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1 An Experiential Introduction to Acceptance and Commitment Therapy (ACT): Where Strangers Meet Dr. Yvonne Barnes-Holmes Department of Psychology National.

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Presentation on theme: "1 An Experiential Introduction to Acceptance and Commitment Therapy (ACT): Where Strangers Meet Dr. Yvonne Barnes-Holmes Department of Psychology National."— Presentation transcript:

1 1 An Experiential Introduction to Acceptance and Commitment Therapy (ACT): Where Strangers Meet Dr. Yvonne Barnes-Holmes Department of Psychology National University of Ireland, Maynooth

2 2 High lifetime incidence of major DSM disorders, many persistent, pervasive in our lives and obstructive High treatment demand from other persons – even more confused because they are suffering and cant work it out High rates of divorce, sexual concerns, abuse, violence, prejudice, which in many cases occur in lives that are NOT otherwise happy General lack of life direction and focused activity, which seems to render life meaningless or bland These are not just momentary concerns – they are psychological arthritis – it wont kill us but it will make our lives miserable -- so much so that some days we wish we were dead 9 Human Suffering: The Truth About Why ACT Can Help Us

3 3 Unknown in non-humans but universal in human society About 10% incidence of attempts About 20% serious struggles including a plan About 20% serious struggles without a plan About 50% not associated with a DSM disorder 7 Suicide

4 4 This means me and you, our families, our children, our friends, our neighbours, and our colleagues (no-one escapes) 8

5 5 So, why have we looked for this? There is something different about being human Because we can feel pain all around us, even in the things that are supposed to be reinforcers It is easy to slip into pain and discomfort It is hard to be happy And its all just so difficult to work out consistently 10

6 6 Why are you doing this? What does that mean for who you are? 1

7 7 Obstacles to Openness It is hard to admit we suffer, so we create obstacles we can hide behind to convince ourselves and others that this is not so: Try these ones for size and see what others fit: 11 Uncertainty Comparisons Worry Regret Shame Sadness Anxiety Pride Inconsistency Embarrassment

8 8 The Sad Truth So, the sad truth is that you are not special – psychological suffering and pain are the normality, as is the ability to create polished obstructions to sharing it Yes, you may think you are, you may even really, really want to believe that you are, but people all over the world have the same problems as you, therapists hear them every day, so do spouses and partners, so do children and parents and children of these parents and their children – sorry excuses for lame parenting and humanity – passed down from generation to generation Every client thinks that she or he is special, so does every therapist 11

9 9 Now There Are Two Problems If you accept that you are not special, then why the obstacles to sharing -- no-one will be surprised because they will have heard it all before But you may have invested heavily in being perfect, sane or normal And all for nothing: it was all a farse because thats not who you are So, now you have two problems – you will forever struggle to be happy because it is so easy to fall into unhappiness and you have wasted chunks of your life (perhaps without ever realising) already trying to be someone that doesnt exist Not even someone that you are not, but someone that never existed -- like Barbie -- a nine-foot giant with a size 0 wasteline 11

10 10 Big Vs. Small: The John Wayne Image 11 We often think that we are being very convincing to others when we are trying to hide who we really are. Metaphorically everyone walks around looking like John Wayne. Among all the clients ever seen or heard about, no-one ever encountered a real John Wayne. When the door to the therapy room closes, we find that the big strong-looking people are just as scared as the rest of us. Will I be liked? Will I fit in? Will I measure up? Even John Wayne, of course, wasnt John Wayne. There are a million John Waynes – all thinking they are the only one – Oh, to be special.

11 11 So, Who Are You? 11 So, you have been pretending for some time to be someone you are not Someone else has been walking around in your shoes, pretending to be you Like little girls in their mums high heels – except youre the parent But you have liked it that way, you prefer it in fact, because that person is MORE, BETTER, and DIFFERENT than you in so many ways And they let you hide behind them, so no-one will see how small you really are

12 12 Big Vs. Small 11 Whenever we try to be BIG, there is a little person inside with no room to move So, inside each of us, there is little X and BIG X If only the BIG person could get out of the way, then the little person could be big BIG people swallow little people up, so much so that they dont even know they exist anymore Maybe youve been swallowed up

