Acceptance and Commitment Therapy | CBT therapist Aid

Hey there everybody, and welcome to today's presentation on Acceptance and commitment therapy, or ACT. I'm your host, Dr. Donnellice Snipes. In this presentation, we're going to go over the goal of ACT or acceptance and commitment Therapy. We'll discuss how ACT differs from other mindfulness based approaches, and then we'll go through the six core principles of act. Why do we care? Jon Kabat Zinn in 2004 said, you can't stop the waves, but you can learn to surf. ACT believes that distracting oneself from distress is like constantly running away from your own shadow. In your attempt to control the negative thoughts and feelings, you're at a loss for control. In other life situations. If you're devoting all of your energy to running from that shadow, you're exhausting yourself because you're never going to escape it completely. But you're also not spending energy on other things that could enhance your life at this point in time. The acronym ACT stands for accept your reactions and be present. Choose a valued direction or be committed to a valued direction. And T stands for take action. ACT is based on contextualism and relational frame theory. And I'm going to go through these, just kind of hit the highlights of them just so you're kind of aware of the background or the framework of act. Relational frame theory is a psychological theory of human language developed largely through the efforts of Ste. Stephen C. Hayes from the University of Nevada, Reno, and Dermot Barnes Holmes of the National University of Ireland. Relational frame theory argues that our ability to understand and predict things in life is based on our ability to create links between things. So, for example, when you were little, you went to the doctor and the first time you may not have known what to expect. So it was really kind of scary. But the first time you went, your brain formed memories through words and pictures in order to help you predict what would happen in the future. When you went to the doctor's office. In other types of therapy, we call those schema. But that really forms what relational frame theory is referring to and is sometimes called phenomenological reality. The way you perceive things in the present is based on memories from similar experiences in the past. And your brain says, okay, I remember something like this, so I can help you predict whether this is going to be no big deal or scary or whatever you're expecting is going to happen. Each person's relational frame, each person's schema are different based on their individual experiences. So that's really important to recognize what I may view as terrifying, somebody else may view as exciting, like roller coasters. And I'll talk about roller coasters a fair amount today because that's a good example of a difference in perception. Snakes and spiders are two other ones. Some people are terrified of snakes and I happen to like them. I mean, well, anyway. Contextualists understand the complexity of a whole event as a reciprocal or back and forth interaction of the individuals and the variables in context. So I can predict how something's going to happen. And if I predict it's going to be scary, then I am going to act in a particular way when I go into that environment. So if I am going to the doctor and I'm walking in there and I'm acting all sheepish and terrified, then the doctor is probably, hopefully going to respond with a kinder, gentler, comforting approach to help me feel more comfortable. If, on the other hand, I don't have any big deal walking into a doctor's office, I may walk in and plop down and the doctor will interact differently with me. At that point in time, they may interact more collegially or friendly with me instead of comforting. So we do want to recognize that how we present, how we act impacts how others act. Likewise, after that experience, if I was scared and I went in and the doctor was comforting, then when I go back, I'm going to have a different perception. I had one doctor many, many years ago that, well, when I was a child, I went to the hospital to get my tonsils out and they took my blood and they were really rough with me and it hurt a lot. They didn't warn me. So I was terrified of needles. And after that, and I continued to be terrified of needles for many, many years. And when I was about 28, I had a doctor that I went to and she had to draw blood and she was going to give me a tetanus shot and I got really tense and really stressed out and she comforted me and said, you know, it's not going to be a big deal, I promise. And when she gave me the shot, I didn't even feel it. And you know, I'm not sure what she did differently, but ever since then, my expectation of getting my blood drawn or getting shots has been different. Do I expect it always to be pain free? No. But I know that there's a possibility, hopefully a good possibility, that it will be easy peasy and it's not going to be a repeat of the past. So when we encounter situations in the future that go against what our expectations were, we modify our expectations. We Modify our schema and say, okay, well, maybe every time I go to the doctor, it's not going to be this, you know, painful, scary ordeal. And we work from there anyhow. Language is learned through interaction with the environment. And contextualists are very aware of schema that guide our expectations, guide our beliefs, and language forms those schema. I've talked in other presentations about attachment and how when children are young, they don't know what anger is or depression is or fear is. They just have a feeling. And responsive adults help them develop their language, help them put a label on