What Every Counselor Should Know about Acceptance & Commitment Therapy

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs. Register@Allce.com Counselortoolbox you I'd like to welcome everybody to today's presentation. Act and the what Every Counselor Should Know we're going to review the main points of Acceptance and Commitment Therapy. How to apply the Matrix, which is basically a quadrant system for applying ACT principles so our clients can really envision what they're doing, what they're thinking, and how it's affecting them in terms of moving toward things that are important to them or not. And we'll finish up with identifying the shortcut question. So the main principles of act and if you remember, ACT stands for Acceptance and Commitment Therapy. The goals are to create a rich and meaningful life while accepting that pain inevitably goes with it. So ACT basically says, you know, if you're being realistic, you've got to understand that some, some days are just going to suck and there's sometimes there's nothing we can do about it. Some days you're going to wake up and you're going to be in pain. And that's just the way it is. If you fight with it, you may be kind of fighting a losing battle. So we want to accept the fact that we've got to use our energy in a way that moves us towards our goals instead of struggling with a losing battle, if you will. ACT wants people to learn to perceive difficult thoughts and feelings as harmless, although maybe uncomfortable, transient psychological events. We get depressed. Yeah, there are going to be some days you're depressed and accepting that instead of getting angry about feeling depressed and feeling guilty about feeling depressed, accepting it and figuring out how to improve the next moment is going to be a lot more effective than getting caught up in this wrestling match with depression. Now, for some people that have major depressive disorder or recurrent episodes of major depression, yes, they experience depression more frequently, so it's not as transient. But we want to help them figure out what they can do when they have those episodes, when they are feeling that way in order to improve their life and keep moving forward. ACT also wants people to take effective action, guided by their deepest values, in which they're fully present and engaged. So no autopilot here. We want people to be mindful of what they need, what they want, what's going on, and choose the actions and choose the thoughts that help move them towards those things that are important to them instead of, you know, maybe getting distracted by different things. So Clean discomfort is when emotions and reactions are accepted and it leads to a natural level of physical and or emotional discomfort. Clean discomfort is saying basically what we talk about in some other theories as radical acceptance. Just saying, I get it, I understand that this is unpleasant. I really don't like it. But I'm going to accept that it is. And instead of struggling with it, I'm going to try to figure out how to improve the next moment. Dirty discomfort. Once you start struggling with it, your struggle switch is turned on and discomfort increases rapidly. And it's kind of like an emotional amplifier. Once you switch it on, then you can have anger about. If you switch it on for anxiety, you can get angry that you're anxious all the time. And then you can get anxious about your anger. You can feel guilty that you are having these unpleasant emotional feelings that are distracting you from your family. I mean, it can get really complex with a whole lot of unpleasant emotions as soon as you start trying to fight with it or eliminate the feeling that you're feeling instead of either understanding where it's coming from and then making a choice about how to deal with that. The more time and energy spent trying to avoid or get rid of unwanted feelings in general, the more likely we're likely to suffer in quicksand. So like I said, sometimes you may be dealing with somebody who has anxiety issues, Generalized anxiety disorder. Well, if they start being afraid that things won't ever get better, then they're going to have anxiety about the stuff that they had anxiety about. Then they're going to have anxiety about their anxiety. Then they may get frustrated and feel hopeless and helpless because their anxiety isn't improving. You see how it kind of layers on itself. And you can see this woman in the picture kind of sinking into her own dysphoric emotions. So we want people to understand that you're going to feel bad sometimes. And if you own that and hold onto that feeling, then it's going to be harder to get out of the quicksand. We want them to understand that feelings prompt us to do something. They're not necessarily something that we have to make go away. We need to understand where they come from and then choose from there, what we're going to do about it. Another thing to make sure that we understand is that emotions are a natural way. Your body prompts you to act when you're scared, when you're angry, Those are your fight or flight. Your body's perceiving a threat. So, okay, I feel this way, understanding, accepting, identifying how I feel and Then figuring out, why do I feel this way? And choosing the next best course of action, that's going to move me towards my goals. Another point is that we want to look at the changeable variables in the context in which the issue occurs. Because, you know, somebody can talk about their depression. Alright, well, this depression may occur in multiple different scenarios in multiple different contexts. So let's look at each context and see maybe what's similar across all the contexts. Or let's look at one context and say, okay, what can we do when you're at home to help you feel less depressed? What can we do in this particular context? Because just kind of throwing suggestions at someone isn't necessarily going to help. We need to understand all of the variables, all of the stimuli that are going into creating this feeling for the person. We want to look at physical vulnerabilities in this context. Are you getting enough sleep? Are you eating well enough? Are you in pain? When I work with women who have postpartum depression, this is one of the things I look at in the context of being a new mother, where you're not sleeping through the night and you're probably not eating the healthiest diet. Some people are really good about it, some people, they're just too tired to really pay attention to what they're eating. So we look at physical vulnerabilities, we look at relationships, and we'll just stay with the postpartum mother at