Associate Professor Duke University Medical Center Durham NC Opportunities in Acceptance and Commitment Therapy ACT for Enhancing Evidencebased Chaplaincy Objectives Describe how evidencebased principles in ACT can be highly synergistic with commitments in healthcare chaplaincy ID: 778213
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Slide1
Jason A. Nieuwsma, PhDAssociate Director, VA Mental Health and ChaplaincyAssociate Professor, Duke University Medical CenterDurham, NC
Opportunities in Acceptance and Commitment Therapy (ACT) for Enhancing Evidence-based Chaplaincy
Slide2ObjectivesDescribe how evidence-based principles in ACT can be highly synergistic with commitments in healthcare chaplaincy.
Employ key practices from ACT to deepen the provision of patient-centered spiritual care.
Explore how using ACT principles can enhance capacities for participating as a member of integrated care teams.
Slide3I undertook great projects: I built houses for myself and planted vineyards. I made gardens and parks and planted all kinds of fruit trees in them. I made reservoirs to water groves of flourishing trees. I bought male and female slaves and had other slaves who were born in my house. I also owned more herds and flocks than anyone in Jerusalem before me. I amassed silver and gold for myself, and the treasure of kings and provinces. I acquired male and female singers, and a harem as well—the delights of a man’s heart. I became greater by far than anyone in Jerusalem before me. I denied myself nothing my eyes desired; I refused my heart no pleasure…
Yet when I surveyed all that my hands had done and what I had toiled to achieve, everything was meaningless, a chasing after the wind; nothing was gained under the sun.
- Ecclesiastes
Slide4“
The single most remarkable fact of human existence is how hard it is for human beings to be happy
.”
- Steven C. Hayes
Slide5Why do we suffer?
Slide6psychosociological underbrush. The physician should not be saddled with problems that have arisen from the abdication of the theologian and the philosopher”…I do not accept such a premise.George Engel,
Science (1977)
At a recent Rockefeller Foundation seminar on the concept of health, one authority urged that medicine "concentrate on the 'real' diseases and not get lost in the
Slide7How do we stop suffering?
Slide8Beck Depression Inventory-II
(BDI-2)
Slide9What success looks like on BDI-2
Slide10Acceptance & Action Questionnaire-II
(AAQ-2)
Slide11What success looks like on AAQ-2
Slide12What does “success” look like in faith?
Slide13Control as a means to achieving success
CAN’T CONTROLExamples
13
CAN CONTROL
Examples
Slide14Tug of War with a Monster
What to do?
Drop the rope!
Slide15Paradox
ACTBeing accepting of negative leads to feeling more positive.
15
Faith tradition examples:
The last shall be first.
Lose your life to gain it.
Reality is not reality.
For neither is the aim “happiness” or “feeling good,” and yet that effect frequently occurs.
Slide16Acceptance and Commitment Therapy (ACT)
What is ACT?
Related to CBT family of treatments
Acceptance
:
Willingness
to experience
Commitment: Living in line with values
Slide17ACT Defined
The ACT care provider works to help the patient accept internal events (thoughts, emotions, memories, and sensations) while also helping the patient to make and keep behavioral
commitment
s
that reflect the patient’s personal values. Oversimplified, you might say: hold and move. “Hold” your experience, whatever it may be, and “move” forward in your life.
The objective of ACT is to foster
psychological flexibility
. Psychological flexibility can be summarized as contacting the present moment fully as a conscious human being, experiencing what is there to be experienced and working to change behavior such that it is in the service of chosen values.
Slide18ACT: Is there “Value-Added?”
ACT challenges conventional cognitive-behavioral approaches to…The assumption of “healthy normality”
The patient/provider dichotomy
The role of thoughts
The significance of values
Measurement
Slide19Why ACT for Interdisciplinary Care?
Evidence-based1,2
Over 250 RCTs show ACT ≥ TAU
3,4
Works for: Bio–Psycho–Social Health
Principle-based
Flexible theory, not fixed protocol
Not confined to particular disorderSynergistic with cultural perspectives/worldviewsValues-centricEmbraces major religious practices
Human flourishing, not absence of disease
A broad tent
Providers
Patients
Powers, M. B., M. B.
Zum
Vörde
Sive
Vörding
, et al. (2009). "Acceptance and commitment therapy: A meta-analytic review."
Psychotherapy and Psychosomatics
78
(2): 73-80.
Ruiz, F. J. (2010). "A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies."
International Journal of Psychology & Psychological Therapy
10
(1): 125-162.
Searches conducted on January 3, 2019.
ACBS keeps an ongoing count of published and “in press” RCTs on ACT (
https://contextualscience.org/ACT_Randomized_Controlled_Trials
). As of November 2018, there were 265 published RCTs on ACT.