it. You're feeling really angry right now. So then the child learns, okay, when I feel this way, this is what they call anger. When I see this color, this is what they call blue. Children aren't born with that knowledge. And we help them develop ways to describe their environment as they grow up. Think of something that was scary as a child, that's no longer scary. So when you were a child, you formed a schema about it and it's not scary anymore. And this could be because you conquered your fears or view it differently. You know, a lot of children are afraid of the dark and they may not be able to tell you why they're afraid of the dark, but it's scary to them. However, as adults, we're generally not afraid of the dark anymore. So our schema has changed through night after night after night after night of sleeping in the dark, we discover, hey, this isn't that big of a deal. And maybe it's actually even kind of relaxing not to have lights bearing down on us when we're sleeping. So we change our schema based on experiences that don't quite fit with our expectations and eventually develop a sense of security in the dark. Or you may have changed your schema because you are a different person. Strangers. When you're a child, if you were afraid of strangers because you were afraid they were going to hurt you or something and you hid behind your caregiver's back, that's not uncommon for young children to do as adults. We can go into the grocery store or wherever and we don't feel scared because we're surrounded by strangers anymore. It's partly because we've interacted with strangers a lot over the years. We've with our caregivers and then independently and no bad things have happened. But it's also partly because we're different now. We are not that, you know, weak, little, easily overpowered six year old. We are a, you know, strong, independent, 26, 56 year old, and that context is really important. What was legitimately terrifying as a child may not be terrifying now because we have other response options. We're not completely dependent. For children, seeing their parents fight can be terrifying because they depend on those people for their existence. As adults, seeing our parents fight is not pleasant, no doubt. However, as adults, we can say, you know what, not going to be a part of this and leave the situation. We are able. We have other responses now that can help us feel safe. We can remove ourselves from unpleasant or dangerous situations. Contextualists emphasize the fact that we must focus on changeable variables in the context to help the person better predict and influence their thoughts about the situation. Is this scary? Is this terrifying? Or is this a good thing? And help influence our feelings. If we're telling ourselves it's going to be scary, then we're going to feel scared. If we're telling ourselves it's no big deal, then we're going to have a sense of calm and our behaviors, you know, cognitive behavioral therapy. Thoughts, feelings and behaviors all interact and our behaviors will follow suit. If we think it's scary and we feel afraid, our behaviors are going to be different than if we think it's no big deal and we're calm. It's important to recognize that. So contextualists say, all right, you have a schema, you have a memory, you have an expectation of this situation based on your prior experiences. Tell me about that. Let's explore what words and pictures that you're using and then let's compare that to this situation. And in other videos I've talked about evaluating the facts of the situation and in context, the facts for and against your beliefs, your thoughts, your feelings in this situation. In this context, yes, last year, 10 years ago, or even now in a completely different situation, it may be terrifying, but in this situation, an example, we'll go with strangers again, if you're with strangers at the grocery store, it's like no big deal. If all of a sudden you're in your living room and a stranger shows up, well, that's kind of terrifying. Or snakes. If you don't know much about snakes and you're out walking through the woods and a snake comes along, it can be a little anxiety provoking. You're like, oh, don't know if that's poisonous or not. However, if you are interacting with your friend's pet snake, that's a completely different context. You know, that animal is safe, so there are or at least not non poisonous. So the context is very different. You're still talking about a snake, but the context is different. And that can also help you reframe it so you're not afraid of all snakes everywhere. You are cautious of snakes that you don't know whether they're poisonous or not. Acceptance and commitment therapy can be used with a wide range of clinical populations. It is not manualized, which allows the therapist to create and individualize their own mindfulness, mindfulness techniques, or even co create them with clients. So there are a lot of different techniques clinicians can use to help people become more aware of their thoughts, feelings and behaviors in the present moment, more aware of their schema that influence their thoughts, feelings and behaviors in the present moment and ways to address them. Symptom reduction is not a goal of act. And you may be sitting there going, wait, if I'm going to a therapist, I want to get rid of my symptoms. I don't want to feel this way anymore. In act, the belief is that attempting to get rid of your symptoms actually creates more distress, anxiety, anger, depression, pain, even. Those are feelings, physical or emotional feelings that we have for a reason. Our body is trying to tell us something and they're going to happen occasionally. So instead of fighting with them and trying