this point. So in these new relationships, talking about boundaries and communication in this context, as a new mother, that family is learning how to balance having this new little person in the family. So there's an adjustment of boundaries and the ability to communicate effectively about what new mom needs in order to get enough sleep or whatever is going to be important in helping her address the postpartum depression thoughts that are occurring in this context of being a new mother. When you're feeling depressed, when you're feeling anxious, when you're exhausted, when you feel like you aren't bonding with your child as much as you should be, and you have guilt about feeling like you're not bonding with your child as much as you should be, all these thoughts can start creating that emotional quicksand. So we want to look at, in this context, what are your thoughts that are maintaining this depression and what can we do to help you deal with them. And then we want to look at what behaviors are you using in this context that may be helping you or holding you back. So figuring out what the context is that we're looking at. Sometimes I Don't know whether I want to say a lot of time, but sometimes when people come to our office and they're experiencing depression or anxiety, sometimes it is situational. So we want to look at what recently happened. What's the context? Maybe it was a new marriage and a blended family or a death or a job change. Anything that's a major stressor can trigger, you know, all kinds of feelings in people. So we want to look at the context that may have started to precipitate that. So six core principles. Values, awareness, contact with the present moment, observing the self acceptance, diffusion, and committed action. And we're going to go into each one of those. So a lack of clarity about values can underlie much of people's distress or keep them stuck. You know, think about going on a road trip without figuring out what your destination is. You just get in the car and go, hey, let's drive. Well, then when you're driving along the interstate, how do you know what exit to get off on? How do you know what's going to take you to somewhere that you want to go? Well, you've got to know where you want to go. Maybe you want to go to all the museums between here and Connecticut. Okay, so you can plot those out, but that is, those are small goals. Those are things we can identify, but you have to know kind of where you're going, otherwise you're just going to kind of be driving aimlessly. So one of the things the act says is figure out what's important to you. Figure out what your destination is, and then you can figure out when something happens. Is this a battle worth fighting? Is it worth my energy in terms of do I need to address it in order to keep moving towards my destination? Because some things come up and they're just not that important. Some things come up and you say, yeah, this is something I need to deal with order to keep moving forward. Once you identify what it is, then you can identify how you want to deal with it in a way that'll help you maximize your energy and keep moving toward the things that are important to you. If you don't know what's important to you, you can get caught up spinning your wheels, trying to fight against something, or use the same energy to work towards something. So if you get angry, you know, maybe you get a demotion at work and you get angry about that. Well, you can get angry and you can throw a temper tantrum and you can complain to HR and you can complain this place and complain the other, or you can get Angry. And you can look and say, all right, this is the way it is right now. What can I do to move toward my goals of getting back on track and getting, getting the promotions and being successful in my occupation? What do I need to do? Is using all this energy to complain to HR and complain to all my co workers a good use of my energy? And generally I would say no in that particular situation. A lot of times that's just going to be energy thrown up into the atmosphere. It's not necessarily going to work against you, but. But it may. It probably won't help you move toward those positive goals. So one of the things you want to ask yourself or have your clients ask themselves is what is the most effective use of your limited energy and time to help you achieve your goals? So before you act on something, go, is this worth my energy clarifying? So now we know why we need to identify our goals and values. Well, what are our goals and values? Who is most important to you? Which people in your life are most important to you? And what do you want those relationships to be like? I mean, I can say I want my kids, my kids are really important to me. That's great. But if I don't know what I want that relationship to look like, then I'm not exactly going to know how to use my energy to create that environment. So I want to be able to express and describe where I'm going. Just kind of like when you use guided imagery and you have people describe specifically where they're going with all their senses and really get into that moment. I want to know what this destination looks like. When I use this with my clients, I'll have them write on a piece of paper descriptions of the relationship, the person that they want a relationship with, what they want that relationship to look like, and what they're going to have to do to get that relationship. Such as, you know, calling the person once a week, or, you know, spending time with them once a week or whatever the case may be. But what do you want that to look like? Do you want daily contact, once a month contact, an occasional letter? What's important to you? And then we move on to what things, events and experiences are meaningful. And this is kind of lumps in work, health and personal growth. What things are important to you when it comes to work? Some people, their work is a job. They do it for a paycheck. It's a means to an end. So they want to keep their job. But advancement or, you know, really getting ahead in that occupation isn't necessarily super high on their list. So in terms of work, keeping their job, keeping in their boss's good graces, that's probably going to be the extent of it. For other people, success and promotion and all that kind of stuff is really important. So that will go over in the goals column of what destination you've got in mind and how do you want to use your energy. People who have the goal of promotion and maybe getting up to C level executive, they're going to want to spend more of their time and they're going to want to set