightening imagesthe mind can churn out 24/7 are real

In fact, these images are like faded photos froman old album, pictures of past hurtful events

Clients fall into this trap when they believe thatthe images are real and that they are part of thepicture of their lives in real-time


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The Personalization Trap

Based on the belief that responsibility forproblems is exclusively linked to the selforothers

In fact, responsibility for problems is rarely one-dimensional or exclusive

Clients fall into the trap when they assignresponsibility for their problems exclusively tothemselves or others

The Pervasiveness Trap


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The Pervasiveness Trap

Based on the belief that the extent of influenceof a stressor or aspect of the conceptualized selfsituation spills over into everyaspect of life

In fact, stressors and aspects of the self usuallydo not affect everyaspect of life

Clients fall into this trap when they believe thatthese things are not context-specific andpermeate everyaspect of their lives


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The Permanence Trap

Based on the belief that current troublingthoughts, feelings, and situations will lastforever

In fact, very few of these situations last forever

Clients fall into the permanence trap when they

believe that temporary conditions and situationswill last foreverand affect them permanently


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Getting Unstuck: The Six CoreTherapeutic Processes

ACT identifies six core therapeutic processes fordeveloping greater psychological flexibility:

1. being present (developing mindfulness)

2. acceptance

3. defining valued directions

4. commitment (taking action)

5. cognitive defusion

6. self-as-context


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Developing Mindfulness

Mindfulness can be developed two ways:informal training (attention building)

formal training (mindful meditation)

Informal training involves using short activitiesto help stress clients become more aware of:

internal (thoughts, scripts etc.) processesexternal (environment) stimuli


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Developing Mindfulness

Formal mindfulness training involves learningand practicing mindfulness meditation

daily practice sessions

increasing duration from 5-20 minutes

Mindfulness meditation is not the same asfocused meditation used for relaxation training


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Developing Acceptance

Acceptance training builds on mindfulnesstraining and sets the stage for willingness

Before clients can begin to accept their unhelpfulthoughts, personal scripts, mental images, andemotions they need to be more mindful of them

Acceptance and willingness activities aretypically integrated with each other


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Developing Acceptance

Involves teaching stress clients about the futilityof trying to change internal potential stressors

Acceptance training involves information givingand the use of metaphors and exercises

Can demonstrate using Chinese Finger Traps


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Defining Valued Directions

The four steps to defining valued directions:1. exploring values

2. choosing and ranking values

3. publicly affirming values4. acting on values

ACT uses a variety of in-session and homeworkassignments to help stress clients do this


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Values Categories

There are ten values categories:

1. intimate relationships2. family relationships

3. friendships and other relationships

4. health5. spirituality


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Values Categories

6. finances

7. learning

8. work

9. the environment

10. civics


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Commitment Training

Since ACT is a values-based form of therapy,goals and objectives must reflect clients values

Clear goals and measurable objectives reduceambiguity and give structure to behavior

Stress clients develop goals and objectives thatreflect their values and guide them to wheretheywant to go


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Commitment Training

Commitment is the actioncomponent ofacceptance and a key step in therapy

Clients dont get better by just talkingabouttheir problems, they must take action

Taking action that is congruent with values isbased on setting clear goals and measurableobjectives for behavior


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Control and Willingness to Act

Control and willingness are inversely related:

the more stress clients try to control troubling

thoughts and painful feelings, the less willingthey are to take valued action

can demonstrate by using The Radio metaphor


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Willingness and Control

A key component of ACT is helping clients shifttheir focus off of what they cannot control andonto what they can control

The focus is on engaging in more helpful*behavior and creating more helpfulenvironments

*in terms of reflecting their values and achievingtheir goals


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Willingness to Act

The key is getting stress clients to take values-congruent action while coexisting with troublingthoughts, personal scripts etc.

behaving in ways that support their valueswill result in new learning and developing

new, more helpful relational frames

give homework assignments to build this


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Willingness and Control

Things than can be controlled:personal environment

behavior

These can be modified and can trigger helpfulthoughts, personal scripts, mental images, and

emotions and new, more positive relationalframes


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Self-as-Context (the Observer Self)

ACT proposes another way of viewing the self,the self as context

In this view, the self is the vessel(the context)that contains a lifetimes worth of thoughts,personal scripts, etc.

This view helps clients see that they are morethantheir thoughts, personal scripts, etc.


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Self-as-Context (The Observer Self)

ACT teaches clients to view themselves as beingmorethan just the sum total of their thoughts,personal scripts, etc.

sets the stage for being able to distancethemselves from these things when they areunhelpful

The observer self allows stress clients to stepback and observe their conceptualized selves


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Self-as Context

ACT often uses chess as a metaphor to explainthis:

a self-as-content view looks at thepiecesand their movement at any given point todescribe the game

a self-as-context view looks at the existenceofthe boardas the context in which thepieces play out many games over time


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Self as Context

Being able to step back and examine anystressful situation from the perspective of beingthe boardupon which it plays out can help:

put individual moves (thoughts etc) and thegame (the entire situation) in a broaderperspective

evaluated in terms of their helpfulness

dismissed as just a bad move or game


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Self as Context

What a silly move that was What a bad choice of moves I made

What a terrible game I played

Wouldnt it be nice to be able to dismiss our

unhelpful thoughts, scripts, mental images &feelings this way?


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Cognitive Defusion

Cognitive defusion techniques teach stressclients how to take an observer self view

ACT uses a variety of metaphors and exercisesto help clients identify when they have fusedwith thoughts etc. and how to defuse from them

The White Board is one such exercise

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