13 13 Whos Been Minding You? 11 So, now weve smelled the rat – the game is up But how did we get swallowed up along the way? Why were we trying so hard? Well your mind is what makes BIG BIG and it played you well, so much so that it has been telling YOU who YOU are

14 14 Rich Minds So your mind has been working you well, always telling you it has a solution to your problems But the solution is always the same -- you just have to be BIG, one way or another, and then the problem will go away because you will believe the story that you really are BIG and because BIG people dont have problems, then you wont have problems either, or at least no-one will know And if they get suspicious, your mind will be right on the ball and will think of a small problem to throw in their direction, just enough to make them think youre human and have real feelings And really -- nothing is handed over 29

15 15 Rich Minds So, your mind is like a rich investment broker, who tells you how to invest your money. Now he is getting richer and richer, so you believe that he is worth investing in. So, when he rings you on the phone you are easily convinced because he is getting richer and richer. But its with your money, and you are not getting richer, you may even be losing money. Its not that the broker cant make money – he obviously can, its just that he cant make you money and whats worse is that he can only make money for himself if he uses yours. Like a lamb invited to a dinner party and relishing the thought of enjoying a great feast, but totally unaware that he is on the menu – so close and yet so far. Isnt a solution always just around the corner! 29

16 16 Minding Your Shoes Thats what minds do best They use your energy and time, but no matter how active they are, it doesnt mean that they are solving your problems But, just to keep you spending, they create a nice story for you to hold onto and the only thing that you are getting out of this is something to hide behind And now youre hiding behind your own mind and your mind has been walking in your shoes – its been driving you around like a taxi driver speaking a foreign language – for the most part you are helpless 29

17 17 But this is not all news to you, you have known for some time that no matter how much you invested in your mind, you were not getting solutions You didnt really believe the story your mind gave you, so you struggled with it (with thoughts like Im not really that bad and secret ways of checking if other people confirm or disconfirm whether your self-evaluations are true) – but still you knew it wasnt really working and you felt like a bit of a fake So, although the story was useful to keep you from the full pain of your problems and anxieties, you were back to two problems The one you started off with and the struggle with your mind about it 32 The Struggle

18 18 So frustration is always part of the struggle We can almost watch ourselves go back and forth with our minds in private internal debates, but yet we are helpless Soon and without you ever really noticing, the struggle can become more painful than the thing you started struggling about in the first place Buts its the only thing you know how to do -- so you struggle -- struggle -- struggle 32 The Struggle

19 19 32 The Struggle But, the struggle is so tempting and feels nice and comfortable, like youve grown into it Its like your favourite old shoes or music from the time you were a teenager You know you should be moving forward and youre not sure if you even like it anymore and you know that this would not be the way to move forward, but its yours and you own it But why so helpless?

20 20 Creative Hopelessness: Man in the Hole The situation you are in seems a bit like this. Imagine that you're placed in a field, wearing a blindfold, and you're given a little bag of tools. You're told that your job is to run around this field, blindfolded. That is how you are supposed to live life. And so you do what you are told. Now unbeknownst to you, in this field there are a number of widely-spaced fairly deep holes. You don't know that at first -- you're naive. So you start running around and sooner or later you fall into this large hole. You feel around and sure enough you can't climb out, and there are no escape routes you can find. Probably what you would do in such a predicament is to take the bag of tools you were given and see what is in there: maybe there is something you can use to get out of the hole. Now suppose there is a tool in that bag, but it's a shovel. It's seemingly all you've got. So you dutifully start digging, but pretty soon you notice you're not out of the hole. So you try digging faster and faster. But you're still in the hole. So you try big shovelfuls, or little ones, or throwing the dirt far away or not. But still you're in the hole. All this effort and all this work, and oddly enough the hole has just got bigger and bigger and bigger. Hasn't it? So you come in to see me, and you're thinking maybe she has a really huge shovel -- a gold-plated steam shovel." Well I don't. And even if I did I wouldn't use it because digging is not a way out of the hole--digging is what makes holes. So maybe the whole agenda is hopeless--you can't dig your way out – you can only dig in. Im sorry. 37

