Acceptance & Commitment Therapy

ADVANCED Workshop with Russ Harris

1
Psychological
Flexibility
Contact With The
Present Moment
Defusion
Acceptance Values

Committed Action
Self-as-context
2
Workshop Rules



3
Workshop Aims
! Case Conceptualisation: DSM & non-clinical
! ABA: function analysis
! Getting Unstuck
! Overcoming resistance
! Mandated/coerced clients
! Trauma & Suicidality
! Addiction & Urge surfing
! Barriers to acceptance
! Values & I dont know
! Self-as-context & the observing self
! Compassion & Forgiveness



The Aim of ACT:
" To maximise human potential for a rich, full and
meaningful life
" To reduce suffering and increase vitality
" To increase psychological flexibility





4



THE WHOLE ACT MODEL RESTS ON .....?





6
Psychological
Flexibility
Contact with the
Present Moment
Defusion
Acceptance Values

Committed Action
Self-as-context
6
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7
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The Resilience Formula
4 approaches to any problem situation:
1. Leave
2. Stay & change what can be changed
3. Stay & accept what cant be changed & live
by your values
4. Stay & give up & do stuff that makes it worse


Exercise: 2 memories
9
a) Client responds well
b) Client responds poorly
- What was that like?
- What happens to your values as a coach/
therapist etc. when you get fused/avoidant?
Physicalising an emotion
Shape & size? Weight (or weightless)?
Location? (E.g. at the surface, deep inside)
Liquid, solid, gaseous?
Colour(s)? Transparent or opaque?
Temperature? Hot or cold spots?
Texture of the surface?
Movement, vibration or sound?
Are you willing to make room for this object, in order to !
NB: In ACT, acceptance is always in the service of
values/goals otherwise, why bother?

10
3 Elements of Self-compassion
(Kristin Neff)
1. Mindfulness (i.e. defusion, acceptance,
contacting the present moment)
2. Kindness
3. Common Humanity

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Qualities of an ACT Coach/Therapist

! Compassionate, radically respectful -- and
(often but not always) playful
! Accepting, defused, present, and guided by
values
! Willing to experience discomfort in the service
of helping others





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Qualities of an ACT Coach/Therapist

! Sees people as stuck, not broken; as
sunsets, not maths problems
! Stance of equality and commonality: my
mountain, your mountain





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Common Coach/Therapist problems
(adapted from Steve Hayes.)
! Inconsistencies & mixed messages
! Talking & explaining ACT, instead of doing it
! Being Mr Fix-it
! Being Mrs Good-listener
! Being Mr Nice Guy




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Common Coach/Therapist problems

! Trying to convince or 'be right
! Taking a one-up position
! Excessive focus on one process, while
neglecting others
! A lack of understanding of the theoretical
underpinnings




15
Hands As Thoughts
In front of you is everything that matters: the people, places,
activities you love etc.
Now get caught up in your thoughts
Notice 3 things:
How much are you missing out on?
How disconnected and disengaged are you?
How difficult is it to take action, to do the things that make your life
work? (give examples)
Now slowly separate from your thoughts
Whats your view of the room like now? How much easier is it to
engage and connect? How much easier is it to take action?
Notice these things (i.e. hands) havent disappeared. If you can use
them, do so. If not, just let them sit there.


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Informed Consent
ACT is a very active form of therapy or coaching not just
talking about problems.
Learning skills to handle difficult thoughts and feelings more
effectively, so they have less impact and influence over you
Clarifying your values: what matters to you, what you want
to stand for in life, how you want to treat yourself and
others, what gives you a sense of meaning or purpose
Taking action: to solve problems, and do things that make
life better
Like playing a guitar needs practice both in session and
between sessions.
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Informed Consent - additional
Also consider discussion of:
a) Number of sessions
b) Pre-empt urge to drop out
c) Evidence base
d) How ACT gets its name: accept what is out of
your personal control and commit to action
that improves your life
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Informed Consent - additional
Also consider asking this:
Can I have permission to interrupt you: so if I
see you doing something that looks like it
might be making your problems worse, I can
point it out, and we can address it?
And can I also do that if I see you doing
something that looks like it might be really
helpful or useful?

