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ACT FOR BEGINNERS > WEEK ONE > Flashcards

WEEK ONE Flashcards

OVERVIEW OF ACT AND THE 'CHOICE POINT'

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1
Q

What are the six core processes of ACT

A
  • Creative Hopelessness
  • Defusion
  • Acceptance
  • Contacting the present moment
  • Self-as-context
  • Values
  • Committed action
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2
Q

what is FUNCTIONAL CONTEXTUALISM

A

A philosophy of science in which all behaviour occurs within context, which includes everything which influences the behaviour in question:

  • physiological
  • physical environment
  • interpersonal development and learning history
  • cognitive
  • social and cultural
  • genetic and epigenetic
  • emotional
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3
Q

WHO CREATED ACT, WHERE, WHEN AND WHO WITH

A

PROFESSOR STEPHEN C HAYES

UNIVERSITY OF RENO, NEVADA

“Making Sense of Spirituality” - 1984

​ - looking at spirituality through the lens of behavioural analysis, the branch of psychology from which ACT evolved.

First called “COMPREHENSIVE DISTANCING” - became ACT in 90’s

KIRK STROSAHL, KELLY WILSON

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4
Q

WHAT CONSTITUTES BEHAVIOUR? WHAT ARE THE TWO MAIN TYPES OF BEHAVIOUR

A

BEHAVIOUR IS ANY ACTION

OVERT/ PUBLIC - potentially observable by others

  • movement
  • speech

PRIVATE - cannot be observed

  • thinking
  • feeling/emoting
  • remembering
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5
Q

WHAT IS AN ANTECEDENT?

A

A CAUSE/ SOURCE/ TRIGGER FOR A BEHAVIOUR

  • situation
  • thoughts
  • feelings
  • biological state
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6
Q

WHAT IS A CONSEQUENCE? WHAT ARE THE DIFFERENT TYPES OF CONSEQUENCE IN THIS CONTEXT?

A

ANYTHING THAT RESULTS FROM A BEHAVIOUR

  • Reinforcing consequences - anything that increases or sustains a behaviour
  • punishing consequences - anything that reduces or eliminates a behaviour
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7
Q

WHAT IS ‘WORKABILILTY’ IN THIS CONTEXT

A
  • No behaviour is good/ bad
  • “is it working to help me build a rich, full and meaningful life, be the person I want to be and do the things I want to do?”
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8
Q

HOW DO WE HELP CLIENTS TO MODIFY A BEHAVIOUR

A

To modify a behaviour, we need to understand the function of the behaviour through clarifying the antecedents and consequences of the behaviour. We target the antecedents and consequences for modification.

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9
Q

WHAT IS ACT

A

ACCEPTANCE AND COMMITMENT THERAPY

ACCEPT WHAT IS OUT OF YOUR PERSONAL CONTROL AND COMMIT TO ACTION THAT IMPROVES YOUR LIFE - NOT PASSIVE ACCEPTANCE THERAPY

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10
Q

WHAT IS THE AIM OF ACT

A
  • IN LAYMAN’S TERMS
    • to live a rich, full and meaningful life while accepting the pain that inevitable goes with it
  • IN TECHNICAL TERMS
    • TO INCREASE PSYCHOLOGICAL FLEXIBILITY
      • to be here now
      • make room for thoughts and feelings that arise
      • do what matters
      • act effectively in line with your values
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11
Q

IS ACT AN EMPIRICALLY SUPPORTED TREATMENT? WHAT IS IT INDICATED FOR?

A

>250 Randomized Controlled Trials published in peer-reviewed journals that show effectiveness of ACT for many disorders

  • 2nd highest number of listings of all therapy models on the APA 12 EST list
    • depression - pending (1998 modest)
    • mixed anxiety - pending (1998 modest)
    • chronic pain - pending (1998 strong)
    • psychosis - modest
    • OCD - modest
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12
Q

WHAT TYPES OF THERAPIES COME UNDER THE CBT UMBRELLA?

