Acceptance & Commitment Therapy (ACT) Science Meets Mindfulness Joanne Steinwachs, LCSW Rocky...
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Transcript of Acceptance & Commitment Therapy (ACT) Science Meets Mindfulness Joanne Steinwachs, LCSW Rocky...
Acceptance & Commitment Therapy
(ACT)
Science Meets Mindfulness
Joanne Steinwachs, LCSWRocky Mountain Counselors ConferenceJuly 30, 2008Denver, CO
2 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
• How I came to ACT• Social work• Looking for a theory• Why do I need a theory?• What is a scientific model of human
behavior?
3 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
What is ACT?
“ACT is a therapeutic approach that uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility.”
Hayes, Wilson, Strosahl, 1999
4 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Where did ACT come from?
• ACT has been called a “third wave” behavioral therapy; placing importance on changing the way individuals relate to their experience as opposed to changing the content of their experience.
• Other “third wave” behavioral therapies include DBT, MBCT and FAP.
5 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
The ACT Question
Given a distinction between you and the stuff you are struggling with and trying to change, are you willing to have that stuff, fully and without defense, as it is, and not as what it says it is, AND do what takes you in the direction of your chosen values at this time, in this situation?
8 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
RFT tells us why humans suffer the way we do
Examples:• Saliva• Connect anything• Sunset• Dog watching TV
9 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Relational Frame Theory
• Where can you go that your thoughts can't find you?
• We can relate anything to anything.
• Virtual reality.
10 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Relational Frame Theory in a nutshell
WORDS MAKE MONSTERS REAL.
11 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
So what does all this mean for us clinicians?
12 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
The ACT Theory of Change
•Our psychological problems originate from thought and language.
•The goal is psychological flexibility to contact with the present moment to change or persist toward our valued ends.
•Verbal regulation, rigid rules, prevent us from moving in valued directions.
13 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
The Primary ACT Model of Psychopathology
Dominance of the Conceptualized Past and
Feared Future: Weak Self-
Knowledge
Inaction, Impulsivity,or AvoidantPersistence
Lack of Values Clarity;
Dominance of Pliance &
Avoidant Tracking
Attachment to the
Conceptualized Self
Experiential
Avoidance
Cognitive
Fusion
Psychological
Inflexibility
14 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Cognitive Fusion
•Humans tend to live in a world excessively structured by literal language.
•Verbal constructions of life can even become a substitute for life itself.
•People cannot distinguish a verbally-based and evaluated world from the world as directly experienced through the senses.
15 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Cognitive Fusion:Reason Giving
• We don’t just give reasons, we view reasons as causes for behavior.
• The reason is taken as a cause for not making progress, perhaps even in a highly valued domain of living.
• We are taught that we must have explanations for our behaviors and furthermore that these explanations must be coherent. Particular in the realm of behavior that doesn’t work, we really are expected to have a good explanations.
17 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Dominance of the Conceptualized Past and Feared Future,
Weak Self Knowledge
• Coulda, shoulda, woulda.• If only.• What if?• Fearful focus on the future, guilty,
shamed focus on the past.
18 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Lack of values clarity, Dominance of pliance and
avoidant tracking
• I don't know what I want. • I should...• Nothing matters to me.• I don't know who I am or what I
want.• Tell me how I should be.• I just don't want to feel afraid,
ashamed, lonely, incompetent, etc.
19 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Inactivity, Impulsivity or Avoidant Persistence
• The couch potato, depression
• The addict.
• “My strategy hasn't worked because I haven't done it long enough or hard enough.”
20 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Attachment to the Conceptualized Self
• I am an attorney.• I am a mother.• I am a loser. • I am a rock star.• I am...• I must be a good (fill in the blank) or
I am nothing.
21 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Experiential Avoidance
•In summary, the ACT processes of psychopathology all add up to efforts to avoid private experiences such as thoughts, images, emotions and physical sensations.
•There is a mounting body of empirical evidence that suggests that experiential avoidance is at the root of many, if not most, psychological disorders.
