Choice Point Model

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From Joseph Ciarrochi:

I wanted to introduce you to a model Ann Bailey, Russ Harris, and I have come up with for facilitating ACT and CBS interventions. The three of us have been using this model continuously, now, for about 6 months, with a wide variety of clients, and we are finding it to be extremely effective. Clients love it.

You can find a PDF of the powerpoint on the Choice Point Model below.

You can also find the powerpoint below, along with an example worksheet.

A choice point is a moment in time when it is possible to choose between values consistent and values inconsistent behaviour.The CP allows you to record key aspects of the situation, the difficult inner experience that shows up, the values ,skills, and strengths used to respond effectively to the situation and the inner experience, and finally the behaviour that can be either value consistent or value inconsistent.

What is the choice point model

The Choice Point is a simple way to help you and your client keep track of where you are in an ACT/ACBS intervention. In the above document,we show how you can use it to summarise willingness, defusion, and self-compassion. It can be used to keep track of all ACT processes, as Russ will illustrate later in videos. We have found that Choice Point gives the client a sense of a safe framework and allows them to be more exploratory, knowing that they can always come back to the ³map², the CP, and know where they are.

There will be questions about how this model relates to other models. The choice point has a clear mapping to tobias and Joanne¹s Bulleseye ,in that the emphasis is on value consistency, rather than appetitive versus aversive-driven behaviour. It is also inspired by the Matrix ability to put things into a simple framework and reach many people .We were struggling to do just that, as we (Ann and I) had to teach ACT principles to dieticians, football players, and other folks who did not necessarily have sophisticated psychological training. After much trial and error with clients, we finally got to the Choice point (and Ann had been using a variant of this for years with Borderline clients).

As far as we can tell, the choice point complements other approaches and does not contradict them.

The Choice Point model illustrates different points of intervention. For example, for the ³situation² part of the choice point (bottom), one can target situation selection and modification (e.g., problem solving, re-engineering the environment). In the values and skills section (bottom right), you can help the client to modify the form or frequency of inner experience (traditional CBT) or you can help the client to respond flexibly to the situation and the inner experience (ACT) or you can help the client identify and use strengths (positive psychology). Of course most therapies probably do all of these activities and differ only in emphasis.

The choice point model and contextual behavioural science: Going beyond ACT

We have attempted to make the CP more generally about Contextual Behavioral Science than ACT. Thus, the choice point worksheet has a place to describe the situation (antecedent events) and the consequences (whether the behaviour is value consistent or inconsistent). The Choice point allows for some avoidance behaviour to be a value-consistent and some appetitive behaviour to be value inconsistent . In a CBS approach, no behaviour is inherently good or bad. It is always assessed in the context of the situation and its consequences to the organism. I have long argued that some appetitive behaviour is value-inconsistent. It doesn¹t have to be "crazy-appetitive" as Kelly puts it. It can be a series of small choices, small appetitive moves, that gradually take you away from the things you
care about. For example, a recent paper shows that induced positive mood can lead to overeating. That sounds like eating under mild appetitive control. Other research shows that as the number of people you eat with increases, so does the amount you eat Šagain, I doubt this effect is mainly about avoidance.

OK, let me be controversial here (you all know how much a love this community and my belief that controversy is necessary). I think that we in ACT (including me) are sometimes making three mistakes.

Mistake 1: Its all about avoidance. I don¹t think we should assume avoidance underpins all unhelpful behaviour. The psychodymanic folks have tried that before us, and I think mostly failed. You can always play the game of "gotcha" and come up with an avoidance explanation for anything, but I think it would be fairly surprising if the appetitive system did not play a key role in some value-inconsistent behaviour. Mostly, behaviour is under both appetitive and aversive control (e.g., I feel guilty if I don¹t exercise and I love exercising)

I'm not saying that avoidance is not central to our suffering; I'm just saying that a complete CBS approach will include potential causes of unworkable behaviour, other than what is explicitly stated in ACT hexeflex.

Mistake 2: Mindfulness is universally good and the "holy grail" of well-being. Being mindful is just another behaviour, which means it's utility needs to be evaluated in context. Recent research suggests that
mindfulness not only disrupts bad habits, it can slow the formation of good habits. Of course, everything depends on how you define the behaviour "mindfulness" and we could play the game of "gotcha," where anything beneficial can be described as involving mindfulness. If everything beneficial is based on mindfulness, then I propose we replace the word "mindful" with "beneficial." I do prefer the ACT phrase, "contact with the present moment", as it seems to have less baggage, and one can easily imagine when contact with the present moment isn't the best move (e.g., when planning and imagining possible futures).

Mistake 3: All attempts at reappraisal and suppression are bad. Again, I return to the CBS mantra Šthe attempt to change inner experience is a type of behaviour, that can only be evaluated in context. I think the coming years will see a push to more clearly specify when interventions like cognitive reappraisal are most and least likely to work (a recent study suggests reappraisal does not work so well when folks can control the situation). Anyway, as you folks know, ACT already does plenty of cognitive restructuring types of stuff, in the form of psych-education and in expanding how people think about feared things.

In closing, I hope what I am putting out there will be of use.

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