A
  • Beck’s Cognitive Therapy, Behavioural Activation, Exposure with Response Prevention, Mindfulness-Integrated Cognitive Behavioural Therapy, Mindfulness-Based Cognitive Therapy, Functional Analytic Psychotherapy, Motivational Interviewing, Metacognitive Therapy, Schema Therapy, Relational Emotive Behavioural Therapy, Prolonged Exposure, Barlow’s Unified Protocol, ACT, Dialectical Behavioural Therapy Integrative Couples Therapy, Others
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13
Q

WHAT ARE THE COMMON AREAS BETWEEN ACT AND TRADITIONAL CBT BASED ON BECK’S THEORY OF COGNITIVE THERAPY?

A
  • EMPHASIS ON EMPIRICAL SUPPORT
  • IMPORTANCE OF DIRECTLY TARGETING COGNITION TO INFLUENCE BEHAVIOURAL CHANGE
  • BORROW FROM BEHAVIOUR ANALYTIC PRINCIPALS
  • ENCOURAGES AWARENESS AND MINDFULNESS OF THOUGHTS
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14
Q

WHAT IS A MAJOR DIFFERENCE BETWEEN ACT AND TRADITIONAL CBT?

A

IN ACT YOU ARE NOT ENCOURAGED TO DISPUTE, CHALLENGE OR DEVALUE YOUR THOUGHTS - THAT IS ACT INCONSISTENT.

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15
Q

PRACTICAL UNDERPINNING OF ACT

A
  • Process Driven
  • Adaptable
    • modify to suit therapist and clients
  • Almost infinite number of tools, strategies, interventions
  • Can be used for individuals
    • 15 - 60 mins
  • Groups
    • 60 - 90 mins
  • Formal/ Informal meditation/ mindfulness
  • interventions can be short or long
  • Brief Therapy - 4-12 1 hour sessions
  • Ultra Brief Therapy - 2-3 sessions of 15 - 20 minutes
  • Long Term
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16
Q

THEORETICAL UNDERPINNINGS OF ACT

’ IF ACT IS LIKE DRIVING YOUR CAR, RELATIONAL FRAME THEORY IS LIKE THE ENGINEERING PRINCIPLES OF YOUR CAR ENGINE”

A

THE ACT TRIANGLE GOES LIKE THIS

ACT

RELATIONAL FRAME THEORY

  • behavioural theory of language and cognition, offshoot of

BEHAVIOUR ANALYSIS

  • all CBT models borrow from Behaviour Analytic Principles

FUNCTIONAL CONTEXTUALISM

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17
Q

NAME SOME ASPECTS OF OTHER THERAPEUTIC MODELS THAT CAN BE INTERCHANGED WITH ACT PROCESSES

A

CBT - cognitive distancing - DEFUSION

BEHAVIOURAL ANALYSIS - behavioural change - COMMITTED ACTION

NARRATIVE - DEFUSION

EMOTIONAL FREEDOM THERAPY - primary and secondary emotions - ACCEPTANCE

POSITIVE PSYCHOLOGY - virtues - VALUES

TRANSPERSONAL - transcendent self - SELF AS CONTEXT

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18
Q

PSYCHOEDUCATION IN ACT

A
  • Quite a lot in early sessions
    • aim to do it through metaphor or experiential exercises
      • pushing away paper
      • hands as thoughts
      • radio doom and gloom
  • can be used to facilitate acceptance of difficult thoughts and feelings
  • helpful to go through the evolution of the human mind
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19
Q

INEVITABILITY OF PAIN

A

WITH CARING COMES PAIN

  • any meaningful aspect of life brings potential pain
    • health
    • career
    • family
  • the longer you live, the more likely you are to experience pain
    • fear, sadness, anxiety, guilt, disappointment, rejection, failure, grief, illness, death, aging, injury
  • REALITY GAP- the bigger the gap between want/ got, the bigger the pain
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20
Q

WHAT IS THE FIRST HAPPINESS MYTH

(remember that clinging to them can keep you stuck)

A
  • Happiness is the natural state for human beings
    • eg if all of the requirements for Maslow’s Heirarchy are met, we must feel happy
  • REALITY
    • Life is an everchanging flow of emotions
      • we don’t say that the natural state of the weather is blue sky and sunny, we expect it to change with the seasons
  • when we have an important loss - sadness
  • challenging situations with unpredictable outcomes - anxiety
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21
Q

WHAT IS THE SECOND HAPPINESS MYTH?

