An introduction to Third-wave behavioral therapy Acceptance and commitment therapy

1. Introduction to
Acceptance Commitment therapy -
ACT
Dr.V.Veera Balaji Kumar
Mindful Therapist
drveerabalaji@gmail.com

2. Life is...
Empty Difficult Wonderful Bore
Challenging Joyful Struggle Satisfactory

4. Thinkaboutthe lasttime you
were hurt,overwhelmed,
stressedout,felthelpless...
• What kind of responses
did you get...
• What kind responses
made you feel truly cared
for,
supportive, understood an
d reassuring ...

5. Validating
feelings,
thoughts >>
Understood,
Accepted, &
Cared
Giving you a hug, embrace, or a cuddle
Giving
Patiently - all you have to share
Listening
Validating your pain: “This must be so hard for you” or
“I can’t begin to imagine what you’re going through”
Validating
Just sitting with you and allowing you to be
Saying
nothing
you while you cry or even crying with you
Holding

6. Mental Health - Public perception & Myths
• Blissful state of mind
• Absence of distressing
or unwanted
thoughts, feelings
images or sensations.
• Ridicule or Stigma

7. World Health Organization
(WHO) definition of
Mental Health
Mental health is “a state of
well-being in which the
individual realizes his or her
own abilities, can cope with
the normal stresses of life,
can work productively and
fruitfully, and is able to make
a contribution to his or her
community”

8. FEELING GOOD
VS
LIVING WELL

9. What & Why
Psychotherapy ?
• Psychotherapy is an intervention
• which considers the life of the individual
in a broad manner,
• encompassing the cognitive
and emotional aspects,
• as well as individual, familial, social and
cultural factors of their personal
experiences and personality,
• in order to improve the individual's
functioning and quality of life.
• Grounded in dialogue, it provides a
supportive environment that allows a
person to talk openly with someone who’s
objective, neutral and nonjudgmental.

11. Assumption of
Healthy
Normality
By their nature, humans are
psychologically healthy
Abnormality is a disease or
syndrome driven by unusual
pathological processes
We need to understand these
processes and change them

12. MAJORREASONTO
SUSPECTTHISISFALSE
The ubiquity of human suffering

13. JEYA'S WEDDING
It was the happiest day of her life until she thought about
her dad who committed suicide when she was 16 years old

14. Destructive Normality - Alternative
Assumption
• the complex set of psychological processes of a normal human mind –
• analysing,
• comparing,
• evaluating,
• planning,
• remembering,
• visualizing
• are often destructive and create psychological suffering for us all.
• Mind = Human language
• The root of this suffering is human language itself.
• Human language - highly complex system of symbols, which includes words, images, sounds,
facial expressions and physical gestures.
• Human language is a double-edged sword.

15. Default mode network
• In 2007 neuroscience experiments – fMRI studies - the brain
is constantly active with a high level of EEG activity even
when the person is not engaged in focused mental work.
• Default mode network (DMN), - a large-scale brain
network primarily composed of the medial prefrontal
cortex, posterior cingulate cortex/precuneus and angular
gyrus.
• Active when a person is at wakeful rest, such as
during daydreaming, mind-wandering, thinking about
others, thinking about themselves, remembering the
past, and planning for the future
• Recent research has begun to detect
links between activity in the default
mode network and mental disorders like
depression, anxiety, and
schizophrenia.
• Curiously this DMN is relatively subdued when meditating.

