Dr. Paul Flaxman City University London 11 th March 2011

1. Acceptance and Commitment Training (ACT) in the Workplace A Three-Session Protocol Dr. Paul Flaxman City University London 11th March 2011

2. Acknowledgements Funders • City University Staff Development Unit • Economic and Social Research Council • Guy’s and St. Thomas’ Charity • Collaborators • Prof. Frank Bond • Jo Lloyd • Mia Soderberg • Dr. Vasiliki Christoloudou • Dr. Matthew Wardley • Dr. Joe Oliver • Eric Morris

3. Presentation Overview • Background • Evolution of the ACT at Work protocol • Why the workplace is a good place for ACT • Overview of the three sessions • Adopting the ACT stance • Implementation issues Q&A

4. Evolution of the ACT at Work Protocol How I got started: ACT working manual (1995); Frank’s ACT for stress protocol; ACT book (1999) How can I translate this for the general public? How can I make it my own? This stuff is confusing

5. Evolution of the ACT at Work Protocol 2002-2004: Three-session ACT training for local council employees (N ~ 500+) 2007-2008: Brief ACT sessions for Central Government employees (N ~ 60) 2008-2009: One day ACT sessions for University staff and students (N ~ 200) 2009-2010: Updated three-session ACT for NHS and central government workers (N ~ 250) 2009: Commissioned by New Harbinger to publish three-session protocol

6. Why the workplace is a good place for ACT 1 in 6 UK workers experiencing a common mental health problem at any one time….. 75% of whom do not receive psychological intervention (Seymour & Grove, 2005) Let’s take the interventions to them!

7. Why the workplace is a good place for ACT Presenteeism costing businesses ‘1.5 to several times’ more than absenteeism (Sainsbury Centre, 2007) Helping people function better while experiencing difficult private events

8. Why the workplace is a good place for ACT Experiential avoidance viewed as a basic vulnerability factor (or ’transdiagnostic’ process) Workplace highlighted as a viable context for preventive intervention (Biglan et al., 2008)

9. A Three-Session Protocol

10. My ‘top tips’ • Don't try to do too much – less is sometimes more (cf. Richardson & Rothstein, 2008) • Use simple organising strategies (e.g., two core skills; Passengers on the Bus) • Do away with the ‘gloss’ – let the processes sell themselves and allow your humanity to shine through! • Focus on cultivating the 6 core processes, rather than any strict ordering of techniques • Use humour

11. Session 1 – Opening • Hopes and expectations • Ground rules (confidentiality etc) • Other support available • Training, not therapy • Importance of attending all sessions • Introduction to the training….

12. Introduction MINDFULNESS Present moment awareness training Untangling from difficult thought and emotion Finding your resilient sense of self VALUES-BASED ACTION Clarifying your most valued life directions Using values as a guide to goals and daily behaviour

13. Introduction RATIONALE (each point open to discussion) • Humans are dealing with two worlds: inside the skin and outside the skin • We can sometimes become overly ‘entangled’ with particular thoughts and feelings • ‘DIFFICULT’ THOUGHTS AND FEELINGS CAN INTERFERE WITH OUR ACTIONS/ BEHAVIOURS/ GOALS

14. Mindfulness Introduction • Developing greater present moment awareness • Noticing the difference between: • Being ‘lost’ in thought, and • Aware of thoughts coming and going • Taking a non-judgemental view of all thoughts, feelings, and sensations

15. Linking mindfulness and values-based action Let’s look at why we will be practicing these rather strange exercises – to start revealing the purpose of this training: 1. Benefits of mindfulness 2. To ensure that our own thoughts and feelings do not interfere with our chosen life directions and goals

16. Passengers on the bus about here!

17. Passengers on the Bus While fighting / arguing with/ trying to remove the unwanted passengers seems the sensible thing to do...... • Do the unwanted passengers get off and stay off the bus? • What’s happening to the bus while we are back there fighting/ arguing with the passengers? • Does engaging with the passengers make them more or less important in our lives?

