Acceptance and Commitment Therapy (ACT) Skills

hi everyone and welcome to today’s presentation on acceptance and commitment therapy skills over the next little while we’re going to discuss the goal of a CT will explore yet again what is mindfulness we’ll talk briefly about how act differs from other mindfulness based approaches and what’s unique to act then we’ll move on to just talking about destructive normality who knew had experienced avoidance finally we’ll move into therapeutic interventions that are common and act talking about how to confront the clients agenda which is generally clients come in and they want us to take away the problem and act wants us to really confront that and say are we talking about taking something away or just changing the way we perceive it and then we’ll work on thinking about control as the problem too often people try to control their depression control their anxiety and the harder they try to control it the more out of control it seems and we will end by exploring the six core principles of Act why do we care as usual not every intervention fits every single person so what we want to do is try to find a host of tools that we can have in our toolbox to present to clients that will build on their strengths if we hear something that sounds like a CT or CBT or experiential interventions we will know that that’s kind of where we want to go in order to help clients learn how to deal with life on life’s terms in a way that’s meaningful to them you can’t stop the waves but you can learn to surf you can’t stop bad things from happening you know sometimes bad things happen and it just sucks but you can learn how to deal with that in a way that is less counterproductive to your health and happiness distracting oneself from distress is akin to constantly running away from one’s own shadow I thought about for a few minutes and it’s kind of meaningful in the attempt to control the negative thoughts and feelings we are at a loss for control in other life situations if you’re constantly running from that shadow you’re not focusing on anything else that’s going on around you which means other things can kind of deteriorate and will cause additional distress even if you figure out how to go get away from your shadow so the act acronym accept your reactions and be present it doesn’t say change them it doesn’t say judge them it just says accept them it is what it is choose a value direction and then take action that all seems pretty simple but it’s not if it was our clients would already be doing it act as but based on relational frame theory which is a psychological theory of human language which was developed largely through efforts of Stephen C Hays of the University of nevada-reno and Dermot Barnes homes at the national university of ireland Maynooth rational frame theory argues that the building block of higher cognition or reasoning is relating that is our ability to create links between things so that’s a whole bunch of technical mumbo-jumbo for when we see things we articulate it in terms that are meaningful to us that’s scary that’s wonderful that’s amazing that is very depressing that is whatever words you use are the way that it’s going to get kind of conceptualized and stored in your memory so if you conceptualize something as all-or-nothing then you may end up perceiving the world in all-or-nothing terms so what we want to do is look at that language and say is this the best way to think about this you know one of the examples that I’ve used before is labeling an event or a behavior instead of a person children and I truly believe children are not bad children make bad choices children do bad behaviors but children are good but that’s my own you know humanistic sort of approach to to life and recovery and all that kind of stuff helping people see that and we’re going to look at some more examples of the way our language can really affect how we interpret something contextual lists seek to understand the complexity and richness of a whole event through appreciation of its participants and features now think about functional contextualism contextual lists say in this context when we when my son was little we would go to different places and at home he knew what the rules were he knew we didn’t touch the TV he knew everything that the way it was supposed to be but when we went to my grandmother’s house he had never been there before and she had a TV and she had other things she had knickknacks and stuff we didn’t have so this was a different situation so the little scientist in him went off and he walked over to the TV because he was trying to figure out in this context in this situation how am I supposed to function functional contextualism see where I’m going here he walked over to the TV and he pointed to it and he looked at me and he said no touch I said that’s right Shawn no touch he reached out and he touched the TV and he looks at me and goes timeout I said yep buddy timeout and he toddled over to the corner and sat down he just wanted to make sure that those rules still applied and it wasn’t anything you know I wasn’t like well he’s doing that to be spiteful or he was just trying to figure it out and as soon as he figured it out he didn’t bother did the TV again so what I want you to get from that is the fact that people will behave differently in different situations and the reason they behave differently in different situations is because there are different variables in play I behave differently when I’m presenting then I do when I’m hanging out with my friends at the gym and I’m sure you behave differently at work than you do at home than you do when your going out for a night with your friends you know on the town it’s all about context and what is the most functional choice of behavior at that point in time so humans learn language through interactions with the environment we need