Section 6: Self as Context- Acceptance and Commitment Therapy (ACT)

Values

1. Connecting with Values 2. Making values psychologically present. 3. Making values specific and tangible. 4. Desired qualities of ongoing action 5. Heart's deepest desires for how you want to behave as a human being 6. How you want to treat anyone or anything 7. Qualities you want to embody 8. Can usually be said in one or two words

Evolution of ACT: Third Wave

1. Contextual CBT 2. Relational Frame Theory (RFT): **An empirically supported theory of mind (language & thoughts) ((Brain is neural net that makes connections and associations **Once they are there, they stay there ( i.e Mary had a little... lamb) **Do not think about it for 30 seconds, thought suppression does not work, will still think about it 3. CBT developed more from the field then the laboratory; Identified problematic thinking and worked to change it; point out it was wrong; practice disputing strategies, use logic and reasoning to CHANGE these thinking errors.

Consider What You Tell Yourself

1. I am a person who... 2. I am a person who does not... 3. Pragmatist- are thoughts working for you? 4. Are some of these unhelpful for you? **This is your "I'm Not Good Enough" Story **Listen and believe them, respond in ways that move you away from life you want to live, not good

Defusing Language: Self-as-Content vs Self-as-CONTEXT

1. I am anxious (self-as-content) **I am having the sensation of anxiety (self-as-context) 2. I AM A FAILURE (self-as-content) **I am having the thought that I am a failure (self-as-context) 3. I MUST DRINK (self-as-content) **I am having the urge to drink (self-as-context) 4. My beach towel; it does not WANT the sand on it; it does not TOLERATE the sand on it; the towel does not resist, attract, or try to control the sand on it. It is simply a container for the sand. 5. Like the towel, we are ACCEPTING when we are WILLING to be a container for the many thoughts, feelings, memories, and other experiences without an effort to control or change in any way

Step-by-step DeFusion: Step 1

1. IDENTIFY 'PROBLEMATIC' THOUGHTS 2. What does your mind say to you about that? 3. When your mind wants to beat you up/ hold you back/ bring you down, what kind of things does it say to you? 4. If I could listen in, what would I actually hear inside your head?

Step-by-step DeFusion: Step 2

1. IDENTIFY CONSEQUENCES of FUSION 2. When you get hooked by these thoughts, what happens? 3. How does your behavior change? 4. And how does that impact on your life? 5. What is function of thoughts inside head? **Avoid my friends, isolate, drink, etc.

Human Suffering is Universal

1. If anger were not such a problem for me, I would have more satisfying intimate relationships 2. If I did not have so much stress, I would work harder at my career and find the job I always dreamed of having 3. People suffer. We all have painful experiences, memories, thoughts, or emotions that we struggle to bear. 4. But it is important to distinguish the natural (Clean Pain) that we all experience as a normal part of life (death of a friend or relative, the loss of a loving relationship) with the suffering associated with trying to avoid this pain (Dirty Pain). 5. Sometimes this process of avoidance is not easy to see. **Boys get message they should not cry, maybe choose aggression **Maybe they cry alone, avoid social setting and connection with others

A Different Approach to Traditional CBT

1. Instead we establish a special environment in therapy that diminishes unhelpful control by difficult thoughts and feelings 2. You have a thought, it is there, can not unthink it, objectify it (make it into object), stop fighting it 3. "I will always be a failure", ((Thank your mind for that thought, it is okay to have that thought, let's say failure 100 times, if that thought was an object, what would it look like? 4. Say word for 30 to 45 second Loses its meaning and connections

DeFusion Techniques

1. Just notice what your mind is telling you right now **Is this a helpful thought? Is this a good use of my time? 2. Notice the form of the thought by describing it **Is it words, sounds or pictures? What does it sound like? 3. "That is an interesting thought" **Buying a thought (fused with it) vs having a thought (my mind is saying I am this or that, thank you mind, I am going to move forward) **Recognizing it as a thought creates distance 4. Label your thoughts **("I am having the thought that . . .") **Say it slowly, sing it, say it in a different voice **Recognize it as thought, not something that is about you 5. Thank your mind 6. Mind vs Experience ("workability" not "truth") **Truth does not matter, reality is subjective, make judgement **How is that thought working for you? Pragmatic focus. **Is it moving you in bad direction?