19
DSM?
The goal of validating these syndromes and
discovering common etiologies has remained
elusive.
Despite many proposed candidates, not one
laboratory marker has been found to be
specific in identifying any of the DSM defined
syndromes
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DSM?
Epidemiological and clinical studies have
shown extremely high rates of co-morbidities
among disorders, undermining the hypothesis
that the syndromes represent distinct
etiologies.
Furthermore, epidemiological studies have
shown a high degree of short term diagnostic
instability for many disorders.
With regard to treatment, lack of specificity is
the rule rather than the exception.
21
DSM?
Many, if not most, conditions and symptoms
represent a somewhat arbitrarily defined
pathological excess of normal behaviors and
cognitive processes.
This problem has led to the criticism that the
system pathologizes ordinary experiences of
the human condition.
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DSM?
Researchers slavish adoption of DSM-IV
definitions may have hindered research in the
etiology of mental disorders.
23
DSM?
Reification of DSM-IV entities, to the point that
they are considered to be equivalent to
diseases, is more likely to obscure than to
elucidate research findings.
24
Where do these quotes come from?
The American Psychiatric Association planning
committee, for the fifth version of the
Diagnostic and Statistical Manual
Pages xviii & xix
Kupfer, D. J., First, M. B. & Regier, D. A. (Eds.).
(2002). A research agenda for DSM-V.
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One More Quote
From same source: Pages xviii & xix ofKupfer, D.
J., First, M. B. & Regier, D. A. (Eds.). (2002). A
research agenda for DSM-V.
All these limitations in the current diagnostic
paradigm suggest that research exclusively
focused on refining the DSM-defined syndromes
may never be successful in uncovering their
underlying etiologies.
For that to happen, an as yet unknown paradigm
shift may need to occur.
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Psychological
Flexibility
Contact With The
Present Moment
Defusion
Acceptance Values

Committed Action
Self-as-context

Fusion with past
or future
Fusion with the
conceptualised self
Fusion with reasons,
rules, and judgments
Experiential Avoidance
Unworkable action
Remoteness from
values
Psychological
Rigidity
Painful Private
Experience
FUSION
THREAT
EXPERIENTIAL
AVOIDANCE
Paradoxical
Effects
Life
Costs
Painful Private
Experience
THREAT
EXPERIENTIAL
AVOIDANCE
Paradoxical
Effects
Life
Costs
Painful Private
Experience
EXPERIENTIAL
AVOIDANCE
Paradoxical
Effects
Life
Costs
Painful Private
Experience
Paradoxical
Effects
Life
Costs
Painful Private
Experience
Painful Private
Experience
Plus FUSION
Plus AVOIDANCE
Plus UNWORKABLE ACTION

TRAUMA

Plus DEFUSION
Plus ACCEPTANCE
Plus WORKABLE ACTION

RESILIENCE


BURNOUT


DEPRESSION


ANXIETY
DISORDER

ADDICTION


ANOREXIA


SUICIDALITY


TRAUMA

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Psychological
Flexibility
Contact With The
Present Moment
Defusion
Acceptance Values

Committed Action
Self-as-context

Fusion with past
or future
Fusion with the
conceptualised self
Fusion with reasons,
rules, and judgments
Experiential Avoidance
Unworkable action
Remoteness from
values
Psychological
Rigidity
Flashbacks
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FEELINGS
THOUGHTS
SMELL
TASTE
TOUCH
HEAR
SEE























PAIN
MEMORY
FEELING
THOUGHT SENSATION
URGE
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PAIN
SMELL
TASTE
TOUCH
HEAR
SEE
FEELINGS
THOUGHTS
SELF-COMPASSION
VALUES & ACTION
Drop Anchor
Something very painful has just shown up, and I want to
help you handle it
Push your feet hard into the floor
Sit forward in your chair
Push your hands hard together,
As well as this painful thought/feeling/memory, notice your
body in the chair hands, feet, back
Also look around notice 5 things you can see
And notice 3 or 4 things you can hear
And also notice you and I, working together
So there is a painful thought/feeling/memory here
And your body in the chair
And a room around you
And you and I working together

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40
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NIGHTMARES
Sleep Hygiene
Nightmare Rehearsal
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SUICIDALITY
Kirk Strosahls three Is
Pain is perceived as:
Intolerable
Interminable
Inescapable
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Psychological
Flexibility
Contact with the
Present Moment
Defusion
Acceptance Values

Committed Action
Self-as-context
43
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ACT is based on ABA Applied
Behavioural Analysis
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ABA is a BIG model
Brief look at 3 bits:
1. Appetitive control vs aversive control
2. Reinforcement versus punishment
3. The 3-Term Contingency
Aversive Control Vs Appetitive Control
Behaviour under aversive control
moving away from what you dont want
escape/avoid an aversive stimulus
Behaviour under appetitive control
gaining access to what you do want
approach/explore an appetitive stimulus





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Exercises in pairs





Eating chocolate, running through a forest, making
love, playing with your kids, doing housework
create scenarios where these things are under:
a) aversive control (avoid/escape something
unwanted)
b) appetitive control (access something wanted)
What is the difference, experientially?