21 21 32 The Struggle So, we know why youve been digging, because thats what we are all trained to do, and once you start, the mind takes over And digging pays off at one level because the struggle keeps the direct pain of the problem in the background and provides a welcome distraction from the demands of delivering on a whole life Wed all be amazing if it wasnt for X

22 22 Now, you have a couple of choices here The most obvious one is that you can keep digging and convincing yourself that it might eventually work This is the default option – the program is set at this dial so that every time you are unwilling to make a choice or commit, then digging will be the outcome And maybe on certain problems thats where you are right now – maybe you just havent struggled enough with that problem Maybe you could even make room for some more struggle – go on, just squeeze a little more in and when you have had enough, then you will know that you have had enough, because you will not be willing to take any more 38 Creative Hopelessness

23 23 And notice that as you get very near to the maximum amount of struggle you are willing to take, part of what might keep you digging even then is that you have done so much of it already So, now your mind tells you you are a fool 38 Creative Hopelessness

24 24 And notice the perspective you have on yourself at this point So, your mind tells you you are a fool and worse And as you buy into that thought, notice that you are heaping more dirt down on top of yourself Its like a client coming in and you saying – you fool how did you let that happen, didnt you see what was going on, that your problems werent going away? Go on – add a few more insults and evaluations – theres always room for more – dig, dig, dig 38 Creative Hopelessness

25 25 But, notice that if this was your client, or if it was your son or your partner – you wouldnt dream of doing that to them And yet, you do it to yourself time and time again Why, so cruel? Perhaps you are the victim and not the perpetrator? 39 Creative Hopelessness

26 26 This situation is like being in a tug-of-war with a monster. It's big, ugly and very strong. In between you and the monster is a pit, and as far as you can tell, it is bottomless. If you lose this tug-of-war, you will fall into this pit and will be destroyed. So you pull and pull, but the harder you pull, it seems the harder the monster pulls, and it appears that you are edging closer and closer to the pit. The hardest thing to see is that your job here is not to win the tug-of- war. Your job is to drop the rope. 40 Creative Hopelessness: Tug of War with a Monster

27 27 So, I say to you – okay – just drop the rope and we will listen and share, knowing only that you are stuck with your struggle and that left to your own devices you will just keep digging I dont know what it feels like to dig in your field or to pull against your monster, I only know my own and that others have them just the same But, I cannot just throw you another line knowing that you will just keep pulling or digging, because your mind cannot be trusted So, no matter what I give you, you will do the same, because my experience and your experience tell us that this is what you have mostly done so far, thats why you still find yourself in this situation So, I say, let me make a small space on my chair, just to help you carry what you are carrying because right now there is no way of putting it down 41 Dropping the Rope

28 28 There will be no moving forward from hopelessness when the mind still has escape hatches it can use to get you out of facing the pain and the struggle directly And if it shows you even the smallest EXIT sign, you will probably take it, because if you had been really able or willing to face what you are facing with dignity, then you would have done so before These escape hatches will keep letting you behave badly – they will let you wriggle out of commitments with lines like I never really loved her anyway or I knew it would never work And if you never really committed, then even failing is not real failure because you never committed anyway – thats why your mind never loses 41 Moving Forward

29 29 But just notice one thing Think about whats on the table – what is really happening in the negotiations Is it really about whether you love the person or whether you want something to work They may not be on the table at all – maybe its about being right and clever and in charge And if that has been the case and you see it, then only you has been made wrong by this – try putting that on the table too 41 Moving Forward

30 30 Okay, so you are stuck, you cant move forward because you cant trust yourself, because youll start struggling And you cant move anyway because you never really did anything like this before, so you dont really know what you are doing You feel a bit of a fool, because you are such a novice Thats a good thought – Test 1 -- will you struggle with it or will you just notice that it showed up at a time of uncertainty Choose now – (1) struggle and play with the thought, fighting back that it is not true or (2) notice that it showed up when it did and that it tried to tell you something about who you are (also notice that it tried to tell you that the thought was BIG and you are small) 47 Moving Forward

