Acceptance and Commitment Therapy Skills and 12 Steps

Foreign. The 2021 Wellness Retreat is an opportunity for clinicians and non clinicians to enjoy fall in Tennessee and maybe even a leaf change while you take a deep dive into learning about the mind, body connection and strategies for improving your overall well being. Up to 21 CEUs will be available for clinicians, but again you don't need to be a clinician to attend. The retreat is being held October 20th through 23rd at Cumberland Mountain State park and is limited to 60 people to allow me to have plenty of time to interact with everyone. Go to allce.comwellness to see the detailed schedule and download the registration form. I look forward to seeing you there. I'd like to welcome everybody to today's presentation on Acceptance and Commitment, Therapy skills and the 12 steps. I am your host, Dr. Donnelly Snipes. Today we're going to talk about the goal of act. What is mindfulness? Things that are unique to act and then some terms that are also unique to act. And we'll wrap it up by talking about the six core principles of ACT or acceptance and commitment therapy. ACT stands for accept your reactions and be present, Choose a valued direction and then take action. This dovetails really nicely with the 12 steps. When you go through the 12 steps with people or when people go through the 12 steps, there are certain principles at each level or at each step and they encompass concepts like starting with powerlessness and unmanageability, hope and faith, courage, integrity, willingness, humility, self discipline and compassion. So basically it says, you know, the first couple of steps are accept the world as it is, accept what's going on and be present. You know, it is what it is right now. Then let's figure out how to move forward and start making positive changes to your life and then take action. Then start doing it. And the 12 steps work well. That way you admit powerlessness. Then you choose to turn your will over to a higher power. You make a fearless, fearless and more moral inventory. Then you start making amends and you know, yada yada as you go through it. So act and the 12 steps are not mutually exclusive. You can use them both together. I have for 20 years used a lot of cognitive behavioral therapy tools with my clients who were going through 12 step programs and I don't think that they are run counter to one another at all. ACT is based on Relational Frame Theory or rft. RFT is a psychological theory of human language developed largely through the efforts of Steven Hayes, Dermot Barnes Holmes and and well and Dermot Barnes Holmes. RFT argues that the building blocks of thought are the ability to create links between things and create schema that help people anticipate things in the future. Well, that's true. I mean, we've talked about schema before in other theories. And schema are those shortcuts that our brain takes based on prior learning to anticipate what's going to happen next. You come up to a stoplight, you've got a schema about stoplights. If it's yellow, you expect it to turn red. If it's red, you expect it to turn green. And if it doesn't do that, then it throws you for a loop. But when you create that schema, you use words. The stoplight is yellow, it should turn red, red. And. And those are the words that you use. And lightning and heat lightning is another example that I like to use. If you've ever been been in Florida, for example, and I don't know where else they have it, but in Florida we have something that people call heat lightning. And it is lightning that you see in the evenings, especially in the summer. It's not the bolt lightning, it's just flashes of light in the sky, but it is not followed by thunder. Whereas lightning, when you see lightning, like in Tennessee, you expect to hear thunder at some point after that. So heat lightning doesn't fit with that schema. And we have to alter our schema a little bit to differentiate. So we're not generalizing and expecting all lightning to behave the same way. We use words to describe our experiences of pain and what to expect. Like we talked about the other class, getting a shot. You know, you have a schema about getting a shot. And if you think it is going to be painful, if you remember when I had a shot before it hurt, well, those are words. And those words paint a picture. And that picture forms the basis of the schema that guide your future actions and reactions. When, when you go in to get a shot. And it's important sometimes to check that schema and see if it's accurate and sometimes alter it. Contextualists understand the complexity and richness of a whole event and subsequent emotional and behavioral reactions through appreciation of the uniqueness of its participants and features of each situation. A contextualist recognizes that what is threatening to a 4 year old may not be threatening to a 24 year old, even if it's the same person when they were 4, then 24. Because when, once they're 24, they have more experiences, they have more tools, they have more ability to protect themselves. At 4, they recognize themselves as very Vulnerable large movements is another one of those contextual things. And I know I'm little on these videos, but you can see that I tend to be very animated when I talk, and I make large movements and I have like, zero volume control. I'm loud, I get excited, I get loud. It's not because I'm angry. But someone who grew up in an environment in which large movements and loud voices indicated that violence was not far behind may be triggered by that because they expect loud movement or loud voices and large movements to lead to something unpleasant. So it would be important to look at the context. In this context, with this person, I. E. Me, and in this situation where you're learning, you know, that's probably not any situation that's going to be confrontational in a classroom. Is it likely that your expectations based on loud voices and large movements are going to be accurate? And the answer is probably not. You know, in reality, probably you need to alter that schema a little bit to reflect the context of this situation. If you see me in a different situation in which I