The Use of ACT as a therapeutic approach to assessment and management of functional neurological symptoms

Transcription

1 The Use of ACT as a therapeutic approach to assessment and management of functional neurological symptoms Stella Plisner Occupational Therapist Neuropsychiatry Stella.plisner@bsmhft.nhs.uk

2 My actual brain! (not to scale!) I used to think that my brain was the most wonderful organ in my body. Then I realised who was telling me this Emo Philips

3 Just suppose for a moment that almost everything you believed about finding happiness turned out to be inaccurate, misleading, or false. And suppose that those beliefs were making you miserable. What if your very efforts to find happiness were actually preventing you from achieving it? Dr Russ Harris The Happiness Trap

4 What is ACT? ACT is a therapeutic approach that uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility. Where did ACT come from? ACT has been called a third wave behavioral therapy; placing importance on changing the way individuals relate to their experience as opposed to changing the content of their experience. Other third wave behavioral therapies include DBT, MBCT and FAP.

5 The Aim of ACT, in lay terms, is to create a rich, full, and meaningful life while accepting the pain that inevitably goes with it Russ Harris ACT Made Simple

6 Psychological inflexibility is central feature of motional disturbance. Psychological flexibility is established via 6 core processes that are conceptualised as positive psychological skills (Hayes et al 2006) Not linear- Overlap and facilitate flexibility

7 Contact with the Present Moment Be here now Open Up Acceptance Essential Components of ACT Values Know what matters Defusion Watch your thinking Self as Context Pure Awarenessobserver to the events around us Committed Action Do what it takes

8 Acceptance and Mindfulness Processes Contact with the Present Moment You can chunk them into two larger groups Acceptance Values Defusion Committed Action Self as Context

9 and Contact with the Present Moment Commitment and Behavior Change Processes Acceptance Values Defusion Committed Action Self as Context

10 A = Accept your thoughts C = Choose a values direction T = Take action Russ Harris

11 Relational Frame Theory Complicated but needs to be mentioned! (sorry) Psychological theory of human language- focuses on how environmental interactions influence a wide range of thoughts and behaviours for example, Pavlovian and operant conditioning to explain apparent unexplained adverse responses (Hayes et al cited in Kangas and McDonald) Think that someone who hates public speaking may have an adverse reaction to the word conference and now the word Sheffield.. Relational frame theory embraces the simple idea that deriving stimulus relations is learned behaviour (Hayes fox et al) ACT is one application of RFT and has substantial peer reviewed articles supporting its principles Much broader than ACT as only some RFT is applied to psychotherapy Helps to guide case conceptualisation

12 In line with this theory, a shift in context that supports the relation between thought, action and emotion is necessary in order to initiate change. ACT conceptualises Psychological events as a set of on-going interactions between the organism and historically and situationally defined contexts (Hayes 2004 p646 cited in Kangas and McDonald p6)

13 If ACT is like driving your car, RFT is like knowing how the engine works: you can be an excellent driver while knowing absolutely nothing about the mechanics (Harris ACT made simple)

14 The quality of our experience, Moment by Moment, will determine the quality of our lives. Matthieu Ricard

15 ACT/ Mindfulness assessment tools- Questionnaires- Acceptance & Action Questionnaire and Variations (AAQ) Automatic thoughts ATQ (F&B) Values measures Mindfulness Measures- Mindful Attention Scale

16 Clinical issues: Service users are fused with language about pain, failure, and fatigue Service users have self-defeating ideas of conceptualised self and difficulty with contacting self as content Service users have limited contact with their values and lack the motivation to change Service users are lonely and have limited social support

17 Clinical Goals Initiate focus on values increase behavioural flexibility Improve ability to notice avoidance and acceptance continuum Improve ability to observe body and mind and notice the connections Address current distressing problems Clarify long term directions Identifying and understanding ways in which controlling private events gets in the way of self-management behaviours (compliance with recommended exercise, diet etc.)

18 Continued Acceptance of negatively- evaluated fears about being sick, being Dis-abled Defusion of negatively evaluated thoughts about being sick, being dis-abled Enhance Commitment to behaviour change in the service of disease and health risk management

19 6 Defusion categories: Past Future Self- Conceptulised self Reason Giving reasons for why we can t do something reason giving mode become physical barriers Rules- Should, Have to, Ought, until, because The Tyranny of the shoulds Karen Horney Mustabation Ellis Judgements- Fuse with judgements about the self

20 Struggle Psychological Inflexibility Unworkable- Creative hoplessness

21 Interventions- Thought work- defusion techniques, deliteralization work Bad thoughts are still your thoughts thanking your mind (Treat like an annoying teenager who wants a reaction) Health related values work- focus on willingness. Self-monitoring of willingness Metaphors/ exercises (note my T-shirt )my ACT purse, Chinese finger trap Mindfulness techniques- mindfulness of the Breath

22 Ok so where is the evidence then?... It s coming! Good results in Health Anxiety and post stroke unexplained medical symptoms Pilot study of processes of change in group based acceptance and commitment therapy for health anxiety. Uncontrolled study indicated decrease in health and anxiety symptoms at 6 month follow up was associated with the change in psychological flexibility and mindfulness during treatment. These findings support the process of change proposed in ACT- APA Citation Hoffman et al: A pilot study of processes of change in group-based ACT therapy for health anxiety. Journal of Contextual and behavioural science 3, Lance McCraken chronic pain

23 Thank you for sharing my willingness to sit through that.. Also Thank you ACBS

24 References- Books ACT made simple: Russ Harris 2009 ACT in practice : Patricia Bach, Daniel Morgan The Happiness Trap: Russ Harris Steve Hayes Acceptance and Commitment Therapy, relational Frame, and the third wave of behavioural and cognitive therapies. Behavioural Therapy 2004: An Acceptance and Commitment Therapy (ACT) Based Intervention for an Adult Experiencing Post Stroke anxiety and Medically Unexplained Symptoms David Graham, David Gillanders, Simon Stuart and Joanna Gouick : Clinical Case studies Is it time to act? The potential of acceptance and commitment therapy for psychological problems following acquired brain injury: Maria Kangas and Skye McDonald 2011 Neuropsychological Rehabilitation Hayes et al Acceptance and Commitment therapy: Model, processes and outcome. Behaviour Research and Therapy :1-25 ACT Podcasts available on line