Presentation on theme: "Wisconsin Public Psychiatry Network Teleconference (WPPNT)"— Presentation transcript:
1 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.
2 Acceptance & Commitment Therapy An Exciting New Treatment ApproachIntro: ACT intro seminars are usually a minimum of 3 hours; likely to leave with more questions than when you started; many references at the end to help you continue your learningAmanda Krupp, MFT
3 Acknowledgements THANK YOU Steven Hayes, Kirk Strosahl, Kelly Wilson, and othersfor developing this amazing therapy modelACT community for being open and generously sharing there materialsCiarrochi, Blackledge & Mercer (2006) for providingthe images related to ACT processes
4 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
5 Goal of ACTLive a rich, full,meaningful life withless struggle
6 The Serenity Prayer (Reinhold Neibuhr) God grant me theSerenity to accept theThings I cannot change,Courage to changeThe things I can,And wisdom to know the differenceACT gives you the skillsBut How???
7 Acceptance & Commitment Therapy (ACT) So What is ACT?A behavioral & experiential model of therapyBased on a new model of why humans sufferSo what is this model of human suffering?Provides a model of how one might respond moreeffectively to sufferingAims to help people live a vital and meaningful life
8 Traditional Perspective of Suffering Humans, given the right circumstances, are naturallypsychologically healthy, happy and contentPsychological pain is abnormal, meaning somethingis wrong that needs to be fixedIf we are suffering due to difficult thoughts, feelings, oremotions, then we should (and can) avoid, reduce, alter,or eliminate them
9 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 pointIf we are suffering, that means we are stuck, not broken or sick
10 ACT Perspective on Suffering Look to your experience. Have you met anyonewho has never experienced . . .SadnessFearAnxietyNegative thoughtsScary dreamsBad memoriesAre these experiences really indicative of pathology if we’ve all had them? Or are they normal parts of being human?These are normal human experiencesOur suffering is due to our use of languageand our attempts to control our internal experiences
11 Philosophical & Theoretical Foundations Relational Frame TheoryOur mind makes arbitrary connections between things.Connections are based on history and contextTastesYummyAppleHealthyIf I polled the audience, we’d likely get a lot of answers – likely most would be positive, but some might be negativeIf I say “Sand,” what shows up for you?
12 Philosophical & Theoretical Foundations: RFT It’s futile and frustrating to control the uncontrollable (Our Mind)Example: Whatever you do, don’t think about aPINK ELEPHANTOur mind has made associations between things and your body will react accordingly, but it doesn’t mean your mind is right.Example: Tornado Siren
13 “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 TillichPsychopathology evolves in part becauseWe let our mental activity dictate our behavior
14 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 thoughshe and the horse are fine, her heart starts racing , she starts to feelthe sensations she had when falling, and has images of falling.Although the horse did not buck and she did not fall, her psychologicalpain is the same.She may choose to never ride outside again – not because it isinherently dangerous, but because she is wrapped up in the psychologicalpain (fear, anxiety, stress, worry, memories) when it’s windy and lettingthe content of her mind dictate her behavior
15 ACT Response to Example . . . Help the girl develop Psychological FlexibilityContacting 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)
16 Psychological Flexibility Means not holding on too tightly (or totally buying into) our ownthoughts and emotions, and acting on longer term values ratherthan short term impulses, thoughts, and feelingsWhy ImportantThoughts & emotions are not good indicators of long term valueOur minds are not always rightWe have no control over thoughts and emotionsIf we buy into and act on them, we may overlook the more important,sustained patterns of action which bring true meaning, vitality andrichness to our lives (i.e horseback rides in the wind with no incident)
17 Psychological Inflexibility Preoccupation with the past or future andLoss of awareness of the presentRumination, worry, depression, anxietyAvoidance ofSensations, feelings,Thoughts, or memoriesLoss of contact withOr clarity ofPersonal valuesSufferingEscapism, AODANot in touch with, or notUsing what matters asYour guideInaction,Impulsivity,Or persistent avoidanceEntanglement in thoughts;Listening to our mindAnd ignoring experienceReactive, lackingdirectionRestrictive sense of self(Believing that we are what our thoughts say we are)Anxiety, OCT“You can’t do it,” “You’re not worthy”
18 Psychological Inflexibility Dominance of ConceptualizationsPreoccupation with past or future andLoss of awareness of the presentLack of Values ClarityOr ContactExperiential AvoidanceAvoidance ofSensations, feelings,Thoughts, or memoriesLoss of contact withOr clarity ofPersonal valuesSufferingInactivity or DisorganizedActivityCognitive FusionEntanglement in thoughts;Listening to our mindAnd ignoring experienceInaction,Impulsivity,Or persistent avoidanceSelf As Content (descriptions)Holding tightly to identity descriptionsBelieving that we are what our thoughts say we are
19 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
20 When we are not fully present in the moment, we miss opportunities to discover what works Loss of Contact With Present Moment
21 Dominance of the Conceptualized Past/Future Borrowed from presentation by Ron Kimball
22 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 hoursWife comes home and lets them inMan spends an hour ruminating and complaining about what an awfulexperience it wasThe dog goes and gets a drinkAnd snuggles up and enjoys theWarmth of the home
23 Experiential Avoidance When faced with two options to turn, you may decide to avoid the left turn and steer clear of the scary thoughts residing there
24 It seems like your thoughts are blocking your way, but really they’re just along for the ride Our thoughts can be very intimidating and convincing sometimes, but can they really hurt you?