more goals using their energy to get to that point. In terms of health, some people are fitness freaks, some people are nutrition freaks, some people, they just don't want to get sick. Whatever it is for your clients, how much energy do you want to use in this area? What goals are important to you in terms of your health? And then personal growth kind of encompasses everything else. Your hobbies, your bucket list, what things do you want to spend time doing? How do you want to spend your free. The next step is to have people identify their values. And values are kind of a muddily concept, if you will, for a lot of people. Because it's like, well, what does that mean? And I tell my clients, when we do this activity, think about the three descriptive words, or maybe five, that you would want on your headstone if you passed away. You know, what five things or characteristics do you want to be remembered by, or which five are important to you. You'll figure out how to phrase it in a way that works for you. And a lot of times they go through and you know, they'll look at this and they're like, well, I want all of these. Well, we all do. Which five are most important? And we'll talk about which ones are most important and how to, how to choose that. Sometimes I say go through and mark every one of the descriptions, every one of the value words on there that's important to you. Then I tell them, go back through and cut it down to the top 10. So they've got to go through and in their mind whittle it down and then cut it down to the top five. Why five? I usually stop at three or five just because if you have too many, it's kind of like having 10 or 15 goals in your life. You're probably not going to do any one of them really, really well. So let's narrow it down to something that's more doable and then you can always add more later. So we're going to Start putting this into the matrix now. And I know there's not four quadrants yet, but we start out where you've got noticing and choosing. So something happens and the client has to stop and think and notice what's going on. Make kind of fill out this chart, and then choose the actions and thoughts that are going to help move them toward their goals and values. A lot of times I'll have them put five or six words over here under goals and values that kind of summarize their goals and values. But in a notebook, they have thoroughly described each one of their goals and values that they're talking about. There's not enough room to put that over here. So once you're clear on your goals and your values and where you want to go, what your destination is, you've painted this picture. It's pretty thorough. Now it's time to figure out what's going on in the moment. You know, I said notice and observe. And a lot of times we'll find that our clients are not good at this. They something happens, they get an urgent to engage in a behavior, they do the behavior, and they kind of get stuck in a cycle without thinking about what are the thoughts and emotions that are prompting this behavior. Going back to Cognitive Behavioral 101, the ABCs, the activating event, then you have the consequences. And those automatic beliefs, a lot of times people don't even pay attention to. So the matrix is also encouraging people to stop, notice what's going on, identify those automatic beliefs and feelings, and then choose how do you really want to respond to this now? So the fly on the wall is one way of thinking about the observing self. It's detaching some another way of looking at it. As a scientist, one way I like looking at it is like the nurse doing the bed check. If you've ever been in the hospital, the nurse comes in, she's like, how are you feeling? What's your appetite? She's not emotionally involved in any of this. She's taking down all your symptoms, taking down all your stuff, and then it goes into the chart. But there's no judgment on her part or his part. So once you've taken that nonjudgmental stance and you're like, okay, I'm just going to look at this with curiosity. Then you want to get in contact with the present moment, bringing forward awareness to your here and now experience. So you want to ask, how am I feeling? What are my thoughts, wants, and urges? You know, that can be pretty big. But if people are practicing this regularly, it gets easier. And if they're practicing this when they're in the heat of the moment of a dysphoric emotion, it's much more focused. What are my thoughts, wants and urges right now? What physical sensations am I experiencing? This helps them identify anger, anxiety, stress, guilt, anything that they're feeling, and then describe the environment. One of the reasons that we have them do this in getting in contact with the present moment, is partly to help them get through that initial rush of fight or flight. Let the adrenaline go away so they can get into their wise mind, if you will, make more conscious decisions about what they need and what they want. So describing the environment is an aspect of mindfulness that helps people get a little bit more grounded. We go through all that. We identify what our thoughts, wants and urges are. Now it's time for radical acceptance, making room for unpleasant feelings, sensations and urges, allowing them to come and go without running from them or giving them undue attention. So if I notice that I'm angry, I'm just going to write it on the chart. I'm angry. If I notice that I'm sad, I'm going to write it on the chart. It's not something that I am going to spend a lot of time going, oh, I can't believe I'm getting angry over this. Again, radical acceptance. I am angry right now. I'm not going to fight that. I'm going to see what I can do to improve the next moment. And some people envision unpleasant emotions or thoughts as clouds in the sky going by. You just see the cloud and you let it go by. I always think of Yoda and he's like, talk to the hand. You must not giving unpleasant feelings or thoughts undue attention. Just saying it is right there. But I am not going to pay a lot of attention to it. I'm just going to let it go. We've identified how we feel. We've radically accepted it. Just it is what it is. Cognitive diffusion means stepping back and recognizing that thoughts are just temporary, automatic events. We don't have to act on them. So unhooking helps us look at thoughts. Even if we're angry and we think we want it, or we feel we want to put our fist through the wall or something, we don't have to. We can have that thought without having to act on it. Which, again, is a problem that a lot of our clients experience is having the thought that or the feeling