Acceptance and Commitment Therapy Skills | A Cognitive Behavioral Approach

Hi everyone and welcome to today's presentation on acceptance and commitment therapy skills. Over the next little while, we're going to discuss the goal of act. We'll explore yet again what is mindfulness. We'll talk briefly about how ACT differs from other mindfulness based approaches and what's unique to act. Then we'll move on to talking about destructive normality. Who knew? And experiential avoidance. Finally, we'll move into therapeutic interventions that are common in act. Talking about how to confront the client's agenda, which is generally clients come in and they want us to take away the problem. And ACT wants us to really confront that and say, are we talking about taking something away or just changing the way we perceive it? And then we'll work on thinking about control as the problem. Too often people try to control their depression, control their anxiety, and the harder they try to control it, the more out of control it seems. And we will end by exploring the six core principles of actual why do we care? As usual, not every intervention fits every single person. So what we want to do is try to find a host of tools that we can have in our toolbox to present to clients that will build on their strengths. If we hear something that sounds like ACT or CBT or experiential interventions, we will know that that's kind of where we want to go in order to help clients learn how to deal with life on life's terms in a way that's meaningful to them. You can't stop the waves, but you can learn to surf. You can't stop bad things from happening. You know, sometimes bad things happen and it just sucks. But you can learn how to deal with that in a way that is less counterproductive to your health and happiness. Distracting oneself from distress is akin to constantly running away from one's own shadow. I thought about that for a few minutes and it's kind of meaningful. In the attempt to control the negative thoughts and feelings, we are at a loss for control. In other life situations, if you're constantly running from that shadow, you're not focusing on anything else that's going on around you, which means other things can kind of deteriorate and will cause additional distress. Even if you figure out how to get away from your shadow. So the ACT acronym accept your reactions and be present. It doesn't say change them. It doesn't say judge them. It just says accept them. It is what it is. Choose a valued direction and then take action. That all seems pretty simple, but it's not. If it was Our clients would already be doing it. ACT is based on relational frame theory, which is a psychological theory of human language, which was developed largely through efforts of Stephen C. Hayes of the University of Nevada, Reno, and Dermot Barnes Holmes at the National University of Ireland. Maynooth, rational frame theory argues that the building block of higher cognition or reasoning is relating. That is, our ability to create links between things. So that's a whole bunch of technical mumbo jumbo for when we see things. We articulate it in terms that are meaningful to us. That's scary. That's wonderful. That's amazing. That is very depressing. That is, whatever words you use are the way that it's going to get kind of conceptualized and stored in your memory. So if you conceptualize something as all or nothing, then you may end up perceiving the world in all or nothing terms. So what we want to do is look at that language and say, is this the best way to think about this? You know, one of the examples that I've used before is labeling an event or a behavior instead of a person children. And I truly believe children are not bad. Children make bad choices, children do bad behaviors, but children are good. But that's my own humanistic sort of approach to life and recovery and all that kind of stuff, helping people see that. And we're going to look at some more examples of the way our language can really affect how we interpret something. Contextualists seek to understand the complexity and richness of a whole event through appreciation of its participants and features. Now think about functional contextualism. Contextualists say, in this context, when my son was little, we would go to different places, and at home, he knew what the rules were. He knew we didn't touch the tv. He knew everything the way it was supposed to be. But when we went to my grandmother's house, he had never been there before, and she had a TV and she had other things, and she had knickknacks and stuff we didn't have. So this was a different situation. So the little scientist in him went off and he walked over to the tv because he was trying to figure out, in this context, in this situation, how am I supposed to function? Functional contextualism. See where I'm going here? He walked over to the TV and he pointed to it, and he looked at me and he said, no touch. I said, that's right, Shawn. No touch. He reached out and he touched the tv, and he looks at me and he goes, time out. I said, yep, buddy, timeout. And he toddled over to the corner and sat down. He just wanted to make sure that those rules still applied. And it wasn't anything, you know, I wasn't like, well, he's doing that to be spiteful, or he was just trying to figure it out. And as soon as he figured it out, he didn't bother the TV again. So what I want you to get from that is the fact that people will behave differently in different situations. And the reason they behave differently in different situations is because there are different variables in play. I behave differently when I'm presenting than I do when I'm hanging out with my friends at the gym. And I'm sure you behave differently at work than you do at home, than you do when you're going out for a night with your friends, you know, on the town. It's all about context and what is the most functional choice of behavior at that point in time. So humans learn language through interactions with