23 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
The Primary ACT Model of Treatment
Contact with thePresent Moment
Committed
Action
Values
Self asContex
t
Acceptance
Defusion
Psychological
Flexibility
24 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Acceptance
•An active embrace of the present moment, fully and without defense.
•Acceptance as an alternative to experiential avoidance.
•Willingness as a choice, not a decision, thought or feeling.
•Acceptance in the service of values-based action.
26 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Cognitive Defusion
•ACT views thoughts as problematic more in terms of function vs. content.
•Fusion with thoughts limits one’s ability to be present and flexibly responsive
•Defusion aims to change the way one relates to their thoughts.
•Thoughts and feelings are not causes of behavior.
28 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Self as Context
•Simple awareness; a safe place from which we can have experiences as they are and not as they say they are.
•Distinguishing between conceptualized versions of self (life story, self-evaluations) and the context in which these events occur.
•Best understood as experienced.
30 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Contact with the Present Moment
•Acceptance and defusion are in the service of “showing up” to the present moment.
•Being present promotes vitality, creativity and spontaneity.
•Being present is reinforced within the context of the therapeutic relationship.
31 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Contact with the Present Moment Exercise
– Type in here
32 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Values
•Clarified values as important “guidance system” which leads to purposeful, enriching patterns of behavior.
•Differentiating values from goals.•Letting go of experiential control in
the service of pursuing valued ends in life.
33 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Values Clarification Exercise
• Going west.• List.
34 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Committed Action
•The ultimate goal of ACT is promoting committed action in valued directions.
•Any movement towards values, however small, leads to increased vitality.
•Emphasis on the process of growth vs. the achievement of specific goals.
•Action triggers barriers that breathe life into all other core interventions.
36 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
This, then is the
overall ACT model
Contact with thePresent Moment
Committed
Action
Values
Self asContex
t
Acceptance
Defusion
37 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Acceptance and Mindfulness
Processes Contact with thePresent Moment
Committed
Action
Values
Self asContex
t
Acceptance
Defusion
38 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Commitment and Behavior Change
Processes
Thus the name “Acceptance
and Commitment
Therapy”
Contact with thePresent Moment
Committed
Action
Values
Self asContex
t
Acceptance
Defusion
39 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Self asContex
t
ACT Question
(1) Given a distinction between you and the stuff you are struggling with
and trying to change
40 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Self as Context
Acceptance
(1) Given a distinction between you and the stuff you are struggling with and trying to change
(2) are you willing to have that stuff, fully and without
defense
ACT Question
41 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Self as Context
Acceptance
Defusion
(1) Given a distinction between you and the stuff you are struggling with
and trying to change
(2) are you willing to have that stuff, fully and without
defense
(3) as it is, and not as what it says
it is,
ACT Question
42 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Self as Context
Acceptance
Defusion
(1) Given a distinction between you and the stuff you are struggling with
and trying to change
(2) are you willing to have that stuff, fully and without
defense
(3) as it is, and not as what it says
it is,
(4) AND do what takes you in the direction
CommittedAction
ACT Question
43 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Self as Context
Acceptance
Defusion
(1) Given a distinction between you and the stuff you are struggling with
and trying to change
(2) are you willing to have that stuff, fully and without
defense
(3) as it is, and not as what it says
it is,
(4) AND do what takes you in the direction
CommittedAction
Values(5) of your
chosen values
ACT Question
44 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Self as Context
Acceptance
Defusion
(1) Given a distinction between you and the stuff you are struggling with
and trying to change
(2) are you willing to have that stuff, fully and without
defense
(3) as it is, and not as what it says
it is,
(4) AND do what takes you in the direction
CommittedAction
Values(5) of your
chosen values
ACT Question
45 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Self as Context
Acceptance
Defusion
(1) Given a distinction between you and the stuff you are struggling with
and trying to change
(2) are you willing to have that stuff, fully and without
defense
(3) as it is, and not as what it says
it is,
(4) AND do what takes you in the direction
CommittedAction
Values(5) of your
chosen values
Contact with the
Present Moment
(6) at this time, in this
situation?