feel threatened, for example, and mama bears come out, well, then that may be very different. So it's important to encourage people to recognize the context of situations. Substance use is another example where we want to look at the complexity and richness of a whole event. If somebody grew up in a household where when a person consumed alcohol, they became violent, they became nasty, they may subsequently anticipate everyone to be an angry drunk and. And that may not be the case, and it may cause a lot of consternation in their other relationships with people who so drink socially and handle it appropriately. Functional contextualism emphasizes that we learn how to describe and anticipate through experiences, you know, in the context what happened and what was functional in that situation. When we. The way we act and the way we react, it's designed to keep us safe. So the way I acted and reacted in that situation, if it kept me safe, then I'm probably going to file that away as, okay, that works, it may not be the best solution. You know, maybe it kept me safe because I distanced myself. However, you know, looking at the context in retrospect, it actually wasn't even a threatening situation, so I distanced myself from a healthy situation. We need to focus on changeable variables in the context to create general rules to predict and influence psychological events such as thoughts, feelings, feelings and behaviors. Going back to that battle needle thing, again, you know, when I go in to get a shot, I talk to myself and I talk myself out of that because my. My first schema that pops in is the one that has the most emotional valence to it, and that's the one that was the distressful experience that I had. But I remind myself in present day, in this context, I don't know this phlebotomist. I've never seen them before, so I don't know that they are going to be painful. I've had shots and I've had my blood drawn from other people that hasn't caused me pain. I need to remind myself that my schema, that overgeneralized schema, that every time a needle is involved, it's going to hurt. I need to remind myself that that's maybe not 100% accurate. And in reality, I told you on Tuesday, I had to have my blood drawn for my physical. And the phlebotomist was great. I hardly felt it. It was beautiful. And that falls into that, you know, category of the context. Reminding myself that, you know, next time I go, she's taken blood from me before, and it's been no big deal. The goal of ACT is to create a rich and meaningful life while accepting that pain inevitably goes with it. We are going to have cloudy days. We are going to have pain. Whether it's physical pain or emotional pain, bad things happen. We don't have, you know, sunny days every day. It's important in ACT to recognize the totality of your life. And this kind of hearkens back to the concepts of hardiness that were proposed in 78, I think, by Kasa. The commitment, control and challenge. Looking at your life and identifying all of the things and people and experiences that are important in your life right now. You know, this thing over here may be kind of sucky, but in the big scheme of things, you know what's going well, what's going poorly. So you can recognize and you can have a rich and meaningful life and experience distress at the same time. We'll talk more about living in the and in a little while. So identifying who is important, what is important to me, what values, things, experiences are important to me, and how can I move toward those goals. And I have a video on the YouTube channel that goes into detail about how to create a. What I call a vision board. But basically you get. I don't have it here. You get a poster board and you make pictures or icons of all of the people, things and experiences that are important to you. And you put them on the board. And then on the each side and the top and the bottom, you identify the four Values, the four core values that are most important to you, like forgiveness or compassion or whatever it is. And write one of those on each side of the board so that frames the life. And then underneath each picture or icon, you write, write a list of things that you can do to nurture that aspect of your life. And then you put another list of things that may not be going well in that area right now that you may need to work on. So it really helps you categorize and visualize what's going on, but it also encourages people to identify ways they can positively use their energy towards working towards their goals instead of using it to sit in misery and just rev their engine, so to speak. ACT is a good abbreviation because this therapy is about acting based on our deepest values in which we are fully present and engaged. In order to be fully present and engaged, we need to be mindful. And mindfulness means consciously bringing awareness to your here and now experience with openness, interest and receptiveness and non judgmentalism, if that's even a word we want to recognize. You know, how is it that I feel right now? It's not good, it's not bad, it just is. Let's use some words to describe how it is. We need to encourage people to start becoming more mindful by trying to do more living in the present moment. This isn't a switch that people can flip. And you know, there are lots of videos on mindfulness as well. I'm not going to go into depth on any of these particular skills, but we do need to encourage people to start at least checking in with themselves a couple times a day and then maybe graduating towards setting aside 20 or 30 minutes a day to be mindful and live in the present moment when they start to wander. You know, bring their attention back, start out with two minutes and then have people build on that. Most people can master two minutes of mindfulness before their thoughts start to wander relatively easily. Unless they're in a hypomanic romantic episode or they have like ADHD in which that can be challenging for them. Set people up for success, you know, identify what they can do and remind them that when their mind wanders, just to say, okay, nope, going to think about that right now and bring it back to the present. Mindfulness also means