Techniques and Components
Techniques and ComponentsThis section is for ACBS members to share techniques you may find useful for some of the treatment components of the ACT model.
Facing the Current Situation ("Creative Hopelessness")/Control is a Problem
Facing the Current Situation ("Creative Hopelessness")/Control is a ProblemPurpose: To notice that there is a change agenda in place and notice the basic unworkability of that system; to name the system as inappropriately applied control strategies; to examine why this does not work
Method: Draw out what things the client has tried to make things better, examine whether or not they have truly worked in the client’s experience, and create space for something new to happen.
When to use: As a precursor to the rest of the work in order for new responses to emerge, especially when the client is really struggling. You can skip this step in some cases, however.
Things to avoid: Never try to convince the client: their experience is the absolute arbiter. The goal is not a feeling state, it is what the Zen tradition calls “being cornered.”
Examples of techniques designed to increase creative hopelessness:
| Creative hopelessness | Are they willing to consider that there might be another way, but it requires not knowing? |
| What brought you into treatment? | Bring into sessions sense of being stuck, life being off track, etc. |
| Person in the Hole exercise | Illustrate that they are doing something and it is not working |
| Chinese handcuffs Metaphor | No matter how hard they pull to get out of them, pushing in is what it takes |
| Noticing the struggle | Tug of war with a monster; the goal is to drop the rope, not win the war |
| Driving with the Rearview Mirror | Even though control strategies are taught, doesn’t mean they work |
| Clear out old to make room for new | Field full of dead trees that need to be burned down for new trees to grow |
| Break down reliance on old agenda | “Isn’t that like you? Isn’t that familiar? Does something about that one feel old?” |
| Paradox | Telling client their confusion is a good outcome |
| Feedback screech metaphor | It's not the noise that is the problem, it’s the amplification |
| Control is a problem | How they struggle against it = control strategies (ways they try to control or avoid inner experience). |
| The paradox of control | “If you aren’t willing to have it, you’ve got it.” |
| Illusion of control metaphors | Fall in love, jelly doughnut, what are the numbers exercise |
| Consequences of control | Polygraph metaphor |
| Willingness vs. control | Two scales metaphor |
| Costs of low willingness | Box full of stuff metaphor, clean vs. dirty discomfort |
These clinical materials were assembled by Elizabeth Gifford, Steve Hayes, and Kirk Stroshal
Cognitive Defusion (Deliteralization)
Cognitive Defusion (Deliteralization)Purpose: See thoughts as what they are, not as what they say they are.
Method: Expand attention to thinking and experiencing as an ongoing behavioral process, not a causal, ontological result
When to use: When private events are functioning as barriers due to FEAR (fusion, evaluation, avoidance, reasons)
Examples of defusion techniques
| ‘The Mind” | Treat “the mind” as an external event; almost as a separate person |
| Mental appreciation | Thank your mind; show aesthetic appreciation for its products |
| Cubbyholing | Label private events as to kind or function in a back channel communication |
| “I’m having the thought that …” | Include category labels in descriptions of private events |
| Commitment to openness | Ask if the content is acceptable when negative content shows up |
| Just noticing | Use the language of observation (e.g., noticing) when talking about thoughts |
| “Buying” thoughts | Use active language to distinguish thoughts and beliefs |
| Titchener’s repetition | Repeat the difficult thought until you can hear it |
| Physicalizing | Label the physical dimensions of thoughts |
| Put them out there | Sit next to the client and put each thought and experience out in front of you both as an object |
| Open mindfulness | Watching thoughts as external objects without use or involvement |
| Focused mindfulness | Direct attention to nonliteral dimensions of experience |
| Sound it out | Say difficult thoughts very, very slowly |
| Sing it out | Sing your thoughts |
| Silly voices | Say your thoughts in other voices -- a Donald Duck voice for example |
| Experiential seeking | Openly seek out more material, especially if it is difficult |
| Polarities | Strengthen the evaluative component of a thought and watch it pull its opposite |
| Arrogance of word | Try to instruct nonverbal behavior |
| Think the opposite | Engage in behavior while trying to command the opposite |
| Your mind is not your friend | Suppose your mind is mindless; who do you trust, your experience or your mind |
| Who would be made wrong by that? | If a miracle happened and this cleared up without any change in (list reasons), who would be made wrong by that? |
| Strange loops | Point out a literal paradox inherent in normal thinking |
| Thoughts are not causes | “Is it possible to think that thought, as a thought, AND do x?” |
| Choose being right or choose being alive | If you have to pay with one to play for the other, which do you choose? |
