Acceptance & Commitment Therapy INTRODUCTORY Workshop with Russ Harris

Transcription

1 Acceptance & Commitment Therapy INTRODUCTORY Workshop with Russ Harris Contact With The Present Moment Acceptance Values Psychological Flexibility Defusion Committed Action Self-as-context

2 Workshop Aims Theoretical overview Experiential overview Practical Tools Personal Growth Have Fun Inspiration 3

3 C B T

4 About ACT The origin The name The data The paradox The aim 5

5 Famous Quotes Life is spelt H.A.S.S.L.E. Albert Ellis Life is difficult. M. Scott Peck Life is suffering. Buddha Most men lead lives of quiet desperation and go to the grave with the song still in them. Henry Thoreau Shit happens! Anonymous 12

6 The Big Question: Why is it so hard to be happy? 13

7 Evolution of the human mind 14

8 Pain From The Past Problems In The Present Fears About The Future

9 The Challenge We Face I. Life is difficult II. A full human life = the full range of emotions III. The normal, healthy human mind naturally amplifies pain 16

10 17 Be Present Contact with the Present Moment Acceptance Values Open up Psychological Flexibility Do What Matters Defusion Committed Action Self-as-context

11 What Is Mindfulness? Paying attention - with openness, curiosity and flexibility Task-focused Attention 18

12 19 WORKABILITY Is it working Contact with to thegive you Present Moment a rich, full and meaningful life? Acceptance If yes, keep doing it. Values If not, would Psychological you consider doing something Flexibility different? What works short term to get rid of unpleasant Defusion thoughts & feelings, often does not work Committed long Action term to give us a rich and full life Self-as-context

13 AWAY Acting ineffectively, behaving unlike the person you want to be TOWARDS Acting effectively, behaving like the person you want to be CHOICE POINT HOOKS Thoughts, feelings, emotions memories, urges, sensations Challenging Situation HELPERS Values, strengths, skills Especially mindfulness skills

14 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 Like playing a guitar needs practice both in session and between sessions. NB Modify this as needs e.g. in grief work, this would sound very different 21

15 2 Questions Q: 1. What valued direction does the client want to move in? Q: 2: What is getting in the way? So where do I start? 22

16 TOWARDS Acting effectively, behaving like the person you want to be A: What s the valued direction? -Values clarification -Goal Setting -Committed Action -Skills training CHOICE POINT HELPERS Values, strengths, skills 23

17 AWAY Acting ineffectively, behaving unlike the person you want to be B: What s getting in the way? -Fusion => Defusion -Avoidance => Acceptance -Automaticity => Awareness CHOICE POINT HOOKS Thoughts, feelings, emotions memories, urges, sensations HELPERS Mindfulness skills 24

18 AWAY Acting ineffectively, behaving unlike the person you want to be TOWARDS Acting effectively, behaving like the person you want to be CHOICE POINT HOOKS Thoughts, feelings, emotions memories, urges, sensations Challenging Situation HELPERS Values, strengths, skills Especially mindfulness skills

19 Where to start? For clients in crisis/panic/dissociative states/overwhelmed by emotions: start with grounding/centering For clients with major grief/loss: Start with self-compassion For the poorly motivated: Values 26

20 The Resilience Formula 4 approaches to any problem situation: 1. Leave 2. Stay & change what can be changed 3. Stay & accept what can t be changed & live by your values 4. Stay & give up & do stuff that makes it worse 27

21 Contact With The Present Moment Acceptance Values Psychological Flexibility Defusion Committed Action Self-as-context 28

22 (Copy me) Imagine your hands are your thoughts and feelings Imagine 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 & feelings What 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. 29

23 3 Tricky Reactions - I feel safe behind here - How will that solve my problems? - I can t do that with my real thoughts & feelings 30

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29 NB. Leaves On A Stream Non-visual version (e.g. black space)? Let them come, stay and go as they please It s okay if the leaves hang around or the river stops flowing - just keep watching Do this for all thoughts: positive and negative Invite clients to creatively modify the exercise: e.g. conveyor belt, blackboard Watch for avoidance: e.g. writing thoughts on blackboard then erasing them 37

30 Cognitive Defusion? ACT is based on RFT, relational frame theory RFT is a theory of symbolic behaviour: how we create, manipulate & respond to symbols Cognition in ACT = symbolic behaviour Symbolic behaviour is involved in all private experiences: thoughts, feelings, emotions, memories, sensations, etc. So cognition in ACT refers to the symbolic aspects of any/all of the above experiences. 38

31 Cognitive Defusion ACT textbooks emphasise defusion from thoughts including assumptions, attitudes, beliefs, judgments, etc. But cognitive defusion means defusion from the symbolic aspects of any private experience: thoughts, feelings, emotions, memories, images, physical sensations, hallucinations, urges, cravings, schemas, etc. 39

32 SEE HEAR TOUCH FEELINGS THOUGHTS FUSION TASTE SMELL MEMORY PAIN FEELING HALLUCINATION EMOTION CRAVING SENSATION URGE PAIN THOUGHT 40

33 SEE HEAR TOUCH FEELINGS THOUGHTS TASTE SMELL SELF-COMPASSION PAIN VALUES & ACTION 41

34 Change the context Thoughts & feelings function differently in different contexts 42

35 Pain in a context of FUSION HEAR SEE TOUCH FEELINGS THOUGHTS TASTE SMELL MEMORY PAIN FEELING HALLUCINATION EMOTION CRAVING SENSATION URGE PAIN THOUGHT 43