to get rid of them and never have them, ACT says, all right, let's form a relationship. Let's figure out how to live a happy life and know that these things are going to pop up sometimes. I lived in Florida for many, many years and I can't make hurricanes go away. You know, I can't control that. I can't get rid of hurricanes, which I would love to do, but I can't. So I. If I wanted to live in Florida, I had to learn how to live with the hurricanes. You know, getting storm shutters for the house and making sure that I had a hurricane supply of water and candles and all that kind of stuff, learning to live with it. So when the hurricane came, which was going to be inevitable, I was able to tolerate the situation until it went away. The other option was to move somewhere else. So, you know, in Tennessee we don't have hurricanes. But that doesn't solve all my problems because guess what? In Tennessee we have tornadoes. There's always something that you're going to have to deal with that's out of your control. So living, learning to live in harmony with your body, with your environment, is the goal of act. So in ACT, they believe that private experience is labeled a symptom. So what we feel, whether it's physical pain or emotional distress, this is labeled a symptom. And we struggle with that. I don't want to feel this way anymore. I want to get rid of it. A symptom is by definition something pathological. And we want to reframe our concept of of symptoms. Remember I said our feelings are our body's way of telling us something. Anger and anxiety are our body's smoke alarm. That's our fight or flight system saying, hey, I'm going to dump a whole bunch of energy for you. Because based on my prior experiences, I think that there might be here, all those hedges there. I think that there might be a threat. So I'm going to give you a bunch of energy so you can get up off the couch and figure out if there's a problem. If there is, you'll have plenty of energy to deal with it. If there's not, then you can pack up the energy and save it for some other time. Think about smoke alarms. When the smoke alarm goes off, does it always mean there's a fire? And if you live in my house, you know, the answer is no. It could be that something dropped on the stove and is smoking. It's nowhere near combusting, it's just causing a lot of smoke. However, the smoke alarm will go off. Smoke alarm is stupid. Our brain is kind of stupid sometimes. It says, just based on what I know, there might be a threat. So the smoke alarm goes off and gives me energy to get up and go look and say, okay, where's the smoke coming from? And is there a problem? What do I need to do about it? In act, the aim is to transform people's relationships with their unpleasant thoughts and feelings, learning to perceive them as harmless, even if uncomfortable. But transient events. When you pull a muscle in your back, it hurts, it's uncomfortable. However, we know that that will heal over time if we know, take care of it. We don't just stop our life right then and go, oh, I've got a pulled muscle, can't do anything, can't live, can't exist. Well, that's kind of silly. You're going to lose four, six, eight weeks that you could be experiencing a rich and meaningful life. If you just stop everything because you've got a pain in your lower back, what do you do? You learn to live with it. You say, okay, my back hurts, so maybe I can't play tennis and maybe I can't pick up my grandkids or play with the dogs in the same way, but there are other ways I can interact with my grandchildren. There are other things I can do for exercise like swimming, that are not going to hurt my back. So those things that are important in my rich and meaningful life, I can still use my energy. I can still experience a lot of the things that are important to me. Even if I've got this pain here, I can have happiness. I can enjoy life, even if I've got this occasional pain. We want to help people. We want to establish a partnership with them to help them regain control of their life, not just to control their thoughts and feelings. Remember, we're not trying to get rid of them. We're not trying to control them. We're trying to learn how to live with them. How do we live in harmony with these things? Act states that normal psychological processes are often destructive and create suffering sooner or later. Unfortunately, our brain, in its attempt to keep us safe, gives more weight, or what they call emotional salience to threats, to negative events, because it says, oh, you don't want to do that again. And the analogy I usually make is, if you're walking down a path in the woods and you accidentally step on a water moccasin because you didn't notice it, that's a problem. If you accidentally run into a bunny, I won't say step on it, because that makes me sad. But if you accidentally run into a bunny, that's sad, but it won't kill you. So your brain, when you're walking through the forest, is often more attuned, looking for the stumps that you're going to trip over, looking for the snakes that could bite you if you stepped on them or what have you. And because it's putting so much energy there, they estimate five times more energy to noticing the threats. It's not noticing a lot of the good things, a lot of the positive things in life. So that normal psychological process, that normal process of our brain saying, hey, I want to protect you, actually creates schema that say, ooh, walking through the forest, going hiking is kind of stressful and scary. Instead of being aware of the entire experience, Memories, perceptions, and schema are created when. When we analyze a situation, we say, okay, I'm walking through the woods. I'm analyzing