ACT I -- Purpose ACT I To present the psychological flexibility model To explore the space of ACT work Steven C. Hayes To explore an in initial set of ACT methods University of Nevada This morning: the model and a little data The afternoon: examples of flexibility methods and a tape Tomorrow: skills and practice A Theme An Invitation Bring your whole self into the How can we best do room. That includes your evidence-based treatment curiosity and you skepticism. while rising to the Intend for these 2 days to make a profound difference. challenge of diversity? My commitment An Intention The 5 Year Old Sitting on the Gray and Pink Sofa Exercise and Introductions
What is a Human Mind? Answer Pivots on WE, not ME Why is Being Human So Hard? What Can Be Done About It? 7 PRAXISCET.com
My Friend Tom My Brown Baby
And Provide the Agenda ME MINDS DS TELL US WHO WE ARE My Beautiful Daughter, Camille Feel Good or Else Contingency It is the Conflict Between that Learning Drives and Something that Development. Happened Far It is Half a More Recently Billion Years Old
“ Where ’ s the Apple? ” “ Apple ” This is Derived Object sign Yields sign object Human Infants Do Not Yet Shown in Non-Humans This Readily Derived Relations Build Out into Networks • Without Normal 1. Mutual Relations That, salivation LD: Receptive sweet smooth Normal red crunchy Language Chance Apple juicy Does Not LD: No receptive Jabuka Occur 3. With Changed Functions 2. In Networks salivation sweet smooth Jabuka red crunchy juicy Devany, Hayes, & Nelson (1986)
Carrying This is the Core of Symbolic Thought, but How Did it Evolve? My Argument: Cooperation Came First Joint Attention and Understanding of Intentionality Social Referencing We Are Physically Rewarding Cooperation Attuned to Intentionality
Symbolic Thought Began as a Form of Social Cooperation Let Me and only Then Was Show You Internalized And Made Efficient Genetically This Simple Perspective Taking Extended to all Cognitive Relations But it Ultimately Extended < Learn Even to Perspective Taking Itself > Derive Reinforcer reinforcer New Functions: If then Perspective Taking Skills Contextual Self YOU The Fromness of Consciousness HERE NOW I THERE THEN
Consciousness is Social , Extending Across Time, Place, and Person Why We Need this Now A Horrifying The Design Recent Experiment Then half of each of these two groups of participants were assigned to wear a “lie detector” that supposedly could tell • 63 undergraduates were presented with accurate if their reports were believed by them to be true; the other descriptions of atrocities against Jews committed at half did not wear the “lie detector”. So this is the design: Auschwitz. • The study was a 2 X 2 design. For one factor, the last Others’ Others’ paragraph either indicated that this terrible suffering had no implications for modern Jews or it indicated Suffering Ended Suffering Persists that even today Jews suffer as a result of what happened in the holocaust. You know if I lie Imhoff, R., & Banse, R. (2009). Ongoing victim suffering increases prejudice: You don’t know if I lie The case of secondary anti-semitism. Psychological Science, 20, 1443 – 1447. doi:10.1111/j.1467-9280.2009.02457.x The Metric is Pre to Post Change in Prejudice/Objectification of Jews 0.6 Finding Prejudice Standardized Residual Change Scores went up 0.4 Can Lie Can't Lie Compassion, 0.2 Peace of 0 No change Mind and -0.2 Purpose -0.4 Prejudice went down -0.6 -0.8 -1 Suffering Suffering is Ended Persisting Imhoff and Banse, 2009
Vilardaga, Estévez, Levin & Hayes, 2012 Caring About Being With Others The Three Elements of Perspective Psychological Empathy Taking Openness Flexible Connectedness 1. Perspective Taking ✔ ✔ ✔ 2. Empathy 3. Psychological openness - Accounts for 26% of Social Anhedonia Prejudice Toward Others Three Senses of Self: Perspective Psychological Empathy Taking Opennes As Conceptualized; As a Process of Knowing; ✔ ✔ ✔ As the Fromness of - Awareness Accounts for ~40% of Poly-Prejudice What Research Tells Us What is a Human Mind? • Perspective taking is central to social and psychological functioning A collection of • Crucial to empathy and compassion biological and (large effect sizes , r = ~ .5) cultural capacities • Needed for self-acceptance and that allow us to self-compassion (moderate to large effect know and to learn sizes , r = ~ .45) through direct • Together these three processes form a experience and psychosocial system of functional connectedness symbolic derivation