36 Pain in a context of Mindfulness & Values SEE HEAR TOUCH FEELINGS THOUGHTS TASTE SMELL SELF-COMPASSION PAIN VALUES & ACTION 44

37 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 hands hard 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 46

38 Dropping anchor - notes 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 47

39 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? 48

40 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? 49

41 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 50

42 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 ) We can also fuse with thoughts we don t believe (e.g. fantasising) 51

43 3 steps to defusion mix & match Notice Name Neutralise 52

44 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 53

45 Contact With The Present Moment Acceptance Values Psychological Flexibility Defusion Committed Action Self-as-context 54

46 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 55

47 Goals or Values? Nurturing, maintaining and caring for my body Lose 10 kg Get a great job Being helpful, friendly and responsible 57

48 Goals or Values? Buy a house Being supportive, protective, caring for my family Get good grades Curiosity, learning, persistence 58

49 Goals or Values? Being sensual and intimate Have an orgasm Have children Being caring, kind, loving 59

50 Goals or Values? Win the match Playing enthusiastically, fairly, skillfully Being creative Write a book Why does this distinction matter? 60

51 Trickier: Goals or Values? Be respected Be respectful Be loved Be loving 61

52 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 62

53 Mind-Reading Machine -What you stand for -Your personal strengths and qualities -The role you have played in their life 63

54 Bull s Eye: Values To Goals Pick a quadrant on the Bull s Eye & identify 2 or 3 key values Then set a values-guided SMART goal for the next week Specific, Meaningful, Adaptive, Realistic, Time-framed A live person s goal 0-10: How realistic? If <7, make it smaller/easier 64

55 Bull s Eye: Values To Goals In pairs, stand up and share your goals Begin with: Here is my commitment Notice what thoughts and feelings show up Afterwards share: a) What unhelpful things did your mind say? b) What uncomfortable feelings showed up in your body? 65

56 I can t do it because I shouldn t do it because I shouldn t have to do it because

57 The Resilience Formula 4 approaches to any problem situation: 1. Leave 2. Stay & change what can be changed 3. Stay & accept what can t be changed & live by your values 4. Stay & give up & do stuff that makes it worse 67

58 Contact With The Present Moment Acceptance Values Psychological Flexibility Defusion Committed Action Self-as-context 68

59 The Alternative to Self-Esteem?

60 I've missed more than 9000 shots in my career. I ve lost almost 300 games. 26 times I've been trusted to take the game winning shot... and missed. I've failed over and over and over again in my life. That is why I succeed.

61 Self-Acceptance You are not who you think you are! 75

62 Which Is The Real you? Take 30 seconds to tell your partner as much as possible about who you are as a human being just positive stuff Take 30 seconds to tell your partner as much as possible about who you are as a human being just negative stuff 79

63 Self-Acceptance You are not who you think you are! If your mind tells you a negative story Thanks, mind! And if it s a positive story Thanks, mind! =>The Good self/bad Self exercise 80

64 Self-Acceptance She was so caring, She loving, had a kind. really Always high opinion there of for me when herself! I needed her! 81

65 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 it But hold it lightly it is not you! =>The I am exercise 82

66 The Observing Self 84

67 ACT RFT ABA Functional Contextualism

68 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 88

69 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 89

70 Acceptance not a good word! Drop the struggle with it Make room for it/ give it space Expand around it Open up Let it flow through you Hold it gently/lightly/softly/kindly Breathe into it Let it be/allow it Sit with it Soften up/loosen up around it Willing to have it But why accept pain? 90

71 (Copy me) Imagine this paper is all your difficult thoughts and feelings Imagine in front of you is everything that matters: the people, places, activities you love etc. And Pushing also all the problems/challenges Away Paper 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 can Notice 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. 91

72 Creative Hopelessness What have you tried? How has it worked, long term? What has it cost you? 92

73 An Important Close Relationship What is painful or difficult in this relationship? Tap into a painful emotion e.g. fear, sadness, anger, guilt so you can work with it 95

74 NAME your feelings Notice Acknowledge Make room Expand awareness 96

75 Self-compassion: 6 Elements 1. 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-talk 4. Acceptance: open up and make room for painful thoughts and feelings 5. Validation: validate your pain as a normal & natural part of being human 6. Connectedness with others: acknowledging and empathizing with pain of others; recognizing your commonality; sharing your pain with others

76 Kindness To Self Kind self-talk (in both content and tone) Kind imagery Kind self-touch Kind deeds

77 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?

78 Empowerment: Locus of Control The more you focus on what is out of your control the more disempowered you are. You have more control over your actions - what you say and do than anything else You can use your actions to influence others and the world around you You can t control others; only influence them. You can t control the world; only influence it. So we need to look at you at what you can do differently with your words and actions

79 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? 102

80 Values Are Not: Goals What you want or need from others Rules or commandments, codes of conduct Shoulds, musts, obligations 103

81 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. 104

82 Properties of Values Here and now Freely chosen Dynamic Evolving Never completed Intrinsically rewarding 105

83 Properties of Values Often need prioritising Never need justifying Values,Virtues & Strengths Pursue vigorously, but hold lightly 106

84 What Prevents Action? FEAR Fusion Excessive goals Avoidance of discomfort Remoteness from values 108

85 The Antidote DARE Defusion Acceptance of discomfort Realistic goals Embracing values 109

86 The Resilience Formula 4 approaches to any problem situation: 1. Leave 2. Stay & change what can be changed 3. Stay & accept what can t be changed & live by your values 4. Stay & give up & do stuff that makes it worse 111