engaging fully in what you're doing rather than getting lost in your thoughts. And a lot of us do this probably driving to work or home from work. We're thinking about what needs to be done or how the day went. We're reflecting on things and we may not really notice a lot about what's going on around us. I mean, we're cognizant enough to drive safely, but we're also thinking about a bunch of stuff, so we probably miss a lot of things. I. I noticed the other day when I was driving home that and, or no, we were coming to the office, it was still dark outside, and we have two snowy owls that are living in our neighborhood now. I love owls. They're really awesome. But I haven't seen a, an owl outside of a zoo in forever. So that was, you know, really exciting for me to see not one, but a pair of them. So anyhow, and allowing your feelings to be as they are, rather than trying to control them. If you're angry, all right, you're angry. If you're stressed, all right, you're stressed. Your feelings, your emotional reactions are your body's way of telling you to do something. If you're happy, if you're content, it tells you to relax. If you are angry, if you are anxious, it generally sends out those excitatory chemicals that says, hey, I'm giving you the energy. Now get up and do something to address this situation. Mindfulness does not require meditation. A lot of times people confuse these things. Now, you can do mindful meditation, but you can also be mindful without meditating in the tradition, traditional sense. When you're driving home from work, you can be mindful while you're driving. You can notice the cars that are around you. You can notice the birds on the power lines or whatever, and, and that helps keep you focused in the present moment. Or you may stay mindful by just singing along to whatever songs on the radio. You are keeping the beat with it. You're keeping time so you're in the present moment. You're not singing and thinking at the same time. Mindfulness skills are divided into four subsets in ACT acceptance, cognitive defusion. And that means separating, becoming unfused from the thoughts. So that's why it's spelled diffusion, not diffusion. Contact with the present moment and the observing self. Now, these are very similar subsets as to what we see. In other words, cognitive behavioral approaches, including dbt. But there are a few really interesting techniques here. ACT can be used in a wide range of clinical populations and settings. Unlike something like dbt, it's not manualized. Now, you can use DBT skills like distress tolerance skills in clinic, but you are not actually using DBT itself unless you're using the manual to fidelity. ACT doesn't have a manual. It allows the therapist to create and individualize their own mindfulness techniques or even co create them with clients. ACT does not have symptom reduction as a goal. And a lot of times people are like, what? The ongoing attempt to get rid of your symptoms actually creates a problem because you're telling yourself, I shouldn't be depressed, I need to get rid of this depression. Well, if you're so focused on getting rid of something, you may forget to add in the positive. And you know, again, it seems like semantics, but it makes a big difference. According to act, the private experience labeled as a symptom, like depression, leads to a struggle with this symptom. I don't want to be depressed, I want to get rid of it. I want to, you know, eliminate it. A symptom is by definition something pathological and something we should try to get rid of. So when we tell ourselves, well, I'm depressed, I need to get rid of it, this isn't something I, I should have, it's bad. Well then that sets up a whole set of negativity. In ACT or act, the aim is to transform the relationship with the difficult thoughts and feelings. Learn to perceive them as harmless, even if uncomfortable, transient psychological events. So depression, distress, anxiety, they may feel horrible when you are experiencing them. I'm not. ACT doesn't take, doesn't minimize that. However, it encourages people to recognize that you can feel this feeling and survive. You can have distress tolerant thoughts as, as Linehan would say, cravings. It's another great time to use act, transforming the relationship with cravings for people in recovery. Recognizing that yes, you may have this craving and it may feel uncomfortable and your brain may be trying to tell you you have to have a drink or you have to go eat that cake or whatever it's telling you. So that may be uncomfortable because you want to do it, but it's a transient event. And cravings and urges tend to come in like a wave crest and, and recede within, you know, 15 to 30 minutes depending on the person. And, and we talk about that. We also can use the same example with pain. You it hurts, but a lot of times pain is somewhat transient. Chronic pain, people can develop tools to address it in order to help move towards that rich and meaningful life that's characterized by pain management. Pain may never completely go away for some people, but we want to help them see that they can experience joy and still have that back pain. Sometimes. ACT postulates that the root of suffering is human language itself because we use global, internal, unchangeable attributions I am depressed. So it's I am. Instead of I am feeling depressed, I am depressed. It's like saying I am Donnelly's, you know, I am depressed. So that's internal and global, and it may feel unchangeable. An alternate statement would be, I am feeling depressed right now. That separates it, and that makes it this feeling that I can do something with or I'm think having the thought that I'm depressed right now. Memories, perceptions, schemas, whatever you want to call them, are created through analyzing, comparing, evaluating, planning, remembering, and visualizing experiences through processes that rely on human language. And we already talked about the stoplight example. People will say things to themselves like, I am stupid. Well, that's global, internal, and potentially unchangeable. But you can diffuse from that by saying, I am having the thought that I'm stupid. A thought. You know, I have a