The Many Pathways to Healing Conference BC

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THE MANY PATHWAYS TO HEALING CONFERENCE: TRAUMA, ADDICTIONS & RELATED DISORDERS

Presented by Jack Hirose & Associates. Sponsored by Sunshine Coast Health Centre and Georgia Strait Women’s Clinic

If you have any questions, please contact your on-site coordinator.

PLEASE REMEMBER:

• Wear your name badge every day.

• Turn off your cell phone.

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EVALUATION FORM:

• Complete your evaluation form each day using the QR code below.

SCHEDULE:

This schedule may vary depending on the flow of the presentation and participant questions

7:30am – 8:30am Sign-In

8:30am – 10:00am Morning Workshops Begin

10:00am – 10:15am Mid-Morning Break (Refreshments Provided)

10:15am – 11:45pm Workshop in Session 11:45pm – 12:45pm Lunch Break Sign-In (CPA Members Only)

12:45pm – 2:15pm Afternoon Sessions Begin 2:15pm – 2:30pm Mid-Afternoon Break (Refreshments Provided) 2:45pm – 4:00pm Workshop in Session 4:00pm Complete Evaluation Forms (Use QR Code Above) & Sign-Out (CPA Members Only)

CERTIFICATES:

• Digital certificates are available for download on the final day for multi-day attendees at: http://registration.jackhirose.com/certificates

CPA MEMBERS

• A new policy requires you to request a form from your on-site coordinator, which must be submitted directly to the association.

• Please sign in after lunch and sign out at the end of the day. Early departures result in the loss of CPA credits.

• Certificates will be updated with CPA credits after form verification (allow 2-4 weeks).

Meaning-Based Therapy in the Treatment of Trauma, Addiction, Anxiety & Depression

Treatment Resistance

Chapman, C., Mills, K., Slade, T., McFarlane, A. C., Bryant, R. A., Creamer, M., … Teesson, M. (2012). Remission from posttraumatic stress disorder in the general population. Psychological Medicine, 42(8), 1695–1703. doi:10.1017/S0033291711002856

Schlaepfer, Thomas & Ågren, Hans & Monteleone, Palmiero & Gastó, Cristobal & Pitchot, William & Rouillon, Frederick & Nutt, David & Kasper, Siegfried. (2012). The hidden third: Improving outcome in treatment-resistant depression. Journal of psychopharmacology (Oxford, England). 26. 587-602. 10.1177/0269881111431748.

Effective Psychotherapy

Medical Model- characterized by insistence on the correct explanation of a disorder and adoption of the concomitant therapeutic actions that are responsible for the patient benefits

Common factors- aspects of therapy that are common to most psychotherapies, such as hope, expectation, relationship with the therapist, belief and corrective experience

Common factors model understands the therapist as an agent of change and that outcomes are linked to the therapist’s characteristics and relationship with the client

Therapist Effects

• Preponderance of evidence indicates that there are important therapist effects (3-7% of variability)

• Therapist effects general exceed treatment effects

• What are the characteristics and actions of effective therapists?

• Empathy

• Authenticity (real relationship)

• Ability to form strong alliances across the range of clients

• Interpersonal skills (Higher linked to better client outcomes)

• Verbal fluency

• Interpersonal perception

• Affective modulation and expressiveness

• Warmth and Acceptance

• Empathy

• Focus on other

• Reflective about practice

General Effects

• Working alliance

• Healthy, affectionate, and trusting feelings toward the therapist without transference

• Agreement about the goals of therapy

• Agreement about the tasks of therapy

• Bond

• Early symptom change may increase rates of alliance

• Placebo/ Expectation (Hope)

• Desire to feel relief

• Induction of an expectation that treatment can accomplish goal

• Presence of emotional arousal

• Attribution

• Client attributes changes to their own efforts (Self- efficacy increase)

• Acquisition of the belief that one’s efforts are responsible for improvement

Resistance

Models of Wellbeing

What makes for a Good Life?

• Aristippus (435- 356 BCE)- Goal of life is to experience the maximum amount of pleasure and happiness consists of the totality of hedonic moments

• Epicurus (34 BCE)- Goal of life is to obtain a happy, tranquil life, one characterized by peace and freedom from fear and pain

• Aristotle- Goal of life is to achieve “eudaimonia,” which is the pursuit of highest virtue

Hedonic Wellbeing

• 1960s- Life satisfaction and happiness was considered key components of well being

• Wellbeing determined by life satisfaction, positive affect and negative affect

Hedonic Wellbeing

• Factors impacting hedonic wellbeing

• Age (U- shaped trend)

• Satisfaction reaches its lowest point at midlife between ages 30 and 60 and then peaks in older adulthood

• Higher income

• Higher education

Eudaimonic Wellbeing

• Wellbeing determined by the presence of particular factors rather than by the absence of illness

• Internal rather than external factors

• Self acceptance

• Positive relationships with others

• Environmental mastery

• Autonomy

• Purpose in life

• Personal growth

Dr. Corey Keyes
Ryff, C.D (2014). Psychological well-being revisited: Advances in the science and practice of Eudaimonia

Positive Relationships

• Sense of belonging

• Depth of emotional ties

• Warm, satisfying trusting relationships with others; is concerned about the welfare of others; capable of strong empathy, affection and intimacy; understands give and take of human relationships

Purpose in Life

• Has goals in life and a sense of direction; feels there is meaning to present and past life; holds beliefs that give life and purpose; has aims and objectives to living

• “A human being, by the very attitude he chooses, is capable of finding and fulfilling meaning in even a hopeless situation.” (Frankl)

• Principal ways to find meaning (Frankl)

• What they gives to the world in terms of creations

• What they take from the world in terms of encounters and experiences

• The stand they take to their predicament in case they must face a fate which they cannot change

Motivation

• “Pleasure cannot be attained by directly intending it. But as we now notice, it may well be obtained by a biochemical medium” (Frankl)

• Fulfillment is contingent to the extent to which an individual finds a unique sense of meaning

• “Man is pushed by drives but pulled by meaning” (Frankl)

• “The man who regards his life as meaningless is not merely unhappy but hardly fit for life” (Albert Einstein)

Pain and Suffering

“As soon as a painful fate cannot be changed, it not only must be accepted but may be transmuted into something meaningful, into an achievement” (Frankl)

Dr. Carol Dweck
Frankl – The Will To Meaning
Dr. Paul T. Wong
Dr. Paul T. Wong
Dr. Paul T. Wong

• Difficulties with emotional regulation

• Difficulties with meaning attribution

• Difficulties with taking responsibility for one's wellbeing and future

• Difficulties with relationship skills

• Difficulties with coping resources and skills

• Difficulties with endurance and tolerance of suffering

• Difficulties with life intelligence or existential intelligence

WHAT CREATES PROBLEMS?

CREATING CHANGE

Meaning Therapy assumes that desirable changes depend on:

• Understanding and accepting the true meaning of one’s life situation

• Self and social validation of personal existence as being meaningful and worthwhile

• Pursuit and actualization of valuable life goals

HOW DO YOU FIND MEANING?

• Activity

⚬ Activities that are intrinsically valuable and interesting

⚬ Activities that are instrumental in attaining significant goals

⚬ Activities that are self- transcended and directed at serving others

• Experience - beauty, truth and love joy and wonder

• Attitude - acceptance in suffering

Discovering Meaning

Three types of values whereby one can discover meaning:

• ·Creative- what the person gives to the world

• ·Experiential- what the person receives from the world

• ·Attitudinal- adopting the right attitude of acceptance and taking a stand towards unavoidable suffering

MT GOALS

Develop a deeper understanding of cause- Not just symptoms

Develop a set of positive meanings as foundation upon which to build a fulfilling and productive life

Learn how to overcome internal and external obstacles to attain meaningful life goals

Learn to live productively in spite of certain unchangeable realities of life, such as suffering, aloneness, and anxiety

Improve relationship skills and connection with others

Stess & Trauma

an a%achment-based developmental perspec3ve

Clinical & Developmental Psychologist

Founder of the Neufeld Institute Vancouver, Canada

A JACK HIROSE SEMINAR

Healing & Trea,ng Trauma Wounds

Richmond, B.C.

November 25, 2024

Copyright 2024 Gordon Neufeld, Ph.D. All rights reserved.

The handout is intended for registered par?cipants of this seminar only.

Please do notduplicate this document without permission.For more informa?on regarding the Neufeld Ins?tute or Dr. Neufeld and his work, please consult the website.

www. neufeldins,tute.org

Stess & Trauma

an a$achment-based developmental perspec3ve

Gordon

grieving to bouncing back stress Response role of relationship play & playfulness vulnerable feelings optimal functioning sense of safety TRAUMA

fight or flight impact of experience & exposure role of adaptation

tears of futility & sadness sense of strength rest and restfulness emotional defense recovery and healing nature of emotion neural plasticity vasovagal response

Chapter One

THE THREAT: an evolution in understanding Stess & Trauma

WALTER CANNON’S FIGHT-FLIGHT RESPONSE TO THREAT

• Harvard medical professor who studied the effects of physical danger on lab animals and formed his thesis in 1915, published in 1932 in the book “The Wisdom of the Body”

• his focus was on the situaQonal response to a threat to survival but made the mistake of isolaQng animals from their own species to survival

• studied the role of adrenalin and the sympatheQc nervous system in responding to threats to physical survival

FlIGHT

THREAT FIGHT

HANS SELYE’S STRESS RESPONSE (1940’S)

• was seeking a common physiological response that could account for the behaviours that Cannon had observed as a response to threat

• assumed that the FEAR system was the physiological pathway for stress, thus making the mistake that aggression came from fear

• assumed that harm or survival was the essence of threat

• since modified to include a third opQon – FREEZE (immobilizaQon or shutdown mediated by the vagus nerve) if flight or fight are not opQons

STRESs

about Hans Selye and the construct of STRESS

• Selye was a Hungarian-Canadian endrocrinologist who worked at McGill in the 30’s and 40’s and later at the University of Montreal

• popularized the construct of stress (word originates from ‘distress’ meaning coming apart) as a term for the generalized effect of threat on the body

• the term was borrowed from physics and engineering where it was used to describe the force exerted on a physical enQty (like a bridge) that would cause it to snap or come apart

• the term became immediately and immensely popular, influencing the vocabulary and thus thinking in many languages

• the term unfortunately gave the impression that stress was bad, leading to breakdown, something Selye tried in vain to correct

Adversive Childhood Experiences

REDUCE DISTRESSING EVENTS

Self-care is the logical deduction of this understanding if THREAT = STRESS LOAD

MANAGE IMPACT OF STRESS

1. When kids pracQce self-care they learn to idenQfy their physical and emoQonal needs and can begin to take care of those needs.

2. PracQcing self-care at a young age allows kids to create a foundaQon that will benefit them as adults.

3. PracQcing self-care allows your child to develop healthy habits that they can benefit from in the future.

4. Your child will be able to become more independent and understand how to take care of themselves.

5. They will develop the skills necessary to keep themselves healthy mentally, physically and emoQonally.

THREAT

FACING SEPARATION = experience of separaSon

SEPARATION is thus the greatest threat

ATTACHMENT = SURVIVAL and is thus our preeminent drive

can’t be with ... not special to ... notunderstoodby... BETRAYED NOT LIKED BY ... feelingunlovedby... replacedby... isolation rejecQon not wanted discounted by ... lack of belonging can’tconnectwith... can’t hold on when apart feelingdifferent losing face not important to ... not recognized by ... threats to identity NEGLECTED NOT HELD ON TO BY ... loneliness not belonging not mafering to ...

Adversive Childhood Experiences

THREAT – an evolution in understanding

threat is to SURVIVAL STRESS itself is the threat

• reduce distressing events

SEPARATION

is the threat

REDUCE SEPARATION

• address issues of safety, food, health, & shelter via naturally developing ...

• manage the impact of stress

... ways to hold on when apart

... viability as a separate being

... resilience in the face of separa3on faced

If FACING SEPARATION is the THREAT,

togetherness is our answer! - and thus CASCADING CARE in the context of togetherness should become our ultimate focus

The WISDOM of the stress response Stess & Trauma

Chapter Two

PURSUIT closure

THE STRESS RESPONSE ACTIVATES PRIMAL EMOTIONS cau3on ALARM

FRUSTRATION

separa3on-triggered change

Atachment’s Emergency First Aid Team

OUR MOTTO - “We promise to get emo5onal when holes appear in the fabric of your togetherness”

SympatheSc Response ParasympatheSc Response REMOTIONAL ESPONSE

SympatheSc Response

REMOTIONAL ESPONSE

first response

SympatheSc Response

EMOTIONAL RESPONSE

ParasympatheSc Response

ParasympatheSc Response

as a last resort , the parasympatheQc system can be deployed as a DEFENSIVE RESPONSE to stress

if trapped or thwarted, can trigger a reverse swing of the pendulum

The Stress Response

ACTIVATES primal separaSon emoSons (ie, alarm, frustraQon and pursuit)

- via the command centre (amygala) of limbic system

- to situaQonally address the separaQon problem

- a two-pronged approach -

defensively emoSonal feedback ( ie, feelings)

orgejul

- via the brain’s sensory gaQng sytem

- to reduce felt suffering and improve abillty to funcQon in distressing circumstances

The Stress Response

animates and armours the heart

• ACTIVATES primal

separaSon emoSons

• while at the same Sme, INHIBITS FEELINGS that would interfere with performing or funcQoning in stressful circumstances

STRESS RESPONSE = MORE EMOTION BUT LESS FEELING

• gives the STRENGTH and TOUGHNESS needed to funcQon or perform in stressful or wounding circumstances

• instantly CHANGES one to be able to COPE with adversity & SURVIVE distressing circumstances

• taps all available resources to enable one to PERSEVERE in the face of distress and OVERCOME stressful circumstances

LOCK, OLLOW, FAWN, IND, ANCY (family, friends, fame, fortune) devolving into

Fixes Fixations

impulses to ATTACH

separa3ontriggered

impulses to Avoid

The stress response in the ‘key’ of

impulses to Attack

Stess & Trauma

Chapter Three

TRAUMA REDEFINED

The Stress Response

animates and armours the heart

• ACTIVATES primal separaSon emoSons

• while at the same Sme, INHIBITS FEELINGS that would interfere with performing or funcQoning in stressful circumstances

PROBLEM:

areabsolutely toemotionalhealth, optimalfunctioning,andtherealizationofpotential

STRESS RESPONSE = MORE EMOTION BUT LESS FEELING

Stress Response

• gives the STRENGTH and TOUGHNESS needed to funcQon or perform in stressful or wounding circumstances

• instantly CHANGES one to be able to COPE with adversity & SURVIVE distressing circumstances

• taps all available resources to enable one to PERSEVERE in the face of distress and OVERCOME stressful circumstances

Resilience Response

ATTACHMENT’S EMERGENCY RESPONSE TEAM

acQvaQon of (alarm, frustraQon & pursuit)

FEELINGS that would interfere with performing or funcQoning in stressful circumstances are INHIBITED

Feelings that have been inhibited BOUNCE BACK to enable opQmal funcQoning and the full realizaQon of potenQal

SAFETY

THREAT

FACING SEPARATION

STRESS RESPONSE

The brain’s naturally evolved emo3onal intelligence

STRESS RESPONSE

STRESS RESPONSE THREAT

RESILIENCE

The brain’s naturally evolved emo3onal intelligence

Is NOT a funcSon of reality NOR is it raSonal in any way; doesn’t even have to be a conscious feeling.

Recovery of feelings REMOVAL OF THREAT

RESILIENCE RESPONSE

The brain’s naturally evolved emo3onal intelligence

STRESS RESPONSE THREAT

RESILIENCE RESPONSE Recovery of feelings REMOVAL OF THREAT

The brain’s naturally evolved emo3onal intelligence

Atachment’s Emergency First Aid Team

OUR MOTTO - “We promise to get emo5onal when holes appear in the fabric of your togetherness”

“We also promise to hang around un5l fu5lity is felt”

When the fixes are fuQle, they need to be FELT as such.

as an afribute

SADNESS brings RECOVERY

HELP THAT IS HELPFUL!!

• keeping or restoring perspective

• right thinking / being positive

• pursuing happiness

• resisting the ‘let-down’

• acquiring the ‘skills’ of resilience

• pursuing calmness & tranquility

RETIREMENT trauma lossofsibling isolation rejecQon unloved loss of job hospitalization differentness losing face tragedy loss of child threats to identity

FACING DEATH

NEGLECT ABUSE loneliness MORTALITY emptynest not gelng one’s way

te nadir

loss of parent

Strength of DEFENSE Strength of BECOMING

- meant to be situa5onal - - meant to be characteris5c -

potenQal sQll unfolding found needed strength vs

OVERCAME

PERSEVERED

persisted despite distress growth force persists

came through distress seemingly ‘unscathed’

changed to withstand or cope with adversive or distressing condiQons

can funcQon or perform in highly stressful or wounding circumstances

SURVIVED

RESILIENT

ADAPTIVE

HARDY

feelings recover quickly aner Qmes of stress

transformed from inside out by adversity

heart was mended and spirits were revived doesn’t need to be sheltered from stress to preserve growth potenQal

Strength of DEFENSE Strength of BECOMING

- meant to be situa5onal -

potenQal sQll unfolding found needed strength vs

OVERCAME

- meant to be characteris5c -

came through distress seemingly ‘unscathed’

PERSEVERED

persisted despite distress growth force persists

changed to withstand or cope with adversive or distressing condiQons

can funcQon or perform in highly stressful or wounding circumstances

HARDY SURVIVED ADAPTIVE RESILIENT

feelings recover quickly aner Qmes of stress

transformed from inside out by adversity

results from a of feeling results from a of tender feeling

heart was mended and spirits were revived doesn’t need to be sheltered from stress to preserve growth potenQal

Stress Response

Resilience Response

ATTACHMENT’S EMERGENCY RESPONSE TEAM

acQvaQon of (alarm, frustraQon & pursuit)

FEELINGS that would interfere with performing or funcQoning in stressful circumstances are INHIBITED

Feelings that have been inhibited BOUNCE BACK to enable opQmal funcQoning and the full realizaQon of potenQal

SAFETY

as judged by the brain’s innate intelligence

sadness ie, feelings of fuQlity re brain’s emoQonal ‘fixes’

Stress Response

acQvaQon of (alarm, frustraQon & pursuit)

ATTACHMENT’S EMERGENCY RESPONSE TEAM

FEELINGS that would interfere with performing or funcQoning in stressful circumstances

are INHIBITED

TRAUMA is NOT what happens to us but what fails to happen within us in response, ie, the lack of a follow-up resilience response that includes SADNESS

Trauma is not an event but a stuck stress response

STRESS RESPONSE

TRAUMA

The brain’s naturally evolved emo3onal intelligence

Chapter Four Stess & Trauma

Signs of a Stuck Stress Response (ie, trauma)

Missing Key Feelings

Brain’s Backup Defenses

FIVE POINT ASSESSMENT of a STUCK STRESS RESPONSE

Stuck Primal Emo3on

Resilience Response is Lacking

STRESS RESPONSE THREAT

Recovery of feelings REMOVAL OF THREAT

RESILIENCE RESPONSE

- stuck in the WORK MODE

- lacking curiosity - lacking emergent or venturing forth energy

RESTLESSNESS

feltplay feltrest felt ftlit the vital signs of well-being

- past history of ungrieved losses

eg, sadness, sorrow, disappointment, grief

- stuck in fuQle endeavours /unable to let go / brain unable to find work-arounds for impediments

eg, cared for, cared about, caring deeply about, etc

eg, sorry, remorseful, guilty about, bad about

feeling RESPONSIBLE

AGITATION PARANOIA ADRENALIN-SEEKING

feeling ALARMED

feelings re CARE

FEELINGS of ATTACHMENT that may go MISSING ... when facing separaQon

feelings of DEPENDENCE eg, needy, trusjul vulnerable

feelings of ANGER ... when personally mistreated

feeling FULL or EMPTY eg, fulfilled, saQated, missing, longing, afachment ‘holes’ BOREDOM

What BOREDOM is about

When the ‘holes’ in togetherness are NOT sufficiently FELT, it is experienced as BOREDOM.