the environment. We need to focus on the changeable variables in the context. Some things aren't changeable. At my grandmother's house, we couldn't just take the tv. Well, we could have, but that wouldn't have been practical. So we needed to work on the changeable variables in the environment. We want to help people create general rules to predict and influence psychological events such as thoughts, feelings, and behaviors. Changeable variables in the environment can include triggers. It can include how to interact with different people. You know, maybe somebody has issues with authority figures that will affect how they interact with people at work versus maybe how they interact at home. So we want to take this into consideration. When somebody talks about having an anger management problem, well, I want to know about that problem, but I want to know about it in every single context. When we were talking about personality disorders, we talked about a pervasive pattern of behavior. So this pattern of behavior existed in multiple settings. So I want to know, what was the context, what were the variables controlling that behavior in each setting? Since it generally presented as a disorder, we can figure out that the behaviors and the choices that were being made in those contexts were probably unhelpful or inappropriate. The goal of act, as with most of our other interventions, is to create a rich and meaningful life while accepting that pain inevitably goes with it. There's going to be times that things just suck, and I'm sorry, it happens. You know, people go away. You'll have losses, you will have disappointments, but they don't last forever. It's important we help people understand when they're creating this rich and meaningful Life. Alright, maybe things are not going the way I want them to right now, but let's get back to basics. Who is important to me? Who is it important to me that I'm around, that I support, that is in my life? You know, it could be kids, it could be family, it could be your best friend, it could be all of the above. Then what is important to me? What are my values? You know, if I have to choose between different things, what things are important for me to have in my life? Is it important for me to have a roof over my head? Some people would say yes. Some people would say, you know, I can crash on my friend's sofa, or I really don't want to have the confines and regulations of living in some sort of formalized housing. And that is definitely a choice. And what experiences are important to me? Is work important to me? Is travel important to me? What is important and how could I move toward those goals? Because we want to have our decisions based on values. Values Driven decisions. ACT is a good abbreviation because this therapy is about taking effective action guided by our deepest values in which we are fully present and engaged. The other thing with ACT we want to remember is just like a lot of other things, our values may change over time. You know, what was important to you when you were 20 likely is not exactly the same as what's important to you today. When you are older than 20. We'll just leave it there. What's mindfulness? Consciously bringing awareness to the here and now experience with openness, interest and receptiveness. Mindfulness does not require meditation. And this is one thing that I really want to drive home to some of my clients. Because I've had situations where I start talking about mindfulness and clients are like, no, I won't, or I can't meditate. And I could try to contradict them and confront them and challenge the resistance, but that's not where they are right now. So I said, okay, how else can we be mindful? How else can we help you become aware of your here and now? One of the things that we used to do in my residential program, every morning and every evening, clients had to fill out check in sheets. They had to identify how they were feeling emotionally, mentally, physically, socially, spiritually and in general. So I mean, that was a lot of thinking right there. And then they had to identify what stage of readiness for change they were in and why. And they had to identify what behaviors they were exhibiting that supported that theory. And finally they had to identify three good things that they did during the day or three things that they wanted to do during the day. If we were talking about in the morning, we wanted clients to start becoming aware of themselves instead of just getting up and being on autopilot. Because we've talked about vulnerabilities, we've talked about understanding that some days you can handle more than others. Encouraging clients who are by all rights in early, early recovery, early or late phases of detox. I mean, they're not feeling so hot. So I want to know how they're feeling. Because then we can start talking about, okay, you feel sluggish today. How can we help you with that? Because there are going to be times when they're in recovery, when they are out of treatment and, you know, two years down the line when they wake up and they've got the flu and they feel like crap and they feel sluggish, but they've got stuff to do. So let's learn how to deal with that now. So anyway, we're not going to require them necessarily to meditate. Some people think it's the greatest thing in the world. And if they can meditate, great. Because there are so many beneficial aspects to meditation. Some of our clients who have anxiety disorders, who have ADHD, or who have extensive trauma histories may have difficulty, at least in the early phases of treatment. With meditation, with quieting their mind. It's really, really scary for them because that's, you know, they spend most of their life just trying to keep their mind busy so they don't mentally go there. Wherever there is facets to mindfulness, living in the present moment. So again, how are you doing right now? And for a lot of our clients, they look at you and they go, fine. If you're in recovery circles, you know