31 31 Being willing and making a commitment to noticing the struggle through which your unwillingness survived are amongst the hardest things you will do in ACT Any actions thereafter will be guided by what you find after noticing the struggle, not by what your mind tells you, so you have full respons-ablity over your actions, any failings will be your own entirely and you will know that, and the success will be yours too Sometimes you will judge wrong and the struggle will get you anyway, and there will always be someone you can find to make a small space in their seat, if you only ask Alternatively, if you begin to struggle with the struggle, then you can be guaranteed of the outcome – there will be no magic to what will happen thereafter 41 Moving Forward

32 32 So, no matter where or when this workshop ends or how much it affects you – there will come a time when you will have to bring your futures forward It may be a Monday morning or a Wednesday afternoon, but it will come and you will have at least one choice to make And at this time you might ask yourself what have you been being about Have you been being about struggle, of one kind or another? 41 Moving Forward

33 33 Discriminating Self as Context from Self as Content Over-attachment with psychological content to the point of fusion or integration with the self, is almost unavoidable and not letting this happen in a problematic fashion requires the development of a very stable sense of who you are (warts and all) Sadly, it is easier to integrate with negative content, because the demands upon behaviour thereafter are less – if you think you are weak then only weak behaviour will be necessary to be consistent with this – and so you cant fail But content is often polarised as we try to pull ourselves away from negative content by using positive content – so our struggle looks like it is between being positive and negative However, no matter how much positive content you try to cling to, the outcome of the struggle will always be the same – more struggle 55

34 34 Polarising: The Box with the Stuff in it Suppose we had this box, some nice, some horrible – its the content of your life. All of your programming. Theres some useful stuff in here, but theres also some rotten smelly stuff. Now lets say that there are some things in here that are really yucky [blow your nose into a tissue and put it in the box]. What would come up? I have to get rid of this. As we continue, the box is getting pretty full and notice that a lot of these items have to do with the first yucky one. Notice that the first piece isnt becoming less importantits becoming more important, because your programming doesnt work by subtraction. So the more you try to subtract an item, the more you add new items that have to do with the old one. Problem is, since the box is you, at some level, the box is in contact with all the bad stuff youve stuffed in the corners. Now if the stuff thats in the corners is really bad, its really important that it cant be seen. But that means that anything related to it cant be seen either, so it too has to go into the corner. So you have to avoid situations where light might be cast into the corners. Gradually your life is getting more and more squeezed and the bad is leaking evermore over the good. 64

35 35 Thoughts and words often function literally, this is simply the way that language works and it is useful for the real world For example, the rule dont run into moving traffic or you will die allows you to imagine in a real sense what will happen if you do, so that you can avoid it – if it didnt have some literal functions then you would have no great reason to avoid it But many thoughts, particularly those that relate to ourselves, lead us to believe that they are actually saying something important about who we are and who we should be – these are always the ones that shout the loudest 55 Thoughts and Words Look Real

36 36 So, the literality exercises clearly demonstrate how thoughts can affect our behaviour directly For example, maybe you had the sense that you just couldnt write the words Now we know that your hand or its capabilities didnt suddenly become paralysed, so your mind was in the driving seat of the hand And so, its a good lesson, be afraid of those thoughts, be very afraid, because left to your own devices, you could let them take over the whole ship and your life would be like the hand on a compass with your mind spinning you around from one direction to the next 55 Thoughts and Words Look Real

37 37 Self as Context vs. Content: The Chessboard Its as if there is a chessboard that goes out infinitely in all directions. Its covered with different coloured pieces, black pieces and white pieces. They work together in teams, like in chess, the white pieces fight against the black pieces. You can think of your thoughts, feelings and beliefs as these pieces. For example, bad feelings (like anxiety, depression, resentment) hang out with bad thoughts and bad memories. Same thing with the good ones. So it seems that the way the game is played is that we select which side we want to win. We put the good pieces (like thoughts that are self-confident, feelings of being in control etc.) on one side, and the bad pieces on the other. Then we get up on the back of the white queen and ride to battle, fighting to win the war against anxiety, depression, thoughts about whatever. Its a war game. But theres a logical problem here, and that is that from this posture, huge portions of yourself are your own enemy. In other words, if you need to be in this war, there is something wrong with you. 65

