Consider it Pure Joy: Approaching Suffering with Acceptance and Commitment to Care for Self and Others

Transcription

1 Consider it Pure Joy: Approaching Suffering with Acceptance and Commitment to Care for Self and Others Jason A. Nieuwsma, PhD Associate Professor, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center Durham, NC

2 Objectives 1. Articulate core evidence-based principles from acceptance and commitment therapy (ACT) that can intersect with chaplaincy. 2. Identify how ACT principles can complement chaplains commitments to journeying with those who suffer. 3. Use ACT practices to improve care of self and others.

3 I undertook great projects: I built houses for myself and planted vineyards. I made gardens and parks and planted all kinds of fruit trees in them. I made reservoirs to water groves of flourishing trees. I bought male and female slaves and had other slaves who were born in my house. I also owned more herds and flocks than anyone in Jerusalem before me. I amassed silver and gold for myself, and the treasure of kings and provinces. I acquired male and female singers, and a harem as well the delights of a man s heart. I became greater by far than anyone in Jerusalem before me. I denied myself nothing my eyes desired; I refused my heart no pleasure Yet when I surveyed all that my hands had done and what I had toiled to achieve, everything was meaningless, a chasing after the wind; nothing was gained under the sun. - Ecclesiastes

4 The single most remarkable fact of human existence is how hard it is for human beings to be happy. - Steven C. Hayes

5 Why do we suffer?

6 At a recent Rockefeller Foundation seminar on the concept of health, one authority urged that medicine "concentrate on the 'real' diseases and not get lost in the psychosociological underbrush. The physician should not be saddled with problems that have arisen from the abdication of the theologian and the philosopher I do not accept such a premise. - George Engel, Science (1977)

7 How do we stop suffering?

8 Beck Depression Inventory-II (BDI-2)

9 BDI-2 What success looks like on BDI Treatment Control Week

10 Acceptance & Action Questionnaire-II (AAQ-2)

11 AAQ-2 What success looks like on AAQ Treatment Control Week

12 What does success look like in faith?

13 Control as a means to achieving success CAN T CONTROL Examples CAN CONTROL Examples 13

14 Tug of War with a Monster What to do? Drop the rope!

15 - Chinua Achebe When suffering knocks at your door and you say there is no seat for him, he tells you not to worry because he has brought his own stool.

16 Pain vs. Suffering Clean discomfort What comes with living life. Examples: Loss Traumatic experience Negative life event Illness Dirty discomfort Created by efforts to control clean Examples Substance abuse Isolation Relationship conflicts Illness 16

17 Quicksand The gut reaction The ACT reaction DON T PANIC Douglas Adams, The Hitchhiker s Guide to the Galaxy

18 Chinese Finger Trap When we are no longer able to change a situation, we are challenged to change ourselves. Victor Frankl

19 Paradox ACT Being accepting of negative leads to feeling more positive. Faith tradition examples: The last shall be first. Lose your life to gain it. Reality is not reality. For neither is the aim happiness or feeling good, and yet that effect frequently occurs. 19

20 Acceptance and Commitment Therapy (ACT) What is ACT? Related to CBT family of treatments Acceptance: Willingness to experience Commitment: Living in line with values

21 Cognitive-Behavioral ^ Waves of Psychotherapy 1 st Wave 2 nd Wave 3 rd Wave Behavioral Cognitive MBCT, CBASP, ACT, DBT, etc. CBT / EBP Beach Alcohol, nudity, & psychoanalysis are prohibited.

22 ACT Defined The ACT counselor works to help the patient accept internal events (thoughts, emotions, memories, and sensations) while also helping the patient to make and keep behavioral commitments that reflect the patient s personal values. Oversimplified, you might say: hold and move. Hold your experience, whatever it may be, and move forward in your life.