| There are four people in here | Open strategize how to connect when minds are listening |
| Monsters on the bus | Treating scary private events as monsters on a bus you are driving |
| Feed the tiger | Like feeding a tiger, you strengthen the impact of thoughts but dealing with them |
| Who is in charge here? | Treat thoughts as bullies; use colorful language |
| Carrying around a dead person | Treat conceptualized history as rotting meat |
| Take your mind for a walk | Walk behind the client chattering mind talk while they choose where to walk |
| How old is this? Is this just like you? | Step out of content and ask these questions |
| And what is that in the service of? | Step out of content and ask this question |
| OK, you are right. Now what? | Take “right” as a given and focus on action |
| Mary had a little …. | Say a common phrase and leave out the last word; link to automaticity of thoughts the client is struggling with |
| Get off your buts | Replace virtually all self-referential uses of “but” with “and” |
| What are the numbers? | Teach a simple sequence of numbers and then harass the client regarding the arbitrariness and yet permanence of this mental event |
| Why, why, why? | Show the shallowness of causal explanations by repeatedly asking “why” |
| Create a new story | Write down the normal story, then repeatedly integrate those facts into other stories |
| Find a free thought | Ask client to find a free thought, unconnected to anything |
| Do not think “x” | Specify a thought not to think and notice that you do |
| Find something that can’t be evaluated | Look around the room and notice that every single thing can be evaluated negatively |
| Flip cards | Write difficult thoughts on 3 x 5 cards; flip them on the client’s lap vs. keep them off |
| Carry cards | Write difficult thoughts on 3 x 5 cards and carry them with you |
| Carry your keys | Assign difficult thoughts and experiences to the clients keys. Ask the client to think the thought as a thought each time the keys are handled, and then carry them from there |
These clinical materials were assembled by Elizabeth Gifford, Steve Hayes, and Kirk Stroshal
Acceptance
AcceptancePurpose: Allow yourself to have whatever inner experiences are present when doing so foster effective action.
Method: Reinforce approach responses to previously aversive inner experiences, reducing motivation to behave avoidantly (altering negatively reinforced avoidant patterns).
When to use: When escape and avoidance of private events prevents positive action
Examples of acceptance techniques
| Unhooking | Thoughts/feelings don’t always lead to action |
| Identifying the problem | When we battle with our inner experience, it distracts and derails us. Use examples. |
| Explore effects of avoidance | Has it worked in your life |
| Defining the problem | What they struggle against = barriers toward heading in the direction of their goals. |
| Experiential awareness | Learn to pay attention to internal experiences, and to how we respond to them |
| Leaning down the hill | Changing the response to material – toward the fear not away |
| Amplifying responses | Bring experience into awareness, into the room |
| Empathy | Participate with client in emotional responding |
| In vivo Exposure | Structure and encourage intensive experiencing in session |
| The Serenity Prayer | Change what we can, accept what we can’t. |
| Practice doing the unfamiliar | Pay attention to what happens when you don’t do the automatic response |
| Acceptance homework | Go out and find it |
| Discrimination training | What do they feel/think/experience? |
| Mindreading | Help them to identify how they feel |
| Journaling | Write about painful events |
| Tin Can Monster Exercise | Systematically explore response dimensions of a difficult overall event |
| Distinguishing between clean and dirty emotions | Trauma = pain + unwillingness to have pain |
| Distinguishing willingness from wanting | Bum at the door metaphor – you can welcome a guest without being happy he’s there |
| How to recognize trauma | Are you less willing to experience the event or more? |
| Distinguishing willingness the activity from willingness the feeling | Opening up is more important that feeling like it |
| Choosing Willingness: The Willingness Question | Given the distinction between you and the stuff you struggle with, are you willing to have that stuff, as it is and not as what it says it is, and do what works in this situation? |
| Focus on what can be changed | Two scales metaphor |
| Caution against qualitatively limiting willingness | The tantruming kid metaphor – if a kid knew your limits he’d trantrum exactly that long; Jumping exercise – you can practice jumping from a book or a building, but you can step down only from the book – don’t limit willingness qualitatively |
| Distinguish willing from wallowing | Moving through a swamp metaphor: the only reason to go in is because it stands between you and getting to where you intend to go |
| Challenging personal space: | Sitting eye to eye |
These clinical materials were assembled by Elizabeth Gifford, Steve Hayes, and Kirk Stroshal
Self as Context
Self as ContextPurpose: Make contact with a sense of self that is a safe and consistent perspective from which to observe and accept all changing inner experiences.
