3005PSY Module 6 - Core Processes of ACT-English PDF

OK, so you've just learned about the general theory underlying Acceptance and Commitment Therapy Act, what we're hoping to achieve, which is these to be able to live a rich, meaningful life. And the way in which we do that is by focusing on the development of psychological flexibility. And as you've...

OK, so you've just learned about the general theory underlying Acceptance and Commitment Therapy Act, what we're hoping to achieve, which is these to be able to live a rich, meaningful life. And the way in which we do that is by focusing on the development of psychological flexibility. And as you've just read, there are six components or six drivers of psychological flexibility. And these are displayed through the ACT Hexaflex. And this is this Hexaflex is used in conceptualisation and treatment planning from the act perspective. So what we're going to do in this mini lecture is take a closer look at each of the areas of the of the ACT Hexaflex. Let's start with contact with the present moment. Now, this should sound familiar to you because it is a component of mindfulness and in fact, the way that we work or try to achieve contact with the present moment with our clients in ACT is through mindfulness. So the opposite of this area of the of the ACT Hexaflex is when a client is overly dwelling on the past. Or you can think about this from your own perspective, even because we often use this therapeutic techniques ourselves. So when you're dwelling on the past too much and ruminating over things that have happened, things that have gone wrong in your life, or conversely, when you're worrying about the future, that's the opposite of what we're trying to achieve here. It also occurs when people have that, have that selective attention which we've already discussed. So selective attention to some aspects of their experience rather than the broad, flexible attention which we're trying to promote so that selective attention could be for physiological sensations or nonverbal cues or negative self-evaluation. So the way that we try to counteract this is through mindfulness. And you can go back to the previous mini lecture and brush up on those core components of mindfulness, if you like. The next core process should also sound familiar because its acceptance, which is a part of mindfulness as well. So, again, I won't spend too long on this because we've already covered a lot of a lot about acceptance in the previous mini lecture, but when we talk about acceptance, what we mean is being intentionally open, receptive and nonjudgmental about your experience. So acknowledging your experiences as they occur, not trying to change them and not trying to judge your experience or your emotions or your thoughts in any way, simply letting them be so we can see spirals with this. Sometimes a client will have a thought, but they think, oh, I'm so stupid. And then they think, oh, I'm not being I'm being judgmental. They're not being accepting. And then they blame themselves. Why can't I get this right? Which starts a bit of a spiral. But what we want is them simply to have the thought to notice it or have the emotion to notice it, accept it for what it is. I'm having a thought that I'm stupid or I'm experiencing anxiety right now and accept it as it is and move on. So acknowledging the reality of the present moment, whether you like it or not, so sometimes in life we will have painful experiences and we need to acknowledge that and accept that that they will occur. Being aware of your reactions in the present moment and how you respond to things. So rather than switching to that automatic pilot mode, being really aware of when I think this, I tend to do this or I tend to feel this, or when I feel this, I tend to do this. And what we want is to create space between the thing that happens internally and then the thing that you do about it. So, for example, you can have a thought of I'm stupid and not necessarily feel bad about it or not necessarily do anything about it. So we're trying to create awareness so that we can separate our internal experience from the elaborative process or the action that occurs after it. So we're allowing painful feelings to be present and we're not trying to control or avoid them in any way, because remembering that when we allow them to occur, they'll often pass more quickly and be less intense. So the opposite of acceptance is experiential avoidance. So we try to control, change, suppress or avoid painful experiences rather than letting them exist. So a metaphor that we often use with clients (and acceptance and commitment therapy makes a lot of use of metaphors), but we will often use the quicksand metaphor. And this is getting pretty old now. But if you can think back to maybe when you were a kid and you watched cartoons or perhaps some of the old Western movies and a character would get stuck in quicksand, and what happens in quicksand when you get stuck in it is that if you try to pull yourself out, if you move and struggle, you actually sink further down. But if you actually stay still, you won't sink any further. And then you can you can pull yourself out from there. But the key is not to panic, not to struggle, or you actually just sink further into the quicksand. So it's about creating space, becoming an observer and actually just standing still or sitting with your experiences until they pass. So acceptance, which we've already covered as also being a core process in mindfulness. So what acceptance is not: it is not approving, wanting or liking the experience, you can have a painful experience and let it be. That doesn't mean that you need to like it or enjoy it or approve of it. Sometimes awful things in life happen and we we accept that. And it doesn't mean that, that you need to approve of the situation or what's occurring to you. It also doesn't mean that you resign yourself to it. So when we create space between what's occurring in our life and the way we respond to it gives us a better chance to plan and problem solve. So this is different to resignation. There are certain things in life that you will want to change, for example, getting out of bad relationships or changing jobs when it's not fulfilling. So you can accept that you are feeling bad or that you're in a bad relationship or a bad job and accept that that is your present experience, but also just make a decision to try and improve things for yourself in the future. And we'll talk about how those decisions and behaviors occur. But it's so the key