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Act for health

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Acceptance & Commitment Therapy for physical health problems

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Act for health

  1. 1. ACT for Health Edinburgh October 2014 Dr Ray Owen Clinical Psychologist drrayowen@gmail.com
  2. 2. Aims for the day ►Consider how core ACT processes relate to working with people who have physical health problems ►Look at specific problems related to Health, and useful ACT-based techniques  E.g. living with uncertainty, altered sense of self, carer burden, tolerating physical treatment, healthy behaviour change ►Reflect on own experience as clinician ►Reflect on own experience as human being ►Feedback suggests more experiences, technique and clinical reflection, less literature survey  All at contextualscience.org
  3. 3. To begin with…
  4. 4. Physical health ►Acute  e.g. cancer with curative intent, recovery from injury ►Long-term / chronic  e.g. chronic pain, bowel disorders, neurological disorders, lung problems ►Palliative  e.g. advanced cancer, late-stage MND ►Health Behaviour Change
  5. 5. TThhee AACCTT MMooddeell ooff PPssyycchhooppaatthhoollooggyy Dominance of Conceptualised Past & Future Psychological inflexibility Experiential avoidance Cognitive Fusion Attachment to the conceptualised self Lack of Values Clarity, dominance of pliance and avoidant tracking Inaction, impulsivity or avoidant persistence
  6. 6. STUCK UNFULFILLE D Experiential avoidance: basing your actions on avoiding feeling bad Fusion: getting tangled up in thoughts Loss of contact with present moment : getting caught up in the past & the future Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself Loss of contact with Values: not recognising what matters to you in life Lack of committed action: not acting effectively to live your life the way you want to
  7. 7. Think of a client…
  8. 8. The PPoossiittiivvee PPssyycchhoollooggiiccaall PPrroocceesssseess AACCTT SSeeeekkss ttoo SSttrreennggtthheenn Being in the present moment / mindfulness Psychological Flexibility Acceptance / Willingness Defusion Self as Context Values Committed Action
  9. 9. MOVING FORWARD: MORE FULFILLED Acceptance / willingness to experience: allowing whatever shows up just to be there. Defusion: treating thoughts as thoughts (not realities) Present moment awareness / mindfulness: living in the Here-and-Now Observing self / flexible perspective-taking: adopting a more flexible sense of self Awareness of Values: recognising what matters to you in life Committed action: doing the things that matter to you, even when it's difficult
  10. 10. Think of a client…
  11. 11. STUCK UNFULFILLE D Experiential avoidance: basing your actions on avoiding feeling bad Fusion: getting tangled up in thoughts Loss of contact with present moment : getting caught up in the past & the future Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself Loss of contact with Values: not recognising what matters to you in life Lack of committed action: not acting effectively to live your life the way you want to
  12. 12. Fusion and Avoidance ►On the buses ►“Why does my mind hurt me that way?” ►Living with an uncertain future ►Thoughts we should pay attention to ►What kind of feelings are we avoiding?
  13. 13. Using the basics ►Another trip on the bus.. ►Not just an explanatory metaphor  Ongoing tool ►A landslide blocking the road
  14. 14. While we’re on the bus… ► Minds say unhelpful things ► Take a minute..  Notice a passenger  What are they saying  What form they take  Where’s that coming from  What is the function of that passenger speaking up ► Actual ► ‘intended’ ► Mind is not usually our enemy ► So why say these things? ► Doing its job(s)  The stay alive machine (can become the EA machine)  The Problem-solving machine (can become the worry-engine)  The Learn From Experience machine (can become the dwell on the past machine
  15. 15. Default assumption ►My mind is not ‘out to get me’ ►It’s mostly trying to help by doing one of its jobs ►Most of the time it’s pretty good at that ►Sometimes in trying to be ‘helpful’ (protect you from harm, from social victimisation, isolation etc etc) its suggestions end up being unhelpful ►Recognising this makes it easier to use ‘Thanks, mind’ ►Why this helps in Health
  16. 16. Uncertainty ►Back to your client  How does uncertainty show up  Potential impact on life  Interaction with core processes ►?especially here-and-now, committed action?
  17. 17. Many paths ►More of a raft than a walk ►Originally used with denial-like behaviours ►BBeenneeffiittss  DDeeffuussiioonn ffrroomm tthhoouugghhttss aabboouutt pprrooggnnoossiiss  OObbsseerrvviinngg sseellff  AAcccceeppttaannccee ooff ffeeeelliinnggss tthhaatt aarriissee  AAbbiilliittyy ttoo ffooccuuss oonn VVaalluueess--ddrriivveenn ccoommmmiitttteedd aaccttiioonn ((nnoott bbeeiinngg ffrroozzeenn iinn ffaaccee ooff uunncceerrttaaiinnttyy))