Boredom-a natural barometer for deficits of feeling - can’t feel the true nature or shape of the hole that exists within -

SIGHT & HEARING

TOUCH & SMELL

feelings of SENSATIONS that may be restricted sensing PAIN sensing BLADDER/BOWEL PRESSURE sensing COLD

& SOILING WETTING

Impact of the

STress Response

- a loss of tnder feeling -

CONFUSING SIGNS OF A WORKING STRESS RESPONSE

the loss of so-called ‘nega3ve’ feelings is typically misinterpreted posi3vely

no longer talks about what distresses or hurt feelings no longer feels unsafe or alarmed no longer reads rejecSon or feels its sSng

be^er able to funcSon or perform under duress no longer given to sadness and disappointment

no longer feels as needy, empty, lonely or dependent no longer is as visibly affected by loss and lack

SIGNS OF AN ACUTE STRESS RESPONSE AFTER A DISTRESSING EVENT

- typically referred to in the ‘disorder approach’ as a post-traumaQc stress syndrome or disorder

Blinded by:

• ‘empathy’ • diagnoses • ‘dysregulaSon’

ALARM

- elevated startle response - flashbacks and nightmares

- avoidance of whatever alarms

- intrusive thoughts & memories

- unable to focus and concentrate

PURSUIT

moreemotionbutlessfeeling

- hyper-arousal and hyper-vigilence

IMPULSIVENESS

FRUSTRATION

- irritability and impaQence

- erupQons of afacking energy - self-afack and suicidal impulses

SIGNS OF STUCK PRIMAL SEPARATION EMOTIONS

- clutching, clinging, possessing, hoarding, acquiring, impressing, pleasing, etc - fragmented fixes & fixaQons with pursuit as the theme – winning, placing, hunQng, chasing, afracQng, demanding, reducing, seeking, enhancing, etc - preoccupaQons with altering self in pursuit of belonging, love or significance

- irraQonal obsessions

- irraQonal avoidance

PURSUIT ALARM

- anxiety reducing behaviour

- an afracQon to what alarms - inability to stay out of trouble - recklessness and carelessness

- afenQon deficits around alarm

moreemotionbutlessfeeling

- preoccupaQons with concealing oneself in pursuit of belonging, love or significance

- anxiety FRUSTRATION

- fits & tantrums

- hilng and fighQng

- obsessions with change

- aggression and violence

- rudeness and meanness

- irritability and impaQence

- chronic agitaQon and restlessness

- erupQons of afacking energy - self-afack and suicidal impulses

THE SEPARATION COMPLEX – A LEGACY OF TRAUMA - the telltale marks of trauma on personality -

- the telltale (but reversable) marks of trauma on personality -

stuck

PURSUIT

stuck in defensive detaching and transference

stuck in defensive alpha or over-dependence

stuck stuck

ALARM

FRUSTRATION

stuck in a defensive flight from feeling & vulnerability (ie, a stuck stress response)

STRESS RESPONSE THREAT

RESILIENCE RESPONSE

Recovery of feelings REMOVAL OF THREAT

Feelings are the mind’s READINGS of emoQonal feedback

depresssion = fla^ened affect

ethreat to attachment can trigger a defensive depressing of emotion m

about defensive detaching

If the separaSon faced is deemed unbearable, the brain can reverse direcSon of the pursuit in an automated a^empt to reduce the threat. The a^achment drive itself cannot be reversed since it is the default and preeminent drive and only increases under threat.

• can be situaQonal or pervasive, physical or emoQonal, parQal or complete

• can involve DEFENSIVE TRANSFERENCE to other persons such as one’s peers and famous figures (includes fantasy afachments)

• can involve the DEPERSONALIZATION of afachment (ie, detaching from persons and afaching instead to pets, groups, objects, naQons, race, ideas, possessions, poliQcs, etc, etc, etc)

• depersonalizaQon can also result in fragmented pursuit – FIXES & FIXATIONS – which are highly addicQng because they cannot fulfill or deliver care

hoarding collecQng

chasing marks clinging clutching possessing achieving

PURSUING PRAISE

WINNING

Some common a^achment-driven where the pursuit is divorced from its relaSonal context: FIXES & FIXATIONS

going for hugs/smiles acquiring seeking status pursuing sameness hunQng for sex PORNOGRAPHY chasing applause

seeking afenQon scoring

placing chasing approval

Stess & Trauma

Chapter Five

The RECOVERY of FEELINGS

Stress Response

Resilience Response

ATTACHMENT’S EMERGENCY RESPONSE TEAM

FEELINGS that would interfere with performing or funcQoning in stressful circumstances are inhibited

Feelings that have been inhibited bounce back to enable opQmal funcQoning and the realizaQon of full potenQal

Provide SAFETY through • RELATIONSHIP • PLAY

RECOVERING FEELINGS

- making it safe to feel -

Where the helper can be ANYONE but preferably a caring adult to whom the child or adult is a^ached or will a^ach

PLAY

RELATIONSHIP helper

acQvaQon of alarm, frustraQon & pursuit applying relaSonal and emoSonal first-aid

- parent - grandparent - relaSve - teacher - coach

- expert - counsellor - therapist - caregiver - case worker - volunteer

- neglect and rejection - wounding by others

We must HAVE their hearts before we can protect their hearts

(eg, parent, teacher, therapist) (or client)

- losses and lacks - shaming or put-downs - abuses and violations

- distress and adversity

toengageand nurture attachment anythingthatcoulddivide

to caring adults and emotional playgrounds

Helping via Relationship

• convey a strong CARING ALPHA presence to inspire dependence

• COLLECT to engage and invite dependence

• COME ALONGSIDE emoQonal experience

• support EXISTING ATTACHMENTS with caring adults

• BRIDGE problems and all separaQons

RELATIONSHIP

Helping via Relationship

• convey a strong CARING ALPHA presence to inspire dependence

• COLLECT to engage and invite dependence

• COME ALONGSIDE emoQonal experience

• support EXISTING ATTACHMENTS with caring adults

• BRIDGE problems and all separaQons

RELATIONSHIP

• convey TRUST in their strength to cope (vs over-protecQon)

• provide CARE (including food) in the context of connecQon

• matchmake to embed in CASCADING CARE

We are meant to fit together in hierarchical attachment arrangements of CASCADING CARE

a NATURAL arrangement in harmony with the dynamics of afachment and the principles of development

as opposed to contrived arrangements based on social roles, gender stereotypes, prevailing assumpQons of equality, or parQcular dynamics between parents and children or between partners of a couple or in friendship

Our objective should be to embed in CASCADING CARE as opposed to pushing for independence or promoQng self-care

Helping via Relationship

• convey a strong CARING ALPHA presence to inspire dependence

• COLLECT to engage and invite dependence

• COME ALONGSIDE emoQonal experience

• support EXISTING ATTACHMENTS with caring adults

• BRIDGE problems and all separaQons

RELATIONSHIP

• convey TRUST in their strength to cope (vs over-protecQon)

• provide CARE (including food) in the context of connecQon

• matchmake to embed in CASCADING CARE

• create SAFE SPACES for feelings to bounce back

ADULT

(eg, parent, teacher, therapist)

SPACE FREE : SPACE FREE : wounding teaching problemsolving screens & distractions

(or client)

Create timely spaces for feelings to bounce back

• AFTER times of stress including separation, school, strained interactions, discipline, special performances, wounding, loss, etc

• ideally BEFORE sleep or the passing of time interferes with the ability of the thinking brain to interpret emotional feedback and link to the situations that stirred one up

• FREE of digital pursuit (social or videogames) and other competing activities

• FREE of problem solving, judgment, correction or teaching

• through RITUALS involving safe relationships and/or emotional playgrounds

Through another’s attachment to us, we can BE their ANSWER even when there are no answers:

• BE their HOME

• BE their place of REST

• BE their sanctuary of SAFETY

• BE their SHIELD in a wounding world

• BE their REASON for holding on

• BE their source of WELL-BEING

The answer is in BEING - not in DOING or SAYING or KNOWING the right things – when empowered by the other’s attachment to us.

RECOVERING FEELINGS

- making it safe to feel -

Where the helper can be ANYONE but preferably a caring adult to whom the child or adult is a^ached or will a^ach

- parent - grandparent - relaSve - teacher - coach - expert - counsellor - therapist - caregiver - case worker - volunteer

applying relaSonal and emoSonal first-aid

Harness the Power of Play

• to safely engage and DISTRACT in alarming situaQons

• to give the brain a chance to REST and RECOVER

• to provide for SAFE EXPRESSION of primal emoQon

• to provide a bubble of SAFETY in a distressing Qmes

PLAY

• to LIGHTEN the emoQonal load

• to aid the RECOVERY of feelings so that the stress response does not get stuck

• to set the stage to access SADNESS when emoQonally ready

When drawing into play, we are transferring into the arms of NATURE itself so it can gently and wisely restore lost feelings

EmoSons are not at work, so the inhibiSon of feelings is reversed

Play is safe so feelings won’t get hurt

EmoSons are freer to move and so more likely to be felt and idenSfied

EmoSons are easier to feel when one step removed from real life

Words or their lack, do not get in the way

Feelings of fuSlity are much easier to access

Feelings are recovered when emotions are at

play

ENCOUNTERS WITH FUTILITY

Suggestions for Harnessing Play

• engage in play by giving PLAY SIGNALS, like a bit of silliness, singing, wearing a playful cape

• set the stage for made-up STORIES, so their emoQons can drive something other than nightmares

• playfully ENGAGE in games, puzzles, stories, music, movement, drama, theatre, etc

• provide MATERIALS to draw, paint, construct, make crans, make music, priming the acQvity where necessary

• sing or hum LULLABY- type songs if possible, to harness their emoQonal and connecQve power

• if defended against closeness, engage in PLAYFUL CONNECTION, providing brief ‘accidental’ experiences of contact that are able to disarm

• engage in the CULTURAL PLAY, ie, the dances, music, art, of their culture of origin

Inviting Instincts & Emotions to Play

• provide opportuniQes to play out ALARM as well as alarming scenarios, while safely in the context of play where it is one step removed and doesn’t count for real

• give residual FRUSTRATION some playful expression via games of construcQon and/or destrucQon

• give SEPARATION- TRIGGERED-PURSUIT safe expression through games or acQviQes characterized by the hunt, the chase, or the find

PLAY

• give ALPHA insQncts safe expression through playing the leader, the boss, the superhero, the rescuer, the one in charge, the one giving the orders

• provide plenty of opportunity for PRETENDING to be someone or something else

• give DEPENDENT insQncts safe expression through playing the baby, the pet, the sick, the wounded, the one in need of care

... in our pursuit of happiness

... in avoiding negaQve thoughts

... in afempQng not to be upset

... in trying to stay in perspecQve

... in afempQng to stay opQmisQc

... in trying to cheer each other up

... in pulng limits on grief and sorrow

... in denying that the glass is half empty

... in trying to change the Eeyores into Tiggers

into the SADNESS whose task it is to facilitate needed endings, strengthen as required, and deliver us back to what happiness exists

PRESS PAUSE

RECOVERING FEELINGS

- making it safe to feel -

PLAY RELATIONSHIP

RECOVERING FEELINGS

- making it safe to feel -

vs adult therapeuSc techniques & methods

vs promoSng selfcare and stress management

vs teaching emoSonal management

vs cogniSve and raSonal approaches

vs treaSng children directly

vs promoSng ‘posiSve feelings’

PLAY RELATIONSHIP

vs trauma debriefing & correcSng percepSons

applying relaSonal and emoSonal first-aid

ConqueringAnxiety StrategiesforHelpingYour AnxiousStudents

Dr.CarolineBuzanko,R.Psychologist www.drcarolinebuzanko.com info@korupsychology.ca

Anxietyisthemost commonmentalhealth problemin kidsK-12… &theleadingreasonforchildren’s emergencyroomvisitsand hospitalizations

Untreated anxietyisthe leadingpredictor ofdepressionin teens&young adults

70%ofallmental healthproblems begininchildhood andadolescence

Anxietyhastripled sinceCOVID

Anxiety ImpairsDaily Functioning

•Sleep!!!

•Academics

•Socialinteractions

•Happinessandoutlook

•Familyrelationships

•Doingthings/goingplaces

•Nutrition

•Self-care

•Independence 5

ADULTSto Understand

Whatisanxiety?

Fearandworries areheretostay

•Normal,protectivefeeling

•Necessaryforsurvival

•Itsok!

•Temporaryinthemoment

•Notdangerous

•Nottobeeliminatedoravoided

•Canhelpmotivate&energizeus

Thebrainwas builttoprotect

However,whilesocietyhaschanged somucheveninthepasttwo decades,ourbrainhasnotchangedin hundredsofthousandsofyears…

Worriestobeexpected

Developmentallyappropriatefears

•Survival:separation,danger

Lifetransitions

•Newschoolorjob,newrelationships,teenageyears,transitiontoadulthood

Stressfulexperiences

•Neworunfamiliarsituations

Worriestobeexpected

Infant/ Toddlers

•Separation

•Novelty

•Loudnoises

•Shyness,fear ofstrangers

•Santa

Preschool

•Animals, dark, thunder,fire

•Nightmares

•Monsters& shadows

•Novelty

•Fearofdeath orghosts

•Separation

•Dark

•Gettinglost

•Thunder

Pre-

•Changes

•Performance

•Gettingsick orhurt

•Animals, monsters, ghosts

•Natural disasters Early Childhood

Adolescence

NormalWorries

Adolescence

•Homealone

•Familyor pets

•Rejection

•Mortality, health Elementary

•Social

•Whatothers think

•Family gettingsick

•School performance

•World events

•Afterhigh school!!!!

Highlevelsofnegative affect

Tendtoviewtheir emotionalexperiences asnegative

Aversivereactionsthat leadtoeffortstoavoid andsuppressthem.

CommonVulnerabilities AmongallEmotional Challenges

Highlevelsofnegative affect

Tendtoviewtheir emotionalexperiences asnegative

Aversivereactionsthat leadtoeffortstoavoid andsuppressthem.

•Constantworriesimpairingdaily

Viewsemotionalexperiencesas negative

•Whycan’tIbelikeeveryoneelse?

•Iamdeficient

•Worriesandpanicareawful

Whentheyevaluatetheemotion: Snowballeffect–themoreshethinksabout everything,themorepanicsymptomsintensify

•Reassuranceseeking

•Avoidance

22 Aversivereactionsthatleadto effortstoavoidandsuppress them.

Differentpartsofthebrainthatactivatesworries needdifferentstrategies

Amygdala Pathway:Physiological

AmygdalaBased Memories: EmotionalMemories

Ruminate

Talktoself

Trytoproblemsolve

Visualimages

Imaginativeworries

Thebraincannottellthe differencebetweenwhatit actuallyseesandwhatitimagines

Anxiety-BasedSchemas

Theworldisascaryplace andIamvulnerable

Everyoneispredisposedto anxiety.

Anxietyisallin howwerespond

•Basedonhowweperceivethedemandsofthesituation.

•Anxietymakesthedemandsfeelwaybiggerthanwhat theybelievetheycanmanage.

•Impairsresilience

•Contributestoeverything weworryaboutas

Self-esteem

Falsemessagestoavoid rejection

•Sohappy!

•Sobeautiful!

“Likes”worsensself-esteem

•Otherswon’tlikethe “real”them.

Massive-Scale Emotional contagion

Webegintoexperiencethe sameemotionsasothers withoutourawareness

•Long-lastingmoods(e.g., depression)canbe transferredthroughsocial networks

Disruptsconnections. Especiallyfamily connections.

Disrupted Attachment

Familyisthemostimportant relationshipoverall development.

Bullyingdoesn’thappenprivatelyanymore

Sendingunsolicitedand/orthreateninge-mail. Encouragingotherstosende-mailorto overwhelmthevictim

Posting/spreadingrumours.

Makingdefamatorycommentsonline

Sendingnegativemessages

Sexualremarks

Postingthevictim’spersonalinformation

Hatespeech

Impersonatingthevictimonline Harassingthevictim

Leavingabusivemessagesonline,includingsocial mediasites

Sendingthevictimpornographyorothergraphic materialthatisknowinglyoffensive

Creatingonlinecontentthatdepictsthevictimin negativeways

Trolling Cyberstalking

Hateraids

ViolentImages

Exposure

•Weakenkids’abilityto manageemotions

•Contributestoanxiety

Poorself-regulationbecause resourcesusedup

•Pooremotionregulation

•Increasedemotional reactivity

•Proactiveaggression

•Anti-socialbehaviours

Technostress

•Hardtodetach=chronicstress

•Don’treceiveanimmediatereplytoatext=anxietyandisolation

•Technology-relatedanxiety(e.g.,pressuretorespondimmediately)

•Shame&stigmaifnotconnected

•Validationthroughsocialmedia

Digital Immigrantsvs. DigitalNatives

•Hardtodetach=chronicstress

•Shame&stigmaIfnot connected

•Noissuebigenoughtorisk beingdisconnected

Over-Naggingand UnrealisticDemands

•Weplacemoredemandson childrenthanadults

•Constantcorrectionandnagging caneroderelationshipsand discourageautonomy

•Wouldwetreatourcoworkersor friendsthesameway?

UnhelpfulInteractions canCreateLoneliness

•Addingstress

•Failingtomeettheir needs

•Unwittinglyresponding inpunishingways,even whentryingtobe supportive

Talkingtoo muchor askinglotsof questions

UnsolicitedSupportvs. PerceivedSupport

•Swoopingincan:

•Underminetheequityinthe relationship

•Createasenseofobligation

•Independenceandself-esteem threatened

•Feelinvalidating

•Seemunsympathetic

•Shutdowncommunication

Accommodationsarereactive.Theytakeawaykids’ abilitytoself-sootheandproblemsolve.

Avoidanxietysituations

Adjustingroutines

Allowthemtobeexcused;slow-re-entry

Distractthemorstopthoughts

Alternativeplaceforlunch

Fixedschedulesandtransitionwarning

Stressballs

Minimizeanxiousfeelings

Breaks/officevisits

Braininhighstress state=amygdalakicks inandbecomesastop signforinformation andanyrational thinking 64

Anxiety…

•Wantscertainty

•Wantspredictability

•Wantscomfort

Avoidtraps

•Othersjumpingintohelporcontinuouslyavoiding:

•Changesbrain&ingrainsanxiety

•Makesindividualsevenmorevulnerable:Confidenceandresiliencestunted Noopportunitiestoexperiencesuccessmanagingemotionsandsituations

•Noopportunitiestolearn(e.g.,thatanxietyisnotdangerous)

Maladaptive copingstrategies Anythingtoavoidor reduceemotions developandmaintain challenges

Breakingthe Cycle: Everythingthat Maintains Anxiety

Negativethought patterns

Inabilitytomanage emotionseffectively

MaladaptiveCoping

Mayaswellfigureouthowtonavigatethem

Remember:Howwerespondto emotionalexperiencesdevelopand maintainchallenges.

Thus,thegoalisto:

•Changeresponsestoemotionalexperiences

•Createnewpathwaysinthebrain–new learningandmemories

•Targettheproblematicemotionregulation strategiespeopleuse

NOTtoeliminateorreducethe intensityofemotionalexperiences–Impossible!

The#1thingthey needtolearn?

Challengingautomaticthoughtsand increasingcognitiveflexibility.

GoodRoleModels: Nooneisimmune

•Empowering

•Promotesbravery,confidence,&resilience

GoodRole Models

•Beingscared&doingit anyway

•Displayvulnerability&cope outloud

•Modeleffectivecoping

•Seekandreceivehelp

•Recognizeownunhelpful thoughtsandbehaviours

Buy-in&Tolerance

•Education(especiallyoutcomesoftraps)

•Awarenessoftraps

•Pros&consoftraps

•Values

•Desiredoutcomes

81

Emotion Coach

Usemirrorneurons

Weshow confidence= TheyFEEL confidence

Emotioncoach

Coachesavoidtraps:

•Reassuring

•Answeringquestions

•Reviewingtheschedule excessively

•Answeringeveryphonecallortext message

•Checking

Emotion coach

Coaches

•Validate

•Showconfidencewith open-endedquestions.

•Whatareyougoingto do?

•Howareyougoingto figurethatout?

CoachingCues

•Showconfidence:Theycanfigureit out

•Collaborateideasre:howthey canfigureitout

•Helpthemmakepredictions

•Focusonlearning

•Howdidyoudo?

