Presentation on theme: "Wisconsin Public Psychiatry Network Teleconference (WPPNT) This teleconference is brought to you by the Wisconsin Department of Health Services (DHS) Bureau."— Presentation transcript:
Wisconsin Public Psychiatry Network Teleconference (WPPNT) This teleconference is brought to you by the Wisconsin Department of Health Services (DHS) Bureau of Prevention, Treatment, and Recovery and the University of Wisconsin-Madison, Department of Psychiatry. The Department of Health Services makes no representations or warranty as to the accuracy, reliability, timeliness, quality, suitability or completeness of or results of the materials in this presentation. Use of information contained in this presentation may require express authority from a third party. 1
An Exciting New Treatment Approach Amanda Krupp, MFT
Acknowledgements THANK YOU Steven Hayes, Kirk Strosahl, Kelly Wilson, and others for developing this amazing therapy model ACT community for being open and generously sharing there materials Ciarrochi, Blackledge & Mercer (2006) for providing the images related to ACT processes
Acceptance & Commitment Therapy (ACT) “ACT is a therapeutic approach that uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility.” Hayes, Wilson, Strosahl, 1999
Goal of ACT Live a rich, full, meaningful life with less struggle
The Serenity Prayer (Reinhold Neibuhr) God grant me the Serenity to accept the Things I cannot change, Courage to change The things I can, And wisdom to know the difference But How???
Acceptance & Commitment Therapy (ACT) So What is ACT? A behavioral & experiential model of therapy Based on a new model of why humans suffer Provides a model of how one might respond more effectively to suffering Aims to help people live a vital and meaningful life
Traditional Perspective of Suffering Humans, given the right circumstances, are naturally psychologically healthy, happy and content Psychological pain is abnormal, meaning something is wrong that needs to be fixed If we are suffering due to difficult thoughts, feelings, or emotions, then we should (and can) avoid, reduce, alter, or eliminate them
ACT Perspective on Suffering ACT assumes that the normal psychological processes of the human mind (thoughts, feelings, memories) are often destructive, and create psychological suffering for all of us at some point If we are suffering, that means we are stuck, not broken or sick
ACT Perspective on Suffering Look to your experience. Have you met anyone who has never experienced... Sadness Fear Anxiety Negative thoughts Scary dreams Bad memories These are normal human experiences Our suffering is due to our use of language and our attempts to control our internal experiences
Philosophical & Theoretical Foundations Relational Frame Theory Our mind makes arbitrary connections between things. Connections are based on history and context Apple Tastes Yummy Healthy If I say “Sand,” what shows up for you?
Philosophical & Theoretical Foundations: RFT It’s futile and frustrating to control the uncontrollable (Our Mind) Example: Whatever you do, don’t think about a PINK ELEPHANT Our mind has made associations between things and your body will react accordingly, but it doesn’t mean your mind is right. Example: Tornado Siren
Psychopathology evolves in part because We let our mental activity dictate our behavior “Language... has created the word “loneliness” to express the pain of being alone. And it has created the word “solitude” to express the glory of being alone. Paul Tillich
Brief Example A girl is riding a horse outside. It is windy. The horse at one point bucks and she falls off. She forms relations in her mind between riding, falling, and the wind. She later rides the horse and the wind starts to blow. Even though she and the horse are fine, her heart starts racing, she starts to feel the sensations she had when falling, and has images of falling. Although the horse did not buck and she did not fall, her psychological pain is the same. She may choose to never ride outside again – not because it is inherently dangerous, but because she is wrapped up in the psychological pain (fear, anxiety, stress, worry, memories) when it’s windy and letting the content of her mind dictate her behavior
ACT Response to Example... Help the girl develop Psychological Flexibility Contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values (what’s most important to you)
Psychological Flexibility Means not holding on too tightly (or totally buying into) our own thoughts and emotions, and acting on longer term values rather than short term impulses, thoughts, and feelings Why Important Thoughts & emotions are not good indicators of long term value Our minds are not always right We have no control over thoughts and emotions If we buy into and act on them, we may overlook the more important, sustained patterns of action which bring true meaning, vitality and richness to our lives (i.e horseback rides in the wind with no incident )
Psychological Inflexibility Suffering Preoccupation with the past or future and Loss of awareness of the present Loss of contact with Or clarity of Personal values Inaction, Impulsivity, Or persistent avoidance Restrictive sense of self (Believing that we are what our thoughts say we are) Entanglement in thoughts; Listening to our mind And ignoring experience Avoidance of Sensations, feelings, Thoughts, or memories Rumination, worry, depression, anxiety Escapism, AODA Anxiety, OCT “You can’t do it,” “You’re not worthy” Reactive, lacking direction Not in touch with, or not Using what matters as Your guide
Psychological Inflexibility Suffering Preoccupation with past or future and Loss of awareness of the present Loss of contact with Or clarity of Personal values Inaction, Impulsivity, Or persistent avoidance Holding tightly to identity descriptions Believing that we are what our thoughts say we are Entanglement in thoughts; Listening to our mind And ignoring experience Avoidance of Sensations, feelings, Thoughts, or memories Experiential Avoidance Cognitive Fusion Self As Content (descriptions) Inactivity or Disorganized Activity Lack of Values Clarity Or Contact Dominance of Conceptualizations
Preoccupation with the Past or Imagined Future “If you aren’t in the moment, you are either looking forward to uncertainty, or back to pain and regret.” Jim Carrey
Loss of Contact With Present Moment When we are not fully present in the moment, we miss opportunities to discover what works
Dominance of the Conceptualized Past/F uture Borrowed from presentation by Ron Kimball
We also miss enjoyment of what’s in front of us Example: Man forgets key and he and dog are stuck outside in the cold rain for 2 hours Wife comes home and lets them in Man spends an hour ruminating and complaining about what an awful experience it was The dog goes and gets a drink And snuggles up and enjoys the Warmth of the home
It seems like your thoughts are blocking your way, but really they’re just along for the ride
Cognitive Fusion When are we fused or stuck: “Buying into” our thoughts Following rules about how to behave rather than responding to the present circumstances Attachment to the “Conceptualized Self” Rigid ideas about who we are and who we ought to be
Cognitive Fusion Entanglement with our thoughts limits and shapes what we see
Cognitive Fusion Our thoughts are like passengers on a bus. Some give helpful advice, some not so helpful. Just because they’re on the bus and in our mind doesn’t mean we have to listen to them or follow their directions. Who’s driving your life?
