Stress Less, Live More: How Stress Less, Live More: How Acceptance and Commitment Acceptance and Commitment Therapy Can Help You Lead a Therapy Can Help You Lead a

Busy yet Balanced lifeBusy yet Balanced life

Dr. Richard BlonnaDr. Richard Blonna

What is Stress?What is Stress?

• Stress means different things to different Stress means different things to different peoplepeople

• What stresses some people challenges othersWhat stresses some people challenges others

• Four classic ways to define stress : stimulus, Four classic ways to define stress : stimulus, response, transaction, and holistic response, transaction, and holistic phenomenonphenomenon

Stress is a StimulusStress is a Stimulus

• Stress is something in the external Stress is something in the external environmentenvironment

• Stress is defined by the stimuli that one is Stress is defined by the stimuli that one is exposed to (stress is bills, work, taxes etc.)exposed to (stress is bills, work, taxes etc.)

• Some stimuli are defined as “life events” Some stimuli are defined as “life events” (Holmes & Rahe)(Holmes & Rahe)

Stress is a ResponseStress is a Response

• Stress is something in the internal environmentStress is something in the internal environment

• Stress is defined as “the non-specific response Stress is defined as “the non-specific response of the body to any demand” (Hans Selye)of the body to any demand” (Hans Selye)

• The non-specific response include symptoms The non-specific response include symptoms such as increased muscle tension, breathing such as increased muscle tension, breathing rate, hormonal release, metabolic rate etc.rate, hormonal release, metabolic rate etc.

Stress is a TransactionStress is a Transaction

• Stress is a transaction between a stimulus and a Stress is a transaction between a stimulus and a response (Lazarus & Folkman, 1987)response (Lazarus & Folkman, 1987)

• The transaction revolves around the appraisal of The transaction revolves around the appraisal of a “potential stressor” based on two questions:a “potential stressor” based on two questions:

Is it a threat?Is it a threat?Can I cope? Can I cope?

Stimulus (potential stressor) and Personality Stimulus (potential stressor) and Personality (the individual) factors mediate the transaction(the individual) factors mediate the transaction

Stress as a Holistic Stress as a Holistic PhenomenonPhenomenon

• Stress is a response that that occurs when Stress is a response that that occurs when the dimensions of health (physical, social, the dimensions of health (physical, social, spiritual, emotional, intellectual, spiritual, emotional, intellectual, occupational and environmental) are out occupational and environmental) are out of balance.of balance.

• Lack of balance causes the body to make Lack of balance causes the body to make adjustments in order to regain and adjustments in order to regain and maintain homeostasismaintain homeostasis

All of these Definitions are All of these Definitions are Partially CorrectPartially Correct

• In actuality, stress is all of these things In actuality, stress is all of these things (stimulus, response, transaction, holistic (stimulus, response, transaction, holistic phenomenon) combined.phenomenon) combined.

• Each of the classic ways of defining stress Each of the classic ways of defining stress accounts for a piece of the puzzle. accounts for a piece of the puzzle.

A New Way of Defining StressA New Way of Defining Stress

• ““Stress is a holistic transaction between an Stress is a holistic transaction between an individual and a potential stressor individual and a potential stressor resulting in a stress response (Blonna, resulting in a stress response (Blonna, 2006).”2006).”

• Blonna’s definition combines elements of Blonna’s definition combines elements of the four classic definitions to form a more the four classic definitions to form a more eclectic picture of stress.eclectic picture of stress.

What is ACT?What is ACT?• Acceptance and commitment therapy (ACT) is a third Acceptance and commitment therapy (ACT) is a third

wave form of cognitive behavior therapy (CBT) wave form of cognitive behavior therapy (CBT) grounded in relational frame theory (RFTgrounded in relational frame theory (RFT

• Numerous ACT studies support its efficacy in treating Numerous ACT studies support its efficacy in treating anxiety, schizophrenia, depression, workplace stress, anxiety, schizophrenia, depression, workplace stress, and burnout, pain, drug use, psychological and burnout, pain, drug use, psychological adjustment to cancer, and diabetes self-management adjustment to cancer, and diabetes self-management (Ciarrochi & Bailey, 2008).(Ciarrochi & Bailey, 2008).

What is ACT?What is ACT?

