Acceptance and Commitment Therapy Skills and 12-Steps

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Acceptance and Commitment Therapy Skills and 12-Steps
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
Objectives
– The Goal of ACT
– What is Mindfulness?
– How Does ACT Differ from Other Mindfulness-based Approaches?
– What is Unique to Act?
– Destructive Normality
– Experiential Avoidance
– Therapeutic Interventions
– Confronting the Agenda
– Control is the Problem, Not the Solution
– Six Core Principles of ACT

ACT Acronym
– Accept your reactions and be present
– Choose a valued direction
– Take action

Overview
– ACT is based on relational frame theory (RFT)
– a psychological theory of human language.
– developed largely through the efforts of Steven C. Hayes of University of Nevada, Reno and Dermot Barnes-Holmes of National University of Ireland, Maynooth.

Overview
– Relational frame theory argues that the building block of thought is the ability to create links between things and create schema that help people anticipate the future.
– Stoplights
– Lightning and Heat Lightning
– Pain
– Distress
– Addictive behaviors
– Certain behaviors in other people
Overview
– Contextualists understand the complexity and richness of a whole event and subsequent emotional and behavioral reactions through appreciation of the uniqueness of its participants and features of each situation.
– Large movements
– Substance use
– Functional contextualism emphasizes:
– We learn how to describe and anticipate through experiences
– We must focus on changeable variables in the context to create general rules to predict and influence psychological events such as thoughts, feelings, and behaviors.
The Goal of ACT

– The goal of ACT is to create a rich and meaningful life, while accepting the pain that inevitably goes with it.
– Who is important?
– What is important to me? (Values, things, experiences)
– How can I move toward those goals?
– “ACT” is a good abbreviation, because this therapy is about acting based on our deepest values and in which we are fully present and engaged.
What is Mindfulness?

– “Consciously bringing awareness to your here-and-now experience with openness, interest and receptiveness.
– Facets to mindfulness
– Living in the present moment
– Engaging fully in what you are doing rather than “getting lost” in your thoughts
– Allowing your feelings to be as they are, rather than trying to control them
– Mindfulness does not require meditation

What is Mindfulness?

– Mindfulness skills are “divided” into four subsets:
– Acceptance
–  Cognitive de-fusion
–  Contact with the present moment
–  The Observing Self

How Does ACT Differ
– ACT can be used in a wide range of clinical populations and settings
– Not manualized
– ACT allows the therapist to create and individualize their own mindfulness techniques, or even to co-create them with clients.
What is Unique to Act?

– ACT does not have symptom reduction as a goal.
– The ongoing attempt to get rid of “symptoms” actually creates a clinical disorder
– Private experience is labeled a symptom → a struggle with the symptom
– A “symptom” is by definition something “pathological” and something we should try to get rid of.
– In ACT, the aim is to transform our relationship with our difficult thoughts and feelings, learn to perceive them as harmless, even if uncomfortable, transient psychological events. (distress, cravings, pain)
Destructive Normality

– ACT postulates that the root of suffering is human language itself.
– Global, internal, unchangeable
– Memories/perceptions/schemas are created through analyzing, comparing, evaluating, planning, remembering, visualizing—through processes that rely on human language.
– I am stupid vs. I have the thought that I am stupid
– I cannot go on vs. I am feeling like I cannot go on
Experiential Avoidance

– The idea that when there is a problem, we must rid ourselves of it creates psychological suffering by setting us up for a struggle with our thoughts and feelings, through experiential avoidance.
– Problem = something we don't want.
– Solution = figure out how to get rid of it, or avoid it.
– The more time and energy we spend trying to avoid or get rid of unwanted private experiences, the more we are likely to suffer “Quicksand”
– Addiction
– Anxiety
– Depression
Experiential Avoidance

– ACT interventions focus around two main processes:
– Developing acceptance of unwanted private experiences which are involuntary.
– Anger/Fear/Depression/Grief
– Pain (autoimmune)
– Cravings
– Commitment and action toward living a valued life.
First Step: Confronting the Agenda

– The need for total control, including of involuntary feelings and physiological behaviors is gently and respectfully confronted (anger, anxiety, pain, panic, cravings)
– Clients identify the ways they have tried to get rid of or avoid unwanted private experiences. (Creative hopelessness)
– They are then asked to assess for each method:
– Did this reduce your symptoms in the long term?
– What did this strategy cost you in terms of time, energy, health, relationships, self-esteem?
– Did it bring you closer to the life you want?