point here, though, is that acceptance is not resignation or giving up. And so when we talk about that opposite of experiential avoidance, we also need to be careful that in understanding that not all avoidance is bad. If something is a genuine, genuine threat to you like a lion or a car swerving towards you, avoid it. So not all avoidance is bad, but when the avoidance is of a private event that doesn't directly threaten our survival, like anxiety, feeling low or upset often what's better is to embrace that and let it pass rather than try and avoid it. Our next core process, cognitive diffusion. Now, if you remember back to what you read, this is really focusing in on this idea that suffering occurs when we take verbal processes literally. And this is really focusing in on the cognitive or the thought process that a person has. So we'll talk about a person being fused with their thoughts or the process of cognitive fusion. And what we mean by cognitive fusion is that it's it occurs when a person believes that thoughts are reality, that thought to the truth, that thoughts are important, that thoughts are orders or that thoughts are wise. That's this idea of fusion, that thoughts essentially are meaningful and truthful interpretations of our environment, which is not always the case. So conversely, cognitive diffusion is when we detach from our thoughts. This is this process of de-centring that we already touched on a little bit earlier in this module and which we also touched on in cognitive restructuring. It's just achieved through different mechanisms. But what we're trying to get out here with the client is that thoughts aren't always meaningful. They aren't always truthful. They aren't always valid. And the key part is being able to let a thought simply be a thought. Having a thought is just a thought. It doesn't necessarily tell us anything important all of the time. So diffusion, it's a process that we do in therapy and what we're trying to achieve is an understanding with the client that thoughts are merely sounds, words, stories or bits of language that pass through our minds, they may or may not be true, and we don't have to automatically believe them. We can decide which thoughts we believe and which ones we don't. They may or may not be important or helpful. And again, we can decide on that. Thoughts are not orders so that we don't have to actually act on them or obey them. And thoughts may or may not be wise. So, again, we can make that decision. So in diffusion, what we're trying to achieve is for a person to detach or de-centre from their thoughts, not suppress them, not push them away. It's different to that, but detach for them and in a sense, view their thoughts from an impassioned or a nonjudgmental observer's point of view. So being simply nonjudgmental and observational about the thoughts that are occurring at any given point in time. So how do we achieve detachment, but not suppression from our thoughts? And this is when we get into the technique part of therapy, and we don't have the time to go through the entire range of techniques that are available to achieve diffusion. But I've got some common ones that we use on the slide here so we can use visualization strategies to help a person to understand that thoughts simply pass. And we have thousands upon thousands of thoughts a day. And for example, the leaves on a stream metaphor that I used earlier is one such visualization strategy that we might use with a client to illustrate this point. We can also do things to encourage the client to reduce the belief or the validity of the thought, to simply notice that the thought is occurring. And it can be as simple as adding a part to the thought. So rather than having the thought of I'm stupid, you had to change it to I'm having the thought that I'm stupid or I'm noticing the thought that I'm stupid. So you're not saying I'm stupid. You're simply labeling. I'm having a thought that says this. So again, trying to separate the person from the thought, you can thank your mind. So thank you mind for letting me to the fact that I'm going into a party and that I'm feeling anxious and for alerting to me that there might be danger there. I've assessed the situation and there isn't really danger but thank you for alerting me to that. So thanking your mind for having a thought. You can name the story, so if there are common threads to the thoughts that a person has, you can simply name it. This is the I can't do this thing again. It comes up from time to time. Sometimes my thoughts tell me that I can't do things. That doesn't mean that those thoughts are true or valid. So it's just that same theme or that same story, again, that I sometimes have with my thoughts. You can have that, you can change the thoughts into a different voice, sometimes we'll ask clients to sing the thoughts because it makes them less scary. It kind of makes them a little bit comical at times. And there are various apps that you can use for this as well. You want to be careful with this one because you don't want the person to feel like you're making fun of a fear that they're having or making fun of a thought that they're having. But it's a way of trying to reduce the power that a thought might have over a person by making it less scary. So the key difference here between CBT or sorry, between cognitive therapy and act is that we're not trying to change the thoughts in any way. So when cognitive therapy, we encourage a client to, again, not believe thoughts as they occur, but to sort of argue back and maybe come up with a range of more adaptive thoughts that they could choose from. In acceptance and commitment therapy, we don't go that far. We simply ask the client to detach from the thoughts, to get to the point at which they understand that the thought isn't valid or true, that it can simply just exist and they can move on. So we don't ask them to come up with alternatives. We simply ask for that process of detachment or de-centering. So there's a slight difference there between cognitive therapy and acceptance and commitment therapy. But the underlying process that we're trying to achieve, which is de-centering, is the same. Now we have self-as-context. Self-as-context can sometimes be a little more difficult to get your head around, but essentially when we talk about having a contextual self, what we're aiming for here is for a person to understand that they have no real identity, that identity is the product of their surroundings and a product of their internal experience. So what we mean by that is