Stress Less, Live More: How
Acceptance and Commitment
Therapy Can Help You Lead a
Busy yet Balanced life
Dr. Richard Blonna
What is Stress?
• Stress means different things to different people
• What stresses some people challenges others
• Four classic ways to define stress : stimulus,
response, transaction, and holistic phenomenon
Stress is a Stimulus
• Stress is something in the external environment
• Stress is defined by the stimuli that one is
exposed to (stress is bills, work, taxes etc.)
• Some stimuli are defined as “life events”
(Holmes & Rahe)
Stress is a Response
• Stress is something in the internal environment
• Stress is defined as “the non-specific response of
the body to any demand” (Hans Selye)
• The non-specific response include symptoms
such as increased muscle tension, breathing
rate, hormonal release, metabolic rate etc.
Stress is a Transaction
• Stress is a transaction between a stimulus and a
response (Lazarus & Folkman, 1987)
• The transaction revolves around the appraisal of
a “potential stressor” based on two questions:
Is it a threat?
Can I cope?
Stimulus (potential stressor) and Personality
(the individual) factors mediate the transaction
Stress as a Holistic Phenomenon
• Stress is a response that that occurs when the
dimensions of health (physical, social, spiritual,
emotional, intellectual, occupational and
environmental) are out of balance.
• Lack of balance causes the body to make
adjustments in order to regain and maintain
homeostasis
All of these Definitions are Partially
Correct
• In actuality, stress is all of these things
(stimulus, response, transaction, holistic
phenomenon) combined.
• Each of the classic ways of defining stress
accounts for a piece of the puzzle.
A New Way of Defining Stress
• “Stress is a holistic transaction between an
individual and a potential stressor resulting in a
stress response (Blonna, 2006).”
• Blonna’s definition combines elements of the
four classic definitions to form a more eclectic
picture of stress.
What is ACT?
• Acceptance and commitment therapy (ACT) is a
third wave form of cognitive behavior therapy
(CBT) grounded in relational frame theory (RFT
• Numerous ACT studies support its efficacy in
treating anxiety, schizophrenia, depression,
workplace stress, and burnout, pain, drug use,
psychological adjustment to cancer, and
diabetes self-management (Ciarrochi & Bailey,
2008).
What is ACT?
• An underlying premise of ACT is that mental
suffering occurs when clients become
psychologically-inflexible and get stuck
• ACT helps clients become more psychologically
flexible, get unstuck, and engage in valuescongruent behavior
Values-Congruent Behavior
• The primary therapeutic outcome for ACT is
getting clients to behave in ways that are
congruent with their values
• Two key aspects of this are helping clients clarify
their values and setting behavioral goals that are
congruent with these values
The Acceptance Component of ACT
• Acceptance has three aspects :
1. Becoming more mindful of thoughts,
emotions, and actions
2. Understanding how thoughts, emotions,
and actions support or oppose values and
goals
3. Accepting that trying to control, avoid, or
eliminate painful thoughts and feelings is
impossible and makes them worse
The Commitment Component of
ACT
• Acceptance and Commitment work together
acceptance is the cognitive part
commitment is the behavioral part
• Commitment involves sticking to values-
congruent behavior while coexisting with
troubling thoughts and painful emotions
The Therapeutic Component of ACT
• ACT does not focus on over-analyzing the past
or trying to change thoughts, personal scripts,
mental images and emotions
• ACT is based on RFT research that demonstrates
the effectiveness of accepting painful thoughts
and troubling emotions and focusing on valuescongruent behavior
ACT and RFT
• ACT is grounded in Relational Frame Theory
(RFT), the language theory that underlies it
• RFT proposes that current thoughts, personal
scripts, mental images and emotions related to
stress are linked to their original frames of
reference (what RFT refers to as relational
frames) from the past in which they were
initially learned
An RFT View of the Human Mind
• RFT compares the mind to a 24/7 computer that
is running multiple programs simultaneously
• The “programs” are thoughts, personal scripts,
mental images, and emotions
• At times, some of the programs get “corrupted”
and cause the mind to freeze (get stuck) and
crash
Relational Frame Theory
• The mind uses information from previous
relational frames as the basis for assessing the
threat posed by current stressors
• In addition, the mind can carry this one step
further and use the same previous information
to jump ahead and project an infinite number of
future situations involving this and similar
stressors
Thoughts
• Thoughts do not occur in a vacuum, they are
connected to specific relational frames
• An underlying principle of ACT is that all
thoughts are not equally helpful or important
• ACT evaluates thoughts in terms of whether or
not they are helpful in reaching goals and taking
valued action.