Results of DeFusion

1. The content of thought remains and is no longer struggled with. 2. The thought loses its behavioral regulatory functions **This means the thought no longer organizes your behavior. **Become condition to certain thoughts, leads to unhelpful behavior **Think of dog salivating in response to tone **Hear tone (thought), do not respond same way

Applied Willingness: Putting Values Into Action

1. The roots of ACT are not as a Cognitive intervention, but as a Behavioral intervention 2. Ultimate aim is not to FEEL Better Feelings 3. But to LIVE A BETTER LIFE 4. Better = what moves client toward their values 5. How do I not let negative thoughts and feelings impede me from living the life I want to live

Cognitive Fusion

1. The tendency of human beings to get caught up in the content of what they are thinking so that our thinking dominates how we view and react to the world. 2. Nobody likes me; I am no good; I have nothing to contribute; I am ugly 3. Lose sight that is simply a thought or idea they could detach from, label you apply 4. Becomes so fused with identity, believe it, part of who we are, just who I am 5. Believing what our minds are saying (self-fueling process) **Nobody likes me; I am no good; I have nothing to contribute; **Avoid social situations, ignore strengths, offer nothing **SEE! I'm all alone. 6. Fusion with thoughts organizes behavior, often in unhelpful ways 7.It is not what we think that is a problem, it is how we relate to what we think

Functional Contextualism: I am not good enough

1. Change the FORM **Dispute this as irrational **Provide evidence this is not true **Chastise myself for saying such mean things to myself 2. Change the function **Is listening to this thought moving me in the direction of my values **Is following this thought workable for me **Can I recognize this as a THOUGHT that I can choose NOT to listen to

Evolution of ACT: Second Wave

1. Cognitive-Behavioral Paradigm (CBT) (value to both sides of schism) 2. Including 'mental' processes, addressed out of practice, but... **Ellis was rough, why can you not accept you are messed up, we all have irrational thoughts 3. Lacked coherent scientific base 4. Did not work for everyone, some could still not refute bad thoughts

Your Mind and ACT

1. Car as metaphor for your mind, super powerful, gets you where you need to go 2. Can go on automatic drive, 3. ACT reigns it in, gets it under control

Finding the Context from which you experience the world

1. I AM NOTHING! **The Conceptualized Self (Self-as-Content) **a descriptor 2. I AM NO THING **The Observer Self (Self-as-Context)

Acceptance is the opposite of EXPERIENTIAL AVOIDANCE

1. 'Experiential avoidance is the phenomenon that occurs when a person is unwilling to remain in contact with particular private experiences (e.g., bodily sensations, emotions, thoughts, memories, behavioral patterns) and takes steps to alter the form or frequency of these events and the contexts that occasion them' (Hayes et al., 1996). 2. Overuse of substance relates to this, self medication, can not deal w/ thoughts, need to escape 3. Do not seek out social connections because of self-doubt (weak, no good)

Functional Contextualism

1. A focus on the CONTEXT & FUNCTION of psychological phenomenon **Not just their form 2. This is fundamentally different than traditional forms of CBT 3. Approach to Problematic Thoughts or Beliefs: **Do NOT dispute or try to change them (form) **ie it is just irrational **DO explore how they are working (function) -Does it impede functioning, how you act, your behavior -Call inviting you to speak at conference =think I am not good enough -Thoughts could impede you from acting, say you have too much on your plate, but really just a response to negative thoughts

ACT Said Simply

1. ACT uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility (that's the goal)

6 Core Processes: The "Hexaflex"

1. Acceptance 2. Defusion 3. Contact with the present moment 4. Committed action 5. Values 6. Self-as-context **Enhancing them enhances psychological flexibility

Let Go

1. Acceptance 2. Defusion 3. Requires contacting inner self, and being in the present moment

Acceptance, is the opposite of...

