Dr. Richard Blonna

1. Stress Less, Live More: How Acceptance and Commitment Therapy Can Help You Lead a Busy yet Balanced life Dr. Richard Blonna

2. What is Stress? • Stress means different things to different people • What stresses some people challenges others • Four classic ways to define stress : stimulus, response, transaction, and holistic phenomenon

3. Stress is a Stimulus • Stress is something in the external environment • Stress is defined by the stimuli that one is exposed to (stress is bills, work, taxes etc.) • Some stimuli are defined as “life events” (Holmes & Rahe)

4. Stress is a Response • Stress is something in the internal environment • Stress is defined as “the non-specific response of the body to any demand” (Hans Selye) • The non-specific response include symptoms such as increased muscle tension, breathing rate, hormonal release, metabolic rate etc.

5. Stress is a Transaction • Stress is a transaction between a stimulus and a response (Lazarus & Folkman, 1987) • The transaction revolves around the appraisal of a “potential stressor” based on two questions: Is it a threat? Can I cope? Stimulus (potential stressor) and Personality (the individual) factors mediate the transaction

6. Stress as a Holistic Phenomenon • Stress is a response that that occurs when the dimensions of health (physical, social, spiritual, emotional, intellectual, occupational and environmental) are out of balance. • Lack of balance causes the body to make adjustments in order to regain and maintain homeostasis

7. All of these Definitions are Partially Correct • In actuality, stress is all of these things (stimulus, response, transaction, holistic phenomenon) combined. • Each of the classic ways of defining stress accounts for a piece of the puzzle.

8. A New Way of Defining Stress • “Stress is a holistic transaction between an individual and a potential stressor resulting in a stress response (Blonna, 2006).” • Blonna’s definition combines elements of the four classic definitions to form a more eclectic picture of stress.

9. What is ACT? • Acceptance and commitment therapy (ACT) is a third wave form of cognitive behavior therapy (CBT) grounded in relational frame theory (RFT • Numerous ACT studies support its efficacy in treating anxiety, schizophrenia, depression, workplace stress, and burnout, pain, drug use, psychological adjustment to cancer, and diabetes self-management (Ciarrochi & Bailey, 2008).

10. What is ACT? • An underlying premise of ACT is that mental suffering occurs when clients become psychologically-inflexible and get stuck • ACT helps clients become more psychologically flexible, get unstuck, and engage in values-congruent behavior

11. Values-Congruent Behavior • The primary therapeutic outcome for ACT is getting clients to behave in ways that are congruent with their values • Two key aspects of this are helping clients clarify their values and setting behavioral goals that are congruent with these values

12. The Acceptance Component of ACT • Acceptance has three aspects : 1. Becoming more mindful of thoughts, emotions, and actions 2. Understanding how thoughts, emotions, and actions support or oppose values and goals 3. Accepting that trying to control, avoid, or eliminate painful thoughts and feelings is impossible and makes them worse

13. The Commitment Component of ACT • Acceptance and Commitment work together acceptance is the cognitive part commitment is the behavioral part • Commitment involves sticking to values-congruent behavior while coexisting withtroubling thoughts and painful emotions

14. The Therapeutic Component of ACT • ACT does not focus on over-analyzing the past or trying to change thoughts, personal scripts, mental images and emotions • ACT is based on RFT research that demonstrates the effectiveness of accepting painful thoughts and troubling emotions and focusing on values-congruent behavior

15. ACT and RFT • ACT is grounded in Relational Frame Theory (RFT), the language theory that underlies it • RFT proposes that current thoughts, personal scripts, mental images and emotions related to stress are linked to their original frames of reference (what RFT refers to as relational frames) from the past in which they were initially learned

16. An RFT View of the Human Mind • RFT compares the mind to a 24/7 computer that is running multiple programs simultaneously • The “programs” are thoughts, personal scripts, mental images, and emotions • At times, some of the programs get “corrupted” and cause the mind to freeze (get stuck) and crash

17. Relational Frame Theory • The mind uses information from previous relational frames as the basis for assessing the threat posed by current stressors • In addition, the mind can carry this one step further and use the same previous information to jump ahead and project an infinite number of future situations involving this and similar stressors

18. Thoughts • Thoughts do not occur in a vacuum, they are connected to specific relational frames • An underlying principle of ACT is that all thoughts are not equally helpful or important • ACT evaluates thoughts in terms of whether or not they are helpful in reaching goals and taking valued action.