Confronting the Agenda
– Control is the Problem, Not the Solution
– Clean Discomfort: When emotions and reactions are accepted, it leads to a natural level of physical and emotional discomfort (mindful acceptance and urge surfing)
– Dirty Discomfort: Once we start struggling with it, our “struggle switch is turned on” and discomfort increases rapidly.
– Struggle switch is like an amplifier—switch it on, and we can have anger about our anxiety, anxiety about our anger, depression about our depression, or guilt about our guilt all of which increase HPA-Axis activation

Six Core Principles of ACT
– Once the control agenda is undermined, we then introduce the six core principles of ACT to help clients develop psychological flexibility:
– De-fusion
– Acceptance
– Contact with the present moment
– The Observing Self
– Values
– Committed action

Cognitive De-fusion (unfusing)
– Learning to perceive thoughts, memories, experiences as bits of language—as opposed to what they can appear to be—threatening events, objective, all-encompassing truths
– Cognitive de-fusion means “stepping back” and recognizing that thoughts are just transient private (subjective) events
– Exercise in cognitive de-fusion:
– Think of a negative self-judgment that takes the form “I am X” such as “I’m stupid.” Think about it. Believe it as much as you can. Notice how it affects you.
– Now insert the phrase “I’m having the thought that….” in front of “I am X.” Think about it. Notice what happens.
– In step 2, most people notice a “distance” from the thought, such that it has much less impact. There has been no effort to get rid of the thought, nor even change it. Instead the relationship with the thought has changed.
De-fusion Techniques
– “I’m having the thought that …”
– Envision the thought as a cloud, a speeding train or a wave
– Thoughts are not causes “Is it possible to think something, AND do something else?”
– Who is in charge here? Treat thoughts as bullies
– OK, you are right. Now what?
– Explore the facts for and against
Acceptance
– Making room for unpleasant feelings, sensations, urges, and other private experiences without struggling with them, running from them, or giving them undue attention.
– Unhooking so that thoughts/feelings don’t always lead to unhelpful action
– Explore effects of avoidance and fighting with emotions and behaviors
– Define the problem as struggling against distress/cravings creating barriers and using energy which could be more effectively used to head in the direction of their goals
– Hardiness and The Serenity Prayer: Change what we can, accept what we can’t.
Contact with the Present Moment
– Bringing full awareness to your here-and-now experience, with openness, interest, and receptiveness; focusing on, and engaging fully in whatever you are doing.
– How do I feel
– What am I thinking
– What physical sensations am I experiencing
– Describe the environment—smell, temperature, colors, objects, people, sounds, etc…
– I (see, hear, smell) ______ It reminds me of _____
The Observing Self | Fly on the Wall
– Accessing a continuity of consciousness that is unchanging, ever-present, and impervious to harm.
– From this perspective, it is possible to experience directly that you are not your thoughts, feelings, memories, urges, sensations, images, roles, or physical body.
– These phenomena change constantly and are peripheral aspects of you, but they are not the essence of who you are.
Values
– Clarifying
– What is most important, deep in your heart
– What sort of person you want to be
– What is significant and meaningful to you
– What you want to stand for in this life
Values
– A lack of values or a confusion of goals with values can underlie the inability to be psychologically flexible.
– The next step in the ACT process is
– “Choosing a direction and establishing willingness”
– Identifying motivating values
– Establish a willingness to help regain control of life, not necessarily just to control thoughts and feelings.

Committed Action
– Setting goals, guided by your values, and taking effective action to achieve them.

Summary
– The goal of ACT is to create a rich and meaningful life, while accepting the pain that inevitably goes with it
– Being aware and present in the moment
– Destructive Normality the psychological processes of a normal human mind are often destructive, and create psychological suffering. “This is depressing. I am helpless”
– Actions designed to avoid the experience in the present
– Therapeutic Interventions focus around two main processes:
– Developing acceptance of unwanted private experiences which are out of personal control.
– Commitment and action toward living a valued life.

Summary
– Confronting the Agenda (to eliminate distress)
– Explore sources of distress
– Explore prior attempts at removing distress
– Explore effectiveness
– In the short and long term
– Specific to the problem and other areas of life
– Six Core Principles of ACT
– Diffusion– Separate self from feelings/experience
– Acceptance—Accept what is
– Contact with the present moment– Mindfulness
– The Observing Self– Fly on the wall
– Values Identification
– Committed Action