16. Problem and Solution
• Biggest evolutionary advantage of human language
- ability to anticipate and solve problems.
• Enabled us not only to change the face of the
planet, but to travel outside it.
• The essence of problem-solving is this:
• Problem = something we don't want.
• Solution = figure out how to get rid of it, or avoid
it.
• This approach obviously works well in the material
world.
• Get rid of anxiety, fear etc >> experiential avoidance
• More time and energy we spend trying to get rid of
unwanted private experiences = the more
psychologically suffering

17. Unworkable change agenda
This belief engenders the idea that healthy people can control and
eliminate negative private content and thereby become "normal".
Belief: Negative private content is toxic and dangerous, and
must be controlled to attain psychological health

18. EXPERIENTIAL AVOIDANCE

19. Experiential avoidance
• A style of dealing with
unwanted experiences viz.
thoughts, feelings, memories,
sensations and distressing
external events
• involves emotional avoidance,
numbing, behavioural
avoidance and other methods
of experiential control even
when it has significant
personal costs

21. CHEMICAL
DEPENDENCE

22. Experiential
avoidance
Vs
Acceptance
Experiential avoidance is a natural
survival instinct embedded within
us that creates our aversive reaction
to unpleasant or uncomfortable
events.
Practice a new mindful way of
meeting experiences with openness
and acceptance.

23. What is this
ACT ?
• ACT is a behavioral therapy approach
that uses acceptance and mindfulness
processes, and commitment and
behavior change processes, to
produce greater
psychological flexibility - facilitate in
engagement in value- congruent
behaviours.
• ACT facilitates the change in the
individual's relationship to their
internal experiences (i.e. thoughts,
sensations) rather than the experience
itself.

24. Behaviour Therapy
1st wave: Behavioral
2nd wave: Cognitive
3rd wave:
MBCT
DBT
ACT

25. What is
Psychological
flexibility ?
• Psychological flexibility is the ability
to stay in contact with the present
moment -- regardless of unpleasant
thoughts, feelings, and bodily
sensations, as conscious
human without needless defense --
while choosing one's behaviors
based on the situation and personal
values.
• It is NOT a state of happiness or ease
but an ability to flexibly navigate
through changing demands of life,
also when difficult thoughts and
feelings arise

26. ACT Model
client acceptance of distressing experiential content,
Enhancing
cognitive defusion techniques to mitigate the deleterious
effects of cognitions,
Utilizing
client ability to attend to the present moment,
Increasing
a self-as-context perspective within the client,
Enhancing
core values meaningful to the client, and
Identifying
committed, effective action toward reaching those valued
ends.
Supporting
six core
processes
produce
psychological
flexibility:

27. Struggle Switch
m
o
n
s
t
e
r

28. DROP THE
ROPE

31. COGNITIVE FUSION
Inability for direct, undefended contact with unwanted private events
viz.thoughts, feelings, memories, sensations
Makes healthy psychological flexibility difficult or impossible,
Excessive attachment to the literal content of thought

32. We become fused
with our thoughts:
– Thoughts may seem to be the
absolute truth, or
– Commands we must obey, or
– Threats we must eliminate, or
– Something we must give all our
attention to

34. MINDFULNESS MOMENT

35. Present
Moment
Awareness
Psychological
flexibility
Self-as-context

36. BEING IN THE
HERE AND NOW

37. Presence
Here-and-now experience
• Present means: consciously
connecting with and engaging in
whatever is happening in this
moment.
• Humans find it very hard to stay
present, absorbed in the past
or the future
• It is easy to get caught up in our
thoughts and lose touch with
the world around us.
• Most of the time we tend to
operate on automatic pilot,
merely “going through the
motions.”

38. Why be present -
Be Here and Now
• To truly appreciate the
richness and fullness of life,
you have to be here while
it’s happening!
• The power to act exists
only in this moment
• To act effectively

39. Functional Contextualism
Relational Frame
Theory
ACT
House of ACT

40. WHICH IS THE RIGHT VIEW OF THE HOUSE ?

41. ACT Philosophy
=> Functional
contextualism
Functional contextualism views
psychological events as an
interaction between whole
organisms and a context that is
defined both historically (e.g., prior
learning histories) and situationally
(current antecedents and
consequences, verbal rules).

42. THIS IS IN
THE SERVICE
OF...?
What is this
thought,
emotion,
impulse,
behavior in the
service of?
Under what
conditions does
it function that
way?
Is this feeling,
thought,
behaviour
Useful?
How often does
it occur ?