•Whatwentwell?

•Whatdidyoulearn?

•Whatwillyoudodifferentlynext time?

Effective Communication Tips Talklesslistenmore

Effective Emotion Coaches

Focusonconnection&safety

•Empathy&Physicalsafety

•Validate&acknowledge

•Howtheyarefeeling

•Howtheyperceivethesituation

•Bepresentwiththesituationyourself

•Beingpresentisbetterthanwords

Suzie’sMom

Learnedreasonablevs.excessive

Modelledherownemotionregulation

Practicedvalidation

•Acknowledgingfear

•Acknowledgingthephysicalsensations

Collaborativelycreatedaplanonnewwaysformomtorespond

•Askingopen-endedquestioninresponsetoSuzie’squestions(e.g.,whatdoyouthink?)

•Respondingtoonecallortextadaywhentherearenoclasses

•Specificguidelineswhenadoctor’svisitiswarranted

•Dooppositeofwhatanxietywants!

Buy-in& Tolerance

•Education(especially outcomesofhertraps)

•Awarenessofhertraps

•Pros&consofhertraps

•Valuesinherrole

•DesiredoutcomesforSuzie

•Emotionaldistressdirectlyrelatedwith hesitancytowardsengaginginthework.

•WeMUSTidentifywhatismoreimportantto themthanfeelinguncomfortable

Inspire

Suzie’sCostBenefitAnalysis

Benefitofanxiety

Protection–alerttopotentialdangers

Makesmefeelsaferandmoreprepared

Betterliked

Preventjudgment

Responsible&takinggoodcareofmyhealth

Easier&morecomfortable

Costofanxiety

Tooupsetandreactive

Socialisolation

Personalrelationshipsaffected

Academicsaffected

Notimeforhobbiesandself-care

Timeconsuming!

Notsustainable

Chronicphysicalsymptoms

Lossofself

Effortfultofeeloverwhelm

Nojoyinlife

WhatisImportant

•Whytheywanttocontrol theirownlife

•Howexhaustinganxietyis

•Howlifewillbedifferent

•Whattheyaremissingouton

Howdoemotional experiencescause problemsinyour life Whatneedsto change?

Allthethingsanxietymakes youavoid

•Seeingfriends

•Sleepovers

•Birthdayparties

•School

•Tryoutsforsports(and thereforesportteams)

•Sleepinginownbed

•Makingnewfriends

Goalsthatpromoteself-efficacy–Icandoit!

•Boostrationale

•Connectsstrategiestowhat’simportanttothem

•Givesusfocus

•Trackprogress

Clarifyexpectations What’stheproblemwiththisgoal: Tobelessanxious

Clarify expectations

•Wearehuman!

•Wecannot eliminateemotions &thediscomfort

•Wecannotchange ourthoughts

SMART GOALS

KeyConcern

ConcreteGoal1

Leavingthehouse despitetheunknown.

Unabletoleavethehousewithoutveryspecificcriteriabeingmet. Leadstoeveryonearguing,feelingoverwhelmed,andlate.

Specific:ByOctober22,Suziewillleavethehouseonherown.Shewill useherskillsinsteadofaskingforreassurance.

Measurable:TrackthenumberoftimesSuzieasksforreassurance.Track heruseofstrategies.

Achievable:Identifyrealisticandfeasiblestrategiesthatwillworkfor Suzie’spersonalneedsandleaveenoughtimetogetready.

Relevant:Learningtocopeiscrucialtobreakthedependencytrapsthat aremaintaininganxiety.ThiswillimproveSuzie’semotionalwell-being–(theprimaryconcerns),aswellasherrelationshipwithhermotherand morning.

Timebound:Implementstrategiesimmediatelyandcontinuetomonitor untilournextappointment.

NecessaryStepstoAchieveGoals

Identifyandcreateaplantoaddressallmaintainingvariables

Define&setclearboundariesandexpectations

IfReassuranceshowsup,Momwillpointtotheplan

Write&postboundariesandexpectations

Implement

NecessaryStepstoAchieveGoals

Skillbuilding:

Awareness

Acceptance(ofdiscomfort)

Detach

Practice

Leaningin

Monitor

Effectivenessoftheestablishedplan

Obstacles

Adjustasneeded

Addressbarrierstosuccess

IndividualBarriers

Willingness,commitment,andconsistency

•Irrationalthoughtsandnegativemindset Self-conceptandself-efficacy Avoidance

FamilialBarriers

ExternalBarriers

Mother'sAnxiety

•Unintentionallyreinforcingavoidancebehaviours Poormodelling Codependency

•Familybeliefsandattitudes Parentingstyle

•Socialpressuresanddynamics Schoolstressors

•Socialmediainfluences Timeconstraints Therapeuticalliance

Emotionscanbehelpful

Butsometimestheycanbeasneakytrickster tryingtomakeyouthinkthereissomething wrong….

MishmashofaBrain

Piecedtogetherovermillenia

•NooneCEO.Lotsofsub selves.

•Differentpartsofthebraincan communicateandworktogether easily

•Othersonlyhaveindirect contact

•Canholdcontradicting informationindifferentpartsof thebrain

Subselvesargue&fightfor control

TheBestEquippedTakesover

•Alotofbackandforth

•Integrative–workingthrough ascenario

•Confrontational–competing towin

•Differentpartsofthebrain activateddependingontheselftalk

Exposeit

•Understandemotionsandhowthey worktotakecontrol

•Yep,there’sBob,that’swhatit does.

•Wow,itisreallyworkinghardto makemethinktheworsttoday!

•Yeah,weknewit’dshowupnow.It doesn’twantmetodothis presentation.

•Itwantsmetoavoidnewthings.

•Itreallyknowshowtotrytostress peopleout.

•Howwetalktoourselves influencesourbehaviours 121

Catastrophizin

gCarlCatastrophizingCarlMindreadingMandy

RigidRichard

AvoidingAlison

OverestimatingOscar

HumiliatingPerfectionistPaula Hannah PermanentPete

FortuneTellingFran

ScarcitySam

All-or-nothingAl

GrumpySelf-criticalCarla McGrumperson

MindreadingMandy

NegativeNed

NOVEMBER

RigidRick

All-or-nothingAllie

AvoidantAlison

Self-CriticalCarla

CatastrophicCam

PerfectionistPete

FortunetellingFran

MindreadingMandy

NegativeNellie

Missingouton

•Seeingfriends

•Learningopportunities

•Wastingtimethatcouldbedoingother things

KIDSto Understand

Emotions Are Adaptive! Tellus something aboutreality

Anger

•Alertsustothreatsorinjustices

•Protectourwell-being

•Alertsustodanger

•Protectsusfromharm Fear

•Positivereinforcementfordoingthingsthatpromoteourwellbeingandsurvival Joy

Shame

•Promptsself-reflection,processing,andchange

•Maintainssocialharmony

Sadness

•Alertsustoloss,separation,orunmetneedsandallowsusto processtheevent

•Promotespersonalgrowthanddeepersocialconnections

Excitement

•Propelsresilienceandgrowth

•Fosterscuriosity,creativity,learning,andadaptability

EmotionsHelpUsNavigateSituations Keepussafeormoveustowardsgoals

125

Teachtheconnection!

•Allarejustasstrongandimportant

•Allinfluenceeachotherandre-trigger emotions

Feelings

ChangeRelationship withEmotions

Fromjudgmentaland criticalstanceinwhich theytrytoavoid, minimize,oreliminate

BehavioursThoughts

RaiseAwareness:Mindfulness

Buildawarenessof:

•Whatishappeningintheworldaroundus

•Whatthefeelingis

•Whatishappeninginthebody

•Whatishappeninginourmind

•Howalloftheserelatestoeachother,andtoourbehaviours

MindfulnessisKey

NOTABOUTRELAXINGNOTABOUTCHANGING EMOTIONALEXPERIENCES

NOTABOUTFIGHTING ORIGNORINGTHEM

WorryLikestoKeepusStuck!

Thoughtsof PastorFuture

Negatively influences affect, thoughts, behaviours Keeping thinkingof pastorfuture

Negatively influences affect, thoughts, behaviours 134 Atthe expenseof valuable information now

•Needtostayhereandattendtothecurrentcontext

•Tokeepprefrontalcortexonline

•Toattendtocorrectiveinformation

•Tolearn!

Versusgettingsuckedintoworries,whichintensifiesthe emotionalexperienceandkeepsusstuck

Mindfulness

Acceptance

Welcominganxietyandallitbrings. Andlivinglifeanyway.

Anxiety/EmotionDialAcceptanceDial

UnderstandAnxiety &Whatitdoes….

Emotions(Anxiety)Manifests Physically

•Mostpowerful

•Usuallyshowsupfirst

•Triggersemotionalresponse beforeweevenrealizeit

•Helpsustopreparetoreactto thesituation

Understand Anxiety& Whatit does….

Whenthealarmgoesoff,thebodygetsreadytofightorrun

Evenwhenitisafalsealarm! Thebrain(andbody)cannottellthedifference.

Ourbodyisgoing torespondbased onitsbestguess

Ourbrain isn’tgoingto waitaround

Ourbrain doesn’tcareif itshazardous ornot

Ourbrainwillrespond basedonwhatweneed tosurvive

•Releasedhormones

•Increaseheartrate

•Increasebloodpressure

•Increaseenergy

•Increasealertness

•Slowsotherprocesses(tofightor runaway)

•Secretesacidintothestomachto emptyit

Theystarttoworryabout thephysicalfeelings,which aredistressing,whichthey willdoanythingtostop

Becomereactive

Misinterpretasdangerousandleadsto morefear,moresensations…

•Wrongcontext

•Needtolearntocorrectlyinterpret ourinteroceptivesignals

•Betterabletointerpretsignals

•Canmakemoreadaptive decisions

•Boostresilience

•Betteremotionregulationand overallemotionalfunctioning

…Orcontrolwhat theycanintheir externalworld

Validate& Normalize Feelings

Ofcourseyoufeel thatway! Nowonder-your adrenalglandssent outallthatstuffthat’s reallyuncomfortable.

Understandingthe FUNCTIONof emotionsalsocritical toaccept&tolerate them!

EmotionsAre Adaptive!

Tellussomething aboutreality

•Alertsustothreatsorinjustices Protectourwell-being Anger

•Alertsustodanger •Protectsusfromharm Fear

•Positivereinforcementfordoingthingsthatpromoteour well-beingandsurvival Joy

Shame

•Promptsself-reflection,processing,andchange

•Maintainssocialharmony

Sadness

•Alertsustoloss,separation,orunmetneedsandallows ustoprocesstheevent

•Promotespersonalgrowthanddeepersocialconnections

Excitement

•Propelsresilienceandgrowth

•Fosterscuriosity,creativity,learning,andadaptability

EmotionsHelpUsNavigateSituations Keepussafeormoveustowardsgoals

UnderstandFunctionofEmotions

MUSThavephysicalreactions toalertustowhatishappening

•Cannotchangereactions withoutthisunderstanding

Understand thetruths!

158

Ourbodiesareintuitive anddesignedtoprotect us.

Itdoesn’tmakesenseif ourbodywasdoing somethingtoharmus.

Trustthebodytodoit’s thingandgetoutofits way.Wedon’tneedto addcommentary.

Heartscanbeathardall daylongandstayhealthy

Understand thetruths!

Ourbodywillalways compensatefor breathing

We’dbeextinctifwe alwaysfaintedindanger.

•FaintinghappenswithLOWblood pressure.

Tensionbuildswhenwe arenotdoinganything withtheenergy

•Getmoving:Shake!

•Whenanxious,lotsofbloodis flowing!

Forcingourselvesto swallowwon’thelpus swallow

•Humorsing

Emotionscomeand, moreimportantly,they go

Thisis normal!!! AndNOT dangerous!

Understandhow stressshowsup= Adaptivethinking

Themysteryisgone

BONUS:Expectingphysical sensationshelpsreduce signalstoamygdala

Ofcourse,Ifeeluncomfortable! Iknowwhatmybodyisdoing. Icanhandlethis.

Iunderstandwhatmybodyisdoing

Icanhandlewhatmybodydoes

Self-Coach

Icanhandlediscomfort

IknowwhatIcandonow

EssentialtoReconnect

Physiologically

Dizzy Racing

Tension

Achy

Sore

Hot Cold

Tingly

Numb

Sharp

Breathless

Shivering

Sweating

Troubleswallowing

Tired

Identify& describeTWO placesanxiety showsup. Strongeron leftorright?

Shivers

Increasedheartrate

Weaklegs

Ringingears

Blurredvision

Muscletension

Shaking

Trembling

Chestpain

Headaches

Burningskin/sweating

Blushing

Changesinbreathing

Stomach-ache/Nausea

Relaxed

Whenwelabelthedifferentpartsof emotionsandourexperiences,we:

•Changeourinterpretationofthem

•Changehowourbodyresponds

•Dampenamygdala’sfalsealarm

•Turnonprefrontalcortex

•Makeadaptivedecisions

•Learnthatwehavecontroloverourresponses

•Iknowwhatyouare&Iknowhowtohandleyou

•Avoidgettingsuckedin–it’sjustapieceof information

MoodInductionPractice

•Observereactions,whatevercomesupphysiologically,inanobjective andnonjudgmentalway

•Thirdpartyreporter

•ItmakessenseIfeel______________________

•FocusonthePRESENTMOMENT

•Groundingtechniques

•Debriefattheendaboutallthereactionsthathappened,inan objectiveandnonjudgmentalway

Emotionsaresimply emotions!

Theywilltakeoverifwearen’tself-awareinthe moment.

Usethemasalearningopportunity,getcurious!

NonjudgmentalAwareness oftheNOWisFoundational

•Withoutmindfulawarenessand acceptanceofemotions,can’t moveonwithanyoftheother worktostrengthenmore adaptiveresponses

•Therefore,needLOTSof practiceandexperiences withuncomfortablefeelings

FocusonPhysical Sensations

Bewithit

•Observeitvs.thinkaboutit

•Breatheintoit

•Expandit

•Allowittobethere

Sensationsmightchangebut theymightnot.Itdoesn’t matter!

•Itmightchange

Learning?

•It’stemporaryifyousitlongenoughwithit

•Stayingcuriouskeepsourprefrontalcortexon

Anxietyisnotinthesituation butthefeelingswehaveand Howweperceivethose feelings

Samemindfulacceptanceapplieswiththoughts

Thebraincannottellthedifference betweenwhatitactuallyseesand whatitimagines &willreactastruth

MindfulAwareness &Acceptanceof Thoughts

•Infiniteamountof thoughts

•(4.617x10^61potential thoughts=fourhundred sixty-oneduodecillionand sevenhundreddecillion)

•Constantstream

•Unawareofmostofthem

•Evenwhentheyaffecthow wefeel

•Easytogetstuckonone

•Ifsensitive,thebizarreones willalwaysstandout

Beawareandacceptitforwhatitis:Arandomthought

Back&forthbattlewhereobsessionstypicallyalwayswin…

MindfulAwareness&AcceptanceofEmotion:

Defusion •Noticing thoughtsvs. getting caughtin thoughts

Past Present Future

Emotionsaresimply emotions!

Wecanexperiencedifferentemotionsdespitethe exactsamecircumstances. Howweinterpretthemcausessuffering. Theywilltakeoverifwearen’tself-awareinthemoment. Usethemasalearningopportunity,getcurious!

Remember! It’sNOTaboutthe trigger… 187

Anxietyisnotinthe situationbutthefeelings wehaveandhowwe perceivethosefeelings Didyouknow? Fearandexcitement feelthesameinthebody? Buthowwethinkaboutitmakesallthedifferenceintheworld….

Threatvs.ChallengeResponse

Notgoodorbad,differentpurposes

Threatresponse:Goalissurvivalinsituationswe aren’tequippedtohandle

•Rushofcortisoltodefendandprotect

Challengeresponse:Opportunityforgrowthwhere wetacklehardbutmanageablesituations

•Moretestosteroneandadrenalinetohelpus achieveourgoal

Ourthoughtsare notalways trustworthy!

Stretch

Makealistofthingsyouorothers havebelievedthatyoudonot believeanymore

Informationfromoureyesand earsonlylooselyconnectedto whatweexperience

Mechanicsofvision:Theeyeislikea camera

•Lightbouncesoffobjects

•Entersoureyes

•Focusedontheretinabythelens

•Retinalimage(2-D)

Knowledge Influences Sensory Information (e.g.,allfacesare alwaysconvex)

Ourknowledge/experience misleadsusintoseeingthe maskasconvex

Bottom-upsensory informationis overriddenbytopdownknowledge

Weinterpretthe informationto createmeaningful PERCEPTIONSof theworld

Withtheseshortcutsitis reallyeasytogetstuck withONEinterpretation (theautomaticconspiracy ENDOFTHEWORLD)

BrainShortcuts

•Cutsoutinformationto maximizebrainresources

•Helpfulattimes(e.g., repetitivestimuli)

•Unhelpfulwhen emotionskickin:Miss otherpossibilities

•Becomerigidand stuck

CognitiveFlexibility

But first, needto get unstuck

ZoomOut!

•Whenwearetooclose,wegetdrawnintotheemotionsofthe experienceandspiraltotheeasywayout.

•Whenwecancreatespace,wecanrespondinhelpfulways

GetUnstuck:Detach Distancing

•“___isnoticing____ishavingthethoughtthat….” •Usethirdpersonlanguage Train,balloons,bubblesclouds,orleavesontheriver

Thankthem

Objectify

•Whatcolour?Howbig?Whatshape?What texture?Howwoulditmoveifitcould? NamethatStory

Detach

•Noticing thoughtsvs. getting caughtin thoughts

Makefunof worriedthoughts

Singit

Drawcartoons

Literalization

Muteit

Sayitreallyfast

Sayitinslowmotion

Mimicit

Exaggerateit

DismissWorriedThoughts

•Yep,that’syourstoryyou’retryingtotell.

•Nicefirstdraft.Niceconspiracy.

•Thisisnormal.

•Thisisnotanemergency.

•You’reannoying.

CreateaBingoCardofStrategies

Theseareonly guesses!!!!

(Basedonunhelpful trickster assumptions)

ANTSInvolve:

NOTgoodor badBUTthey DOlimit our flexibility

Overestimation

•Believesomethingbadis forsuregoingtohappen

Catastrophizing

•Worsecasescenario

•Completelyawful

•Completelyunmanageable

Overestimation

•Believesomethingbadis forsuregoingtohappen

Catastrophizing

•Worsecasescenario

•Completelyawful

•Completelyunmanageable

Scratchatthe door
Burglar
Ghost Monster
Kidnapper

Overestimation

•Aboutthelikelihoodof somethinghappening

Catastrophizing

•Abouttheimportance oftheevent

Leadtospiralling

CognitiveFlexibility

•Leanintostrongemotions

•Keepourprefrontalcortexonlineby GETTINGCURIOUS

•Breakanxietymaintainingcycles: Changerelationshipandresponseto emotion-provokingsituations

Imadea mistake Theyrealize Iam incompetent Iamgoing tobefired Myfamilyis goingto rejectme Homeless

CognitiveFlexibility:Get UnstuckfromThinking Traps

Goalistoincreaseflexibilityin appraisingsituations

NOTtoeliminate,replace,orfix thinking–thisISonepossible waytolookatthesituation

•Respondinadaptiveways

Acknowledge. Detach. Editthefirst draft.

Whatareother possibilities?

Scratchatthe door
Sister
Dog

CognitiveFlexibility:Co-ExistenceImportant! (withotherpossibilitiesbasedontheNOW)

Enhance Cognitive Flexibility withHelpful Open-Ended Questions

Createachecklist

•Togenerate alternative explanations

•Toacknowledge theirabilityto cope

Alternative explanations

Howwouldmyfriendinterpretthis?Grandma?Pet?

Isthereanyshredofusefulnessinthisthought?

Whatwouldgetforbuyingintothisstory?

AmIgoingtofollowmythoughtsormyexperience?

WhatadvicewouldIgivetosomeoneelse?

WhathaveInotconsidered?

Whatevidenceisthereforandagainstthisthought?

HowmuchdoIbelievethisistrue?WhatdoIknowforsure?

IfIwereinasitcom,whatwouldbefunnyaboutthissituation?

Whatlittlechangewillhelp?