thought, and I'll forget it before I walk into the kitchen. I'll get in the kitchen, I'll be like, what? What did I think I needed to do? So thoughts are. Are something that we can manage, whereas if we believe it is something that is part of us, it may be harder. And this is what we call destructive normality in act. Because normality is global, internal, and unchangeable a lot of times, and that's destructive. When we alter our normal patterns of language, then they become less destructive. Experiential avoidance is another concept that we need to talk about. And it's the idea that when there's a problem, we got to get rid of ourselves. And the need to get rid of it and the inability to get rid of it right away starts creating psychological suffering by setting us up for our struggle with our thoughts and feelings through experiential avoidance. When we have a problem, it's something we don't want. So we struggle with figuring out how to get rid of it instead of saying, okay, this over here, it's unpleasant. I don't like it. Let me put this over here. Leave it in this box right now. Let me look at what else is going on in my life and. And recognizing that we can have this box over here of icky stuff and other things that are important. When my mother was ill and after she died, the, you know, that was my icky box right there. That was where all the hurt was. But there were also things in my life like my son graduating from high school and, you know, my daughter excelling in. In the things that she did and getting her black belt. There were a lot of other things in my life that were going well, that were bringing me joy. So helping me focus on the total experience, recognizing, you know, the good things as well as acknowledging, yeah, this, this albatross over here. I'm, I'm not going to be sad when it finally goes away. The more time and energy we spend trying to avoid or get rid of those unwanted private experiences, the more we're likely to emotional quicksand when we start to struggle with it. If we feel depressed, for example, then we get angry about the fact that we can't seem to shake that depression and we might, might start feeling guilty that we don't have the energy to do the things that we wanted to do because of our depression. And then we get angry at ourselves for failing to do that. So you start struggling and you're struggling with increasing numbers of dysphoric emotions. We see this with anxiety, depression, addiction, you know, kind of the list goes on. Over 10,000 people come to BetterHelp every day looking for a counselor. BetterHelp makes it easy for you to move your practice online and focus on what you love most. Helping others better helps easy to use platform. Takes care of referrals and billing and provides a secured platform to communicate with your clients. Join more than 18,000 therapists at better Help helping to improve people's mental health and lives. ACT interventions focus around two main processes. Developing acceptance of unwanted experiences which are involuntary. Remember emotions when you first feel them. That is sort of an involuntary reaction based on those prior schema and the automatic thoughts. If we want to bring in some CBT here that we have a initial reaction that is normal feelings are normal. Anger. When we, when we experience anger, that's an involuntary reaction. Now what we do with it, that can be voluntary. But that initial feeling of anger or anxiety or happiness, those are often involuntary. So we want to accept them as a communication. Maybe an email, whatever you want to call it. From our body that hey, something needs to, something needs to be done when we have pain. That's your body saying there's a problem here, something needs to be done. You know, you may need to change positions, you may need to ice it. You know, whatever it is you need to do, but it's your body saying there is something wrong. Pain is a communication and cravings. People can crave certain foods because they are nutrient deficient or people will crave substances in, in substance, in addiction. And that craving represents often an imbalance in neurotransmitters. The craving develops when the person's body begins to rely on those addictive behaviors or that addictive substance to maintain the neurotransmitter balance. And then when they're not using, the brain starts going, hey, you know, everything's out of kilter here. I really need a hit of dopamine right now. And, and the cravings will come. And that's the body's way of saying, we need to stabilize the system. When we start recognizing feelings as communication from our body, as involuntary experiences that, you know, give us a clue that we need to evaluate the situation and choose a purposeful action. And that's where the next step we're getting to. When you feel these feelings, act tells us, and DBT2 encourages you to get into the your wise mind to evaluate the situation, to observe what's going on and figure out the best course of action, the best use of your energy to move you toward your goals. Because generally, if you're moving towards your goals, you're also at the same time moving away from the things that you don't like. Not always, but most of the time. The other aspect of ACT is commitment and action toward living that valued life. So instead of using our energy to fight against the depression or to be angry and stew in resentment, we're using energy to do things that are going to help us be happy. And we're going to say, you know what? That's not worth my energy. Or maybe it is worth my energy. I'm going to do something about it, and then I am going to turn my attention to something else. Grief, for example. You know, grief is one of those things that you got to work through. You may have to use your energy to work through it. However, fighting against it, you know, trying not to grieve, trying to ignore it, trying to deny it, that takes a lot of energy. The choice to use energy to process that grief and start to work through it. And, you know, in the next couple of years, as you're, as you have those little grief bursts, acknowledging it, recognizing it, figure out figuring out the best way for you to cope with that, and then, you