Intervention L4 - Third Wave Behaviour Therapies

Question 1

Describe Mindfulness.

Answer 1

• Involves paying ATTENTION to the PRESENT MOMENT.
• NONJUDGEMENTAL observation of the ongoing stream of internal and external stimuli as they arise.

Roots in Buddhist philosophy.

Question 2

Clinical Applications of Mindfulness?

Answer 2

• DBT
• Mindfulness-Based Stress Reduction (MBSR)
• Mindfulness-based Cognitive Therapy (MBCT)
• Acceptance & Commitment Therapy (ACT) –> accepting thoughts, not modifying them like in CBT.

Question 3

What was mindfulness originally introduced to western society for?

Answer 3

• Jon Kabat-Zinn - introduced it to use with chronic pain - more of a medical application
• Marsha Linehan - applied it to behavioural therapy.

Question 4

What are some concepts in Mindfulness?

Answer 4

NON-ELABORATIVE processing - reducing over-engagement with cognitive content & processes, affect.

Thought DECENTREING
- thoughts are mental events, not necessarily real or accurate, do not require a behavioural responds, and they WILL PASS through the mind if not subject to elaborative processing.

• Less literal interpretations, evaluations, judgements of stimuli
• reduced discrepancy-based processing
• RESPOND rather than REACT to emotions
• allows emotions to be less overwhelming and not dictate behaviour
• less likely to ruminate or worry.

ACCEPTANCE vs AVOIDANCE of experience

• “sitting with” the thought rather than needing to distract, avoid or escape
• similar to exposure
• clinical application - uRGE surfing

Question 5

What is the idea of ‘acceptance’ vs ‘avoidance’?

Answer 5

This is the idea of ‘sitting with’ an uncomfortable thought rather than reacting, and attempting to distanct, avoid or escape experiences through elaborative processing.

very similar to exposure.

eg. noticing an itch and not scratching

urge surfing - clinical application.

Question 6

What is the idea of ‘decentreing’ thoughts?

Answer 6

The idea that thoughts are mental events, not necessarily real or accurate, do not require a behavioural responds, and they WILL PASS through the mind if not subject to elaborative processing.

Question 7

What is ACT and its key aims?

Answer 7

Acceptance & Commitment Therapy.

Goals:
Psychological Flexibility - can you allow experiences to be there without necessarily engaging in habitual patterns of behaviour?

Accepting and managing inevitable pain and stress that goes along with living –> rich and meaningful life.

Question 8

What does ACT believe that suffering is caused by?

Answer 8

• Aiming for symptom reduction –> by sitting with it, paradoxically it does reduce symptoms
• The normal part of being human
• Pursuit of happiness
• Literal use of language - when we take thoughts as truth
• the focus on avoiding suffering is believed to lead to more suffering.

Question 9

What is the ACT “Hexaflex”?

Answer 9

6 Fundamental Processes of ACT –> which all lead to PSYCHOLOGICAL FLEXIBILITY.

CADSVA

1. Contact w/ the Present Moment
2. Acceptance
3. Defusion
4. Self as Context
5. Values
6. Committed Action

Question 10

What is “Contact with the present moment”?

Answer 10

• MINDFULNESS, instead of rumination about past or worrying about future
• Instead of selective attention to specific aspect of experience - Eg. physiological symptoms of anxiety, then they aren’t mindful of the rest of their experience.

NARROWS ATTENTION. want to broaden.

Question 11

What is “Acceptance”?

Answer 11

• being OPEN, RECEPTIVE & NON-JUDGEMENTAL to the present moment!
• ACKNOWLEDGE REALITY as it is.
• this is NOT passive resignation (hopeless acceptance.)
• ALLOW painful experiences to be present rather than trying to control/avoid.
• it is the opposite of experiential avoidance

Question 12

What is experiential avoidance?

Answer 12

Experiential avoidance (EA) has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences—even when doing so creates harm in the long-run.

• Avoidance is fine when the stimulus is tangible and a direct threat - eg. lion
• Not so good when it is a private event that doesn’t directly threaten survival - eg. memories

WE AVOID THIS IN ACT.

Question 13

What is ‘Cognitive Defusion’?

Answer 13

Cognitive Fusion = taking thoughts/language literally.

Cognitive Defusion = distancing from thoughts

• this is NOT suppressing thoughts
• they are just sounds, words, stories that enter and leave minds.

How to do this:
Name the story. Leaves on a stream. “I am having the thought that….” to create distance.

Question 14

How do we try to achieve cognitive defusion?

Answer 14

Try to distance the person from their own thoughts.

Name the story. Leaves on a stream. “I am having the thought that….” to create distance.

Question 15

What is “Self-As-Context”?

Answer 15

Contextual self - no real identity - identity is just a product of feedback, previous experience and cognitive fusion (i am stupid, i am superior…)

Observing self - a consistent awareness/perspective from which to observe all experiences. Being AWARE of AWARENESS.

Want to realise that what we define as our identity are just constructs, external stories, and aren’t actually US.

Question 16

What does “Values” refer to in ACT?

Answer 16

• Getting in touch with their values and what matters to them - what do they want in life.
• These are not GOALS - you can’t check values off a list.
  They’re bigger life directions.
• What do you want in your eulogy? What’s your 80th birthday like?

What this achieves:

• Gets people to look at their internal self and provides perspective for them to deal with and see their thoughts.
• Less focussed on what they want to get rid of, but more what they want to have.
• Can provide a good path for what they want to go about in therapy.
• Useful for exposure - Do you want to push through this…. etc…

Question 17

How can we go about identifying values in ACT?

Answer 17

• What do you want your life to stand for?
• Write your eulogy
• If nobody knew what values, what would they be?
• What were your dreams as a child?
• Who is at your 80th birthday and what would they say?

Question 18

What is “Committed Action”?

Answer 18

• Setting clear GOALS in line with VALUES & work towards them.
• Committed action = values-guided action
• Values can’t be achieved, it’s more like a direction to head towards rather than a place to get to.
• Not always fun. Can trigger stuff.
• Willing - are you willing to experience pain in order to live a rich and meaningful life in accordance with your values?

Question 19

What are the 6 core processes to look for when a client comes in?

Answer 19

1. Contact with the present moment: time spent focussing on past/worrying about future? How did this develop?
2. Cognitive Fusion: what content is client fused with? Rules? Stories?
3. Acceptance/Experiential Avoidance: what is the client avoiding? Are they engaging in a lot of avoidant behaviour/suppressing/behaviour? Are they willing to accept??
4. Self-as-Content: What is their conceptualised self? Is there fusion with this? - what’s their view of themselves
5. Values: how connected are they to their values? Can they make contact with what matters to them?
6. Committed action: Is the client acting in ways consistent with values. Are they actively engaging? - they may have a clear set of values but not acting in line with it.

Question 20

What are some techniques in ACT?

Answer 20

Values exercises to identify values

Defusion exercises - trying to get distance from thoughts - leaves on a stream

Techniques to assist clients to MAKE CONTACT with experiences rather than engage in efforts to AVOID these experiences (which ultimately lead to increases in the experiences).

Increase willingness to have particular experiences in the service of living in line with values