that F.I.N.E. is an acronym. You can look up what it means, but it basically means you're not fine. That's just a knee jerk response. We want to ask them in the present moment, emotionally, how are you feeling? Cognitively, how are you feeling? And physically, if you can get those three, you're going to have them really focusing more on the present moment. Encourage them to engage fully in what they're doing rather than just getting lost in their thoughts. So if they're out on a walk, have them pay attention to what's going on. Have them pay attention to the birds, to the leaves, to the kitty cats that are hiding under the trailer. Whatever it is that they see, they hear, they smell. Sometimes we would have clients go out on walks around. We had a, I think it was a three acre campus have them go out on a walk and come back, and then they would talk about as a group what they saw, heard, smelled, etc. And it would be amazing that you'd send 10 people out and you'd probably get six or seven different perspectives of what was out there. You know, there was a lot of overlap, but there were inevitably things that one person noticed that nobody else did. Mindfulness also means allowing your feelings to be as they are, rather than trying to control them. I have a friend right now who's really stressed out, and it's stressing him out that he's stressed out. And I'm like, you know what? Let's just think about it this way. You're stressed out by everything that I know about that's going on in your life. You have a reason to be stressed out. So let's accept it. It is what it is. Where do we want to go from here? Instead of trying to say he shouldn't be stressed or calling him, he called himself Whiny. I'm like, not so much. You know, a lot of people couldn't handle that. So as a therapist or a coach or a friend, we want to encourage people to just accept, identify, and accept their feelings. Mindfulness skills are divided into four subsets. Acceptance, it is what it is. Cognitive diffusion. I can separate myself from my emotions. I don't have to be my emotions. Contact with the present moment, how am I feeling? Thinking, doing right now. And the observing self. I love the observing self because this is the fly on the wall. This is the fly that's sitting over there that's watching you, going, girl, what are you thinking? How does ACT differ? ACT can be used in a wide range of clinical populations and settings because it's not a manualized protocol that you have to go, well, I don't know if my clients can actually handle this part. It is a technique. It allows therapists to create and individualize their own mindfulness techniques or even create. Co create them or create them with clients. You can go online, and if you type in mindfulness, you will come up with literally hundreds of worksheets, activities, and ideas. So if you get stuck, try looking at those. Explore from there. One of the ones I learned, and I think we talked about it in the last session, was the name five. Name five things that you can think of or that you see right now that are hard. You know, the wall, the floor, the chair. Having people really pay more attention to what's going on in their environment. You remember that game that a lot of us Used to play back before there were iPhones, when we'd go on long car trips and you'd look at the billboards and you'd find billboards to fit each letter of the Alphabet. Whatever keeps you occupied. But it made you be more aware of what was going on, at least visually around you. What is unique to act? ACT does not have symptom reduction as a goal. The ongoing attempt to get rid of symptoms. And this is really important, so just bear with me while I read it to you for a second. The ongoing attempt to get rid of symptoms actually creates a clinical disorder, the private experience, which is labeled as a symptom. Anxiety produces a struggle with that symptom. So you're trying to control your anxiety and you're getting frustrated because you can't control your anxiety, which makes you feel helpless, which increases your anxiety about the fact that you can't control your anxiety. Does that make any sense? No. A symptom, by definition, is something pathological and something we should try to get rid of. But in reality, everybody feels anxiety. We are born with the fight or flight reaction. It's a normal feeling. It's what you do with it that can be pathological. So identifying the feeling, saying, all right, my body or my brain is perceiving that there's a threat right now. Okay, let's take a look at that. In act, the aim is to transform our relationships with our difficult thoughts and feelings and learn to perceive them as harmless, maybe uncomfortable, transient psychological events. The thought that I can't do this anymore, that's a feeling. That's a valid thought. Now, do we need to hold on to that and perseverate on it, or can we just let it go out the window? Destructive normality. I love this term. ACT assumes that the psychological processes of a normal human mind are often destructive, create psychological suffering for us all sooner or later. ACT postulates that the root of this suffering is human language itself. Now, some of the things that we've talked. If you think back to the abandonment class and some of the other classes, a lot of our schemas are formed in early childhood where we are thinking in concrete terms, where we are learning and relating in concrete terms, all or nothing, focusing on one aspect. So the verbal representation of whatever it is that is scary or threatening tends to be not as functional when you're an adult and you have more skills and more independence and more ability to survive on your own. So it's this language that tells you, I must do this all the time. I should have done that that can cause suffering. Memories, perceptions and schemas are created through, through analyzing, comparing, evaluating, planning, remembering and visualizing. All of these processes rely on human language. Think about a time