38 38 And since it appears that youre on the same level as these pieces, they can be as big or even bigger than you are, even though these pieces are in you. So somehow, even though it is not logical, the more you fight the bigger they get. If it is true that if you are not willing to have it, youve got it, then as you fight them, they get more central to your life, more habitual, more dominating, and more linked to every area of your life. The logical idea is that you will knock enough of them off the board so that you will eventually dominate themexcept your experience tells you that the exact opposite happens. Apparently the black pieces cannot be deliberately knocked off the board. So the battle goes on. You feel hopeless, you have a sense that you cant win, and you cant stop fighting. If youre on the back of that white horse, fighting is the only choice you have because the black pieces seem life-threatening. Yet living in a war zone is a miserable way to live. 66 Self as Context vs. Content: The Chessboard

39 39 Discriminating Self as Context from Self as Content Much of what we see as bad content is evaluation When this concerns the self it can become particularly painful and particularly sticky Here there are high levels of fusion between the content and the self and non-literal exercises are necessary to defuse the perspective on these 67

40 40 Self as Context vs. Content: The Signpost Say you were looking at a mountain and there is a signpost pointing to it that reads, Bad Mountain. If youre over at the signpost, looking at the mountain from the point of view of bad mountain that appears to be what the mountain actually is. However, if you stand back and look at both the mountain and the signpost, you can see that they are two different things. One is the mountain, and one is the evaluation of it. The thing that says bad is not the mountain, but a sign pointing to it. If you see this, its not necessary to tear all the signs down. The problem is if you take the signs to be the things that they point to. 68

41 41 Self as Context vs. Content: House and Furniture Its as if you are a house, filled with furniture. The furniture is not, and can never be the house. Furniture is the content of the house and the house merely holds or contains it. It provides the context in which the furniture can be furniture. Whether the furniture is thought to be good or bad, says nothing about the value of the house. You are the house but not the furniture. Your thoughts and feelings are the furniture. Just as the furniture is not the house, your thoughts and feelings are not you. They are simply experiences you have that are like pieces of furniture. 61

42 42 Discriminating Self as Context from Self as Content 73 Out of the place from which there is a distinction between you and that with which you struggle (including struggle itself), are you willing to feel that, think that, experience that, as it is, not as it says it is, and do whatever works for you in that situation?

43 43 It can be very difficult to decipher what is and is not experiential willingness Willingness is not a feeling or a belief, it is ultimately an action When all is said and done, ACT is fundamentally about courage and taking a leap of faith when all you know is what you dont know 47 Experiential Willingness

44 44 To show you how you have already started, notice that willingness was coming here and being honest And even when you are being willing, there is plenty of room for everything else that might show up Welcome it in -- good and bad – and show off your willingness to it Its simply a matter of what you choose to be about 47 Experiential Willingness

45 45 Imagine there are two scales, like the balance and volume knobs on a stereo. One is right out here in front of us and it is called, for example sadness. It can go from 0 to 10. In the position youre in, what brought you in here was this: This sadness is too high. Its way up here and I want it down here and I want you, the therapist, to help me do that please. In other words, you have been trying to pull the pointer down on this scale. But now theres also another scale. Its been hidden. It is hard to see. This other scale can also go from 0 to 10. What we have been doing is gradually preparing the way so that we can see the other scale. Weve been bringing it around to look at it. It is really the more important of the two, because it is the one that makes the difference, and it is the only one that you can control. This second scale is called Willingness. It refers to how open you are to experiencing your own experience when you experience it without trying to manipulate it, avoid it, escape it, change it, and so on. 48 Experiential Willingness: The Two Scales

46 46 When sadness is up here at 10, and youre trying hard to control it, to make it go down, make it go away, then youre unwilling to feel it. In other words, the willingness scale at that time is down at 0. But this is a terrible combination. Its like a wrench. When you have a wrench set one way, no matter how hard you turn the handle on the wrench it can only tighten the bolt. Its like that. When sadness is high, and willingness is low, the wrench is tight and sadness cant go down. Thats because if you are really, really unwilling to have sadness, then sadness is something to be sad about. Its as if when sadness is high, and willingness drops down, the sadness kind of locks into place. You turn the wrench and no matter what you do with that tool, it drives it in tighter. So what we need to do in this therapy is shift our focus from the sadness scale to the willingness scale. Youve been trying to control Mr. Sadness for a long time, and it just doesnt work. Instead of doing that, we will turn our attention to the willingness scale. Unlike the sadness scale, which you cant move around at will, the willingness scale is something you can set anywhere. 49 Experiential Willingness: The Two Scales