A
  • HAPPINESS MEANS FEELING GOOD
    • most definitions are “a state of pleasure / contentment
      • by this definition, there is no such thing as lasting happiness
    • “living a rich and meaningful life in which we feel the full range of human emotions” is much more realistic
      • the things that make life deeply fulfilling also give rise to plenty of painful emotions
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22
Q

WHAT IS THE THIRD HAPPINESS MYTH?

A
  • IF YOU’RE ARE NOT HAPPY, YOU ARE DEFECTIVE
    • more and more normal human emotions are being pathologized and overmedicated
    • the human mind evolved in such a way that it naturally creates psychological suffering
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23
Q

IN WHAT WAY HAS THE HUMAN MIND EVOLVED TO CREATE PSYCHOLOGICAL SUFFERING?

A

ON CONSTANT ALERT

  • mind constantly on alert for danger
    • useful to replay events to learn and prepare for next time
  • Modern minds have inherited this
    • worrying, anxiety, avoidance, catastrophizing
      • rumination is usually unhelpful

BELONGING TO A GROUP

  • was essential
    • alone you die
  • Instinct to belong is still there
    • fitting in
    • following rules
    • unfavourable comparisons
      • no longer comparing to a small group - social media allows us to compare to vast groups and unrealistic/ fake expectations

SCARCITY

  • survival demands that we look for more - water, food, sun, sex
    • we also want more than the other - makes us more attractive sexual partners
  • in modern life this leads to
    • greed
    • dissatisfaction
    • want
    • a feeling of scarcity
    • fear of ‘losing it all’
24
Q

HOW DOES MODERN LIFE MAKE THESE INSTINCTS PROBLEMATIC?

A

Thinking patterns have been intensified by complexity of modern life

  • never-ending to do list
  • always rushing to be somewhere else
  • so many data sources to worry about

The mind isn’t the problem is not defective or abnormal, it is just trying to keep you safe and away from pain.

25
Q

WHAT IS ‘RADIO DOOM AND GLOOM’ AND HOW CAN IT BE USED TO HELP OUR CLIENTS?

A

Imagine being absorbed in an activity. A radio is playing in another room. Suddenly, you notice it playing a song you like and you start to sing along. The song changes, you lose interest and become absorbed in your task again.

We can do this with helpful and unhelpful thoughts and emotions - WE ARE NOT TRYING TO IGNORE THEM - we are tuning them out. WE ARE NOT PLAYING ANOTHER STATION TO DROWN THE FIRST ONE OUT - we would never be able to concentrate.

26
Q

WHAT ARE SOME OF THE POSITIVE AND NEGATIVE EMOTIONS WE MAY EXPERIENCE WHEN WE CARE? WHAT ARE SOME OF THE MALADAPTIVE COPING MECHANISMS PEOPLE USE TO AVOID CARING/ FEELING PAIN?

A
  • JOY, CONNECTIVENESS, HAPPINESS
  • CONFLICT, DISAGREEMENT, TENSION, DISCORD
  • ALCOHOL
  • DRUGS
  • EXERCISE (EXTREME)
  • SLEEP
  • SOCIAL ISOLATION
27
Q

WHAT IS THE MAIN PARADIGM SHIFT IN ACT?

A

Instead of looking at thoughts, feeling actions in terms of good/bad, we look at them in terms of WORKABILITY

  • are they moving us towards or away from what we want to do, where we want to go, who we want to be
28
Q

HOW DOES STEPHEN HAYES DEFINE SELF AS CONTEXT?

A

“MAKE CONTACT WITH A SENSE OF SELF THAT IS A SAFE AND CONSISTENT PERSPECTIVE FROM WHICH TO OBSERVE AND ACCEPT ALL CHANGING INNER EXPERIENCES”

29
Q

OUTLINE SOME OF THE CHALLENGES THAT WE FACE AS THERAPISTS WHEN WORKING WITH CLIENTS WHO RESIST ACCEPTANCE AND DENY PAINFUL FEELINGS?