when you are, when you were a kid. You're thinking about it right now. Most likely you're using words, maybe not out loud, but you're talking to yourself. You're like, I remember that time when I was six and daddy took me on the toboggan across the field. You used words with that. And I remember how much fun it was. So now I think of snowboarding and tobogganing as fun because that's the only association I really have for it. Think about this. I am stupid. Remember when I was talking about a child versus a child's behaviors versus I have the thought that I'm stupid. So if you think to yourself, I am stupid and really think about that for a while and keep telling yourself that, it's pretty depressing if you think to yourself, alright, I am having the thought that I am just a dummy right now. That's different. Because thoughts come and go. I can let a thought go. Another example that our clients may experience. I can't go on. I just, I can't go on like this versus, you know, right now I'm feeling like I can't go on. A feeling can come and it can go. I can't come and go. I'm either here or I'm not. And you know, I really want me to stay here for a while longer. So it's we're looking or we're talking about attributions. We've talked about those before. Global, internal, stable attributions. I am stupid. It's about me. It's global. I'm stupid about everything. I didn't say I was stupid about parallel parking. I said I was stupid. It's global, it's internal. It means it's part of me. So if I get rid of it, then I'm getting rid of part of me. What do I do with that? That's one of the reasons I don't like labeling disorders as. Because people say I am depressed. You have depressed feelings. You have symptoms of depression right now, but are you depressed? And I've got to be really careful with my language because I'll fall into that trap. Because it's just shorter to say I am depressed or I am an addict. But then people tend to personify that and I don't want them to do that. 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. There's a problem. I'm feeling anxious. I don't want to feel anxious. My solution, I need to figure out how to get rid of anxiousness, or I need to avoid anxiousness. And in my attempt to control it, I end up making it worse instead of just accepting that it is. Eventually it'll just kind of peter out or making a choice to do something. And we're going to talk about the ACT matrix at the end of this presentation. The more time and energy we spend trying to avoid or get rid of unwanted private experiences, that's thoughts and feelings, anything that's going on in our head, the more we are likely to suffer. Quicksand. Think about the old movies where somebody fell into a pit of quicksand, and the more they struggled, the more they sank. This is what's happening with our clients. The more they struggle with their anxiety, with the tools they have at that present point in time, the more they're going to sink. So what we need to help them do is just accept, okay, let me chill out for a second. I'm in the quicksand. Let me think about what I'm going to do. With addiction, the more people struggle to try to control their drinking, to try to control their addiction, the more they obsess about it. The more they think about drinking, the more they think about the pornography which makes them want to do it. It gives them this really strong desire. And then they get frustrated, especially if they do relapse or engage in the behavior. Then they get frustrated, they feel depressed, they feel worthless. They want to go back to that behavior because it's a numbing, avoidant behavior. And then it creates this whole dynamic of failure, beginning failure. Anxiety and depression are the same way. When people feel them, often they want to try to get rid of them. So they try to pretend that they're not anxious or depressed. They try to confront the anxiety or the depression. Unfortunately, a lot of times they confront it in not so nice ways. So encouraging clients just to accept without judgment. And that is so hard. Act interventions focus around two main processes. Developing acceptance of unwanted private experiences which are out of personal control. When something happens, whatever it is, loud noise goes boom and you startle. That's an anxiety reaction. Now, am I going to get upset because I jumped and I startled, or am I going to say I jumped and I startled, moving on back to what I was doing. People who are struggling with their anxiety will often get Frustrated and get stuck on the fact, well, I shouldn't have jumped. That was stupid. That was an irrational reaction. It was what it was, it happened, your body responded. And when we think about it, there's a loud noise you're not expecting. Startle is probably a pretty functional response. We just let it go. Because then your cognitions, your higher level reasoning kicks in and says, no, there's nothing to be worried about, car backfired or something. And a commitment and action toward living a valued life that is not getting stuck in this never ending quicksand. So the first step, confronting the agenda, the client's agenda of emotional control is driven gently and respectfully. Undermined. I like that I'm going to undermine you, but I'm going to do it respectfully. What we want clients to understand, and we need to come to an understanding of if we're going to use this technique, is that controlling depression, controlling anxiety while doing the same things, it's not going to happen. So we need to try a different approach. Clients identify the ways they've tried to get rid of or avoid unwanted private experiences. This is commonly called creative hopelessness, which I really don't like creating hopelessness, but it highlights the fact that what you've done in the past has not worked. So let's see what we might be able to think of that might work and bring you closer to the life you want. Questions we ask of them, did it reduce your symptoms in the long term? And of course I'm