this. This is similar to when I went camping with my family when I was a child. Okay, so we're analyzing this situation, comparing it to past situations that we know have experienced. We're remembering what happened, what we felt, what was dangerous, maybe what was good. We're evaluating the situation, planning on how to react. All of those things rely on language. So if we're using images and language that focuses on those natural processes of okay, these are all the dangers that you need to be aware of. It can cause us a lot of anxiety. We also tend to use personification or personalized language when we describe things. And it's much harder to get rid of something we are something that's part of us than it is to get rid of a thought or a feeling. In act, Hayes makes a big point of highlighting the difference between saying I am stupid versus saying I'm having the thought that I'm stupid. When I say I am stupid, it feels like it's part of me and it's inextricable. I'm having the thought, well, I can change my thoughts. Heck, I forget what I wanted from the kitchen by the time I get there half the time. Or I cannot go on versus I'm having the feeling that I cannot go on. I cannot go on is a definite statement. That's what it is. I am having the feeling that I can't go on. Feelings can change, thoughts can change. ACT asserts that human language naturally creates psychological suffering by setting us up for struggle with our thoughts feelings through experiential avoidance. So we have a problem. There's something we don't want to feel. Depression, to feel pain. Whatever it is, our solution is to figure out how to get rid of it or avoid it completely. Now, we see this sometimes in relationships when people who have been hurt before just don't want to get in relationships or don't want to commit to relationships or be vulnerable in relationships because their thought is, well, I can avoid the pain by just not going there. However, you know, how does that impact their rich and meaningful life? How does that impact their quality of life if they're afraid and avoiding connecting with anybody? The more time and energy we spend trying to avoid or get rid of unwanted experiences, the more we are likely to suffer what Hayes refers to as emotional quicksand. And in quicksand, when you step in it, the more you struggle, the deeper you sink and you just spend. And the deeper you sink, the more energy you've got to spend to struggle because your more of you is encased in the quicksand. And it's important to recognize this when we feel depressed. For example, okay, you feel depressed. Now, you can be curious about that, acknowledge it, and we'll talk about ways to work with it in a minute. Or you can get angry about the fact that, oh crap, I feel depressed again, you can feel guilty, I'm depressed, I'm not going to have the energy to do the things that I really want to do with my kids. Kids, you can be anxious. I wonder how long this depression is going to last and if people are going to abandon me because I can't do the things that it could. Oh, my gosh. It's exhausting even thinking about all of the additional emotions that people can ramp up to when. When they have an unpleasant experience. Whether it's physical pain or emotional pain, the ACT interventions focus around two main processes. Developing acceptance of the unwanted experience, which is out of personal control. So I'm accepting the fact that, okay, I'm depressed, or I'm accepting the fact that, all right, I pulled a muscle. There's nothing I can do about that now. The muscle already done been pulled. I can try not to do it in the future, but right now it is what it is. Once we accept that unwanted experience and recognize that, yeah, it's unpleasant, it sucks. However, it's not going to last forever. We can also make committed action to using the rest of our energy. Instead of getting all upset about being in pain, we make a decision to use the rest of our energy to enhance or to nurture all of the other things in our life that are important to us. The goal of ACT is to create what I often refer to as a rich and meaningful life, while accepting that pain inevitably goes with it. What is a rich and meaningful life? Well, that depends on every person. Each person needs to say, okay, thinking about having a rich and meaningful life, if I had one right now, who's important in it? You know, which friends, which mentors, which family members, and yourself, obviously, what is important to me, what things and experiences are important to me? And it could be your pets, it could be your house, could be your car, whatever it is. You're going to make a list of all those things that are important to you and the experiences. Maybe traveling is really important to you. Having a rich and meaningful life, that's something that is really important. Okay, put it on the list. So those are things that are important to you, and those are things that you're going to use energy to work toward or to nurture. Values is the final thing. Identifying what values are important to you. And I often ask people if you want somebody to describe you using three words. What three words do you want people to think of when they describe you? And that helps people narrow down their values a little bit. So it can be like compassionate, intelligent, dedicated, loyal, whatever. Some people have five values, but no more than five because it's too hard to remember all of them. ACT is a Therapy that involves being fully present and engaged or mindful and then choosing to act purposefully based on your values and desires for a rich and meaningful life. The six core principles of ACT help clients develop psychological flexibility. And those six