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Rational Emotive behaviour therapy - Goals of Therapy

• learn to separate evaluation of behaviour from evaluation of self. - identify irrational, self-defeating beliefs - directly challenge/disputing irrational beliefs. - modify thinking by replacing thoughts based on irrational belief with ones based on rational beliefs. - achieving unconditional self-acceptance & unconditional other acceptance

Primary contribution of REBT

Ellis' insistence that psychological disturbance is maintained by distorted beliefs

Other critical points

clients create their own emotional disturbance by irrational thinking & they can alleviate suffering by changing their underlying thoughts - therapists must teach clients how to monitor carefully their language for words such as should, must, ought, and always - therapists can challenge clients' illogical thinking

Criticisms of REBT

• places too much emphasis on thought processes to the relative exclusion of many legitimate feelings; may contribute to repression or denial of feelings - small range for client effectiveness

Acceptance & Commitment Therapy (ACT) Two Major Goals

1. Acceptance of unwanted thoughts & feelings that the client cannot control 2. Commitment & action of the client which are consistent with client's personal values. Embrace your demons and follow your heart!

Relational Frame Theory is the Foundation of

ACT

Central theoretical tenet - individuals relate to events on multiple levels

1. Relational frames 2. Evaluative frames 3. Temporal frames 4. Causal Frames 5. Spatial frames

Relational frames =

comparative & evaluative frames e.g., "I am smarter than…" or "I am slower than…"

Evaluative frames =

relation of identity, sameness, or similarity e.g., "I am different from…" or "I am similar to…"

Temporal frames =

relation to past, present, future (self) e.g., "If I thought that way then…", "If I were younger then…"

Causal Frames =

relation to what lead to a particular event occurring e.g., "cause of" or "My depression in the cause of…"

Spatial frames =

relation of distance to self e.g., "near/far" or "here/there"

Relational Frame Theory argues

the ability to form and use these different relational frames is at the heart of people's ability to cope successfully. Therefore, relational frames can also be at the core of psychological distress. "Even beautiful sunsets may not be safe for individuals in pain… If 'happy' is the opposite of 'sad', then happiness can remind human beings of being sad. The two are related." (Hayes & Smith, 2005, pg. 21)

Change Processes - ACT is considered a

transdiagnostic treatment

Psychological Inflexibility is

at the core of individuals experiencing psychological issues

Psychological flexibility =

contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behavior in the service of chosen values (Hayes, 2004)

Psychological inflexibility is maintained by 6 interrelated processes

1. Cognitive Fusion 2. Attachment to conceptualized self 3. Experiential avoidance 4. Disconnection from the present moment 5. Unclear values 6. Inaction with respect to values

1. Cognitive Fusion (self-as-content) =

tendency to take thoughts (& feelings) literally, leading us to believe they accurately describe how things are rather than seeing them as they actually are - just thoughts, Looking at thoughts, rather than from thoughts.

Antidote of Cognitive Fusion

Cognitive Defusion (self-as-process or self-as-context) = let go of thoughts as valid explanation of your experience, so they can be seen only as thoughts e.g., "I am doing something with my thoughts"

ACT Change Processes - Cognitive Fusion-Defusion

Am I the thoughts that are going through my head? Or, am I the one who is aware of these thoughts that are going through my head?

Who am I, then?

1. Physical self 2. Thinking self or "mind" 3. Observing self

2. Attachment to the Conceptualized Self =

extreme cognitive fusion with entire self-concept! invested in stories of about who they are and how they got that way

Attachment to the Conceptualized Self Results in

highly rigid behaviours aimed at validating/defending one's stories

Attachment to the Conceptualized Self Antidote

Detachment from Conceptualized Self (C.S.) = become observers of C.S. & recognize that their C.S. is not who they are - it is just a story

3. Experiential Avoidance =

escape from or avoid unpleasant private (i.e., internal) events such as thoughts, feelings, physical sensations, & circumstances that might lead to them (e.g., distraction)

Antidote of Experiential Avoidance

Experiential Acceptance

4. Disconnection from the Present Moment =

living almost exclusively in our internal reality, which is often in the past or future; "living in our heads"

Disconnection from the Present Moment Antidote

Mindful Contact with Present Moment employing strategies from MBCT or Mindfulness Based

Stress Reduction (Kabbat-Zinn) are often used to

increase moment to moment engagement Mindfulness-Based Cognitive Therapy (MBCT) Core Themes

Decentering =

capacity to take a present focused & non-judgmental stance regarding thoughts & feelings, and to accept them

Doing mode versus Being mode =

moving from a lot of thinking about future or past (doing) to a non-striving and non-judgmental mode

5. Unclear Values =

unsure of what is "near and dear" to them, unclear on core values, having difficulty acting, feel "stuck" & behaviours become habitual & automatic

Unclear Values Antidote

Increase Clarity of Values = discover, clarify and focus on things that are important to them, on their personal values; clear values help guide/direct actions in a purposeful way

6. Inaction with respect to Values =

result of unclear values or experiential avoidance

Inaction with respect to Values Antidote

Value-Guided Action or "committed action" = encouraging clients to act in accordance with their values but also "commit" to value-guided behaviour fully; trying to live in terms of your values is different from committing to live by your values

Core Skills in MBCT

1. Attention and Awareness 2. Accepting and letting go

Attention and Awareness

• increase awareness of little attention to present moment! - then to "wandering mind" and the "doing mode" - learn to bring attention back to a single focus

Accepting and letting go

• step out & stay out from these routines by letting go - relinquish involvement in cognitive routines, freeing self from attachment/aversion driving the thinking pattern - thought as mental events, not facts

MBCT Training Program

8 weekly, 2-hour sessions (max 12 group members)

Sessions 1 to 4

fundamental skills, pay attention to present internal and external experiences without evaluating them

Sessions 5 to 8

approach mood shifts more mindfully; accepting and letting go - relapse prevention strategies; monthly follow-up - the more mindfulness exercises you do, less likely to experience a subsequent depressive episode

ACT Interventions - Use of Matrix

Sets up psychological flexibility point of view

ACT as an Approach

stresses accepting painful thoughts/ feelings, committing to engaging in behaviours, consistent with one's values, and promoting psychological flexibility, promotes Acceptance and Change

Transdiagnostic approach

used with many different types of disorders/psychological issues!

ACT Evidence for efficacy with particular populations

Chronic pain - strong evidence, highly efficacious! OCD, anxiety disorders, depression - moderate level of efficacy

ACT in perspective

ACT research continues to be more theory driven, examining the six factors contributing to psychological inflexibility through