or the urge to do something leads to the urge with no pause in between. Where they go Is this really what I want to do right now? So cognitive diffusion. When people start feeling that way, a lot of people identify. You know, I want to put my fist through the wall or I want to scream or I want to eat half a pint of Haagen Dazs or whatever. It is a simple exercise. Think of the behavior, whatever it is that you want to do. I need to. We'll stay with Haagen Dazs for right now. I need to eat a half a pint of ice cream or I need to have a drink. Think about it. I mean, I've worked with, talked to, socialized with a lot of people that are like, oh, it was the worst day, I need a drink. So think about that. Believe it as much as you can and notice how it affects you. And that really kind of propose propels you to needing it. The other way to do it is to stop when you hear yourself saying that and insert the phrase I'm having the thought that in front of I need to. So I'm having the thought that I need to have a drink. How is having a thought different than having a need? Well, generally we feel more in control of our thoughts. Generally we can say, all right, I'm having the thought that this is going. Let me replace it with another thought. Another way to look at it or way to help clients experience it is use a self judgment statement such as I'm stupid. Think about it, believe it as much as you can, and you know, this is a hard one. Have them choose their own self judgments. I don't want to send anybody down a bad road, but notice how it affects you when you think to yourself, I'm stupid, I'm ugly, I'm whatever. A lot of our clients use those phrases, I am something negative. Have them practice inserting the phrase I'm having the thought that I am stupid, whatever, and encourage them to practice that because that separates them from being whatever it is to having a thought about being whatever it is and it's easier. Or people often find it easier to deal with it when they perceive it in terms of thoughts. Other unhooking techniques. If they don't want to do that one, okay, that's fine. Thoughts are not causes. So is it possible to think that thought that I need to have a drink and do something different? Is it possible to think I need to have a drink and instead go to the gym? Yeah, it's possible. Ask themselves, who's in charge here? Treat thoughts, especially the unhelpful, unpleasant ones, as bullies. They're telling you you need to do this, which is, you know, in the back of their mind they know it's self destructive or getting them away from their goals. Treat them as bullies. The other unhooking technique is to say, you know what brain, you're right. This really the situation really stinks. Okay, now what if you quit arguing with it and just accept that it is what it is now what you're moving forward. That's where you want to go. And the final step is committed action. Committing to mindfulness to identify diversions. Anything that is making you or causing you to use your energy in ways that move you away from, or at least don't move you toward your goals. Being willing to accept what is that? Radical acceptance. So people are committing to at least trying to accept it is what it is. They're committing to actively unhooking to examine the situation objectively. So these are all commitments they need to make before they can really implement this practice. I'll be mindful. I will try to accept and use my distress tolerance skills. I will try to examine the situation objectively so I can commit to behaviors that are going to move me toward my goals and values. That sounds reasonable. And it also helps people choose to let go of thoughts, feelings and behaviors that divert them from their goals. So we want to help them see how being aware they can see what their options are and they can actively choose. It empowers them to to make choices that will move them towards their goals. So back to our happy matrix. Your goals and values are over here, and I just put some over here to give you an idea. And when I do it with my clients, we start out really general, not talking about any specific instance. I say when you notice that you're having a bad day, when you notice that you're depressed or you're anxious, we're not talking about anything in particular. What behaviors can you do that will help you move toward your goals and values? And a lot of times we talk about things and I incorporate DBT skills. We talk about vulnerability prevention, getting enough sleep, eating well enough, getting some recreation and relaxation. We talk about the acronyms improve and accepts, which are also DBT acronyms for distress tolerance skills. Sometimes we'll go into the ABCs of cognitive behavioral therapy or the challenging questions activities and just plain old setting goals. If they have goals, like if they want to be successful in their job and they have goals up here that will help them move toward being successful in their job, then when they're having a bad day, they can say, all right, I can either struggle with this emotion and fight against it, or I can use this energy to work toward one of my goals that will help me be more successful. In DBT terms, we might talk in terms of that being activities or focusing on one thing in the moment. So instead of focusing on their depression, they're focusing on doing something active and positive that's going to going to move them toward their goals. So they've got their goals and values already. We talk about all these options and I give them a cheat sheet and I ask them to fill out an explanation for each one of these. And obviously they do this on their own time, at home and not in group, because it could take so much time. Imagery. What place, what thing can you imagine that will help you feel better? Maybe you can imagine what it'll be like when your depression is alleviated. Maybe you can imagine what it'll be like when you get that promotion. Maybe you can imagine the island in the Pacific that you want to go visit this summer, Whatever it is, that's imagery that's positive, that can help people get out of their emotional dysphoria, even for a moment, take a little mental break, if you will. Imagery can also be helpful in helping people with anxiety. If they imagine doing something that's anxiety provoking and doing it well, because theoretically they're coming to us because they want to deal with their anxiety, they want to get rid of it. So if we help them develop imagery scripts in which they're actually successfully accomplishing a task or doing a feared activity, it can help them move toward that goal, alleviating their