to focus on the changeable variables in the context some things aren’t changeable at my grandmother’s house we couldn’t just take the TV out well we could have but that wouldn’t have been practical so we needed to work on the changeable variables in the environment we want to help people create general rules to predict an influence psychological events such as thoughts feelings and behaviors changeable variables in the environment can include triggers it can include how to interact with different people you know maybe somebody has issues with authority figures that will affect how they interact with people at work versus maybe how they interact at home so we want to take this into consideration when somebody talks about having an anger management problem well I want to know about that problem but I want to know about it in every single context when we were talking about personality disorders we talked about a pervasive pattern of behavior so this pattern of behavior existed in multiple settings so I want to know what was the context what were the variables controlling that behavior in each setting since it generally presented as a disorder we can figure out that the behaviors and the choices that were being made in those contexts were probably unhelpful or inappropriate the goal of act is with most of our other interventions is to create a rich and meaningful life while accepting that pain in it inevitably goes with it there’s going to be times that things just suck and I’m sorry it happens you know people go away you’ll have losses you will have disappointments but they don’t last forever it’s important we help people understand when they’re creating this rich and fini meaningful life all right maybe things are not going the way I want them to right now but let’s get back to basics who is important to me who is it important to me that I’m around that I support that is in my life you know it could be kids it could be family it could be your best friend it could be out with the above then what is important to me what are my values you know if I have to choose between different things what things are important but for me to have in my life is it important for me to have a roof over my head some people would say yes some people would say you know I can crash on my friends sofa or I really don’t want to have the confines and regulations of living in some sort of formalized housing and that is definitely a choice and what experiences are important to me is work important to me is travel important to me what is important and how could I move toward those goals because we want to have our decisions based on values values driven decisions a CT is a good abbreviation because this therapy is about taking effective action guided by our deepest values in which we are fully present and engaged the other thing with a CT we want to remember is just like a lot of other things our values may change over time yes what was important to you when you were 20 likely is not exactly the same as what’s important to you today when you are older than 20 we’ll just leave it there what’s mindfulness consciously bringing awareness to the here and now experience with openness interest and receptiveness mindfulness does not require meditation and this is one thing that I really want to drive home to some of my clients because I’ve had situations where I start talking about mindfulness and clients are like no I won’t or I can’t meditate and I could try to contradict them and confront them and challenge the resistance but that’s not where they are right now so I said okay how else can we be mindful how else can we help you become aware of you’re here and now one of the things that we used to do in my residential program every morning and every evening clients had to fill out check-in sheets they had to identify how they were feeling emotionally mentally physically socially spiritually and in general so I mean that was a lot of thinking right there and then they had to identify what stage of readiness for change they were in and why and they had to identify what behaviors they were exhibiting that supported that theory and finally they had to identify three good things that they did during the day or three things that they wanted to do during the day if we were talking about in the morning we wanted clients to start becoming aware of themselves instead of just getting up and being on autopilot because we’ve talked about vulnerabilities we’ve talked about understanding but some days you can handle more than others encouraging clients who are by all rights in early early recovery early or late phases of detox I mean they’re not feeling so hot so I want to know how they’re feeling because then we can start talking about okay you feel sluggish today how can we help you with that because there are going to be times when they’re in recovery when they are out of treatment and you know two years down the line when they wake up and they’ve got the flu and they feel like crap and they feel sluggish but they’ve got stuff to do so let’s learn how to deal with that now so anyway we’re not going to require them necessarily to meditate some people think it’s the greatest thing in the world and if they can meditate great because there are so many beneficial aspects to meditation some of our clients who have anxiety disorders who have ADHD or who have extensive trauma histories may have difficulty at least in the early phases of treatment with meditation with quieting their mind it’s really really scary for them because that’s you know they spend most of their life just trying to keep their mind busy so they don’t men we go there wherever there is facets to mindfulness living in the present moment so again how are you doing right now and for a lot of our clients they look at you and they go fine and if you’re in recovery circles you know that fine is an acronym you can look