• An underlying premise of ACT is that An underlying premise of ACT is that mental suffering occurs when clients mental suffering occurs when clients become psychologically-inflexible and get become psychologically-inflexible and get stuck stuck

• ACT helps clients become more ACT helps clients become more psychologically flexible, get unstuck, and psychologically flexible, get unstuck, and engage in values-congruent behaviorengage in values-congruent behavior

Values-Congruent BehaviorValues-Congruent Behavior

• The primary therapeutic outcome for ACT The primary therapeutic outcome for ACT is getting clients to behave in ways that is getting clients to behave in ways that are congruent with their valuesare congruent with their values

• Two key aspects of this are helping clients Two key aspects of this are helping clients clarify their values and setting behavioral clarify their values and setting behavioral goals that are congruent with these valuesgoals that are congruent with these values

The Acceptance Component of The Acceptance Component of ACTACT

• Acceptance has three aspects :Acceptance has three aspects :

1. Becoming more mindful of thoughts, 1. Becoming more mindful of thoughts, emotions, and actions emotions, and actions

2. Understanding how thoughts, 2. Understanding how thoughts, emotions, emotions, and actions support or and actions support or oppose values and oppose values and goals goals

3. Accepting that trying to control, 3. Accepting that trying to control, avoid, or avoid, or eliminate painful thoughts and eliminate painful thoughts and feelings is feelings is impossible and makes impossible and makes them worsethem worse

The Commitment Component The Commitment Component of ACTof ACT• Acceptance and Commitment work Acceptance and Commitment work

togethertogether

acceptance is the cognitive partacceptance is the cognitive part

commitment is the behavioral partcommitment is the behavioral part

• Commitment involves sticking to values-Commitment involves sticking to values-congruent behavior while coexisting withcongruent behavior while coexisting with troubling thoughts and painful emotionstroubling thoughts and painful emotions

The Therapeutic Component of The Therapeutic Component of ACTACT• ACT does not focus on over-analyzing the ACT does not focus on over-analyzing the

past or trying to change thoughts, past or trying to change thoughts, personal scripts, mental images and personal scripts, mental images and emotionsemotions

• ACT is based on RFT research that ACT is based on RFT research that demonstrates the effectiveness of demonstrates the effectiveness of accepting painful thoughts and troubling accepting painful thoughts and troubling emotions and focusing on values-emotions and focusing on values-congruent behavior congruent behavior

ACT and RFTACT and RFT

• ACT is grounded in Relational Frame Theory ACT is grounded in Relational Frame Theory (RFT), the language theory that underlies it(RFT), the language theory that underlies it

• RFT proposes that current thoughts, personal RFT proposes that current thoughts, personal scripts, mental images and emotions related scripts, mental images and emotions related to stress are linked to their original frames of to stress are linked to their original frames of reference (what RFT refers to as relational reference (what RFT refers to as relational frames) from the past in which they were frames) from the past in which they were initially learned initially learned

An RFT View of the Human An RFT View of the Human Mind Mind • RFT compares the mind to a 24/7 computer RFT compares the mind to a 24/7 computer

that is running multiple programs that is running multiple programs simultaneouslysimultaneously

• The “programs” are thoughts, personal scripts, The “programs” are thoughts, personal scripts, mental images, and emotionsmental images, and emotions

• At times, some of the programs get At times, some of the programs get “corrupted” and cause the mind to freeze (get “corrupted” and cause the mind to freeze (get stuck) and crashstuck) and crash

Relational Frame TheoryRelational Frame Theory

• The mind uses information from previous The mind uses information from previous relational frames as the basis for assessing relational frames as the basis for assessing the threat posed by current stressorsthe threat posed by current stressors

• In addition, the mind can carry this one In addition, the mind can carry this one step further and use the same previous step further and use the same previous information to jump ahead and project an information to jump ahead and project an infinite number of future situations infinite number of future situations involving this and similar stressorsinvolving this and similar stressors

Thoughts Thoughts • Thoughts do not occur in a vacuum, they Thoughts do not occur in a vacuum, they

are connected to specific relational frames are connected to specific relational frames

• An underlying principle of ACT is that all An underlying principle of ACT is that all thoughts are not equally helpful or thoughts are not equally helpful or importantimportant

• ACT evaluates thoughts in terms of whether ACT evaluates thoughts in terms of whether or not they are helpful in reaching goals or not they are helpful in reaching goals and taking valued action.and taking valued action.