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In each session we:






Undermine narrow,
inflexible behaviour under
aversive control
Model, instigate and reinforce
broad, flexible behaviour under
appetitive control
Note: narrow inflexible behaviour
can be under appetitive control
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A Antecedents





B Behaviour C- Consequences





C


Situation
Thoughts
Feelings
Immediate outcomes
that either increase or
decrease the behaviour


If consequences => lNCREASE in behaviour,
they are REINFORCING
Something an
organism does
- Public
- Private
If consequences => DECREASE in behaviour,
they are PUNISHING
PUNISHMENT vs REINFORCEMENT
DIFFERENTIAL REINFORCEMENT
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A Antecedents





B Behaviour C- Consequences
(reinforcing)








Situation
Thoughts
Feelings
immediate outcomes
that maintain the
behaviour
Situation: alone in
house at night, tired
Thoughts & Feelings:
I have no friends I
wish I had a social life
Sadness, loneliness,
Anxiety, boredom
Urge to smoke dope

Feeling of relief;
painful thoughts,
feelings, urges
disappear



Costs:
Addiction worsens;
stays home more &
social isolation
increases; more
feelings of loneliness
and sadness

Smokes marijuana
Present Moment,
Defusion,
Acceptance
Values &
Committed action
Workability
Something an
organism does
- Public
- Private
TRIGGERS
PAYOFFS

DIFFERENTIAL REINFORCEMENT
OF A MORE WORKABLE BEHAVIOUR
payoffs VS costs
Reinforcing Consequences (Payoffs)









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1. Escape/avoid an aversive stimulus
2. Access an appetitive stimulus
negative reinforcement
positive reinforcement
Functional Analysis: 3 Questions For
Any Unworkable Behaviour:
B- BEHAVIOUR:
What is the person doing?
A- ANTECEDENTS (TRIGGERS):
What situations, thoughts, feelings immediately
precede the behaviour?
C CONSEQUENCES reinforcing it (PAYOFFS):
What immediate outcomes of the behaviour maintain
it over time?







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7 Common Reinforcing Consequences
(payoffs) for Unworkable Behaviour









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1. I avoid/escape an unpleasant situation/event
2. I avoid/escape unpleasant thoughts/feelings
3. I feel good
4. I gain attention
5. I get my needs met
6. I feel like I am problem solving
7. I feel like I am making sense of things
WORKABILITY:
payoffs VS costs
Exercise in pairs: Functional Analysis
Identify Antecedents (triggers): situation,
thoughts, feelings
Identify Reinforcing consequences (payoffs)
NB: This will be unique for each individual!
Client 1: B Behaviour = drug/alcohol use
Client 2: B Behaviour = social withdrawal
Client 3: B Behaviour = procrastination on a task
Client 4: B Behaviour = aggression









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Exercise in threes
Client: Pick a quadrant of the bulls eye to work on.
Identify a problematic behaviour in that quadrant.
Therapist/coach 1:
Identify the Triggers (situation, thoughts, feelings)
Identify the Payoffs
Therapist/coach 2:
Summarise: So in the short term, this helps you to X,Y,Z.
But in the long term, what costs does this have?
Identify the Costs
Validate: So this really takes you away from the bulls eye
Summarise briefly how ACT can help (ultra-brief version
of informed consent)






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A Common Reply To Questions
About Values:
55


I DONT KNOW!



Consider the
function of
this behaviour


Is it a request for help,
due to lack of
knowledge?


