Acceptance and Commitment Therapy for Substance

Acceptance and Commitment
Therapy for Substance Abuse
Fern Richie, DSN, APRN-BC
[email protected]
Serenity Prayer
“God, grant me the serenity to accept the
things I cannot change, the courage to
change the things I can, and the wisdom to
know the difference.”
Acceptance & Commitment
 “I
just want to be happy” – a psychological trap of
needing to “feel good” all of the time
 Psychological flexibility - a better goal?
 Being in the present moment with full awareness and
openness to our experience, and taking action guided
by our values
 Living a full, rich, and meaningful life
 Both pleasurable and uncomfortable feelings will be
 Rather
than attempts to avoid pain, ACT focuses
 Helping us make room for pain
 Reduce its impact
 Create a life worth living despite pain
More on ACT
 Based
on assumption that many unwanted internal
experiences cannot be eliminated, so they must be
 Is a behavioral therapy, with an existential component
 By using mindfulness and acceptance strategies, we can
step back from instantaneous emotional reactions
rather than use over them
 By accepting, rather than fighting/struggling with
aspects of our inner worlds over which we have no
control, we can invest time and effort in what we can
control – practice recovery strategies
 Persist when persistence is useful
 Desist when what we are doing isn’t working
The Importance of Values
Values are the fuel; the danger of running
on empty
 Values get lost in the shuffle of living
 Values and adjustment disorder
 If not “living” our values, we will begin to feel
 If feeling uncomfortable
 May incorrectly appraise a stressor
 May try to “fight the feeling”
 End up feeling worse, not better
What About Symptom Reduction?
Emphasis of most Western psychotherapeutic
approaches is symptom reduction
ACT assumes the position that quality of life is
primarily dependent upon mindful, values-guided
 This is possible regardless of how many symptoms
you have
 Through ACT we try to change our relationship with
our symptoms
Thus values-congruent living is desired outcome
 Usually ACT will result in symptom reduction
We All Suffer…
“Life is spelt H.A.S.S.L.E.” – Albert Ellis
 “Life is difficult.” – M. Scott Peck
 “Life is suffering.” – Buddha
 “Shit happens! - Anonymous
ACT and Suffering
ACT aims to help people learn and grow
as a result from their suffering
◦ Use pain as a springboard into creating a
more meaningful life
“Our clients are not broken, they are just
 What gets people stuck?
◦ Fusion
◦ Experiential avoidance
Our thoughts dominate our behavior
◦ In ACT, we might say “you’re being pushed
around by your thoughts” or, “the thoughts are
telling you what to do”
How workable are the thoughts?
◦ Does the thought help client move toward a
better life?
◦ No attempt in ACT to change one’s thoughts
Experiential Avoidance
Trying to get rid of or escape from
unwanted experiences
 Higher experiential avoidance is
associated with higher levels of substance
abuse (Hayes et al, 2004)
 Must help the client get in touch with the
cost and futility of experiential avoidance
Mantra of ACT
A Accept one’s thoughts and feelings; be
 C Choose a valued direction
 T Take action
ACT for Substance Abuse
Sit in kindness with the uncertainty of
 Accept your life as it is – but also how it
may become
 Find strength in the things that really
matter to you
 Commit to act in the present moment
 Learn how a change of perspective can
help you see yourself with fresh eyes
Wilson, 2012
Paying attention in a particular way: on
purpose, in the present moment, nonjudgmentally
 Curiosity and openness, even to a difficult
moment (better than running from it or
fighting it or using over it)
 Helps to develop a detached relationship
to thoughts and feelings
 Shift from “impulsive reacting” to “skillful
Six Core Processes of ACT
 Acceptance
 Contact with the present moment
 Self-as-Context
 Values
 Committed Action
 Fusion
means getting caught up in our thoughts
and allowing them to dominate our behavior
 Rules
 Reasons
 Judgments
 Defusion
means separating or distancing from our
thoughts, letting them come and go, rather than
being caught up in them
 Noticing thoughts rather than being caught up in
 Letting thoughts come and go rather than holding on
to them
Getting to Defusion
 Begin
to notice your thoughts
 “So, what’s your mind telling you now?”
 “And what does your ‘thinking self ’ have to say about
 Next, look
at workability of your thoughts
 “So, is that a helpful thought? If you hold on tightly to it,
does it help you deal with the situation differently?”
 “If you let that thought tell you what to do, will it take you
in the direction of a rich, full, and meaningful life, or in the
direction of being stuck and suffering?”
 Notice
when you are fused or defused with your
 “So, right now, how caught up are you in that thought?”
Not the same as approval, tolerance, or even
liking something
Accept if and when doing so enables us to act on
our values
Is a process, not a technique
◦ Expand, make space
◦ Letting go of any urge to resist or avoid what is in
front of you at the present moment
 This may mean “sitting with” a craving to use
 Recognize that a craving is just that – a craving
◦ Show self-compassion
 “I’m not a bad person because I am craving the dope right now.”
Contact with Present Moment
in the here and now, fully conscious
of our experience (rather than being lost
in our thoughts and missing out on life)
Helps us perceive more accurately what is
 Whether to change or persist in current
 This
is hard for those of our clients who
have experienced trauma
Statements about:
◦ What we want to be doing with our life
◦ What we stand for
◦ How we want to act on an ongoing basis
Leading principles that guide and motivate us
 Our hearts deepest desires for the way we
want to be and act in the world
 Is success measured by achievement of
 Is success measured by living out our values?
Committed Action
Taking larger and larger steps of effective
action, guided and motivated by values
 Being flexible and adaptable
 Persist with or change behavior to better
coincide with one’s values
Steps to Committed Action
Choose a domain of life that is high
priority for change
 Identify the values to pursue this domain
 Develop goals, guided by these values
 Take action mindfully
From Suffering (Active Addiction) to
Vitality (Recovery)
Fusion with thoughts
 Experiential
 Unworkable actions
Being present
 Opening up
 Doing what matters
A perfect match? No, but a great fit.
Both are into-action programs
◦ We must create the life worth living
 Non-acceptance blocks us from doing this
Both focus on practice
Both are traditions that are a means to an
end: the end is a better life
 Both focus on commitment in the “here and
now,” not the future
◦ “In this very moment, am I engaged in right action?”
◦ “Do the next right thing”
‘Having spent the better part of my life trying
to either relive the past or experiencing the
future before it arrives, I have come to
believe that in between these two extremes is
◦ Author unknown
Helpful Websites
Wilson, K. G. (2012). The Wisdom to
Know the Difference: An Acceptance and
Commitment Therapy Workbook for
Overcoming Substance Abuse. Oakland,
CA: New Harbinger Publications.
 Harris, R. (2009). ACT Made Simple.
Oakland, CA: New Harbinger
 Harris, R. (2008). The Happiness Trap.
Boston: Trumpeter.
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