ThoughtsThoughts• Can organize thoughts in terms of their Can organize thoughts in terms of their

helpfulness:helpfulness:

helpful thoughts – are consistent with helpful thoughts – are consistent with one’s values and goals and facilitate one’s values and goals and facilitate values-congruent behaviorvalues-congruent behavior

unhelpful thoughts - are inconsistent unhelpful thoughts - are inconsistent with with one’s values and goals and interfere one’s values and goals and interfere with with values-congruent behavior. values-congruent behavior.

Personal Scripts Personal Scripts

• Personal scripts are like scenes in a play Personal scripts are like scenes in a play except the play is one’s life.except the play is one’s life.

• Each script has its own inner dialogue (self-Each script has its own inner dialogue (self-talk) that represents how the scenetalk) that represents how the scene

played out (old script) played out (old script)

is currently running (present script) is currently running (present script) will ultimately play out (future script).will ultimately play out (future script).

Personal ScriptsPersonal Scripts

• Each script is connected to a relational Each script is connected to a relational frame, the context that sets the stage for frame, the context that sets the stage for the inner-dialoguethe inner-dialogue

• Personal scripts often get outdated because Personal scripts often get outdated because the relational frame or the person changesthe relational frame or the person changes

• Outdated personal scripts are seldom Outdated personal scripts are seldom helpful in taking valued action.helpful in taking valued action.

Mental ImagesMental Images

• Mental images are the visual images that Mental images are the visual images that accompany the personal scriptsaccompany the personal scripts

• Think of the scripts as the dialogue and the Think of the scripts as the dialogue and the images as the moving pictures images as the moving pictures

• As with personal scripts, mental images are As with personal scripts, mental images are linked to relational frames that set their linked to relational frames that set their contextcontext

Mental ImagesMental Images

• Mental images, are similar to personal scripts in that Mental images, are similar to personal scripts in that they can get outdated and no longer represent who they can get outdated and no longer represent who the person isthe person is

• Many adults still have images of themselves as Many adults still have images of themselves as helpless or worthless childrenhelpless or worthless children

• Outdated mental images are seldom helpful in taking Outdated mental images are seldom helpful in taking valued action.valued action.

EmotionsEmotions• ACT views emotions as something that ACT views emotions as something that

cannot be controlled and therefore should cannot be controlled and therefore should be acknowledged and accepted not be acknowledged and accepted not analyzed or changedanalyzed or changed

• Emotions are also linked to past, present, or Emotions are also linked to past, present, or future relational frames future relational frames

• Even though emotions cannot be controlled, Even though emotions cannot be controlled, the behavior associated with them can bethe behavior associated with them can be

RFT and ControlRFT and Control

• The mind’s ability to synthesize past and The mind’s ability to synthesize past and present relational frames and extrapolate present relational frames and extrapolate into the future is tremendously useful into the future is tremendously useful when planning for things it can control:when planning for things it can control:

behavior behavior

some aspects of the environmentsome aspects of the environment

These are known as external potential These are known as external potential stressorsstressors

RFT and ControlRFT and Control

• The same ability can also be a source of The same ability can also be a source of emotional distress when dealing with things it emotional distress when dealing with things it cannot controlcannot control::

thoughtsthoughts

personal scriptspersonal scripts

mental imagesmental images

emotionsemotions

• These are known as internal potential These are known as internal potential stressorsstressors

RFT and ControlRFT and Control

• RFT teaches us that the more people try to RFT teaches us that the more people try to control, avoid, or eliminate potential stressors control, avoid, or eliminate potential stressors that cannot be controlled, the worse they get that cannot be controlled, the worse they get

• Learning how to manage them is the keyLearning how to manage them is the key

be mindful of thembe mindful of them

accept themaccept them

be willing to act while coexisting with be willing to act while coexisting with themthem

Acceptance vs ControlAcceptance vs Control

• Most people fail in their stress Most people fail in their stress management attempts because they try to management attempts because they try to control, avoid, or eliminate internal control, avoid, or eliminate internal potential stressorspotential stressors

• This is doomed to fail because more than This is doomed to fail because more than half of all stress is associated with internal half of all stress is associated with internal potential stressors that cannot be potential stressors that cannot be controlledcontrolled

ACT & StressACT & Stress

• Often clients who seek the services of Often clients who seek the services of therapists and counselors do not have mental therapists and counselors do not have mental disorders that meet the criteria established in disorders that meet the criteria established in the DSM lVthe DSM lV