up what it means but it basically means you’re not fine that’s just a knee-jerk response we want to ask them in the present moment emotionally how are you feeling cognitively how are you feeling and physically if you can get those three you’re going to have them really focusing more on the present moment encourage them to engage fully in what they’re doing rather than just getting lost in their thoughts so if they’re out on a walk have them pay attention to what’s going on have them pay attention to the birds to the leaves to the kitty cats that are hiding under the trailer whatever it is that they see they hear they smell sometimes we would have clients go out on walks around we had a I think it was a three acre campus having them go out on a walk and come back and then they would talk about as a group what they saw heard smelled etc and it would be amazing that you’d send ten people out and you’d probably get six or seven different perspectives of what was out there you know there was a lot of overlap but there were inevitably things that one person noticed that nobody else did mindfulness also means allowing your feelings to be as they are rather than trying to control them I have a friend right now who’s really stressed out and it’s stressing him out that he’s stressed out and I’m like you know what let’s just think about it this way you’re stressed out but hey everything that I know about that’s going on in your life you have a reason to be stressed out so let’s accept it it is what it is where do we want to go from here instead of trying to say he shouldn’t be stressed or calling him he called himself whiny I’m like you know a lot of people couldn’t handle that so as a therapist or a coach or a friend we want to encourage people to just accept identify and accept their feelings mindfulness skills are divided into four subsets acceptance it is what it is cognitive diffusion I can separate myself from my emotions I don’t have to be my emotions contact with the present moment how am I feeling thinking doing right now and the observing self I love the observing self because this is the fly on the wall this is the fly that’s sitting over there that’s watching you going girl what are you thinking how does a CT differ act can be used in a wide range of clinical populations and settings because it’s not a manualized protocol that you have to go well I don’t know if my clients can actually handle this part it is a technique it allows therapists to create and individualize their own mindfulness and techniques or even create co-create them or create them with clients you can go online and if you type in mindfulness you will come up with literally hundreds of worksheets activities and ideas so if you get stuck try looking at those explore from there one of the ones I learned and I think we talked about it in the last session was the name five name five things that you can think of or that you see right now that are hard you know the wall the floor the chair having people really pay more attention to what’s going on in their environment you remember that a game that a lot of us used to play back before there were iPhones when we’d go on long car trips and you look at the billboards and you’d find billboards to fit each letter of the alphabet whatever keeps you occupied but it made you to be more aware of what was you know going on at least visually around you what is unique to act act does not have symptom reduction as a goal the ongoing attempt to get rid of symptoms and this is really important so just bear with me while I read it to you for a second the ongoing attempt to get rid of symptoms actually creates a clinical disorder the private experience which is labeled as a symptom anxiety produces a struggle with that symptom so you’re trying to control your anxiety and you’re getting frustrated because you can’t control your anxiety which makes you feel helpless which increases your anxiety about the fact that you can’t control your anxiety does that make any sense no a symptom by definition is something pathological and something we should try to get rid of but in reality everybody feels anxiety we are born with the fight-or-flight reaction it’s a normal feeling it’s what you do with it that can be pathological so identifying the feeling saying all right my body or my brain is perceiving that there’s a threat right now okay let’s take a look at that enact the aim is to transform our relationships with our difficult thoughts and feelings and learn to perceive them as harmless maybe uncomfortable transient psychological events the thought that I can’t do this anymore that’s a feeling that’s a valid thought now do we need to hold on to that and perseverate on it or can we just let it go out the window destructive normality I love this term act assumes that the psychological processes of a normal human mind are often destructive and create psychological suffering for us all sooner or later act postulates that the root of this suffering is human language itself now some of the things that we’ve talked if you think back to the abandonment class and some of the other classes a lot of our schemas are formed in early childhood where we are thinking in concrete terms where we are learning and relating in concrete terms all or nothing focusing on one aspect so the verbal representation of whatever it is that scary or threatening tends to be not as functional when you’re an adult and you have more skills and more independence and more ability to survive on your own so it’s this language that tells you I must do this all the time I should have done that that can cause suffering memories perceptions and schemas are created through analyzing comparing evaluating planning remembering and visualizing all of these processes rely on human language think about a time when you are when you were a kid you’re thinking about it right now most likely