ACCEPTANCE, COMMITMENT AND VALUE-BASED LIVING
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019UNC CHAPEL HILL SCHOOL OF SOCIAL WORK CLINICAL LECTURE SERIESACCEPTANCE, COMMITMENTAND VALUE-BASED LIVING:An overview of acceptance& commitment therapy (ACT)to empower meaningful livingJennifer Plumb Vilardaga, PhDDuke University Medical CenterTHE ACT MODEL1. Psychological Inflexibility: potentialpsychological suffering2. Psychological Flexibility: one path forpsychological health3. Informs intervention strategies to promotepsychological health A mindfulness-based therapy from within thecognitive behavioral therapy tradition(note: health happiness)ACT MODEL OF HUMAN SUFFERING:PSYCHOLOGICAL INFLEXIBILITYFusion thoughts as realityEvaluation judgments of self, experiences, worldAvoidance unwillingness to experienceReason-Giving the “whys” for behavior, who we are, our problemsUNC Chapel Hill School of Social Work Clinical Lecture Series1
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019IS THERE ANOTHER WAY? In the place of literal meaning, there are multiplemeanings (your thinking, what is present, context,history, feelings) In the place of evaluations – own your evaluations anddo what works In the place of reason-giving – honest ignorance andcommitment to a course In the place of emotional control – emotionalopenness and acceptanceACTPROMOTESACTPROMOTESOpen UpWatch yourthinkingBe Here NowKnow WhatMattersDo What it TakesThe ObserverUNC Chapel Hill School of Social Work Clinical Lecture Series2
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019A BRIEF OVERVIEW OF THE EVIDENCE SAMHSA placed ACT on the National Registry of Evidence-based Programs and Practices(NREPP) in 2011 Substance abuse Opioid dependence (Stotts et al., 2012; Hayes et al., 2004), Methamphetaminedependence (Smout et al., 2010), self-stigma in SUD (Luoma et al., 2012) Anxiety, PTSD, and Depression OCD (Twohig et al., 2010), anxiety disorders (Arch et al., 2012; Craske et al., in press) Experiential Avoidance as a predictor (Kashdan et al., 2012; Plumb et al., 2004) Depression & anxiety (Forman et al., 2007) General distress (Lang et al., 2012), VA roll-out for depression (Walser et al., 2013) Behavioral Medicine Chronic Pain (Vowles et al., 2011; Wetherell et al., 2011) Diabetes (Gregg et al., 2007) Weight management (Forman et al., 2013) Smoking Cessation (Bricker et al., 2010; Vilardaga et al., 2018) Cancer and end of life (Rost et al., 2012; Plumb Vilardaga et al., 2019)MODEL OF INTERVENTION:OPEN (ACCEPTANCE, DEFUSION)AWARE (PRESENT MOMENT, SELF)ACTIVE (VALUES, COMMITMENT)THIS SOUNDS GREAT!BUT HOW DO I START? Early assessment from an ACT perspective 1) Ask what the client wants to be about A start may not be fully clarified (open, defusedvalues) just yet 2) Ask what gets in the way of that The client’s presenting problem as they see it. Wethen reframe that from an ACT perspective using themodel.UNC Chapel Hill School of Social Work Clinical Lecture Series3
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019Values are Guiding PrinciplesThey help us choose actions that matter most.Guiding PrinciplesARE:The direction(ongoing actions)What matters to us inour heartsA sense of meaningHow we want to actExample:Guiding Principlesare NOT:The destination (goalsor achievements)Just morals or “shoulds”People, places, activities,or feelingsHow we want others toact toward usWe don’t achieve “being caring,”but we can be caring in many situations.CONSIDERATIONS FOR VALUESPlaces to start – an easy heuristic: Connection With another person? Something in nature? Some activity(eating, drinking, music)? Caring About something, someone, or some activity? Expressingconcern or affection for self or others? Contribution To your environment/work, health, happiness, others’ wellbeing? Looking after nature, your body, mind or spirit? Across life domains (family, work, health, spirituality)EXAMPLE GUIDING PRINCIPLESBeing Caring or NurturingUnderstanding MyselfLiving with IntegrityExpressing My TalentsMentoring or Teaching OthersBeing CreativeChallenging MyselfBeing Free/IndependentBeing KindBeing Responsible or ReliableIntimacy/sharing InnerexperienceCaring for My BodyPreserving the environmentBeing Physically ActiveBeing PracticalContributing to theWorldLearningExploring or beingadventurousDeepening my Spiritual BeliefsAppreciatingBeing passionateGrowing as a PersonPromoting JusticeLeaving a LegacyHelping or Supporting OthersImproving my SkillsExpressing HumorBeing Useful or IndustriousBeing Self-DisciplinedBeing AdaptableQuestioning NormsLiving SimplyBeing HopefulBeing Tolerant/Open to NewIdeasTaking RisksFollowing TraditionBeing Guided by ReasonBeing Honest /GenuineConnecting with NatureUNC Chapel Hill School of Social Work Clinical Lecture Series4