Thoughts
• Can organize thoughts in terms of their
helpfulness:
helpful thoughts – are consistent with
one’s values and goals and facilitate
values-congruent behavior
unhelpful thoughts - are inconsistent with
one’s values and goals and interfere with
values-congruent behavior.
Personal Scripts
• Personal scripts are like scenes in a play except
the play is one’s life.
• Each script has its own inner dialogue (self- talk)
that represents how the scene
played out (old script)
is currently running (present script)
will ultimately play out (future script).
Personal Scripts
• Each script is connected to a relational frame,
the context that sets the stage for the innerdialogue
• Personal scripts often get outdated because the
relational frame or the person changes
• Outdated personal scripts are seldom helpful in
taking valued action.
Mental Images
• Mental images are the visual images that
accompany the personal scripts
• Think of the scripts as the dialogue and the
images as the moving pictures
• As with personal scripts, mental images are
linked to relational frames that set their context
Mental Images
• Mental images, are similar to personal scripts in
that they can get outdated and no longer
represent who the person is
• Many adults still have images of themselves as
helpless or worthless children
• Outdated mental images are seldom helpful in
taking valued action.
Emotions
• ACT views emotions as something that cannot
be controlled and therefore should be
acknowledged and accepted not analyzed or
changed
• Emotions are also linked to past, present, or
future relational frames
• Even though emotions cannot be controlled, the
behavior associated with them can be
RFT and Control
• The mind’s ability to synthesize past and present
relational frames and extrapolate into the future
is tremendously useful when planning for things
it can control:
behavior
some aspects of the environment
These are known as external potential stressors
RFT and Control
• The same ability can also be a source of
emotional distress when dealing with things it
cannot control:
•
thoughts
personal scripts
mental images
emotions
These are known as internal potential stressors
RFT and Control
• RFT teaches us that the more people try to
control, avoid, or eliminate potential stressors
that cannot be controlled, the worse they get
• Learning how to manage them is the key
be mindful of them
accept them
be willing to act while coexisting with them
Acceptance vs Control
• Most people fail in their stress management
attempts because they try to control, avoid, or
eliminate internal potential stressors
• This is doomed to fail because more than half of
all stress is associated with internal potential
stressors that cannot be controlled
ACT & Stress
• Often clients who seek the services of therapists
and counselors do not have mental disorders
that meet the criteria established in the DSM lV
• These clients, the “worried well”, are stuck
because of their psychological inflexibility, and
suffer from stress, anxiety and worry that keeps
them from taking values-congruent action
ACT & Stress
• The worried well, like clients with more serious
mental disorders, also struggle with:
unhelpful thoughts, personal scripts, mental
images, and emotions that contribute to
their psychological inflexibility and keep
them stressed and stuck in a rut
ACT & Stress
• ACT can help these clients develop greater
psychological flexibility, get unstuck, take
values-congruent action, and meet their goals
• ACT can also help these clients keep their stress,
anxiety, and worry from turning into more
serious mental disorders
An ACT View of Stress
• An ACT view of stress supports a transactional
way of defining stress
• Thoughts, personal scripts, mental images, and
emotions all come into play during the stress
appraisal process
An ACT View of Stress
• All of the core process that contribute to
psychological inflexibility also come into play
during stress transactions
• All of the six therapeutic processes can be
adapted to help clients manage their stress
The Six Core Processes
• There are six “core processes,” that contribute
to psychological inflexibility and stress:
attachment to the conceptualized self
cognitive fusion
dominance of outmoded scripts and learning
experiential avoidance
lack of clarity concerning values
inaction, impulsivity, and rigidity.
Attachment to the Conceptualized
Self
• The conceptualized self refers to the self-
descriptions clients to describe themselves:
“I’m a mother”
“I’m of average height and build”
“I’m a happily married man”
“I’m an architect”
“I’m a teacher”
• The mind creates stereotypes or shortcuts
around these descriptions
Attachment to the Conceptualized
Self
• These statements sum up how people view
themselves and measure up to societal
standards (IQ, SES, body image etc.)
• ACT refers to this way of describing the self as a
self-as-content view (you are the sum total of
all of the things contained within you)
• People get attached to their self-statements
Attachment to the Conceptualized
Self and Stress
• Stress clients often take a self-as-content view
of themselves
• They use labels and past diagnoses to describe
themselves and their problems (social phobic,
asthmatic, dyslexic, etc.)
