ACT Therapy – TLC Retreat Notes

Credit Sue Price notes - TLC Conference Session

TLC Retreat Session September 2002 
Acceptance and Commitment Therapy 

**This was originally an email sent to me from a remailer - so these are
Sue P's notes from a Session at the recent TLC Retreat (Sept 2002). 
_____________________________________ 

**(If you don't already know what TLC is, it is the Trichotillomania
Learning Center - and the only Not-for Profit Association for
Trichotillomania. Their Website is www.trich.org. They have encouraged
me and others to post and distribute our notes from the TLC Retreat
sessions, in order to help as many people as possible!) I recommend that
you look through their site ... the Calendar section lists events and
Support Groups (who know they may be in your area). 

_____________________________________ 

TLC Retreat Session September 2002 
Acceptance and Commitment Therapy
Douglas Woods, Ph.D.

______________________________________________ 

Here are my notes on "Acceptance and Commitment Therapy" from the TLC
retreat. This one was hard to write up notes on, so if you have
questions, please ask and I'll try to answer. This was one of the most
popular sessions at the retreat so I thought it was worth a shot. My
side comments are in 
[]'s. 
!
Douglas Woods, Ph.D.   Dept of Psychology, University of
Wisconsin-Milwaukee 
!
__________________________________

ACT is an acceptance-based, behaviorally oriented therapy. It was first
proposed by Hayes et. al. (1999) but I think Dr. Woods is the first to
study treating ttm with it. 
!
ACCEPTANCE: allowing urges, emotions, thoughts and feelings to occur
without 
attempts to control them. 
!
Acceptance does NOT mean a hopeless acceptance of the fact you have TTM. 
!
Why work on acceptance? He conducted an online study which showed that
pullers who are less accepting of private events tend to have stronger
urges to pull and more severe pulling. 
!
[I found the concept of "private events" confusing at first. From what I
can tell, it's anything that happens inside you that you experience
privately. As he said: thoughts, feelings, emotions, urges] 
!
People follow rules not experience. He cited a study where people played
a slot machine that was rigged to never pay off for the player. The
people who were told that the machine WOULD pay off eventually, played
longer than the people who were not told anything. The point is, people
follow rules over their experience. 
!
Where this fits in with trich: the rule is, "if you feel bad, get rid of
it." This is what society teaches us. This works well in many situations
(if the kids are too noisy, send them outside; if someone is tailgating
you, change lanes, etc.) 
!
But this does not work with private events such as feelings. Trying to
just get rid of bad feelings, urges, etc. does not work long term. But
we keep doing this anyway because that's the rule we've been taught. 
!
ACT breaks down rules by emphasizing experiential exercises over verbal
rules. The idea is that the person accepts that while the rule they've
been taught is "get rid of it", their experience shows that this has not
worked, and then they can learn a willingness to experience those
private events. [Side note: the addiction book that I've found so
helpful makes similar points: that our society teaches us that feeling
bad is intolerable, to be avoided, and if you feel bad you must do
something to stop feeling bad RIGHT AWAY. This is the kind of thinking
that fosters addiction, and changing this way of thinking and being
willing to FEEL bad is a major part of combatting addiction.] 
!
!
Steps to Acceptance 
!
1. Creative Hopelessness 
Focuses on getting the person to see that attempts to stop, alter or
avoid private events such as thoughts, emotions or feelings have been
unsuccessful. Pulling is often another way to avoid or control private
events. 
!
He asked us to think about an uncomfortable private event that we're
dealing with right now. He asked how we tried to deal with it. The
common answers people gave were: avoided thinking about it, distracting
themselves from it, and denial. We confirmed that none of these things
work long term in dealing with the private event. It comes back. 
!
2. Willingness 
Focuses on getting the participant to be willing to experience negative
or uncomfortable private events. 
!
If trying to control private events is the problem, willingness to
experience uncomfortable feelings may be a solution. 
!
3. Defusion 
He said that even if urges etc. are not originally language-based, they
become so because WE are language-based. (There was a lot of clinical
stuff he went over making this point.) 
!
We need to understand language for what it is, and that words are
powerful only because we let them be. 
!
This step is about de-literalizing private events. We did two exercises
to illustrate this. 
!
First he asked us what we associate with the word "milk". We said white,
cold, frothy, things like that. Then he has us say, out loud,
"milkmilkmilkmilkmilkmilkmilk. . ." over and over. (Try it, it's
physically not easy to keep this up!) Picture an entire room of us
saying it over and over, and he had us keep it up for what seemed like
forever. When he finally stopped us, he said, "I bet you're not thinking
of that white frothy stuff any more." 
!
The idea is that "milk" made us think of the white frothy stuff, but
only because of what WE associate with that word. By repeating the word
over and over, we de-literalized it. It became just a word, the letters
m-i-l-k. 
!
Similarly, an urge that's felt as "I need to pull" can be de-literalized
by repeating "I need to pull I need to pull I need to pull" until they
are just words, not something that must be acted on. 
Those words don't have power unless we give it to them. 
!
The second exercise is, imagine you are watching a parade and a band is
marching by. Imagine that your thoughts, whatever's bothering you, are
written up on cards that the band members are carrying. And just watch
those "thoughts on cards" go past you. 
Acknowledge them but separate yourself from them. 
!
4. Understanding the Self 
!
My notes are sketchy here so from his handout: Who are "you?" Who is
your "self?" 
!
- Conceptualized Self: who do we say we are? What do we stand for? How
do we see ourselves? (we typically think of this as our only self, and
defend it) 
!
- Knowing Self: the "self" that is experiencing events as they are
occurring 
!
- Observing Self: the "self" that has always been and always will be. He
made an analogy to a chessboard: I am the board, not the game that is
happening on it. Whatever happens on the board does not have to affect
me. 
!
5. Valuing 
- You have the ability to choose your behavior. You must choose to move
in your valued direction. 
!
- What do you value? What do you want your life to stand for? 
!
- Need to make psychological room for private events while you move your
life in the valued direction. 
!
[I think an example of what he means by the last item is: a valued
direction for me, is not pulling. By trying to move my life in that
valued direction, I will have uncomfortable private events and I need to
accept this and be ready for this. 
He also said: 
-Committed Action Invites Obstacles (disguised as private events) 
- The Journey in the Valued Direction involves fear and action 
So I take it as, anything I do to move my life in a direction I value
(trich-related or not) can bring up private events that will be
uncomfortable. He is saying "choose to move in your valued direction"
while experiencing these private events.]
! 
More comments on Willingness 
!
- Willingness is not the same as "wanting". He had a "Joe the Bum"
metaphor (acknowledging that "bum" is not PC.) Say you are having a
party that all your neighbors are invited to, and everyone is having a
great time. Then Joe the Bum shows up. You don't want him there, nobody
likes him, he's dirty, he's smelly. But if you spend your time trying to
physically keep him out, you won't be enjoying your party. But if you
are WILLING to accept that he's there and not fight it, even though you
don't WANT him there, you can still enjoy your party. 
!
- Willingness is all or nothing 
!
The idea is to combine acceptance techniques with other behavior therapy
procedures. A clinical study showed this is effective, based on five
different measures of pretreatment and posttreatment hair pulling.
Caveat is that this was a small sample size; he will be doing more
clinical research. 
______________________________________

x 
x