Method: Mindfulness and noticing the continuity of consciousness
When to use: When the person needs a solid foundation in order to be able to experience experiences; when identifying with a conceptualized self
Examples of techniques designed to increase self as context
| Observer exercise | Notice who is noticing in various domains of experience |
| Therapeutic relationship | Model unconditional acceptance of client’s experience. |
| Metaphors for context | Box with stuff; house with furniture; chessboard |
| “confidence” | con = with; fidence = fidelity or faith – self fidelity |
| Riding a bicycle | You are always falling off balance, yet you move forward |
| Experiential centering | Make contact with self-perspective |
| Practicing unconditional acceptance | Permission to be – accept self as is |
| Identifying content as content | Separating out what changes and what does not |
| Identify programming | Two computers exercise |
| Programming process | Content is always being generated – generate some in session together |
| Process vs outcome | Practice pulling back into the present from thoughts of the future/past |
| ACT generated content | Thoughts/feelings about self (even “good” ones) don’t substitute for experience |
| Self as object | Describe the conceptualized self, both “good” and “bad” |
| Others as objects | Relationship vs being right |
| Connecting at “board level” | Practice being a human with humans |
| Getting back on the horse | Connecting to the fact that they will always move in and out of perspective of self-as-context, in session and out. |
| Identifying when you need it | Occasions where “getting present” is indicated (learning to apply first aid) |
| Contrast observer self with conceptualized self | Pick an identity exercise |
| Forgiveness | Identify painful experiences as content; separate from context |
These clinical materials were assembled by Elizabeth Gifford, Steve Hayes, and Kirk Stroshal
Valuing as a Choice
Valuing as a ChoicePurpose: To clarify what the client values for its own sake: what gives your life meaning?
General Method: To distinguish choices from reasoned actions; to understand the distinction between a value and a goal; to help clients choose and declare their values and to set behavioral tasks linked to these values
When to use: Whenever motivation is at issue; again after defusion and acceptance removed avoidance as a compass
Examples of values techniques
| Coke and 7-Up | Define choice and have the client make a simple one. Then ask why? If there is any content based answer, repeat |
| Your values are perfect | Point out that values cannot be evaluated, thus your values are not the problem |
| Tombstone | Have the client write what he/she stands for on his/her tombstone |
| Eulogy | Have the client hear the eulogies he or she would most like to hear |
| Values clarification | List values in all major life domains |
| Goal clarification | List concrete goals that would instantiate these values |
| Action specification | List concrete actions that would lead toward these goals |
| Barrier clarification | List barriers to taking these actions |
| Taking a stand | Stand up and declare a value without avoidance |
| Pen through the board | Physical metaphor of a path – the twists and turns are not the direction |
| Traumatic deflection | What pain would you have to contact to do what you value |
| Pick a game to play | Define a game as “pretending that where you are not yet is more important than where you are” -- define values as choosing the game |
| Process / outcome and values | “Outcome is the process through which process becomes the outcome” |
| Skiing down the mountain metaphor | Down must be more important than up, or you cannot ski; if a helicopter flew you down it would not be skiing |
| Point on the horizon | Picking a point on the horizon is like a value; heading toward the tree is like a goal |
| Choosing not to choose | You cannot avoid choice because no choice is a choice |
| Responsibility | You are able to respond |
| What if no one could know? | Imagine no one could know of your achievements: then what would you value? |
| Sticking a pen through your hand | Suppose getting well required this – would you do it |
| Confronting the little kid | Bring back the client at an earlier age to ask the adult for something |
| First you win; then you play | Choose to be acceptable |
These clinical materials were assembled by Elizabeth Gifford, Steve Hayes, and Kirk Stroshal