Abilityto cope

Howwouldmysuccessfulfutureself-handlethissituation?

Whatisgoingpositivelyinmylifethatwillhelpmecope?

HowhaveIcopedwithemotionalexperiencedinthepast?

Whataspectofthissituationiseasytotarget?

Ifthiswastrue,wouldIstillsurvive?

Ifthiswastrue,whatarefivepossibilitiesre:whereIwillbeinayearfromnow?

223

Ifthiswastrue,whathavelearned?

BeCreative!

Chainofflexibility

ColumboApproach

•Guidethemtocreate discrepancies

•Canyoureadeveryone’s minds?

•Allthetime?

•Witheverything?Orcertain things?

•Examples?

PracticeCognitive Flexibility

•Yes,And Storyre-write

•Cantryvisualization

•Externalizationofvoices

•Problem-solving

•Playdevil’sadvocate

•Counterarguments

HypothesisTesting

Lotsofexperimentsand experiencesneeded!

•WhatdoIthinkwillhappen?

•Howsure?(1-10)?

•Wasthehypothesisright?

•WhatdidIlearn?

Helpthembethinkers

Independentproblemsolversto figurethingsout

Withoutcallsortexts

Withoutfakecrutches

(Wecan’tknow,soavoidreassurance.)

Let’sfigurethatout.

Whatcouldyoudo?

WhatIknowWhatIdon’tknow

Wherewe’regoing Whattimewe’re leaving WhatIwilleatfor lunch Whoisinmygroup •Whoourgroup leaderis

Wherewillsit WhoI’llsitwith Weather? Whattimewe’llget back Wherethebathrooms are Bugs? Howmuchwalking? Allergicreaction •Snackbreaks Ifthebuswillbeon time Howbusyit’llbe Howloudit’llbe

Modelling

•Ifeelfrustrated.Ineedtotakeaminutetothink whattodonext. Canyouhelpmebrainstormideas?

•That’satighttimeline.Iamgoingtoplanthisout.

•Iamalittlenervous;Ihavenoideawhatwill happen.Let’sfigurethisout.

Perfectionismisthemostseriousthinking trap&rootofdepression

Focusoncoreconcepts

•Unrealisticexpectations

•Rumination

•Needforapproval

•Concernaboutmistakes

•Doubtsaboutactions

•Additionaltrapslikecircumstantialthinking,quality/quantity 235

BreakintoParts

Helpfulpartsofperfectionism

Helpsusprepare

Helpsusstrivefor excellence

Unhelpfulpartsofperfectionism

Becomeparalyzed

Procrastinate&create morestress

Stifleslearningand growth

Narrowsourworld

Makesusperformworse

PerfectionismlikestoworkwithPals

•Youneverdoanything right

•Noonelikesyou

•Everythingyoudosucks

•Youalwaysfailandwill continuetofail Henchmen

Breakinto parts

•Goodandnotsogood

•Thispartishard

•Iwillfocusononestepat atime

237

Ican brainstorm Icanfollow atemplateIcanedit

BuildProceduralThinking!

•Striveforexcellence,butaddress unrealisticstandards

•Emotionsrelatedtoexpectations

•Focusonwhat’snext(vs. circumstances,rumination,should’s)

TheImportanceof Mistakes

Talkaboutyourownmistakes

Talkaboutothers’experiences

Embracingmistakes: MistakeoftheDay!

Whatwasthisexperiencelike?

Whatdidyoulearnfromthismistake

Whatwillyoudothenexttimeyouareinthis situation?

Whatadvicecanyoutellothersbasedonthis?

Forgingahead

•Avoidgettingstuck

•Noneedtoaskwhy,lecture,or explaintheproblem

•HaveTHEMthinkofthehows

•Howwilltheyfixthismistake?

•Howwilltheymoveon?

•Howwilltheyhandle ______________?

Practice!

•Startwithemotionfree problems

•Movetowardemotionally chargedproblems

CoreSkill: Mindful Awarenessof Emotion: Behaviours

Coreskills

Identifyingandmodifyingunhelpfulemotion-driven behaviours

Whatitlookslike

•Ourbodycommunicateshowwe arefeeling

•HowwouldothersknowwhenIam feelinganxiousbylookingatme?

Behaviours:Internalizing

•Withdrawn/isolated

•Shy

•Sad/irritable

•Head/stomach-aches

•Eatingissues(under-orover-eating;food intolerances)

•Sleepproblems/Fatigue

•Lowself-esteemandconfidence

•Rejection

•Repetitivebehaviours/obsession

•Difficultiesconcentrating,fidgety

•Avoidance

•Disorganized

•Cry

Behaviours: Externalizing

•Easilytriggered

•Disrespectful Oppositionalanddefiant

•Difficultytransitioning Aggression/intimidation

•Difficultiesconcentrating

•Liesorsteals Temperoutbursts

•Restless/fidgety Interrupts/Intrudes

•Impulsive

•Giveupeasily

•Argumentative

•Yell

•Repetitivequestions

•Seekconstantapproval Substanceuse

Whensomeoneavoidsthingsthey don’tfeelcomfortablewith, theylosethechancetopractice andgrow

Thoughts&Feelingsleadto(avoidant)behaviours

PeoplewillthinkI’mstupid

•Iavoidspeakingupinmeetings

IfeellikeIwillvomit

•Iavoidgoingout

Everything•IavoiddoinganythingIcan’tdoperfectly mustbedone perfectly

•IavoiddrivingIamgoingtobeinacar accident

PeoplewillthinkIamboring

•Iavoidhangingoutwithfriends

Withavoidance,theynever learn!

BiasedThoughts Neverlearnthoughts arebiasedandbad thingsmightnot happenorbeasbad asthought.

Safetybehaviours Neverlearntheycan copeontheirown Hinderstheirability tofacechallenges

Anxiety strengthened Worriedthoughts seembelievable

Emotional (Avoidant) Behaviours

Function: Toreducethe intensityofthe emotion

SubtleAvoidanceAvoidfullexperience

CognitiveAvoidanceAvoiddistressing

Important!

MUSTunderstandhowtheirbehavioursaremaintaining,orevenworsening,their emotionaldiscomfort

Thebehaviourisreinforcedinthemoment,increasingthelikelihoodofusing thisstrategyagaininthefuture

Remember!Short-andlong-termoutcomesof maladaptivevs.adaptivecopingstrategies

Maladaptive Coping Feelbetterin themoment Worsens anxietyinthe longrun Ingrains anxiety pathways

Adaptive Coping Feel distressing inthe moment

Tolerate &manage anxietyin thelong run Createnew healthy pathways

IensureIlook perfecttofeelsafe againstpotential embarrassment.

•ButIendupmissingschool

•ButIfightwithmymom

Iskipsocial functionstoavoid rejection

•ButImissoutseeingmy friendsandnurturing thoserelationships

Iconstantlycheck myhealthtostayin controlandcatch anythingearly

•ButImissoutonthings

•Timeconsuming

•Alwaysworriedandno timeforhobbies

Ifailschool Homelifeistense

Iwilllose relationshipsand becomeisolated.

Idisruptrelationships, loseself,become depressed

90%ofwhatpeoplelearnis fromwhattheyexperience

Don’tunderestimatethepowerofthe anxiousemotionalbrain!

•Changeisneurological–weneed tochangethebrain

•Behavioursaffectemotionsmore effectivelythanthoughtortalking

•Brainischangedthrough EXPERIENCES

•Can’tthinkortalkourwayto change

•Focusonstrength(behaviours) ratherthanweakness(thoughts)!

Speedofrecovery directlyrelatesto yourwillingness tofeelanxiety

Resilience

Abilitytoadaptwelltoadversity, trauma,tragedy,threats,oreven significantsourcesofstress.

Suzie

WHATISTHE PROBLEM?

•NeedtomakesureI lookperfectinthe morning NeedtomakesureI amhealthy

WHATDOESANXIETY WANTUSTODO? WHATOUTCOMEDO IWANT?

Togotoschoolwithout worryingabouthowI lookorwhatothers willthink

Togetthroughaday withoutworryingIam goingtodie.(Caroline change:Stilldoing whatIneedtodo whenIhaveaworried thoughtaboutdying)

•Guarantee perfection Discusscolour wheel Analyzeeveryinch Reassure Seethedoctor everyweekto ensureIamhealthy Checkhealthstatus daily

WHATACTIONSARE NEEDED? WHATNEEDSTO CHANGE?(&WHATIS THEOPPOSITE?)

Controlforcertainty needstochange. Therefore, Gotoschool withoutchecking Doctorschedule andasneeded basedonspecific guidelines

•Acknowledge henchmen Dropintothebody Talkback (whatever) Saygoodbyeto mom(without askingabouthowI lookandwithout hertellingme) Writemysymptoms ifneededfornext regulardoctor appointment

WhatamIgoingtodonext? (TheOppositeofWhatAnxietyWants)

•Harassingmomto AvoidensureIlookperfect judgment

Avoid•Skipsocialfunctions rejection

EnsureHealthy

•Wastetime constantlychecking

•Fightingwithmom

•Leavewithoutasking mom Face uncertaintyof possible judgment

•Gotosocial functions Face uncertaintyof possible rejection

•Paintinsteadof checkingDr.Google Face uncertaintyof myhealth status

Suzie’sHomework

•Goingtoschoolwithoutreassurance

•Toleratinguncertaintyofwhethershe issick

•Makingherownappointments

•Fillingupthecarwithgas

•Goingthroughhermorningroutine withoutconsultingDr.Google

•Handinginworkwithoutmom checkingit

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Coreskills

Integrationofalltheskillsthroughemotionexposureto masteradaptiveresponses

IntegrateSkillsthrough EmotionExposure

Integrateskillstomasteradaptiveresponses

•Talkingnotenoughtochangethebrain!

•Doingmakesstrongermemories

•Doinggivesusexperience

•Quickerprogress

•ProvokeSTRONGEMOTIONS-MUSTshowupfor learningtohappen

Worryis…

Emotionalexposuresbecause theprimaryfocusisnotthe specificsituation,image,or activitybuttheemotion itself.

EmotionExposures

Interoceptive

Situational-based

Imaginal

•Elicitdistressingphysical sensations

•Confrontdistressing thoughtsoremotions.

EmotionExposures

Interoceptive

Situationalbased

Imaginal

•Facesituationsthatprovoke intenseemotionalreactions

271

•Elicitdistressing physicalsensations

•Facesituationsthat provokeintense emotionalreactions

•Confrontdistressing thoughtsor emotions.

272 Combine for maximal benefits

GoalsforALLExposures

PROCESSvs.OUTCOME

•Basedonsomethingactionable

•Targetsdistress

•Ensurestheylearn somethingnewfirsthand vs.anxietyreduction

ExposuretoLEARN

Anxietyissafe, tolerable,&temporary

•Safetybehavioursarenot neededtotolerateanxietyorto staysafe

•Theamygdalawilllearn:Thisis notdangerous!(Andstops sendingthefalsealarm.)

ExposuretoLEARN

Despitefeelinganxious,Istilldidit

•And…Icanstilllivelifeanddoanything,evenwhilefeelinganxious!

ExposureTOLEARN

•Somethingaboutthespecificissue (basedontheirprediction)

•Didthefearedoutcomehappen?

•No

•Lesslikely

•Lesssevereand/or

•NotasdangerousasI thought

•Yes…

ExposuretoLEARN

Despitefeelinganxious, Istilldidit

And…Icanstilllivelifeand doanything,evenwhile feelinganxious!

Gettingunstuck

FaceFear Without safety behaviours Without theworst thing happening Or,ifitdoes, theycan handleIt

PhysicalSymptomsarea NaturalResponse

•Butoftenmisinterpretedas dangerous,whichcreatesa positivefeedbackloop

•Oftenmotivatedtoavoidthese

InteroceptiveExposure:LeanIntoDiscomfort!

•Confrontworrisomebodysensations

•Evokethingstheyworryabout Ultimategoal:Toleratethephysicalsensations

•Withoutbeingscaredofthem(andthereforemakingthemworse)

•Withoutneedingtoengageinemotion-drivenbehaviourstoreduce,avoid,or eliminatethefeelings

InteroceptiveExposure

Learning:Theuncomfortablephysicalsensationsaretolerable, temporary,andnotdangerous.

•Iamnot

•Havingaheartattack

•Losingcompletecontrol

•Suffocating Dying

InteroceptiveExposure

Beprepared!

•Weneedtheirconfidenceinthisprocesssoweneedtobe confidentourselves

BePrepared!

Hyperventilate/fast breathing(dizziness)

Spininplace(dizziness, nausea)

Wearsomethingtight aroundneck(tightnessin throat)

Breathethroughastraw reallyfast(breathlessness) •Holdyournose!

Jumpingjacks,runonthe spotorupanddownstairs (increasedheartrate)

Shakeheadsidetosideor drawacirclewithyour nose(dizziness)

Stareatceilinglightfor1 min.andthentrytoread something(blurredvision)

Stareathandsfor2-3min. (unreality)

Getthemtodowhatever causesthefeelings

Collaborativelychooseamoderate &distressingexercise

•Repeatit

•Evokesensationsasintenselyaspossible Sustainsensationsbeyondfearedoutcome limits

Repeat–especiallywithany“yeahbut’s”

•Nodistractionnoravoidance

•Record

•Lengthoftime&numberofrepetitions

•Physicalsensations

•Intensityofsensations

Levelofdistress

•Assignforhomework!

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ToleratingUncertainty

•Lifeisfullofuncertainty:wecan neverknowwhatisgoingto happenfromonemomenttothe next

•Brainwilldowhateveritcan toavoiduncertainty

•Buildtolerancebygoingintothe unknown!

Becomesogoodatmanaging ANYemotionthatcomesup.

Learntoresponddifferentlythrough LOTSOFEXPERIENCES

Anxiety

Shame

Guilt

Rejection

Disappointment

Frustration

Self-doubt

RejectionPractice

SettingupExposure

Setupthesituation&collaborateaspecificplan

Addressobstacles

Addresssafetybehaviours

Honesty&Remindthemhowanxietyworks

Rationaleandbuy-in

Testitout!

Validate&normalize

Debrief&Evaluate

Reinforce

Keepgoing

SettingupExposure

Setupthesituation:COLLABORATIVELYCreateaMenuof FearedSituations&Internal/ExternalStimuli

Haveavarietyandmatchsituations, thoughts,andphysiological experiences

Makeitworthwhile:Includethe hardest,scariestthingstheythink arevalidandneedtobeavoided

Remember:FocusonPROCESSvs. triggeroroutcome,LEARNINGvs. anxietyreduction

ReasonableRisk

Notabsolutelyrisk-freebut somethingpeopledoeveryday

•Saysomethingstupid

•Dosomethingembarrassing

Makeamistake

•Sweatinfrontofothers

Wearsomethingatrocious

•Asksomeoneout

•Forgettolockthedoor

•Gotothetoiletinpublic

•Walkoutsideonareallywindyday

FearedSituations&Internal/ExternalStimuli

Antecedents(Triggerstoanxiety)

Snakes

Feelingnausea

Tryingsomethingnew

Initiatinganinteraction

Presentations

Beingwithunfamiliarpeople

Intrusivethoughtsre:break-ins

Intrusivethoughtsre:housesettingonfire

Youarethe expertandI needyour expertise!

Wewillputour expertheads togethertofigure outthebestplan.

Rateit

Collaborate

Theygettochoosewhattheywanttodo

Severalthingscanmakeiteasierorharder(e.g., distance,time,people)

DoesNOTneedtobeeasiestfirst MUSTsurpasstheidentifiedpointatwhichthe fearedoutcomeisexpected

SettingupExposure: Collaborateaspecificplan

OnMondaymorningat10:00,Iwill:

•Mindfullywalk(focusingonmyfeet movement)inthedirectionofM’sdesk.

•Iwillmaintainanaturalpaceandposture withmyeyesup

•WhenIreachtheintersectionofdesk,Iwill lookatMandsmile

•AsIreachthecornerofM’sdesk,Iwillsay “Hi”clearlyandaudibly

•Iwillcontinuewalkingpastthedesktothe photocopiertophotocopyadocument

•IwillreturntomydesktonotehowIfelt before,during,andaftertheexposureand ratetheawfulness. Step-by-stepplan

Settingup Exposure: Address

Obstacles

IntenseAnxietyorPanicBeforethe Attempt

•Dropintothebodyandreviewmygoaland copingcards

•Identifythefirststepandgoanyway

Misnotattheirdesk

•Practicewalkingpastthedesk

•TryagainwhenMisback

•Dotheexposureatthenextalternatetime

Igetcalledintoameeting

•Dotheexposureatthenextalternatetime

NoSafetyBehaviours

Allowed!

(It’sonlyanillusionofsafetyanyway)

TheProblemwith SafetyBehaviours

Habitsthatmaintain&worsensanxiety

•Nolearninghappens:believethe behaviourpreventedcatastrophe

•Stilltryingtocontrolanxiety(sonever confrontfears)

•Effortfulandexhausting(whichcauses moreanxietyanddysregulation)

SafetyBehaviours

AVOID FalseFearBlockers

Anythingtomakethemfeelbetter inthemoment

CalmingstrategiesStaypresentwithwhatis,tolerate, andnoticewhathappens. Amygdalalearnsbyfeelingthe discomfortandseeingthat nothingneedstohappenforitto goaway(andcanhandleit).

Predictionsare importantfor learning! Setupas experimentsto ensurelearning

PredicttoMaximizeLearning!

SettingupExposure Honesty!

You’regoingtofeel uncomfortable

Anxietywillbeatitshighest whenyoudosomething differentthefirsttime withoutsafetybehaviours

SettingupExposure You’regoingtofeeluncomfortable MUST Activateto generate Developnew, competing braincircuits

SettingupExposure: Remindhowanxietyworks

Anxietyis

•Uncomfortable&thisiswhatit does…

•Normal(ofcourseyouaregoingto bescared!)

•Safe(it’smeanttoprotectyou!)

•Temporary(let’sseehowlongthis feelinglasts)

SettingupExposure: Honesty!

•Wehavenoideawhatisgoingtohappen

•Iknowyouwillhandleit

Wecannevermakeanyonedoanything–especially distressingthings-iftheydon’twanttodo

SettingupExposure

Rationale&Buy-InCollaborate

•Whatisimportanttothem

•Whyarewedoingthis?Howwillitbe helpfulforyou?

•Howdoesworrygetinthewayofyour life?

•Newlearning Tomanageemotions

•Icanhandleit! BUT…Fakeit‘tilyoumakeitdoesn’twork

(Maskingisexhaustingandtoohardinthefaceofarealchallenge)

RealBraveryisNOT Fearlessness.

Braveryisacknowledgingwhensomethingis hard(notpretendingitisn’t)

•Withanhonestappraisal,wecanrespond productively

Remember! Speedofrecovery directlyrelatestoyour willingnesstofeel anxiety

SettingupExposure: Testitout

Thisistheonly waytocreate newexperiences thatcontradict witholdworries

SettingupExposure: Validate&Normalize

Nomatterwhat!

•Sticktotheplan untilyousurpassthe fearedoutcome handleANYTHING

•Mustlearntheycan gofurtherthanthe worrymadethem believetheycan

SettingupExposure: Debrief&Evaluate

Learning happenshere todisconfirm conspiracy

EvaluatetoMaximizeLearning!

Important Foundations

Whenexposure isdone

•Lotsofopportunities

•Candoitontheirownwithout safetybehaviours

•NOTabouttheirsubjective distress!!!!

Willingnesstofaceanxiety provokingexperiences!!!

Moving on

WhatIcouldn’tdo becauseofworry:

WhatIcandonow:

WhereIam goingnext:

LifestyleFocus

Opportunists:Choosing tobeanxiousnowfor moresuccesslater

MissionsforSelf-Exposure

You’reonlylimitedbyyourowncreativity!

Createthemesfortheweek

•Imperfection

•Makeaguesswhendon’tknow

•Focusonquantityvs.qualityinatimed task

•Fastdecisionmaking

•Independence

•Bookownappointments

Buythingsontheirown

•Orderthefamily’spizza

•Talkingtopeople

•Askstrangerfortimeordirections

•Asksomeonetoplay

•Complimentsomeone

Challengesarepartof life.Needtobe challengedtogain directexperience workingthroughit andlearntheycan handleit.

