Download ACT

ACCEPTANCE AND
COMMITMENT THERAPY
Sources:
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment
therapy: An experiential approach to behavior change. New York: Guilford.
Definition
•‘ACT is a psychological intervention based on
modern behavioural psychology, that applies
mindfulness and acceptance processes, and
commitment and behavior change processes, to
the creation of psychological flexibility’
ACT adheres to Contextual
Behavioral Science
definition of behavior
• Definition of behavior: any and all actions of
whole organisms in and with a context
considered historically and situationally.
The importance of language
• Language is to mean;
• Spoken language
• Private language
• The process of languaging/thinking is very
important
• Our verbal/cognitive skills enable us to
problem solve in the external world with
relative ease and speed
• And it near enough ensures that human
beings are the dominant species on the planet
despite being weak, slow and poorly
defended.
• However! Language also has a dark side!
• Our abilities to compare, analyse, evaluate,
weigh up the risks etc. can also lead to
psychological issues
– For example, think of someone who compares
themselves to their friends in terms of love,
money, success. Even worse think of someone
who compares their current self to how they
envisaged themselves to be ten years ago
• The same problem solving skills that are super
helpful in the real world may not be helpful in
the realm of psychological health.
• ACT is based on the principle of Experiential
Avoidance (EA).
• The more you try to get away from or solve psychological
issues, the less you solve and the worse things get.
• The same tools that work well in the external
world may cause real harm when turned
toward the internal world
Two Modes of Mind
• One is discrepancy based, problem solving
7/7/2017
Don’t think of a white bear
Don’t be anxious
Two Modes
• The other is engagement based, noticing with
curiosity
• It is buried amid the cacophony of modern life
• That is the focus of the acceptance,
mindfulness, and values approaches
7/7/2017
• Put more simply, ACT is interested in promoting healthy behaviors
• It understands that many of us listen to our problem solving mode
of mind when it comes to psychological issues i.e. we try to escape
feeling down/angry/anxious etc.
• However the more we try to avoid feeling these ways, the more our
lives generally constrict.
• For example
– In the real world, if we fear a future drought, we buy water. And in the
internal world, if we fear future rejection, then we make sure no-one
will ever hurt us by not connecting with people
• Sometimes the cost of avoidance can be vast
Expanding avoidance
All animals escape and avoid aversive
events
But only humans can bring aversive events
into any setting, from language combined
with experience
“Car”
CAR
That Means We Can Be Stuck
in Pain for Longer
So We Try to Avoid Pain Itself
• Experiential avoidance is built into human
language and then amplified by the culture
– Experiential avoidance is the tendency to attempt to
alter the form, frequency, or situational sensitivity of
historically produced negative private experience
(emotions, thoughts, bodily sensations) even when
attempts to do so cause psychological and
behavioral harm
7/7/2017
• the struggle is often with ourselves – what
our mind and body creates.
• That stuff is often outside our control. The
skill is to recognize that and act where we
DO have control.
ACT
• Behavioral intervention to help people
learn to live
– more in the present moment,
– more focused on important values and goals,
and
– less focused on painful thoughts, feelings, and
experiences.
Acceptance and
Commitment Therapy
• Said as one word, not letters
• A psychotherapy based on a relational
framing approach to human language and
cognition that uses acceptance and
mindfulness processes, and commitment
and behavior change processes, to create
psychological flexibility
ACT adheres to Contextual
Behavioral Science
definition of behavior
• Definition of behavior: any and all actions of
whole organisms in and with a context
considered historically and situationally.
ACT adheres to Functional
Contextualism
• Functional: What works?
• Contextualism: In a given situation
• Functional Contextualism:
– What works in a given situation (and how it works)
ACT: Accept, Choose, and Take Action
• Accept: an active process of feeling feelings
as feelings, thinking thoughts as thoughts,
remembering memories as memories etc.
CBS definition of acceptance
• "Acceptance is taught as an alternative to experiential
avoidance. Acceptance involves the active and aware embrace
of those private events occasioned by one’s history without
unnecessary attempts to change their frequency or form,
especially when doing so would cause psychological harm. For
example, anxiety patients are taught to feel anxiety, as a
feeling, fully and without defense; pain patients are given
methods that encourage them to let go of a struggle with
pain, and so on. Acceptance (and defusion) in ACT is not an
end in itself. Rather acceptance is fostered as a method of
increasing values-based action."
ACT: Accept, Choose, and Take Action
• Choose and Take Action
– Basic premise: ‘We donot control the internal
events that seemingly stand in the way of fulfilling
commitments’
– ‘Acceptance is done in the service of valued
change in the external world, not in the internal
world of private experiences’
– Principle of workability: internal events can’t be
changed, but external events can be shaped.
Goals
• To teach how to engage with and overcome
painful thoughts and feelings through
acceptance and mindfulness techniques,
• to develop self-compassion and flexibility,
• and to build life-enhancing patterns of
behavior.