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019My Guiding Principle:ONE Small ThingI can do in service ofthis principle betweennow and next week:WHAT GETS IN THE WAY OF VALUES?CASE FORMULATION: ABC OF ACTA: SituationWhat did younotice?ExternalEvent; orPrivateExperience(memory,thought,feeling)B: ResponseWhat did you do? ApproachAvoid/Attemptto controlPrivatePublicC: ConsequenceHow did it work?AWAY frominternalexperience?Or TOWARDmeaningfulliving?Asking many questions that help clientsexamine their own behaviorWHY THE FOCUS ONAVOIDANCE / ATTEMPTSTO CONTROL?UNC Chapel Hill School of Social Work Clinical Lecture Series5
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019LIGHT AND DARK SIDES OF extension of: Problem-solving Evaluation, judgmentPast & Future: here now Plan LearnPast & Future: here now Rumination Worry Relive trauma (PTSD)Values Self directed rules Experienced as choice Remote & verbalconsequences Guide action long termContext of literality(fusion) Thoughts reality Thoughts actionsWith the amazing abilities of our minds,suffering can occur even when we are physically safe.“Car”CARIN OTHER WORDS When people feel bad, they carry around verbaldescriptions of the hurt These descriptions keep the person in contactwith the hurt People don’t like hurting They want to avoid the hurt They try to control their thinking about the hurtUNC Chapel Hill School of Social Work Clinical Lecture Series6
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019WEGNER ‘WHITE BEAR’EXPERIMENTS Problem: The language based relationship of “not thinkingabout X” means X is in the rule Result: Even during “Avoid Anxiety” – Anxiety is in the roomPAIN VS. SUFFERINGFeel: Angry, Ashamed.Think: “It’s not fair!”; “’I’m so stupid”Response: Don’t pay it (avoidance move)LIFEPAIN:ParkingticketOutcome: Fine increasesFeel: More anger, more shame Life pain happens. Pain doesn’t feel good. And yet What if we could shift the energy to work on reducing suffering?UNC Chapel Hill School of Social Work Clinical Lecture Series7
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019ACT STANCE Suffering happens for all of us -- thanks to our minds! We do not “KNOW” -- but have a unique perspective Model tells us what difficulties may be in a person’s life Asking questions, oriented toward successful working in valueddirections, allows the client to assess for themselvesTwo Mountains MetaphorACT STANCEBalance:Being Active and Being With the clientin their suffering Allowing change to happen at client’s own pace Painful to watch suffering Remember: something is working for that client,maintaining behavior Focusing on values (strengths) can increase quality of life May never remove all sufferingINCREASING AWARENESS:EXPLORING CONTROL Exploring attempts at controlling internalexperiences Increase awareness of tendency to overuse problem-solving, fixing, or controlling strategies External objects, situations –possible(e.g., repaint the room) Internal experience – more tricky(e.g., can you pain over sadness?) What has your experience been? How hasthat worked to get you where you want to be? How much effort does it take? How would you choose to use your time?UNC Chapel Hill School of Social Work Clinical Lecture Series8
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019AWARENESS(PRESENT MOMENT) Mindfulness Perspective taking Flexible attention Noticing parts of experience, reactions to it De-mystify, label (e.g., Physicalizing) Practice willingness for parts (e.g., Tin Can Monster) What about tenseness in your chest is ‘impossible’ to have? At home or in session practice Encourage contact with the here and nowOPEN UP (ACCEPTANCE/ WILLINGNESS) Allowing, make space for, be with experience Chinese Finger Traps – lean in Quicksand – increase contact with Physicalize it Bring the unwanted along for the ride Take your keys with you Willingness is not wanting PAIN FOR A PURPOSE:Values dignify being opento experienceUNC Chapel Hill School of Social Work Clinical Lecture Series9
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019EXERCISE:YOUR THERAPISTVALUESOPEN UP (DEFUSION) Catch the process of thinking Catching theevaluative processof our mindsCatching the tendency is to respond tothoughts as if they are reality Language supports this – “I am a bad person”All in service of getting “unstuck” from the traps of our mindsUNC Chapel Hill School of Social Work Clinical Lecture Series10
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019OPENNESS TO THOUGHTS STRATEGIES A GOOD START ARE MINDFULNESS EXERCISES AIMED ATOBSERVING THOUGHTSNo one will everlove meI can’t handlethis !!I am a freakI amworthlessI am noticingthe thought that AWARENESS (OBSERVER SELF) Sense of observing one’s own experience Observation has been the constant Help transcend limitations of a rigidconceptualization of self Helpful to strengthen whenthere has been some ‘shift’in sense of self Trauma Acquired disability Re-adjusting to civilian lifeACTIVESituating Meaning and ActionVALUE GuidingPrinciple ionUNC Chapel Hill School of Social Work Clinical Lecture Series11