Dosomething hard&takerisks! Everyday.

AdultsBeing Helpful

•Encouragekidstotry newthings,evenwhen scared

•Teachkidstobe comfortableintheworld

•Thereisnocertainty

Willingness ActionPlan

BONUS

CommonObstacles:

•Lackofunderstandingaboutanxietyandwhat maintainsit

•Unclearrationale

•Rationaleirrelevantorweak

•Fusiontounhelpfulthoughts(e.g.,justifications)

•Excessive(e.g.,toobig,skillsorresourceslacking)

•Individualisnotinvolvedinselectingandplanning

•Exposuresaren’tworrying–tooeasy

•Somethingstillmakesthemfeelsafe(yeahbut…)

•Practicesessionstoonarrow

CommonObstacles:

•Implementedincorrectly

•Focustoomuchonconvincingor reframing

•Nolearninghappening

•Poortherapeuticrelationship

•Depression

•Failingtoaddressothers’ accommodations

•Failingtoaddresssafetybehaviours

•Unintentionallyreassuringor accommodatingourselves

•Workingharderthantheindividual

•Stuckintryingtoconvincethem

FocusingonHabituation

Sendingthewrongmessages

•Anxietyisbad(becauseitmustbe reduced)

•Somethingiswrongwithme (becausetheonlywayIwillbefixed isifIdon’tfeelanxious)

•Misinterpretinevitableand normalunexpectedanxiety becomessignsoffailure

•Hopelessness

•Anxietyiscontrollable

•Exposurecanbecomeanother safetysignal

Whattodoinstead…

HabituationFocusonlearning:Feared outcomebeliefscontradicted?Did youhandleit?

Whattodoinstead…

Eliminateanxiety&fearful associations Createnewlearningpatternsthat competewitholdones

Whattodoinstead…

ConditionalSafetyLearningLearnnon-danger-based associationsacrosscontextswith differentpeopleandeverywhere anxietycanshowup

https://parentsoftheyear.buzzsprout.com/https://bit.ly/overpoweringemotionspodcast

ART THERAPY FOR KIDS AND TEENS

-Jules Fieffer, Cartoonist,

Understanding the Art Materials

1. Each person relates differently to different materials

2. Allow them to explore

3. Some materials allow for more control

4. Some materials force you to let go of control

5. Force them out of their comfort zone

6. May bring up memories

7. Help to create rituals*

1. Provides another language to tell their story

2. Can project feelings outside of themselves

3. Can be more objective and safe

4. Containment of overwhelming feeling

5. Gives a voice where it is too scary to speak

6. Learn to tolerate frustration

7. Try new things/ experiences

Fear and Anxiety stored in the Amygdala

Eric Kandel, "In Search of Memory"

Containment of overwhelming feeling

Gives a voice where it is too scary to speak

● We all begin with the same starting points

● We all are given the same directives

● We all hear and interpret things differently

● Things may get miscommunicated

● Things may get misunderstood

● When expectations are too high we may be disappointed

● Opportunity to think creatively

● Observe how others interpret the world, without judgement

When it comes to your children, What are you most concerned about?

Behaviors

Health

Relationships Grades

Instability

Divorce, adoption, separation or change of caregivers

Moving

Unclear expectations

Premature or late development

Neurodevelopmental Disorders

Disability

Financial Difficulties

Caregivers’ mental illness, drug/alcohol dependence

Minority population

First Generation

Changes in religious affiliations

Life transitions

Social Anxiety

Academic Anxiety

Testing Anxiety

Academic anxiety refers to the feelings of worry, tension, or dread that are associated with academic settings or tasks.

1. The Generation of Testers

2. Students are overwhelmed by the pressures to succeed

3. What are the Signs? Anxious students may express their fears by:

a. crying or throwing tantrums, seek constant approval or reassurance from others, headaches, stomachaches, racing heartbeat, or difficulty breathing.

4. “In the Pew survey of teens, academic pressure tops their list of stressors: 61 percent say they face a lot of pressure to get good grades.”

5. SINCE COVID - 19 shown an increase in general anxiety in children under 17

Has the potential to negatively impact all aspects of life, including social relationships, academic performance, emotional wellbeing, and future work opportunities

1. Social Media Binging can lead to lower self-esteem and fatigue

2. Social Change

3. Constant notifications, comparisons to others, pictures of events they weren’t invited to, pressure to get comments and “likes”

4. Warning signs: avoiding school, avoiding eye contact, overly critical, fidgety. mumbling, etc.

5. Parents support - empathetic support, structure, reassurance, and boundaries

Shortness of breath

Heaviness in their body/muscle fatigue

Dry mouth

Clammy hands

And more!

Case study: Phoebe

9 Years Old

Mother died from drug overdose

History Of Physical And Sexual Abuse

Living in a Residential Group Home

(No father involved)

1. Deep breathing exercises: Bubble Breaths

2. The power of positive self- talk & Affirmations: “I can do hard things!”

3. Healthy Nutrition & Sleep Schedule

4. Activity focusing on bodily regulation yoga is a great place to start, look into Somatic practices.

5. Understand, don’t invalidate.

6. Positive Interactions

7. Play!

8. Take the pressure off!

9. Co- Regulation Rituals: family dinners, tea time,

10. Parent Groups/Sessions

11. Family/Parent Meetings

12. Modeling self- care, boundaries, assertive communication and self- efficacy

13. Provide Safe Spaces

14. Tools to use:

a. Fidgets

b. Therapy :)

c. Normalize asking for support and recognizing “anxiety tics”

You cannot put your seatbelt on in the middle of a car accident

1. Don’t try to eliminate their anxiety

2. Don’t avoid things just because they make your child anxious

3. Express positive - but realistic - expectations

4. Respect their feelings, but don’t empower them

5. Don’t ask leading questions

6. Don’t reinforce your child’s fear

7. Be encouraging

8. Keep the anticipatory period short

9. Think things through together

10. Model healthy ways of handling anxiety

Draw what scares you

Draw what makes you feel brave DO

● Limit news and images

● Be honest But reassuring

● Say “It will be OK”

● Validate their feelings

● Talk about anxiety

● Talk about other feelings

● Seek professional help, if needed

DON’T

● Avoid the scary things

● Minimize their feelings

● Excessively discuss your own fears

Case study: Rebecca 8 years old:

1. What feelings do you have about (given situation)?

1. What color is that feeling?

1. What shape is it?

1. Where in your body do you feel it?

1. Does it move around or stay in one place?

1. Does that feeling make you do anything?

Safe Place drawing

1. What can you see?

2. What can you hear?

3. What can you smell?

4. What can you taste?

5. What can you feel?

Draw a Heart

1. Turn the paper over to back

2. List 5- 7 feeling

3. Choose a color for each feeling

5. Flip paper back over to the heart

4. Draw how much of each feeling you have right now

1. Draw the Yucky

1. Draw the opposite of the Yucky

1. Imagine that something magical could come along and change the first drawing into the second drawing. What would your magic look like?

Deep breathing exercises 2. The power of positive self- talk & affirmations 3. Healthy nutrition & sleep and daily schedule 4. Activity focusing on bodily regulation

a. Yoga

b. Somatic practices

5. Listen, don’t invalidate.

6. FOSTER RESILIENCE

Start early

Be consistent

Make it part of your routine

1.

Let them Fail

Self Regulation

Self Care

Service to Others

Ask for Help

Act Confident

● Positive physical development

● Academic achievement/intellectual development

● Good coping skills and problem- solving skills

● Engagement and connections in two or more of the following contexts: school, with peers, in athletics, employment, religion, culture

● High self- esteem

● Clear and stable expectations

● Self Efficacy

● Emotional self- regulation

Stick Person Drawing

Something above

Anything else

Holding something
Standing on something
Wearing something
Something beside
Dropping something
Wearing something else

Practice Prevention

Reduce Frustration To Reduce Tantrum Frequency

Don’t give in to Demands

Stay Calm

Humor and/or Distraction

Don’t take it Personally

Differentiate between feelings and behaviors Model appropriate anger management

Establish anger rules

Case Study: Kenji 11 years old

Oppositional Lying Stealing Acting out

Mother died of cancer when he was 5 - living in Japan

Moved in with maternal aunt, and she dies of cancer when he was 7yo

Moved to US to live with maternal Uncle and Aunt

Be consistent Teach healthy coping skills

Consequences when necessary

1. Draw your yucky feeling

2. Use colors, shapes, lines 3. Crumple it up 4. Open it - Say something to it 5. Rip and tear it up

6. Throw half away

7. Write the opposite feeling on the colored papertear into 3 equal parts

8. Give away your opposite feelings

9. Take away someone else’s yucky

10. Collage the parts back together

Play “Freeze!Focus!”

Make Memory Musical

Make the Day a Story

Puzzles and Play

Help children to be in control

Watercolor Paints, blow with straws

Control Breathe

Be intentional

Have fun

Learn to delay gratification - “make future me happy”

● Frequent worrying

● Trouble concentrating

● Skipping activities they used to enjoy

● Difficulty with sleep

● Clinging to caregivers

● Extreme focus on safety and health

● Irritability or edginess

● Shutting down

● Repetitive behaviors

1. Name their feelings

1. Talk about the feeling

1. Identify where in the body those feelings manifest and live

1. Recognize the connection between thoughts and feelings

1. Learn to separate thoughts, feelings and behaviors

● Frequent worrying

● Trouble concentrating

● Skipping activities they used to enjoy

● Difficulty with sleep

● Clinging to caregivers

● Extreme focus on safety and health

● Irritability or edginess

● Shutting down

● Repetitive behaviors

● Delayed Gratification

● Self Restraint

● Trusting the Process

● Encourages Creativity

● Increased Self- Esteem

“Art, like morality, consists of drawing a line somewhere”

- an a%achment-based developmental approach -

Gordon Neufeld, Ph.D.

Copyright 2024 Gordon Neufeld, Ph.D. All rights reserved.

The handout is intended for registered par?cipants of this seminar only.

Please do notduplicate this document without permission.For more informa?on regarding the Neufeld Ins?tute or Dr. Neufeld and his work, please consult the website.

www. neufeldins,tute.org

The Current Crisis of WellBeing

what is happening to our kids?

an a$achment-based developmental perspec3ve

The current Crisis of WellBeing

- some facts and figures -

• school-aged children suffered an approximate 40% increase in depression, anxiety, irritability and aLenMon problems over the span of the pandemic. Studies indicate these problems are not abaMng.

• during the pandemic, adolescent psych wards were filled, children’s help lines were overwhelmed, and self-reports of anxiety and depression were unprecedented

• suicides and cuTng were increasing before the pandemic, conMnued to do so through the pandemic, and are sMll on the rise

• some studies reported that up to 70% of children experienced harm to their mental health when isolated from their peers (in contrast to about 20% who thrived when sent home from school)

• most experts assumed that being socially isolated from peers must be bad for the mental health of children and so prescribed more peer interacMon as a result

Current Crisis Crisis of WellBeing

ARGUMENT for WELL-BEING being ROOTED in ATTACHMENT

THEORY:

• togetherness is our preeminent drive and as such, has the most profound and widespread impact on emoMonal, mental and developmental processes and dynamics

• togetherness replaces survival as a drive in evoluMon, as survival becomes a natural outcome of togetherness

• the ‘trouble spots’ in our brain have evolved from emoMon extending the reach of insMnct - aLachment being our primary drive

ARGUMENT for WELL-BEING being ROOTED in ATTACHMENT

SOME OF THE EVIDENCE:

• longitudinal study of adolescent health and well-being

• loneliness research which reveals togetherness as the answer to well-being

• happiness research which reveals the key factor as being embedded in caring relaMonships

• marriage research that reveals longevity, health, and well-being as resulMng from being in caring relaMonship

• famous Harvard 2023 study revealing that being embedded in caring relaMonships is the #1 factor in well-being

The most consistent and widespread finding is that those embedded in a context of CARING ATTACHMENTS are found to be less at risk for mental health issues and problems

NATURE’S TEMPLATE FOR GIVING AND RECEIVING

Attachments are specifically structured for giving & receiving CARE ... signals ... care

SEEKING CARE

dependent insMncts dependent instincts

• for an invitation to exist

• for contact and connection

• for sameness & belonging

• for safety and comfort

• to get one’s bearings

• for warmth & love

• for recognition

• for significance

• for understanding

• for a relational ‘home’

PROVIDING seeking

PROVIDING CARE

alpha instincts

• for a sense of togetherness

We are meant to fit together in hierarchical attachment arrangements of CASCADING CARE

a NATURAL arrangement in harmony with the dynamics of aLachment and the principles of development

as opposed to contrived arrangements based on social roles, gender stereotypes, prevailing assumpMons of equality, or parMcular dynamics between parents and children or between partners of a couple or in friendship

Our objective should be to embed in CASCADING CARE as opposed to pushing for independence or promoMng self-care

making sense of the

Current Crisis Current Crisis of WellBeing

threats to identity NEGLECT

both parents working

loneliness CHANGE moving school

adopMon daycare DIVORCE facing DEATH RETIREMENT anothersibling

isolation failure being LOST secrets bedtime hospitalization residenMal school disability losing face personal injury loss of loved one

ABUSE

loneliness not belonging not maLering to ...

can’t be with ... not special to ... notunderstoodby... BETRAYED NOT LIKED BY ... feelingunlovedby... replacedby... isolation rejecMon not wanted discounted by ... lack of belonging can’tconnectwith... can’t hold on when apart feelingdifferent losing face not important to ... not recognized by ...

threats to identity NEGLECTED NOT HELD ON TO BY ...

cau$on ALARM

closure separa$on-triggered change

PURSUIT

FRUSTRATION

Stress Response

Resilience Response

PRIMAL SEPARATION EMOTIONS ARE ACTIVATED

Feelings that have been inhibited bounce back to enable opMmal funcMoning and the realizaMon of full potenMal

FEELINGS that would interfere with performing or funcMoning in stressful circumstances are inhibited the recovery of feelings requires a sense of SAFETY

TIME (ideally the end of the day or end of the week at most)

EMOTION IS AT THE HEART OF THE MATTER

• emoMon is in charge of managing the brain, including development, prioriMes, aLenMon, and memory

• the stress response is emoMonal in nature

• emoMonal processes precede and undergird mental processes – in evoluMon, in development, and in everyday funcMoning

EMOTION NEEDS TO MATTER TO US

• most problems in learning, aLenMon, and maturaMon are rooted in emoMon

• adaptaMon (including healing & recovery) is an emoMonal process

• mental processes are primarily derivaMves of emoMon, rather than the other way around

• almost all troubled thinking and behaviour (including diagnoses) are found to have roots in emoMon

• emoMons need to be resolved to reduce symptoms as well as to effect deep and lasMng change

EMOTION IS STILL DISCOUNTED & ECLIPSED

EMOTION IS AT THE HEART OF THE MATTER

STILL MISREAD & MISINTERPRETED

• emoMon is in charge of managing the brain, including development, prioriMes, aLenMon, and memory

• the stress response is an emoMonal process

• emoMonal processes precede and undergird mental processes – in evoluMon, in development, and in everyday funcMoning

EMOTION NEEDS TO MATTER TO US

MORE CONCERNED WITH MANAGING EMOTIONS THAN UNDERSTANDING THEM MOST MEDICATIONS NUMB EMOTION WITH LITTLE PROTEST FROM SO-CALLED EXPERTS STILL CONSIDERED INFERIOR TO REASON

• almost all troubled thinking and behaviour (including diagnoses) are found to have roots in emoMon

MEDICAL DIAGNOSES STILL ECLIPSE THE ROLE OF EMOTION

• most problems in learning, aLenMon, and maturaMon are rooted in emoMon

WOMEN & CHILDREN STILL BLAMED FOR BEING TOO EMOTIONAL

MORE CONCERNED WITH ‘CALMING DOWN’ THAN MAKING ROOM TO BE ‘STIRRED UP’

• adaptaMon (including healing & recovery) is an emoMonal process

• mental processes are primarily derivaMves of emoMon, rather than the other way around

STILL ECLIPSED BY THEIR EFFECTS ON COGNITION & BEHAVIOUR

• emoMons need to be resolved to reduce symptoms as well as to effect deep and lasMng change

KEY INSIGHTS REGARDING E M O T I O N

• there is PURPOSE to emoMon - it is Nature’s way of moving us and taking care of us

• each emoMon has specific WORK to do (ie, emoMons are Nature’s workforce)

• emoMons need sufficient REST in order to do be effecMve in their work

• emoMons seek RELIEF through expression but this will be thwarted if working aLachments are threatened

• emoMons need to be RESOLVED in some way or another or they will get stuck

• the emoMonal system needs to DEVELOP for opMmal funcMoning but can only do so if condiMons are conducive

• the emoMonal system begins in the ‘EITHER OR’ mode and is meant to mature into ‘THIS AND’ funcMoning where inner conflict is felt

• emoMons need to be FELT for opMmal funcMoning and for children to flourish

Stress Response

PRIMAL SEPARATION EMOTIONS ARE ACTIVATED

FEELINGS that would interfere with performing or funcMoning in stressful circumstances are inhibited

The core emo3onal condi3on underlying mental health problems is

Resilience Response

Feelings that have been inhibited bounce back to enable opMmal funcMoning and the realizaMon of full potenMal

the recovery of feelings requires a sense of SAFETY

MOREEMOTIONBUTLESSFEELING

TIME (ideally the end of the day or end of the week at most)

The Continuum of ALARM Problems

ANXIETY problems (obsessions & compulsions)

feel unsafe but alarm not linked to the separa$on faced

alarm is displaced alarm is perverted alarm is dysfunc;onal

AGITATION, ATTENTION, & DISCIPLINE problems

driven by alarm that is not felt

ADRENALIN SEEKING problems

devoid of feelings of alarm, fu$lity & vulnerability

including cuVng & burning

The Continuum of Aggression Problems

EXISTENCE of attacking impulses

ERUPTIONS of attacking energy

VIOLATING aggression problems

not feeling the fu$lity of changing the frustra$ng circumstances

including suicidal impulses

devoid of feelings of alarm, fu$lity & vulnerability

Stress Response

Resilience Response

PRIMAL SEPARATION EMOTIONS ARE ACTIVATED

FEELINGS that would interfere with performing or funcMoning in stressful circumstances are inhibited

Feelings that have been inhibited bounce back to enable opMmal funcMoning and the realizaMon of full potenMal

the recovery of feelings requires a sense of

SAFETY

TIME (ideally the end of the day or end of the week at most)

More Wounding in today’s world

SAFETY

interac3on

scrip3ng & supervision

The experience of SAFETY required for the recovery of feelings is ...

... NOT a func3on of reality, percep3on or cogni3on

... an inherent wired-in state of the brain when in one of two basic modes

1. the a$achment drive in the dependent mode where closeness is experienced and seems secure

2. the play drive where emoMons are at play attachment-based safety play-based safety

less empathy

more bullying

ADULT

CHILD

more social interac3on

less scrip3ng & supervision

less empathy

more bullying

ADULT

We must HAVE their hearts before we can protect their hearts

CHILD

more social interac3on

less scrip3ng & supervision

less empathy

more bullying

ADULT

We must MATTER MORE than those who are wounding the child

CHILD

more social interac3on

less scrip3ng & supervision

NOT work NOT for real expressive PLAY

Feelings are recovered when emotions are at play!

The current Crisis of WellBeing

Why are today’s kids not receiving the CARE they need, nor experiencing the SAFETY they require for the spontaneous recovery of their feelings? what is happening to our kids?

1. They are NOT depending upon the adults who care.

2. The proximity in their aLachments is constantly threatened, depriving them of the SAFETY required to recover their feelings.

3. They are NOT engaging in the kind of play that provides the SAFETY required to recover their feelings.

Our children are losing their play, especially their emo$onal play:

• although play is a natural insMnct & primary drive, it is not demanding and so requires space, as well as protecMon from compeMng acMviMes

• SPORTS PLAY has become organized and outcome-based, compeMng with ‘play for play’s sake’

• creators of DIGITAL SCREEN GAMES primarily harness the more robust aLachment drive (eg, winning, dominaMng, placing) which is outcome-based, highly addicMve in this depersonalized form, and takes the place of the kind of play that children truly need

• ENTERTAINMENT has become universally accessible, replacing and suffocaMng the more fragile expressive play children require

• PARENTS now seek acMviMes to help their children ‘GET AHEAD’, at the expense of the play children need to get ahead developmentally

• SCHOOLS are becoming more OUTCOME DRIVEN, reducing the playful acMviMes that are required for healthy development to occur

The current Crisis of WellBeing

what is happening to our kids?