core principles are contact with the present moment or. Or being mindful. What are my thoughts, feelings and behaviors in this context at this time? Defusion, which means not being fused with your thoughts and feelings. Being able to say, I'm having the thought, I'm having the feeling, I'm having the experience. Acceptance of those thoughts, feelings and experiences. It is what it is. The observing self and the and this is one we haven't talked about much yet, and we will. But the observing self is kind of like the fly on the wall. Or if you want to think of it as a scientist or an artificial intelligent. Artificially intelligent being that takes data in the mindfulness data. It takes in the information about your rich and meaningful life. It takes in and then it identifies the options. You know, how can we respond? What's the in this situation and which one will help us get closer? Use our energy most efficiently to get towards our rich and meaningful life. And then we make a committed action. So what is mindfulness? And I have a lot of videos on the YouTube channel about mindfulness, so I'm not going to spend a whole lot of time going into it. But basically mindfulness is consciously bringing awareness to your present experience with openness, interest and receptiveness, sometimes referred to as being non judgmental. It is what it is and a lot of you coil at that statement. Partly my experience has been partly when people hear that, it triggers a feeling of powerlessness in them and they don't like that, which is why they recoil at it and they're like, oh, I don't like that feeling. That makes me angry. Okay, well you feel angry when I say it is what it is. So let's notice that non judgmentally and explore why. Facets to mindfulness is an awareness of the present moment. What's going on with you right now, engaging fully in what you're doing rather than getting lost in your thoughts. If you drove to work today or even once you woke up, did you mindfully think, okay, I'm going to get up and then think about every step you took, or as soon as your alarm went off this morning, did you kind of kick into autopilot and you did the same thing that you do every morning and really didn't think twice about it? I think most of us go into autopilot mode and act Encourages us to not do that, to stop when we get up in the morning. Be mindful, you know, do a survey, say, what am I thinking? Feeling, needing right now. All right, what can I do to meet those needs right now? Okay. But being consciously aware of what we're doing instead of just doing it because is important. And allowing your feelings to be as they are rather than trying to control them. And mindfulness, we don't try to make our depression or our anxiety or our anger go away. We just notice that that's what we're feeling right now, and that's fine. It's what we're feeling. In dialectical behavior therapy, which is another kind of cognitive behavioral therapy, Linehan often talks about radical acceptance of what's going on. And it's really important to recognize how we're feeling. And instead of trying to control our feelings, being curious about what's going on, what's causing them, because change is constant. What we feel right now, we don't have to feel in the next moment. Every moment is an opportunity to start over again. If we're feeling angry right now, okay, what can I do in the next moment to improve how I'm feeling? How can I improve the next moment now? It is important for people to recognize that mindfulness does not require meditation. Meditation often involves mindfulness. But mindfulness you can do on the fly. You can do when you're driving. You can notice the cars around you. Hopefully, you can notice the birds on the power line and the color of the trees as the flowers come out in spring or the leaves change in the fall. That's being mindful instead of being lost in your thoughts as you drive to work. Mindfulness skills are divided into four. Contact with the present moment, Being aware of what's going on. What do I. What are five things that I see, Four things that I hear, Three things that I smell, Two things that I feel. For example, you know, being aware of what's going on right now. Acceptance of that experience. You know, I may notice that it's raining. That's one thing I see. Well, I just washed my car. Gosh darn it. I really don't want it to rain. Well, getting angry about it ain't gonna do me any good, so. Acceptance. I notice it's raining. All right, it's raining. What do I do now? Cognitive diffusion. I'm angry that it's raining because I just washed my car. Okay, I'm having the feeling that I'm angry that it's raining because I just washed my car. Is This a feeling that I want to hold on to. Is this a feeling I need to do something with? Or is this one I can just let go into the universe and the observing self, which kind of coordinates this stuff and helps us decide, notice what's going on right now. And based on our definition of a rich and meaningful life, helps us decide on a course of action. Contact with the present moment can involve a lot of different things. And remember I said in act, Haze is not manualized. So Hays is allowing therapists and individuals to develop their own mindfulness activities. What we're doing is just basically encouraging people to check in with themselves. How do I feel? What am I thinking? What physical sensations am I experiencing? Or describe the environment. You know, what do I smell? What are the temperature, colors, objects, what have you? Or even just a simple statement. I see, hear, and smell these three things, and it reminds me of I can walk into a house and I smell Pine Sol. And it reminds me of my grandmother contact with the