临床与咨询心理学导论 21 - Mindfulness and Acceptance
L21 Mindfulness & Acceptance-Based Approaches
参考文献/图片来源：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.
21.1 Overview
Mindfulness/Acceptance Approaches
• View: Problems result from an inability to accept what is out of one’s control
• Focus of treatment: Maximize potential for a full and meaningful life
• Approach:
- Learn skills to deal with painful thoughts/feelings so that they have less impact and influence over you
- Clarify your values
- Use skills/knowledge to guide, inspire and motivate changes for for a life worth living
Mindfulness: An Overview
• Mindfulness: Full engagement with both internal mental processes and external experiences in a nonjudgmental way
• Core of “Third-Wave” Treatments
- Acceptance-based therapies (e.g., ACT, DBT)
• Change relationship with thoughts – not the thoughts themselves!
- Major departure from cognitive therapy and traditional CBT
• Facilitates acceptance
- Allowing negative internal experiences to happen, recognizing that they may be unpleasant but are harmless
21.2 Acceptance & Commitment Therapy (ACT)
Overview
• ACT developed by Steve Hayes (1980s)
• Symptom reduction is a byproduct not a goal
• We are predisposed to try to find solutions to problems
• Experiential Avoidance:
- Typical means of problem solving are ineffective for negative emotions
- Trying to avoid or get rid of problems leads to more distress
• Control is the problem à “Struggle switch” is on
• When we attempt to control negative emotions, they control us
• By learning to experience “symptoms” as harmless, even if uncomfortable, transient psychological events, they lose their power
Six Core Principles of ACT
• Being in the present moment: Full awareness of the here and-now, with openness, interest, and receptiveness - Allows you to perceive accurately what is happening - Allows you to engage fully in what you are doing - Example: The 5-5-5 Technique
• Acceptance: Opening yourself fully to experience, pleasant or unpleasant; allowing experiences to come and go without struggling, running, or giving them undue attention - “It is what it is, and I am ok” - Example: Demons on a Boat
• Defusion: Observe thoughts/language without being caught up in their perceived meaning - “Looking at thoughts rather than looking through thoughts” - “Noticing thoughts rather than being caught up in them” - Example: Leaves on a stream
• The “Observing Self”: There is a fundamental “you” that is a constant even a midst your ever-changing thoughts, feelings, memories, urges, sensations, etc.
• Values: “Your heart’s deepest desires for the sort of person you want to be and the things you want to do in your time on this planet; what you want to stand for in life”
• Committed Action: Overt behavior guided by your values
• “Embrace your demons, and follow your heart”
21.3 Dialectical Behavior Therapy (DBT)
Borderline Personality Disorder (BPD)
• A pervasive pattern of instability of interpersonal relationships, self-image, and affect, and marked impulsivity beginning by early adulthood and present in a variety of contexts, indicated by 5+ of the following:
- Frantic efforts to avoid real or imagined abandonment
- Pattern of unstable and intense interpersonal relationships; alternating between extremes of idealization and devaluation
- Identity disturbance: markedly and persistently unstable self-image
- Impulsivity in > 1 area that is potentially self-damaging
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Affective instability due to a marked reactivity of mood
- Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger
- Transient, stress-related paranoid ideation or severe dissociative symptoms
Etiology and Treatment for BPD
• Dialectical Behavior Therapy (DBT)
- Developed by Marsha Linehan (1980’s)
- Initially for chronically suicidal women
- Treatment combines CBT with mindfulness practices
• The Dialectic
- Both/and rather than either/or
- “Walking the middle path”
- Facilitates both: • Acceptance and Change
DBT: Treatment for BPD
• Goal of Treatment: “A life worth living”
- Develop a more realistic and positive sense of self
- Learn problem-solving and emotional regulation skills
- Learn assertiveness skills
- Challenge and change all-or-nothing thinking
• Skills Training: 1. Mindfulness; 2. Distress Tolerance; 3. Emotion Regulation; 4. Interpersonal Effectiveness
• Clinician Tools (for 1-on-1 therapy):
- Use Validation: Explicitly communicating your understanding of motivation for an action
- Use Diary Cards: Assign client to track behaviors between therapy sessions and identify treatment targets for each session
- Conduct Chain Analysis to determine the ABCs of a behavior