know, doing so so you can get back online towards moving towards your rich and meaningful life. All of those things can be very empowering. In act. The first step in ACT is confronting the agenda. A lot of people want to have total control, including the control of involuntary feelings and physiological reactions and behaviors. We want to start gently educating or confronting that need for control. Because we can't control our involuntary reactions, we can't prevent ourselves from ever getting angry. We can address how we react when we get Angry, but we can't prevent that involuntary reaction when, if somebody has an autoimmune disease or a chronic pain issue, they can't always prevent a flare up. However, they can adjust how they act to that flare up in order to address it in the most efficient, effective way possible so they can get back towards, you know, that path of their rich and meaningful life. We want to have clients identify the ways they've tried to get rid of or avoid these experiences. And in act they call it creative hopelessness. In what way? In what things have you done, you know, what creative solutions have you explored to try to get rid of this feeling that ended up making you feel even more helpless and hopeless? Basically. So they're asked for each strategy. Did it reduce your symptom in the long term? What did this strategy cost you in terms of time, energy, health, relationship and self esteem? And did it bring you closer to the life you want? So you can plug any of these things in here. Drinking. When you get stressed, you go home, you get blitzed. All right, did it reduce your symptoms in the long term? What did it cost you in terms of time, energy, health, relationships and self esteem? And did it bring you closer to the life you want? Generally, the answer is no to all of the above. Same thing for aggression. Sleeping, gambling, you know, plug in the dysfunctional behavior or the unhelpful behavior and, and you start helping people see that, okay, you were creatively trying to figure out how to survive a situation that felt intolerable. And you know, kudos to you for wanting to survive. That is, you know, I want to give you credit for the, for being courageous enough to try to do something because you want to keep on keeping on. That's awesome. However, it's clearly not producing the results that you want. So what do we do about that? Through this process, we're trying to help them see that control is the problem, not the Solution. In the 12 steps, the first step is we admitted we were powerless over fill in the addiction and our lives had become unmanageable. People with addictions have at their core a huge need for control. The world feels out of control and there are a lot of reasons for that. But control becomes a huge issue in addictions. And they, they've tried to control their use and it's failed. And they've tried to control their symptoms and it's failed. Well, they're not able to control that distress. So controlling it is the. Trying to control it is the problem. Clean discomfort means when emotions and reactions are accepted, it leads to a natural level of physical and emotional discomfort. So when you have an urge accepting, yeah, this is unpleasant, I really want to use right now, or when you're depressed accepting, you know, I feel really depressed right now and I really don't like feeling this way, but acknowledging it and saying it is how it is. And I know the tools I have, the tools that I've developed to figure out how to more effectively deal with this in a way that's going to help me move toward the life I want and be the person I want. Dirty discomfort, like we talked about earlier, is once we start struggling with that emotion, instead of accepting it and saying, okay, what can I do to best address this situation? If we start struggling with it and telling ourselves we shouldn't feel this way and getting angry that we're having this urge again or whatever it is, our discomfort increases rapidly. Hayes refers to it as a struggle switch. And it's turned on and it's like an amplifier. This is when we start having anger about our urges, anger about our anxiety, anxiety about our anger. You know, it just kind of starts getting all googled up. All of this leads to increased HPA axis activation. The more distressed we feel, the more hopeless we feel, the more helpless we, we feel, the more that HPA axis is hyper activated. So what does act say to do? Well, once the control agenda is undermined, that was the step one, helping people recognize that they can't control their pain. You know, they can control how they react to their pain. They may not be able to control it. They can't control their anger. They can't prevent from ever having it. They can control how they act and react when, when they feel angry. It's a difference. It's a semantic difference, but it is a difference. Then we start having them develop diffusion, acceptance, contact with the present moment and committed action. So defusion or unfusing from your thoughts, and I know that's not a word either means learning to perceive thoughts, memories, experiences, et cetera, as bits of language. We take language, we create a memory with it, and then when we, we recall it, we use those words. We know that memories are almost never a hundred percent accurate. And we know that memories generally evolve a little bit over time. As we tell it, we may tell it differently, we may use new language and that morphs that memory. That's one of the reasons why, you know, when people tell those, quote, fish stories, the fish starts out as being, you know, yay big. And, and after they've told it for five or 10 years, all of a sudden, the fish was big enough to bring down the boat. Um, but we help people recognize that our memories are our language. They are not necessarily, and they are generally not threatening. Event all events or objective, all encompass all encompassing truths. We recognize that our memories can be kind of faulty. And while that event, when it happened, may have been threatening in this context, in the present day, we don't know necessarily that this situation is going to be threatening. We don't want to assume because the