• These clients, the “worried well”, are stuck These clients, the “worried well”, are stuck because of their psychological inflexibility, and because of their psychological inflexibility, and suffer from stress, anxiety and worry that suffer from stress, anxiety and worry that keeps them from taking values-congruent keeps them from taking values-congruent action action

ACT & StressACT & Stress

• The worried well, like clients with more The worried well, like clients with more serious mental disorders, also struggle serious mental disorders, also struggle with:with:

unhelpful thoughts, personal scripts, unhelpful thoughts, personal scripts, mental mental images, and emotions that images, and emotions that contribute to contribute to their psychological their psychological inflexibility and keep inflexibility and keep them stressed them stressed and stuck in a rutand stuck in a rut

ACT & StressACT & Stress

• ACT can help these clients develop greater ACT can help these clients develop greater psychological flexibility, get unstuck, take psychological flexibility, get unstuck, take values-congruent action, and meet their values-congruent action, and meet their goalsgoals

• ACT can also help these clients keep their ACT can also help these clients keep their stress, anxiety, and worry from turning stress, anxiety, and worry from turning into more serious mental disordersinto more serious mental disorders

An ACT View of StressAn ACT View of Stress

• An ACT view of stress supports a An ACT view of stress supports a transactional way of defining stresstransactional way of defining stress

• Thoughts, personal scripts, mental images, Thoughts, personal scripts, mental images, and emotions all come into play during the and emotions all come into play during the stress appraisal process stress appraisal process

An ACT View of StressAn ACT View of Stress

• All of the core process that contribute to All of the core process that contribute to psychological inflexibility also come into psychological inflexibility also come into play during stress transactions play during stress transactions

• All of the six therapeutic processes can be All of the six therapeutic processes can be adapted to help clients manage their adapted to help clients manage their stressstress

The Six Core ProcessesThe Six Core Processes• There are six “core processes,” that contribute There are six “core processes,” that contribute

to psychological inflexibility and stress: to psychological inflexibility and stress:

attachment to the conceptualized selfattachment to the conceptualized self

cognitive fusioncognitive fusion

dominance of outmoded scripts and dominance of outmoded scripts and learning learning

experiential avoidance experiential avoidance

lack of clarity concerning valueslack of clarity concerning values

inaction, impulsivity, and rigidity.inaction, impulsivity, and rigidity.

Attachment to the Attachment to the Conceptualized SelfConceptualized Self• The conceptualized self refers to the self- The conceptualized self refers to the self-

descriptions clients to describe themselves: descriptions clients to describe themselves:

““I’m a mother”I’m a mother”

““I’m of average height and build”I’m of average height and build”

““I’m a happily married man” I’m a happily married man”

““I’m an architect” I’m an architect”

““I’m a teacher”I’m a teacher”

• The mind creates stereotypes or shortcuts The mind creates stereotypes or shortcuts around these descriptions around these descriptions

Attachment to the Attachment to the Conceptualized SelfConceptualized Self

• These statements sum up how people view These statements sum up how people view themselves and measure up to societal themselves and measure up to societal standards (IQ, SES, body image etc.)standards (IQ, SES, body image etc.)

• ACT refers to this way of describing the self ACT refers to this way of describing the self as a as a self-as-content self-as-content view (you are the sum view (you are the sum total of all of the things contained total of all of the things contained within youwithin you))

• People get People get attachedattached to their self-statements to their self-statements

Attachment to the Attachment to the Conceptualized Self and StressConceptualized Self and Stress• Stress clients often take a self-as-content view Stress clients often take a self-as-content view

of themselvesof themselves

• They use labels and past diagnoses to They use labels and past diagnoses to describe themselves and their problems describe themselves and their problems (social phobic, asthmatic, dyslexic, etc.) (social phobic, asthmatic, dyslexic, etc.)

• Often these labels limit their psychological Often these labels limit their psychological flexibility and coping options resulting in stressflexibility and coping options resulting in stress

Cognitive FusionCognitive Fusion

• Cognitive Fusion Cognitive Fusion is the process ofis the process of fusing fusing with with an aspect of the conceptualized selfan aspect of the conceptualized self

• Can fuse with positive or negative attributes:Can fuse with positive or negative attributes:

I am a runner (positive)I am a runner (positive)

I am a loser (negative)I am a loser (negative)

• In a sense, cognitive fusion is over-In a sense, cognitive fusion is over-attachment to one aspect of the attachment to one aspect of the conceptualized selfconceptualized self

Cognitive Fusion & StressCognitive Fusion & Stress

• Stress clients often fuse with elements of Stress clients often fuse with elements of their conceptualized self and create their conceptualized self and create stereotypes that limit their potential stereotypes that limit their potential

• A common occurrence with cognitive A common occurrence with cognitive fusion is the person becoming the problem:fusion is the person becoming the problem:

““I am an asthmatic”I am an asthmatic”

vs.vs.