If so, do brief
psychoeducation, give
some examples of
values, then do an
experiential exercise


A far more common
function of I dont
know:


56
A Antecedents





B Behaviour C- Consequences
(reinforcing)








Situation
Thoughts
Feelings
immediate outcomes
that maintain the
behaviour
Situation: therapy/
coaching session
being asked about
values
Thoughts & Feelings
Oh shit! I dont know!
Anxiety, confusion.
Urge to change the
topic

Says I dont know
Present Moment,
Defusion,
Acceptance
Values &
Committed action
Workability
Something an
organism does
- Public
- Private
TRIGGERS
PAYOFFS

DIFFERENTIAL REINFORCEMENT
OF A MORE WORKABLE BEHAVIOUR
payoffs VS costs

Costs:
Fail to clarify values,
Fail to set meaningful
Goals
Remain stuck
nothing changes

Conversation ends
Feeling of relief;
anxiety/confusion
disappears



Validate: yes, right now, you
dont know.
So would you be willing to:
Sit with the question a bit
longer?
Do an exercise with me?
Fill in a worksheet?



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Clues: Important Domains of Life
What does the client:
! Complain about?
! Get angry about?
! Worry about?
! Feel guilty about?
! Fear?
! Desire?

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Clues: Important Domains of Life

" Explore pain in all its forms: what does this
pain tell you really matters?
" For suicidal clients: What has stopped you
from killing yourself?
" If these painful thoughts/feelings/memories
were no longer a problem, what would you
do differently?


Useful Questions For Crisis/Loss
What do you want to stand for in the face of
this?
10 years from now, if you were to look back at
the way you dealt with this issue, what would
you like to say about the way you behaved,
the way you handled it, what you stood for?
59
More Useful Questions
You are 80 years old, looking back on your life
today; complete these sentences:
I spent too much time worrying about !.
I did not spend enough time doing things such
as !
If I could go back in time, what Id do differently
is !
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Values Checklist
! Take 10 minutes

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Life Compass
! Take 10 minutes

Get People Moving: 3 Factors
1. Small change
2. Positive direction
3. Owned by the client
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On a scale of zero to ten, how
likely are you to do this?

The Brief Bulls Eye
" A) Pick a quadrant
" B) What matters to you in this part of your life?
" C) Where are you now, on the dartboard?
" D) Whats one tiny thing you could do in the next week to
move you towards the bulls eye?
" E) How will your mind try to talk you out of that?
" F) What difficult feelings might show up?
" G) Are you willing to make room for those thoughts and
feelings, in order to do this?
" H) On a scale of zero to ten, how likely are you to do this?


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Mandated/Coerced Clients: 5 Steps
1. Normalise: e.g. Most people feel upset or annoyed
2. Validate & empathise: e.g. Of course you feel that way! Id feel the same!
3. Declare your values: e.g. My aim is to help people have better lives
4. Q: What possible outcome from this would make it feel like a good use of
your time?
5. The Free Will Switch (adapted from Kelly Wilson)
Off = you are here for others/ waste of your time/ nothing in it for you
On = you are here for yourself/ can make free use of my resources/ something of
value in it for you
On or Off, you are still in the session: it just determines if its a waste of your
time or not.
If client chooses off: either a) In that case, we may as well end the session,
because without your cooperation Im powerless
or b) Okay, well lets keep going then, but notice how keeping the switch off really
makes the session drag/ sucks the life out of you/ makes this seem like a total
waste of time
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Resistance To Change: 7 Factors
Treatment mismatch
Discordant Therapeutic Relationship
Secondary Gains
FEAR:
Fusion
Excessive goals
Avoidance of discomfort
Remoteness from values
66
Informed consent
Pros & Cons of change
Defusion
Realistic goals
DARE
Acceptance of discomfort
Embracing Values
Embody ACT in session
Why dont we stop it?

67
Problematic In-Session Behaviour
68
A Antecedents





B Behaviour C- Consequences
(reinforcing)








Situation
Thoughts
Feelings
immediate outcomes
that maintain the
behaviour
Situation: the client is
doing some form of
problematic behaviour
Thoughts & Feelings
Anxiety
If I confront this, thats
rude/ will destroy
rapport/ shell get angry
or upset/ hell leave/
shell complain about
me

Therapist/coach
makes no active
attempt to point out,
confront, address or
interrupt the clients
behaviour. Instead,
opts for active
listening
Present Moment,
Defusion,
Acceptance
Values &
Committed action
Workability
Something an
organism does
- Public
- Private
TRIGGERS
PAYOFFS

