Acceptance and Commitment Therapy in Clinical Practice

Transcription

1 Acceptance and Commitment Therapy in Clinical Practice with John P. Forsyth and Jamie R. Bolles Fellow Travelers on this life journey University at Albany, SUNY Our Intentions & Yours and, an invitation if for only 1.5 days 1

2 -- Hayes, Strosahl, & Wilson, 1999 Kessler et al.,

3 Kessler et al., 2005 (Drum et al., 2008). (Drum et al., 2008). 3

4 4

5 5

6 6

7 7

8 A human mind is a wandering mind, and a wandering mind is an unhappy mind -- Matthew A. Killingsworth and Daniel T. Gilbert 8

9 9

10 10

11 The Social Programming And Message is this: It s normal to be happy Pain isn t normal Pain is a problem to be solved 11

12 And when it doesn t work? We do more of the same & keep running (from ourselves!) 12

13 Pain is Inevitable, Suffering is Optional 13

14 14

15 15

16 Dominance of Conceptualized Past and/or Feared Future Experiential Avoidance Lack of Values Clarity Psychological Inflexibility Cognitive Fusion Inaction, impulsivity, avoidant persistence Attachment to Conceptualized Self In the Room Moment to Moment Watch for Hardening Lack of Vitality Repetition Seems Old Attachment Pulling Back, Turning Away Weak or Absent Purpose or Life Direction Your own work helps 16

17 (2) are you willing to have that stuff, fully and without defense Acceptance Opening Up Defusion Watch Your Thinking The Present Moment Be Here, Be Now Psychological Flexibility Be Present, Show Up, and Do What Matters (6) at this time, in this situation? Values Know What Matters Committed Action Do What Works (5) of your chosen values (4) AND do what takes you in the direction (3) as it is, and not as what it says it is, Self as Context Observing Self (1) Given a distinction between you and the stuff you are struggling with and trying to change 17

18 BE PRESENT Contact With the Present Moment Self-as-Context Defusion OPEN UP Acceptance Psychological Inflexibility Committed Action Values DO WHAT MATTERS 18

19 ACT 19

20 Making Room for New Possibilities 20

21 Why we stick with it It works elsewhere It seems to work for others You are told it should work for you It even SEEMS to work short run What have you tried? How has it worked? What has it cost you? FOCUS ON WORKABILITY What Does the Client s Experience Tell Them? 21

22 Delete A Memory Numb Your Leg Falling in Love Perfect Polygraph 22

23 23

24 Context for the work and what we are working toward What are your goals for therapy? The next five years? Your life? Where do you see yourself in two years? What do you want to achieve? What do you hope to accomplish? How do you want to live your life? Adventure is in the journey, not the destination. How you get there matters. 24

25 Distinguishing Values from Goals What do you want your life to stand for? What s most important to you? If wasn t such a problem for me, then I would? Experiential Exercises Listen To Your Heart Do Epitaphs & Review Funeral or Retirement Party 25

26 OR Yoouurr Naamee:: Yoouurr Naamee:: Let s start with the valued directions worksheet Value Value Value Value 26

27 What stands between you and you living out your values You can toss one, but not without getting rid of the other. 27

28 Internal historical Barriers Thoughts Feelings & urges Memories Physical sensations External Barriers Use problem solving Brainstorming Task analysis (small units) 28

29 Changing your relationship with your history Showing up right where YOU are 29

30 Mindfulness Paying Attention On Purpose In the Present and Without Judgment How do we nurture this work in ourselves and our clients? 30

31 Values Daily opportunities for mindfulness practice 31

32 The Observer YOU Watch for. Rules about life Reasons Judgments Dwelling in past or future Self ( I am Posture (hardening) Getting hooked, entangled, snared 32

33 Watch your thinking Normalize thinking Mind as an entity Look at thoughts Notice thoughts Disarm the mind playfully Ask Is this thought helpful in the service of my values? Reduce the hooks for struggle Getting off Butt(s). Using AND I m having the thought that Thank your mind for that thought Apply Gentleness ACTs of Kindness and Compassion Facing Our Demons Using Exposure Within ACT 33

