Psychology: Acceptance and Commitment Therapy
natalia.na
ACTSeminar-Part3LectureSlides-Sp2020-1.pptxAcceptance and Commitment Therapy-PSYC 498/598
Spring 2020 quarter
Kevin Criswell, Ph.D.
Just so you all are aware, students with the accommodation to do so may be audio recording this seminar.
As Steve Hayes said in his TEDx talk in Nevada, “Life asks us questions…and one of the most important questions it asks us is, ‘What are you going to do about difficult thoughts and feelings?’”
1
Open Up
Open Up: Defusion
“Defusion”? “Fusion”? What are you talking about?
Cognitive fusion: becoming “fused” with an idea that the mind brought up.
What “cognitive fusion” can look like:
Clipboard metaphor
“I am angry.”
“It would be great to see my good friend, but I am tired right now.”
And other ways we buy into the thoughts our mind brings up…
Open up: Defusion
What cognitive defusion can look like:
Feeding the tiger metaphor
Chessboard metaphor
Fix-it metaphor
“I am having the feeling of anger right now.” (see relationship to mindfulness here)
“It would be great to see my good friend, and I am tired right now.” (a glimpse into how DBT and ACT are similar in some emphases)
Titchener’s repetition
Leaves on a stream
Open up: Titchener’s repetition
Literally saying a word repeatedly for at least 40 seconds.
I want you to imagine cookies. Freshly-baked, your favorite variety (if you don’t like cookies, this will still work; just imagine them as best you can!).
Now say “cookies” rapidly as you can for 40 seconds straight…
GO!
Open up: Titchener’s repetition
Reflection (handout):
Were you able to imagine freshly baked cookies? How powerful would you say the image was to you?
As you said “cookies” rapidly over 40 seconds, what happened to that image that you had of cookies? Did you feelings or thoughts about cookies change at all?
Imagine using other words that have significant emotional or cognitive load:
Depression
Anxiety
PTSD
And more…
Open up: Leaves on a stream (meditation)
Another cognitive defusion exercise that is commonly combined with mindful awareness to detach from the natural function of our minds: to come up with thoughts constantly.
This has other versions that involve the same concept:
Clouds in the sky
Mind Train
Thoughts are placed on leaves and the individual is invited to observe the natural passing of thoughts, without the need to buy into or pause and seriously consider any of the thoughts as they float by.
Open up: Acceptance
Acceptance can be equated with the idea of willingness to experience discomfort in the service of living consistently with one’s values.
“…feel what is there to be felt even when it is hard.” (TEDx Talks, 2016, February)
In my opinion, this is the most difficult therapeutic process to facilitate.
The “sales pitch” for this is tough: “I want you to accept and/or be willing to experience discomforts that come along with living according to your values.”
I like front-loading the “why” one wants to change (i.e., values) and the “how” to make careful decisions about how one lives (i.e., building a strong “mindfulness muscle”).
Open Up: Acceptance
Consider (handout): When focusing on psychological pain, what are the things we ought to accept vs. the things we do not need to accept?
“Fix-it” metaphor
“Chinese Finger Trap” metaphor
“Quicksand” metaphor
A (possibly) helpful delineation: The “world within” vs. “the world without”
The point: The answer is going to be different for everyone, given different individual circumstances across different stages of life. This is why being client-centered here can be so critical.
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Open Up: Acceptance
Meditation for Working with Difficulties
Reflection: Please take some notes on the following:
How willing did you feel as you considered difficulties during the exercise?
How much do you think that willingness to have a difficulty (a difficult thought or a difficult emotion) is tied to living a vital, values-based life?
Note: Just engaging in personal meditations is probably insufficient to truly build up willingness to experience necessary discomfort.
Self-monitoring methods can facilitate this process (e.g., “struggling vs. opening up worksheet”)
Open up: Acceptance
The interesting part: This process is not unique to ACT
“Vulnerability”
“Emotional Openness”
Given the empirical convergence, this typically suggests an important, transtheoretical process.
In other words: Willingness to experience discomfort along the way of a values-based life seems to be an important construct that impacts psychological wellbeing.
Putting it All Together
Let’s watch another TED Talk by Steve Hayes: https://www.youtube.com/watch?v=o79_gmO5ppg
How did he describe ACT in this talk?
How was this different compared to the talk I showed you towards the beginning of this seminar?
My take: This is an excellent example of an integrative framework of therapy, which is founded on the ACT approach to treatment.
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Psychological Flexibility
(1) Given a distinction between you and the stuff you are struggling with and trying to change
(2) are you willing to have that stuff, fully and without defense
(3) as it is, and not as what it says it is,
(4) AND do what takes you in the direction
(5) of your chosen values
(6) at this time, in this situation?
If the answer is “yes,” that is what builds...
ACT question (ACBS, 2019):
Psychological flexibility
Clinical Example of Applying ACT
Treating anxiety-related issues with an ACT-based approach
Let’s read about the History involved in this case study together (See the Case Study in your handouts).