1. Behavioral Avoidance **I'll never find a spouse **I'll never be successful **So fused with thought, act in way that is consistent with thought **Self-fulfilling prophecy 2. Distraction **What can I complain about now **Let me tell you how it is someone else's fault **Video games, social media, or TV **Look at things other than what is happening in own life 3. General numbing of experience **Alcohol **Drugs

Values Assessment

1. Behavioral focus is NOT: **What is your Dx; your problems... 2. Behavior focus IS: **In what direction do you want to take your life **Family, social, employment, health... 3. Values **You may feel hopeless and unhappy because you are not moving in YOUR intended direction

Evolution of ACT: First Wave

1. Behaviorist Paradigm: Examining the contingencies that regulate behavior 2. Skinner breakaway from psychodynamic theory **Looks at observable behavior 3. Schism between behaviorists and cognitivists **Behavior vs. cognition

Step-by-step DeFusion: Step 3

1. FUSION IS THE PROBLEM 2. So when you get hooked by/pushed around by/ caught up in/ fused with these thoughts, they have a big impact on you. 3. The more you get fused/hooked/caught up/pushed around by them, the more stressed you are, the more you get stuck, the harder life gets

Control as the Problem

1. How can we help them remember to Accept what they can't change, that control is not the answer **If only there was some catchy phrase to remember this... 2. God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

ACT Question

1. Given a distinction between you and the stuff you were struggling with and trying to change, are you willing to have that stuff fully and without defense, as it is, and not as what it says it is, and do what takes you in the direction, of your chosen values, at this time, in this situation? 2. If answer is yes, that enhances psychological flexibility, that is ACT 3. Acceptance= you willing to have that stuff fully and without defense 4. Defusion= as it is, and not as what it says it is **All kinds of things that you believe in your head are not true, can you defuse from them? 5. Contact with the present moment=at this time, in this situation? 6. Committed action=and do what takes you in the direction 7. Values= of your chosen values, 8. Self-as-context=Given a distinction between you and the stuff you were struggling with and trying to change (distinction between you and your mind)

Creative Hopelessness & Self-as-Context and Contact with the Present Moment

1. Hopelessness **Have you struggled with this problem for a while? **And have efforts to manage it on your own worked? **NO, We are not saying you are hopeless! **But the status quo may be... **Saying: is there a sense of futility in breaking free of patterns (thoughts of anxiety, substance abuse, etc.) 2. Creative **Become AWARE of this sense of hopelessness **Embrace it and use it to direct change 3. Self-as-context **Is there a part of you, deep inside, aware that just maybe, life is not going as planned. 4. Contact with the Present Moment **Moment of clarity; Honest self-reflection **NOTE Overlap with AA: We admitted we were powerless over alcohol - that our lives have become unmanageable What you have been trying not working, something different has to happen

Contact with the Present Moment

1. Mindfulness 2. Being in touch 3. Relapse after sustained sobriety, I wasn't thinking, I just bought the alcohol, need to switch off autopilot, need to be aware in present moment when around alcohol

Step-by-step DeFusion: Step 4

1. NORMALIZE 'NEGATIVE THOUGHTS' 2. These are perfectly natural thoughts that most people have 3. My mind is very much like your mind Normal to get stuck in ruts 4. Be present in moment, recognize you are stuck, do I always have to respond this way?

Step-by-step DeFusion: Step 5

1. New Possibility 2. I don't know how to stop your mind from generating those thoughts. 3. But I do know a different way of responding to them, so that when they show up, you don't have to get all caught up in them. 4. You don't have to struggle with them or get pushed around by them. 5. Would you be interested in learning how to do that?

