Acceptance and Commitment Therapy LECTURE NOTES.pptx

Acceptance and Commitment Therapy LECTURE NOTES.pptx

1. DR MARIA LIVANOU ACCEPTANCE & COMMITMENT THERAPY (ACT) Figure 1: Meditation ( Pixabay : John Hain, 2020:online)

2. AIMS Overview of ACT Basic principles - therapeutic elements - techniques

3. ACT is a type of behavior therapy It’s about acting in line with your goals or wishes or core values It’s about changing what you do (not what you feel or think) WHAT IS ACT? Because ultimately it is about taking action, altering one’s own behavior

4. A therapy that aims at changing the way the person interacts with (or relates to) thoughts and feelings by creating contexts in which unhelpful functions are diminished. e.g., in ACT a negative thought is noticed or observed or acknowledged; it can be repeated out loud, focusing on its sound; the person could ‘label’ the process of thinking (“ I am having the thought that I will fail my assignment”). By doing so, the literal quality of the thought is weakened, as is the tendency to treat it as what it refers to (“I will indeed fail my assignment”) rather than what it is directly experienced to be (e.g., the thought “I will fail”). WHAT IS ACT?

5. It’s a “third-way” (or third generation) behavioural therapy, together with Dialectical Behaviour Therapy, Mindfulness-based Cognitive Therapy and Compassion-focused therapy Even though it is considered to be a relatively new intervention, it stems from a therapeutic approach called “ Comprehensive Distancing”, known since the 1980ies ( Zettle & Hayes, 1986; Hays et al, 2006) WHAT IS ACT?

6. ACT: BASIC PREMISES (a) - RIGIDITY Psychological problems and emotional distress often result from psychological rigidity . i.e., cognitive fusion and avoidance

7. ACT: BASIC PREMISES (b) - RIGIDITY Cognitive fusion : a state in which our negative thoughts dominate our behavior and where negative thoughts are accepted as real events the content of negative thoughts seems real, behavioural options seem limited and thoughts that are about the past or the future affect directly the here-and-now Avoidance : Experiential avoidance aims at changing the intensity, form, or frequency of negative thoughts, feelings, bodily sensations, or memories ( Hayes et al, 1996).

8. ACT: BASIC PREMISES (c) – THE ROLE OF LANGUAGE AND THOUGHT Rigidity is reflected in the way that language and cognition interact with direct contingencies This way of interaction is associated with inability to persist or change in the service of long-term valued ends . Psychological inflexibility: emerges from weak or unhelpful contextual control over language processes. (Hays et al., 2006)

9. ACT: BASIC PREMISES (d) – FROM RIGIDITY TO FLEXIBILITY To recover, the person needs to become cognitively ‘flexible’ and this can be achieved through ACCEPTANCE DEFUSING VALUES-BASED LIVING These are achieved through mindfulness exercises

10. PSYCHOLOGICAL FLEXIBILITY & THE ACT HEXAFLEX: The six core therapeutic processes of ACT Figure 2: The ACT Hexaflex (Harris, 2009: p.10)

11. “…to maximise the human potential for a rich and meaningful life, while effectively managing the pain that inevitably goes with it.” (Harris, 2009, p. 3) WHAT IS THE GOAL OF ACT?

12. MAIN THERAPEUTIC ELEMENTS OF ACT Acceptance: being aware of thoughts and feelings, observing them without avoidance. Defusion : distancing , disconnecting or seeing thoughts and feelings for what they are, not what they say they are E.g., rather than endorsing the thought "I‘ve failed as a parent”, accept “ I’m having the thought that I have failed as a parent “ Acting in line with own personal values and goals

13. Some ‘basic challenges’ in life need to be considered as constant: Life is difficult A full human life comes with the full range of emotions, both pleasant and painful A normal human mind naturally amplifies psychological suffering ACCEPTANCE (a)