43. Relational frame theory-RFT
• Explains the fundamental human
ability to relate anything to anything
and form a relational network of ideas
and concepts – derived stimulus
relations
• Relational framing exponentially
increases the speed and diversity of
human learning.
• We begin to see the world not AS IT IS,
but as our relational network tells us it
is.
• Arbitrarily applicable
relational responding (AARR) - ability to
symbolize.

44. ARBITRARILY
APPLICABLE
RELATIONAL
RESPONDING
(AARR)

45. A painful
injection
relation frame

46. IMAGINED FUTURES AND ANXIETY

47. Acceptance
and
Commitment
therapy
• ACT is an intervention approach designed to
bring language to heel, so that it can become
a tool to be used when it is useful, rather than
an unseen process that consumes the
humans that host it.
• ACT rather than seeking to change the
content of problematic thinking lets direct
experience be more of a guide when that is
more effective
• Let the environmental contingencies guide
the behaviour

48. ACT
technology
ACT tends to use a relatively non-linear
form of language.
ACT therapists rely heavily on paradox,
metaphors, stories, exercises, behavioral
tasks, and experiential processes.
Direct instruction and logical analysis
has a relatively limited role, although it
does occur.

50. Goal of the
Cognitive
Defusion
process
help the client detect the hidden properties of
language that produce fusion,
to shake the client's confidence in implicitly
trusting the "reality" of private experiences and
to recreate the "space" that exists between
thought and thinker, feeling and feeler.
ultimately help the client use willingness and
acceptance strategies on a more consistent basis
distancing from thoughts and evaluations reduces
their capacity to function as psychological barriers.

51. Cognitive
Defusion
Paradox
• The aim of defusion is NOT to get
rid of unpleasant thoughts, but
rather to see them for what they
are—just words—and to let go of
struggling with them
• If…
• Helpful We Use;
• Unhelpful We Defuse

52. Thought
Discernment
 Does it help me to be the
person I want to be?
 Does it help me to build the
sort of relationships I’d like?
 Does it help me to connect
with what I truly value?
 Does it help me, in the long
term, to create a rich, full,
and meaningful life?

53. Defusion =
Flexible
Responding
We pay attention to the
thought with:
• Curiosity: We see it for what it
is - words and pictures
• Openness: We explore
whether it’s helpful or not
• Flexibility: If it’s helpful, we let
it guide us; if not, we let it be.

54. Defusion
techniques
• I am having the thought that …
• Thank your mind
• Imagine this thought on a computer
screen. Change the font colour size or
type
• What does that thought look like? How
big is it? What does it sound like? Your
voice or someone else’s? Close your
eyes and tell me, where is it located in
space? Is it moving or still? If moving, in
what direction and at what speed?
• The movie story: If all these thoughts and
feelings were put into a book or movie,
titled “the something something story,” Or
what would you call it?

55. Present
Moment
Awareness
Psychological
flexibility
Self-as-context
Acceptance
Cognitive
Defusion

58. Values
(Know What Matters)
• Deep in your heart, what do you
want your life to be about?
• What do you want to do with
your brief time on this planet?
• What truly matters to you in
the big picture?
• What sort of personal qualities
do you want to cultivate?
• How do you want to behave
toward yourself, others, and the
world around you?

59. GLOBE
TROTTING
• living a dream
that most of us
would envy
• Prasanna says,
“We have visited
all 7 continents
including
Antarctica.
Together, we have
been to all 193
Countries.

60. Values
(Know What Matters)
• Purpose gives our life direction,
and presence allows us to make
the most of our journey.
• Values are about how you want to
behave on ongoing basis
• Are your “chosen life directions.”
• Values are like a compass because
they give us direction and guide our
ongoing journey.
• Values are NOT: goals, desires,
needs, ethics, morals, feelings, rules,
beliefs, codes of conduct

61. Value hierarchy
• Each of us has a hierarchy of
values.
• This is our sense of what’s most
through to what’s least
important.
• Do we choose to watch TV or
invest that time in personal
improvement?
• Do we sleep longer or go
jogging?

