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Acceptance and commitment therapy webinar dr veera_balajikumar phd_16_08_2020
ACT aims to increase psychological flexibility through six core processes: acceptance, defusion, contact with the present moment, self-as-context, values, and committed action. It does not aim to control or eliminate private experiences like thoughts and feelings, but to create distance from them and enable values-based action. ACT uses metaphors, exercises and other experiential techniques grounded in functional contextualism and relational frame theory to undermine cognitive fusion and enhance flexibility. The goal is for language to serve values rather than dominate experience.
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Acceptance and commitment therapy webinar dr veera_balajikumar phd_16_08_2020
- 1. Introduction to Acceptance Commitmenttherapy - ACT Dr.V.Veera Balaji Kumar Mindful Therapist drveerabalaji@gmail.com
- 2. Life is... Empty DifficultWonderful Bore Challenging Joyful Struggle Satisfactory
- 4. Thinkaboutthe lasttime you werehurt,overwhelmed, stressedout,felthelpless... • What kind of responses did you get... • What kind responses made you feel truly cared for, supportive, understood an d reassuring ...
- 5. Validating feelings, thoughts >> Understood, Accepted, & Cared Givingyou a hug, embrace, or a cuddle Giving Patiently - all you have to share Listening Validating your pain: “This must be so hard for you” or “I can’t begin to imagine what you’re going through” Validating Just sitting with you and allowing you to be Saying nothing you while you cry or even crying with you Holding
- 6. Mental Health -Public perception & Myths • Blissful state of mind • Absence of distressing or unwanted thoughts, feelings images or sensations. • Ridicule or Stigma
- 7. World Health Organization (WHO)definition of Mental Health Mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”
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- 9. What & Why Psychotherapy? • Psychotherapy is an intervention • which considers the life of the individual in a broad manner, • encompassing the cognitive and emotional aspects, • as well as individual, familial, social and cultural factors of their personal experiences and personality, • in order to improve the individual's functioning and quality of life. • Grounded in dialogue, it provides a supportive environment that allows a person to talk openly with someone who’s objective, neutral and nonjudgmental.
- 11. Assumption of Healthy Normality By theirnature, humans are psychologically healthy Abnormality is a disease or syndrome driven by unusual pathological processes We need to understand these processes and change them
- 12. MAJORREASONTO SUSPECTTHISISFALSE The ubiquity ofhuman suffering
- 13. JEYA'S WEDDING It wasthe happiest day of her life until she thought about her dad who committed suicide when she was 16 years old
- 14. Destructive Normality -Alternative Assumption • the complex set of psychological processes of a normal human mind – • analysing, • comparing, • evaluating, • planning, • remembering, • visualizing • are often destructive and create psychological suffering for us all. • Mind = Human language • The root of this suffering is human language itself. • Human language - highly complex system of symbols, which includes words, images, sounds, facial expressions and physical gestures. • Human language is a double-edged sword.
- 15. Default mode network •In 2007 neuroscience experiments – fMRI studies - the brain is constantly active with a high level of EEG activity even when the person is not engaged in focused mental work. • Default mode network (DMN), - a large-scale brain network primarily composed of the medial prefrontal cortex, posterior cingulate cortex/precuneus and angular gyrus. • Active when a person is at wakeful rest, such as during daydreaming, mind-wandering, thinking about others, thinking about themselves, remembering the past, and planning for the future • Recent research has begun to detect links between activity in the default mode network and mental disorders like depression, anxiety, and schizophrenia. • Curiously this DMN is relatively subdued when meditating.