Values vs. Goals

1. Nurturing, maintaining and caring for my body (value) **Lose 10 lbs. (goal) 3. Get a great job (goal) **Being helpful, friendly and responsible in the workplace (value)

RFT

1. Our wonderful minds make associations 2. There is no process of UNLEARNING these associations 3. Efforts to change or control these associations are the problem

Acceptance: Pain vs Suffering

1. Psychological pain is NORMAL **Can NOT get rid of it 2. Pain is different than Suffering The struggle to escape normal psychological pain is what leads to suffering

Self-as-Context: Three Senses of Self

1. Self-as-content (conceptualized self or story) **I'm a psychologist! **Descriptors, judgements, evaluations 2.Self-as-Process (moment-to-moment awareness of internal & external stimuli) **I'm giving a lecture. Are they bored? Do they like me? Is my hair ok???? 3. Self-as-Context **You as a point of reference **When you challenge self-conceptualizations, people need something to hang on to, there is a you separate from those self-concepts

Show up

1. Self-as-context **Need to understand there is word machine in head, and there is you 2. Contact with the present moment

ACT Even More Simply

1. Show Up **Be present and there 2. Let Go **Of unhealthy thoughts 3. Get Moving **Move in direction you want to move 4. Living a rich, full life with less struggle.

Self-as-Context

1. The "you" that was aware of the sounds, sensations. 2. The Observer Self. 3, Not "thing-like." No "there" there 4. Perspective from which... 5. Best conveyed through metaphors 6. Spirituality?

DeFusing Language: Making Room For ACCEPTANCE

1. The Solution is to EXPERIENCE these emotions, thoughts, & memories 2. Gain Awareness that you are responsible **Read as RESPONSE-ABLE **Find you, you can change 3. A Willingness to have unpleasant thoughts, feelings, memories, and urges

Traditional CBT

1. Uses interventions to alter thoughts and feelings **"I will always be a failure" is irrational, overgeneralization, black and white thinking, aren't you sometimes a success? 2. From an modern behavioral point of view we worry about that strategy, since these kinds interventions could elaborate and complicate the network, and paradoxically increase the functions of negative thoughts and feelings

Get Moving

1. Values 2. Committed Action

Committed Action

1. Values provide the compass...commitment provides the walking. 2. Voting with your feet. Don't tell me what matters, show me what matters... (goals connected to values) 3. Traditional behavior therapy methods exposure, social skills training, behavioral activation 4. Build patterns of actions over time 5. Outside Willingness (vs. Inside Willingness or Acceptance) 6. Commitment: Be willing to do what you need to do (actual forward movement now) to live a rich full life... 7. Acceptance: Be willing to experience whatever shows up (privately) as you take those steps forward. 8. Try not. Do, or do not. There is no try." Yoda 9. If we don't decide where we're going, we're bound to end up where we're headed. Chinese saying

Acceptance

1. What comes to mind? 2. What it is not: **Tolerating, putting up with **Resignation **Defeat, a "less than" alternative 3. What it is: **An act, a behavior, a move **Openness, without defense **Dropping judgment **Recognize control as the problem

DeFusing Language

1. When Control is the Problem, Try DeFusion 2. The Solution is to Alter the FUNCTION of these emotions, thoughts, & memories 3. Many of these verbal relations have a set FUNCTION 4. I AM ANXIOUS **I will drink to reduce this anxiety because I can't bear it. 5. I AM A FAILURE **I might as well get drunk, since I am a failure anyway. 6. I MUST DRINK **This urge is just too strong, I can't resist it 7. The goal of DuFusing language is not to get rid of these feelings. 8. The goal is to gain some distance, Be in touch with the Present Moment so you can see these thoughts and not act FROM these thoughts. 9. These thoughts and reactions are like your Hands in your Face. **Up close to your eyes so you can't see. Move them away, gain some distance.

The Conceptualized Self

1. Your 'conceptualized self' is important and often useful. You wouldn't want to get rid of it 2. You may even want to work on developing it 3. But hold it lightly - it is not you! **Just things you say about yourself

According to ACT and RFT:

1. normal language & cognitive processes are at the heart of most suffering 2. Russ Harris: The "I'm Not Good Enough" Story **The Happiness Trap, writes about ACT **Story about he as a medical doctor, published author, will still struggle with thoughts that he is not good enough 3. Remembering nursery rhymes is harmless enough, but what happens when the association is not so nice...