A
  1. LIFE IS DIFFICULT
  2. FULL HUMAN LIFE COMES WITH A FULL RANGE OF EMOTIONS
  3. THE NORMAL HUMAN MIND HAS EVOLVED IN SUCH A WAY THAT IT CREATES PSYCHOLOGICAL SUFFERING. IT AMPLIFIES OUR PAIN BY:
    1. reliving pains from the past
    2. finding problems in the present
    3. conjuring up fears in the future
    4. judging, criticizing, comparing
  4. AVOIDANCE OF PAIN PROVIDES SHORT-TERM RELIEF BUT AMPLIFIES PROBLEMS IN THE LONG TERM - BUT OUR BRAINS ARE WIRED TO SEEK SHORT-TERM GAINS AND IMMEDIATE PLEASURE
30
Q

WHAT ARE THE SIX CORE THERAPEUTIC PROCESSES OF ACT?

A
  • CONTACTING THE PRESENT MOMENT - BE HERE NOW
  • DEFUSION - WATCH YOUR THINKING
  • ACCEPTANCE - OPEN UP
  • SELF-AS-CONTEXT - FLEXIBLE PERSPECTIVE TAKING
  • VALUES - KNOW WHAT MATTERS
  • COMMITTED ACTION - DO WHAT IT TAKES
31
Q

WHAT IS ‘CONTACTING THE PRESENT MOMENT’ ?

A

BE HERE NOW

  • being psychologically present, paying flexible attention
    • consciously connecting with and engaging in whatever is happening in this moment
  • flexibly bringing our awareness to either the physical world around us or the psychological or physical world within us, or both simultaneously
  • consciously paying attention to our here-and-now experience instead of drifting off into our thoughts or operating on ‘automatic pilot’
  • narrow, broaden, sustain or shift focus as needed
    • direct attention to where it needs to go for most effective results
32
Q

WHAT IS DEFUSION?

A

WATCH YOUR THINKING

  • learning to step back and separate or detach from our thoughts, images and memories
    • learning more flexible ways to respond to our cognition
      • awareness
      • naming to separate and detach
      • neutralizing
        • full term is COGNITIVE DEFUSION
  • let our thoughts come and go as if they were just cars driving past outside our house
    • step back and watch our thinking instead of getting tangled up in it
  • we see our thoughts for what they are
    • nothing more or less than words and pictures
    • we hold them lightly instead of clutching them tightly
33
Q

WHAT IS ACCEPTANCE?

A

OPEN UP

  • opening up and making room for painful feelings, sensations, urges and emotion
    • we drop the struggle
    • give them breathing space
    • allow them to be as they are
      • not fighting, running, resisting or getting overwhelmed
  • does not mean liking or wanting them, just making room for them
    • it is not passive acceptance of the situation
34
Q

SELF AS CONTEXT in ACT

A

FLEXIBLE PERSPECTIVE TAKING

  • two distinct elements to the mind
    • thinking self
    • observing self
  • thinking self
    • most familiar
      • generates thoughts, beliefs, memories, judgments, fantasies, plans
  • observing self
    • that aspect of self that is aware of what we’re thinking, feeling etc
      • pure awareness
  • as you go through life there are changes - body, thoughts, feelings, roles
    • the “you” that is able to notice or observe never changes
      • the same “you” that has been there your whole life
  • with clients we tend to refer to “the observing self” rather than “self-as-context”
35
Q

WHAT DO WE MEAN BY ‘VALUES’ IN ACT?

A

KNOW WHAT MATTERS

  • deep in your heart, what do you want your life to be about
    • what do you want to stand for
    • what do you want to do with your brief time on this planet
    • what truly matters to you in the big picture?
  • VALUES ARE DESIRED QUALITIES OF ONGOING ACTION
    • ​they describe how we want to behave on an ongoing basis
  • clarifying values is an essential step in creating a meaningful life
    • in ACT we often refer to values as “CHOSEN LIFE DIRECTIONS”
      • ​compare values to a compass because they give us direction and guide our ongoing journey
36
Q

WHAT DO WE MEAN BY ‘COMMITTED ACTION’ IN ACT?