that it's influenced by feedback from others. And what others say about you is influenced by your previous experience and also by your cognitive fusion with thoughts that you have about yourself. So, for example, if you're really fused with the thought of I'm worthless, then that's part of the way that you view yourself. And that's not self-as-context. Self as context is that you have this no real identity, that it's fluid and moves from moment to moment. When people become really fused with evaluations that they have about themselves, like I'm worthless or I'm or I'm incompetent or whatever it happens to be or even that I am competent or I am good (so positive evaluations), we typically call that self-as-content. That the identity of the person is really fused with the content of their thoughts. So these rigid self concepts end up creating defensiveness or low self-esteem or self- fulfilling prophecies. So conceptualizing yourself by the content of your thoughts often creates problems. And we've given some examples there of some of the ways in which a person may be fused with their conceptualization of self. So self-as-context is awareness of your awareness. So awareness that sometimes I think I'm worthless, but sometimes I think I'm really good. Ultimately, neither of those are probably true because my my identity is shaped by external experiences around me. So you're developing this contextual self and trying to separate the person from the content of the thoughts that they have about themselves. And you can do that through diffusion and through mindfulness strategies and acceptance. A fifth area of the hexaflex is values. Values is a really important part of acceptance and commitment therapy, and it's actually often where we start in therapy. So when we talk about values, we're talking about our chosen life directions and it's different to goals. So values relates to what's meaningful to you in your life and how you want to live your life. And we can set goals based on our values. So values provide us with motivation and inspiration, and they give our life meaning. Now, you might recall earlier that you read that we don't want to pursue happiness, but happiness will happen when we pursue things that are meaningful to us. That's where values come in. If we know what our values are, what our personal values are, and we start to pursue those values or live life in accordance with them will experience a sense of satisfaction and happiness. So we want clients to move towards understanding their values and living in accordance with them. So once we understand our values, then we can set goals around those values from there. So goals are things that can be ticked off or achieved. So, for example, I want to get married or I want to do well at uni. You can tick that off and achieve it. But the underlying value for each of those might be something like I want to have good relationships in my life or I want to be a strong partner in my life. That's a value, it's something that you can't ever really tick off because it's something that you need to continually work towards or your value might be, I want to have a good career and to find meaning in the work that I do. Again, that's probably not something that you can tick off. It's something that you continually work towards to value. But doing well at uni would be a goal that contributes to living in accordance with that value. So that would be something that you can tick off and a goal is set around the value. So in that sense, values are processes. So you can't tick off being a loving parent. It's an ongoing process that you engage in. At the start of therapy, when we're working from an ACT perspective, we'll often do a bit of values exploration and this can occur over several sessions. And what we try to understand is the values that are important to a person and within each value domain who they want to be or what they want their life to look like. And so we often talk about assessing values within specific domains. So, for example, within the domain of family. We'll try and find out from the person, well, what sort of a daughter do you want to be? What sort of a sister do you want to be? What kind of a relationship we want to have with your children? And what qualities do you want to bring to those relationships? So it's very broad exploration about what's personally meaningful to them. With intimate relationships. We might try the same. What sort of a partner would you like to be? What kind of a relationship would you like to have? And then we'll ask those same questions with regards to parenting, friendships, career. Education, personal growth, recreation and leisure. So what how do you have fun? How do you unwind? What sorts of activities bring you meaning in your leisure time? Spirituality, citizenship, environment and community and health and physical well-being. And oftentimes, when a person isn't happy in life, when they're experiencing emotional difficulties, it's because there's a domain in which they're not living in accordance with their values. So we try to understand what's meaningful to them across these domains. The key part being that not all value domains are important to everyone. So, for example, someone may hold really strong values with regards to family and intimate relationships, but not really care about citizenship. And that's okay, because everyone will place different values on each domain. The importance that you give to each domain and the values that you have within that domain may also change at different stages of your life. So in your early 20s, your most important domains might be leisure and career, because that's, you know, you're studying at university and friendships and perhaps intimate relationships as well. And in later adult life, your values may center around parenting and career and perhaps community as well, giving back to your community so your values, the importance of each domain and the values within them likely change over the course of one's life. So it's something that you need to assess from time to time and explore what are my personal values and how have they changed at this point and what's meaningful to me at this point? When working with a client, you also need to distinguish between true values and social desirability and family values so you can ask questions around this, like if no one ever knew that this was your value, would you still hold it? And you sometimes get this with career, particularly in families where career is really important. So the person might hold a value of: I really need to do well and I need to have this particular type of profession because I want to be a respected member of the community. And you ask them, well, if your parents didn't know, if your family didn't know, if nobody knew what your career was going to be or or nobody knew your value, would you still hold it? And so you try to separate out the societal pressure that might be on someone with all the pressure from one's family and understand, is this actually something that's meaningful to you individually? Because it's going to be really hard to work towards a value that's not personally meaningful. And often that's when distress occurs, is when a person is trying to work towards a value that's not actually their value, it's someone else's. And sometimes values can conflict, so parenting can conflict with one's career or education can conflict with one's leisure time, and that can also cause distress. So when we work with clients, after finding out what their values are and what's personally meaningful to them, we work with them about, well, let's set some goals. And those goals are about working towards living consistently with their values, but also in a way that's feasible, knowing that we only have limited time in each day and each week. And how do we get the most out of that for you to live consistently with your values? So there are various techniques and questions that we can use to explore a person's personal values, so I I've already covered some of them and we can ask questions within specific domains, but we can also ask broadly, what do you want your life to stand for? Or we can ask a person who they admire and then what, why do they admire them? So we're trying to get at the underlying qualities that this person values in others and perhaps then how they can foster those values in themselves. We can also ask a person to write their own eulogy. Now, this might sound a bit dark and morbid, but when we ask a person, what would you want people to say about you when you pass, it's often, people don't often comment. Well, I want them to say, you know, how much time I spent at work and how how I didn't make any mistakes in this particular spreadsheet. They're not often the things that come out, the things that come out of it, they would want people to talk about what a good friend they were and what a loving and loving parent they were and what a great family environment they fostered. And so through this activity of writing your own eulogy, you can start to uncover, well, what are the things that are personally meaningful versus the things that you just find yourself doing day in, day out, sort of thoughtlessly. You can ask the person what they wanted to be as a child and why. So, again, trying to get at qualities there, qualities that they admire, but also being aware of potential distress there if the person becomes upset that their life didn't actually turn out the way they wanted it to. So just being aware of possibilities for grief there. And as I mentioned, act often begins with values work. It's often our starting point and we move on from there. And once we understand what's meaningful to a person, then we can start to use those other techniques to shape their life. So I've got a little quote there, but he has a 'why' can put up with any 'how'. So if they know why they're doing something and that they're working towards something that's personally meaningful, they can usually put up with a lot of distress to get there. And sometimes we do ask people to do hard things in therapy and they're much more likely to do that when it's personally meaningful. So our final process is committed action. This is really what we do with our values, so once we understand a person's values, we work with them to set short, medium and long term goals within each domain or for each value. And then we take committed action. And what we mean by that is we then start to engage in behaviors to work towards those values. So we have a value of being a good partner, but we're not living consistently with that value. Then we would set some short term goals or a short term goal might be, well, I might cook dinner for my partner tonight because that would be something that would be nice to do and something that would help to build our relationship. And medium term goal might be I'm going to try and fight less and I'm going to try and use better communication strategies. And a long term goal might be something that you would look to achieve over a period of six to 12 months. And so we often come back and reflect on our values and also revise our goals accordingly. So we have to understand that committed action may not always be pleasant. Sometimes it involves actually doing very difficult things. So if you have a value of being in a loving relationship, but your current one isn't meeting that and you've tried really hard to get that relationship to meet that, it may involve actually leaving that relationship so that you're then able to work towards the value that's important to you. Developing friendships may involve experiencing social anxiety and sticking with that. Helping people through psychology may involve doing statistics, doing an uncomfortable process along the way. So a committed action, are behaviors that are values guided, they're effective and they're mindful. So it's pulling a few of our key processes together. So when we engage in committed action, we're working towards our values in a way that's very mindful. And this may involve, for example, using processes like diffusion to help us get through that social anxiety situation or accepting an uncomfortable experience that is sitting through a statistics lecture. So it brings a few key processes together. So committed action involves willingness, so are you willing to experience this uncomfortable thing in order to live a rich and meaningful life in accordance with your values? So it may involve further work with fusion, mindfulness and acceptance, as I've already mentioned. So there are six key processes of the ACT Hexaflex, and we use the ACT hexaflex in assessment. We use it in case conceptualisation to understand what's maintaining a person's suffering. And then we use it in treatment planning to develop strategies to help a person move towards psychological flexibility, which is the core goal of acceptance and commitment therapy. We'll often start off with values and then we'll move into more skill based work and committed action. So hopefully this gives you an understanding of that hexaflex and the structure behind ACT.