WHATS A MORE WORKABLE BEHAVIOUR?
payoffs VS costs
Costs:
Clients problematic
behaviour persists
Unable to do effective
therapy/coaching
Increasing frustration,
anxiety/ boredom/
disengagement for the
therapist/coach

Feeling of relief;
anxiety disappears


69
Psychological
Flexibility
Contact With The Present Moment
Defusion
Acceptance Values

Committed Action
Self-as-context

Im noticing something problematic
here and Id like to share it with you
Im feeling pretty
anxious about it.
My hearts racing.
My minds telling me
youll be upset or angry
or think Im rude
So even though Im
feeling really nervous,
Im going to tell you what
Ive noticed
But my aim in here is to
help people live better lives
so if I ignore this, Im not
being true to myself and Im
doing you a disservice
Staying On Track 1
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1. Permission to start session differently &
rationale for doing so (e.g. not making
progress, sessions inefficient)
2. Confirm that you are a team, working
together
3. Agree to a specific domain/area to work on
4. Your mind will try hard to get us off track.
Lets see if we can notice all the tactics it
uses.
Staying On Track 2
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1. Notice, name and normalise each tactic
Write them down on a piece of paper
2. Ask the client to tick a tactic whenever it
recurs
3. If client say This wont work because X,Y,Z
then ask, Shall we stop the session,
because your mind says XYZ or shall we
let your mind say that and carry on?
Staying On Track 3
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1. Return to the agenda repeatedly
2. Repeatedly draw attention to minds tactics;
unhook and return
3. Reinforce any workable behaviour you see
eg point out and comment favourably on
functionally positive non-verbal behaviour
(e.g. eye contact, body posture),
acceptance, defusion, engagement,
willingness, vulnerability, commitment,
connection with values etc.
1. Ask client to assess their own behaviour in
session in terms of workability: towards or
away from values (e.g. the bulls eye)
2. Ask client to assess how their behaviour
affects the therapeutic/coaching relationship
3. Permission to interrupt, and rationale for
doing so
4. Rationale for learning to focus, unhook, and
refocus


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Other Useful Tips
1. Keep noticing and naming habitual cognitive
patterns
2. Psycho-education about automaticity versus
choice: I want you to have more choice about
what you do at the moment you seem to be
totally controlled by your thoughts and
feelings
3. Have client take ownership of agenda


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Other Useful Tips
75
A Antecedents





B Behaviour C- Consequences
(reinforcing)








Situation
Thoughts
Feelings
immediate outcomes
that maintain the
behaviour
TAKING DRUGS
Workability =
payoffs VS costs
Something an
organism does
- Public
- Private
TRIGGERS
PAYOFFS

DIFFERENTIAL REINFORCEMENT
OF A MORE WORKABLE BEHAVIOUR
Present Moment,
Defusion,
Acceptance
Values &
Committed action
GAMBLING
CHECKING EMAILS
COMPULSIVE
CLEANING
MICRO-MANAGING

WORKING LATE
HAIR PULLING
SHOUTING AT
EMPLOYEES
TAKING DRUGS




REASON GIVING:
Reasons why I cant change/
wont change/
shouldnt have to change



76
A Antecedents





B Behaviour C- Consequences
(reinforcing)








Situation
Thoughts
Feelings
immediate outcomes
that maintain the
behaviour
Situation: therapy/
coaching session
talking about changing
behaviour
Thoughts & Feelings
Anxiety
Feeling Under
pressure
Thoughts about why I
cant change/wont
change/shouldnt have
to change

Reason-giving
I cant change/ wont
change/ shouldnt
have to change
because of X,Y,Z
Present Moment,
Defusion,
Acceptance
Values &
Committed action
Workability
Something an
organism does
- Public
- Private
TRIGGERS
PAYOFFS

DIFFERENTIAL REINFORCEMENT
OF A MORE WORKABLE BEHAVIOUR
payoffs VS costs

Costs:
Problematic behaviour
maintains

Conversation ends
Feeling of relief;
anxiety disappears
pressure lifts


REASON-GIVING
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What if client identifies a tangible
benefit?
What if client
identifies tangible
benefits?

VALIDATE IT!
Workability:
Payoffs vs costs
Are there more
workable ways of
getting those
payoffs?



Is skills-training
required?
REASON-GIVING
78
What if client identifies a tangible
benefit?
What if client
identifies genuine
barriers?