34 Taking Care of Old Wounds Nurturing compassion, forgiveness & Kindness It s like you re surfing The same wave that can be a source of pain, can be a beautiful flowing grace and source of power. It s all a matter of how you respond to it. -- Trey Anastasio Tonglen Practice Giving & Receiving Breathe in & welcome pain Breathe out & give away relief My pain is being felt by millions of people all over the word. I m not alone! 34

35 You & Your Hurts Someone You care for who is suffering Someone You dislike or are indifferent toward Strangers People you will likely never know On the Spot too! Facing Fears in the Service of Values 35

36 Meaning of a word The action of uncovering or leaving without shelter or defense; unsheltered or undefended condition To lay bare; to lay open to attack, danger, or anything objectionable; to render accessible to anything which may affect, especially detrimentally To deprive of concealment; to discover; to lay open to public inspection, or bring to public notice Where does it show up in ACT? 36

37 EVERYWHERE Acceptance Opening Up Defusion Watch Your Thinking The Present Moment Be Here, Be Now Psychological Flexibility Be Present, Show Up, and Do What Matters Self as Context Observing Self Values Know What Matters Committed Action Do What Works Exteroceptive In vivo actually confronting feared stimuli Applied tension variant of in vivo exposure for blood- injection- injury phobia In Virtuo virtual reality technologies Interoceptive Imaginal guided imagery, scripts Writing exercises about painful events Inducing physical arousal exercise, breathing Systematic desensitization - - imaginal What is exposure in the service of? 37

38 There s no law in the universe that says you must feel at ease around dogs or that you should like them or like thinking and feeling discomfort So, why are we doing this? Let s make this be about something... Your life! Are you willing to find out what it s like to be inside your skin, without defense? Let s see what s there to be thought and felt Are you willing to do that if that meant? If yes, then can be arranged in a hierarchy like CBT Identify exercise link barriers with values. Practice exercise (intero & exteroceptive) in- session & bring client value(s) in the room. Client to apply mindful- acceptance skills. Chart progress getting with discomfort just as it is. Use the FEEL PRACTICE FORMS. Reflect on practice. Repeat exercises (can be arranged in hierarchy). Review ratings on FEEL PRACTICE FORMS. 38

39 Bring client s awareness to other events inside and outside There is more to notice than the psychological lion in the room Let s watch ACT exposure in ACTion Steve Hayes with Troy 39

40 Work with the client for behavior change in the service of chosen values Make room for all their automatic reactions and experiences Help client take responsibility for patterns of action, building them into larger and larger units Think small What is the client willing to do? Select activities Based on YOUR values Make commitments To act on YOUR values Use Value and Goals Worksheet Brainstorm baby steps toward value Take a step & move with barriers Mindfulness & defusion strategies Practice patience, kindness Embrace the moment 40

41 Poor Examples of Goals Exercise More Eat Better Go back to school Meet new people Save money Good Examples of Goals Walk 2 times a week (15-30 min) Eat at least 1 piece of fruit per day Take a writing course at a community college in Sept. Sign up for a hiking course and have a conversation with a new person on every hike Put $100 in my savings account each month Travel Be less anxious Go to Paris on my 40 th birthday Practice relaxation exercise once a day Practice exposure exercises Complete exposure exercises weekdays between 7 and 9pm Bus Driver Exercise: My Life Bus Navigating Value Conflicts Watch for Relative importance Win- win or win- lose Balancing acts Short changing values Support Flexibility Life as a dance 41

42 Common therapist problems: Inconsistencies in control vs. acceptance Trying to convince the client, to be right, and to understand all are intensely verbal One- up vs. compassionate caring non- judgment Excessive focus on any one area - - see Hexaflex Lack of understanding of model and processes - over time you will need to grapple with the materials Tricky client behaviors: Superficial agreement Fluid shifts in content into more comfortable areas Client behavior that pushes our buttons Am I doing this right? Am I using mindfulness or defusion to avoid? Slipping into old patterns Still hanging on to old hopes that anxiety will go away Falling off the path not practicing & applying skills Not seeing how the skill set applies to other areas (e.g., anger, depression, loneliness, lack of motivation, fatigue, illness) Losing sight on values why am I doing this? 42