18. The Bus of Life Exercise For one important area of your life: 1. Identify the most important chosen direction for your bus service (values) 2. Identify a few bus stops along the way (goals) 3. Identify the very next turn (tonight/ tomorrow/ this week) (actions) 4. Identify any passengers (thoughts, feelings, memories, urges etc) that have the potential to ‘hijack’ your bus (internalbarriers)

19. Theory bit Inside the skin/ outside the skin distinction (Undermining experiential avoidance)

20. More mindfulness/ acceptance work What is the alternative to fighting/ arguing/ debating/ suppressing these passengers? • ‘Untangling’ from them • Getting a bit of distance between you and your passengers • Seeing them for what they actually are **Physicalizing exercise about here**

21. Session 1 Homework • Bring present moment awareness to your journey to work each day • Mindfulness of breathing (10 mins each day) • Complete the Bus of Life exercise across five life areas • Start to get a good sense of: • Your chosen values, goals, actions • Any ‘difficult’ or ‘unhelpful’ passengers that want to control your bus

22. ACT Stance Focused on the core processes from the outset... Trainer: Does anyone else have any hopes or expectations about what you might get from these three sessions? Participant: I’d love to learn something that would help me to stop worrying and going over and over things in my head. Trainer: Right. So your mind loves a good worry? Participant: It sure does. You name it, I’ll worry about it!

23. ACT Stance Trainer: Neat. We’ll have a good look at that in these sessions; worrying is one thing minds are very good at! My mind is the same – it loves a good old worry. Anyone else’s mind do something similar? (all but one person in the group raised their hands)

24. ACT Stance After a physicalizing exercise... Trainer: Did anyone notice a feeling or sensation pop up? Participants: I certainly did. It was like a sense of dread or foreboding. Trainer: Great. Nice. And where in your body did you experience that?

25. ACT Stance Participant: Right in the pit of my stomach – like a burning sensation and a feeling of heaviness Trainer: Good stuff - you've really noticed it. And did it take on some shape and form as if it were a physical object... ?

26. Session 2 (one week later) Session aim: Strengthening the two core skills • Mindfulness of breathing/ body (5 to 10 mins) • Mindfulness homework review (brief) • Values homework review (additional coaching around values, goals, and actions)

27. Defusion Did anyone find that their ‘Mind Chatter’ interfered with values-directed action? Anything your Mind ‘says’ that causes you to stop the bus or move in a less valued direction? So, let’s look at a couple of exercises that help to ensure YOU are the driver .........

28. Defusion I’m having the thought that...“I’ll do it tomorrow” “I’ll do it tomorrow” “Why should I, he doesn't really deserve it” I’m having the thought that ...”he doesn't really deserve it” I’m having the thought that ...”I’ll probably do it wrong” “I’ll probably do it wrong”

29. Defusion Also works with the ‘feeling’ passengers: I’m having a feeling of.... embarrassment It’s embarrassing I was having a feeling of.... stress I was too stressed I was having a bodily sensation of.... a knot in my throat and chest A use of language that establishes some healthy distance between you – a conscious human being – and your internal experiences

30. Defusion Let’s take a look at these thought passengers for what they actually are: **Milk exercise here** Quickly followed by other thought barriers that came up “tomorrow”, “wrong”, “no time”, “danger” etc And we let this control our actions, and therefore our life?!

31. Defusion Also useful to start glimpsing thoughts as thoughts as they come and go Noticing those moments when we get hooked by a particular thought ***White Screen OR Leaves on the Stream OR Soldiers in the Parade here***

32. Self-as-context There’s a highly resilient and stable part of you being used and slowly revealed here • From where were you observing your thoughts just now? • Who was noticing your breathing? • The observing self: • A perspective that we don't often use • You find it every time you practise a mindfulness exercise • A place that is unharmed by difficult thoughts and feelings

33. Final values clarification, goal and action planning Step 1: Pick one of your most important values – see if you can capture it in just a few words Step 2: Identify short-term, medium term, and long-term behavioural goals that would help you pursue that direction Step 3: Choose the next action that will get you moving down that valued path

34. Taking a stand Each person stands, states the value, along with the next values-based action

35. Session 2: Homework • Consider the next few weeks as the testing ground for cementing these two core skills • Four week schedule of mindfulness practice (supported by CD) • Values-based goal and action planning sheets Pursuing valued actions will surely give rise to potential internal barriers for you to work on

36. Session 3 (1, 2, or 3 months later) • Cementing the two core skills • Mindfulness practice and check-in • Bull’s eye exercise • Additional defusion work on barriers • Physicalizing exercise or Tin Can Monster • Taking a stand on most important valued direction for the rest of this year

37. ALL ABOARD! Thank you for listening!