Mindfulness and ACT

Question 1

Define mindfulness

Answer 1

Def→ “The awareness that arises from paying attention on purpose, in the present moment, and non-judgmentally” (Kabat-Zinn, 1994)

Question 2

What are the different types of mindfulness?

Answer 2

Different types of mindfulness
- Mindfulness of thoughts→ for clients who excessively ruminate, worry, or try to suppress intrusive thoughts or images
- Mindfulness of internal stimuli→ for intense emotion and other distressing internal experiences
- Mindfulness for self-compassion→ for clients who experience a great deal of self- criticism

Question 3

What are the three components of mindfulness?

Answer 3

Three components
- Attention→ fully attending to present moment without bein preoccupied
- Intention→ know why we are doing what we are doing
- Attitude→ the way we pay attention

Question 4

What are the seven attitudinal foundations of mindfulness?

Answer 4

Seven attitudinal foundations of mindfulness
- Non-judging
- Patience→ do not try to rush it
- Beginners mind→ open minded
- Trust
- Non-striving→ not trying to move things forward
- Acceptance
- Letting go/be or non-attachment

Question 5

What are the two ways to practice mindfulness and examples?

Answer 5

Formal mindfulness meditation practice
- Mindful breathing→ usually start with 5minutes
- Body scan
- Mountain meditation→ picture yourself as mountain not moving, very stable
- Loving kindness mediation→ foster warmth feelings for others

Informal practice
- incorporate into daily routine
- Awareness of thoughts, emotions, bodily sensations and sensory input during everyday activities
- ex→ Walking, Washing dishes, Brushing teeth, Eating
- not looking at your phone, doing one thing at a time

Question 6

What should a therapist do before using mindfulness in a session?

Answer 6

• educate clients about cognitive model
• ask them to engage in their negative thought process during the session
• ask them to rate their negative emotions before and after the mindfulness session
• Guide them in drawing conclusions about the experience
• Collaboratively set an Action Plan item, typically practicing the formal mindfulness for about 5 minutes every morning

—>wants clients to engage in an unhelpful thought process before starting the exercise
- acts as a behavioral experiment to test dysfunctional beliefs which give motivation to practice
- important to replicate conditions clients will experience when using the strategy at home

Question 7

What is mindfulness-based stress reduction?

Answer 7

MBSR-> Formal program developed by Kabat-Zinn
- 8 week workshop with 2-3 hour group sessions each week, daily homework, and one-day retreat
- Not considered a formal therapy, but a compliment to traditional medical or psychological treatment
- To be a certified MSBR teacher, complete a 7-day course at Center for Mindfulness at U Mass Medical Center

Question 8

What is mindfulness-based cognitive therapy (MBCT)?

Answer 8

Origins
- developed in late 90s
- developed for depression relapse prevention
- not used for depression periods

Structure
- Group treatment that integrates MBSR with CBT
- move away from CBT’s emphasis on changing content of negative thinking towards attending to way in which all experience is processed

Question 9

What are some evidence for efficacy of MBCT?

Answer 9

Hoffman et al., (2010); Journal of Consulting and Clinical Psychology
- Mindfulness-based therapy for depression and anxiety across a range of conditions
- look at pain
- Pre-post treatment: g = 0.63 for anxiety; g = 0.59 for mood
- In patients with mood and anxiety disorders, g = .97 for anxiety and .95 for mood, respectively

Khoury et al., (2015); Journal of Psychosomatic Research
- MBSR in healthy individuals
- Pre-post mindfulness: g = 0.55; Between-group: g = 0.53
- Large effects on stress; moderate effects on depression, anxiety, distress, quality of life
- good even if no psychological problem

Question 10

What is Acceptance and commitment therapy?