you’re using words maybe not out loud but you’re talking to yourself you’re like I remember that time when you know I was six and daddy took me on the toboggan across across the field you know you used words with that and I remember how much fun it was so now I think of snowboarding and tobogganing as fun because that’s the only Association I really have for it think about this I am stupid remember when I was talking about a child versus a child’s behaviour versus I have the thought that I’m stupid so if you think to yourself I am stupid and really think about that for a while and keep telling yourself that it’s pretty depressing if you think to yourself all right I am having the thought that I am just a dummy right now that’s different because thoughts come and go I can let a thought go another example that our clients may experience I can’t go on I just I can’t go on like this versus you know right now I’m feeling like I can’t go on a feeling can come and it can go I can’t come and go I’m either here or I’m not and you know I really want me to stay here for a while longer so it’s Bert we’re looking or we’re talking about attributions we’ve talked about those before global internal stable attributions I am stupid it’s about me it’s global I’m stupid about everything I didn’t say I was stupid about parallel parking I said I was stupid its global it’s internal it means it’s part of me so if I get rid of it then I’m getting rid of part of me what do I do with that that’s one of the reasons I don’t like labeling disorders as because people say I am depressed you have depressed feelings you have symptoms of depression right now but are you depressed and I’ve got to be really careful with my language because I’ll fall into that trap because it’s just shorter to say I am depressed or I am an addict but then people tend to personify that and I don’t want him to do that experiential avoidance act asserts that human language naturally creates psychological suffering by setting us up for a struggle with our thoughts and feelings through experiential avoidance there’s a problem I’m feeling anxious I don’t want to feel anxious my solution I need to figure out how to get rid of anxiousness or I need to avoid anxiousness and in my attempt to control it I end up making it worse instead of just accepting that it is and eventually it’ll just kind of peter out or making a choice to do something and we’re going to talk about the act matrix at the end of this presentation the more time and energy we spend trying to avoid or get rid of unwanted private experiences that’s thoughts and feelings anything that’s going on in our head the more we are likely to suffer quicksand think about the old movies where somebody fell into a pit of quicksand and the more they struggled the more they sank this is what’s happening with our clients the more they struggle with their anxiety with the tools they have at that present point in time the more they’re gonna sink so what we need to help them do is just accept okay let me chill out for a second I’m in the quicksand let me think about what I’m going to do with addiction the more people struggle to try to control their drinking to try to control their addiction the more they obsess about it the more they think about drinking the more they think about the pornography which makes them want to do it it gives them this really strong desire and then they get frustrated especially if they do relapse or engage in the behavior then they get frustrated they feel depressed they feel worthless they want to go back to that behavior because it’s a numbing avoidant behavior and that creates this whole dynamic of failure beginning failure anxiety and depression are the same way when people feel them often they want to try to get rid of them so they try to pretend that they’re not anxious or depressed they try to confront the anxiety or the depression unfortunately a lot of times they confront it in not so nice ways so encouraging clients just to accept without judgment and that is so hard act interventions focus around two main processes developing acceptance of unwanted private experiences which are out of personal control when something happens whatever it is loud noise goes boom and you startled that’s an anxiety reaction now am I going to get upset because I I jumped and I startled or am I gonna say I jumped and I startled moving on back to what I was doing people who are struggling with their anxiety will often get frustrated and get stuck on the fact well I shouldn’t have jumped that was stupid that was an irrational reaction it was what it was it happened your body responded and when we think about it there’s a loud noise you’re not expecting startles probably a pretty functional response we just let it go because then your cognitions your how higher-level reasoning kicks in and says no there’s nothing to be worried about car backfired or something and a commitment and action toward living a value life that is not getting stuck in this never-ending quicksand so the first step confronting the agenda the client’s agenda of emotional control is gently and respectfully undermined I like that I’m gonna undermine you but I’m gonna do respectfully well we want clients to understand and we need to come to an understanding of if we’re gonna use this technique is that controlling depression controlling anxiety while doing the same things it’s not going to happen so we need to try a different approach clients identify the ways they’ve tried to get rid of or avoid unwanted private experiences this is commonly called creative hopelessness which I really don’t like creating hopelessness but it highlights the fact that what you’ve done in the past has not worked so let’s see what we might be able to think of that might work and bring you closer to the life you want questions we asked of them did it Razoo reduce your symptoms in the