anxiety, finding meaning in things. And I put a lot of these on behaviors because it's something a person has to do when they notice they're upset, they have to choose to start thinking about these things, and they have to choose a behavior, a distress tolerance activity that will help them deal with their unpleasant emotion. Prayer, relaxation, one thing at a time. Taking a mental vacation, getting encouragement, doing activities that help them feel happy, or move them towards things that are important. Sometimes we can't change whatever's making you upset. This weekend, one of my foster kittens on Saturday became violently ill, and I wasn't sure she was going to make it through the weekend. I was stressed, but all I could do was give her the care that I knew how to give her, work with my foster coordinator and make sure she got the best care possible. But other than that, I couldn't magically fix it. So in between times when she was Sleeping, I had to do something else. I engaged in other activities to help myself stay busy. That also helped me work towards other goals, like having a clean house. So I wouldn't dwell on, oh my gosh, what's going to happen to itty bitty Kitty? So activities can be really helpful. They can be a distraction, but they can also help people move toward other goals that are important to them. Contributing is volunteering comparisons. I don't use comparisons very much because I just personally don't like them. The theory is if you compare yourself to other people who are doing less well, you will feel better about your particular situation. Do things that elicit the opposite emotion. If you're feeling dysphoric, do something that's going to help you feel happy. Watch a funny movie. Go out and do something that makes you happy. Push away the thought. Just, you know, tell it to talk to the hand. I'm not going to think about this right now. Which, that's great. But a lot of times you've got to pair that with something else. Focus on positive thoughts. And you can also focus on sensations. Get a massage. Take a. What's the word I'm looking for? Hot tub. Go to the gym and get in the hot tub for me. I put on my music and I put it on really loud and I go run as hard as I possibly can. So between not being able to breathe and not being. And kind of being in my own little musical zone, a lot of times that will jar me out of that negativity, at least for a little while. And we also want to have our clients focus on vulnerability prevention. They're not going to keep moving towards their goals and objectives if they're not taking good care of themselves. So looking at sleep, nutrition, recreation, physical health, interpersonal effectiveness skills and time management, not getting overwhelmed, those are all things that are going to be more or less applicable to each client. So I want to know, what are you going to do to make sure you're getting good sleep? What are you going to do to make sure you're getting decent nutrition and yadda, so forth and so on? I have them, like I said, fill out a workbook or journal. And for every one of these things, it's an I can do this by. And they describe what they're gonna do or describe what the imaginary scene looks like. So they have it on hand when they're in crisis. Is not the time to go, okay, you're having a bad day, let's try some imagery. Where do you want to go? Or what do you want to think about? They're just like I want to feel better. We want them to focus and identify the happy things early and have this in their toolbox so they can refer to it. So back to the matrix. Now there are four things. Your goals and values are over here. This is your destination. So some things that you can do to help you help you work towards your goals and values. Getting my work done helps me be successful. Spending time with my family helps me feel like I'm being a good mother. And again, I've already defined that a lot more on a separate sheet of paper, but these are just kind of my cues. Vulnerability prevention and there's a lot of things there, but I know that I need to pay attention to those mindfulness and using distress tolerance skills. All of those, no matter what kind of thing is causing my bad mood or dysphoric state, all of those things can potentially be used to help me harness that energy and move towards something that's important to me. The next step is to identify thoughts and feelings that move you towards your goals and values. Now I did behaviors first because we so often go from activating event to, to consequences and you know, we don't pay a lot of attention to the thoughts. So if somebody's having a bad day and they choose a behavior, well, the idea is that they're going to feel better if they do whatever behavior that is or if they prevent further distress by using their vulnerability prevention skills. But I want to know what feelings and thoughts are going to help you for a lot of our clients is going to be things like courage, hope, optimism, enthusiasm, patience, compassion with self and others, willingness to let stuff go, willingness to radically accept and self esteem. So many times I find that a lot of our clients struggle with stuff, especially anger and fear related issues because of their fear of being rejected or feeling like a failure. So I want to make sure that they feel good about themselves and we can figure out how to set some goals and things that they can do in order to improve their self esteem. But I want them to feel good in their own skin. Once we know the good stuff, we know what they're going to do, what things they can do to move towards their goals. In general, we know what kinds of thoughts and feelings they want to have and they've identified mantras and wonderful things that will help them feel optimistic and energized and motivated to move towards their goals. Then we want to switch over to the other side and we say when you're having a bad day, something Happens that makes you really angry or anxious. What are the behaviors that move you away from your goals and values? And oftentimes these behaviors are escape or quick fix. Somebody makes them angry, they want to lash out to get their power back. Okay, I can understand that. However, in the big scheme of things, is that a good use of your energy? So we list those behaviors that people and each person is going to be different that they typically use in order to escape, avoid, or regain power. So sleeping too much, avoiding life by being a couch potato, you know, just shutting the blinds and doing a Netflix marathon for two solid weeks, self soothing with food, drinking, lashing out or being impatient or