47 47 Its not a reaction, a thought, or a feelingits a choice. Youve had it set low. You came in here with it set low-in fact coming in here in the first place may initially have been a reflection of its low setting. What we need to do is to get it set at high. If you do this, if you set willingness high, I can guarantee you what will happen to sadness. Ill tell you exactly what will happen and you can hold me to this as a solemn promise. If you stop trying to control sadness, your sadness will be low or it will be high. I promise you. Swear. Hold me to it. And when it is low, it will be low, until its not low and then it will be high. And when it is high, it will be high until it is not high anymore. Then it will be low again. Im not teasing you. There just arent good words for what it is like to have the willingness scale at highthese strange words are as close as I can get. I can say one thing for sure, though, and your experience says the same thing –if you want to know for sure where the sadness scale will be, then there is something you can do. 50 Experiential Willingness: The Two Scales

48 48 Just set willingness very low and sooner or later when sadness starts up, the wrench will lock in and you will have plenty of sadness. It will be very predictable. All in the name of getting it low. If you move the willingness scale up, then sadness is free to move. Sometimes it will be low, and sometimes it will be high, and in both cases, you will keep out of a useless and traumatic struggle that can only lead in one direction. 51 Experiential Willingness: The Two Scales

49 49 52 Experiential Willingness Much of the key willingness work in ACT is done in vivo Clients wriggle easily when in discomfort and it can take a lot for a therapist to remain open to this and willing to tackle it But, if you fail to do so, clients will easily detect this and you will reduce your capacity for willingness on both sides on future occasions At this point, you must be completely open to your own discomfort and stay one step ahead

50 50 52 Experiential Willingness You can check the level of willingness you have for what you value by thinking about the following questions: Is this what you dreamed of? Is this what you really expected? Are you somehow now worth less than before?

51 51 52 Experiential Willingness But willingness is just a set of small steps Commitments give the steps momentum and direction You can start being willing at any time And the more consistently you do it with commitments, the more you will be surrounded with what you value

52 52 Choosing and Valuing a Direction: The Gardening Metaphor Imagine that you selected a spot to plant a garden. You worked the soil, planted the seeds and waited for them to sprout. Meanwhile, you started noticing the spot across the road also looked like a good spot – maybe even a better spot. So you pulled up your vegetables and went across the street and planted another garden there. Then you noticed another spot that looked even better. Values are like a spot where you plant a garden. You can grow some things very quickly, but others require time and dedication. The question is: Do you want to live on lettuce, or do you want to live on something more substantial – potatoes etc.? You cant find out how things work in gardens when you have to pull up stakes again and again. Of course, if you stay in the same spot, you begin to notice its imperfections. Maybe the ground isnt quite as level as it looked when you started or perhaps the water has to be carried quite a distance. Some things you plant may seem to take forever before they come up. It is at times like this that your mind will tell you You should have planted elsewhere. This will probably never work. It was stupid of you to think you could grow anything here. The choice to garden here allows you to water and weed and hoe, even when these thoughts and feelings show up. 79

53 53 Choosing and Valuing a Direction: What Your Life Stands For I want you to close your eyes and relax for a few minutes and put all the other stuff weve been talking about out of your mind. Now I want you to imagine that through some twist of fate, you have died but you are able to attend your funeral in spirit. You are watching and listening to the eulogies offered by your spouse, your children, your friends, colleagues and so on. Imagine just being in that situation and get yourself into that room emotionally. Ok, now I want you to visualise what you would like these people who were part of your life to remember you for. What would you like your husband to say about you as a wife? Have him say that. Really be bold here. Let him say exactly what you would most want him to say if you had a totally free choice about what that would be. Now what would you like your children to remember you for as a mother? Again, dont hold back. If you could have them say anything what would it be? Even if you have not actually lived up to what you would want, let them say it as you would most want it to be. 77

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