““I am someone who has asthma”I am someone who has asthma”

Dominance of Outmoded Dominance of Outmoded Personal Scripts & StressPersonal Scripts & Stress

• Stress clients often fuse with personal scripts Stress clients often fuse with personal scripts and prior learning that are outmoded and no and prior learning that are outmoded and no longer represent who they are as individualslonger represent who they are as individuals

• The relational frames these scripts are based The relational frames these scripts are based on relate to failed attempts to cope with on relate to failed attempts to cope with potential stressors that were similar in potential stressors that were similar in nature to the ones being appraised in the nature to the ones being appraised in the present moment present moment

Lack of Clarity of Values & Lack of Clarity of Values & StressStress• Stress clients often feel unable to cope with Stress clients often feel unable to cope with

potential stressors that threaten their valuespotential stressors that threaten their values

• Sometimes the threat is due to being unclear Sometimes the threat is due to being unclear about the underlying valuesabout the underlying values

• Stress clients often adhere to values that are Stress clients often adhere to values that are based on outmoded personal scripts that no based on outmoded personal scripts that no longer represent who they are longer represent who they are

Experiential Avoidance & Experiential Avoidance & StressStress

• Stress clients often avoid experiences that Stress clients often avoid experiences that expose them to potential stressors that expose them to potential stressors that they’ve previously found stressfulthey’ve previously found stressful

• Their 24/7 thinking and feeling machines Their 24/7 thinking and feeling machines (their minds) project into the future and (their minds) project into the future and extrapolate a limitless number of extrapolate a limitless number of threatening and failed coping scenarios threatening and failed coping scenarios based on past relational framesbased on past relational frames

Inaction, Impulsivity, Rigidity, Inaction, Impulsivity, Rigidity, & Stress& Stress

• Experiential avoidance contributes to Experiential avoidance contributes to stress clients’ inaction and rigidity due to stress clients’ inaction and rigidity due to a lack of understanding of the relationship a lack of understanding of the relationship between action and personal valuesbetween action and personal values

• They often act impulsively because their They often act impulsively because their behavior is not congruent with their values behavior is not congruent with their values (often due to lack of clarity regarding their (often due to lack of clarity regarding their values) values)

Psychological Inflexibility and Psychological Inflexibility and Unhelpful Thinking TrapsUnhelpful Thinking Traps

• Psychological inflexibility often results in Psychological inflexibility often results in falling into common thinking trapsfalling into common thinking traps

• Blonna (2010), synthesized 10 common Blonna (2010), synthesized 10 common thinking traps that contribute to getting thinking traps that contribute to getting stuckstuck

• ACT refers to the process of falling into ACT refers to the process of falling into these thinking traps as “getting hooked” these thinking traps as “getting hooked”

The “Thoughts Are Reality” The “Thoughts Are Reality” TrapTrap

• This is based on the belief that the thoughts This is based on the belief that the thoughts clients have about events represent the clients have about events represent the objective reality of the eventsobjective reality of the events

• In fact, unless they are experiencing events In fact, unless they are experiencing events first-hand, their thoughts are just that; what first-hand, their thoughts are just that; what they they think about think about the event the event

• Clients fall into the trap when they think Clients fall into the trap when they think their thoughts are the their thoughts are the actualactual events instead events instead of just of just their thoughts their thoughts about themabout them

The “Thoughts are True” TrapThe “Thoughts are True” Trap• The “thoughts are true” trap is based on the The “thoughts are true” trap is based on the

belief that just because clients think of belief that just because clients think of something that these thoughts must be true. something that these thoughts must be true.

• Many of the thoughts clients have are really Many of the thoughts clients have are really judgments or evaluations and not really judgments or evaluations and not really ‘truths” based on evidence ‘truths” based on evidence

• Clients fall into the “thoughts are true” trap Clients fall into the “thoughts are true” trap when they fail to realize that these truthswhen they fail to realize that these truths are are really their personal judgments or really their personal judgments or evaluationsevaluations. .