hearing Dr. Phil in the back of my mind going, well, how's that working for you? I'm like, what did this strategy cost you in terms of time, energy, health, vitality and relationships? So, okay, you might have fought it for a while or whatever, but at what cost? And did it bring you closer to the life you want? Generally, if somebody is trying to reduce their symptom and it's having a bunch of costs, it's taking them further away from the life they want. Because what they're seeing as costs are trade offs and trade offs are generally things we trade off things that we want for other things. Confronting the agenda. Alright, so we see that trying to control your depression, anxiety, addiction, whatever it is, hasn't worked. You're here, you're ready to try something else. Score. Alright, so let's try to think about it this way. Control is the problem, not the solution. And they're gonna look at you like you've got three heads and that's okay. You know, I'm good with that. Clean discomfort is when emotions and reactions are accepted and it leads to a natural level of physical and emotional discomfort. Think about getting a shot. You know, I am a great big old sissy when it comes to getting a shot. Now if I went into the doctor's office with clean discomfort, I'd just be like, alright, fine, get it over with. The nurse would jab me, it'd be over. Bada bing. Oh, but no, no, I dread going there. I don't sleep well the night before, I dread going there. I sit in the doctor's office and I'm like, oh, this is gonna hurt. My shoulder's gonna hurt for the next three days. Perseverate on it. I get in there and as soon as she puts the alcohol on my arm, even though I'm trying not to do it, I'm trying to control it, I tense my arm up, which means not only does it hurt more, but it creates a bruise and just cascade of effects. The same problem with emotions. When we start to struggle with our fear or with our depression and we start to lose, then we get angry at ourselves for not being able to control our fear or depression. And then we start to feel helpless and all these negative emotions just compound on each other dirty discomfort. Once we start struggling with that emotion. The struggle switch is what they call it in act is turned on and it says, alright, ready, go. Discomfort increases rapidly. The struggle switch is like an emotional amplifier. Switch it on and then not only do we have anxiety, but we have anger about our anxiety, anxiety about our anger, depression about our depression, or guilt about our guilt or all of the above. Some people are really talented and they can have like every negative emotion concurrently. That's not necessarily a beneficial talent. But I have known people who have, you know, basically gone through their behavior chain analysis and identified, you know, that they ended up feeling all of those feelings as a result of the initial negative feeling. So the six core principles. Once the emotional control agenda is undermined, once people realize that trying to control this, you know, just trying to think it away is not going to work, then we introduce the six core principles of ACT to help clients develop psychological flexibility. We all like flexibility. Diffusion sounds just like what it is. We're going to kind of diffuse this moment. Acceptance, alright, I'm going to accept it is what it is. Contact with the present moment, that observing self, remember my fly on the wall values and committed action. So let's look at those. Cognitive diffusion is learning to perceive thoughts, images and memories as bits of language as opposed to something that's dangerous. It's a memory, it's a thought. It can't hurt me now. I can choose to hold on to it. I can choose to magnify it, or I can choose to just let it go in and out. Cognitive diffusion means stepping back and recognizing that thoughts are just transient, private, subjective events. What do we mean by that? It's not an objective truth what happened, happened, but what you are remembering is your subjective account of what happened. If you were scared, if you were depressed, think about a race. There are five runners in a race. One person wins and four people lose. The person that won is like score. You know, they remember that event as very positive. The four people that lose, one person says, hmm, I need to work on my speed a little bit more. Another person says, I should have done better getting off the block when the gun went off. The third person identifies something else they can work on and the fourth person's like, I am a total failure. They all ran the same race, but they all had different subjective interpretations and subjective memories of that event. So a simple exercise that came out of some of the readings. Think of a negative self judgment that takes the form of, I am X, I am stupid, I am lazy, I am. You know, of course we're going to think about negative stuff because our clients don't usually come to us and say, I am awesome. Believe it as much as you can. And we talked about this earlier. Notice how it affects you when you repeatedly tell yourself that now some of you are probably thinking back to Stuart Smallig and looking in the mirror and going, I am good enough, I am smart enough, and gosh darn it, people like me. But anyway, when people hold on to a negative thought, then they start to sort of personify. They take on that negative thought and it affects them mentally, it affects them emotionally. If you keep telling yourself you're stupid, how does that work to make you happier? How does that work to make you less anxious? Then turn it around or add the phrase, I am having the thought that I'm having the thought that I'm stupid. Notice what happens once you add that clause in the front or phrase. It's been a while since I had English. People start to notice a distance from the thought. And they also, like I talked about earlier, they're not talking about themselves anymore. It's not this global, internal, stable thing that they're talking about. It's