A

DO WHAT IT TAKES

  • taking effective action, guided by our values
    • translating values into effective action
      • psychological, physical or both
      • private - engaging, appreciating, focussing attention on the task at hand
        • only via ongoing values-congruent action that life becomes rich, full and meaningful
  • WE WON’T HAVE MUCH OF A JOURNEY IF WE JUST STARE AT THE COMPASS - THE JOURNEY ONLY HAPPENS WHEN WE MOVE OUR ARMS AND LEGS IN OUR CHOSEN DIRECTION
  • values guided action gives range to a wide range of thoughts and feelings, pleasant and unpleasant
  • doing what it takes to live by our values
    • even if it brings pain or discomfort
  • all traditional behavioural interventions can be used in this part of the model
    • goal setting
    • exposure
    • behavioural activation
    • skills training
  • any skill that enhances and enriches life can be taught under this section of the hexaflex as long as it is in the service of valued living, not experiential avoidance
    • negotiation
    • time management
    • assertiveness
    • problem solving
    • self-soothing
    • crisis coping
37
Q

WHAT DO WE MEAN BY ACT

A

A SIX-FACETED DIAMOND

THE ABILITY TO BE IN THE PRESENT MOMENT WITH FULL AWARENESS AND OPENNESS TO OUR EXPERIENCE, AND TO TAKE ACTION GUIDED BY OUR VALUES - BE PRESENT, OPEN UP, DO WHAT MATTERS

  • The six core processes aren’t separate
    • six facets of one diamond
      • the diamond itself is psychological flexibility
  • PRIMARY AIM OF ACT IS TO INCREASE PSYCHOLOGICAL FLEXIBILITY
    • the greater our ability to be conscious, open and act on our values, the greater our quality of life because we can respond more effectively to the problems and challenges life inevitably brings
    • through engaging fully in our lives and allowing our values to guide us, we develop a sense of meaning and purpose and experience a sense of vitality
    • use VITALITY a lot in ACT
      • not a feeling
        • sense of being fully alive and embracing the here and now, regardless of how we may be feeling in the moment
        • can experience vitality on our deathbed or in extreme grief because
    • “there is as much living in a moment of pain as in a moment of joy” - Strosahl, 2004, p.43
38
Q

WHAT IS THE TRIFLEX?

A

A DISTILLATION OF THE 6 CORE THERAPEUTIC PROCESSES OF ACT DISTILLED INTO 3 LARGER PROCESSES

  • Contacting present moment/ self as context
    • BE PRESENT
  • Commited action and Values
    • DO WHAT MATTERS
  • Acceptance an Defusion
    • OPEN UP
39
Q

WHAT IS THE MAIN PURPOSE OF THE HEXAFLEX AND TRIFLEX IN ACT?

A

These are not designed for use with a client during a session. They are meant to help coaches and therapists to learn, understand and implement the ACT model. A better tool to use with clients is the CHOICE POINT

40
Q

WHAT DO WE MEAN BY ‘WORKABILITY’ IN ACT?

A

IS AN ACTION OR BEHAVIOUR WORKING TO GIVE YOU WHAT YOU NEED FOR A RICH, FULFILLING LIFE?

  • is it taking you towards or moving you away?

the whole ACT model rests on the concept of workability.

41
Q

HOW DO WE EMPLOY THE CONCEPT OF WORKABILITY TO HELP CLIENTS?

A

ASK - IF THIS ACTION/ BEHAVIOUR IS NOT TAKING YOU WHERE YOU WANT TO GO, ARE YOU OPEN TO DOING SOMETHING DIFFERENT?

  • as long as we come from a stance of workabillity and bring it back to the client’s experience, we never have to get into a debate or argument about good/ bad, should/ shouldn’t
  • with most clients, will need to spend time exploring short-term workability (often avoidance) and how it does not work in the long-term
42
Q

WHERE SHOULD WE START WHEN WORKING WITH THE ACT MODEL WITH A CLIENT?

A
  • ACT is a non-linear model
  • start at any point, with any client in any session
    • if you get stuck on one point, move to another point and come back to it later
  • do the HEXAFLEX DANCE
43
Q

WHAT ARE THE TWO MAIN QUESTIONS THAT WE ARE ADDRESSING (DANCING BETWEEN) WITH ACT?