25 Cognitive Fusion When are we fused or stuck: “Buying into” our thoughtsFollowing rules about how to behave rather thanresponding to the present circumstancesAttachment to the “Conceptualized Self”Rigid ideas about who we are and who we ought to be
26 Cognitive FusionEntanglement with our thoughts limits and shapes what we see
27 Cognitive FusionOur 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?
28 ACT Model of Effective Living Contact with the Present MomentPreoccupation with Past or FutureBe in the moment, mindful, engaged withThe here-and-nowAcceptance &WillingnessLack of Contact WithAnd Clarity of ValuesValues, PurposeAnd MeaningExperiential AvoidancePsychologicalFlexibilityActive openness toExperience withoutDefense or judgmentNot goals, but how youWant to live your life, what you want it to be aboutCognitive DefusionInactivity or DisorganizedActivityCommitted ActionCognitive FusionSee our thoughts for whatthey are – products of the mindContent remains, but no longerControls your behaviorMoving towards what’sMost important to youSelf as ContextSelf as ContentTranscendent sense of selfWe are not our thoughts, feelings, images
29 ACT Model of Effective Living Contact with the Present MomentBe in the moment, mindful, engaged withThe here-and-nowAcceptance &WillingnessValues, PurposeAnd MeaningPsychologicalFlexibilityActive openness toExperience withoutDefense or judgmentNot goals, but how youWant to live your life, what you want it to be aboutCognitive DefusionCommitted ActionSee our thoughts for whatthey are – products of the mindContent remains, but no longerControls your behaviorMoving towards what’sMost important to youSelf as ContextTranscendent sense of selfWe are not our thoughts, feelings, images
31 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?
32 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
33 Experiential Avoidance Acceptance & Willingness Actively open to and contacting psychological experiences without defense or judgmentExercises:Bothersome thoughts on paperPassengers on a bus
34 Cognitive DefusionExercises:Leaves on a streamWatching a movie
36 What happens if you stop struggling? The monster might still follow you around, but nowYou are free to live36
37 Self as ContextA sense of self that is a consistent perspective from which to observe and accept all changing experiencesExercises:What are youChessboard or house metaphor
38 Values: What you want your life to be about Imagine you can plan your own eulogyHow 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
39 Case Example 48 year old male Raised in Missouri Lost job two years ago, wants to return to workPrevious diagnoses of Generalized Anxiety & DepressionMoved to WI a year ago and is living with his girlfriendPresenting concerns: depression
40 Case Example Experiential Avoidance Cognitive Fusion Ongoing effort to avoid negative self-evaluationsAvoids any situations where could be judgedCognitive FusionAttached to idea that can’t move forward until negative self-evaluations are goneFused with idea that because he became depressed and was fired, he is no longer hireableLoss of contact w/ Present MomentFrequent rumination about past (events, identity)Regular worries about what could go wrong if he takes a step forwardSelf as ContentAttached to self-as-content:A failure, weak, scared, “I am depressed”Lack of contact with ValuesNo long has idea of what’s importantNo guiding values – reactive to internal experiencesLack of Committed ActionNo participation in work, social lifeProcrastination
41 Case Example: What did I do Start with values – develop a sense of hope and directionDefusion and self-as-context exercisesYou’re not your thoughts, feelings, memoriesYou aren’t your identity descriptionsDocument avoidance activitiesWhat are the costs of avoidance?Mindfulness exercises –be in the momentnotice and accept whatever shows up
42 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?
43 ResearchAs of March 2012, there are over 60 randomized controlled trialsConsidered “empirically-based” by the American PsychologicalAssociation for depression and chronic painApproaching empirically-based status for anxiety, psychosis,substance abuse, and worksite stressSee for specifics