Presentation on theme: "ACT in the treatment of chronic illness"— Presentation transcript:
1 ACT in the treatment of chronic illness JoAnne Dahl, Department of Psychology, University of Uppsala Sweden
2 Why do people get “stuck” in pain? Riddle about SwedenWhen pain was unavoidable, it was bearable, when pain became avoidable, it became unbearableThe solution becomes the problem.
3 Solutions for chronic pain Evidence for most common medical treatments for pain is limited or non-existentthe greater the access to quick fix solutions, the greater the pain sensitivitythose societies offering most attention and solutions are those with greatest prevalence and disability
4 ACT and chronic illness attempts to control negatively evaluated aspects of an experience may actually increase suffering in the long run: avoiding pain (symptoms) causes pain (suffering) and produces actions: narrow, rigid, less valuedsymptoms have been allowed to get in the “drivers seat”
5 experiential avoidance of symptoms predicts poorer long-term outcome: if you can’t stand it, you’ve got it
6 clean symptom/dirty symptoms clean symptoms are those directly elicited by pathology (damaged tissue, dysfunctional brain activity, low insuline, allergene)dirty symptoms are the suffering caused by avoiding symptoms
7 why avoiding the problem becomes the problem There is a difference between avoiding a dangerous situation or avoiding the thought of a dangerous situation, the first will save you life the second will handicap you for life
9 Fundamental assumptions People are capable of living a meaningful life with pain, anxiety and any other discomfortAvoidance of pain or symptoms tends to make us loose sight of valued directions and thus a loss of life quality
10 Aim of TreatmentTo help the person with pain to identify and act consistently with valued directions, independent of pain symptomsTo create psychological flexibility when relating to discomfort generally
11 Treatment principles Valued direction in life dimensions Exposure in valued directions: previously avoidedAcceptance of what cannot be directly changedDefusion of thoughts which are not functional
12 When you alter your life in the service of reducing symptoms, your symptoms flourish and your life quality diminishes
14 Creative hopelessness Goal LifeVärden i livetarbetavännerintimtGoal: freedom from painCost; Imay failCost: loss of life quality: no friends, no job, no funWhat happens whenwhat is importanthurts?
15 Mindy chatter: when I feel pain, reasons, predictions consequences Life Restriction and loss: life skrinks, present moment disappears, vitality is lostcontrol andavoidance cycle:moving down intostruggle and awayfrom a values-basedvital lifeEntanglement: taking literally,mindy solutions that call for escape, avoidance, making deals, losing who you areRelief:temporaryrelief, illusions that mindysolutions may work this timeControl and avoidance:complying with mindy solutions and buying these thoughts and engaging in the actual behavior they structure
16 Values: the life directions I choose, what I want my life to be about Acceptance and beingpresent: makingroom forpain in themoment it occursCommitment and flexibility: choosing to take action consistent with my values, enhancing life flexibilityACT: moving uptowards a valuesbasedvital lifeMindfulness and defusion:observing my thoughts asthoughts, taking heed if theyare helpful, staying conscousas the observer self, cognitiveflexibilityGrowth and contact with barriers: as I step forward I grow and develop and feel pain
19 Figure 8. 3. The two cycles pain clients can choose Figure 8.3. The two cycles pain clients can choose. The choice at the top cycles upward toward vitality, the choice at the at the bottom cycles downward into struggle. Note that both cycles involve repeated, perhaps even frequent, contact with pain. Adopted from an idea by David Chantry and modified by Hayes and Smith (in press). Pain The Acceptance and Commitment Cycle -- Moving Up Toward a Values-Based Vital Life The Control and Avoidance Cycle -Moving Down into Struggle and Away from a Values-Based Vital Life Mindfulness and defusion (Observing my thoughts as thoughts; taking heed if they are helpful; staying conscious as an observing self; enhanced cognitive flexibility) Values (The life direction I choose; what I want my life to be about) Control and Avoidance (Complying with mindy solutions by buying these thoughts and engaging in the actual behavior they structure) Acceptance and being present (Making room for pain in the moment when it occurs) Entanglement (Taking literally mindy solutions that call for escape, avoidance, making deals; losing who you are) Mindy chatter (When I feel pain my mind chatters with reasons, predictions, and comparisons) Growth and Contacted Barriers (When I step forward, especially into new territory, I grow I also often again encounter ...) and Commitment and Flexibility (Choosing to take action consistent with my values; enhancing life flexibility) Relief (A temporary respite from pain; the illusion that the mindy solutions may work this time) Life Restriction and Loss (Life shrinks; the present moment disappears; I lose vitality; and I often notice even more ...)
25 conclusionsAcceptance based treatment compared to controlled based appears to lead to more promising long-term resultsThe person with chronic pain is more interested in getting his/her life back than simply getting rid of the pain.
26 A development and evaluation of an integrative health model in treatment of epilepsy: Two randomized controlled trials investigating the effects of a short-term ACT intervention compared to attention control in India and South Africa. Tobias Lundgren, JoAnne Dahl and Lennart Melin Department of psychology, Uppsala University, Sweden
27 DesignRandomized Controlled TrialParticipants in South Africa = 27Two conditions, ACT and Attention Control.Inclusion criteria:4 seizures in the last 3 monthsAble and willing to participateNo other ongoing illnessesAge 15 – 50
28 Evaluation of an empowerment program: ACT Cooperative project between Epilepsy South Africa, Uppsala UniversitySweden and the International Bureau for Epilepsy IBEApplication of an integrative health model, acceptance based behavior therapy in Epilepsy South AfricaGrietha Van Wyk, Tobias Lundgren & JoAnne Dahl Department of psychology, Uppsala University, SwedenGrietha Van Wyk, Epilepsy South AfricaProf. JoAnne Dahl, Commission Chair IBE, Uppsala UniveristyTobias Lundgren, Uppsala University, Sweden
29 • Accept your “tendency to seize” • Choose your valued direction A Simpler Version of theGoals of ACT• Accept your “tendency to seize”• Choose your valued direction• Take action to regain your quality of life in the face of all difficulties
31 Measure of persistency in striving for living a vital life in the face of difficulties
32 Self-rating evaluation of where you place your activity level today in relation to the bull’s eye of vitality you want
33 Self rated evaluation of the degree to which epilepsy and thoughts about epilepsy is accepted or avoided
34 Future researchDevelop an integrative health model with a focus on empowerment of human resources to act consistent towards long term valued living.Look for the mechanism in behavior change.Training the trainers in ACT program in several Epilepsy South Africa CentersText
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