14. ACCEPTANCE (b) Resisting or trying to push away (or trying to numb) pain, emotional distress and / or negative thoughts tends to make things worse Pain, emotional distress and negative thoughts can be accepted and experienced, being fully conscious / aware that they are an experience that one has to live through, rather than a permanent state Acceptance is an acknowledgement of and a willingness to allow these experiences Openness, awareness

15. DEFUSION Understanding and accepting that thoughts and feelings may or may not be true or important true → Whatever is happening, is not happening in the physical world but it’s only words or mental pictures important → We can choose how much attention to pay to it (Harris, 2009 )

16. EXAMPLES Cognitive fusion → Cognitive defusion : “I’ll make a fool of myself if I participate in this presentation” → “ I’m having the thought that I’ll make a fool of myself if I participate in this presentation .” “I can’t get out of my house” → “I’m having the thought that I can’t get out of my house.” Avoidance →Values-based action : “I want to be a person who controls their life choices. I will make the presentation / get out of my house, even though I am having the thought ….”

17. COMMITMENT & VALUES-BASED LIVING: The importance of values Values give meaning and purpose to our life. They are linked with what really matters, so being clear about our values, means being clear about what really matters. Values guide our lives; they often reflect our hopes about how we would like to be now, or how we would like to be remembered when we are no longer here Values are not just personal goals or things we want to achieve It is important to be aware of our values E.g. family, parenthood, friendship, careers, connecting with nature, healthy living, community service

18. COMMITMENT & VALUES-BASED LIVING: The need for behaviour change Acceptance , defusion and being present are not ends in themselves. They merely help the person think clearly and take the path they need to take (for a life that is consistent with their own values). ACT encourages people to take action linked to chosen values .

19. COMMITMENT & VALUES-BASED LIVING: What is the difference between GOALS and VALUES? A value is an abstract concept that cannot be achieved as an object, whereas concrete goals (that are consistent with values) can be achieved. Like other behavioural interventions (e.g., exposure), ACT involves homework exercises and tasks that are linked to short, medium, and long-term behavioural goals.

20. Clarifies values – goals / clarifies what is important and meaningful (gets us to revisit our values and consider what is inspiring or meaningful to us and motivates us to act in a way that can enrich and enhance our life). Promotes psychological flexibility, i.e., the ability to adapt to changes and balance competing necessities and roles ( Kashdan & Rottenberg , 2010) Teaches mindfulness skills to help us engage fully with thoughts and feelings and cope with them (without avoiding ) Focuses on helping us achieve values-congruent living (rather than symptom-free living) How does ACT help?

21. What do we know about the effectiveness of ACT? Check the literature for evidence (case studies, uncontrolled and controlled clinical studies, RCTs and systematic reviews or meta-analyses) What kind of mental health difficulties did the people in these studies have? (depression? anxiety?) EFFECTIVENESS: Independent study

22. Core principles of ACT: 1) Accept what is out of your personal control 2) Commit to taking action that enriches your life. Basic premises: psychological inflexibility (the role of cognitive fusion and avoidance) Interventions: mindfulness elements (acceptance, defusion ) and values-based action SUMMARY

23. REFERENCES Harris, R. (2009). ACT made simple. An Easy-to-Read Primer on Acceptance and Commitment Therapy . Oakland, CA: New Harbinger Publications. Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K. Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology. 1996;64:1152–1168.  Hayes , SC., Luoma , JB, Bond , FW, Masuda , A., Lillis , J. (2006). Acceptance and Commitment Therapy : Model , processes and outcomes ". Psychology Faculty Publications. 101 . https ://scholarworks.gsu.edu/psych_facpub/101 Kashdan , T., & Rottenberg , J. (2010). Psychological flexibility as a fundamental aspect of health Clinical Psychology Review, 30 (7), 865-878 Zettle , R. D., & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior : The context of reason giving. The Analysis of Verbal Behavior , 4, 30-38.