present moment. I'm noticing something, and I'm noticing that, hey, it triggers a feeling in me, kind of a warm, fuzzy feeling, curious. I wonder what that's about. Oh, it's reminding me of when I would go to my grandma's house. Those simple little things can help us be more mindful and aware not only of things that trigger our distress, but also things that can trigger our happiness. And we want to add those things in. I know when I see a chickadee or a Carolina wren, and it makes me happy. It reminds me of when my children were young, and it reminds me of bird watching with my mother. So those things, I try to incorporate more into my life because I know that they increase my happiness. Now, uniquely, to act the person's agenda of emotional control initially in the early sessions is respectfully undermined. We ask people to identify how they've tried to get rid of or avoid their unwanted experience. And Hays calls this creative hopelessness. What they were doing, they were using their creativity to try to survive. They were doing the best they could with the tools they had, but it didn't work. And that's the hopelessness part. So then we say, all right, you've tried a bunch of things, and they haven't worked. So are you willing to consider maybe an alternate approach? And a lot of times, by the time people are in counseling, they are. When people are asked to assess how they've tried to get rid of their distress, we ask them, did this reduce your symptoms in the long term? Drinking alcohol, for example, for some people, Makes their distress go away in the short term, but in the long term, no. As soon as they sober up, the problem's still there. Moving. Like I mentioned before, living in Florida, you know, we had the hurricanes. Well, you know, hurricanes are stressful. Move to Tennessee. That's not why we moved, but moved to Tennessee. And you know, if I expected not to be to have that same problem, I would be very disappointed because in Tennessee we have tornadoes. So in the long term, moving away from Florida to get away from natural disaster really didn't help me. It is better to learn how to live with it, work in harmony with it. We also want to ask people, what did this strategy cost you in terms of time, energy, health, vitality and relationships. When we confront their agenda, we want to help them recognize that control. Trying to control these things, many of which are out of your control. Control is the problem, it's not the solution. Trying to control your depression or control the weather. Clean discomfort is when emotions and reactions are accepted and it leads to a natural level of physical and emotional discomfort. So instead of trying to control it and make it go away, we notice it and we say, all right, this is how I'm feeling right now. This is what's going on. Dirty discomfort is when you start struggling with it, your struggle switch is turned on and discomfort increases rapidly. It's kind of like an emotional amplifier. And if you've had anxiety or depression before, you know how it very quickly can spiral because you start feeling frustrated and angry and overwhelmed because of the fact that you feel anxious right now. Once we help people recognize that trying to avoid it, never experience it or get rid of it immediately once it's there, you know, I just want to. I want to make it go away. That doesn't work. So we need to learn what are some steps that might be helpful to improve the next moment. Learning to perceive thoughts, images and memories as bits of language and pictures, as opposed to what they can appear to be, which is threatening events or objective truths. This is the way it is and will always be. Not necessarily. Cognitive defusion means stepping back and recognizing that thoughts and feelings are just transient or passing subjective events. It's how we interpret the situation. But it doesn't have to stay that way. We don't have to stay angry. It's just a transient event because of something. And that's where we need to get curious. One exercise that Hayes uses in teaching cognitive diffusion is to think of a negative self judgment that takes the form of I am X, such as I am stupid. Think about it, believe it as much as you can and notice how it affects you. I mean, if you continue to tell yourself I am stupid, that eventually wears on your self esteem. Now insert the phrase I'm having the third thought that I'm having, the thought that I'm stupid. And you may say, well, that's a stupid thought. But a thought is something out here. And I encourage people to envision thoughts and feelings as something they can hold. It's not part of who you are, it's something you have. Now do you choose to keep it, give it away or let it go? Most people, when they start inserting the phrase I'm having the thought that I am X find that it relieves a lot of their discomfort. It's like, okay, it's not something I have to do. Having a thought does not have to lead to an action. Another example is for people who are smokers. For example, having the thought that I have to have a cigarette. Okay, well that seems to be a pretty definitive truth. But is it. What happens if you insert the phrase I'm having the thought that I have to have a cigarette? Are you beholden? Are you controlled by your thoughts or can you change your thoughts? There are a variety of diffusion techniques. You can treat the mind, treat those thoughts and feelings as external events or separate entities. Like I said, I usually envision like a word cloud or a bubble that people can hold. You can have people remember that thoughts are not causes. Is it possible to think a thought and do something different? I have to have a cigarette. I'm having the thought that