The “All Thoughts Are Equally The “All Thoughts Are Equally Important” TrapImportant” Trap

• The “all thoughts are equally important” The “all thoughts are equally important” trap gives equal weight to all thoughtstrap gives equal weight to all thoughts

• Clients fall into this trap when they take all Clients fall into this trap when they take all of their thoughts too seriously (after all, of their thoughts too seriously (after all, they are only thoughts) and assign them they are only thoughts) and assign them the same high importance.the same high importance.

The “Thoughts Are Orders” The “Thoughts Are Orders” TrapTrap• The “thoughts are orders” trap revolves The “thoughts are orders” trap revolves

around the belief that just because clients around the belief that just because clients think think about doing something they feel that about doing something they feel that they have tothey have to act act on it. on it.

• Clients fall into the “thoughts are orders Clients fall into the “thoughts are orders trap” when they mindlessly act in trap” when they mindlessly act in response to unhelpful thoughts because response to unhelpful thoughts because they took them as marching orders. they took them as marching orders.

The “Thoughts Are Threats” The “Thoughts Are Threats” TrapTrap

• Thinking that something can harm you is Thinking that something can harm you is different from actually different from actually being being in harm’s way. in harm’s way.

• Sticks and stones will break your clients bones, Sticks and stones will break your clients bones, but words (or thoughts) will never hurt them, but words (or thoughts) will never hurt them, unless they allow them to.unless they allow them to.

• Clients fall into this trap when they believe their Clients fall into this trap when they believe their thoughts can actually cause themselves harm.thoughts can actually cause themselves harm.

The “Outdated Personal The “Outdated Personal Scripts” TrapScripts” Trap

• Based on the belief that outdated personal Based on the belief that outdated personal scripts are still validscripts are still valid

• In reality, outdated scripts are like faded old In reality, outdated scripts are like faded old newspaper clippings from the pastnewspaper clippings from the past

• Clients fall into this trap when they think these Clients fall into this trap when they think these old scripts are still valid even though they stand old scripts are still valid even though they stand in the way of creating newer, more helpful onesin the way of creating newer, more helpful ones

The “Scary Pictures are Real” The “Scary Pictures are Real” TrapTrap• Based on the belief that the frightening Based on the belief that the frightening

images the mind can churn out 24/7 are realimages the mind can churn out 24/7 are real

• In fact, these images are like faded photos In fact, these images are like faded photos from an old album, pictures of past hurtful from an old album, pictures of past hurtful eventsevents

• Clients fall into this trap when they believe Clients fall into this trap when they believe that the images are real and that they are that the images are real and that they are part of the picture of their lives in real-timepart of the picture of their lives in real-time

The “Personalization” TrapThe “Personalization” Trap• Based on the belief that responsibility for Based on the belief that responsibility for

problems is exclusively linked to the self problems is exclusively linked to the self oror othersothers

• In fact, responsibility for problems is rarely In fact, responsibility for problems is rarely one-dimensional or exclusiveone-dimensional or exclusive

• Clients fall into the trap when they assign Clients fall into the trap when they assign responsibility for their problems exclusively responsibility for their problems exclusively to themselves or othersto themselves or others

The “Pervasiveness” TrapThe “Pervasiveness” Trap

• Based on the belief that the extent of influence Based on the belief that the extent of influence of a stressor or aspect of the conceptualized of a stressor or aspect of the conceptualized self situation spills over into self situation spills over into every every aspect of aspect of lifelife

• In fact, stressors and aspects of the self In fact, stressors and aspects of the self usually do usually do not affectnot affect every every aspect of lifeaspect of life

• Clients fall into this trap when they believe Clients fall into this trap when they believe that these things are not context-specific and that these things are not context-specific and permeate permeate every every aspect of their livesaspect of their lives

The “Permanence” TrapThe “Permanence” Trap

• Based on the belief that current troubling Based on the belief that current troubling thoughts, feelings, and situations will last thoughts, feelings, and situations will last forever forever

• In fact, very few of these situations last In fact, very few of these situations last forever forever

• Clients fall into the permanence trap when Clients fall into the permanence trap when they believe that temporary conditions and they believe that temporary conditions and situations will situations will last forever last forever and affect them and affect them permanentlypermanently

