ACCEPTANCE AND COMMITMENT THERAPY Sources Hayes S C

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 3/19/2018

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 3/19/2018

• 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 v. 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 3/19/2018

• 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 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 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 • • 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 • • • > 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? " • • • 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; 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=Nda. CEO 4 Wt. DU

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. • Words cause a lot of problems for us, because when we think something, we automatically assume that we are thinking is real • Thoughts can be lumped into one of two categories: Descriptions and evaluations. • Descriptions – Are thoughts that simply describe the directly observable aspects of things. – Are about senses (sight, touch, smell, taste, hear) to identify descriptions. • 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 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 • a. Description • b. Evaluation • c. Both 3) I am no good to anybody • 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-Happiness. Trap. Pocketbook-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

Centered Response Style

Mindfulness / Self-as-context ‘Observer you’ Chessboard metaphor

Engaged Response Style

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