Derived Relations Look Like Trained Ones Why is it So Hard? Right Hemisphere Left Hemisphere Directly Trained and Derived Relations We can experience Non-Equivalent Stimuli pain anytime, anywhere Our judgmental abilities overwhelm Directly Trained us and create the illusion of aloneness Equivalent Stimuli Barnes-Holmes, et al. (2006) Through human cognition we can We Are Feeding Something bring aversive events into any setting Depression (1990-2020): 4, 3, 2, 1 “ Car ” 1980 – 2010 adult stress CAR 1930 – 2010 MMPI Chronic pain LOOK AT WHAT WE SELL
I’m ___ The Illusion of Aloneness Open Acceptance Essential Components of ACT Defusion
Contact with the Present Moment Acceptance Essential Components of ACT Aware Defusion Self as Context Actively Contact with the Present Moment Engaged What Can We Do About it? Acceptance V alues From the WE of Awareness we Can Essential Components Learn to Open Up, to of ACT Be Here, and to Care and Live on Purpose Defusion Committed Action as Part of the Community. Self as Context
Perspective Taking Helps Us Contact with the The Rx Present Moment Model Acceptance V alues Come into the Now, and Psychological Flexibility Let Engage Go Life Defusion Committed Action Self as Context Spinhoven, Drost, de Rooij, van Example Correlational and Longitudinal Hemert & Penninx, 2014, BT Psychological flexibility predicts most forms 2,316 adults assessed with diagnostic of psychopathology and quality of life in interviews and a psychological flexibility children, adults, and the elderly measure over a four year period Mediates the effects of many is not most Flexibility predicted anxiety and depressive key targeted processes in evidence based disorders two years later, beyond baseline treatment: e.g., anxiety sensitivity, cognitive values of these disorders. reappraisial and so on Flexibility mediated over 4 years the growth and clustering of disorders Controlled Studies on an Amazing Range of Areas ACT RCTs work stress, pain, smoking, anxiety, depression, diabetes management, substance use, stigma toward substance users in recovery, adjustment to cancer, epilepsy, coping with psychosis, borderline personality disorder, trichotillomania, obsessive-compulsive disorder, marijuana dependence, skin picking, racial prejudice, prejudice toward people with mental health problems, whiplash associated disorders, generalized anxiety disorder, chronic pediatric pain, weight- maintenance and self-stigma, exercise, chess playing, tinnitus, eating disorders, clinicians’ adoption of evidence-based pharmacotherapy, and training clinicians in psychotherapy methods other than ACT.
ACT and US Japanese Students Study Design Muto, Hayes, & Jeffcoat, 2011 • 70 of all 138 Japanese students participated • It is hard to be an international student • 35 get a Japanese translation of Get Out of Your • Japanese students are the largest group at the Mind and Into Your Life (translation done by Drs. University of Nevada Muto, Harai, Yoshioka, and Okajima); 35 wait list • But sometimes students are ashamed to seek help • 8 weeks to read it (with quizzes); 2 mo. follow up • Strategy: bibliotherapy to a large portion of the • Wait list then also gets 8 weeks to read it student group. And will ACT work with Asian students? Reliable Changes for those with Some Result – General Mental Health Depression (DASSD > 13) Wait List Workbook +75% +50% Average + level of a +25% treatment + seeking clinical 0% - population -25% Impact on Rehospitalization Coping with Psychotic Symptoms Bach & Hayes, JCCP, 2002 1.0 ACT Could this work even with the most horrifying .9 forms of private events? .8 80 S ’ s hospitalized with hallucinations and/or .7 delusions randomized to either ACT or TAU 3 hours of ACT; all but one session in-patient .6 Treatment as Usual ACT intervention focused on acceptance and 40 80 120 defusion from hallucinations / delusions Days After Initial Release
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