not them that is X. It's a thought that's telling them their ex. And we can silence thoughts. We can make them go away. Diffusion techniques, some Things. And if you Google these, you can find lots and lots more. The mind Treat the mind as an external event, almost as a separate person. My mind is doing this. I don't have to do it. My mind is interpreting it this way. I don't have to necessarily accept or reject it. I can just observe what my mind's doing and be in awe. I'm having the thought that helping people learn that thoughts are not causes. It's possible to think that thought as a thought and do X. Is it possible to think that this is really scary, but do it anyway? Certainly. Is it possible to think that I'm never going to get through this and get through it anyway? Absolutely. Thoughts are not causes, they are just interpretations or our mind's best guess about what's going to happen. Another technique is who's in charge here? Treat negative thoughts as bullies. If the person is constantly having negative thoughts, telling them they're stupid, they're no good, they're never going to amount to anything. Have the person treat it like a bully and say, I don't have to listen to you. Or kind of a radical acceptance approach here. This negative thought comes in my head, I'm stupid. Okay, you're right. So now what? What are you gonna do about it? Instead of arguing with it, instead of kind of trying to contradict it, instead of putting it out here, they say, alright, maybe there's something to what you say. How can I fix it? What can I do about it? That moves me closer to my values. And in act we always want to have that clause on the end that moves me closer to my values. Acceptance means making room for unpleasant feelings, sensations, urges and other private experiences. We don't have to let them set up shop there, but we have to understand or accept the fact that they're going to come and then they're going to go. Kind of like, you know, an unwanted family member that comes, stays the night and then moves on. You know, just don't let them unpack and stay there for a while. We want to allow them to come and go without struggling with them, running from them, or giving them undue attention. So again, back to that family member. You have Uncle Bob and he is just the worst house kissed. And he shows up on your doorstep one day and says, hey, I was just passing through town and figured I'd stay the night with you. And you're like, great. So you could struggle with Uncle Bob and say, no, you really can't. He's like, oh, but what you use a whole lot of energy trying to theoretically, tactfully tell him no and he's not hearing about it. Or do the Anybody Loves Raymond or Everybody Loves Raymond thing and hide under the door when you see him coming, like, everybody get down, get down, get down, turn off the lights. That's not the best reaction either. And it takes a lot of energy. Or giving it undue attention and getting really upset that Bob had the audacity to show up on your doorstep probably is not going to do any good. So you can just allow him to come and go without struggling with it. Unhook Thoughts and feelings don't always lead to action. You may be really ticked off that Bob did this, but does it mean you have to act out in anger? Does it mean it has to ruin the rest of your evening? Not necessarily. What can you do to unhook your thoughts from your feelings? Identifying the problem when we're battling with an inner experience, it distracts us and derails us. So if we're debating over something and we're just constantly going back and forth and it's been scary before, but we know we've got to do it, oh my gosh, I don't want to do it. Going to a reunion with Uncle Bob, maybe you don't want to go because you know he's just going to get drunk and be loud and obnoxious. You can dread it, battle it and think about it and perseverate on it, but that just uses a lot of energy. So it goes back to that question of at what cost. You can explore the effects of avoidance and how that has worked in your life. You know, if you've tried to avoid Uncle Bob, not answered his phone calls, you know, we saw it didn't work. He just showed up at the doorstep anyway. So, you know, maybe we ought to just figure out a different way to approach it. Defining the problem. Identify what the struggle is against and barriers toward heading in the direction of those goals. I have a friend who just retired from the military and he struggles a lot with feeling okay and self efficacy and everything. He's used to the military lifestyle, he's used to the camaraderie and, and it's terrifying to have to take on a whole new life now. So he's struggling against this anxiety and fear and everything that's keeping him stuck. So in act, in acceptance, we would look at defining the problem. What is it that you're terrified about? Let's list all those things and let's start identifying the barriers towards heading in the direction of Those goals. I'm not saying you don't have a right to be terrified. You are what you are. However, I don't want you to unpack and stay there. And the serenity prayer. Change what we can, accept what we can't, and the wisdom to know the difference. Too often people try to change the unchangeable like other people or the weather or, you know, a lot of things that we have no control over. So some things, Facebook, for example. Sometimes you've just got to turn off Facebook thinking about Uncle Bob. You know, you've known uncle Bob for 30 some odd years and he hasn't changed yet. So trying to change him now probably isn't going to work because he's happy the way he is. So we can either continue to try to change him, which is not going to work, or accept the fact that he's just Uncle Bob. I hope nobody out there has an Uncle Bob. If you do, sorry, was not meant to actually pick on him. Contact with the present moment. Bringing full awareness to your here and now experience. With openness, interest and receptivity. Focusing on and engaging fully