irritable. So getting angry in response and sometimes self handicapping, doing things so they don't have to worry if they fail. They can point to, well, if I would have gotten a good night's sleep, I would have been able to do that. There are a lot of other things and you want your clients to fill this out. But what behaviors do you do oftentimes when you're not feeling happy, what behaviors do you tend to want to do that you think are going to make yourself feel better? You know what, they may make you feel better in the short term. No doubt about it. However, in the long term, did it help you move towards your goals? Sometimes it won't make you go backwards, but many times it's not going to move you toward your goals. And the final quadrant are thoughts and feelings that move you away from your goals and values. And these are often described as distress, intolerant thoughts and unpleasant feelings. You know, anger is probably not going to propel me towards my goal. Optimism, may, a feeling of empowerment may. But I want to identify what kinds of things do I tell myself when I have unpleasant thoughts or unpleasant feelings? And I normalize for clients that anger, anxiety, guilt, all of those are perfectly normal natural emotions. Emotions are not bad. Emotions are designed to prompt you to do something. What you choose to do in response to the emotion is what can be unhelpful to you. So identifying what triggers your anger, then you can start dealing with it so you don't have to feel like you need to escape it right away. You don't have to feel like you can't tolerate it. Some thoughts people may have, I can't do this. People just suck. I'm helpless to change anything. What's the point? Rule breakers always win. No good deed goes unpunished. This is one you can do in group if you want to, to talk about distress, intolerant thoughts. Because Those are the ones that generally say, I can't feel this way, I can't tolerate it. I'm never going to get out of it. I'm drowning in the quicksand. When you feel this way, when you feel like you're drowning, you want it to go away. If you feel like you cannot stand it any longer or you're going to go crazy, you want to make it go away. So a lot of times the initial reaction is to go to one of these quick fixes because, yeah, it does help it go away in the short term. But then when you, you know, when the Netflix marathon is over or you sober up, or you get up and go to work the next day and have to face people, that problem may still be there. So it's important to understand that they can get stuck in a loop here where they escape for a little while. The escape wears off, they feel like they're stuck, they feel like it's intolerable, so they escape again. And we just get stuck over here using a bunch of energy in a never ending loop. So putting it all together, people notice when they're having a dysphoric moment. And I use dysphoric because it can be any of those unpleasant emotions. All right, that's fine. So then they can start charting out what behaviors can I do that's going to move, that are going to move me toward my goals? What thoughts and feelings am I having right now? What do I need? This is that mindfulness we were talking about, what behaviors do I want to do? And they're kind of jotting this down on the little worksheets so they can get it out there so they can see it. Another nice thing about having them do this is it makes them take some time to think about what's going on. It also allows that adrenaline to go away so they can start looking at it more like a scientist, more like somebody who's not emotionally involved in it, and it becomes data points. Data points are easier to deal with than something that feels like it's making you suffocate. So putting it together, it's important to remember and remind our clients that unhooking is the key. We need to help them figure out how when they get upset, they're able to practice the pause or unhook or whatever you want to call it in order to separate from their emotions, get out of that emotional mind into their wise mind so they can make more effective decisions and commit to them. They want to get over here. Our clients want to get over here, this is more like if you've ever seen the movie up, you know, the dog was pouring his heart out to this guy saying, you know, I've never met anybody like you and oh, squirrel. So he was, the dog was moving towards something that was important, saying something that was meaningful, and then all of a sudden he was distracted. Kind of what we got going on in life. So we want to help people be able to ignore the squirrels and continue moving towards the things that are our goals and values. So one example is if somebody does something embarrassing, and I use this example a lot when I do the matrix because I think a lot of people can relate to it. When I was after I came back after my first child, and I don't know why that's really significant, but I was working in a community mental health center and our facilities, we didn't have staff facilities, we used everybody's facilities, but our facilities were up in the front lobby and from the front lobby you would walk down the hall of the residential wing to get to my office. That's fine. So I came back and I was working one day and I went up and I used the facilities and I walked back down the residential hallway where the 85 co educational clients were engaging in daily activities and get to my office. Well, almost to my office. And one of my staff pulls me aside and they're like, Dr. Snipes, you got your dress tucked into your britches. Sure enough, I had my dress tucked into my britches and everybody had gotten a good show. So I was mortified. Did I want to leave work, hide in my office and never come out again? Yeah. So when that happened, my first reaction, the first thing I noticed not was how I was feeling or what I was thinking, but crap, I want to run away. I want to get out of this situation. All right, well, that's fine. Stepping back and saying, why do you feel this way? Well, I was embarrassed, felt pretty stupid at that point. Did I have the thought that everybody got a good laugh? Yeah. And they probably did, you know, that's okay. Noticing and choosing. If I had the matrix at that point, I would have said, you know what? All right, yeah, they probably noticed I have some options. What's important to me? Well, my clients were important to me, my job was important to me, and being successful at my job was important to me. So at that point, escaping from the momentary embarrassment was less important than continuing with my day and serving my clients. And once