context is different. Cognitive defusion means stepping back and recognizing that thoughts are just transient, private events. Think of a negative self judgment that takes the form I am X, such as I am stupid. Think about it, believe it as much as you can, and notice how it affects you. Now insert the phrase I'm having the thought that I am stupid. Instead of saying I am stupid, notice what happens. And for a lot of people, just inserting that phrase in front of the global statement makes it so much more manageable. Instead of saying I, the thought that I have to have a cigarette or I have to have a drink, saying I am having the thought or I'm having the urge to have a drink. An urge comes and goes. A thought comes and goes. Those things we can deal with. We know we can change our thoughts. And hopefully in addiction, people learn that they can deal with or cope with their urges, survive their urges. So when we separate it, when it becomes less global, internal and stable, it's a whole lot easier to deal with. Diffusion techniques I am having the thought that we just talked about, that one. You can envision the thought as a cloud, a speeding train or a wave. You know, if you've ever watched clouds, you know, you make the little cloud animals and then they gradually morph and disappear and change into something else. Well, that's what our thoughts can do. So imagine staring up at the big fluffy clouds and each thought is a cloud and they eventually they dissipate. Telling yourself thoughts are not causes. It's possible to think something and do something else. It's possible to have a craving, to think that I have to have a drink and abstain. It's possible to think that giving a speech in front of people is terrifying and still go out there and give the speech. Another technique is to really just treat the thoughts as bullies. And when you start having those thoughts, that dirty discomfort, talking back to them and saying, you know what? Who's in charge here? I'm not going to waste my energy fighting against the barrage of negativity. Tell your brain, all right, you're you're right. Now what? So you're notice that you're feeling scared. You say, all right, you're right. Going out and talking to a hundred people is kind of scary. Now what? What do I do? How do I use my energy in a way to keep moving toward being the person I want to be? And the last suggestion is exploring the facts for and against that thought. Once you have it out there as a thought, you know, I'm having the thought that I have to have a drink. What are the facts for and against that thought? Thought that you have to have a drink. Acceptance means making room for unpleasant feelings, sensations, urges, and other private experiences without struggling with them, running from them, or giving them undue attention. Tis what it is. My kids hate it when I say that, but they say it now too unhooking. So that those thoughts and feelings don't always lead to unhelpful actions or behaviors. So when we have those feelings, it's important to encourage people to stop, actively unhook from those feelings, unhook from that speeding train, you know, let those cars go off on their own and say, you know what? I'm having the thought that this is unbearable. Explore the effects of avoidance and fighting with emotions and behaviors. You know you're going to do that partly in that undermining the control issue. Define the problem as struggling against distress or pain or cravings and creating barriers using energy that could be more effectively used to head in the direction of their goals. If you are anxious about something, maybe you are terrified about the test results that you're going to get back after your physical or whatever does sitting around stewing in that, sitting in that anger, stewing in it is that using your energy in a way that helps you nurture the things that are important in your rich and meaningful life. The answer is probably no. So what else could you do with that energy that would be more productive since you can't get the results any faster, what else could you do with your energy in that period of time? And really just helping people look at how they're using their energy and whether it's in a purposeful fashion or whether they're basically stuck in the mud and spinning their wheels? Hardiness and the Serenity Prayer we say the Serenity Prayer in, in recovery a lot. Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. And an acceptance with act. It's encouraging people to recognize that, you know, like we started out by Saying sometimes life just is not as pleasant as you would like it to be. Sometimes some aspects of your life may suck. You know, let's just, let's put it all out there. However, it's rare. Not saying it always happens or never happens, but it's rare that your whole life, everything in it totally sucks. You know, generally you want to start changing that language instead of saying life sucks, saying, this part of my life is unpleasant right now. Contact with the present moment means bringing full awareness to your here and now experience with openness, interest and receptive. And receptiveness. Focusing on and engaging fully in whatever you're doing, noticing how, how you feel, what you're thinking, what physical sensations you're experiencing, describing the environment, the smell, temperatures, colors, objects, etc, or you can just do a shortcut. I see, hear or smell X. It reminds me of, you know, I, when I smell lemons, it reminds me of the, the cleaner that my grandmother used, used to use. And it brings a smile to my face. You know, that's contact with the present moment. You know, I'm in my house and my grandmother passed away many, many years ago. But being present and noticing, you know, all of a sudden I'm having this happy feeling, where's it coming from? Ah, I know, I know what's going on. But that helps people start being more cognizant. Instead of working on autopilot, the observing self accesses a continuity of consciousness that's unchanging, ever present and impervious to harm. It's that fly on the wall that you can't ever seem to catch. From this perspective, it's possible to experience directly that you are not your