Why are today’s kids not receiving the CARE they need, nor experiencing the SAFETY they require for the spontaneous recovery of their feelings?

Because they are NOT depending upon the adults who care, their aCachments are con;nually threatened, and they are NOT engaged in true play.

WHY is this so?

Their ATTACHMENT INSTINCTS are AWRYPEER ORIENTATION

PEER ORIENTATION

Children taking their cues from each other as to how to act, what to do, how to talk, what to wear, how to express oneself, what is valued, what is expected, what is right and what is wrong The compe3ng nature of most peer a$achments today (ie, can’t be close to both peers and adults simultaneously) pulls children out of orbit from around the adults responsible for them.

THE PROBLEMS WITH PEER ORIENTATION

• does NOT serve survival as children were not meant to take care of each other

• destroys the natural context for raising & educaMng children

• robs adults of the power they need to parent, teach and treat

• breeds ALPHA children and fosters DEPERSONALIZATION

• fuels a preoccupaMon with digital devices and social media, which further compete with family

• the more peers maLer, the more separaMon to be faced, resulMng in escalaMng emo3onal distress

• robs children of the shielding and protecMon they need to live in an wounding world

• is not conducive to feeling, as the vulnerability is too much to bear

• can result in chaoMc polarizaMon & tribaliza3on which in turn can create a ‘lord of the flies’ scenario

positive polarity negative polarity shies away from resists contact alienates looks down upon ignores & disregards mocks & mimics disowns opposes & betrays holds in contempt ridicules and derides spoils things for discounts as not ma$ering annoys and irritates eschews loathes keeps secrets from or creates secrets about

seeks to be with makes contact endears looks up to a$ends & listens to imitates & emulates possesses is loyal to holds dear a$empts to find favour makes things work for seeks to ma$er to seeks to please befriends loves shares secrets with or keeps the secrets of

society is not structured to facilitate peer togetherness

The PEER-ORIENTED ...

SUFFER more WOUNDING ...

eleva3ng the separa3on-triggered emo3ons of alarm, frustra3on and pursuit ...

while losing the very feelings that would lead to their resolu3on.

children are not meant to take care of each other

increasing tribalizaMon renders peer interacMon unsafe

The peer oriented are less inclined to play for play’s sake, or take their emoMons to play:

• peer-oriented children are stuck in a relentless pursuit of proximity which interferes with the condiMons leading to emergent and expressive play

• children take their cues from their peers as to the acMviMes and entertainment to engage in, again interfering with emergent and expressive play

• the peer-based pop cultures have not inherited the classic emoMonal playgrounds of older cultures (expressive wriMng, drawing, dance and composing)

INSIDIOUS IMPACT OF PEER ORIENTATION

• loss of safety and thus increased wounding & defendedness

• loss of feeling and thus true growth, adaptaMon, and well-being

• elevated & unresolved alarm, frustraMon, and pursuit, manifesMng in countless syndromes associated with mental illness

• lack of received care resulMng in increased distress and restlessness including boredom

• aLachment tribalizaMon, polarizaMon, depersonalizaMon hypersexualizaMon, and resulMng obsessions & addicMons

• stuck in the aLachment drive resulMng in developmental arrest and loss of playfulness

INSIDIOUS IMPACT OF PEER ORIENTATION

• loss of safety and thus increased wounding & defendedness

• loss of feeling and thus true growth, adaptaMon, and well-being

• elevated & unresolved alarm, frustraMon, and pursuit, manifesMng in countless syndromes associated with mental illness

• lack of received care resulMng in increased distress and restlessness including boredom

• aLachment tribalizaMon, polarizaMon depersonalizaMon hypersexualizaMon, and resulMng obsessions & addicMons

• stuck in the aLachment drive resulMng in developmental arrest and loss of playfulness

INSIDIOUS IMPACT OF PEER ORIENTATION

• loss of safety and thus increased wounding & defendedness

• loss of feeling and thus true growth, adaptaMon, and well-being

• elevated & unresolved alarm, frustraMon, and pursuit, manifesMng in countless syndromes associated with mental illness

• lack of received care resulMng in increased distress and restlessness including boredom

• aLachment tribalizaMon, polarizaMon depersonalizaMon hypersexualizaMon, and resulMng obsessions & addicMons

• stuck in the aLachment drive resulMng in developmental arrest and loss of playfulness

INSIDIOUS IMPACT OF PEER ORIENTATION

• loss of safety and thus increased wounding & defendedness

• loss of feeling and thus true growth, adaptaMon, and well-being

• elevated & unresolved alarm, frustraMon, and pursuit, manifesMng in countless syndromes associated with mental illness

• lack of received care resulMng in increased distress and restlessness including boredom

• aLachment tribalizaMon, polarizaMon depersonalizaMon hypersexualizaMon, and resulMng obsessions & addicMons

• stuck in the aLachment drive resulMng in developmental arrest and loss of playfulness

attaching to PARENTS and other adults responsible for the child

emergence into PERSONHOOD

PEERS

able to relate to PEERS without loss of individuality or loss of adult attachment

The current Crisis of WellBeing - some facts and figures -

• during the pandemic, adolescent psych wards were filled, children’s help lines were overwhelmed, and self-reports of anxiety and depression were unprecedented

• suicides and cuTng were increasing before the pandemic, conMnued to do so through the pandemic, and are sMll on the rise

• most experts assumed that being socially isolated from peers must be bad for the mental health of children and so prescribed more peer interacMon as a result

Reversing peer orientation should be a top priority in the support of our children’s well-being

- collect the eyes, some smiles and some nods

- collect before any other interacMon

- use play and playfulness to engage

- by giving something of ours to hold on to

toengagethe attachment instincts anythingthatcoulddivide

- all separaMons, including the night

- all problems as well as differences

- to embed in cascading care

- to emotional playgrounds that engage

Assume the role of being their ANSWER

• a COMPASS POINT to orient by (regarding what’s happening but especially regarding their strengths, uniqueness & contribuMons)

• a HOME BASE, GUIDE or COMFORTER if needed

• for NURTURANCE – offering a ‘TOUCH OF PROXIMITY’ to hold on to

- a sign of belonging, or something special that belongs to us

- a likeness or similarity, something held in common

- a touch of loyalty – that we will come to their side and alongside

- a sign of significance, something beyond the role expectaMons

- a touch of warmth or delight, something that suggests liking

- a sign that we truly get them or understand them

- some sign of being welcomed and invited into our presence

Three Common ATtachment Disorders

... and how they impact received care and recovered feelings

1. PEER ORIENTATION

3. DEPERSONALIZED ATTACHMENT

Typical manifesta;ons of alpha children

bossy, controlling or demanding

compelled to take over or take charge

difficulty with taking direcMon or asking for assistance

obsessed with winning or being seen as the best

can be driven to dominate or show superiority

seeks to be on top or take front stage

driven to trump interacMon, to have the last word

may need to be in the know / can act as a know-it-all

Typical manifesta;ons of alpha children

bossy, controlling or demanding

compelled to take over or take charge

difficulty with taking direcMon or asking for assistance

can be driven to dominate or show superiority

- is part of the ATTACHMENT drive which is Nature’s answer to SURVIVAL for birds and mammals

- it’s ulMmate purpose is to take CHARGE of the CARE of one’s dependents

- is meant to create a LEAD in the aCachment dance, inspiring trust and dependence in response

seeks to be on top or take front stage

driven to trump interacMon, to have the last word

may need to be in the know / can act as a know-it-all

obsessed with winning or being seen as the best an alpha complex has formed when these aQributes characterize their personality or their rela$onships with adults who care for them

- requires extensive taming and development to turn the raw displacement insMncts into an effecMve ALPHA CARING RESPONSE

- should never be characterisMc of an individual, only an aLachment DANCE with a ‘dependent’ in need

- successful development requires ample PRACTICE in a context rich with FEELING,

- if characterisMc of a child, can seriously INTERFERE with development and being taken care of, including being parented or taught

FEELINGS convert raw displacement into ALPHA CARING

- unites primi;ve displacement ins;ncts with their ul;mate care-taking

PURPOSE

feelings of CARING & RESPONSIBILITY

- develops the capacity for CONSIDERATION - necessary to make caring effec;ve

feeling CONFLICTED

(can begin between 5-7 years but only if condi;ons are conducive)

feeling the FUTILITY of controlling & domina3ng

- soHens and prunes displacement ins;ncts to where they become sensi;ve to context and in the service of caring and community

DEVELOPING THE CARING ALPHA RESPONSE

“neurons that FIRE together WIRE together”

DIVERSE MANIFESTATIONS of UNTAMED ALPHA

moved to exploit the vulnerable & needy (the bully response) unrelenMng drive to dominate & displace

narcissism

chronic resistance or opposiMonality

drive for superiority and supremacy

obsessed with winning, placing, status, coming out on top

fuels the impulse to ‘lord it over’

driven to be the centre of aLenMon

compeMng with spouse or children for care

authoritarianism, racism, imperialism, and colonialism unable to depend, submit or take direcMon

Caring

The Continuum of Troubling Alpha Behaviour

common alpha syndromes perversion of alpha ins;ncts

bossiness ea3ng problems BULLYING

lacking feelings of dependence and neediness

devoid of feelings of caring and responsibility

HOW ELEVATED DISPLACEMENT INSTINCTS IMPACT LEARNING AND THE CLASSROOM

- CANNOT COMMAND their aLenMon or orchestrate their behaviour

- they do not accept their teachers as authoriMes and are NOT RECEPTIVE to instrucMon

- tend to be fraught with ALARM problems (eg, anxietybased, agitaMon-based and adrenalin-based)

- their peer relaMonships are oqen fraught with CONFLICT, or they can develop significant followings that draw students away from their teachers

- tend to be fraught with FRUSTRATION problems (aLacking energy, impulses & behaviour)

- tend to be fraught with ADAPTATION problems as not able to feel the fuMlity encountered (eg, sadness & grief)

ALARM-BASED PROBLEMS - anxiety, agitaMon, & adrenalin seeking (cannot make oneself feel safe)

ATTENTION ISSUES - cannot command their aLenMon / elevated alarm scaLers aLenMon / must be the centre of aLenMon

FRUSTRATION ISSUES - aggression, violence and self-aLack including suicide

EATING ISSUES - anorexia & food issues of all kinds

LEARNING PROBLEMS - literacy problems, dysfuncMon due to learning disabiliMes, difficulMes with seeking assistance

COMPLIANCE ISSUES - resistance & opposiMonality

ENTITLEMENT ISSUES - self-evident to them that they are most important

PEER ISSUES - conflict, bullying, dominance, and supremacy issues

the making of the bully response highly moved to displace Lacking feelings of caring & responsibility the BULLY response to perceived vulnerability, neediness, threat or weakness

- to assert dominance by exploiting vulnerabilityRenders today’s children increasingly UNSAFE and highly ALARMED, whether peer-oriented or not

ALARM-BASED PROBLEMS - anxiety, agitaMon, & adrenalin seeking (cannot make oneself feel safe)

ATTENTION ISSUES - cannot command their aLenMon / elevated alarm scaLers aLenMon / must be the centre of aLenMon

FRUSTRATION ISSUES - aggression, violence and self-aLack including suicide

EATING ISSUES - anorexia & food issues of all kinds

LEARNING PROBLEMS - literacy problems, dysfuncMon due to learning disabiliMes, difficulMes with seeking assistance

The alpha problem has been totally ECLIPSED by misinterpreMng alpha as ‘independence’, by our aversion to the construct of ‘hierarchy’, by our lack of understanding of the nature & purpose of aLachment, and by the lack of any supporMng language – rendering the symptoms unexplained and resul$ng in a fu$le baQle against them

COMPLIANCE ISSUES - resistance & opposiMonality

ENTITLEMENT ISSUES - self-evident to them that they are most important

PEER ISSUES - conflict, bullying, dominance, and supremacy issues

FACTORS CONTRIBUTING TO BEGETTING ALPHA CHILDREN

- schools tend to generate PEER ORIENTATION which, in turn begets alpha children

- many parents and teachers think they are being forward thinking by PUTTING CHILDREN IN THE LEAD

- today’s adults use behaviour management methods that make it UNSAFE TO DEPEND, evoking alpha by defense

- parents have LOST THEIR CONFIDENCE in being their children’s ‘answer’, presenMng as weak or inadequate, and thus evoking alpha by default

- today’s adults are increasingly seeking answers as to HOW TO parent and teach, puTng them in the ‘dependent’ mode

- decades of veneraMng independence has made us BLIND to the problems of children who resist dependence because of being stuck in the alpha mode

PEER ORIENTATION, the ALPHA COMPLEX and MENTAL HEALTH

- the perfect storm - peer orientaMon creates CONTRIVED hierarchies devoid of care and safety

DEPENDENT peer-oriented children, having lost their adult shields, suffer significant WOUNDING at the hands of their peers

increasing numbers of ALPHA peer-oriented kids who are devoid of taming feelings, evolve into BULLIES who make life unsafe for EVERYONE

the lack of received care and recovered feelings results in escalaMng and pervasive MENTAL HEALTH PROBLEMS

Reversing runaway alpha should be a top priority in the support of our children’s well-being!

Children need to be deeply & personally attached in the dependent mode to the adults responsible for them ... for the delivery of care

to empower the adults to fulfill their roles to shield from wounding for the regular recovery of feelings for the transmission of culture to make flourishing possible to activate and direct their desire to be good for the unfolding of human potential to activate caring and develop empathy to properly purpose their shyness & counterwill to support wellness & mental health

Take ALPHA INSTINCTS to PLAY

• use controlled games of compeMMon and conquest to safely vent the quest for dominance and supremacy

• use stories, imaginaMon, drama, role play and theatre to invent or idenMfy with alpha characters who always come out on top

• provide playful acMviMes where there is plenty of opportunity for leading, direcMng, or orchestraMng

• use playful games and acMviMes where children and students get to displace the adults in charge – eg, being the boss, having the last word, giving the orders, making the demands, making up the rules

• encourage or support alpha caring play, where alpha insMncts are used to take care of others

• provide ample access to emoMonal playgrounds where there is more chance for the alpha insMncts to awaken the impulse to care

School-Based Practice – developing the vertical dimension

STUDENT-TEACHER RELATIONSHIPS

EMOTIONAL PLAYGROUNDS

CASCADING CARE RELATIONSHIPS

FAMILY RELATIONSHIPS

Embed in CASCADING CARE

• our aim should be to shield students at risk by fostering an aLachment with a safe caring adult who is willing to serve that role

• matchmake by presenMng one as the ANSWER to the other

• use playful acMviMes to matchmake students to teachers and across the grades and the ages

• our aim should also be to matchmake students hierarchically so that every student experiences being both cared for and in charge of taking care of

• matchmake the more mature students with those in need, to serve as HOME BASE as needed

• uMlize the ‘house system’ if possible, to foster cascading care across the grades and ages

Assume a caring alpha lead in order to ...

1. INSPIRE the DEPENDENCE necessary in order to fulfill one’s responsibiliMes and to foster healthy development

2. Render students RECEPTIVE to your instrucMon and MOTIVATED to be good for you, thus OPTIMIZING their learning as well as their behaviour

3. Possess the POWER to SCRIPT the behaviour of the immature

4. Serve as the ATTACHMENT IN COMMON in one’s class in order to keep children from revolving around each other and maLering too much to each other

5. FuncMon as a SHIELDING aLachment as needed (for wounding that may come from others including peers, siblings, parents or other adults)

6. Bring the followers of charismaMc ALPHA STUDENTS under your control and influence

Mastring te Lead in te dance of atachment

• assume the posture and demeanor of the ALPHA in charge, concealing one’s own needs and insecuriMes

• perceive the student(s) as being IN NEED of you, as an ANSWER to their aLachment needs

• INVITE dependence and make it SAFE to depend

• convey CARING and find a way to get the message across that you will take care of them

• be GENEROUS - providing more than is pursued

• seize the lead by ANTIPICATING ‘demands’ and geTng there first

• READ the needs & take the lead (don’t ask too many quesMons)

• WIN the alpha baLles you can, but avoid the rest

• invite the INEVITABLE to preserve one’s alpha and convey that the relaMonship can take the weight

• ARRANGE scenarios where there is no choice but to depend upon you

• for an invitation to exist

• for contact and connection

• for sameness & belonging

• for safety and comfort

• to get one’s bearings

• for warmth & love

• for recognition

• for significance

• for understanding

• for a relational ‘home’

• INSPIRE dependence by taking a strong caring alpha LEAD

• INVITE dependence by gestures of CARE

• make it SAFE to depend, never using their rela$onal needs against them

• be GENEROUS with one’s care, providing more than is pursued

• DON’T BE FOOLED by the myriad illusions of independence

• for a sense of togetherness

Three Common ATtachment Disorders

... and how they impact received care and recovered feelings

1. PEER ORIENTATION

2. ALPHA COMPLEX in a dependant

about the defensive DEPERSONALIZATION of a$achment

If a$aching is sensed as leading inevitably to unbearable separa3on or wounding, the a$achment brain can reverse the direc3on of the pursuit to reduce the vulnerability involved. The a$achment drive itself cannot be reversed since it is the preeminent/default drive and only increases under threat.

- depersonalized aLachment cannot fulfill so the drive remains unabated and any experienced proximity becomes addicMve

- depersonalized aLachment cannot deliver care or safety, but competes with personal aLachments that could

- can involve the defensive transference to non-personal enMMes: objects, pets, groups, categories, ideas, religion, race, poliMcs, naMons, etc (fuels racism, sports obsessions, and all the ...ISMs)

the DEPERSONALIZATION of attachment

Sarah Matthew Genevieve Rorie Scott

Ms.Kerr Kendall Sherry

the PURSUIT of PROXIMITY with a PERSON ATTRACTING WINNING MEASURING UP DEMANDING IMPRESSING HELPING BEING NICE BEING CHARMING SEEKING STATUS the the to be to be to be to be to be to be to be ATTENTION APPROVAL VALUED SPECIAL ESTEEMED IMPORTANT LIKED LOVED RECOGNIZED of of by to by to by by by

the DEPERSONALIZATION of attachment

The Depersonaliza3on & Fragmenta3on of Pursuit

the PURSUIT of ATTRACTING WINNING MEASURING UP DEMANDING IMPRESSING HELPING

BEING NICE

BEING CHARMING

SEEKING STATUS

The depersonaliza3on and fragmenta3on of a$achment-based pursuit in the face of threatened connec3on

Some common a$achment-driven where the pursuit is divorced from its rela3onal context:

PURSUING PRAISE chasing marks clinging clutching possessing achieving seeking aLenMon scoring

WINNING

Reversing defensive depersonalization should be a top priority in the support of our children’s well-being

Right Relationships & Emotional Playgrounds

ENCOUNTERS WITH FUTILITY

REST RECOVERY RESILIENCE RENEWAL

HELP THAT IS HELPFUL!!

• keeping or restoring perspective

• right thinking / being positive

• pursuing happiness

• resisting the ‘let-down’

• acquiring the ‘skills’ of resilience

• pursuing calmness & tranquility

Do NOT allow the popular construct of ‘mental health’, thrice removed from a working reality a) a euphemised spin on mental illness which is b) itself an instrumental analogy vs evidence-based reality, and c) an indirect ‘fruit’ versus useful point of intervenMon - to thus ECLIPSE its developmental ROOTS in ATTACHMENT and EMOTION

MISDIRECTING and thus EXHAUSTING our valuable resources and energy with regards to the emo;onal well-being of our beloved children and youth.