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019Build patterns of actions linked to ValuesGuidingPrinciple XPANDINGGUIDING PRINCIPLE ACTIVITY WORKSHEET: EXAMPLE 1Guiding Principle:RelationshipsHobby/Free TimeGuiding Principle:Sharing & being presentAction: Go to dinner with friendsAction:When, Where, Who with: Thurs nightWhen, Where, Who with:Work/CommunityGuiding Principle:Action:When, Where, Who with:Health/Well-BeingGuiding Principle:Connecting with NatureAction: Walk 10 minsWhen, Where, Who with: In mornings in thewoodsGUIDING PRINCIPLE ACTIVITY WORKSHEET: EXAMPLE 2Guiding Principle:RelationshipsHobby/Free TimeGuiding Principle:Being PlayfulAction:When, Where, Who with:Work/CommunityGuiding Principle:.Action: Watch a funny movie.When, Where, Who with: by myselfHealth/Well-BeingGuiding Principle:Action: Bringing food to a pantryAction:When, Where, Who with: Tuesday mornsWhen, Where, Who with:UNC Chapel Hill School of Social Work Clinical Lecture Series12
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019FURTHER CLARIFYING VALUES:AFTER DOING OPENNESS AND AWARENESS WORK Common for clients to use values as rigid guides ratherthan flexible ones With openness and awareness, can start to look at wherevalues become rigid, or values act as indicator for “failure”Importance of self-compassionfor our (shared) humannessVALUES RIGIDITY:EXAMPLEACT APPLIED TO COMMON ISSUES Anxiety/Worry Workability of avoidance /behaving based on worries Goes well with exposuretechniques Depression Don’t have to “feel like it” in orderto do what is meaningful Goes well with BehavioralActivation Substance Use Treatment Consistent with MotivationalInterviewing Goes well with emotionregulation model of substanceuse Health/Medical settings Begin re-orienting to values, evenwith changes in functioning A softer, gentler way to increasecompliance with medical recsAcculturation stress Increase flexibility of valuesexpression Values are not inconsistent withreligious or cultural beliefsImproving communication/familyfunctioning Attention to values as a processcan improve communication,understanding, and interpersonalfunctioningUNC Chapel Hill School of Social Work Clinical Lecture Series13
Acceptance, Commitment, and Value-based Livingw/ Jennifer Plumb Vilardaga, PhD2/11/2019WHAT TO DO NEXT Get connectedwww.contextualscience.org Values based dues get you loads of freedocuments/handouts, protocols, research articles, etc.Learn More: Lots of great texts to read One day workshop on Values in particular here atUNC on April 26, 2019Jennifer.plumb.Vilardaga@duke.eduSELF-HELP RESOURCES/ADJUNCT TO THERAPYUNC Chapel Hill School of Social Work Clinical Lecture Series14
& commitment therapy (ACT) to empower meaningful living Jennifer Plumb Vilardaga, PhD Duke University Medical Center UNC CHAPEL HILL SCHOOL OF SOCIAL WORK CLINICAL LECTURE SERIES THE ACT MODEL 1. Psychological Inflexibility: potential psychological suffering 2. Psycho
Tom Krieshok Notes on ACT page 1 of 6 Acceptance and commitment therapy Acceptance and commitment therapy (or ACT) is a behavioral treatment that is based in the idea that suffering comes not from the experience of e
Organizational Commitment Questionnaire (OCQ) measure three commitment factors: acceptance of the organization’s values and goals, willingness to work to help the organization, and a desire to remain with the organization. Organizational Commitment Scale (OCS): measures three aspects of commitment: identification, exchange, and affiliation
"Acceptance Certificate" is the means of formal acceptance issued to the Contractor by the Customer on the successful completion of a User Acceptance Test. "Acceptance Procedures" means the terms and conditions applicable to accepting completion of the Requirements and Specifications and as set out in Schedule 8 (Acceptance Procedures)
The Acceptance Criteria contained in HCIG-01 are intended to be used for final acceptance inspections and any later reinspect1ons of completed structural welds. Rhen approved by the Eng1neer, these Acceptance Criteria are also appl1cable to the reinspection of welds wh1ch have been previously inspected using HCIG-01 or other acceptance criteria.
Acceptance Rate IB Diploma Student Survey Acceptance Rate Seattle, Washington Austin, Texas 63.4% 81.5% University of Washington University of Texas at Austin Acceptance Rate Acceptance Rate 45% 39% IB Course Credits Awarded? Yes, in most cases, five quarter credits (or more) are awarded for HL subjects in which you've scored a 5 or higher.
painkillers and pain management strategies, is an intolerance and increased sensitivity to pain. II. Overview of ACT for chronic pain Acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is an acceptance and mindfulness based approach that can be applied to many problem
Acceptance and Commitment Therapy (ACT) is a mindfulness-based, values-directed behavioural therapy. There are six core processes in ACT: The Essence of ACT: 2 major goals Acceptance of unwanted private experiences which are out of personal control
behaviors, job performance, absenteeism, and tardiness (Meyer et al., 2002). Meyer and Allen (1997) provide a comprehensive overview of the theoretical lineage of this model. Key words: Organizational commitment, affective commitment, normative commitment, continuance commitment. 1. Introduction Employee is the main resource for the organization.