Answer 10

Origins
- Developed by Stephen Hayes (development psychologist)
- Defined as→ “Therapeutic approach that uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce greater psychological flexibility” (Hayes, Wilson, Strohasal, 1999)

Not a treatment
- work on psychological flexibility→ ability to persist in or change behavior when it is in service of valued ends in a particular context
- symptoms reduction is just a by product of engaging meaningfully with your life
- positive associations between psychological inflexibility and most forms of psychopathology
- implicated in the onset of mood and anxiety disorder
- relates to negative physical health outcomes such as greater pain intensity and pain-related disability, decreased health-related quality of life and productivity, greater severity and frequency of physical symptoms, and greater healthcare utilization

ACT perspective on suffering
- negative emotions and thoughts are normal human experience
- suffering is due to use of language and our attempts to control our internal
human experience
- go against common view of suffering which is that psychological pain means that something is wrong

Question 11

What are the 6 core skills that ACT is aiming for?

Answer 11

Flexibly and purposeful-ly remaining in the present moment
- being mindful of thoughts, feelings, bodily sensations, and action potentials, including during distressing experiences

Perspective taking skills
- Keeping balanced and broad perspective on thinking and feeling, such that painful or distressing thoughts and feelings do not automatically trigger maladaptive avoidance behaviors

Clear values
- clarifying fundamental hopes, values, and goals such as being there for one’s family, pursuing meaningful work, and so on

Acting in accord with core values
- cultivating commitment to doing things in line with identified hopes, values, and goals

Acceptance of negative feelings
- especially if arise when performing actions consistent with patients’ hopes, values, and goals

Defusion
- seeing negative feelings as what they are rather than truth

Question 12

What is the concept of workability?

Answer 12

Concept of workability
- whether those behaviors are working in terms of effectively solving the problem and of moving one toward valued ends
- examining the costs of using this strategy in the long run on valued life areas

Question 13

What are the philosophical foundations of ACT?

Answer 13

Based on relational frame theory (RFT)
- Our mind makes arbitrary connections between things, with connections based on history and context
- way i am interpreting melon is based on fact that I was thinking about apple before
- make sense of emotions the same way
- depend on context in which we encounter them but in reality just labels

Question 14

What are the the core domains of the psychological inflexibility?

Answer 14

Cognitive fusion
- “Verbal dominance over behavioural regulation” OR taking your thoughts to literally
- goal is defusion→ Mindfully noticing thinking as it occurs
- “I am having the thought that….”
- Watching thoughts go by as if they were on leaves floating down a
stream

Experiential avoidance
- Attempt to alter form, frequency, or function of private experiences, even when doing so is costly or ineffective
- try to supress experiences
- goal is acceptance→ Adopt an intentionally open and flexible posture about moment-to-moment experiences

Loss of flexible contact with present
- Fusion and experiential avoidance lead to desire to be somewhere else
- Goal is mindfulness→ Attend to what is present in a focused, voluntary, and flexible way
- Use language to note and describe internal events, rather than to predict and judge them

Attachment to Conceptualized Self
- ideal of self that we are attached to (past self, ideals self)
- Promote contact with sense of self based on the here-and-now
- “Noticing self” or “Observer perspective”→ seing ourselves from external POV

Values Problems
- Persist or change in behaviour in the service of one’s chosen values
- work towards your values
- Values→ Predominant reinforcer is intrinsic to behaviour pattern itself; a direction rather than a destination
- Key problems in values: They are not yours; They are not clear; they are based on avoidance

Inaction, impulsivity, and avoidance persistence
- Develop patterns of action linked to chosen values
- Set short-term, medium-term, and long-term concrete goals that are value-consistent

Question 15

Explain the use of metaphors in ACT

Answer 15

Use of metaphors
- problem in language so should use metaphors to experience the idea rather than just talking about it
- creative hopelessness→ Bring people into experiential contact with the fact that what they have done so far has not worked
- ex→ Chinese finger trap: the more you struggle the more suffering you have
- ex→ Tug-o-war: each pulling on one side (suffering), using too much energy and are stocked, put down the rope

Question 16

What are the evidence supporting ACT?

Answer 16

Research support for treating
- depression
- mixed anxiety conditions
- OCD
- Chronic pain
- psychosis
—>would be most effective for comorbid medical and psychiatric conditions
—>Research focused on testing processes of change and on functional, rather than symptom-focused, outcomes
—>Mediation analyses that examine whether the treatment predicts change in ACT processes

Brief sessions shown successful
- 1day workshop
- telehealth coaching calls
- online and smartphone interventions
- 20-min sessions integrated into primary care visits