Diagnosing syndromes and Battling against Symptoms

vs

- crusades against bullying, meanness, discriminaMon, violence, insensiMvity, injusMce, intolerance

- prosocial programs aimed at children being nice and kind

- discipline approaches aimed at teaching a lesson, socializa3on approaches aimed at declaring hurrul interacMon unacceptable, and legal approaches punishing the violators

- skill-based programs aLempMng to teach empathy, self-control, emoMonal literacy, graMtude, etc

- mental health advocacy and literacy programs as well as selfcare programs

Cutivating the Conditions for Well-Being

RIGHT RELATIONSHIPS WITH CARING ADULTS

... that can deliver CARE and provide safe sanctuary for FEELING

PLAYGROUNDS for EMOTION

... so that emo;on can find REST, working aCachments can be PROTECTED, vulnerable feelings can be RECOVERED, and the CARE that has been delivered via trus;ng dependence to caring adults can be FELT

Through a child’s attachment to us, we can BE their ANSWER even when there are no answers:

• BE their HOME

• BE their place of REST

• BE their sanctuary of SAFETY

• BE their SHIELD in a wounding world

• BE their REASON for holding on

• BE their source of WELL-BEING

The answer is in BEING - not in DOING or SAYING or KNOWING the right things – when empowered by the other’s attachment to us.

The Current Crisis of WellBeing

what is happening to our kids?

an a$achment-based developmental perspec3ve

AcceptanceandCommitmentTherapy: TranscendingTraditionalApproaches

ObjectivesDayOne

•Toexplaintheunderlyingtheoreticaland philosophicalprinciplesofthemodel

•DiscussthesixbasictenetsofACT

•Tolayoutthegeneralclinicalapproach

•Togiveexamplesoftheexperientialtechniques andconceptstogainsomeskillinusingthem

•Toencourageyoutoexplorethismodel experientially

InformedConsent

•Attimes,thisworkshopwillaskforyour willingnesstoengageinexperientialexercises

•Yourprivacywillneverbeviolated,butyouwillbe invitedtotakeafewrisks

•Forthatreason,wemustagreetoconfidentiality

•Youmaychoosetodeclineparticipation

TheUbiquityofHumanSuffering

Theassumptionof“Healthy Normality”isamyth

AlternativeAssumption:DestructiveNormality

Normallanguageandcognitiveprocessesoftenare destructiveandcanamplifyorexacerbatenormal processesintopathologicalsuffering.

Question:

Ifthatistrue,whydon’tweallstrugglewith anxiety,depressedmoods,insecurities,fears, etc….?

Whatis"thirdwave"therapy

•Firstwave:behavioraltherapy

•Secondwave:cognitivebehavioraltherapy

•Thirdwave:acceptance-basedbehavioral therapy

Allthird-wavetherapiesare…

Groundedinanempirical,principlefocusedapproach,thethirdwaveof behavioralandcognitivetherapyis particularlysensitivetothecontext andfunctionsofpsychological phenomena,notjusttheirform.Thus, ittendstoemphasizecontextualand experientialchangestrategiesin additiontomoredirectanddidactic ones(Hayes,2004).

Thethird-wavetherapies

•Dialecticalbehavioraltherapy(DBT)

•Acceptanceandcommitmenttherapy(ACT)

•Mindfulness-basedcognitivetherapy(MBCT)

•Functionalanalyticpsychotherapy(FAP)

Third-wavetherapiesare…

•Morecontextualandexperiential,lessdidactic,andmore focusedonfunctionoverform

•UnlikeCBT,thereislittleemphasisonchangingthe contentofthoughts;instead,theemphasisisonchanging awarenessofandrelationshiptothoughts

•Helpimproveoutcomes

•Helpimproveunderstandingofhumanbehavior

Allthird-wavetherapiesinclude:

•Acceptanceandmindfulness

•Spirituality

•Values

•Emotionaldeepening

•Genuineness,intimacy

•Thepresentmoment

Thethird-waveapproach

COGNITIVE

•Developawarenessofgetting hookedtonegativethoughtsand thinkingpatterns

•Developbalancedthinkingby lookingatthefunctionof“buying into”negativethinkingvs.learning tojust“notice”thoughts

•Learnnewskillsi.e.acceptance, defusion,self-compassion, mindfulness

•Clarifyingwhatandwhois importantinlife

•Committoengaginginvaluebasedbehaviours.

AcceptanceandCommitmentTherapy(ACT)

•Aformofthird-waveexperiential behavioralpsychotherapy

•basedonarelationalframeapproach tohumanlanguage, •andaresultingperspectiveon psychopathology

AcceptanceandCommitmentTherapy(ACT)

•PronouncedasonewordACTnot“A-C-T”

•Emphasisonacceptance-willingnesstohave •Approachtocognition

•Notdisputing“negativethoughts” •Nottryingtochangethoughts(thoughchange sometimeshappens) (Hayesetal.,1989)

ACT…

•veryexperiential •useofmetaphors

•perceptionofboththerapistandclientas peoplestrugglingwithwhatlifeoffers

•ACTfocusesontheindividual’sbehaviorand thecontextinwhichitoccurs.

•Treatmentsuccessisthe“successfulworking” ofanindividual’sbehavioraccordingtothat person’svaluesanddesiredoutcomes.

ACTsuggests…

•psychologicalpainisnormal

•cannotgetridofit

•painisdifferentfromsuffering

•acceptingyourpainreduces suffering

(HayesandSmith,2005)

ACTfromtheBeginning

•Inthelate1970s/early1980s,StevenHayesetal. begantodevelopaviewbasedonthebehavioral literatureonrulegovernancethatpsychopathologywas oftenanissueofcognitiverigidity

•Hayesetal.developedandborrowedproceduresto undermineattachmenttoverbalrulesandtofocuson behaviorchangeinstead

•Theycalledit“ComprehensiveDistancing”

•Andtheytestedit

FirstClinicalACTStudy

•Verysmall(N=18)randomizedpilotwith depressedsubjectscomparingBeck’sCTand ACTina12-weekstudy(3-monthfollow-up)

•DoneatBeck’sCenterforCognitiveTherapybya Beck-trainedcognitivetherapist

•Withprocessmeasures

DifferenceinOutcome

WithDifferentChangeProcesses

Reductionsinthe Believabilityof DepressiveThoughts (Frequencywasnot different)

FirstACTComponentStudy

Acceptanceanddefusionpractice

CBTpractice

Informationaboutpain

32subjects

Coldpressortask(upto5minutes)

(Hayesetal.,PsychRecord,1999)

Results–SecondsofPainTolerance

Results–BelievabilityofEmotionalandCognitive Reasons

Thentheydidsomethingstrange…

•Hayesetal.stoppeddoingACTresearchfor nearly15yearsandinfact,didnotevenpublish thepainstudyuntil15yearslater

•Duringthattime,theyworkedonthephilosophy ofscience–comingupwithfunctional contextualism

•Andtheyworkedonabasictheoryoflanguage andcognition

Asofmid-2024,therearenearly1,050ACTrandomized controlledtrials.

Detailsofeachofthesestudies,alongwithlinkstothe originalresearcharticles,canbefoundon:

https://contextualscience.org/ACT_Randomized_Controlled_Trials

AmericanPsychologicalAssociation,SocietyofClinical Psychology(Div.12),ResearchSupportedPsychological Treatments:

•ChronicPain-StrongResearchSupport

• Depression-ModestResearchSupport

• Mixedanxiety-ModestResearchSupport

• Obsessive-CompulsiveDisorder-ModestResearchSupport

•Psychosis-ModestResearchSupport

BookreviewingACTResearch

Hooper,N.,&Larsson,A.(2015)TheresearchJourneyof AcceptanceandCommitmentTherapy(ACT).London: PalgraveMacmillan

http://www.palgrave.com/gp/book/9781137440150#otherversion=97811374401

LimitationsofResearch

LimitationsoftheResearchandPotentialRisks

•Acute,floridhallucinations

•Catatonicdepression

•Individualswithanadversereactiontomindfulness exercises

ACT:TheFoundation PhilosophyandTheory

-FunctionalContextualism(FC)

-RelationalFrameTheory(RFT)

WhyLearnFunctionalContextualismandRFT?

•Understandhowlanguageisthesourceofoursuffering

•Uselanguageasanintervention

•HelpstobecomeamorecompetentACTclinician!

WhatisFunctionalContextualism?

Amodernphilosophyofsciencerootedinphilosophical pragmatismandcontextualism.Itismostactively developedinbehavioralscienceingeneralandthefield ofbehavioranalysisandcontextualbehavioralscience.

Inotherwords,

1.ContextMatters:Imagineyou’resolvingapuzzle.Insteadof examiningindividualpieces,functionalcontextualismencourages youtoconsiderthewholepicture—thecontext.It’slike understandingawordbyexaminingitssentence.

2.UsefulInsights:Functionalcontextualismfocusesonvaluable insights.It’snotaboutbeingperfectlyaccurate;it’saboutwhat helpsyoutakeeffectiveaction.Thinkofitasfindingpractical solutionsratherthanjusttheoreticalanswers.

3.BehaviorandLanguage:Thisideaisusedinpsychologyand therapy.Therapyisaboutunderstandinghowourthoughtsand feelingsaffectouractions.It’slikefiguringouthowwords(language) impactourbehavior.

FunctionalContextualism

•FunctionalContextualismistheunderlying philosophyofACT

•Whatisthe“function”ofanyparticular behavior?

•CorefocusofActbecomes“workability”

Context

•Anythingthatinfluencesbehavior

•Canbeanythingthatprecedesbehavior(Antecedent)

•Canbeanythingthatcomesafterbehavior (Consequence)

ALWAYSASKYOURSELFWTF?!

(Whatthefunction)

WhataretheFunctionsofHumanBehavior?

•Escape/Avoidance–escapingoravoidingpainorademand situation.

•Attention–abehaviordonetogaintheattentionofothers.

•Access–abehaviortoaccessatangibleobjectorsituation.

•Sensory–abehaviorthatisself-stimulatorytofeelgood.

Example:

Eatingapieceofcandy(Behavior)

Canbeinfluencesbybeinghungry (Antecedent)

AND

Canbeinfluencedbythetasteofcandy inthemouth(Consequence)

WhatContextsExist?

•Situational •Physiological

•Genetic •Epigenetic •Cognitive

•SocialCultural •Emotional

•Interpersonal •Developmentandlearninghistory

Example:

•Situational–Placewherethebehaviorofeatingcandyis influenced Trick-or-Treating BirthdayParty

•Interpersonal–Thoughtsandemotionsthatmayinfluencethe behaviorofeatingcandy Iwantcandytoo! I’mbored

Receptivelanguage-theunderstandingthatwordshave meaning

Expressivelanguage-theabilitytosaywordswithmeaning

Aswedevelop,westarttounderstandthatsoundsbecome wordsandwordsaregivenmeaning.

Learningthroughlanguageandcognitionis secondarytolearningthroughexperience.

Welearnthrougharbitraryandnon-arbitrary means

Repulsed Disgusted Queasy Nauseated

FunctionofBehavior

FoundationofLanguage

RFTModelofPsychopathology

Insummary…

•Whenpeoplefeelbad,theycarryaroundverbal descriptionsofthehurt

•Thesedescriptionskeepthepersonincontactwiththe hurt

•Peopledon’tlikehurting

•Theywanttoavoidthehurt

•Theytrytocontroltheirthinkingaboutthehurt

ACTtriestoundermine...

•Thedominationofliteral,evaluative,andtemporal language

•Connectinsteadwithourvalues

•Behavemoreflexiblyandeffectively,focusedonour values,notourfear

ACTStanceonDisorders

•Attemptsto“getridof”painfulprivateexperiencescan betheunderpinningofmentalhealthissues…

•“Painful”thoughtsandemotionsdonotproducemental disordersinandofthemselves.

PsychologicalInflexibility

•Clientsneedtogetridofnegativeprivateexperiences

•Thisisbestachievedbyexperientialavoidance

•Experientialavoidanceisthecoreproblemmostclients face

PsychologicalInflexibility “Inflexahex”

Thesixcoreprocessesare interconnectedandmaintain psychologicalinflexibility

TransdiagnosticApproach

•Transdiagnosticapproachesthattargetunderlying psychologicalprocesses(ratherthansymptomconstellations) areincreasinglybecomingthenewgoldstandardofevidencebasedtreatment.

•Process-basedtreatmentbridgesclinicalscienceand practice,cantargetabroaderrangeofproblemsthan diagnosis-basedprotocols,andismoreeasilyindividualized andadministeredtotheclient.

Assessmentphase

•TransdiagnosticApproach

•UsingtheACTconceptualizationmodel–Inflexahex

•Targetcoreprocessesregardlessofsymptoms andco-morbidity

ExperientialAvoidance

ExperientialAvoidance

•Individualsoftentrytodecreasenegativeprivate experiencesthrough“experientialavoidant”behaviors, whichcanbeovertorcovert.

•Thisisacommonoccurrenceinallofus…ignoring, distracting,forgetting,etc.

HigherAvoidanceScoresAre…

•Associatedwith:

•Distressintolerance

•Higheranxiety

•Substanceabuse

•MoreDepression

•Moreoverallpathology

•Poorerwork performance

•Inabilitytolearn

•Lowerqualityoflife

•Historyofsexualabuse

•High-risksexual behavior

•BPDsymptomatology anddepression

•Thoughtsuppression

•Alexithymia

•Anxietysensitivity

•Longtermdisability

•PTSDfollowingtrauma

Commonovertavoidantbehaviors

•Excessiveuseofalcohol

•Substanceabuse

•Excessivesleeping

•ZoningoutinfrontoftheTV

•ExcessiveVideogaming

•CompulsiveShopping

•Sleepingtoomuch

Avoidanceisalsoexperiential…

•Attemptingtochangeemotions'form,frequency, orsituationalsensitivity,especiallythosethatare universalandcontextuallyappropriate.

Experientialavoidanceis…

Cognitivemodification-Excessivelytryingto controlorchangethoughtsandemotions

Cognitivereappraisal-Tryingtoseethingsina positivelight

Suppression–tryingtosuppressthoughtsand emotions = EliminationAgenda!

“Thesinglemostremarkablefactabout humanexistenceishowharditisforhumans tobehappy.”

(Hayes,Strosahl,&Wilson,1999)

WhatExactlyis“Happiness”?

“Happiness”hastwoverydifferent meanings

1.Thecommonmeaning–isto“feel good.”

Feelingasenseofpleasure,gladness, orgratification.However,likeall humanemotions,feelingsof happinessdon’tlast.

(Harris,2008)

2.Farlesscommonmeaning–is“livingarich,full, andmeaningfullife.”

Whenwetakeactiononthethingsthattrulymatterdeep inourhearts,moveindirectionsthatweconsider valuableandworthy,clarifywhatwestandforinlife,and actaccordingly… Then,ourlivesbecomerichandmeaningful,andwe experienceapowerfulsenseofvitality.

(Harris,2008)

FourMythsofHappiness

1.HappinessisTHEnaturalstatefor ALLhumanbeings

2.Ifyou’renothappy,you’redefective

3.Tocreateabetterlife,weMUSTget ridofnegativefeelings

4.YouSHOULDbeabletoCONTROL whatyouthinkandfeel

(Harris,2008) Avoidance=Suffering

PrimaryPainvs.SecondaryPain

•Lostjobduetoeconomy=sadness,frustration, andirritability“HowamIgoingtofeedmy family?”(Primary)

•Negativeevaluationoftheprimarypain“I’ma loser,”“I’llneverfindajob”“Ican’thandlethis!”= andleadstoAvoidantbehavior(e.g.,Drinking excessively)

•Whichcanthenleadtofurtherproblems=guilt overavoidantbehavior,familymembersupset,etc. (Secondary)

“Sufferingusuallyrelatestowantingthingsto bedifferentthantheyare.”~AllanLokos

Fusion

•Inflexiblebehaviorinfluencedmorebyverbalnetworks.

•Thoughts,feelings,judgmentsandmemorieshave moreinfluenceoverrespondingthandirectexperience withtheworld.

•Mostclientsbelievewhattheirmindistellingthem,not whattheirexperiencehasbeen.

Fusion

•Lookforinstanceswhererespondingisguidedby evaluationsandinflexiblerules.

•Thiswilllooklike‘cognitivedistortions’inCBT.

ClinicalExamples

•“I’msuchanidiot”

•“NothingwillEVERchange”

•“I’munlovable”

•“Iambroken”

•“IwillALWAYSscrewup”

ExperientialAvoidanceandFusion

•Experientialavoidanceincreasestheimpactandeven frequencyofavoidedthoughts,feelings,and sensations

•Cognitivefusionincreasestheimpactandeventhe frequencyofentangling,negativethoughts

Fusionmeasures

•AutomaticThoughts-Believability(ATQ-B)

•BelievabilityofAnxiousFeelingsandThoughts Questionnaire(BAFT)

•CognitiveFusionQuestionnaire

•StigmatizingAttitudes–Believability(SAB)

ThreeSensesofSelf

•ConceptualizedSelf

•Self-as-Context

•Self-as-process

Theconceptualizedself

•Theconceptualizedselfisthesamethingasself-ascontentandattachmenttotheconceptualizedselfis usuallyrelatedtofusionwithcontent.

Pros

Aconceptualizedselfisuseful

Itallowsustoparticipateinaverbal socialcommunityandanswerquestions suchas:

•Whatisyourname?

•Whatdoyoudoforaliving?

•Wheredoyoulive?

•Isthatyourson?

•Howoldareyou?

•Tellmeaboutyourhobbies?

Attachmenttotheconceptualizedself

Duringcaseconceptualization,lookfor statementssuchas:

•Iamtoo…

•IfonlyIdid…(ordidn’t…)thenIwould

•MyproblemisthatI…

•Iama(failure,loser,wimp,druggie,etc.)

•Iamnot(smart,pretty,strong)enough

•Ican’t…

Core Belief Chart

Example

“Iwastraumatized”(historicalfact)getsusedinacause-andeffectrelationshiplike“Mytraumacausesmetonotbesafein theworld”andservesasanexplanationforcurrentbehavior: “So,becauseIcan’ttrust,Ican’tlivemylife.”

DominatingConceptof thePastandFeared Future,AKA

Ruminating/Forecasting

Dominatingconceptofthepastand/orfeared future

•Fusionwiththeverballyconstructed pastorfuturemeansthatoneisnotin contactwiththepresentmoment

•Wordspullusintothepastandfuture

•Ruminationaboutthepastorfeared future

•Anticipatoryanxietyandavoidance

MindfulnessMeasures

•FiveFacetMindfulnessQuestionnaire(FFMQ)

•FreiburgMindfulnessInventory

•MindfulAttentionAwarenessScale(MAAS)

LackofValuesClarity AKAUnclearValues

Lackofvaluesclarity

•Theclientmaydescribeagenerallackofvitalityandbe vagueaboutvaluesandgoals.

•Theclientmaymisunderstandthedifferencebetween valuesandgoals.

Listenfor…

What’sthepoint? Nothingmatters. Idon’tknowwhereI’mgoing. Idon’tknowwhattodo. WhatshouldIdowithmylife? Everythingseemsmeaningless…Ifeel disillusioned. Eversince(mydivorce,myillness,I startedusingdrugs,etc),mylifehas beengoingnowhere.

•PersonalValuesQuestionnaire

•TheSurveyofGuidingPrinciplesquestionnaireand cardsort

•VLQ-ValuedLivingQuestionnaire

•ValuesBull'sEye

•ValuesCompasspictures

•ValuingQuestionnaire(VQ)

TheACTClinicalInterview

•Theclient’spresentingconcerns

•Pastexperiencesthathaveshapedtheclient’scurrent behavior

•Currentcontext/experiencesthatmaintaintheclient’s clinicalissues

(Patterson&Rowland2016)

ExperientialAvoidance–(administertheAAQ)

•Whathaveyoubeendoingtocopewithyour(anxiety, depression,clinicalissues)?

Listenforavoidant,compulsivebehaviors(Excessive useofalcohol,substanceabuse,excessivesleeping, zoningoutinfrontoftheTV,etc.)

•Whathaveyoudoneinternallytocontrolunwanted thoughts,memories,images,andemotions?

Listenforinstancesofsuppression,minimization, distraction,ignoring,etc.

•Whatunwantedthoughts,memories,images,and emotionsaremostpresentforyoudaily?

•Howmuchtimeandenergydoyouspendtryingnotto thinkofpainfulthoughts,memories,images,oremotions?

•Givemeanexampleofsomethingpainfulyouhave recentlyexperiencedandhowyourespondtoit.Copewith it?

Listenforworkableandunworkablestrategies.