Slide20Premises of ACTPsychological pain is normal, it is important, and everyone has it.You cannot deliberately get rid of your psychological pain, although you can take steps to avoid increasing it artificially.
You can live a life you value.
Slide21Six Aims of ACTFor patient/provider to:
Be in the present moment.Accept what is.Watch your thinking.
Be aware of yourself.
Know your values.
Carry out valued behavior.
Slide22The ACT Model
Acceptance
Cognitive
Defusion
Values
Committed
Action
Contact with the Present MomentSelf asContext
Slide23The ACT Model
Opening Up
Developing Awareness
Doing What Matters
Slide24Acceptance Opening up and making room for painful feelings, sensations, urges, and emotions.
Slide25Acceptance
In ACT, acceptance is not a passive resignation but an active acknowledgment.
Acceptance = Willingness
25
Slide26Want to panic?
26
Levitt, J. T., T. A. Brown, et al. (2004). "The Effects of Acceptance Versus Suppression of Emotion on Subjective and Psychophysiological Response to Carbon Dioxide Challenge in Patients With Panic Disorder."
Behavior Therapy
35
(4): 747-766.
Slide27Want to do it again?
27
Levitt, J. T., T. A. Brown, et al. (2004). "The Effects of Acceptance Versus Suppression of Emotion on Subjective and Psychophysiological Response to Carbon Dioxide Challenge in Patients With Panic Disorder."
Behavior Therapy
35
(4): 747-766.
Slide28Cognitive Defusion Learning to “step back” and separate or detach from our thoughts, images, and memories.
Slide29Don’t think about….
29
Slide3030
CHOCOLATE CAKE
Slide31Leaves on a Stream
https://www.mindfulnessmuse.com/wp-content/uploads/2011/09/Cognitive-Defusion-Exercise-1.pdf
Slide32The ACT Model
Opening Up
Developing Awareness
Doing What Matters
Slide33Contact with the Present Moment Consciously connecting with and engaging in whatever is happening in this moment.
Slide34Contact with Present MomentAbout “therapist” as much as “client”Not just meditationMindfulness:
“paying attentionin a particular way:on purpose,in the present moment,
and non-judgmentally”
(Kabat-Zinn)
Nice, but…
Slide35A Different Approach to Past, Present, & FutureInstead of…re-hashing the past
to make sense of the presentin order to predict the future…ACT seeks to…minimize the distraction of dwelling in the pastor fantasizing about the future
in order to live richly in the present.
Slide36Self as Context Developing awareness of the “observing self” that is aware of what we’re thinking, feeling, sensing, or doing in any moment.
Slide37Three Senses of SelfConceptualized selfSelf-concept; self-description“Who I am” as a person
Self-as-awarenessOngoing process of noticing our experienceContacting present momentSelf-as-contextSpace from which “noticing” happens (the “observing self”)
The “I” (as opposed to “me”)
Slide38The Pieces and the Board
Slide39The Continuous You
Slide40The ACT Model
Opening Up
Developing Awareness
Doing What Matters
Slide41Values Knowing and clarifying desired qualities of ongoing actions, or chosen life directions.
Slide42ValuesIn ACT, values:are here & now.
are not about being justified.often need to be prioritized.are best held lightly.
are freely chosen.
Slide43Committed Action Taking effective action, guided by our values, even in the face of pain and discomfort.
Slide44Commitment
Values
Direction
Process-oriented
Intangible
Can’t check off
Goals
DestinationOutcome-orientedTangible
Can check off
Slide45The Willingness & Action Plan
Slide46Slide4747
Trust no future,
howe'er
pleasant!
Let the dead Past bury its dead!
Act
, - act in the living Present!
Heart within, and God
o'erhead
!
Longfellow,
A Psalm of Life
Slide48Slide49Questions?
Slide50Recommended ACT ReadingsHayes, S.C. & Lillis, J. (2012) Acceptance and Commitment Therapy. Washington, DC, American Psychological Association.
Hayes, S. C. (2005).
Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy
. Oakland, CA, New Harbinger Publications.
Wilson, K.G. (2008).
Mindfulness for Two. Oakland, CA, New Harbinger Press.
Harris, R. (2009).
ACT Made Simple: A Quick-Start Guide to ACT Basics and Beyond. Oakland, CA, New Harbinger Press.Nieuwsma, J.A., Walser, R.D., & Hayes, S.C. (Eds.). (2016). ACT for clergy and pastoral counselors: Using acceptance and commitment therapy to bridge psychological and spiritual care. Oakland, CA: Context Press / New Harbinger Publications.
Worksheets available at:
http://www.thehappinesstrap.com/free_resources