long term and of course I’m hearing dr. Phil in the back of my mind going well how’s that working for you what did this strategy cost you in terms of time energy health vitality and relationships so okay you might have fought it for a while or whatever but at what cost and did it bring you closer to the life you want generally if somebody is trying to reduce their symptom and it’s having a bunch of costs it’s taking them further away from the life they want because what they’re saying is costs are trade-offs and trade-offs are generally things we trade off things that we want for other things confronting the agenda all right so we see that trying to control your depression anxiety addiction whatever it is hasn’t worked you’re here you’re ready to try something else score alright so let’s try to think about it this way control is not control is the problem not the solution and they’re gonna look at you like you’ve got three heads and that’s okay yeah I’m I’m good with that clean discomfort is when emotions and reactions are accepted and it leads to a natural level of physical and emotional discomfort think of about getting a shock you know I am a great big old sissy when it comes to getting a shot now if I went into the doctor’s office with clean discomfort I just be like all right fine get it over with the nurse would jab me I’d be over but a Bing oh but no no I tread going there I don’t sleep well the night before I dread going there I sit in the doctor’s office I’m like oh this is gonna hurt and my shoulders gonna hurt for the next three days four separate on it I get in there and as soon as she puts the alcohol on my arm even though I’m trying not to do it I’m trying to control it I tense my arm up which means not only does it hurt more but it creates a bruise and just cascade of effects the same problem with emotions when we start to struggle with our fear or with our depression and when we start to lose then we can Angry ourselves for not being able to control our fear or depression and then we start to feel helpless and all these negative emotions just compound on each other dirty discomfort once we start struggling with that emotion the struggle switch is what they call it and act is turned on and it says all right ready go discomfort increases rapidly the struggle switch is like an emotional amplifier switch it on and then not only do we have anxiety but we have anger about our anxiety anxiety about our anger depression about our depression or guilt about our guilt or all of the above some people are really talented and they can have like every negative emotion concurrently that’s not necessarily a beneficial talent but I have known people who have you know basically gone through their behavior train analysis and identified you know that they ended up feeling all of those feelings as a result of the initial negative feeling so the six core principles once the emotional control agenda is undermined once people realize that trying to control this you know just trying to think it away is not gonna work then we introduce the six core principles of act to help clients develop psychological flexibility we all like flexibility diffusion sounds just like what it is we’re gonna kind of diffuse this moment acceptance all right I’m gonna accept it is what it is contact with the present moment that observing self remember my fly-on-the-wall values and committed action so let’s look at those cognitive diffusion is learning to perceive thoughts images and memories as bits of language as opposed to something that’s dangerous you know it it’s a memory it’s a thought it can’t hurt me now I can choose to hold on to it I can choose to magnify it or I can choose to just let it go in and out cognitive diffusion means stepping back and recognizing that thoughts are just transient private subjective events what do we mean by that it’s not an objective truth what happened happened but what you are remembering is your subjective account of what happened if you were scared if you were depressed think about a race there are five runners in a race one person wins and four people lose the person that won is like score you know they remember that event as very positive the four people that lose one person says hmm I need to work on my speed a little bit more another person says I should have done better getting off the block when when the gun went off the third person identifies something else they can work on and the fourth person is like I am a total failure they all ran the same race but they all have different subjective interpretations and subjective memories of that event so a simple exercise that came out of some of the readings think of a negative self judgment that takes the form of I am X I am stupid I am lazy I am you know of course we’re gonna think about negative stuff cuz our clients don’t usually come to us and say I am awesome believe it as much as you can and we talked about this earlier notice how it affects you when you repeatedly tell yourself that now some of you are probably thinking back to Stuart smiling and looking in the mirror and going I am good enough I am smart enough and gosh darn it people like me but anyway when people hold on to a negative thought then they start to sort of personify they take on that negative thought and it affects them mentally it affects them emotionally if you keep telling yourself you’re stupid how does that work to make you happier how does that work to make you less anxious then turned it around or add the phrase I am having the thought that I’m having the thought that I’m stupid notice what happens once you add that clause in the front or phrase it’s been a while since I had English people start to notice a debt a distance from the thought and they also like I talked about earlier they’re not talking about themselves anymore it’s not this global internal stable thing that they’re talking