19. Thoughts • Can organize thoughts in terms of their helpfulness: helpful thoughts – are consistent with one’s values and goals and facilitate values-congruent behavior unhelpful thoughts - are inconsistent with one’s values and goals and interfere with values-congruent behavior.

20. Personal Scripts • Personal scripts are like scenes in a play except the play is one’s life. • Each script has its own inner dialogue (self- talk) that represents how the scene played out (old script) is currently running (present script) will ultimately play out (future script).

21. Personal Scripts • Each script is connected to a relational frame, the context that sets the stage for the inner-dialogue • Personal scripts often get outdated because the relational frame or the person changes • Outdated personal scripts are seldom helpful in taking valued action.

22. Mental Images • Mental images are the visual images that accompany the personal scripts • Think of the scripts as the dialogue and the images as the moving pictures • As with personal scripts, mental images are linked to relational frames that set their context

23. Mental Images • Mental images, are similar to personal scripts in that they can get outdated and no longer represent who the person is • Many adults still have images of themselves as helpless or worthless children • Outdated mental images are seldom helpful in taking valued action.

24. Emotions • ACT views emotions as something that cannot be controlled and therefore should be acknowledged and accepted not analyzed or changed • Emotions are also linked to past, present, or future relational frames • Even though emotions cannot be controlled, the behavior associated with them can be

25. RFT and Control • The mind’s ability to synthesize past and present relational frames and extrapolate into the future is tremendously useful when planning for things it can control: behavior some aspects of the environment These are known as external potential stressors

26. RFT and Control • The same ability can also be a source of emotional distress when dealing with things it cannot control: thoughts personal scripts mental images emotions • These are known as internal potential stressors

27. RFT and Control • RFT teaches us that the more people try to control, avoid, or eliminate potential stressors that cannot be controlled, the worse they get • Learning how to manage them is the key be mindful of them accept them be willing to act while coexisting with them

28. Acceptance vs Control • Most people fail in their stress management attempts because they try to control, avoid, or eliminate internal potential stressors • This is doomed to fail because more than half of all stress is associated with internal potential stressors that cannot be controlled

29. ACT & Stress • Often clients who seek the services of therapists and counselors do not have mental disorders that meet the criteria established in the DSM lV • These clients, the “worried well”, are stuck because of their psychological inflexibility, and suffer from stress, anxiety and worry that keeps them from taking values-congruent action

30. ACT & Stress • The worried well, like clients with more serious mental disorders, also struggle with: unhelpful thoughts, personal scripts, mental images, and emotions that contribute to their psychological inflexibility and keep them stressed and stuck in a rut

31. ACT & Stress • ACT can help these clients develop greater psychological flexibility, get unstuck, take values-congruent action, and meet their goals • ACT can also help these clients keep their stress, anxiety, and worry from turning into more serious mental disorders

32. An ACT View of Stress • An ACT view of stress supports a transactional way of defining stress • Thoughts, personal scripts, mental images, and emotions all come into play during the stress appraisal process

33. An ACT View of Stress • All of the core process that contribute to psychological inflexibility also come into play during stress transactions • All of the six therapeutic processes can be adapted to help clients manage their stress

34. The Six Core Processes • There are six “core processes,” that contribute to psychological inflexibility and stress: attachment to the conceptualized self cognitive fusion dominance of outmoded scripts and learning experiential avoidance lack of clarity concerning values inaction, impulsivity, and rigidity.