A
  1. WHAT VALUED DIRECTION DOES THE CLIENT WANT TO MOVE IN?
  2. WHAT IS GETTING IN THE WAY OF THAT?
44
Q

NAME SOME SPECIFIC SITUATIONS IN WHICH YOU MIGHT APPLY PARTICULAR ASPECTS OF THE HEXAFLEX AT THE BEGINNING OF THE THERAPEUTIC PROCESS

A
  • clients who present in crisis
    • dropping anchor exercises
      • a form of contacting the present moment, grounding and centering yourself mindfully
  • grief and loss issues
    • self-compassion
      • acknowledge pain, be there and a kind and caring way for yourself
  • poorly motivated, don’t know what they want from therapy or life
    • start with values
      • engage motivation and develop sense of direction
    • defusion
      • particularly with hopelessness
  • fixated on avoiding pain, just want to feel good
    • creative hopelessness
45
Q

DESCRIBE THE ‘ANTI-HEXAFLEX’

A

PSYCHOLOGICAL RIGIDITY - SIX CORE PATHOLOGICAL PROCESSES - the opposites of the therapeutic processes

  • inflexible attention
  • remoteness from values
  • ineffective, inappropriate, unworkable action
  • fusion
  • experiential avoidance
  • fusion with self-concept
46
Q

WHAT ARE THE KEY FEATURES OF PSYCHOLOGICAL RIGIDITY?

A
  • a state of ineffectiveness
  • find it harder to engage in life
    • live according to values
    • act effectively
    • appreciate life
  • caught up in fusion and avoidance
  • stuck in ineffective patterns of action and behaviour

It is not an all or nothing state, we are all rigid to some extent, but the higher the level of rigidity, the more problems created, more severe diagnosis, more psychological suffering

47
Q

DESCRIBE THE OPPOSITE OF CONTACT WITH THE PRESENT MOMENT - INFLEXIBLE ATTENTION

A
  • the way an individual pays attention or what the individual pays attention to is self-defeating, counterproductive, making things worse rather than better
    • DISENGAGEMENT
      • automatic pilot
        • unrewarding/ unfulfilling
    • DISTRACTION
      • attention not where it needs to go
        • thoughts, feelings, squirrels
    • DISCONNECTION
      • can’t flexibly tune in to thoughts and feelings
        • may not have skills needed
        • may be using experiential avoidance
  • rare to get one of these without the others
48
Q

DESCRIBE THE OPPOSITE OF LIVING ACCORDING TO VALUES - REMOTENESS FROM VALUES

A
  • many clients live in a way that is remote or incongruent with their values
    • don’t know what values are
    • don’t know what THEIR values are
    • disconnected from their own values
      • acting in ways that are incongruent with their values
49
Q

DESCRIBE THE OPPOSITE OF COMMITTED ACTION - INEFFECTIVE ACTION

A
  • Actions and behaviours that are ineffective move you away from where you want to be, not towards
  • sometimes relieve short-term problems and pain, but in the process create other and bigger problems and more pain
50
Q

DESCRIBE THE PATHOLOGICAL APPROACH TO SELF-AS-CONTEXT - FUSION WITH SELF-CONCEPT

A

SELF CONCEPT, CONCEPTUAL IMAGE, CONCEPTUALIZED SELF

  • formed from all the thoughts, beliefs, ideas, judgments and assumptions about
    • who I am
    • how I got this way
    • what I can and can’t do
  • very often fusion with self-concept occurs
    • it becomes absolute truth and dictates what we can and cannot do or be
  • clients often fuse with a negative self-concept
    • bad, useless, worthless
  • sometimes they fuse with a positive one
    • I’m ok, everyone else is the problem
      • taken to the extreme in Narcisstistic Personality Disorder

Engaging the observing self allows us to see that these are just thoughts and ideas and helps us to defuse from our self-concepts

  • they don’t run my life or dictate my choices
51
Q

DESCRIBE THE OPPOSITE OF ACCEPTANCE - EXPERIENTIAL AVOIDANCE

A
  • attempting to ignore, avoid or remove unwanted private experiences
    • thoughts, feelings, memories, beliefs
  • normal to some degree
    • high levels of avoidance create massive problems and are found across many different types of DSM disorders
52
Q

DESCRIBE THE OPPOSITE OF DEFUSION - FUSION

A
  • cognitions have a negative influence or impact on actions and behaviours
    • become rigid and inflexible
      • leads to ineffective and value incongruent patterns of actions and behaviour
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ACT FOR BEGINNERS (1 decks)

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