in whatever you are doing. So when you are doing it, focus on, how do I feel? I mean, as you are sitting in your chair right now, how do I feel? What am I thinking about? You know, maybe your mind's wandering because you're like, oh, yeah, I had an Uncle Bob like that. Or maybe you've got a patient in 18 minutes and you're trying to figure out, all right, what do I have going on with that patient? Contact with the present moment would theoretically be staying focused right here, right now, and trying to identify things that relate to this presentation. Thinking about clients that that's worked with, or thinking about how you might use this in further sessions today, even if you can't stay completely attuned to my voice. Not everybody's an auditory learner. I get that. Not a problem. Focus on what physical sensations you're experiencing. You know, you see me sitting in the chair and I am a very active talker, but I also move around in my chair a lot. I'm just that way. Physical sensations can be, are you hot? Are you cold? Is your leg going to sleep? Are you sitting on a hard chair? Think about, you know, we're supposed to think about when we're doing computer work. Are we sitting with good posture and relaxing our neck and shoulders? Describe the environment, smell, temperature, colors, objects, people, sounds, etc. Challenge yourself to take, you know, a break every hour or every two hours. You know, not Everybody has the luxury of having an hour to do it. And go through these and just bring full awareness to the here and now for a week. Every hour throughout the day that you're awake for a week, practice becoming in contact with the present moment. See what happens. It may not have any effect, but my guess is it will. You can also do this through a simple. I see, hear and smell. And it reminds me of whenever I smell Pine Sol. It reminds me of my grandma's house. So that's a pleasant memory for me. When I smell that, it triggers happy sensations and happy neurochemicals and happy, happy, happy. So guess what? I cleaned my house with the observing self. Yeah, I told you I love this little fly. Accessing a continuity of consciousness that's unchanging, ever present and impervious to harm. Have you ever tried to get a fly? I am not good at getting flies. The flies in my house are impervious to harm, and they just sit up on the wall and laugh at me. So from this perspective, yes, I've got some paranoid delusions, but we're moving on. From this perspective, it's possible to experience directly that you are not. Your thoughts from feelings, memories, urges, sensations, images, roles or physical body. So if you imagine yourself to be the fly on the wall, you can look down at that person of you and go, gee, why is she doing that? Or that's crazy, Or a score, having a good day today. These phenomena change constantly and are peripheral aspects of you, but they're not the essence of who you are. So this fly seeing the peripheral you. This fly is just looking and seeing you act or react the way you do. Think about if you get a new dog, and especially an older dog, a rescue dog, and they have some behaviors, and you're like, where did that come from? Contextual. What's going on? What did it get them in the past? But the dog is also sitting there watching you, going, are you sure you want to do that? So values. Clarifying what is most important deep in your heart. And some people hate that phrase, but you know, when it comes down to it, what is most near and dear to you? What sort of person do you want to be? What is significant and meaningful to you? And what do you want to stand for in this life? Now, any of those could be an entire essay. And you could spend. You could have a client do one each week for four weeks to help him or her start identifying their values. Stephen Hayes has a whole series of books that walk you through these six steps. There's guess what six books and help you help clients more effectively implement the six components of act. But clarifying. He has a whole book on it. So obviously it's not just four bullet points. There are a lot of different ways to help clients clarify their values versus what they were told they should think or should feel. A lack of values or confusion of goals with values can underline the underlie the inability to be psychologically flexible. So if you're confusing a goal with a value. I want to be rich. That's not a value. What is your value? That's a goal. Why do you want to be rich? Why do you value money? I'm talking about that. The next step in the ACT process is choosing a direction and establishing willingness. Identifying motivating values. What direction do I want to go? And again, how does it get me closer to where I want to be and who I want to be with? And establish a willingness to help regain control of life, not necessarily just to control thoughts and feelings. So I'm going to take control of my life and I'm going to understand that there are going to be bumps in the road, but I'm also going to understand that I'll also get to feel the good things because I'm in contact with the present moment. That's right. Committed action. Setting goals guided by your values and taking effective action to achieve them. Sometimes this is called purposeful action. Everything you do has a purpose, and that purpose is to get you closer to where you want to go, not to set you backwards. And I told you we would end with the ACT matrix, and that's a whole different book. There are activities on psychological flexibility that work with this. But to try to kind of put it all into context and tie it up with a handy little bow on the top of it, you have your behaviors and your five sense. Experiencing what's observable to others. When you walk into a room, what do others see? Others see you. Others see the other people in the restaurant. Others see the expressions on your faces. Others can feel the temperature of the room, but they don't know what's going on inside your head and they don't know what you're