Post on 29-Jun-2015
description
ACT for Health
EdinburghOctober 2014
Dr Ray OwenClinical Psychologistdrrayowen@gmail.com
Aims for the day
► Consider how core ACT processes relate to working with people who have physical health problems
► Look at specific problems related to Health, and useful ACT-based techniques E.g. living with uncertainty, altered sense of self,
carer burden, tolerating physical treatment, healthy behaviour change
► Reflect on own experience as clinician► Reflect on own experience as human being► Feedback suggests more experiences,
technique and clinical reflection, less literature survey All at contextualscience.org
To begin with…
Physical health
►Acute e.g. cancer with curative intent, recovery
from injury►Long-term / chronic
e.g. chronic pain, bowel disorders, neurological disorders, lung problems
►Palliative e.g. advanced cancer, late-stage MND
►Health Behaviour Change
The ACT Model of PsychopathologyThe ACT Model of Psychopathology
Psychological inflexibility
Dominance of Conceptualised Past & Future
Experiential avoidance
Cognitive Fusion
Attachment to the conceptualised self
Lack of Values Clarity,
dominance of pliance and
avoidant tracking
Inaction, impulsivity or
avoidant persistence
STUCK
UNFULFILLED
Experiential avoidance: basing your
actions on avoiding feeling
bad
Fusion: getting tangled up in
thoughts
Loss of contact with present moment : getting caught up in the past & the future
Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself
Loss of contact with Values: not recognising what matters to you in life
Lack of committed action: not acting effectively to live your life the way you want to
Think of a client…
The Positive Psychological The Positive Psychological
Processes ACT Seeks to StrengthenProcesses ACT Seeks to Strengthen
Psychological Flexibility
Being in the present moment /
mindfulness
Acceptance / Willingness
Defusion
Self as Context
Values
Committed Action
MOVING FORWARD:
MORE FULFILLED
Acceptance / willingness to
experience: allowing
whatever shows up just to be
there.
Defusion: treating thoughts as thoughts (not
realities)
Present moment awareness / mindfulness: living in the Here-and-Now
Observing self / flexible perspective-taking: adopting a more flexible sense of self
Awareness of Values: recognising what matters to you in life
Committed action: doing the things that matter to you, even when it's difficult
Think of a client…
STUCK
UNFULFILLED
Experiential avoidance: basing your
actions on avoiding feeling
bad
Fusion: getting tangled up in
thoughts
Loss of contact with present moment : getting caught up in the past & the future
Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself
Loss of contact with Values: not recognising what matters to you in life
Lack of committed action: not acting effectively to live your life the way you want to
Fusion and Avoidance
►On the buses►“Why does my mind hurt me that
way?”►Living with an uncertain future►Thoughts we should pay attention to
►What kind of feelings are we avoiding?
Using the basics
►Another trip on the bus..►Not just an explanatory metaphor
Ongoing tool
►A landslide blocking the road
While we’re on the bus…► Minds say unhelpful things► Take a minute..
Notice a passenger What are they saying What form they take Where’s that coming from What is the function of that passenger speaking up
► Actual► ‘intended’
► Mind is not usually our enemy► So why say these things?► Doing its job(s)
The stay alive machine (can become the EA machine) The Problem-solving machine (can become the worry-engine) The Learn From Experience machine (can become the dwell on
the past machine
Default assumption
► My mind is not ‘out to get me’► It’s mostly trying to help by doing one of its jobs► Most of the time it’s pretty good at that► Sometimes in trying to be ‘helpful’ (protect you
from harm, from social victimisation, isolation etc etc) its suggestions end up being unhelpful
► Recognising this makes it easier to use ‘Thanks, mind’
► Why this helps in Health
Uncertainty
►Back to your client How does uncertainty show up Potential impact on life Interaction with core processes
►?especially here-and-now, committed action?
Many paths
►More of a raft than a walk►Originally used with denial-like behaviours►BenefitsBenefits
Defusion from thoughts about prognosisDefusion from thoughts about prognosis Observing selfObserving self Acceptance of feelings that ariseAcceptance of feelings that arise Ability to focus on Values-driven committed Ability to focus on Values-driven committed
action (not being frozen in face of uncertainty)action (not being frozen in face of uncertainty)
But what about the thoughts we SHOULD attend to?
► “I’m sure that lump wasn’t here last week..”► In ACT, we’re interested in the behaviour in
context Behaviour here includes internal behaviour eg
thoughts Need to know context and function
► ‘Defuse and move on’ vs ‘pay attention to and act upon’ nb anyway more able to evaluate and act from
defused position► Old vs New thoughts► Risk-related
Approaches other than classic defusion
►Safe review period (if still here by… then I’ll..)