23 ACT: Is there Value-Added? ACT challenges conventional cognitive-behavioral approaches to The assumption of healthy normality The patient/provider dichotomy The role of thoughts The significance of values Measurement

24 Why ACT in Chaplaincy? Evidence-based* 131 RCTs show ACT TAU (May 2016) Works for: Bio Psycho Social Health Principle-based Flexible theory, not fixed protocol Not confined to particular disorder Synergistic with faith perspectives Values-centric Embraces major religious practices Human flourishing, not absence of disease A broad tent Providers Patients * Powers, M. B., M. B. Zum Vörde Sive Vörding, et al. (2009). "Acceptance and commitment therapy: A metaanalytic review." Psychotherapy and Psychosomatics 78(2): * Ruiz, F. J. (2010). "A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies." International Journal of Psychology & Psychological Therapy 10(1): * ACBS keeps an ongoing count of published and in press RCTs on ACT ( As of 5/3/16, this site showed 131 RCTs on ACT, with 117 of those published and the remainder in press.

25 Desire for Evidence-based Skills Among Healthcare Chaplains I would like my chaplain care to be more evidence-based. Strongly Agree & Agree Neutral Strongly Disagree & Disagree 100% 5% 1% 6% 6% 80% 31% 40% 60% 40% 20% 94% 63% 54% 0% Civilian (N=160) VA (N=386) DoD (N=162) Fitchett, G., Nieuwsma, J.A., Bates, M.J., Rhodes, J.E., & Meador, K.G. (2014). Evidence-based chaplaincy care: Attitudes and practices in diverse healthcare chaplain samples. Journal of Health Care Chaplaincy, 20,

26 Disagree Neutral Agree Overt Familiarity with ACT among Chaplains CPE Supervisors & Psychotherapy Familiar with Incorporate w/ chaplaincy

27 Covert Familiarity with ACT among Chaplains Not let their thoughts and feelings get in the way of how they want to Stop their worries from getting in the way of their success. Stop comparing their lives to others'. Recognize that the experience of emotion itself is not necessarily a Accept that they cannot control every aspect of life. Understand that they can experience painful memories but Let go of worry about not being able to control their worries and feelings. Acknowledge fear of feelings and feel them anyway. Live a life they value despite painful experiences and memories. AAQ-2 Application Understand that it is okay to remember something unpleasant Disagree Neutral Agree Accept that life is full of positive and negative experiences; they are intertwined. Gain perspective which helps them recognize that the experience of a thought is not the same as thought content. Consider thoughts as interpretations of reality, rather than absolute truths that must be acted upon. Commit to living their lives in accordance with their values regardless of things that may get in the way; do what matters. Identify values and things that are important to them. Maintain contact with the present moment. 6 ACT Elements Disagree Neutral Agree

28 Premises of ACT Psychological pain is normal, it is important, and everyone has it. You cannot deliberately get rid of your psychological pain, although you can take steps to avoid increasing it artificially. You can live a life you value.

29 Six Aims of ACT For patient/provider to: 1. Be in the present moment. 2. Accept what is. 3. Watch your thinking. 4. Be aware of yourself. 5. Know your values. 6. Carry out valued behavior.

30 The ACT Model Contact with the Present Moment Acceptance Values Cognitive Defusion Committed Action Self as Context

31 Self-Care: Acceptance Exercise

32 Self-Care: Commitment Exercise 1. My value is 2. My goal is to (be specific) 3. I m willing to make room for

33 Discussion As a chaplain, in what ways do you foster practices of: Acceptance (or willingness )? Commitment (or identifying values and patterns of behavior)? Are there ways in which you see ACT as complementing your work as a chaplain? Are there potential areas of tension that you see between ACT and chaplaincy?

34 Recommended Readings For chaplains, clergy, pastoral counselors: Nieuwsma, J.A., Walser, R.D., & Hayes, S.C. (Eds.). (2016). ACT for Clergy and Pastoral Counselors: Using Acceptance and Commitment Therapy to Bridge Psychological and Spiritual Care. Oakland, CA, New Harbinger Press. For learning to use clinically: Wilson, K.G. (2008). Mindfulness for Two. Oakland, CA, New Harbinger Press. Harris, R. (2009). ACT Made Simple: A Quick-Start Guide to ACT Basics and Beyond. Oakland, CA, New Harbinger Press. For self-help: Hayes, S. C. (2005). Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy. Oakland, CA, New Harbinger Press. Also, worksheets available at:

35 Available July 1, 2016 (Amazon)

36 36 Questions? Contact Information: Jason Nieuwsma, PhD