VALIDATE IT!
If resources are
missing:



Change the goal!
Either: get the
resources
Or modify to
adapt to the lack
If the resource
missing
is a skill?





TRAIN IT!
REASON-GIVING
79
I cant help it
Ive got no
control!
I cant resist it!
It happens before
I know it!
REASON-GIVING
80
VALIDATE!
Yes, right now
thats how it is!
Like to change it?
Requires learning
some new skills
Avoidance of discomfort
Why accept pain?
81
Pushing Away Paper
In front of you is everything that matters: the people, places,
activities you love etc.
Now push these feelings away from you, hard as you can
Notice 3 things:
How tiring is it?
How distracting is it; how difficult is it to fully engage or connect?
How difficult is it to take action, to do the things that make your life
work? (give examples)
Now rest it on your lap
How much less effort is that? How much easier is it to engage and
connect? How much easier is it now to take action?
Notice your feelings (i.e. the paper) havent disappeared. But you
have a new way of responding to them, so they dont hold you
back or tie you down or stop you engaging in your life


82
I Just Want To Get Rid of It #1
Validate: Of course you do. Who wouldnt?
Values:
If I had a magic wand and I made it disappear, then
what would you do differently?
What have you given up, or missed out on, while
trying so hard to avoid or get rid of your pain?
If making room for this pain, and letting it flow
through you without a struggle, could help you to
! (mention key values and goals) ! would you be
interested in learning how to do that?

83
I Just Want To Get Rid of It #2
Research shows: lots of good research showing that
when we use this approach symptoms reduce. But
it doesnt happen through directly attacking them
they reduce as a side-effect of doing this (push the
paper demo)
84
I Just Want To Get Rid of It #3
Declare your own helplessness:
I dont know how to get rid of your pain.
But I do know a new way of responding to it, so it has
less impact and influence over you!etc
N.B. Double-check: did you get informed consent
from the client? Does the client know or remember
you are working from the ACT model? If not, go
through it!
85
I Just Want To Get Rid of It #4
Only Two Ways: As long as you only have these two
ways of responding (fusion & avoidance demo with
paper) it will always seem horrible/ feel
overwhelming/ control your life.
86
I Just Want To Get Rid of It #5
Creative Hopelessness:
What have you tried doing to get rid of it?
How has it worked, long term?
What has it cost you?
What have you missed out on?
The more effort you put into avoiding or getting rid of
this pain, the worse your life gets. Do you want to
do more of whats not working?
87
I Just Want To Get Rid of It #6
Medical metaphor: its like diabetes or asthma cant
get rid of those, but learn new ways of responding
to them so you can still live a rich, full and
meaningful life
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I Just Want To Get Rid of It #7
Hard facts: no coach or therapist or doctor, working
from any model of therapy, can guarantee to get rid
of unwanted thoughts and feelings. They all work
the same way: new ways to handle thoughts and
feelings so they have less impact and influence
over you. I cant do the impossible. But I can help
you find new ways to handle etc !
89
I Just Want To Get Rid of It #8
Confront the illusion of control: Of course you want to
get rid of it thats natural. But lets have a look at
how much control we actually have:
- delete a memory
- dont think about ice cream
- make your leg go numb
- polygraph metaphor
90
I Just Want To Get Rid of It #9
Defusion: so your mind says I have to get rid of it -
thats the only solution So do we end the session,
because your mind says I have to get rid of it;
there is no other solution - or do we let your mind
say that, and carry on and try to find another way?

91
I Just Want To Get Rid of It #10
Self-compassion:
This must be really hard for you. What are you
feeling right now? Where is that in your body? Can
I get you to try something: place a hand over it, and
hold it gently ! etc. Whats that like?

92
I Just Want To Get Rid of It #11
Is the pain there now? Can I get you to try
something? Push your feet into the floor ! sit up
straight ! look around you ! notice what you can
see and hear ! engage with me ! notice that
your pain is here, AND theres a lot of other stuff
here too: your body, and the room, and you and
me, doing something important right now !

93
I Just Want To Get Rid of It #12
The things youre doing to avoid/get rid of this pain
are they taking you closer to the bulls eye, or
further away?
If I could show you a new way of handling this pain,
that would help you get closer to the bulls eye,
would that be time well spent?

94
I Just Want To Get Rid of It #13
Would you be willing to try an experiment? To try
doing something completely different than what
you normally do when this pain shows up? Just for
a few seconds, to see what its like?