thoughts, feelings, memories, urges, senses, images, roles, or physical body. All of these things can change constantly and are on the peripheral aspects of the essence of you. So being that fly on the wall and just kind of seeing Donnelly's teaching, seeing Patricia watching the the class today, you know, that observing fly on the wall is seeing what's going on. Kind of like watching a television show and, you know, moving its little feet, going, I wonder what we could do here. The fly doesn't get tangled up in emotions about the situation. The fly is much more objective, if you will encourage people to clarify their values, what's most important deep in their heart, what sort of person they want to be, what's significant and meaningful to them and what they want to stand for in this life. Now, I used to do an activity. It was the epitaph activity. You know, what do you want? If people could only put Three words or four words on your epitaph, what four words would you want? But I always found that morbid. So now I just say, if you want people to describe you in four words, what four words do you want people to use to describe you? It's a little less morbid. A lack of values or a confusion of goals with values can underlie the inability to be psychologically flexible. So, for example, I may want to be liked by everybody, but that's a goal, that's not a value. My value is being friendly or being compassionate, being the best version of me that I can be. And I've got some amount of agency over being the type of person, best person I can be. Goals are what I want to achieve with that or what I want other people to do. The next step in the act process is choosing a direction and establishing willingness. Willingness. You know, where do you want to go? You come in, you came in for your appointment today. You are experiencing clinical depression. You are struggling with addictive behaviors. And I always try to. Instead of saying you are depressed or you are an addict, which is the language we're getting, getting away from, I say you are experiencing clinical depression. You are struggling with addictive behavior. So we're again diffusing from that some. Where do you want to go from here? What does recovery look like to you? What does a rich and meaningful look like life look like to you? And that's when we start defining what our end point is. Once we have the beginning and the end, then we can figure out how to get there and what the steps are, just like you do, you know, when you try to map out something on Google Maps, you put in your beginning point and your destination, and Google will figure out how to get you there. And you can drag the little, you know, the little blue line up and down to maybe avoid highways or something. Same thing with the recovery process. You know, we have a general idea now let's figure out exactly the best way for you to get from point A to point B. Then we need to establish a willingness to regain control of their life, not necessarily just to control thoughts and feelings. And this goes back to, you know, when we talk about the 12 steps. Admitting powerlessness over the addictive behaviors or the substance and not trying to control everything. Some things in recovery have to be turned over to people's higher power, however they define that. Committed action means setting goals guided by those values and taking effective action to achieve them. Pretty simple there. So there is a philosophy or an approach, I guess, called the act matrix. And it can get a little bit complicated for people. I generally simplify it. Where on the top of the line are behaviors, they're things that you can do. On the underneath the main line are the things that you think they're your private experiences. So on the top of the line you are here. Wherever this middle thing is. Then the things that you do to use your energy that move you further away from being the person that you want to be, move you further away from the things that are important to you, like your kids or a promotion or whatever that is. Those things go over here. Sleeping too much, excessively withdrawing from people, drinking, acting aggressively, whatever it is, those behaviors that are unhelpful uses of your energy. Then over on the right side, you are going to have a list of the things that you can do. What things can you do in order to help you achieve your goals? You know, one of my goals for a rich and meaningful life is to be able to hopefully see my grandchildren grow up. And that means I have to be healthy. In order for me to be healthy, it means I need to get enough sleep, eat a healthy diet, you know, fill in the blanks. So all of those things, vulnerability, prevention, positive health behaviors, positive, you know, interacting with others, recreation, nurturing, relationships, all of those things could go over here. Underneath are the thoughts and feelings. So what thoughts do you have in this current situation that might be using energy to move you away from the things that are important, such as struggling, refusing to, to let go of the anger, the resentment, whatever it is, you know, being attached to that, or fear that if you let go of that anger or resentment or guilt, that something bad will happen. You know, those are all great targets for, for therapy to help people feel like they can use their energy instead of staying in that fight or flight place, instead of staying in a position of feeling vulnerable and attacked, what can you think, what can you do, what can you feel that can help you move toward a. Your rich and meaningful life? The goal of act is to create a rich and meaningful life while accepting that unpleasant things, emotional, physical pain inevitably go with it. Being aware and present in the moment helps us notice what's happening and then choose a meaningful course of action. Destructive normality is the psychological process of the normal mind that is often destructive and creates suffering. It uses language in these global, internal, stable forms that says, you know, this is depressing. Well, this, you could say this feels depressing right now. And that is something that is, you know, right now tells us it's transient. Feels depressing