Psychological Flexibility
… is contacting the present moment
more fully as a conscious human
being, as it is, not as what it says it is,
and based on what the situation
affords, changing or persisting in
behavior in the service of chosen
values.
The ACT Question
• 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?
ACT Model of Psychopathology
• The assumption of ‘healthy normality’
– Absence of disease and pain like in Greek
traditions
• The assumption of ‘destructive normality’
ACT Model of Psychopathology
• ‘Most human suffering is due to the mind’
• ‘It is not that people are thinking the wrong
thing—the problem is thought itself’ and how
we use it excessively.
• We apply language excessively to the content
of our inner world– whereas the main
purpose was to detect and evaluate external
dangers and developing plans to adapt to it.
ACT Model of Psychopathology
• We tend to describe, categorize, relate, and
ealuate our experiences all the time, thus
become ‘fused’ with our cognition
The system that traps people
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Human problems are caused
Reasons are causes
The problem of access
The real function of reason giving (p. 54)
Thoughts and feelings are good reasons
Thoughts and feelings are causes
– Only events external to the behavior can cause behavior
• To control the outcome, we must control thoughts and
feelings
FEAR
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Fusion,
Evaluation,
Avoidance, and
Reasons
FEAR
Cognitive Fusion
We have a lot of verbal labels and symbols fused with events
they describe, prior experiences, future expectations, and the
people who describe them…
FEAR
Cognitive Fusion
OUR USUAL WAY:
DO WHAT YOU FEEL
Maybe also,
DO WHAT YOU THINK, FEEL WHAT YOU THINK, THINK WHAT YOU FEEL
ACT WAY:
A thought is a thought
A feeling is a feeling
A behavior is a behavior
…Think what you think
Feel what you feel
Do what you do…
Fusion
• "Does your mind ever get in your
way?"
FEAR
Cognitive Fusion
Example: ‘I am depressed’
– ‘It is not the thought itself, but the fusion with it, and the
resulting avoidance that does the damage.’
• WHAT ABOUT:
– ‘I AM HAVING THE THOUGHT THAT I AM DEPRESSED’
FEAR
Cognitive Fusion
• When you analyze your negative thoughts further with
the goal of eliminating them, this can never work
because:
– 1. negative emotions are instrumental to our living
– 2. when we allocate attention onto negative
thoughts or feelings with the intent to eliminate
them, we tend to increase its frequency , intensity,
duration.
Defusion
is the ability to ‘step back’ and acknowledge thoughts
as the product of one’s mind.
• ACT aims to create new contexts for experiencing
thoughts (Hayes et al, 2006).
– Rather than each thought being treated as a ‘true
fact’, clients learn to experience thoughts in a
context of deliteratisation where a thought is
viewed as no more than a symbol or the product
of one’s history (Hayes et al, 1999).
• Therefore the problem is not ‘what we think’ but the
type of relationship we have with our thoughts.
WE might be hooked by many
different problems that can
happen as a result of fusion
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> You might get hooked by daydreaming, pulling your attention away from the task at hand
> You might get hooked by judgments and evaluations of self/others/life etc.
> You might get hooked by grandiose ideas, or revenge fantasies, or ideas of entitlement
> You might get hooked by reason-giving about why you can’t, shouldn’t, or shouldn’t have
to make meaningful changes
> You might get hooked by trying to be right
> You might get hooked by hopelessness or helplessness
> You might get hooked by a conceptualized self
> You might get hooked by desires for sex, money, power, drugs etc.
> You might get h ooked into dwelling on, analyzing, or obsessing about unwanted thoughts
and feelings
> You might get hooked into worrying about the future, or dwelling on the past
> You might get hooked into trying hard to avoid or get rid of unwanted thoughts and feelings
(Experiential avoidance
Fusion
"Does your mind ever get in your way?"
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Therapist actively contrasts what the client’s “mind” says will work versus what the
client’s experience says is working
Therapist uses language conventions, metaphors and experiential exercises to
create a separation between the client’s direct experience and his/her
conceptualization of that experience (e.g., get of our butts, bubble on the head, tin
can monster)
Therapist uses various interventions to both reveal that unwanted private
experiences are not toxic and can accepted without judgment
Therapist uses various exercises, metaphors and behavioral tasks to reveal the
conditioned and literal properties of language and thought (e.g, milk, milk, milk;
what are the numbers?)