I have to have a cigarette. Well, do you have to obey that thought? Do your thoughts control you or are you able to make choices? Who's in charge here? Treating thoughts as bullies. And this is really helpful for people who have a really loud negative inner critic that is saying you suck. You're the worst person. You're never going to succeed. Who's in charge here? Stop being a bully. I get to make the decision about what's right for me. I, I get to make the comments about who or what I am. Thoughts are not causes. Thoughts are not truth. Thoughts are just words. Sometimes you're going to have an experience like anxiety or depression and you're going to notice that, hey, you know, it is right on. You know, you're getting ready to go into surgery and you're feeling anxious and you say, well, I'm having the thought that I'm, or I'm having the feeling that I'm anxious about going into surgery. All Right. Well, that's a legit reason to have some anxiety. So now what? Now what do I do with that anxiety? Because just sitting there stewing in anxiety doesn't change the situation. If anything, it amplifies your anxiety because you start thinking about all of the different things that you could be anxious about or that could go wrong. So what do you do with that anxiety? How do you deal with that feeling in order to accept that, hey, it's natural to feel anxious before going into surgery. Acceptance means making room for unpleasant feelings, sensations, urges, and other experiences, allowing them to come and go without struggling with them, running from them, or giving them undue attention. When I feel angry, for example, okay, I notice it. I'm not going to immediately evict it because it's there for a reason. It's there because my brain is telling me, hey, just FYI, there might be a threat out there that you need to check. So I notice it. I get curious about, I wonder why I'm angry about this. And then I can decide. So, for example, on social media, if somebody starts, you know, being a bully on social media, it can make people angry and, you know, they're being trolls, I guess is the term that they use now. And part of you may get angry and want to respond, you know, and really feed the troll, as they say, because you feel threatened, because they took your personal power, you couldn't respond to them right away, and they made you feel vulnerable. And you get angry about that. Okay, Noticing your anger, being curious, okay, why is it that when this person was being a troll, it made me angry? Okay, I can see why that would happen. And then that observing self says, okay, based on your values and all the things that are important in life, is using your energy to feed this troll and get into a back and forth that you're probably never gonna win. Is that a good use of your energy? And the answer is no. And my husband and my son repeatedly remind me, don't feed the trolls, because you're never gonna win that fight. So acceptance means accepting that I'm angry. I don't like what that person did. However, what are my options to deal with this situation now? And you can block them, you can delete the comment. There are a lot of alternate responses besides trying to engage that person and win the argument, so to speak. Remember that thoughts and feelings don't have to lead to action. Just because I'm angry and I want that person to apologize or something doesn't mean that I have to try to do it. Because again, Ultimately, that's going to be a losing battle. Identify the problem instead of getting distracted by battling with the inner experience. Instead of battling with, well, I shouldn't get angry over this. It's kind of silly. Identify the problem. Well, this happened. It made me feel out of control or vulnerable. I don't like that. How can I deal with this problem so it doesn't happen as much in the future? Instead of focusing on trying to tell myself, well, I need to just let it go and quit being angry. Explore the effects of avoidance. If you try to avoid getting in situations when you're that will trigger distress, how does that keep you isolated and hemmed in you? You know, life can be risky. Living a rich and meaningful life means occasionally being vulnerable. So if you avoid any potential for distress, how is that going to affect you? Identify the barriers toward heading in the direction of your goals. What's keeping you from nurturing this relationship with your child? A lot of us get over focused, if you will, on work, for example, and we put a lot of our energy into work because it's something that's important to us, it's something that we love. But we fail to step back and notice and devote attention to the other things that are important in our rich and meaningful life. So maybe one of the things that's preventing you from having the relationship with somebody that you want is the fact that you don't devote any time to them. You're devoting all of your time and energy to work. Okay, well that's a barrier. So how are you going to fix that? The Serenity Prayer encourages people to have the serenity to accept the things they cannot change, the courage to change the things they can, the wisdom to know the difference. And that flows right in with acceptance and commitment. Therapy Hays encourages people to recognize you can't keep yourself from feeling a feeling. However, you can change the way you respond to that feeling. We want to help people clarify their values and I talked about this earlier in terms of defining a rich and meaningful life, what is most important? Deep in your heart, what sort of person do you want to be? What is significant and meaningful to you? Or what do you want to stand for in this life? Oftentimes a lack of values or confusion