- 16. Problem and Solution •Biggest evolutionary advantage of human language - ability to anticipate and solve problems. • Enabled us not only to change the face of the planet, but to travel outside it. • The essence of problem-solving is this: • Problem = something we don't want. • Solution = figure out how to get rid of it, or avoid it. • This approach obviously works well in the material world. • Get rid of anxiety, fear etc >> experiential avoidance • More time and energy we spend trying to get rid of unwanted private experiences = the more psychologically suffering
- 17. Unworkable change agenda Thisbelief engenders the idea that healthy people can control and eliminate negative private content and thereby become "normal". Belief: Negative private content is toxic and dangerous, and must be controlled to attain psychological health
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- 19. Experiential avoidance • Astyle of dealing with unwanted experiences viz. thoughts, feelings, memories, sensations and distressing external events • involves emotional avoidance, numbing, behavioural avoidance and other methods of experiential control even when it has significant personal costs
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- 22. Experiential avoidance Vs Acceptance Experiential avoidance isa natural survival instinct embedded within us that creates our aversive reaction to unpleasant or uncomfortable events. Practice a new mindful way of meeting experiences with openness and acceptance.
- 23. What is this ACT? • ACT is a behavioral therapy approach that uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility - facilitate in engagement in value- congruent behaviours. • ACT facilitates the change in the individual's relationship to their internal experiences (i.e. thoughts, sensations) rather than the experience itself.
- 24. Behaviour Therapy 1st wave:Behavioral 2nd wave: Cognitive 3rd wave: MBCT DBT ACT
- 25. What is Psychological flexibility ? •Psychological flexibility is the ability to stay in contact with the present moment -- regardless of unpleasant thoughts, feelings, and bodily sensations, as conscious human without needless defense -- while choosing one's behaviors based on the situation and personal values. • It is NOT a state of happiness or ease but an ability to flexibly navigate through changing demands of life, also when difficult thoughts and feelings arise
- 26. ACT Model client acceptanceof distressing experiential content, Enhancing cognitive defusion techniques to mitigate the deleterious effects of cognitions, Utilizing client ability to attend to the present moment, Increasing a self-as-context perspective within the client, Enhancing core values meaningful to the client, and Identifying committed, effective action toward reaching those valued ends. Supporting six core processes produce psychological flexibility:
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- 31. COGNITIVE FUSION Inability fordirect, undefended contact with unwanted private events viz.thoughts, feelings, memories, sensations Makes healthy psychological flexibility difficult or impossible, Excessive attachment to the literal content of thought
- 32. We become fused withour thoughts: – Thoughts may seem to be the absolute truth, or – Commands we must obey, or – Threats we must eliminate, or – Something we must give all our attention to
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- 36. BEING IN THE HEREAND NOW
- 37. Presence Here-and-now experience • Presentmeans: consciously connecting with and engaging in whatever is happening in this moment. • Humans find it very hard to stay present, absorbed in the past or the future • It is easy to get caught up in our thoughts and lose touch with the world around us. • Most of the time we tend to operate on automatic pilot, merely “going through the motions.”
- 38. Why be present- Be Here and Now • To truly appreciate the richness and fullness of life, you have to be here while it’s happening! • The power to act exists only in this moment • To act effectively
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- 40. WHICH IS THERIGHT VIEW OF THE HOUSE ?
- 41. ACT Philosophy => Functional contextualism Functionalcontextualism views psychological events as an interaction between whole organisms and a context that is defined both historically (e.g., prior learning histories) and situationally (current antecedents and consequences, verbal rules).
- 42. THIS IS IN THESERVICE OF...? What is this thought, emotion, impulse, behavior in the service of? Under what conditions does it function that way? Is this feeling, thought, behaviour Useful? How often does it occur ?
- 43. Relational frame theory-RFT •Explains the fundamental human ability to relate anything to anything and form a relational network of ideas and concepts – derived stimulus relations • Relational framing exponentially increases the speed and diversity of human learning. • We begin to see the world not AS IT IS, but as our relational network tells us it is. • Arbitrarily applicable relational responding (AARR) - ability to symbolize.