Getting Unstuck: The Six Core Getting Unstuck: The Six Core Therapeutic ProcessesTherapeutic Processes

• ACT identifies six core therapeutic processes ACT identifies six core therapeutic processes for developing greater psychological for developing greater psychological flexibility:flexibility:

1. being present (developing mindfulness)1. being present (developing mindfulness)

2. acceptance2. acceptance

3. defining valued directions3. defining valued directions

4. commitment (taking action)4. commitment (taking action)

5. cognitive defusion5. cognitive defusion

6. self-as-context6. self-as-context

Developing MindfulnessDeveloping Mindfulness

• Mindfulness can be developed two ways:Mindfulness can be developed two ways:

informal training (attention building)informal training (attention building)

formal training (mindful meditation)formal training (mindful meditation)

• Informal training involves using short Informal training involves using short activities to help stress clients become more activities to help stress clients become more aware of:aware of:

internal (thoughts, scripts etc.) internal (thoughts, scripts etc.) processesprocesses

external (environment) stimuliexternal (environment) stimuli

Developing MindfulnessDeveloping Mindfulness

• Formal mindfulness training involves learning Formal mindfulness training involves learning and practicing mindfulness meditationand practicing mindfulness meditation

daily practice sessions daily practice sessions

increasing duration from 5-20 minutesincreasing duration from 5-20 minutes

• Mindfulness meditation is not the same as Mindfulness meditation is not the same as focused meditation used for relaxation focused meditation used for relaxation trainingtraining

Developing AcceptanceDeveloping Acceptance

• Acceptance training builds on mindfulness training Acceptance training builds on mindfulness training and sets the stage for willingnessand sets the stage for willingness

• Before clients can begin to accept their unhelpful Before clients can begin to accept their unhelpful thoughts, personal scripts, mental images, and thoughts, personal scripts, mental images, and emotions they need to be more mindful of thememotions they need to be more mindful of them

• Acceptance and willingness activities are typically Acceptance and willingness activities are typically integrated with each otherintegrated with each other

Developing AcceptanceDeveloping Acceptance

• Involves teaching stress clients about the Involves teaching stress clients about the futility of trying to change internal potential futility of trying to change internal potential stressorsstressors

• Acceptance training involves information Acceptance training involves information giving and the use of metaphors and giving and the use of metaphors and exercises exercises

• Can demonstrate using Chinese Finger TrapsCan demonstrate using Chinese Finger Traps

Defining Valued DirectionsDefining Valued Directions• The four steps to defining valued directions:The four steps to defining valued directions:

1. exploring values 1. exploring values

2. choosing and ranking values 2. choosing and ranking values

3. publicly affirming values3. publicly affirming values

4. acting on values4. acting on values

• ACT uses a variety of in-session and homework ACT uses a variety of in-session and homework assignments to help stress clients do thisassignments to help stress clients do this

Values CategoriesValues Categories

• There are ten values categories: There are ten values categories:

1. intimate relationships1. intimate relationships

2. family relationships2. family relationships

3. friendships and other 3. friendships and other relationshipsrelationships

4. health 4. health

5. spirituality5. spirituality

Values CategoriesValues Categories

6. finances6. finances

7. learning7. learning

8. work8. work

9. the environment 9. the environment

10. civics10. civics

Commitment TrainingCommitment Training

• Since ACT is a values-based form of therapy, Since ACT is a values-based form of therapy, goals and objectives must reflect clients’ goals and objectives must reflect clients’ valuesvalues

• Clear goals and measurable objectives reduce Clear goals and measurable objectives reduce ambiguity and give structure to behaviorambiguity and give structure to behavior

• Stress clients develop goals and objectives Stress clients develop goals and objectives that reflect their values and guide them to that reflect their values and guide them to where where they they want to gowant to go

Commitment Training Commitment Training

• Commitment is the Commitment is the actionaction component of component of acceptance and a key step in therapyacceptance and a key step in therapy

• Clients don’t get better by just Clients don’t get better by just talkingtalking about about their problems, they must take actiontheir problems, they must take action

• Taking action that is congruent with values Taking action that is congruent with values is based on setting clear goals and is based on setting clear goals and measurable objectives for behaviormeasurable objectives for behavior

