ACT II An ACT Skills Building Workshop

Transcription

1 ACT II An ACT Skills Building Workshop Steven C. Hayes PRAXISCET.com

2 Praxis COI Who is Here PRAXISCET.com 2

3 Day 1 PRAXISCET.com 3

4 PRAXISCET.com 4

5 Our Goal Together Azrin / Rosenfarb / and our Objectives 4 Person Groups PRAXISCET.com 5

6 Life Your Life Draw the line. Take the time Then write about one (or 2) highs and one (or two) low. 8 min sharing touching at least one high and low with full listening and no interruption (appoint a time keeper) Each listener can ask one short clarify question if you have one Then one round with 1-2 minutes each of appreciation, emotional reaction, connection PRAXISCET.com 6

7 Life You should be on your last speaker. If you finish and others are working you can slip out on your break (or visit the book table) We will reconvene at ~ 10:50 PRAXISCET.com 7

8 Evolution on Purpose

9 Variation

10 Selection

11 Retention

12 Context

13 Level

14 Dimension

15 Variation Selection Retention Context Level Dimension PRAXISCET.com 15

16 Enemies of Variation: Avoidance

17 Enemies of Variation: Rule Following (Sort of)

18 The Problem: Verbal Problem Solving Increases Variation, BUT

19 Verbal Problem Solving is not Always Enough

20 Avoidance and Excess Verbal Rule Following are Linked: The Mind Puts Our Hearts on a Leash

21 The ACT Solution: Put the Mind on a Leash

22 Evolution on Purpose: Variation

23 Evolution on Purpose: Fit the Moment Inside and Out

24 Evolution on Purpose: Pick Your Selection Criterion

25 Evolution on Purpose: Groove What Works

26 Open Acceptance Essential Components of ACT Defusion

27 Contact with the Present Moment Acceptance Essential Components of ACT Defusion Aware Self as Context

28 Contact with the Present Moment Actively Engaged Acceptance Values Essential Components of ACT Defusion Committed Action Self as Context

29 Acceptance Defusion Flexible Attention to the Now Perspective Taking Sense of Self Values Committed Action PRAXISCET.com 29

30 Variation Selection Retention Context Level Dimension PRAXISCET.com 30

31 What EvoS Adds Variation Flexible and New Selection - Values Retention - Habits Context Here and Now Level Whole and Social Dimension In Balance PRAXISCET.com 31

32 ACT, Exposure, and Skills Exposure: Organized contact with previously repertoire narrowing stimuli for the purposes of increasing response flexibility Skills: Deliberate creation of values-based response patterns Problem solving Behavioral activation Cognitive reappraisal What ACT adds: the core space

33 ACT and Exposure / Skills Is there evidence this helps? Yes More engagement and willingness (Levitt et al) Empowers parenting skills (PPP study) Better outcomes than traditional CBT in anxiety disorders from post to follow up Specifically, better outcomes for those with: Co-occurring depression High behavioral avoidance of sensations EA data so far is confusing

34 Rationales Exposure Link to willingness and values Always get permission Limit by time and situation only Ward off avoidance Skills Link to flexibility and workability Link to incremental practice Ward off internal problem solving

35 Case Conceptualization with the Matrix Outside Away Toward Inside

36 Given a distinction between you and the things you are struggling with and trying to change, are you willing to experience those things, fully and without defense, as it is and not as it says it is, and do what takes you in the direction of your chosen values in this time and situation? Now Accept Values Defuse Action Noticing Self

37 Assessment The dimensions of circle means the strength of each process. Accept Hypothesized Indirect Influence Now Values Influential Event Defuse Action Noticing Self

38 Treatment Planning Anticipated Rx Influence Now Accept Values Use strength to target Defuse Action Noticing Self

39 Track Results Now Accept Values Defuse Action Noticing Self

40 The Therapeutic Relationship in ACT Detect the flexibility processes in the client Embody these processes in your personal presence Engage pain and caring with these processes Instigate, model, and reinforce change

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43 Day 2 PRAXISCET.com 43

44 Day 2 Agenda Recognizing flexibility processes words first (rats!) Skills building on all six processes For each, a tape extension from Sandra. Then 4 person practice staying on this process. Only difference: we will rotate roles periodically, and at each rotation we will rate and have a brief group case consult Hexadancing

45 Reads: Fusion Being right / looking good Stories and reasons Truth with a capital T Well practiced (the rhythm of suffering) Doesn t notice thinking as an ongoing process New information disappears or is integrated Loops back

46 Reads: Experiential Avoidance Hiding, running, or fighting when painful experiences come up Physical metaphors for the same (e.g., freezing; clenched fist; grip chair; eyes down) Cannot enjoy positive emotions without clinging or fear of loss You think how did we get here? Alexithymia Elaborated networks of difficult thoughts, feelings, memories, or bodily sensations

47 Reads: The Present Misses internal and external events in the now Inflexible attention cannot persist or cannot change as needed Speaking of the past or future produces entanglement with worry, anxious prediction, or rumination Lack of vitality in the room

48 Nobody home Reads: Self as Context Misses or unable to take perspective of others including you Entangled with conceptualized self Lower levels of genuine empathy and compassion Lack of connection in the room

49 Reads: Values Treats goals as values Caring is bound up with compliance, avoidance, or fusion (e.g., have to ) Sense of purposelessness in the present Closes off caring to close off pain

50 Read: Committed Action Impulsivity Incapacity Inaction Avoidance of commitments and failure to keep them

51 Day 2 Skills building on all six processes (I hope) For each, a tape extension from Sandra. Then 4 person practice staying on this process. In this case SELF AS CONTEXT Only difference: we will rotate roles periodically, and at each rotation we give feedback on the flexibility space and have a brief group case consult

52 Skills Building Process This is practice, not performance Try new things Don t let anyone hide ( I don t know ACT ) Skills builders can get brief help from their assistants During feedback: personal first; process second Limit discussion until feedback is heard

53 1. Acceptance 2. Defusion 3. Self 4. Now 5. Values 6. Commitment Hexadancing

54 Shifting Links - Acceptance What s hardest about that? What is in there that you can t have?

55 Shifting Links - Defusion When these thoughts occur are they right up on you?

56 Shifting Links Present Moment What are you feeling in your body right now

57 Shifting Links - Values If you weren t struggling with these things what would you most want in your life?

58 Shifting Links - Action What are you now not doing that you know would take you in that direction?

59 Shifting Links - Self And who is noticing that?

60 Objectives Accomplished PRAXISCET.com 60

61 You guys did great! (And thanks for supporting my boy) PRAXISCET.com 61

62 QUESTIONS? ACBS Come to WC XIII in Berlin, July 2015