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- 46. IMAGINED FUTURES ANDANXIETY
- 47. Acceptance and Commitment therapy • ACT isan intervention approach designed to bring language to heel, so that it can become a tool to be used when it is useful, rather than an unseen process that consumes the humans that host it. • ACT rather than seeking to change the content of problematic thinking lets direct experience be more of a guide when that is more effective • Let the environmental contingencies guide the behaviour
- 48. ACT technology ACT tends touse a relatively non-linear form of language. ACT therapists rely heavily on paradox, metaphors, stories, exercises, behavioral tasks, and experiential processes. Direct instruction and logical analysis has a relatively limited role, although it does occur.
- 50. Goal of the Cognitive Defusion process helpthe client detect the hidden properties of language that produce fusion, to shake the client's confidence in implicitly trusting the "reality" of private experiences and to recreate the "space" that exists between thought and thinker, feeling and feeler. ultimately help the client use willingness and acceptance strategies on a more consistent basis distancing from thoughts and evaluations reduces their capacity to function as psychological barriers.
- 51. Cognitive Defusion Paradox • The aimof defusion is NOT to get rid of unpleasant thoughts, but rather to see them for what they are—just words—and to let go of struggling with them • If… • Helpful We Use; • Unhelpful We Defuse
- 52. Thought Discernment Does ithelp me to be the person I want to be? Does it help me to build the sort of relationships I’d like? Does it help me to connect with what I truly value? Does it help me, in the long term, to create a rich, full, and meaningful life?
- 53. Defusion = Flexible Responding We payattention to the thought with: • Curiosity: We see it for what it is - words and pictures • Openness: We explore whether it’s helpful or not • Flexibility: If it’s helpful, we let it guide us; if not, we let it be.
- 54. Defusion techniques • I amhaving the thought that … • Thank your mind • Imagine this thought on a computer screen. Change the font colour size or type • What does that thought look like? How big is it? What does it sound like? Your voice or someone else’s? Close your eyes and tell me, where is it located in space? Is it moving or still? If moving, in what direction and at what speed? • The movie story: If all these thoughts and feelings were put into a book or movie, titled “the something something story,” Or what would you call it?
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- 58. Values (Know What Matters) •Deep in your heart, what do you want your life to be about? • What do you want to do with your brief time on this planet? • What truly matters to you in the big picture? • What sort of personal qualities do you want to cultivate? • How do you want to behave toward yourself, others, and the world around you?
- 59. GLOBE TROTTING • living adream that most of us would envy • Prasanna says, “We have visited all 7 continents including Antarctica. Together, we have been to all 193 Countries.
- 60. Values (Know What Matters) •Purpose gives our life direction, and presence allows us to make the most of our journey. • Values are about how you want to behave on ongoing basis • Are your “chosen life directions.” • Values are like a compass because they give us direction and guide our ongoing journey. • Values are NOT: goals, desires, needs, ethics, morals, feelings, rules, beliefs, codes of conduct
- 61. Value hierarchy • Eachof us has a hierarchy of values. • This is our sense of what’s most through to what’s least important. • Do we choose to watch TV or invest that time in personal improvement? • Do we sleep longer or go jogging?
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- 66. ACT Acronym Accept unwantedprivate experiences such as thoughts, feelings, memories, and sensations as well as external events that are not amenable to direct control. Accept Choose a set of valued life directions that would enlarge one's sense of vitality, purpose and meaning. Choose Build larger and larger patterns of committed action that are consistent with these valued ends Take Action
- 67. Therapeutic Interventions 1.Developing acceptanceof unwanted private experiences which are out of personal control. 2.Commitment and action toward living a valued life. Confronting the Control Agenda • “Did this reduce your symptoms in the long term? • What did this strategy cost you in terms of time, energy, health, vitality, relationships? • Did it bring you closer to the life you want?”
- 68. 2 Questions we Dance between A- What valued direction does the client want to move in? B - What’s getting in the way?