35. Attachment to the Conceptualized Self • The conceptualized self refers to the self- descriptions clients to describe themselves: “I’m a mother” “I’m of average height and build” “I’m a happily married man” “I’m an architect” “I’m a teacher” • The mind creates stereotypes or shortcuts around these descriptions

36. Attachment to the Conceptualized Self • These statements sum up how people view themselves and measure up to societal standards (IQ, SES, body image etc.) • ACT refers to this way of describing the self as a self-as-content view (you are the sum total of all of the things contained within you) • People get attached to their self-statements

37. Attachment to the Conceptualized Self and Stress • Stress clients often take a self-as-content view of themselves • They use labels and past diagnoses to describe themselves and their problems (social phobic, asthmatic, dyslexic, etc.) • Often these labels limit their psychological flexibility and coping options resulting in stress

38. Cognitive Fusion • Cognitive Fusion is the process of fusing with an aspect of the conceptualized self • Can fuse with positive or negative attributes: I am a runner (positive) I am a loser (negative) • In a sense, cognitive fusion is over-attachment to one aspect of the conceptualized self

39. Cognitive Fusion & Stress • Stress clients often fuse with elements of their conceptualized self and create stereotypes that limit their potential • A common occurrence with cognitive fusion is the person becoming the problem: “I am an asthmatic” vs. “I am someone who has asthma”

40. Dominance of Outmoded Personal Scripts & Stress • Stress clients often fuse with personal scripts and prior learning that are outmoded and no longer represent who they are as individuals • The relational frames these scripts are based on relate to failed attempts to cope with potential stressors that were similar in nature to the ones being appraised in the present moment

41. Lack of Clarity of Values & Stress • Stress clients often feel unable to cope with potential stressors that threaten their values • Sometimes the threat is due to being unclear about the underlying values • Stress clients often adhere to values that are based on outmoded personal scripts that no longer represent who they are

42. Experiential Avoidance & Stress • Stress clients often avoid experiences that expose them to potential stressors that they’ve previously found stressful • Their 24/7 thinking and feeling machines (their minds) project into the future and extrapolate a limitless number of threatening and failed coping scenarios based on past relational frames

43. Inaction, Impulsivity, Rigidity, & Stress • Experiential avoidance contributes to stress clients’ inaction and rigidity due to a lack of understanding of the relationship between action and personal values • They often act impulsively because their behavior is not congruent with their values (often due to lack of clarity regarding their values)

44. Psychological Inflexibility and Unhelpful Thinking Traps • Psychological inflexibility often results in falling into common thinking traps • Blonna (2010), synthesized 10 common thinking traps that contribute to getting stuck • ACT refers to the process of falling into these thinking traps as “getting hooked”

45. The “Thoughts Are Reality” Trap • This is based on the belief that the thoughts clients have about events represent the objective reality of the events • In fact, unless they are experiencing events first-hand, their thoughts are just that; what they think about the event • Clients fall into the trap when they think their thoughts are the actual events instead of just their thoughts about them

46. The “Thoughts are True” Trap • The “thoughts are true” trap is based on the belief that just because clients think of something that these thoughts must be true. • Many of the thoughts clients have are really judgments or evaluations and not really ‘truths” based on evidence • Clients fall into the “thoughts are true” trap when they fail to realize that these truthsare really their personal judgments or evaluations.

47. The “All Thoughts Are Equally Important” Trap • The “all thoughts are equally important” trap gives equal weight to all thoughts • Clients fall into this trap when they take all of their thoughts too seriously (after all, they are only thoughts) and assign them the same high importance.

48. The “Thoughts Are Orders” Trap • The “thoughts are orders” trap revolves around the belief that just because clients think about doing something they feel that they have to act on it. • Clients fall into the “thoughts are orders trap” when they mindlessly act in response to unhelpful thoughts because they took them as marching orders.

49. The “Thoughts Are Threats” Trap • Thinking that something can harm you is different from actually being in harm’s way. • Sticks and stones will break your clients bones, but words (or thoughts) will never hurt them, unless they allow them to. • Clients fall into this trap when they believe their thoughts can actually cause themselves harm.

50. The “Outdated Personal Scripts” Trap • Based on the belief that outdated personal scripts are still valid • In reality, outdated scripts are like faded old newspaper clippings from the past • Clients fall into this trap when they think these old scripts are still valid even though they stand in the way of creating newer, more helpful ones