• Often these labels limit their psychological
flexibility and coping options resulting in stress
Cognitive Fusion
• Cognitive Fusion is the process of fusing with an
aspect of the conceptualized self
• Can fuse with positive or negative attributes:
I am a runner (positive)
I am a loser (negative)
• In a sense, cognitive fusion is over-attachment
to one aspect of the conceptualized self
Cognitive Fusion & Stress
• Stress clients often fuse with elements of their
conceptualized self and create stereotypes that
limit their potential
• A common occurrence with cognitive fusion is
the person becoming the problem:
“I am an asthmatic”
vs.
“I am someone who has asthma”
Dominance of Outmoded Personal
Scripts & Stress
• Stress clients often fuse with personal scripts
and prior learning that are outmoded and no
longer represent who they are as individuals
• The relational frames these scripts are based on
relate to failed attempts to cope with potential
stressors that were similar in nature to the ones
being appraised in the present moment
Lack of Clarity of Values & Stress
• Stress clients often feel unable to cope with
potential stressors that threaten their values
• Sometimes the threat is due to being unclear
about the underlying values
• Stress clients often adhere to values that are
based on outmoded personal scripts that no
longer represent who they are
Experiential Avoidance & Stress
• Stress clients often avoid experiences that
expose them to potential stressors that they’ve
previously found stressful
• Their 24/7 thinking and feeling machines (their
minds) project into the future and extrapolate a
limitless number of threatening and failed coping
scenarios based on past relational frames
Inaction, Impulsivity, Rigidity, &
Stress
• Experiential avoidance contributes to stress
clients’ inaction and rigidity due to a lack of
understanding of the relationship between
action and personal values
• They often act impulsively because their
behavior is not congruent with their values
(often due to lack of clarity regarding their
values)
Psychological Inflexibility and
Unhelpful Thinking Traps
• Psychological inflexibility often results in falling
into common thinking traps
• Blonna (2010), synthesized 10 common thinking
traps that contribute to getting stuck
• ACT refers to the process of falling into these
thinking traps as “getting hooked”
The “Thoughts Are Reality” Trap
• This is based on the belief that the thoughts
•
•
clients have about events represent the
objective reality of the events
In fact, unless they are experiencing events
first-hand, their thoughts are just that; what
they think about the event
Clients fall into the trap when they think their
thoughts are the actual events instead of just
their thoughts about them
The “Thoughts are True” Trap
• The “thoughts are true” trap is based on the
•
•
belief that just because clients think of
something that these thoughts must be true.
Many of the thoughts clients have are really
judgments or evaluations and not really ‘truths”
based on evidence
Clients fall into the “thoughts are true” trap
when they fail to realize that these truths are
really their personal judgments or evaluations.
The “All Thoughts Are Equally
Important” Trap
• The “all thoughts are equally important” trap
gives equal weight to all thoughts
• Clients fall into this trap when they take all of
their thoughts too seriously (after all, they are
only thoughts) and assign them the same high
importance.
The “Thoughts Are Orders” Trap
• The “thoughts are orders” trap revolves around
the belief that just because clients think about
doing something they feel that they have to act
on it.
• Clients fall into the “thoughts are orders trap”
when they mindlessly act in response to
unhelpful thoughts because they took them as
marching orders.
The “Thoughts Are Threats” Trap
• Thinking that something can harm you is
different from actually being in harm’s way.
• Sticks and stones will break your clients bones,
but words (or thoughts) will never hurt them,
unless they allow them to.
• Clients fall into this trap when they believe their
thoughts can actually cause themselves harm.
The “Outdated Personal Scripts”
Trap
• Based on the belief that outdated personal
scripts are still valid
• In reality, outdated scripts are like faded old
newspaper clippings from the past
• Clients fall into this trap when they think these
old scripts are still valid even though they stand
in the way of creating newer, more helpful ones
The “Scary Pictures are Real” Trap
• Based on the belief that the frightening images
the mind can churn out 24/7 are real
• In fact, these images are like faded photos from
an old album, pictures of past hurtful events
• Clients fall into this trap when they believe that
the images are real and that they are part of the
picture of their lives in real-time
The “Personalization” Trap
• Based on the belief that responsibility for
problems is exclusively linked to the self or
others
• In fact, responsibility for problems is rarely onedimensional or exclusive
• Clients fall into the trap when they assign
responsibility for their problems exclusively to
themselves or others
The “Pervasiveness” Trap
• Based on the belief that the extent of influence
of a stressor or aspect of the conceptualized self
situation spills over into every aspect of life
• In fact, stressors and aspects of the self usually
do not affect every aspect of life
• Clients fall into this trap when they believe that
these things are not context-specific and
permeate every aspect of their lives
The “Permanence” Trap
• Based on the belief that current troubling
thoughts, feelings, and situations will last
forever
• In fact, very few of these situations last forever
• Clients fall into the permanence trap when they
believe that temporary conditions and situations
will last forever and affect them permanently
Getting Unstuck: The Six Core
Therapeutic Processes
• ACT identifies six core therapeutic processes for
developing greater psychological flexibility:
1. being present (developing mindfulness)
2. acceptance
3. defining valued directions
4. commitment (taking action)
5. cognitive defusion
6. self-as-context
Developing Mindfulness
• Mindfulness can be developed two ways:
informal training (attention building)
formal training (mindful meditation)
• Informal training involves using short activities
to help stress clients become more aware of:
internal (thoughts, scripts etc.) processes
external (environment) stimuli
Developing Mindfulness
• Formal mindfulness training involves learning
and practicing mindfulness meditation
daily practice sessions
increasing duration from 5-20 minutes
• Mindfulness meditation is not the same as
focused meditation used for relaxation training
Developing Acceptance
• Acceptance training builds on mindfulness
training and sets the stage for willingness
• Before clients can begin to accept their unhelpful
thoughts, personal scripts, mental images, and
emotions they need to be more mindful of them
• Acceptance and willingness activities are
typically integrated with each other
Developing Acceptance
• Involves teaching stress clients about the futility
of trying to change internal potential stressors
• Acceptance training involves information giving
and the use of metaphors and exercises
• Can demonstrate using Chinese Finger Traps
Defining Valued Directions
• The four steps to defining valued directions:
1.