Clinical Example of Applying ACT
Partners/groups: How would you describe ACT to this client, assuming he has never tried an ACT-based treatment before?
Feel free to try to come up with your own metaphors or
Feel free to use some of the metaphors we already covered.
Note: Try connecting his issues that he struggles with to how ACT may be helpful to him.
Let’s broadly separate the course of treatment into 2 sections: Early and Later Sessions
Early sessions
From an ACT perspective, what are the most important things that James should work on during the first 2-3 sessions (think of the ACT Hexaflex or Triflex)?
Given the important things you identified above, can you think of some ACT exercises or practices that would help him improve during the first 2-3 sessions?
Course of ACT-based treatment: The Later Sessions
Later sessions
From an ACT perspective, what are some things you anticipate that James will need to continue working on for several sessions (think of the ACT Hexaflex or Triflex)?
Given the things you identified above, can you think of some ACT exercises or practices that would help him improve during the later sessions of ACT-based therapy?
What was the “textbook” course of treatment?
Let’s listen to the remainder of the case study of James (listen to my reading of the case, as written in the article by Eifert et al., 2009).
An important message: “Although we outline the treatment program in the form of session-by-session guidelines, the actual delivery of ACT is more akin to a fluid dance around several core processes rather than a linear progression…At a practical level, this means that concepts, metaphors, and exercises introduced early on, may be revisited again at any time they seem relevant. Therapists are encouraged to sequence and apply exercises and metaphors in a flexible and creative fashion” (Eifert et al., 2009, p. 370).
feeling better…
Choice
Feel better
Feel better
Seek pleasure
Avoid discomfort
Narrowing
“Bad” emotions are to be “fixed”
Emotional openness
Willingness/acceptance
Commit to personal values
All emotions can be experienced
Canvas Discussion Assignment(S)
Participation credit for Module 3: Brief Discussion post
Due by 11:59pm on June 7th
Carefully follow directions on the discussion assignment page!
Reflection Discussion Assignment (Everyone)
Due by June 7th by 11:59pm
Follow directions to get full credit!
Application Discussion Assignment (Graduate-level only-PSYC 598)
Due by June 7th by 11:59pm
Follow directions to get full credit!
Curious about ACT want to learn more?
Check the Canvas Course page.
ACBS website: https://contextualscience.org/about_act
Free Materials via “ACT Mindfully” (R. Harris): https://www.actmindfully.com.au/free-stuff/
The Happiness Trap (illustrated version available) and ACT Made Simple by Russ Harris
Get out of Your Mind and into Your Life by Steve Hayes
References
APA.org. (2012). What Are The Benefits of Mindfulness? Retrieved from https://www.apa.org/education/ce/mindfulness-benefits.pdf
Association for Contextual Behavioral Science (ACBS). (2019). State of ACT Evidence. Retrieved July 1, 2019, from https://contextualscience.org/state_of_the_act_evidence
Association for Contextual Behavioral Science (ACBS). (n.d.). About ACT. Retrieved from https://contextualscience.org/state_of_the_act_evidence
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7-18.
Eifert, G. H., Forsyth, J. P., Arch, J., Espejo, E., Keller, M., & Langer, D. (2009). Acceptance and Commitment Therapy for anxiety disorders: Three case studies exemplifying a unified treatment protocol. Cognitive and Behavioral Practice, 16, 368-385.
Harris, R. (2009). ACT made simple. Oakland, CA: New Harbinger Publications.
Hayes, S. C., Pistorello, J., & Biglan, A. (2008). Acceptance and Commitment Therapy: model, data, and extension to the prevention of suicide. Brazilian Journal of Behavioral and Cognitive Therapy, X(1), 81-102.
Hayes, S. C. (2005). Get out of Your Mind & into Your Life. Oakland, CA: New Harbinger Publications.
Kashdan, T. B., & Rottenberg, J. (2010). Psychological flexibility as a fundamental aspect of health. Clinical Psychology Review, 30(7), 865–878. doi:10.1016/j.cpr.2010.03.001
Purser, R. (2015). The myth of the present moment. Mindfulness, 6(3), 680-686.
Society of Clinical Psychology. (SCP) (2016). Treatments Home. Retrieved June 30, 2019, from https://www.div12.org/psychological-treatments/
TEDx Talks. (2016, July). Mental Brakes to Avoid Mental Breaks | Steven Hayes | TEDxDavidsonAcademy [Video file]. Retrieved from https://www.youtube.com/watch?v=GnSHpBRLJrQ
TEDx Talks. (2016, February). Psychological flexibility: How love turns pain into purpose | Steven Hayes | TEDxUniversityof Nevada [Video file]. Retrieved from https://www.youtube.com/watch?v=o79_gmO5ppg&t=87s
Self as
Context
Contact with the
Present Moment
Defusion
AcceptanceCommitted
Action
Values