is a perception or, you know, you could say, this is depressing right now. Maybe the whole situation is, is depressing. And some people want to adjust their language accordingly. And that's fine, whatever is meaningful for people. But encouraging them to get to a more specific, instead of global perception of situations. You know, in this context, at this point in time, this is what's going on. So specific, changeable, you know, something that is transient. This may be unpleasant right now. However, you know, I believe that it will change or I can do something to change it. And many times externalizing it instead of saying, this is me, you know, this I am depressed or I am an alcoholic or I am whatever. Saying I have behaviors, I have addictive behaviors that I'm struggling with, I am struggling with. Symptoms of depression can be a semantic step towards freedom. People, we want to encourage them to take actions designed to embrace their experience of the present instead of avoid it. You know, recognize that, okay, it is, I don't like this, but I'm going to do it anyway. And processing through that situation. Therapeutic interventions focus around two main processes. Developing acceptance of those unwanted experiences which are out of personal control. Remembering. We can't control that instant anger reaction that we may feel, that fight or flight when the HPA axis is triggered, but we can control what we do with that feeling once we notice it. We can control our reaction to that physiological involuntary symptom. And encouraging people to figure out ways to be committed towards handling situations and feelings and those sorts of things in ways that are an effective use of their energy that helps them move toward that valued life. When confronting the agenda to eliminate distress, we want to explore the sources of their distress, their prior attempts at removing that distress, and you know, as Dr. Phil would say, how'd that work for you? And then use the six core principles of act. Diffusion, acceptance, mindfulness, objective observation, values identification, and then committed action in order to identify skills and tools and choose ways to use our energy that will help us feel empowered and feel safer and feel propelled towards that rich and meaningful life. Just like dbt, there is a whole lot to act. And Hayes has a lot of books out. He has one that I just started reading called how to Get Unstuck in act. So there are a lot of different ways that ACT can be used. If you are cognitive behavioral therapy oriented, you know, I really encourage you to at least read some of the papers that are included in your classroom that were written about act. You don't necessarily have to buy the books. There are a lot of things in PubMed that were published looking at the effectiveness of ACT and Hayes has written a lot himself that is available online if you want to learn more. But obviously, you know, his books and his videos are also very good and they're available through new Harbinger publications. Ah, great question, Bryant. ACT works really well as a component of substance abuse treatment for most people with substance abuse issues. However, when they've got trauma issues, obviously the core of a lot of trauma issues is a sense of unsafeness. Let's go back here. So they're going to often have a lot of behaviors that they've developed to try to protect themselves. And those behaviors may have developed, you know, in the case of borderline personality, they may have had a trauma and started developing those self protective maladaptive behaviors when they were knee high to a grasshopper. So they may have a litany of away behaviors and, and away thoughts because they feel so perpetually unsafe because they experience emotional disregulation so often. And it's going to be important to educate them about emotional dysregulation and help them one of their symptoms is that dysregulation. So you know, in the middle here, when I feel like I am emotionally dysregulating, when I feel like I'm spiraling, some people call it, what things do I do that are counterproductive and what feelings and thoughts do I have that are counterproductive? So you would address each one of those trauma related or borderline personality related behaviors that the person and thoughts that the person experiences when they start to, to experience distress. And you would work through each one of them that way. The ultimate goal of ACT is to help empower people and help them diffuse from those hopeless, helpless thoughts where people feel like they are always vulnerable while they're always under threat. So it can potentially be helpful. And I think there is an article in the classroom on using ACT with borderline personality disorder. But like everything, no single intervention is probably going to be effective for any person and no single intervention is going to be effective for every person. Uh, so it's important to tailor things based on the person's present situation, their cognitive abilities. You know, if they're in, you know, in detox or an early recovery, they may not be able to process all this right away. If they've got fetal alcohol spectrum issues, they may not be able to process this at all. So it's important to tailor the interventions to the individual in order to help them become more mindful. And basically it comes down to the simple question, simplest question of or statement I am feeling, what can I do to best improve the next moment? You know, if you want to distill everything we've talked about down into two sentences, that's usually what I use. And I encourage people that I work with. That's kind of our shorthand. You know, I am feeling angry. All right. What can I do to improve the next moment? And that can help them stay more mindful, more non judgmental, but also more committed toward forward action. Instead of saying, what can I do to get rid of this anger? Is what can I do to improve the next moment? That was a great, great question, though. Thank you. Alrighty, everybody. Have a absolutely fabulous weekend. I hope wherever you are, it warms up or stays warm. Weather is really freaky around here right now. And I will see you on Tuesday.