ACT Model of Effective Living Psychological Flexibility Preoccupation with Past or Future Contact with the Present Moment Be in the moment, mindful, engaged with The here-and-now Experiential Avoidance Acceptance & Willingness Active openness to Experience without Defense or judgment Cognitive Fusion Cognitive Defusion See our thoughts for what they are – products of the mind Content remains, but no longer Controls your behavior Self as Content Self as Context Transcendent sense of self We are not our thoughts, feelings, images Lack of Contact With And Clarity of Values Values, Purpose And Meaning Not goals, but how you Want to live your life, what you want it to be about Inactivity or Disorganized Activity Committed Action Moving towards what’s Most important to you
ACT Model of Effective Living Psychological Flexibility Contact with the Present Moment Values, Purpose And Meaning Committed Action Self as Context Cognitive Defusion Acceptance & Willingness See our thoughts for what they are – products of the mind Content remains, but no longer Controls your behavior Active openness to Experience without Defense or judgment Moving towards what’s Most important to you Be in the moment, mindful, engaged with The here-and-now Not goals, but how you Want to live your life, what you want it to be about Transcendent sense of self We are not our thoughts, feelings, images
Acceptance & Willingness Given the distinction between you and the stuff you struggle with, are you willing to have that stuff, as it is and not as what it says it is, and do what works in this situation?
Acceptance & Willingness “Today I choose life. Every morning when I wake up I can choose joy, happiness, negativity, pain... To feel the freedom that comes from being able to continue to make mistakes and choices – today I choose to feel life, not to deny my humanity but to embrace it.” Kevyn Aucoin
Experiential Avoidance Acceptance & Willingness Exercises: Bothersome thoughts on paper Passengers on a bus Actively open to and contacting psychological experiences without defense or judgment
Cognitive Defusion Exercises: Leaves on a stream Watching a movie
36 What happens if you stop struggling? The monster might still follow you around, but now You are free to live
Self as Context Exercises: What are you Chessboard or house metaphor A sense of self that is a consistent perspective from which to observe and accept all changing experiences
Values: What you want your life to be about Imagine you can plan your own eulogy How do you want to be remembered? What would you want people to say about you? Values are not goals or feelings – they are choices about how to live
Case Example 48 year old male Raised in Missouri Lost job two years ago, wants to return to work Previous diagnoses of Generalized Anxiety & Depression Moved to WI a year ago and is living with his girlfriend Presenting concerns: depression
Experiential Avoidance Ongoing effort to avoid negative self-evaluations Avoids any situations where could be judged Cognitive Fusion Attached to idea that can’t move forward until negative self- evaluations are gone Fused with idea that because he became depressed and was fired, he is no longer hireable Loss of contact w/ Present Moment Frequent rumination about past (events, identity) Regular worries about what could go wrong if he takes a step forward Self as Content Attached to self-as-content: A failure, weak, scared, “I am depressed” Lack of contact with Values No long has idea of what’s important No guiding values – reactive to internal experiences Lack of Committed Action No participation in work, social life Procrastination Case Example
Case Example: What did I do Start with values – develop a sense of hope and direction Defusion and self-as-context exercises You’re not your thoughts, feelings, memories You aren’t your identity descriptions Document avoidance activities What are the costs of avoidance? Mindfulness exercises – be in the moment notice and accept whatever shows up
The ACT Question Given a distinction between you and the stuff you are 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?
Research As of March 2012, there are over 60 randomized controlled trials Considered “empirically-based” by the American Psychological Association for depression and chronic pain Approaching empirically-based status for anxiety, psychosis, substance abuse, and worksite stress See for specificswww.contextualpsychology.org