►Checking out with others►If new, evaluation / challenge►Looking at impact►Worry Time
Avoiding feeling bad
► Emotions► Physical sensations – emotion related► Physical sensations – health related
When distinct, when overlap When is it safe to accept?
►E.g. aching in fibromyalgia vs crushing chest pain in heart disease
In a war vs living with the enemy Narrowing lives in battle with symptom For highly intrusive symptoms, look at ACT for
chronic pain literature (Vowles, McCracken, Dahl)
STUCK
UNFULFILLED
Experiential avoidance: basing your
actions on avoiding feeling
bad
Fusion: getting tangled up in
thoughts
Loss of contact with present moment : getting caught up in the past & the future
Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself
Loss of contact with Values: not recognising what matters to you in life
Lack of committed action: not acting effectively to live your life the way you want to
The self
►Over-attachment to the conceptualised self
►Self-as-content, self-as-process, self-as-context
►Flexible perspective-taking►Development of key relational frames
►What’s your mind telling you right now?
How your (conceptualised) Self gets in the way..
► Stuck in a story ‘still the person I used to be’
►Someone who never gives up►The strong one►Carer
‘lost the person I used to be’► ‘shadow of my old self’►No use any more►That was the real me
Adjustment► I’m a burden
Versions► Version 1► Version 1.1► ...Version 1.5► …Version 1.6► Version 2.0► …Version 2.1► Version 2.1.1► Version 2.1.2► ..Version 2.2► ..Version 2.3► Version 3.0► Version 4.0► Version 4.0.4► Version 4.1► Version 4.4► etc
► Alpha► Beta► Cupcake► Donut► Eclair► ►
►
► Froyo► Gingerbread► Honeycomb► Ice cream sandwich►
► Jelly Bean► KitKat
I THEN, I NOW.. For you► At primary
school► Young adult ► Now► characteristics
► Psychological► Physical► Social
► A personality trait
► An ambition► A friendship► A talent
► ‘positive’ or ‘negative’
I THEN, I NOW.. For client(nb. tailored appropriately for their history)
► Young adult ► Pre-illness ► Now► characteristics
► Psychological► Physical► Social
► A personality trait
► An ambition► A friendship► A talent
► ‘positive’ or ‘negative’
Old me new me exercise
► Elicits ‘stories’ about self► Allows us to notice balance of them► How firmly held?
Can challenge if appropriate (new thought / insight)
► Doing the exercise is act of defusion► Mourn the past, accept the present► Are they fixed (e.g. ‘less sociable’)► Reinforces transitions over time
‘this too will pass’
STUCK
UNFULFILLED
Experiential avoidance: basing your
actions on avoiding feeling
bad
Fusion: getting tangled up in
thoughts
Loss of contact with present moment : getting caught up in the past & the future
Inflexible sense of self: getting stuck in an unhelpful 'story' about yourself
Loss of contact with Values: not recognising what matters to you in life
Lack of committed action: not acting effectively to live your life the way you want to
►Doing treatment►Hopelessness►Carer burden►Making a choice
Values & Goals
Treatment
► Originally from cancer treatments (chemotherapy & radiotherapy), however..
► ‘doing’ not ‘having’► “Why did you choose to have treatment?”
“no choice” What hoping to achieve “not dying” vs “what do with more/better quality
life” Acknowledge cost of having Price you are willing to pay in order to increase your
chances of … e.g. being close to your children Fast initial way into Values (often session 1) Emphasises active role vs victim story
CHOICE POINT
AWAY FROM VALUES
TOWARDS VALUES
HOOKS, e.g.
Urge to avoid discomfort
Desire for short-term gains
Old habits
Hooked by thoughts
Stuck in a story
etc
HELPERS, e.g.
Awareness of Values
Skills:
-Present moment awareness
-Defusion
-Acceptance
-Flexible perspective taking
Effective goal-setting
etc
Adapted from Ciarrochi, Bailey & Harris 2013
Finally..
► The same core processes of ACT apply in living well with physical health problems as with any other adversity
► Same interventions can work► Some tailored/tweaked/specific ones too► True whether aiming to
Make healthy behaviour change Cope with an more acute health crisis ‘facing the
storm’ or live a fulfilling life despite chronic health
problem, where aim is ‘living with the enemy’
►Please leave feedback on this event
►At
www.surveymonkey.com/s/H33JMPT