thinking. Down at the bottom are your thoughts, emotions, and internal experiences. Now, this project or this activity divides this into four quadrants. So when you're looking at towards the left side, you're moving away from your goals and values. So what do I do that moves me away from discomfort? And how is this moving me away from my goals or values? So a lot of times clients will come in and they'll say, when I'm really stressed out, I have a few drinks. Okay, that's what you do. And we're not judging. We're not doing anything. We're just writing it down. So we have a few drinks up here. What am I thinking or emotionally experiencing right now that's moving me away from my goals? A lot of times it's fear, depression, anxiety. This is why they're here. So you take that dysphoria. I'm just going to generalize it. And when you feel dysphoric, you drink. So then the person is stuck on this left side of the activity, this left side of the quadrant thingy. Because once they drink, then they've just intensified. They haven't fixed anything. They just escaped for a little while. So then they sober up and they're still dysphoric. Then we move over here and say, okay, what's moving me toward my goals? Well, first I have to know what my goals are. So what and who is important to me? What am I thinking or emotionally experiencing that's moving me toward my goals or values? And these are things like accomplishments, success, happiness, observable things, things that other people can see that are moving you toward your goals and values. What could I do to move me toward who and what is important to me, and what am I doing right now that is moving me toward my goals or values? So when something happens, people are in. Maybe somebody's in a bad relationship and they decide to break up, and it's excruciating, and they're in agony over this relationship loss. So they're down here, they're feeling something negative and they want to escape. But then we say, okay, that is definitely one thing you could do. However, does escaping move you more toward your goals and values? Does it move you toward where you want to be? The answer is probably no. So then we say, okay, what could you do that would help move you toward that? Or maybe they're thinking of getting back in the relationship. That's one of their options. If they're not going to escape, maybe they just need to suck it up and get back in the relationship. Then we say, okay, is that going to move you toward your goals of being happy and successful in everything you've identified? Or logically, is it going to move you away from. I mean, this is all just very. I don't want to say clinical, but it's very factual. Encouraging people to just keep that in their head every time they do something or have to make a decision or have a thought. If they have a thought that says you're stupid, they need to ask themselves, is that self talk that's going to move me toward my goals or is it self talk that's going to hold me back or worse yet, move me further away from where I want to be six months from now? The goal of ACT is to create a rich and meaningful life while accepting that pain inevitably goes with it. It happens. Part of living a meaningful rich life is being aware and in the present moment. Most of the time. I mean, in reality, we're not going to stay completely grounded and present 24 7, 365 because we get caught up in work, we get caught up in stuff. But if we can encourage ourselves to do it multiple times a day, then we're going to be more aware of where we are, how we are, and how we're feeling. Destructive normality is the psychological process of a normal human mind, which can be seen as destructive and create psychological suffering. People start to feel that they're helpless. They're trying to get rid of something that's normal. You feel anxiety. That is a normal feeling. That is a normal reaction. I totally get why you feel that right now. What do we do about it? Actions designed to avoid the experience in the present are not going to be helpful. We want to help people. Just identify and accept therapeutic interventions focus around two main processes. Developing acceptance of unwanted private experiences which are out of personal control. So that automatic thought, that automatic feeling, it happened. Now there's no need to beat yourself up for it. It happened. Let it go. If you give it attention, it's kind of like a stray dog. If you give it attention, it's going to keep coming back. Trust me, I have more than one stray dog that comes to my house, whoops, anyway. And commitment and action toward living a valued life. Once you've decided to try to try to quit controlling the things that you can't control, then you can use all that energy toward making decisions and taking action to move toward where you want to go. How cool is that? If you quit being stressed about being stressed or worried about being angry, you have a whole lot more energy to do what you want to do. This also applies to holding on to resentments. You know, we talk about people using a lot of energy to nurture grudges and resentments. That feeling, whatever that feeling is, is something that they can choose to let go. You don't have to continue feeling resentful. You can choose what to do with it. Confronting the agenda to eliminate distress, you're not going to eliminate it. It's going to happen. So explore sources of distress. Explore prior attempts at removing distress and that effectiveness. How did that work for you in the short term? May have worked great. How did it work for you in the long term with regard to what was the cost, and how did it impact the other areas of your life? And did it move you closer to or further away from from your goals? And finally, the six core principles of ACT are diffusion, separating self from the experience, acceptance is what it is contact with the present moment through mindfulness, observing the self as a fly on the wall, values identification, and then choosing committed action.