  18. 18. But what about the thoughts we SHOULD attend to? ►“I’m sure that lump wasn’t here last week..” ►In ACT, we’re interested in the behaviour in context  Behaviour here includes internal behaviour eg thoughts  Need to know context and function ►‘Defuse and move on’ vs ‘pay attention to and act upon’  nb anyway more able to evaluate and act from defused position ►Old vs New thoughts ►Risk-related
  19. 19. Approaches other than classic defusion ►Safe review period (if still here by… then I’ll..) ►Checking out with others ►If new, evaluation / challenge ►Looking at impact ►Worry Time
  20. 20. Avoiding feeling bad ►Emotions ►Physical sensations – emotion related ►Physical sensations – health related  When distinct, when overlap  When is it safe to accept? ►E.g. aching in fibromyalgia vs crushing chest pain in heart disease  In a war vs living with the enemy  Narrowing lives in battle with symptom  For highly intrusive symptoms, look at ACT for chronic pain literature (Vowles, McCracken, Dahl)
  21. 21. STUCK UNFULFILLE D Experiential avoidance: basing your actions on avoiding feeling bad Fusion: getting tangled up in thoughts Loss of contact with present moment : getting caught up in the past & the future Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself Loss of contact with Values: not recognising what matters to you in life Lack of committed action: not acting effectively to live your life the way you want to
  22. 22. The self ►Over-attachment to the conceptualised self ►Self-as-content, self-as-process, self-as-context ►Flexible perspective-taking ►Development of key relational frames ►What’s your mind telling you right now?
  23. 23. How your (conceptualised) Self gets in the way.. ►Stuck in a story  ‘still the person I used to be’ ►Someone who never gives up ►The strong one ►Carer  ‘lost the person I used to be’ ►‘shadow of my old self’ ►No use any more ►That was the real me  Adjustment ►I’m a burden
  24. 24. Versions ► Version 1 ► Version 1.1 ► ...Version 1.5 ► …Version 1.6 ► Version 2.0 ► …Version 2.1 ► Version 2.1.1 ► Version 2.1.2 ► ..Version 2.2 ► ..Version 2.3 ► Version 3.0 ► Version 4.0 ► Version 4.0.4 ► Version 4.1 ► Version 4.4 ► etc ► Alpha ► Beta ► Cupcake ► Donut ► Eclair ► ► ► ► Froyo ► Gingerbread ► Honeycomb ► Ice cream sandwich ► ► Jelly Bean ► KitKat
  25. 25. I THEN, I NOW.. For you ► characteristics ► At primary ► Young adult ► Now school ► Psychological ► Physical ► Social ► A personality trait ► An ambition ► A friendship ► A talent ► ‘positive’ or ‘negative’
  26. 26. I THEN, I NOW.. For client (nb. tailored appropriately for their history) ► Young adult ► Pre-illness ► characteristics ► Now ► Psychological ► Physical ► Social ► A personality trait ► An ambition ► A friendship ► A talent ► ‘positive’ or ‘negative’
  27. 27. Old me new me exercise ►Elicits ‘stories’ about self ►Allows us to notice balance of them ►How firmly held?  Can challenge if appropriate (new thought / insight) ►Doing the exercise is act of defusion ►Mourn the past, accept the present ►Are they fixed (e.g. ‘less sociable’) ►Reinforces transitions over time  ‘this too will pass’
  28. 28. STUCK UNFULFILLE D Experiential avoidance: basing your actions on avoiding feeling bad Fusion: getting tangled up in thoughts Loss of contact with present moment : getting caught up in the past & the future Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself Loss of contact with Values: not recognising what matters to you in life Lack of committed action: not acting effectively to live your life the way you want to
  29. 29. ►Doing treatment ►Hopelessness ►Carer burden ►Making a choice  Values & Goals
  30. 30. Treatment ►Originally from cancer treatments (chemotherapy & radiotherapy), however.. ►‘doing’ not ‘having’ ►“Why did you choose to have treatment?”  “no choice”  What hoping to achieve  “not dying” vs “what do with more/better quality life”  Acknowledge cost of having  Price you are willing to pay in order to increase your chances of … e.g. being close to your children  Fast initial way into Values (often session 1)  Emphasises active role vs victim story
  31. 31. CHOICE POINT AWAY FROM VALUES TOWARDS VALUES HOOKS, e.g. Urge to avoid discomfort Desire for short-term gains Old habits Hooked by thoughts Stuck in a story etc HELPERS, e.g. Awareness of Values Skills: -Present moment awareness -Defusion -Acceptance -Flexible perspective taking Effective goal-setting etc Adapted from Ciarrochi, Bailey & Harris 2013
  32. 32. Finally.. ►The same core processes of ACT apply in living well with physical health problems as with any other adversity ►Same interventions can work ►Some tailored/tweaked/specific ones too ►True whether aiming to  Make healthy behaviour change  Cope with an more acute health crisis ‘facing the storm’  or live a fulfilling life despite chronic health problem, where aim is ‘living with the enemy’
  33. 33. ►Please leave feedback on this event ►At www.surveymonkey.com/s/H33JMPT

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