2.
3.
4.
exploring values
choosing and ranking values
publicly affirming values
acting on values
• ACT uses a variety of in-session and homework
assignments to help stress clients do this
Values Categories
• There are ten values categories:
1.
2.
3.
4.
5.
intimate relationships
family relationships
friendships and other relationships
health
spirituality
Values Categories
6. finances
7. learning
8. work
9. the environment
10. civics
Commitment Training
• Since ACT is a values-based form of therapy,
goals and objectives must reflect clients’ values
• Clear goals and measurable objectives reduce
ambiguity and give structure to behavior
• Stress clients develop goals and objectives that
reflect their values and guide them to where
they want to go
Commitment Training
• Commitment is the action component of
acceptance and a key step in therapy
• Clients don’t get better by just talking about
their problems, they must take action
• Taking action that is congruent with values is
based on setting clear goals and measurable
objectives for behavior
Control and Willingness to Act
• Control and willingness are inversely related:
the more stress clients try to control troubling
thoughts and painful feelings, the less willing
they are to take valued action
can demonstrate by using “The Radio” metaphor
Willingness and Control
• A key component of ACT is helping clients shift
their focus off of what they cannot control and
onto what they can control
• The focus is on engaging in more helpful*
behavior and creating more helpful
environments
*in terms of reflecting their values and achieving
their goals
Willingness to Act
• The key is getting stress clients to take values-
congruent action while coexisting with troubling
thoughts, personal scripts etc.
behaving in ways that support their values
will result in new learning and developing
new, more helpful relational frames
give homework assignments to build this
Willingness and Control
• Things than can be controlled:
personal environment
behavior
• These can be modified and can trigger helpful
thoughts, personal scripts, mental images, and
emotions and new, more positive relational
frames
Self-as-Context (the Observer Self)
• ACT proposes another way of viewing the self,
the self as context
• In this view, the self is the vessel (the context)
that contains a lifetime’s worth of thoughts,
personal scripts, etc.
• This view helps clients see that they are more
than their thoughts, personal scripts, etc.
Self-as-Context (The Observer Self)
• ACT teaches clients to view themselves as being
more than just the sum total of their thoughts,
personal scripts, etc.
sets the stage for being able to distance
themselves from these things when they are
unhelpful
• The observer self allows stress clients to step
back and observe their conceptualized selves
Self-as Context
• ACT often uses chess as a metaphor to explain
this:
a self-as-content view looks at the pieces
and their movement at any given point to
describe the game
a self-as-context view looks at the existence
of the board as the context in which the
pieces play out many games over time
Self as Context
• Being able to step back and examine any
stressful situation from the perspective of being
the board upon which it plays out can help:
put individual moves (thoughts etc) and the
game (the entire situation) in a broader
perspective
evaluated in terms of their helpfulness
dismissed as just a bad move or game
Self as Context
• “What a silly move that was”
• “ What a bad choice of moves I made”
• “What a terrible game I played”
• Wouldn’t it be nice to be able to dismiss our
unhelpful thoughts, scripts, mental images &
feelings this way?
Cognitive Defusion
• Cognitive defusion techniques teach stress
clients how to take an observer self view
• ACT uses a variety of metaphors and exercises
to help clients identify when they have fused
with thoughts etc. and how to defuse from them
• The White Board is one such exercise