I got back into my office and I started getting into my paperwork and doing What I needed to do, focusing on one thing at a time, I forgot about the other thing. Now, periodically that thought would come up again and I'd push it away. I figured, you know, what, if it comes up, I'm going to laugh about it. You know, that's definitely an option. And that kind of goes with interpersonal effectiveness skills. Sometimes things just happen and you have to accept that they happened and roll with them. Thoughts that I could have in my head, you know, instead of thinking everybody's laughing at me, I need to hide out, you know, what other people do embarrassing things. So having compassion for myself and others, just being like, well, you screwed up. You proved you were human. It could have been worse. Yeah, it could have been. So optimism goes there and a willingness to just accept things as they are. Looking at it as what I call a humbler or a compassion grower. You know, sometimes things just happen that are sort of, in my mind, designed to help you relate to other people. And that was definitely one of them. So when I had all. If you have all these charted out, I can notice and choose what's going to get me towards my goals. Is hiding in my office or leaving work going to do any good? No, they saw what they saw. They gonna remember it tomorrow and the next day. So you're not going to call into work that many days. Is it what I wanted to do? Yes. However, I chose to move over here because I knew running away wasn't going to solve any of the problems. And like I said on the last slide, the next day when I showed back up to work, it would still. That issue would still be there. So I needed to confront it and just deal with it. Ultimately, nobody really said anything, which was another thing that I noticed later was that I noticed or I was far more concerned about it than anybody else was, or at least they didn't say anything to me. So. Dealing with clients who have chronic illness. A lot of our clients have some sort of chronic illness, whether it's pain or lupus or fibromyalgia or migraines, I guess all of those have pain. So what can a client do? And again, this is a general thing, not any particular incident, but if they have chronic depression or chronic something, what can you do to prevent problems as much as possible and deal with problems when they come up? Have good sleep habits. That's going to help prevent it. Eat healthfully, it's probably going to help prevent exacerbation. At least do your therapy exercises. That goes with activities in the Improve and Accepts acronym so therapy activities, you know, they're not always the most fun if you've ever been in physical therapy, but knowing that they will help you achieve your goal of being pain free or not having the chronic illness, there's some motivation to do it. Focus your attention on things you can control. With clients with chronic pain, what is it that you can control today? Some days the pain is going to be worse. And I truly believe that there is a relationship between the weather and certain types of pain. So if you have a client who says, you know, my arthritis is really acting up today, the weather, you know, we've got some sort of a front coming in, all right, you can't control the weather. What can you control? How can you react to that? So encouraging them to focus on those things that are within their control and encouraging them to reach out and get encouragement from other people, get support, and setting small achievable goals, one thing at a time, you are not going to make your pain disappear overnight. What are your smaller achievable goals in terms of whatever your chronic illness is? Maybe it's sleeping through the night, maybe it's going four hours without a particular symptom. Maybe it's another goal altogether that you want to achieve despite the fact that you've got a chronic illness. And that's fine too, because when you're focusing on that, you're focusing less on the fact that your chronic illness is there and or flaring up that day. When you do those things, you want to look at what feelings and thoughts are increasing when you're doing that. If the person wakes up and you know they're having a flare up of whatever the chronic illness is, they may feel helpless, hopeless, depressed. Resentment at people who are healthy, angry at themselves for being weak or lazy. We can be really judgmental of ourselves. Anxiety that they'll lose people and things that are important to them because they're not, quote, normal. Guilt over not being able to do the things they think they should be doing. So many therapeutic issues there. Another thing I ask my clients is when you're having these thoughts, okay, what thoughts can you have? How can you reframe this order to help you feel happier? Have hope, gratitude, determination, empowerment, self compassion, Any of those. One of the things would be, for example, if they've got a chronic illness, they wake up and they're just like, I just can't make any forward movement, I can't make any. That's one of those extreme words. Distress, intolerant thought. So I want them to focus on how much they've actually accomplished and how much they actually do when they're saddled with, when they have to deal with this chronic illness, in addition to everything else they do all the time, I want them to give themselves credit for getting up in the morning and trying because they're doing stuff that everybody else does while also juggling this chronic illness that makes them pretty strong in my book. So I want them to think about how can they reframe things instead of being angry at themselves for being weak or lazy, how can they reframe that in a way that helps them feel determined, empowered, or maybe just self compassionate? If your child, if your best friend was experiencing the same chronic illness, would you think of them as weak or lazy? You know, knowing what the answer to that is before you ask the question to the client obviously is definitely helpful. But encouraging them to reframe some of the negative thoughts, encouraging them to do things preventatively. And then when they do have an episode, a flare up, whatever you want to call it, they have a plan in place for how they can deal with it in order to help them keep moving toward the things that are important. And I keep saying those things that are important because they can have this plan and it can be a great plan. But if they can't see the point, then they're probably not going to be overly motivated to do it. If they have this plan and they can see how it's going to help them move towards