- 69. Where to startin ACT? • For clients overwhelmed by thoughts & feelings (extreme fusion, dissociative states, flashbacks, emotional dysregulation, panic attacks etc.): start with grounding (dropping anchor) • For major grief/loss: self- compassion • For the poorly motivated: values & defusion from hopelessness • For clients fixated on feeling good and avoiding pain: “creative hopelessness”
- 70. Establishing behavioural goals for therapy • Emotionalor process goals = how I want to feel (or not feel) • Outcome goals = what I want to have or get (or get rid of) • Behavioural goals = what I want to do • ASAP – ideally the first session – establish behavioural goals • A simple way: ‘towards moves’ on the ACT Matrix>
- 73. CONTACTING THE PRESENT MOMENT I,here, now notice WHAT I see, hear, touch, taste, smell, think, feel, do SELF-AS-PROCESS I, here, now notice THAT I see, hear, touch, taste, smell, think, feel, do TRANSCENDENT SELF or OBSERVING SELF I, here, now notice THAT I am continuous, unchanging, distinct from, & more than WHAT I see, hear, touch, taste, smell, think, feel, do DEFUSION I, here, now notice my thoughts and see them as words and pictures ACCEPTANCE I, here, now notice my thoughts and feelings and allow them to be as they are VALUES I, here, now notice what is important and meaningful to me and put it into words SELF-AS- CONTEXT
- 74. Self-as-Context Qualities of theObserving-Self • Can’t be judged as good or bad, right or wrong, because all it does is observe. • Sees things as they are, without judging, criticizing, or doing any of the other thinking processes that set us up for a struggle with reality. • Therefore, it gives acceptance in its truest, purest form.
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- 77. Committed Action (Do WhatIt Takes) • Taking effective action, guided by our values. • Committed action means “doing what it takes” to live by our values even if that brings up pain and discomfort. • Facing and overcoming the barriers • SMART goals
- 78. Therapeutic Relationship • Therapists :Thanks to human language, they are in the same boat as their clients • Therapists might say, “…from where I am on my mountain, I can see obstacles on your mountain that you can’t see.“ • “So I can point those out to you, and maybe show you some alternative routes around them…”
- 79. ACT Acronym Accept unwantedprivate experiences such as thoughts, feelings, memories, and sensations as well as external events that are not amenable to direct control for what they are, not what they appear to be. Accept Choose a set of valued life directions that would enlarge one's sense of vitality, purpose and meaning. Choose Build larger and larger patterns of committed action that are consistent with these valued ends Take Action
- 80. 80 Dr Veera BalajiKumar Contact for further information: drveerabalaji@gmail.com
Editor's Notes
- #15 Mind - complex set of cognitive processes—such as analysing, comparing, evaluating, planning, remembering, visualizing—and all these processes rely on human language The public use of language includes speaking, talking, miming, gesturing, writing, painting, singing, dancing and so on. The private use of language includes thinking, imagining, daydreaming, planning, visualizing and so on. technical term for the private use of language is “cognition.” On the positive it helps us make maps and models of the world; predict and plan for the future; share knowledge; learn from the past; imagine things that have never existed, and go on to create them; develop rules that guide our behavior effectively, and help us to thrive as a community; communicate with people who are far away; and learn from people who are no longer alive. The dark side of language is that we use it to lie, manipulate and deceive; to spread libel, slander and ignorance; to incite hatred, prejudice and violence; to make weapons of mass destruction, and industries of mass pollution; to dwell on and “relive” painful events from the past; to scare ourselves by imagining unpleasant futures; to compare, judge, criticize and condemn both ourselves and others; and to create rules for ourselves that can often be life-constricting or destructive.
- #44 If someone mentions a word (e.g., water, lemon, trauma, accident, peace), the mind focuses on it as if it were present even though it is not present/real now.
- #48 Practically speaking, we don’t take long client histories. Nor do we necessarily attempt to work out which diagnostic classification system in vogue most fits our clients. Instead, in an initial session, we focus on two simple goals: connecting with client experience and presenting the psychological flexibility point of view. Truly, this approach is about empowering clients.