Therapist helps client elucidate the client’s “story” while highlighting the
potentially unworkable results of literal attachment to the story (e.g., evaluation
vs. description, autobiography rewrite, good cup/bad cup)
Therapist detects “mindiness” (fusion) in session and teaches the client to detect it
as well
Undermining Fusion
Passengers in the bus metaphor
• Passengers On A Bus - an Acceptance &
Commitment Therapy (ACT) Metaphor.avi
Undermining Fusion
Demons on the boat metaphor
• Demons on the boat - an Acceptance &
Commitment Therapy (ACT) Metaphor.avi
Helicopter View metaphor
Internal Hijackers Metaphor
• http://www.youtube.com/watch?v=NdaCEO4
WtDU
Milk Milk Milk exercise
FEAR
Evaluation
• ACT undermines evaluation of what is bad
or what is good, that you should not ‘should’
yourself by reducing the dominance of
language
We often get ourselves into trouble by confusing descriptions
and evaluations. We often think evaluations are as solid as
prison bars, or as dangerous as real threats.
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Words cause a lot of problems for us, because when we think something, we automatically
assume that what we are thinking is real
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Thoughts can be lumped into one of two categories: Descriptions and evaluations.
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Descriptions
– Are thoughts that simply describe the directly observable aspects of things.
– Are about senses (sight, touch, smell, taste, hear) to identify descriptions.
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Evaluations: thoughts that compare events and assign an evaluative label (like good or bad,
unbearable or bearable, shameful, embarrassing, and any other way of negatively or
positively evaluating feelings events, people, or experiences).
– Evaluations are often anything that cannot be directly experienced by using our 5 senses
(sight, touch, hear, smell and taste).
We often get ourselves into trouble by confusing descriptions
and evaluations. We often think evaluations are as solid as
prison bars, or as dangerous as real threats.
• When you are faced with distress and trying to choose whether you’re
willing to experience it, notice the thoughts your mind throws at you.
– Which ones are descriptions?
– Which ones are evaluations?
How much of what you are thinking, no matter how compelling, is ‘just
talk’, just words your mind is spitting out. You don’t have to accept the
elaborate story your mind weaves around your experiences. You just
need to notice the ‘fishy’ nature of that story and take your experience
with you—as it is, and not as your mind claims it is.
Evaluation or Description?
1) Life is uncertain and difficult to predict
• a. Description
• b. Evaluation
• c. Both
4) Cancer may change my energy levels
• a. Description
• b. Evaluation
• c. Both
2) Life is unfair
• a. Description
• b. Evaluation
• c. Both
5) I am helpless
3) I am no good to anybody
• a. Description
• b. Evaluation
• c. Both
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a. Description
b. Evaluation
c. Both
FEAR
Avoidance
• We seek immediate relief of an undesirable
emotion, but the long-term effect of
avoiding is the reverse.
• Headstuck! What is Experiential Avoidance
.avi
FEAR
Reason Giving
‘People start believing in their own reasons’
• Sample-Pages-from-The-HappinessTrapPocketbook-by-Russ-Harris-Bev-Aisbett.pdf
Psychological Flexibility Model
• In a hexagon-shaped model (hexaflex)
representing 6 processes
– The four on the left are thought to be mindfulness
and acceptance processes
– The four on the right are commitment and
behavior change processes
Psychological Flexibility
… is contacting the present moment
more fully as a conscious human
being, as it is, not as what it says it is,
and based on what the situation
affords, changing or persisting in
behavior in the service of chosen
values.
The ACT Question
• 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?
ACT’s model of psychological flexibility (Hayes et al 2006)
OPEN - CENTERED/BE PRESENT - AND ENGAGED/DO
WHAT MATTERS
‘I’ IN RELATION TO MY 5 SENSES
HERE AND NOW
KNOW WHAT MATTERS
OPEN UP
WATCH YOUR THINKING
‘I’ AS AN OBSERVER
AWARENESS
DO WHAT IT TAKES
• BE PRESENT, OPEN UP, AND DO WHAT
MATTERS
Psychological Rigidity and Suffering
• ‘Pain is a natural consequence of living but
people suffer unnecessarily when their overall
level of psychological rigidity prevents them
from adapting to internal or external contexts’
Psychological Rigidity and Suffering
• Verbal and cognitive processes limit human ability to adapt to
new conditions in important ways via experiential avoidance
and fusion (cognitive entanglement)
• The range of behavioral actions are thus limited
• Loss of contact with present consequences of actions
• Inability to realize what is working and not working (what is
most effective) and inability to change course
• Continued fusing with analysis of difficulties coupled with
avoidance of aversive conditions lead to further behavioral
restrictions
ACT’s model of psychological rigidity
(adapted from Hayes et al, 2006)
Open Response
style
Acceptance
Essential
Components
of ACT
Defusion
Contact with the
Present Moment
Acceptance
Essential
Components
of ACT
Defusion
Centered
Response Style
Self as
Context
Mindfulness /
Self-as-context
‘Observer you’
Chessboard metaphor
Contact with the
Present Moment
Acceptance
Engaged
Response
Style
Values
Essential
Components
of ACT
Defusion
Committed
Action
Self as
Context
The ACT Question
• 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?
MATRIX
DESIGN
ACT formulation