L21 Mindfulness & Acceptance-Based Approaches?

參考文獻(xiàn)/圖片來(lái)源：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.

21.1 Overview

Mindfulness/Acceptance Approaches

? View: Problems result from an inability to?accept what is out of one’s control

? Focus of treatment: Maximize potential for?a full and meaningful life

? Approach:

- Learn skills to deal with painful?thoughts/feelings so that they have less?impact and influence over you

- Clarify your values

- Use skills/knowledge to guide, inspire?and motivate changes for for a life?worth?living

?

Mindfulness: An Overview

? Mindfulness: Full engagement with both internal mental?processes and external?experiences in a nonjudgmental way

? Core of “Third-Wave” Treatments

- Acceptance-based therapies (e.g., ACT, DBT)

? Change relationship with thoughts – not the thoughts?themselves!

- Major departure from cognitive therapy and traditional CBT

? Facilitates acceptance

- Allowing negative internal experiences to happen, recognizing?that they may be unpleasant but are harmless

?

?

21.2 Acceptance & Commitment Therapy?(ACT)

Overview

? ACT developed by Steve Hayes?(1980s)

? Symptom reduction is a byproduct?not a goal

? We are predisposed to try to find?solutions to problems

? Experiential Avoidance:

-?Typical means of problem solving are?ineffective for negative emotions

- Trying to avoid or get rid of problems?leads to more distress

? Control is the problem à “Struggle switch” is on

? When we attempt to control negative emotions, they?control us

? By learning to experience “symptoms” as harmless, even if?uncomfortable, transient psychological events, they lose?their power

?

Six Core Principles of ACT

? Being in the present moment: Full awareness of the here?and-now, with openness, interest, and receptiveness?-?Allows you to perceive accurately what is happening?- Allows you to engage fully in what you are doing?- Example: The 5-5-5 Technique

? Acceptance: Opening?yourself fully to experience,?pleasant or unpleasant;?allowing experiences to come?and go without struggling,?running, or giving them?undue attention?- “It is what it is, and I am ok”?- Example: Demons on a Boat

? Defusion: Observe thoughts/language without being caught up?in their perceived meaning?-?“Looking at thoughts rather than looking through thoughts”?- “Noticing thoughts rather than being caught up in them”?- Example: Leaves on a stream

? The “Observing Self”: There is a fundamental “you” that is a?constant even a?midst your ever-changing thoughts, feelings,?memories, urges, sensations, etc.

? Values: “Your heart’s deepest?desires for the sort of person?you want to be and the things?you want to do in your time on?this planet; what you want to?stand for in life”

? Committed Action: Overt?behavior guided by your values

? “Embrace your demons, and follow your heart”

?

?

21.3 Dialectical Behavior Therapy (DBT)

Borderline Personality Disorder (BPD)

? A pervasive pattern of instability of interpersonal relationships, self-image, and affect, and marked impulsivity beginning by early adulthood?and present in a variety of contexts, indicated by 5+ of the following:

- Frantic efforts to avoid real or imagined abandonment

- Pattern of unstable and intense interpersonal relationships; alternating?between extremes of idealization and devaluation

- Identity disturbance: markedly and persistently unstable self-image

- Impulsivity in > 1 area that is potentially self-damaging

- Recurrent suicidal behavior, gestures, or threats, or self-mutilating?behavior

- Affective instability due to a marked reactivity of mood

- Chronic feelings of emptiness

- Inappropriate, intense anger or difficulty controlling anger

- Transient, stress-related paranoid ideation or severe dissociative?symptoms

?

Etiology and Treatment for BPD

? Dialectical Behavior Therapy (DBT)

- Developed by Marsha Linehan (1980’s)

- Initially for chronically suicidal women

- Treatment combines CBT with mindfulness practices

? The Dialectic

- Both/and rather than either/or

- “Walking the middle path”

- Facilitates both: ? Acceptance and Change

DBT: Treatment for BPD

? Goal of Treatment: “A life worth living”

- Develop a more realistic and positive sense of self

- Learn problem-solving and emotional regulation skills

- Learn assertiveness skills

- Challenge and change all-or-nothing thinking

? Skills Training: 1. Mindfulness; 2. Distress Tolerance; 3. Emotion Regulation; 4. Interpersonal Effectiveness

? Clinician Tools (for 1-on-1 therapy):

- Use Validation: Explicitly communicating your understanding of motivation for an action

- Use Diary Cards: Assign client to track behaviors between therapy sessions and identify treatment targets for each session

- Conduct Chain Analysis to determine the ABCs of a behavior