Fusion–(administertheCFQ)

•Doyoubelieveyourunwantedthoughtstobetrue?Especially theonesthatareself-critical,judgmental,andevaluative. Listenfor‘Iam’statements,irrationalbeliefs,cognitive distortions,etc.

•Whenyoubelieveyourthoughts,doyouactonthem?

•Howworkableisyourbehaviorwhenyouactonnegative thoughts?

DominatingConceptofPastandFearFuture–(followupwith administeringtheMAAS)

•Howoftendoyoufindyourselfthinkingaboutthepast? Whatdoyouthinkaboutthepast?

•Howoftendoyouthinkaboutthefuture?Whatdoyou thinkwillhappeninthefuture?

Listenforexcessiveruminationandoranticipatory anxiety‘whatif”statements.

LackofValuesClarity–(followupwithadministeringavalues assessment;VLQ,)

•Whataresomethingsthatareimportanttoyou?What givesyourlifemeaningandvitality?

•Whatdoyouvalue?

ListenforstatementsWhat’sthepoint?Ihavenoidea, Nothingreally…

CaseConceptualization

Rick,29singleCaucasianmale,livesaloneinatwo-bedroom condo.

Heworksasanengineerandisdissatisfiedwithhiscareerpathbut lovesandisgoodatprogramming

Historyofsocialanxiety–smokesmarijuana

Adoptedatagethree(fatherisdeceased,motherisinanursing home)

Presentingcomplaints–ThereasonIneedcounselingispretty apparent.Ihatemyjobandgetpaidsquat,butatthesametime,I won'tquit,askforaraise,orpitchmyideas.It’sthesamewith gettinghigh.Idon’tevenenjoyit.Idoittotaketheedgeoff.Idon’t haveanyfriends,noragirlfriend.Thefutureisbleak.I’mfucking loserwithnoendinsight!

Rick:Igotstonedlastnightafterstayingcleanforfourdays.Wehadastaff meeting,andIwantedtosuggestthatnewproductagain;I’vebeenthinking aboutitforayearandcan’tgetuptheballstotalkaboutit….Butthen,whenI thoughtaboutspeakingup,myhandsstartedtoshake,myfacegothot,and mymindstartedblank.IknewIwouldn’tbeabletosayanythingwithout lookinglikeanasshole,soIjustkeptmymouthshut.Andthen,whileIwas thinkingaboutthisstuff,Ididn’thearthebossaskmeaquestion,and suddenly,everyonewasstaringatme,waitingformetosaysomething.I knowIturnedallred,andIheardsomeonesnickeringwhenIhadtoaskthe bosstorepeatthequestion.AndthenIjustmumbledsomethingstupid.I wantedtodisappear.Andthentherealkicker---AdamsuggestedtheproductI wasgoingtosuggest,andeveryonesaidwhatagreatideaitis.Nowhe,as usual,getsallthekudoswhileI’mtheonewholookslikealoser.Iwasdriving homejustthinking,“I’msuchanasshole;nothingisevergoingtochange.AndIcouldn’tstopthinkingaboutthatdamnmeeting.Andthen,whensome neighborhoodkidaskedifIwantedtoscoresomegoodweed,Iwaslike, “Whatthehell?Nothing’severgoingtochange.”SoIboughtahalf-ounceand gotstoned.ItfeltgreatuntilIwokeupthenextday,andnowit’sstilllike, “Nothingisevergoingtochange!I’malwaysgoingtoscrewup.What’sthe pointinstayingoffofthemarijuana?”It’s,like,theonlythingworthwhileinmy life.WhyshouldIquititjustbecausesomeshrinkthinksIshould?Noone elsecaresifIsmoketheshitornot.WhyshouldIcare?

Contactwiththe PresentMoment

Acceptance

Thusthename “Acceptanceand Commitment Therapy” and

Action Values Commitment andBehavior ChangeProcesses

Contactwiththe PresentMoment

Action Values isthis psychological space TheEssenceof ACTWork andwhatitis, istheanswerto thiscentral...

Acceptance

(6)atthistime,in thissituation? ACTQuestion

(2)areyouwillingto havethatstuff,fully andwithoutdefense

Iftheansweris “yes,”thatis whatbuilds...

(3)asitis,andnotas whatitsaysitis,

Contactwiththe PresentMoment

(5)ofyourchosen values

(4)ANDdowhat takesyouinthe direction

(1)Givenadistinctionbetween youandthestuffyouare strugglingwithandtryingto change

Psychologicalflexibilityis:

…contactingthepresentmomentfully …asaconscious,historicalhumanbeing, …andbasedonwhatthesituationaffords …changingorpersistinginbehavior …intheserviceofchosenvalues.

Thepsychologicalflexibilityprocesses

PSYCHOLOGICALFLEXIBILITYPROCESSSYSTEM AcceptanceAffective DefusionCognitive PresentmomentAttentional TranscendentselfSelf ValuesMotivational CommittedactionOvertbehavioral

InformedConsent

1)Addressalternativetherapies

2)Addressrisksandbenefits

3)Proposeaspecifictimeframe

4)Orientpersontotherapist,clientroles

5)Givegeneraldescriptionsofoperatingprinciples https://contextualscience.org/informed_consent_for_act

ACTinAction

Typically,youdonot‘teach’ACT.

1.GiveclientsanexperienceoftheACT processes.

2.Insession,youmodeltheACT processes.

TheTherapeuticRelationship

•ThesixcoreACTflexibilityprocesses(transcendentself, defusion,acceptance,presentmoment,values,and committedaction)arecentraltothetherapeuticrelationship.

•Ifwemodelpsychologicalflexibilityinthetherapyroom, clientsinternalizeit,justasyouinternalizeit.

•Thebetweennessofthetherapistandclientinteractionsis central.

TherapeuticRelationship:EXTREMELYIMPORTANT

1.Needstobesafeandsupportive

2.Givelotsofpositivesupportandfeedback

3.Lotsofvalidationofpain

4.Lotsofvalidationofdifficultyinmakingchanges

5.Self–disclosureintheinterestofvalidation

6.Explaintherationalebehindtechniques.

Sessionsshouldfollowthefollowingformat:

•BriefUpdateandMoodCheck

•BridgefromPreviousSession

•SetAgenda

•ReviewHomework

•Potentialsupportingexercises(seebelow)

•FinalSummary

•AssignHomework

•Feedback

“Wecanshiftourworkfromsomethingthat looksmorelikefixingaproblemto somethingthatlooksmorelikebuildinga life.”
~SteveHayes

Activelycontactingpsychological experiencesdirectly,fully,andwithout needlessdefensewhilebehaving effectively.

Hayes,Wilson,Gifford,Follette,&Strosahl,1996,p.1163

Colloquially,Acceptanceisawillingnessto havethecapacitytofeelsothatyoucanlearn fromyourexperiences.

ACCEPTANCEisnot:

•Tolerating,puttingupwith

•Resignation

•Defeat,a“lessthan”alternative

•Passive

Whathelpswillingnesstoaccept?

•CreativeHopelessness”—engenderinga postureofgivingupstrategieswhengiving upiswhatiscalledforinserviceoflarger goals.

•Wehelpclientsunderstandthatthe alternativetocontroliswillingness.

•“Areyouwillingtohavewhatshowsup?”

CreativeHopelessness

•Makingtheclientawareofan‘unworkable’changeagenda. •Workability=theextenttowhichabehavior‘works’inthelong termtocreatearich,full,meaningfullife.

•Theclientistryingtoimprovetheirlifebyusingemotionalcontrol strategiesincontextswheretheydon’tworkand/orreducetheir qualityoflife.

•Q:Whathaveyoutried?Howhasitworkedinthelongterm?What hasitcost?

BuildingWillingness

•Explorehowthestepstheclienttookhaveworkedornot •Don’timplytheircopingstrategieswerewrong •VALIDATEwhatevertheclientdidtosurvive.

•VALIDATEthatthesecontrolstrategiesareoftenhelpfulinthe shortterm.

•GENTLY,COMPASSIONATELYgettheclientintouchwiththe realitythatthesestrategiesareNOTHELPFULinthelongterm.

LearningtoSay“Yes”

InACTwork,weencourageclientstodeliberately seekoutorimaginesituationstheyavoid andchangetheirrelationshiptothethoughts, feelings,andmemoriesthatarise.

TheMiracleQuestion

Whatwouldyoudoifamiraclehappenedandallthe thingsyouarestrugglingwithwereinstantlysolved?

CreativeHopelessnessMetaphors

•Quicksand

•Personinthehole

•Tug-of-warwithaMonster

•TheStruggleswitch

WillingnessExercises

•Ball-in-a-Pool

•UnwelcomedPartyGuest

•FingerTrap

•HoldingtheCactusLightly

•TurnuptheWillingnessknob

GoalsforClinicians

Helpclientsletgooftheagendaofcontrolasappliedto internalexperiences.

Helpclientsseeexperientialwillingnessasan alternativetoexperientialcontrol.

Helpclientscomeintocontactwithwillingnessasa choice,notadesire.

Helpclientstounderstandwillingnessasaprocess,not anoutcome.

Howtohelpclients

Usedefusionexercisesinsessionsuchas:

•Deliteralizinglanguage

•Lemon…Lemon…Lemon

•AnotherVoice

Focusonfunctionality

•“Andwhatisthatstoryintheserviceof?”

•“Isthishelpful,oristhiswhatyourminddoes toyou?”

•“What’susefulaboutbelievingthisthought?”

•Buyingathoughtvs.Havingathought

•Thankyourmindforthatthought.

“Howoldisthatthought?”

“Ifthatthoughthadavoice,howwoulditsound?”

“Whatdoesthatthoughtremindyouof?”

“Justsaythatthoughtagainslowlyandlet’swatchwhatshowsup.”

“Inanormalmodeofmind,whatdoesthatthoughtusuallypullfromyou?”

“Canwedistillthatthoughtdowntoitssimplestformortheme?Thecore themeofthatthoughtis______________?”

“Ifthatthoughtwereanobject,howbigwoulditbe?”

“Whatotherthoughtsdoyouhaveinassociationwiththatthought

Metaphors/analogies

•Cloudsinthesky

•Leavesonastream

•SushiTrain

•Passengersonthebus

DefusionExercises

•ThoughtsonPost-Itnotes

•DefusingStorytelling

Self-as-Context

Itisexperiencedwhenwenoticeourownprivateorpublic experienceinthepresentmoment

•Ifeelsad(orhungry,tired,anxious,happy)

•Iamthinkingaboutwhattohavefordinner

•Iamwalkingtothecoffeeshop

•Iamtypinganemailmessagetomyboss

•Iamhavingthethought,“Idon’twanttogo.”

•Iamhavingapanicattack

•Iamobsessingaboutgerms

Howtohelpclients

•Discussevaluationsvsdescriptions

•GoodCupBadCup

•Lookingatthoughtsasjustthoughts

•“Iamhavingthethought,“I’mabadperson”vs“I’ma badperson”

•Metaphors

Activities

•Touchyournose,yourtoes,yourclothes…

•Youasababy,asalittlekid,youasyouareNOW

•Yourboxofstuff

•Chessboardmetaphor

ContactingthePresentMoment

Mindfulness: …ismucheasierlearnedbyexperience …involves: payingattentioninaparticularway; onpurpose, inthepresentmoment, andnonjudgmentally -JonKabat-Zinn

Whydoweteachclientstobeincontactwiththepresent moment?

Tohelpclients… •discoverthatlifeishappeningrightnow •toreturnto“now”fromaconceptualizedpastor future…whetheritbefilledwithsorroworhappiness •tonoticewhatishappeningintheirrelationshipsnow •Toacceptmoment-to-momentemotionalexperiences

Mindfulness

TheofficialACTdefinitionofmindfulnessis: Asaconscioushumanbeing,defused,accepting,andopen contactwiththepresentmomentandtheprivateeventsit containsisexperientiallydistinctfromthecontentbeing noticed.

Italsohelpstoundermineavoidanceand struggle…

Ifwearepresentlyfocused,weusuallyhave nothingagainstwhichtofight;weonlyhavewhat ispresent.

GoalsofMindfulness

Comeintocontactwiththepresentmomentwillingly,in theservicesofgreatervitalityandpsychological flexibility.

Establishobservationandawarenessskills.

Continuepracticingtheseskillssotheyarehoned.

Contactthepresentmomentinthepresenceofan aversiveexperiencethatconstrictsbehavior.

HowDoWeTeachClientsTobeMindful?

•Asclinicians,weneedtoencourageclientstoobserve andnoticewhatispresentintheirenvironmentand theirprivateexperience.

•Cliniciansshouldencouragetheirclientstolabeland describewhatispresentwithoutexcessivejudgmentor evaluation.

Linehan,1993

Observeandnotice + labelanddescribe = “Mindfulness”

Linehan,1993

Itisanactiveprocessofmoment-to-moment awarenessofyour:

Surroundings

“IamhereinthisroomlisteningtoJennifertalkabout Mindfulness.”

AND

PrivateEvents

“Iambored,Ifeeltired,Ineedmorecoffee…”

Obstaclesintryingtoteachmindfulness

Clientsandclinicianscanmisunderstandthegoalof mindfulness.

•MindfulnessisNOTatechniquetodiminishan undesirablefeelingsuchasanxiety.

•MINDFULNESSandRELAXATIONarenotthesame. Theyareseparatetechniqueswithseparategoals.

BestMindfulnessApps

•Headspace

•SmilingMind

•InsightTimer

•MindfulnessDaily

•Calm

•ACTcoach

•Stop,Breathe&Think

Informationfrom:ManiM,KavanaghDJ,HidesL,StoyanovSR.BasedonIPhoneApps.JMIRmHealth 2015;3(3):e82.AvailableatURL:http://mhealth.jmir.org/2015/3/e82

ValuesClarification

VALUESASSESSMENT: DIRECTMEANS

•PersonalValuesQuestionnaire(Blackledge&Ciarrochi, 2005)

•ValuedLivingQuestionnaire(Wilson&Groom,2002)

Intimaterelationships

ValuesQuestions

Startwithwhattheycaremostabout

Iftheysay,“tofeelbetter,”Iask,“Ifyoufeltbetter,what wouldlifelooklikeforyou?”“IfIhadamagicwand…”

•Otherwaystostart

Say,“Formetohelp,Ineedyourhelpfirst.Iwantto knowwhatitisliketobeyouandwalkaroundinyour shoes.”

“Inaworldwhereyoucouldchooseanydirection,what wouldyouwantyourlifetostandfor?Andareyoudoing thatnow?“Areyouwillingtodowhateverneedstobe donetomoveinthatdirection?”

Valuesactivities

CommittedAction

CommittedAction

•Committedactionisastep-by-stepprocessof actingtocreateawholelife,alifeofintegrity,true toone’sdeepestwishesandlongings.

•Commitmentinvolvesbothpersistenceand change–whicheveriscalledforinlivingone’s values.

•Committedactionisinherentlyresponsible–basedontheviewthatthereisalwaysanabilityto respondinanysituation.

CommittedAction

•Specificandmeasurableinsomeway

•Practicalandwithintheclient’sabilities

•Avoid“deadmen’sgoals”

•Linkedtotheirvalues

CommittedAction

•Lotsofcontracts(forhome,forwork,withthetherapist)

•Practicedoingthingswhenmad,sad,hyper,aswellashappy (sometimeshadto“pretend”feltspecificways,andothertimes thisnaturallyoccurred)

•Talkabouthowitfeelseithereasierormorechallenging–noting consequencesintheshort-andlong-termeitherway

ACTQuestion

(2)areyouwillingto havethatstuff,fully andwithoutdefense

Iftheansweris “yes,”thatis whatbuilds...

(3)asitis,andnotas whatitsaysitis,

(6)atthistime,in thissituation?

(5)ofyourchosen values

(4)ANDdowhat takesyouinthe direction

(1)Givenadistinctionbetween youandthestuffyouare strugglingwithandtryingto change

-ACT-companion(iOS& Android),http://www.actcompanion.com/ -ACTCoach(iOS& Android),https://itunes.apple.com/us/app/actcoach/id804247934?mt=8 -ACTMindfully (Android),https://play.google.com/store/apps/details?id=it.marcot uri.actmindfully -ACTive:Value-basedliving (iOS),https://itunes.apple.com/us/app/active-value-basedliving/id1343994479 -BlueLifeCoach(iOS&Android)http://bluelifecoach.com -IHereNow (iOS),https://itunes.apple.com/se/app/iherenow/id872764840?mt =8 -Learn2ACT(iOS&Android),http://www.learn2act.net -TheSleepSchoolApp(iOS& Android),https://my.thesleepschool.org/category/insomnia/ -2MorrowHealth(suiteofACT-basedappsforvarioushealth issues),https://www.2morrowinc.com/2morrow-health/

PattersonJennifer@comcast.net

UsefulResources

•Drjenniferlpatterson.com

•Patterson-jennifer@comcast.net

•AssociationforContextualBehavioralSciences www.contextualscience.org

•https://www.praxiscet.com/

•https://contextualscience.org/ACTinPractice

References

•Bach,P.,&Moran,D.(2008).ACTinpractice:Caseconceptualizationin AcceptanceandCommitmentTherapy.Oakland,CA:NewHarbinger.

•Bullis,J.R.,Boettcher,H.,Sauer‐Zavala,S.,Farchione,T.J.,&Barlow,D. H.(2019).Whatisanemotionaldisorder?Atransdiagnosticmechanistic definitionwithimplicationsforassessment,treatment,andprevention. ClinicalPsychology:ScienceandPractice,26(2),e12278.

•Eifert,G.H.;Forsyth,J.P.(2005).ACTforAnxietyDisorders.Oakland,CA: NewHarbingerPublications,Inc.

•Eifert,G.H.,Forsyth,J.P.,Arch,J.,Espejo,N.,Keller,M.,&Langer,D. (2009).AcceptanceandCommitmentTherapyforanxietydisorders:Three casestudiesexemplifyingaunifiedtreatmentprotocol.Cognitiveand BehavioralPractice,16,368–385.

•Hayes,S.C.,Strosahl,K.,&Wilson,K.G.(1999).AcceptanceandCommitment Therapy:Anexperientialapproachtobehaviorchange.NewYork:GuilfordPress.

•Hayes,S.C.,Luoma,J.B.,Bond,F.W.,Masuda,A.,&Lillis,J.(2006). Acceptanceandcommitmenttherapy:Model,processesandoutcome. BehaviourResearchandTherapy,44,1-25.

•Hayes,S.C.;Smith,S.(2005).GetOutofYourMindandIntoYourLife.Oakland, CA:NewHarbingerPublications,Inc.

•Harris,R.(2008).TheHappinessTrap.Boston,MA:TrumpeterBooks.

•Killingsworth,M.A,Gilbert,D.T.(2010).Awanderingmindisanunhappymind. Science,volume330,Issue6006,pp.932DOI:10.1126/science.1192439

•Linehan,M.(1993)SkillsTrainingManualforTreatingBorderlinePersonality Disorder.NewYork,NY:TheGuilfordPress.

•McKay,M;Lev,A;Skeen,M.(2012).AcceptanceandCommitment TherapyforInterpersonalProblems.Oakland,CA:NewHarbinger Publications,Inc.

•McKay,M.;Fanning,P.;Lev,A.,Skeen,M.(2013).TheInterpersonal ProblemsWorkbook.Oakland,CA:NewHarbingerPublications,Inc.

•Neff,K.(2011).Self-Compassion:ThePowerofBeingKindtoYourself. NewYork,NY:HarperCollinsPublishers.

•Neff,K.(2016)TheSelf-CompassionScaleisavalidandtheoretically coherentmeasureofself-compassion.Mindfulness.7(1),264-274

•Stahl,B.;Goldstein,E.(2010).AMindfulness-BasedStressReduction Workbook.Oakland,CA:NewHarbinger,Inc.

•Stoddard,J.A.;Afari,N.(2014).TheBigBookofACTMetaphors.Oakland, CA:NewHarbinger,Inc.

•Zettle,R.D.(2007).ACTforDepression.Oakland,CA:NewHarbinger Publications,Inc.

•Zettle,R.D.,Rains,J.C.,&Hayes,S.C.(2011).Processesofchangein acceptanceandcommitmenttherapyandcognitivetherapyfordepression: AmediationreanalysisofZettleandRains.BehaviorModification,35, 263-283.

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