about it’s not them that is X it’s a thought that’s telling them their X and we can silence thoughts we can make them go away diffusion techniques some things and if you google these you can find lots and lots more the mind treat the mind is an external event almost as a separate person my mind is doing this I don’t have to do it my mind is interpreting it this way I have to necessarily accept or reject it I can just observe what my mind is doing and being aw I’m having the thought that helping people learn that thoughts are not causes it’s possible to think that thought as a thought and do X is it possible to think that this is really scary but do it anyway certainly is it possible to think that I’m never going to get through this and get through it anyway absolutely thoughts are not causes they are just interpretations or our minds best guess about what’s going to happen another technique is who’s in charge here treat negative thoughts as bullies if the person is constantly having negative thoughts telling them they’re stupid they’re no good they’re never going to amount to anything have the person treat it like a bully and say I don’t have to listen to you or kind of a radical acceptance approach here this negative thought comes in my head I’m stupid okay you’re right so now what what are you gonna do about it instead of arguing with it instead of kind of trying to contradict it instead of putting it out here they say all right maybe there’s something to what you say how can I fix it what can I do about it that moves me closer to my values and an AC T we always want to have that clause on the end that moves me closer to my values acceptance means making room for unpleasant feeling sensations urges and other private experiences we don’t have to let them set up shop there but we have to sit understand or accept the fact that they’re gonna come and then they’re gonna go kind of like you know an unwanted family member that comes stays the night and then moves on you know and just don’t let them unpack and stay there for a while we want to allow them to come and go without struggling with them running from them or giving them undue attention so back to that family member you have Uncle Bob and he has just the worst house kissed and he shows up on your doorstep one day and says hey I was just passing through town and figured I’d stay the night with you and you’re like great so you could you could struggle with Uncle Bob and say no you really can’t he’s like oh but why you use a whole lot of energy trying to theoretically tactfully tell him no and he’s not hearing about it or do the anybody loves room or Everybody Loves Raymond thing and hide under the door when you see him coming like everybody get down kick you get down turn off the lights it’s not the best reaction either and it takes a lot of energy or giving it undue attention and getting really upset that Bob had the audacity show up on your doorstep probably is not gonna do any good so you can just allow him to come and go without struggling with it unhook thoughts and feelings don’t always lead to action you may be really ticked off that Bob did this but doesn’t mean you have to act out in anger doesn’t mean it has to ruin the rest of your evening not necessarily what can you do to unhook your thoughts from your feelings identifying the problem when we’re battling with an inner experience it distracts us and derails us so if we’re debating over something and were you know just constantly going back and forth and you know it’s been scary before but we know we’ve got to do it oh my gosh I don’t want to do it going to a reunion with Uncle Bob maybe you don’t want to go because you know he’s just gonna get drunk and be loud and obnoxious you can dread it and battle it and think about it and perseverate on it but that just uses a lot of energy so it goes back to that question of at what cost you can explore the effects of avoidance and how that has worked in your life you know if you’ve tried to avoid Uncle Bob not answered his phone calls you know we saw it didn’t work he just showed up at the doorstep anyway so you know maybe we ought to just make a different way to approach it defining the problem identify what the struggle is against and barriers toward heading in the direction of those goals I have a friend who just retired from the military and he struggles a lot with feeling okay and self-efficacy and everything he’s used to the military lifestyle he’s used to the camaraderie and it’s terrifying to have to take on a whole new life now so he’s struggling against this anxiety and fear and everything that’s keeping him stuck so in a CT in acceptance we would look at defining the problem what is it that you’re terrified about let’s list all those things and let’s start identifying the barriers towards heading in the direction of those goals I’m not saying you don’t have a right to be terrified you are what you are however I don’t want you to unpack and stay there and the serenity prayer change what we can accept what we can’t and the wisdom to know the difference too often people try to change the unchangeable like other people or the weather or you know a lot of things that we have no control over so some things Facebook for example sometimes you’ve just got to turn on Facebook um thinking about Uncle Bob you know you’ve known Uncle Bob for 30-some odd years and he hasn’t changed yet so trying to change him now probably isn’t gonna work because he’s happy the way he is so we can either continue to try to change him which is not gonna work or accept the fact that he’s just Uncle Bob I hope nobody out there has an uncle Bob if you do sorry was not meant to actually pick on him contact with the present moment bringing full awareness to your here and now experience with openness interest and receptivity focusing on and engaging fully in whatever you are doing so when you’re