Sambalpur Call Girls 👙 6297143586 👙 Genuine WhatsApp Number for Real Meet
Act for health
1. ACT for Health
Edinburgh
October 2014
Dr Ray Owen
Clinical Psychologist
drrayowen@gmail.com
2. Aims for the day
►Consider how core ACT processes relate to
working with people who have physical health
problems
►Look at specific problems related to Health, and
useful ACT-based techniques
E.g. living with uncertainty, altered sense of self, carer
burden, tolerating physical treatment, healthy behaviour
change
►Reflect on own experience as clinician
►Reflect on own experience as human being
►Feedback suggests more experiences, technique
and clinical reflection, less literature survey
All at contextualscience.org
4. Physical health
►Acute
e.g. cancer with curative intent, recovery from
injury
►Long-term / chronic
e.g. chronic pain, bowel disorders, neurological
disorders, lung problems
►Palliative
e.g. advanced cancer, late-stage MND
►Health Behaviour Change
5. TThhee AACCTT MMooddeell ooff PPssyycchhooppaatthhoollooggyy
Dominance of
Conceptualised
Past & Future
Psychological
inflexibility
Experiential
avoidance
Cognitive Fusion
Attachment to the
conceptualised self
Lack of Values
Clarity,
dominance of
pliance and
avoidant tracking
Inaction,
impulsivity or
avoidant
persistence
6. STUCK
UNFULFILLE
D
Experiential
avoidance:
basing your actions
on avoiding feeling
bad
Fusion: getting
tangled up in
thoughts
Loss of contact with
present moment :
getting caught up in the
past & the future
Inflexible sense of self:
getting stuck in an unhelpful 'story'
about yourself
Loss of contact
with Values: not
recognising what
matters to you in life
Lack of
committed
action: not acting
effectively to live
your life the way
you want to
8. The PPoossiittiivvee PPssyycchhoollooggiiccaall
PPrroocceesssseess AACCTT SSeeeekkss ttoo SSttrreennggtthheenn
Being in the
present moment /
mindfulness
Psychological
Flexibility
Acceptance /
Willingness
Defusion
Self as
Context
Values
Committed
Action
9. MOVING
FORWARD:
MORE
FULFILLED
Acceptance /
willingness to
experience:
allowing whatever
shows up just to be
there.
Defusion: treating
thoughts as
thoughts (not
realities)
Present moment awareness
/ mindfulness: living in the
Here-and-Now
Observing self / flexible
perspective-taking: adopting a
more flexible sense of self
Awareness of
Values: recognising
what matters to you in
life
Committed action:
doing the things that
matter to you, even
when it's difficult
11. STUCK
UNFULFILLE
D
Experiential
avoidance:
basing your actions
on avoiding feeling
bad
Fusion: getting
tangled up in
thoughts
Loss of contact with
present moment :
getting caught up in the
past & the future
Inflexible sense of self:
getting stuck in an unhelpful 'story'
about yourself
Loss of contact
with Values: not
recognising what
matters to you in life
Lack of
committed
action: not acting
effectively to live
your life the way
you want to
12. Fusion and Avoidance
►On the buses
►“Why does my mind hurt me that way?”
►Living with an uncertain future
►Thoughts we should pay attention to
►What kind of feelings are we avoiding?
13. Using the basics
►Another trip on the bus..
►Not just an explanatory metaphor
Ongoing tool
►A landslide blocking the road
14. While we’re on the bus…
► Minds say unhelpful things
► Take a minute..
Notice a passenger
What are they saying
What form they take
Where’s that coming from
What is the function of that passenger speaking up
► Actual
► ‘intended’
► Mind is not usually our enemy
► So why say these things?
► Doing its job(s)
The stay alive machine (can become the EA machine)
The Problem-solving machine (can become the worry-engine)
The Learn From Experience machine (can become the dwell on the past
machine
15. Default assumption
►My mind is not ‘out to get me’
►It’s mostly trying to help by doing one of its jobs
►Most of the time it’s pretty good at that
►Sometimes in trying to be ‘helpful’ (protect you
from harm, from social victimisation, isolation etc
etc) its suggestions end up being unhelpful
►Recognising this makes it easier to use ‘Thanks,
mind’
►Why this helps in Health
16. Uncertainty
►Back to your client
How does uncertainty show up
Potential impact on life
Interaction with core processes
►?especially here-and-now, committed action?
17. Many paths
►More of a raft than a walk
►Originally used with denial-like behaviours
►BBeenneeffiittss
DDeeffuussiioonn ffrroomm tthhoouugghhttss aabboouutt pprrooggnnoossiiss
OObbsseerrvviinngg sseellff
AAcccceeppttaannccee ooff ffeeeelliinnggss tthhaatt aarriissee
AAbbiilliittyy ttoo ffooccuuss oonn VVaalluueess--ddrriivveenn ccoommmmiitttteedd
aaccttiioonn ((nnoott bbeeiinngg ffrroozzeenn iinn ffaaccee ooff uunncceerrttaaiinnttyy))
18. But what about the thoughts we
SHOULD attend to?
