DEVELOPING PSYCHOLOGICAL FLEXIBILITY TO IMPROVE QUALITY OF LIFE DR MATTHEW SMOUT SENIOR CLINICAL PSYCHOLOGIST & TEAM MANAGER CENTRE FOR TREATMENT OF

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1 DEVELOPING PSYCHOLOGICAL FLEXIBILITY TO IMPROVE QUALITY OF LIFE DR MATTHEW SMOUT SENIOR CLINICAL PSYCHOLOGIST & TEAM MANAGER CENTRE FOR TREATMENT OF ANXIETY AND DEPRESSION CLINICAL LECTURER SCHOOL OF PSYCHOLOGY, UNIVERSITY OF ADELAIDE

2 PSYCHOLOGICAL FLEXIBILITY The ability to persist or cease responding according to what the situation warrants, to best serve one s values Recognise and adapt to fluctuating situational demands Shift mindsets or behaviour when these compromise personal or social functioning Maintain balance among important life domains Be aware, open and committed to behaviours congruent with deeply held values Kashdan & Rottenberg (2010)

3 PSYCHOLOGICAL FLEXIBILITY EXAMPLES: VITALITY WITH PAIN Exercising with chronic pain or depression, because greater fitness will enable greater participation in life Giving a talk when you fear public speaking because your viewpoint is unique and could help others Asking someone out on a date when you have a fear of, as well as a desire for intimacy Enrolling at university as a mature-aged student after having dropped out when younger because the world is more interesting when you can learn more about it Hugging your daughter while experiencing contamination obsessions because you love your daughter and want her to receive affection and warmth from you Eating when you have no appetite even though you are underweight because you want more from life than a thin body Bringing your attention back to a conversation after you have drifted off, because listening to that person is important to you Asking for help when you don t trust people, because you know you can t solve all your problems by yourself Resisting a cigarette despite a craving so not to be a slave to a habit

4 THE HAPPINESS TRAP PSYCHOLOGICAL INFLEXIBILITY Evolution equipped us with: Emotions to direct behaviour A bias toward actions that increase immediate pleasure or immediately reduce pain Language cognition Western culture promotes: Dissatisfaction artificial needs expand markets Technological escalation expectation that every problem has a solution Religion, government, media communication context of focusing on what to believe We demand to live happily ever after

5 PAIN V SUFFERING Pain: an inevitable side-effect of living Suffering results from psychological inflexibility: Unwillingness to accept a reality that can t be changed at that time Thinking focused on past or future can magnify pain or enable suffering in pain s absence Arbitrary negative evaluation can negate present mood-enhancing experiences or amplify present pain Surrendering to beliefs about powerlessness and disengaging from meaningful and enjoyable activities adds loss to pain Attributing the pain s source to an unchangeable quality of the self extends suffering Rigid perseverance despite ineffectiveness maintains suffering and precludes opportunities for relief

6 PSYCHOLOGICAL FLEXIBILITY: CORE SKILLS OPEN (open up) Acceptance Defusion AWARE (be present) (contact) Present moment Self-as-context ENGAGED (Do what matters) Values Committed action

7 ACT: ACCEPTANCE Voluntarily, intentionally contacting previously-avoided psychological experiences: thoughts, emotions, physical sensations and their triggers Maintaining attention on these experiences: without resistance or conditionality, without negative evaluation with understanding, gentleness, patience, allowing -> welcoming (selfcompassion) Shifting attention flexibly between these internal experiences and other aspects of the present environment

8 ACT: DEFUSION Voluntarily, intentionally contacting thoughts (self-evaluations, rules, beliefs, images etc) [acceptance of thoughts] without accepting their truth, usual meanings or influence Methods include: Simply observing thoughts (mindfulness of thoughts) Interacting with thoughts outside literal contexts

9 ACT: CONTACT THE PRESENT-MOMENT Build through: Mindfulness of sensation Mindful activity Intentional, value-directed attention

10 ACT: SELF-AS-CONTEXT A contentless sense of self as a unique locus through time and space; not limited to your body, thoughts, emotions, abilities, roles, achievements Build through: Mindfulness of self as observer Cease repeating old self-beliefs, self-evaluations or self-stories Pursuing actions based on values and present workability; not beliefs about personal limitations

11 ACT: VALUES Qualities you freely choose to embody as a person (not those that merely suit others or constitute habits) Deliberately unattainable: continue to provide direction over time and situations Provide an alternative basis for self-evaluation in self-regulation (vs emotions, reactions of others) Clearest when calm, centred Practice: planning values-consistent responses when anticipating upcoming situations Scheduling values-consistent activities Evaluating how one behaved v how one felt in stressful situations

12 ACT: COMMITTED ACTION Organising your environment and routines to support you spending time in accordance with the balance between life domains that reflects your values Practising acceptance, defusion and flexibly, intentionally directing your attention as needed to overcome obstacles to valued living Urges to quit/escape/not persist Urges for immediate gratification

13 ACT OUTCOME RESEARCH 100+ RCTs Problem areas include: Depression, anxiety, OCD, pain, psychosis, workplace stress, substance abuse, other health (tinnitus, epilepsy) Delivery: individual, group, self-help book, internet-delivered Meta-analyses: effect-sizes Vs WLC, psychological placebos: g = 0.63 (Ost, In press) Vs TAU: g = 0.42 (Powers et al., 2009) g = 0.55 (Ost, In press) Vs Active psychotherapy (post-test): g = 0.18 (Powers et al., 2009) - g = 0.40 (Ruiz, 2012) Limitations in RCTs but no evidence of harm or reduced efficacy

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