doing it focus on how do I feel I mean as you’re sitting in your chair right now how do I feel what am I thinking about you know maybe your mind’s wandering because you’re like oh yeah I had an uncle Bob like that or maybe you’ve got a patient in 18 minutes and you’re trying to figure out alright what’s what do I have going on with that patient contact with the present moment would theoretically be staying focused right here right now and trying to identify things that relate to this presentation you know thinking about clients that that’s worked with or thinking about how you might use this in further sessions today even if you can’t stay completely attune to my voice not everybody’s not a Tory learner I get that not a problem focus on what physical sensations you’re experiencing you know you see me sitting in the chair and I am a very active talker but I also move around in my chair a lot I’m just that way physical sensations can be are you HOT are you cold is your leg going to sleep are you sitting on a hard chair think about you know we’re supposed to think about when we’re doing computer work are we sitting with good posture and relaxing or our neck and shoulders describe the environment smell temperature colors objects people sounds etc challenge yourself to take you know a break every hour or every two hours you know not everybody has the luxury of having an hour to do it and go through these and just bring full awareness to the here and now for a week every hour throughout the day that you’re awake for a week practice becoming in contact with the present moment see what happens it may not have any effect but my guess is it will you can also do this through a simple I see hear and smell blank and it reminds me of whenever I smell pine-sol it reminds me of my grandma’s house so that’s a pleasant memory for me when I smell that it triggers happy sensations and happy neuro chemicals and happy happy happy so guess what I clean my house with the observing self yeah I told you love this little fly accessing a continuity of consciousness that’s unchanging ever-present and impervious to harm have you ever tried to get a fly I am not good at getting flies you know the flies in my house are impervious to harm and they just sit up on the wall and laugh at me so from this perspective yes I’ve got some paranoid delusions but we’re moving on from this perspective is possible to experience directly that you are not your thoughts feelings memories urges sensations images rolls or physical body so if you imagine yourself to be the fly on the wall you can look down at that person of you and go gee why is she doing that or that’s crazy or ask or having a good day today these phenomena change constantly and our peripheral aspects of you but they’re not the essence of who you are so this fly is seeing the peripheral you this fly is just looking and seeing you act or react the way you do think about if you get a new dog and especially a new an older dog a rescue dog and they have some behaviors and you’re like where did that come from contextual what’s going on what did it get them in the past but the dog is also sitting there watching you going are you sure you want to do that so values clarifying what is most important deep in your heart and some people hate that phrase but you know when it comes down to it what is most near and dear to you what sort of person do you want to be what is significant and meaningful to you and what do you want to stand for in this life now any of those could be an entire essay and you could spend you could have a client do one each week for four weeks to help him or her start identifying their values Steven Hayes has a whole series of books that walk you through these six steps there is what six books and help you help clients more effectively implement the six components of a CT but clarifying he has a whole book on it so obviously it’s not just four bullet points there are a lot of different ways to help clients clarify their values versus what they told we’re told they should think or should feel a lack of values or confusion of goals with values can underline the underlie the ability inability to be psychologically flexible so if you’re confusing a goal with the value I want to be rich that’s not a value what is your value that’s a goal why do you want to be rich why do you value money I’m talking about that the next step in the Act process is choosing a direction and establishing willingness identifying motivating values what direction do I want to go and again how does they get it closer to where I want to be and who I want to be with and establish a willingness to help regain control of life not necessarily just to control thoughts and feelings so I’m gonna take control of my life and I’m gonna understand that there are going to be bumps in the road but I’m also gonna understand that I’ll also get to feel the good things because I’m in contact with the present moment that’s right committed action setting goals guided by your values and taking effective action to achieve them sometimes this is called purposeful action everything you do has a purpose and that purpose is to get you closer to where you want to go not to set you backwards and I told you we would end with the act matrix and that’s a whole different book there are activities on psychological flexibility that work with this but to try to kind of put it all into context and tie it up with a handy little bow on the top of it you have your behaviors and your $0.05 experiencing what’s observable to others when you walk into a room what do others see others see you others see the other people in the restaurant others see the expressions on your faces others can feel the temperature of the room but they don’t know what’s going on inside your head and they don’t know what you’re thinking down down at the bottom are your thoughts emotions and internal