95
Urge Surfing
96
Urge Surfing
97
Use your breath as an anchor
Notice where the urges arise, and how your body responds
Watch like a curious child
Breathe into and make room for whatever discomfort arises
Let your mind chatter away like a radio in the background
If it seems like you have to swallow, count to ten. Then make a choice: either
swallow mindfully, or keep watching the urge and see what it does next
Notice your relief when the urge drops, and your anxiety when it rises again
Even if your mouth is full of saliva, you can breathe through your nose
If you get lost or overwhelmed, come back to your breath, anchor yourself,
then re-engage in the exercise
Notice even with the urge present, you can a) direct your attention and b)
control your arms and your legs

98
Psychological
Flexibility
Contact with the
Present Moment
Defusion
Acceptance Values

Committed Action
Self-as-context
98
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Self-as-context
Flexible Perspective Taking
Ability to observe and describe from a
perspective or point of view
enables or facilitates many different
experiences, including theory of mind,
empathy, compassion, self-compassion,
acceptance, defusion, and a transcendent
sense of self (often called the observing
self).
99
And now .
100
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What are you doing here?
What am I doing here?
What were you doing there?
What was I doing there?
What are you doing now?
What am I doing now?
What were you doing then?
What was I doing then?

The only constants?
I
Here
Now
THEN
NOW
YOU
I
HERE
THERE
Perspective Taking Skills
Slide Courtesy of Steve Hayes
Self-as-Context
The locus of
consciousness:
everything is
noticed from a
perspective of I,
here, now
Slide Courtesy of Steve Hayes
Flexible Perspective Taking
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Notice X
Contact with the Present Moment = notice WHAT you
see, hear, touch, taste, smell, think, feel, do
Self-as-process = notice THAT you are seeing,
hearing, touching, tasting, smelling, thinking, feeling,
doing ! and noticing
Observing self (transcendent self) = notice THAT
part of you which is continuous, unchanging, distinct
from, and more than WHAT you see, hear, touch,
taste, smell, think, feel and do
Self-as-context = flexibly noticing from a perspective
of I, here, now
106
The Observing Self: why bother?
1. Aids defusion especially from the
conceptualised self
2. Aids acceptance, willingness, and formal
exposure: a safe place inside you
3. Important aspect of spirituality
4. For survivors: a part of you was unharmed

107
NB: 1 & 2 are easily achieved through defusion
& acceptance skills without need for explicit
observing self exercises.
Observing Self
Two Simple interventions:
Notice X - and be aware youre noticing
Stage show metaphor

108
Notice your breath (10 seconds pause)
Be aware youre noticing (10 seconds pause)
Notice what youre thinking ...
Be aware youre noticing ...
Notice what you can hear ....
Be aware youre noticing ....
Notice what your mind is telling you ...
Be aware youre noticing ....
Notice what you can feel in your feet ....
Be aware youre noticing ....
Notice what thoughts youre having ....
Be aware youre noticing ...
So theres a part of you that notices everything
Optional: Life is like a stage show ! and on that stage are all your
thoughts and feelings and everything you can see, hear, touch, taste and
smell ! and theres a part of you that

109
Dilemmas # 1: The Hard Facts
110
1. There is no simple answer. If one choice was
clearly much better then you wouldnt have a
dilemma!
2. So we probably wont solve it in todays session!
3. No matter what choice you make, anxiety and
doubt is certain.
4. There is actually no way not to choose.

Dilemmas #2: The Practicalities
111
1. Each morning: acknowledge todays choice.
2. Each morning: What do I want to stand for in
the face of this? Live those values
3. Through the day: name the story, get present
4. Spend 5-10 mins each day MINDFULLY
focusing on pros and cons of each choice
using a pen & paper, or computer
5. Self-compassion; this situation may go on for
a long time
Anger
112
Anger Management?
Aggression Management!
113
A Antecedents





B Behaviour C- Consequences
(reinforcing)








Situation
Thoughts
Feelings
immediate outcomes
that maintain the
behaviour
Workability =
payoffs VS costs
Something an
organism does
- Public
- Private
TRIGGERS
PAYOFFS

DIFFERENTIAL REINFORCEMENT
OF A MORE WORKABLE BEHAVIOUR
Present Moment,
Defusion,
Acceptance
Values &
Committed action
AGRESSION
Forgiveness
114