►“I’m sure that lump wasn’t here last week..”
►In ACT, we’re interested in the behaviour in context
Behaviour here includes internal behaviour eg thoughts
Need to know context and function
►‘Defuse and move on’ vs ‘pay attention to and act
upon’
nb anyway more able to evaluate and act from defused
position
►Old vs New thoughts
►Risk-related
19. Approaches other than classic
defusion
►Safe review period (if still here by… then I’ll..)
►Checking out with others
►If new, evaluation / challenge
►Looking at impact
►Worry Time
20. Avoiding feeling bad
►Emotions
►Physical sensations – emotion related
►Physical sensations – health related
When distinct, when overlap
When is it safe to accept?
►E.g. aching in fibromyalgia vs crushing chest pain in heart
disease
In a war vs living with the enemy
Narrowing lives in battle with symptom
For highly intrusive symptoms, look at ACT for chronic
pain literature (Vowles, McCracken, Dahl)
21. STUCK
UNFULFILLE
D
Experiential
avoidance:
basing your actions
on avoiding feeling
bad
Fusion: getting
tangled up in
thoughts
Loss of contact with
present moment :
getting caught up in the
past & the future
Inflexible sense of self:
getting stuck in an unhelpful 'story'
about yourself
Loss of contact
with Values: not
recognising what
matters to you in life
Lack of
committed
action: not acting
effectively to live
your life the way
you want to
22. The self
►Over-attachment to the conceptualised self
►Self-as-content, self-as-process, self-as-context
►Flexible perspective-taking
►Development of key relational frames
►What’s your mind telling you right now?
23. How your (conceptualised) Self gets
in the way..
►Stuck in a story
‘still the person I used to be’
►Someone who never gives up
►The strong one
►Carer
‘lost the person I used to be’
►‘shadow of my old self’
►No use any more
►That was the real me
Adjustment
►I’m a burden
24. Versions
► Version 1
► Version 1.1
► ...Version 1.5
► …Version 1.6
► Version 2.0
► …Version 2.1
► Version 2.1.1
► Version 2.1.2
► ..Version 2.2
► ..Version 2.3
► Version 3.0
► Version 4.0
► Version 4.0.4
► Version 4.1
► Version 4.4
► etc
► Alpha
► Beta
► Cupcake
► Donut
► Eclair
►
►
►
► Froyo
► Gingerbread
► Honeycomb
► Ice cream sandwich
►
► Jelly Bean
► KitKat
25. I THEN, I NOW.. For you
► characteristics ► At primary
► Young adult ► Now
school
► Psychological
► Physical
► Social
► A personality trait
► An ambition
► A friendship
► A talent
► ‘positive’ or
‘negative’
26. I THEN, I NOW.. For client
(nb. tailored appropriately for their history)
► Young adult ► Pre-illness ► characteristics ► Now
► Psychological
► Physical
► Social
► A personality trait
► An ambition
► A friendship
► A talent
► ‘positive’ or
‘negative’
27. Old me new me exercise
►Elicits ‘stories’ about self
►Allows us to notice balance of them
►How firmly held?
Can challenge if appropriate (new thought / insight)
►Doing the exercise is act of defusion
►Mourn the past, accept the present
►Are they fixed (e.g. ‘less sociable’)
►Reinforces transitions over time
‘this too will pass’
28. STUCK
UNFULFILLE
D
Experiential
avoidance:
basing your actions
on avoiding feeling
bad
Fusion: getting
tangled up in
thoughts
Loss of contact with
present moment :
getting caught up in the
past & the future
Inflexible sense of self:
getting stuck in an unhelpful 'story'
about yourself
Loss of contact
with Values: not
recognising what
matters to you in life
Lack of
committed
action: not acting
effectively to live
your life the way
you want to
30. Treatment
►Originally from cancer treatments (chemotherapy
& radiotherapy), however..
►‘doing’ not ‘having’
►“Why did you choose to have treatment?”
“no choice”
What hoping to achieve
“not dying” vs “what do with more/better quality life”
Acknowledge cost of having
Price you are willing to pay in order to increase your
chances of … e.g. being close to your children
Fast initial way into Values (often session 1)
Emphasises active role vs victim story
31. CHOICE POINT
AWAY FROM
VALUES
TOWARDS VALUES
HOOKS, e.g.
Urge to avoid
discomfort
Desire for
short-term
gains
Old habits
Hooked by
thoughts
Stuck in a story
etc
HELPERS, e.g.
Awareness of
Values
Skills:
-Present moment
awareness
-Defusion
-Acceptance
-Flexible perspective
taking
Effective goal-setting
etc
Adapted from Ciarrochi, Bailey & Harris 2013
32. Finally..
►The same core processes of ACT apply in living
well with physical health problems as with any
other adversity
►Same interventions can work
►Some tailored/tweaked/specific ones too
►True whether aiming to
Make healthy behaviour change
Cope with an more acute health crisis ‘facing the storm’
or live a fulfilling life despite chronic health problem,
where aim is ‘living with the enemy’