experiences now this project or this activity divides this into four quadrants so when you’re looking at towards the left side you’re moving away from your goals and values so what do I do that moves me away from discomfort and how is this moving me away from my goals or values so a lot of times clients will come in they’ll say when I’m really stressed out I have a few drinks okay that’s what you do and we’re not judging we’re not doing anything we’re just writing it down so we put have a few drinks up here what am I thinking or emotionally experiencing right now that’s moving me away from my goals a lot of times it’s fear depression anxiety this is why they’re here so you take that dysphoria I’m just going to generalize it and when you feel just for it you drink so then the person is stuck on this left side of the activity this left side of the quadrant thingy um because once they drink then they’ve just intensified they haven’t fixed anything they just escaped for a little while so then they sober up and they’re still dysphoric then we move over here and say okay what’s moving me toward my goals well first I have to know what my goals are so what who is important to me what am I thinking or emotionally experiencing that’s moving me toward my goals or values and things these are things like accomplishment success happiness observable things things that other people can see that are moving you toward your goals and values what could I do to move me toward who and what is important to me and what am i doing right now that is moving me toward my goals or values so when something happens people are in maybe somebody’s in a bad relationship and they decide to break up and it’s excruciating and they are just you know they’re in agony over this relationship loss so they’re down here they’re feeling something negative and they want to escape but then we say okay that is definitely one thing you could do however does escaping move you more toward your goals and values does it move you toward where you want to be the answer is probably no so then we say okay what could you do that would help move you toward that or maybe they’re thinking of getting back in the relationship that’s one of their options if they’re not going to escape maybe they just need to suck it up and get back in the relationship now we say okay is that going to move you toward your goals of being happy and successful and everything you’ve identified or logically is it going to move you away from I mean this is all just very I don’t want to say clinical but it’s very factual encouraging people to just keep that in their head every time they do something or have to make a decision or have a thought if they have a thought that says you’re stupid they need to ask themselves is that self-talk that’s going to move me toward my goals or is it self-talk that’s going to hold me back or worse yet move me further away from where I want to be six months from now the goal of Act is to create a rich and meaningful life while accepting that pain inevitably goes with it it happens part of living a meaningful rich life is being aware and in the present moment most of the time I mean in reality we’re not going to stay completely grounded and present 24/7 365 because we get caught up and work we get caught up and stuff but if we can encourage ourselves to do it multiple times a day then we’re going to be more aware of where we are how we are and how we’re feeling destructive normality is the psychological process of a normal human mind which can be seen as destructive and creates psychological suffering people start to feel that they’re helpless they’re trying to get rid of something that’s normal you feel anxiety that is a normal feeling that is a normal reaction I totally get why you feel that right now what do we do about it actions designed to avoid the experience in the present are not going to be helpful we want to help people just identify and accept therapeutic interventions focus around two main processes develop developing acceptance of unwanted private experiences which are out of personal control so that automatic thought that automatic feeling it happened now there’s no need to beat yourself up for it it happened let it go if you give it attention it’s kind of like a stray dog if you give it attention it’s gonna keep coming back trust me I have more than one stray dog that comes to my house whoops anyway and commitment and action toward living a valued life once you’ve decided to try to try to quit controlling the things that you can’t control then you can use all that energy toward making decisions and taking action to move toward where you want to go how cool is that if you quit being stressed about being stressed or worried about being angry you have a whole lot more energy to do what you want to do this also applies to holding on to resentments you know we talk about people using a lot of energy to nurture grudges and resentments that feeling whatever that feeling is is something that they can choose to let go you don’t have to continue feeling resentful you can choose what to do with it confronting the gym agenda to eliminate the stress you’re not going to eliminate it it’s going to happen so explore sources of distress explore prior attempts at removing the stress and that effectiveness how did that work for you in the short term may have worked great how did it work for you in the long term with regard to what was the cost and how did impact the other areas of your life and did it move you closer to or further away from your goals and finally the six core principles of act are diffusion separating self from the experience acceptance is what it is contact with the present moment through mindfulness observing the self as a fly-on-the-wall values identification and then choosing committed action

Michael Martin

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