Acceptance and Commitment Therapy Skills

Acceptance and Commitment
Therapy Skills
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC
Executive Director, AllCEUs
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5

Objectives
 The Goal of ACT
 What is Mindfulness?
 How Does ACT Differ from Other Mindfulness-based
Approaches?
 What is Unique to Act?
 Destructive Normality
 Experiential Avoidance
 Therapeutic Interventions
 Confronting the Agenda
 Control is the Problem, Not the Solution
 Six Core Principles of ACT

Why I Care/How It Impacts Recovery
 "You can't stop the waves, but you can learn to
surf" Kabat-Zinn 2004
 Distracting oneself from distress is akin to
constantly running away from one’s shadow. In
the attempt to control the negative thoughts and
feelings, one is at a loss for control in other life
situations.

ACT Acronym
 Accept your reactions and be present
 Choose a valued direction
 Take action

Overview
 ACT is based on relational frame theory (RFT)
 a psychological theory of human language.
 developed largely through the efforts of Steven C.
Hayes of University of Nevada, Reno and Dermot
Barnes-Holmes of National University of Ireland,
Maynooth.
 Relational frame theory argues that the building
block of higher cognition (reasoning) is 'relating',
i.e. the human ability to create links between
things.

Overview
 Contextualists seek to understand the complexity
and richness of a whole event through
appreciation of its participants and features.
 Functional contextualism emphasizes:
 Humans learn language (i.e., communication) through
interactions with the environment
 We must focus on changeable variables in the
context in which these events occur in order create
general rules to predict and influence psychological
events such as thoughts, feelings, and behaviors.

The Goal of ACT
 The goal of ACT is to create a rich and meaningful
life, while accepting the pain that inevitably goes
with it.
 Who is important?
 What is important to me? (Values, things, experiences)
 How can I move toward those goals?
 “ACT” is a good abbreviation, because this
therapy is about taking effective action guided by
our deepest values and in which we are fully
present and engaged.

What is Mindfulness?
 “Consciously bringing awareness to your here-and-
now experience with openness, interest and
receptiveness.
 Facets to mindfulness
 Living in the present moment
 Engaging fully in what you are doing rather than
“getting lost” in your thoughts
 Allowing your feelings to be as they are, rather than
trying to control them
 Mindfulness does not require meditation

What is Mindfulness?
 Mindfulness skills are “divided” into four subsets:
 Acceptance
 Cognitive diffusion
 Contact with the present moment
 The Observing Self

How Does ACT Differ
 ACT can be used in a wide range of clinical
populations and settings
 Not manualized
 ACT allows the therapist to create and
individualize their own mindfulness techniques, or
even to co-create them with clients.

What is Unique to Act?
 ACT does not have symptom reduction as a goal.
 The ongoing attempt to get rid of “symptoms” actually
creates a clinical disorder
 Private experience is labeled a symptom  a struggle with
the symptom
 A “symptom” is by definition something “pathological” and
something we should try to get rid of.
 In ACT, the aim is to transform our relationship with
our difficult thoughts and feelings, learn to perceive
them as harmless, even if uncomfortable, transient
psychological events.

Destructive Normality
 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.
 Memories/perceptions/schemas are created through
analyzing, comparing, evaluating, planning,
remembering, visualizing—and all of these processes
rely on human language.
 I am stupid vs. I have the thought that I am stupid
 I cannot go on vs. I am feeling like I cannot go on

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.
 Problem = something we don't want.
 Solution = figure out how to get rid of it, or avoid it.
 The more time and energy we spend trying to avoid or get rid
of unwanted private experiences, the more we are likely to
suffer “Quicksand”
 Addiction
 Anxiety
 Depression

Experiential Avoidance
 The ACT interventions focus around two main
processes:
 Developing acceptance of unwanted private
experiences which are out of personal control.
 Commitment and action toward living a valued life.

First Step: Confronting the Agenda
 The client's agenda of emotional control is gently
and respectfully undermined
 Clients identify the ways they have tried to get
rid of or avoid unwanted private experiences.
(Creative hopelessness)
 They are then asked to assess for each method:
“Did this reduce your symptoms in the long term?
What did this strategy cost you in terms of time, energy,
health, vitality, relationships?
Did it bring you closer to the life you want?”

Confronting the Agenda
 Control is the Problem, Not the Solution
 Clean Discomfort: When emotions and reactions
are accepted, it leads to a natural level of
physical and emotional discomfort
 Dirty Discomfort: Once we start struggling with it,
your “struggle switch is turned on” and
discomfort increases rapidly.
 Struggle switch is like an emotional amplifier—switch it
on, and we can have anger about our anxiety, anxiety
about our anger, depression about our depression, or
guilt about our guilt.