62. ACT
HEXAGON–
INFLEXIHEX
&
HEXAFLEX

63. Present
Moment
Awareness
Psychological
flexibility
Self-as-context
Clarity &
Connection
to Values
Committed
Action
Acceptance
Cognitive
Defusion
OPEN AWARE ACTION

65. ACT
HEXAFLEX

66. ACT Acronym
Accept unwanted private experiences such as thoughts,
feelings, memories, and sensations as well as external
events that are not amenable to direct control.
Accept
Choose a set of valued life directions that would enlarge
one's sense of vitality, purpose and meaning.
Choose
Build larger and larger patterns of committed action that
are consistent with these valued ends
Take
Action

67. Therapeutic Interventions
1.Developing acceptance of unwanted private experiences which are out
of personal control.
2.Commitment and action toward living a valued life.
Confronting the Control Agenda
• “Did this reduce your symptoms in the long term?
• What did this strategy cost you in terms of time, energy, health, vitality, relationships?
• Did it bring you closer to the life you want?”

68. 2 Questions
we Dance
between
A - What valued
direction does the
client want to move
in?
B - What’s getting
in the way?

69. Where to start in ACT?
• For clients overwhelmed by
thoughts & feelings (extreme fusion,
dissociative states, flashbacks,
emotional dysregulation, panic
attacks etc.): start with grounding
(dropping anchor)
• For major grief/loss: self-
compassion
• For the poorly motivated: values &
defusion from hopelessness
• For clients fixated on feeling good
and avoiding pain: “creative
hopelessness”

70. Establishing
behavioural
goals for
therapy
• Emotional or process goals = how I want
to feel (or not feel)
• Outcome goals = what I want to have or
get (or get rid of)
• Behavioural goals = what I want to do
• ASAP – ideally the first session – establish
behavioural goals
• A simple way: ‘towards moves’ on the ACT
Matrix>

73. CONTACTING THE PRESENT
MOMENT
I, here, now
notice WHAT I see, hear,
touch, taste, smell, think,
feel, do
SELF-AS-PROCESS
I, here, now
notice THAT I see,
hear, touch, taste,
smell, think, feel, do
TRANSCENDENT SELF
or OBSERVING SELF
I, here, now notice THAT I
am continuous,
unchanging, distinct
from, & more than WHAT
I see, hear, touch, taste,
smell, think, feel, do
DEFUSION
I, here, now
notice my thoughts
and see them as
words and pictures
ACCEPTANCE
I, here, now
notice my thoughts
and feelings and allow
them to be as they are
VALUES
I, here, now notice what
is important and
meaningful to me and
put it into words
SELF-AS-
CONTEXT

74. Self-as-Context
Qualities of the Observing-Self
• Can’t be judged as good or bad,
right or wrong, because all it does
is observe.
• Sees things as they are, without
judging, criticizing, or doing any
of the other thinking processes
that set us up for a struggle with
reality.
• Therefore, it gives acceptance in
its truest, purest form.

75. Self-as-Context
Two major components

77. Committed Action
(Do What It Takes)
• Taking effective action, guided
by our values.
• Committed action means “doing
what it takes” to live by
our values even if that brings up
pain and discomfort.
• Facing and overcoming the
barriers
• SMART goals

78. Therapeutic
Relationship
• Therapists : Thanks to human
language, they are in the same boat
as their clients
• Therapists might say, “…from where
I am on my mountain, I can see
obstacles on your mountain that you
can’t see.“
• “So I can point those out to you, and
maybe show you some alternative
routes around them…”

79. ACT Acronym
Accept unwanted private experiences such as thoughts,
feelings, memories, and sensations as well as external
events that are not amenable to direct control for what
they are, not what they appear to be.
Accept
Choose a set of valued life directions that would enlarge
one's sense of vitality, purpose and meaning.
Choose
Build larger and larger patterns of committed action that
are consistent with these valued ends
Take
Action

80. 80
Dr Veera Balaji Kumar
Contact for further information:
drveerabalaji@gmail.com