of goals and values can underlie psychological inflexibility. So maybe my value, you know, I really value independence and being able to make choices and feel safe and empowered. And that's a value of mine. I can confuse that with the goal of objective success. And so I can focus all my energy on Succeeding at work and the other resources in my life that may have helped me be independent, you know, that can help me have that rich and meaningful life, may drop away. So we want to make sure that people are acting in concert with their values. What is it? What is the choice that you can make that most embodies the three or five characteristics that you want to be known for? Let's go back to the trolls, for example. If you want to be known for being compassionate and intelligent and loyal, okay, great. Does fighting with the troll do anything to embody those values? And the answer is no, it doesn't. Trying to reason with them probably doesn't either, because that's not why they're there. So instead, how can you take that energy and redirect it towards something that's important to you? How can you show compassion and loyalty to something that's important to you and use that energy proactively? The fly on the wall is the consciousness that is changing, ever present and impervious to harm. This consciousness, or artificially intelligent being, if you will, observes what has been made known through mindfulness and with the awareness of the person's values, gets curious and says, okay, this is what's going on. This is what our experiences have told us till now. This is what's important to the person or me. So what is the best choice? Given all this data, what is the best choice for how to use our energy right now? The next step in the act process is committed action or choosing a direction and establishing a willingness. You can choose and say, okay, I'm going to do this and then never do it. So you need to choose and act purposefully, take that energy and say, okay, this is what I'm doing right now, and actually do it. That can be assisted by identifying motivating values of those values of those things that you want to be known for. How is this course of action that you've chosen embodying those values, using your energy to help you embody those? It's important to set goals guided by values and desires for a rich and meaningful life and regularly take effective action to achieve them. Some people like pie charts. I tend to like things that are more linear. But if you have a pie chart, you only have so much time and energy in any given day, week, year, identify at least the top 10 things that are important to you and figure out, how am I going to spend my energy? So I'm nurturing all these things. Just like in a garden, you can't just water the tomatoes and expect everything else to grow, you have to water everything if you want it to grow and not wither away and die. Creating the action plan means identifying current behaviors, feelings and thoughts that you engage in that may waste your energy, drain your energy. Like sitting in your car, stuck in the mud and just revving your engine. All you're doing is burning your gas and digging deeper into the hole. So what behaviors? It can be avoiding through sleeping or drinking, or it can be yelling and throwing a temper tantrum. There are lots of behaviors that we often use in response to distress to try to make it go away. What feelings and thoughts do you have that draw you away? And that's where this dirty discomfort comes in. Feeling guilty about having a depressive episode, well, that is a feeling that is not helping you. Struggling with the depressive episode is not a purposeful use of your energy. And then what toward behaviors can you engage in? How can you use your energy on a day to day basis to keep moving towards those things that are important in your rich and meaningful life? And when you're having an episode, when you're in distress, when you're feeling angry, for example, all right, this is how I'm feeling right now. What behaviors can I do that can help me improve the next moment to deal with this situation? What feelings can I nurture like empowerment and confidence? And what thoughts can I tell myself? Those distress tolerant thoughts that that will help me get through this unpleasant but transient experience. The goal of ACT is to create a rich and meaningful life, accepting the pain that inevitably goes with it. Being aware and present in the moment is crucial. Destructive normality refers to the psychological processes that are often destructive and create suffering and actions that we use to avoid distress and in the present moment. So we want to help people recognize that the way we normally behave often digs us deeper into the ditch. Therapeutic interventions include focusing on developing mindful awareness and acceptance of unwanted experiences which are out of personal control. Developing a vision of a rich and meaningful life and choosing committed and purposeful action to help us move toward that rich and meaningful life. Confronting the agenda is something that ACT therapists help people engage in in order to address or identify their sources of distress. We explore their sources of distress, prior attempts at removing the distress and the effect of those attempts in the long term. And finally, the six core principles of act. Remember our mindful contact with the present moment. Diffusion or separating ourself from feelings, experiences and things. Acceptance of what is in the moment. Identification and living by our values using the observing fly on the wall sort of perspective in order to objectively evaluate the situation and then choosing and engaging in purposeful action.