Six Core Principles of ACT
 Once the emotional control agenda is
undermined, we then introduce the six core
principles of ACT to help clients develop
psychological flexibility:
 Diffusion
 Acceptance
 Contact with the present moment
 The Observing Self
 Values
 Committed action

Cognitive Defusion
 Learning to perceive thoughts, images, and memories as bits
of language, and pictures—as opposed to what they can
appear to be—threatening events, objective truths
 Cognitive defusion means “stepping back” and recognizing
that thoughts are just transient private (subjective) events
 Here’s a simple exercise in cognitive defusion for yourself:
 Think of a negative self-judgment that takes the form “I am X” such
as “I’m stupid.” Think about it. Believe it as much as you can. Notice
how it affects you.
 Now insert the phrase “I’m having the thought that….” in front of “I
am X.” Think about it. Notice what happens.
 In step 2, most people notice a “distance” from the thought, such that it has much less
impact. Notice there has been no effort to get rid of the thought, nor to change it. Instead
the relationship with the thought has changed—it can be seen as just words.

Diffusion Techniques
 ‘The Mind” Treat “the mind” as an external
event; almost as a separate person
 “I’m having the thought that …”
 Thoughts are not causes “Is it possible to think
that thought, as a thought, AND do x?”
 Who is in charge here? Treat thoughts as bullies
 OK, you are right. Now what?

Acceptance
 Making room for unpleasant feelings, sensations, urges,
and other private experiences
 Allowing them to come and go without struggling with
them, running from them, or giving them undue attention.
 Unhooking Thoughts/feelings don’t always lead to
action
 Identifying the problem When we battle with our inner
experience, it distracts and derails us.
 Explore effects of avoidance Has it worked in your life
 Defining the problem What they struggle against =
barriers toward heading in the direction of their goals
 The Serenity Prayer Change what we can, accept what we
can’t.

Contact with the Present Moment
 Bringing full awareness to your here-and-now
experience, with openness, interest, and
receptiveness; focusing on, and engaging fully in
whatever you are doing.
 How do I feel
 What am I thinking
 What physical sensations am I experiencing
 Describe the environment—smell, temperature, colors,
objects, people, sounds, etc…
 I (see, hear, smell) ______ It reminds me of _____

The Observing Self | Fly on the Wall
 Accessing a continuity of consciousness that is
unchanging, ever-present, and impervious to
harm.
 From this perspective, it is possible to experience
directly that you are not your thoughts, feelings,
memories, urges, sensations, images, roles, or
physical body.
 These phenomena change constantly and are peripheral
aspects of you, but they are not the essence of who
you are.

Values
 Clarifying
 What is most important, deep in your heart
 What sort of person you want to be
 What is significant and meaningful to you
 What you want to stand for in this life

Values
 A lack of values or a confusion of goals with
values can underlie the inability to be
psychologically flexible.
 The next step in the ACT process is
 “Choosing a direction and establishing willingness”
 Identifying motivating values
 Establish a willingness to help regain control of life,
not necessarily just to control thoughts and feelings.

Committed Action
 Setting goals, guided by your values, and taking
effective action to achieve them.

Toward my
goals & values
Away from my
goals & values
Behaviors & 5 sense
experiencing (observable)
Thoughts, Emotions and
Internal (mind) experiences
• What do I do that moves me away
from discomfort?
• How is this moving me away from
my goals or values?
• What am I thinking or emotionally
experiencing right now that is
moving me away from my goals or
values?
• Fear, Depression, Helplessness,
Hopelessness, Anger, Self-Doubt,
Shame
• What could I do to move me
toward who and what is important
to me?
• What am I doing right now that is
moving me TOWARD my goals or
values?
• What & who is important to me?
• What am I thinking or emotionally
experiencing that is moving me
TOWARD my goals or values?
• Accomplishment, success,
happiness

Summary
 The goal of ACT is to create a rich and meaningful life, while
accepting the pain that inevitably goes with it
 Being aware and present in the moment
 Destructive Normality the psychological processes of a normal
human mind are often destructive, and create psychological
suffering. “This is depressing. I am helpless”
 Actions designed to avoid the experience in the present
 Therapeutic Interventions focus around two main processes:
 Developing acceptance of unwanted private experiences which are out
of personal control.
 Commitment and action toward living a valued life.

Summary
 Confronting the Agenda (to eliminate distress)
 Explore sources of distress
 Explore prior attempts at removing distress
 Explore effectiveness
 In the short and long term
 Specific to the problem and other areas of life
 Six Core Principles of ACT
 Diffusion– Separate self from feelings/experience
 Acceptance—Accept what is
 Contact with the present moment– Mindfulness
 The Observing Self– Fly on the wall
 Values Identification
 Committed Action

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