their goals and values and the people that are important to them, well, then yeah, they're probably going to have a little bit more get up and go. So the shortcut question, sometimes people are going to be on the fly. Something's going to happen. They're going to start getting a migraine when they're at work and they can't sit down and do the chart, or they've been doing the chart for a while and they're just not going to do it anymore. What's the shortcut? Are my current thoughts, feelings and actions moving me closer to or further away from my goals and values? So if something makes somebody angry, for example, and they want to lash out and they want to get even and they want to complain and they want to fuss, okay, that's how you want to. What you're feeling right now, those are your urges. Are those getting you closer to or further away from the things that are important? Only the individual can answer that. The other even shorter question for the person to ask themselves is this in brackets, whatever this is worth my energy is it worth my energy to get upset about the person who tailgated me all the way to the store? Is it worth my energy to get upset over the line at the grocery store that was 15 people deep and there were only two registers open? No, because getting angry about it isn't going to do anything. It's not going to solve the problem. It's just going to waste my energy, disrupt my neurotransmitters and make me less, have less energy to do the things that are important to me. I encourage clients to keep these two questions on a little index card or on their mobile device if they need those prompts to remind them just to ask themselves, you know, what is this something I really want to do? So the goal of ACT is to create a rich and meaningful life while accepting that pain inevitably goes with it. Therapeutic interventions focus around two main processes. They want to develop acceptance of unwanted private experiences which are out of personal control, which is a fancy way of saying thoughts and feelings. It's not something anybody else can observe. And our emotions, our feelings are generally sort of reactions. So at that moment, you know, you didn't think, well, this happened, so I guess I'm going to get angry. Whatever it was happened and you got angry, alright, so that was out of your control at that moment. What is in your control is the ability to improve the next moment and commit to the actions that will help you live a life that's filled with meaning and value and all that kind of stuff. Every event is an opportunity to choose thoughts and behaviors that will help you use your energy to move toward your goals and values. Anytime something happens, you can stop and think, is this worth my energy? It doesn't even have to be something that upsets you. I know I tend to be very squirrelified and something will come along and it's like the new shiny thing. And I'm like, oh, I want to do that and I want to do that, but I need to stop. From a time management perspective, say, is this, whatever this new shiny thing is going to help me move toward my identified goals and values, or is it just going to distract me? And it could be a good shiny thing, but if it's not something that is going to help me along my path, I need to really consider whether I want to devote energy to it. Acceptance means accepting without judgment how you feel and the situation as it is. Instead of fighting against it, it is what it is. The next moment is an opportunity to improve. Commitment and purposeful action mean that you choose to use your energy on thoughts and behaviors that move closer to your goals. Sound like a broken record there. Having those goals out there, knowing what you want, being able to envision them, helps people stay motivated because it's, you know, kind of like that Christmas present or something that you've been working toward. We want to help them envision what the end point is and be able to regularly check in with that and see it as something exciting and motivating. And if it stops being that, then that's something we want to take a look at clinically. Alrighty. Are there any questions? I would encourage you to spend some time with the little matrix and go through it for yourself, looking at how it applies. There are a lot of YouTube videos from different people on how to apply the act matrix. They all differ a little bit. So, you know, feel free to go on YouTube and look at some other ways that people have used to help people help clients learn to apply the ACT Matrix. I find the ACT Matrix is best to introduce at the midpoint of treatment after we've already gone through some of the basic DBT distress tolerance skills, cognitive behavioral stuff. And that really allows them to be able to more clearly articulate the toward behaviors, the things they can do to help them move toward their goals and deal with those unpleasant emotions in a positive way because we've helped them identify ways that they can start addressing those unhelpful thoughts. Workbooks for people who want more hands on homework. I don't have any workbooks, so to speak. I would really suggest the, like I said the videos on YouTube. There is a book called the Act Matrix. Yep, here it is. See if I can get the ACT Matrix and it's by Kevin Polk, Dr. Kevin Polk. He has some videos on YouTube. This is not a book for clients. I found it a little bit challenging and clinical in many parts to really interpret. So most clients would find it very frustrating. From your standpoint. If you want to learn more about his version of the ACT Matrix and how to apply it, it's a good book. It's not an easy read, but it is a very good read. I will see what I can do to put together some resources for homework if you will and I will post them on allce.com there's a tab now that is for resources. Pull that up. So when y' all ask me about things like this and I don't have quick answers for resources, this is where I will put it under the resources tab so you can go click on the link. And any books I find workbooks or any worksheets that I make will be listed there and it'll probably be a week or so before I get those resources up, but you can certainly come back and check the Resources tab anytime you want. Okay everybody have an absolutely amazing weekend. I know we are about halfway through the summer, so if you've got youngins at home, they're probably starting to get a little bit antsy. But you know, hopefully you'll have a great relaxing weekend with the family or with the critters or whatever you have at home. And I will see you next week. 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