ACT Book Summary: Pages 141 - 147

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Chapter 5 finishes with:

  1. personal work for the clinician
  2. a clinical vignette
  3. appendices containing daily experiences diary, identifying programming exercise, feeling good exercise, rules of the game exercise and clean versus dirty discomfort diary. I'll deal with each of these in turn:

Personal work for the clinician
Having identified a problem in your own life, explore the strategies that you have used or are currently using to solve this problem
a) consider each strategy and designate it as either an acceptance or control strategy
b) examine the distribution of control and acceptance strategies. Is there a trend?
c) For each control strategy, identify what it was that you hoped (hope) to control, avoid, manipulate, change or eliminate

Clinical Vignette
The clinical vignette describes a 45yo male with severe anxiety attacks at work and more recently at home. There is stress at work (high stress job), a recent move and relationship difficulties. The client uses deep breathing, distraction, hypervigilance to physical symptoms, avoidance of work and tranquilizers to cope with the anxiety.

The question(s) for clinicians are:
a) how would you conceptualize the client's major coping strategies and assumed goals?
b) How would you discuss these solutions with the client?
c) What would your goal(s) be in doing so

The answers are as follows:
a) strategies are primarily to reduce or control anxiety and appear not to work (long term)
b) is anxiety serving another function? Are there areas in your life that you legitimately have reason to be anxious about
c) Goal is to separate clean versus dirty anxiety (legitimate stressors versus the struggle, fusion)

Appendices

Daily experiences diary
Client records uncomfortable moments, including feelings, thoughts and bodily sensations as well as efforts to handle these things
Client and therapist can explore the use of acceptance versus control strategies. Therapist can reinforce strategies that reflect acceptance.

Willingness diary
Client provides a global rating for each day (e.g., emotion rating from 1-10).
Client records the amount of effort put in to getting this to go away (rating 1-10)
Client records how workable the day was (rating 1-10)
Client and therapist explore the relationships between the struggle to controland the workability of the day.

Identifying programming exercise
Clients are encouraged to explore how a significant childhood event (or events) shaped or programmed who they are now to demonstrate how dysfunctional coping strategies are passed on. This is to demonstrate the arbitrary nature of learning events.

Feeling good exercise
Clients fill out a questionnaire tapping into a number of specific language rules that act as self-instructions (e.g., "the way to be healthy is to learn better and better ways to control and eliminate negative emotions")

Rules of the game exercise
Clients are asked to generate their favorite life sayings (e.g., no pain, no gain).
Client and therapist can then explore sayings with reference to acceptance versus control strategies or on the basis of a number of other dimensions (e.g., black/white thinking, severity of consequence, good versus bad)

Clean versus Dirty discomfort diary
Client is encouraged to explore particular "high risk" situations in terms of clean discomfort (what immediately showed up in the way of thoughts, feelings etc) versus dirty discomfort (what emerged as a result of the struggle with these initial feelings)