ACT Question
46 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
If the answer is yes, that is what builds…
47 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Psychological
Flexibility
Contact with thePresent Moment
CommittedAction
Values
Self asContext
Acceptance
Defusion
48 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
A Model of the ACT Therapeutic Relationship
49 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
ACT Therapeutic Posture
• Whatever the client is experiencing is not the enemy
• You can’t rescue clients from difficulty• Compassionately accept no reasons• If the client is trapped, confused,
frustrated, afraid, angry or anxious, be glad
• Be glad if you are experiencing this- you are in the same boat as your client
50 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
ACT Therapeutic Posture, Continued
• With acceptance, defusion, self, and values, it is more important to do as you say than to say what you do.
• Don’t argue, don’t persuade- it’s the client’s life and experience
• You are in the same boat- never protect yourself by moving one up
• The issue is always function, not form or frequency. When in doubt, ask yourself or the client “What is in the service of?”
51 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
ACT Empirical Evidence
• Substance abuse: one study reported less drug use than with a 12-step program
• Quit smoking: ACT worked better than nicotine patches n=67. Quit rates were similar at post, but, at a one-year follow up, the 2 groups were significantly different. The ACT group had maintained their gains (35% quit rates) while the nicotine patches quit rates had fallen, i.e. less than 10%
52 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
ACT Empirical Evidence
• Chronic pain: ACT gets chronic pain patients back to work faster, with fewer sick days and fewer visits to the GP, less self reported pain symptoms
• Stress management: Bond and Bounce study shows ACT is more effective than a previously supported behavioral approach to reducing worksite stress and anxiety
53 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
ACT Empirical Evidence•Depression: Study with Beck’s CT and
ACT- n=18, a 12 week study, ACT had better outcomes at a 6 month follow up with a reduction in believability of depressive thoughts
•Epilepsy: one study with 27 institutionalized South African epileptics who had just 9 hours of ACT in 2004 experienced significantly shorter and fewer seizures than those in a placebo treatment in which the therapist offered a supportive ear.
54 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
ACT Empirical Evidence
• Psychosis: ACT and re-hospitalization after 3 hours of ACT- •a) 50% reduction in hospitalization •b) an increase in self reporting of
symptoms, therefore, accepting the symptoms of psychosis if they admit the symptoms
•c) reduction in the believability of distressing thoughts, hence a change in the function of the thoughts
55 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
ACT Empirical Evidence• Panic Disorder: Acceptance methods
(drawn directly from the ACT book) did a better job than control strategies in promoting successful exposure in panic disordered clients
• High Risk Sexual Behaviors: Components of ACT were included as a component of a successful program to reduce high-risk sexual behavior in adolescents
• Social Phobia: ACT versus CBT: more willingness to be anxious in the situation and thus less fear over the time of public speaking, therefore ACT more successful
56 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Ways to Learn More About ACT• Trainings: Russ Harris, Boulder, Sept ??• Join ACBS
• Values based dues.• Many trainings are listed on the site along with a
staggering amount of information. www.contextualpsychology.org
• Join and read the list serve. Talking ACT. • [email protected]
m• Read the books.• Go to a Conference
• 2009 International Conference, Amsterdam• 2010 in San Antonio
• Get into a consultation group• Seek supervision/consultation; I have a list
of local consultants.
57 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Learning ACT• Join ACBS, the ACT (and maybe the
RFT) listserves, and spend hours on www.contextualpsychology.org,
• Read these books to start (plus others)
58 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
More books on ACT with specific
populations.
59 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Now What?
Given that the only certainty is death, and the time of death is uncertain, what matters to do right now?
Acceptance and Commitment Therapy is one way to discover the answer to this question.
60 Joanne Steinwachs, LCSW 303-691-9509 [email protected]
Questions
Joanne Steinwachs, LCSW, PC1776 S Jackson St
Suite 616Denver CO 80210
303-691-3369
www.joannesteinwachslcsw.com
Association for Contextual Behavioral Psychology
www.contextualpsychology.org