Control and Willingness to ActControl and Willingness to Act• Control and willingness are inversely Control and willingness are inversely

related:related:

the more stress clients try to control the more stress clients try to control troubling thoughts and painful feelings, the troubling thoughts and painful feelings, the less willing they are to take valued actionless willing they are to take valued action

can demonstrate by using “The Radio” can demonstrate by using “The Radio” metaphormetaphor

Willingness and ControlWillingness and Control• A key component of ACT is helping clients A key component of ACT is helping clients

shift their focus off of what they cannot shift their focus off of what they cannot control and onto what they can controlcontrol and onto what they can control

• The focus is on engaging in more helpful* The focus is on engaging in more helpful* behavior and creating more helpful behavior and creating more helpful environments environments

*in terms of reflecting their values and *in terms of reflecting their values and achieving their goalsachieving their goals

Willingness to ActWillingness to Act

• The key is getting stress clients to take values-The key is getting stress clients to take values-congruent action while coexisting with congruent action while coexisting with troubling thoughts, personal scripts etc.troubling thoughts, personal scripts etc.

behaving in ways that support their values behaving in ways that support their values will result in new learning and developing will result in new learning and developing

new, more helpful relational new, more helpful relational framesframes

give homework assignments to build thisgive homework assignments to build this

Willingness and ControlWillingness and Control

• Things than can be controlled:Things than can be controlled:

personal environment personal environment

behavior behavior

• These can be modified and can trigger These can be modified and can trigger helpful thoughts, personal scripts, mental helpful thoughts, personal scripts, mental images, and emotions and new, more images, and emotions and new, more positive relational frames positive relational frames

Self-as-Context (the Observer Self-as-Context (the Observer Self)Self)• ACT proposes another way of viewing the ACT proposes another way of viewing the

self, the self, the self as contextself as context

• In this view, the self is the In this view, the self is the vesselvessel (the (the context) that contains a lifetime’s worth of context) that contains a lifetime’s worth of thoughts, personal scripts, etc.thoughts, personal scripts, etc.

• This view helps clients see that they are This view helps clients see that they are more than more than their thoughts, personal scripts, their thoughts, personal scripts, etc.etc.

Self-as-Context (The Observer Self-as-Context (The Observer Self)Self)• ACT teaches clients to view themselves as ACT teaches clients to view themselves as

being being moremore than just the sum total of their than just the sum total of their thoughts, personal scripts, etc.thoughts, personal scripts, etc.

sets the stage for being able to distance sets the stage for being able to distance themselves from these things when themselves from these things when

they are they are unhelpful unhelpful

• The observer self allows stress clients to step The observer self allows stress clients to step back and observe their conceptualized selves back and observe their conceptualized selves

Self-as ContextSelf-as Context

• ACT often uses chess as a metaphor to explain ACT often uses chess as a metaphor to explain this:this:

a self-as-content view looks at a self-as-content view looks at thethe piecespieces and their movement at any given point to and their movement at any given point to describe the gamedescribe the game

a self-as-context view looks at the a self-as-context view looks at the existence existence of of the board the board as the context in which as the context in which the the pieces play out many games over timepieces play out many games over time

Self as ContextSelf as Context

• Being able to step back and examine any Being able to step back and examine any stressful situation from the perspective of being stressful situation from the perspective of being the board the board upon which it plays out can help:upon which it plays out can help:

put individual moves (thoughts etc) and put individual moves (thoughts etc) and the the game (the entire situation) in a broader game (the entire situation) in a broader perspective perspective

evaluated in terms of their helpfulness evaluated in terms of their helpfulness

dismissed as just a bad move or gamedismissed as just a bad move or game

Self as ContextSelf as Context

• ““What a silly move that was”What a silly move that was”

• “ “ What a bad choice of moves I made”What a bad choice of moves I made”

• ““What a terrible game I played”What a terrible game I played”

• Wouldn’t it be nice to be able to dismiss Wouldn’t it be nice to be able to dismiss our unhelpful thoughts, scripts, mental our unhelpful thoughts, scripts, mental images & feelings this way?images & feelings this way?

Cognitive DefusionCognitive Defusion

• Cognitive defusion techniques teach stress Cognitive defusion techniques teach stress clients how to take an observer self view clients how to take an observer self view

• ACT uses a variety of metaphors and exercises ACT uses a variety of metaphors and exercises to help clients identify when they have fused to help clients identify when they have fused with thoughts etc. and how to defuse from themwith thoughts etc. and how to defuse from them

• The White Board is one such exerciseThe White Board is one such exercise