Clinical psychology
Ninth Edition
Jonathan S. Abramowitz
Mitchell J. Prinstein
Timothy J. Trull
Generelle notater:
Key Concepts:
Mindfulness, Acceptance, and Dialectical Thinking:
• Mindfulness:
• Present moment awareness.
• Originated from Buddha's teachings around 2600 years ago.
• Defined in psychology as purposefully paying nonjudgmental attention
to the present moment.
• Acceptance:
• Willingness to embrace internal experiences (thoughts, feelings,
sensations), even if unpleasant.
• Follows mindfulness, involves acknowledging and not avoiding
discomfort.
• Dialectical Thinking:
• Rooted in Chinese philosophy (yin and yang).
• Viewing issues from multiple perspectives.
• Accepting contradictory positions as potentially true simultaneously.
Acceptance and Commitment Therapy (ACT):
• Developed by psychologist Steven Hayes in the 1980s.
• Falls within the broader category of Cognitive Behavioral Therapy (CBT).
• Focuses on clients' values and taking action based on personal values.
• Differs from traditional CBT by not emphasizing symptom reduction but
promoting living fulfilling lives despite psychological symptoms.
Theoretical Basis:
• Grounded in relational frame theory, emphasizing the connections between
stimuli.
• Clients seek treatment to gain control over unpleasant thoughts and feelings,
leading to experiential avoidance.
Experiential Avoidance:
• Coping strategy involving attempts to push away unpleasant thoughts,
emotions, or cravings.
, • Becomes problematic when habitual, rigid, and automatic, leading to
increased distress and impairment.
ACT Principles (Table 13.1):
• Acceptance: Making room for unpleasant experiences without struggling.
• Cognitive Defusion: Viewing private experiences as language rather than facts.
• Contact with the Present Moment: Full awareness and engagement in the
present.
• The Observing Self: Understanding thoughts and feelings are not the essence
of who we are.
• Values: Clarifying what is important and meaningful in life.
• Committed Action: Setting goals based on values and taking action to achieve
them.
Psychological Flexibility:
• ACT aims to develop psychological flexibility.
• The ability to be present, engage in meaningful activities despite difficult
thoughts and feelings.
Metaphors in ACT:
• Quicksand analogy: Struggling with difficult thoughts and feelings intensifies
them; leaning into them can reduce their impact.
• Party metaphor: Clients host a party representing life, with unwanted thoughts
and feelings as uninvited guests; choosing to enjoy the party despite their
presence.
Acceptance Techniques in ACT:
• Encouraging clients to make space for unpleasant thoughts and feelings.
• Alternative to experiential avoidance, allowing these experiences without
struggling or avoidance.
Cognitive Defusion:
• Stepping back and observing thoughts and feelings without getting "caught
up" in them.
• Example of Kiara's obsessive doubts having less influence if seen as passing
events.
In summary, ACT focuses on mindfulness, acceptance, and values-based actions to
help clients develop psychological flexibility, allowing them to live meaningful lives
despite the presence of difficult thoughts and feelings. The therapy emphasizes
acceptance, cognitive defusion, and various metaphors to facilitate these concepts.
,Defusion Techniques and Metaphors:
• Passengers on the Bus Metaphor:
• Represents unwanted private experiences (thoughts, feelings).
• Helps clients change their relationship with obsessional thoughts.
Kiara's Defusion Metaphor (Passengers on the Bus):
• Bus Driver (Client):
• Life represented as a bus, bus route as life path.
• Passengers (Thoughts, Feelings):
• Some pleasant, some unpleasant (obsessional thoughts).
• Struggling with Unpleasant Passengers:
• Attempting to throw them off the bus, scuffling, making deals.
• Loss of Control:
• Clients realize they've given up control by trying to appease the
passengers.
• Alternative Approach:
• Encourages clients to start driving the bus where they want to go,
despite passengers' protests.
Exposure and Response Prevention (ERP):
• Using Kiara's metaphor to set the stage for exposure therapy.
• Practice "driving the bus" and letting the passengers (obsessional thoughts)
be present without trying to control them.
Contact with the Present Moment:
• ACT Interventions:
• Aim to enhance awareness of the present moment.
• Example: Mindful eating exercise with a grape to focus on taste and
texture.
• Encourages clients to engage fully in daily routines with all five senses.
The Observing Self:
• Clients distinguish themselves from their thoughts and feelings.
• Chessboard Metaphor:
• Clients as the chessboard, thoughts and feelings as pieces.
• Clients notice thoughts and feelings without being changed by them.
Values:
• Values vs. Goals:
• Values are compass-like, guiding life direction.
• Examples: athleticism, creativity, family and interpersonal connections.
• Shane's Values Exercise:
, • Bull's eye exercise to assess alignment of behavior with values.
• Identifies inconsistencies and guides treatment goals.
Committed Action:
• Goal Setting:
• Involves setting goals aligned with identified values.
• Example: Kiara cutting back on compulsive rituals despite obsessional
urges.
• Clients learn to engage in value-driven activities despite unwanted
thoughts and feelings.
Client–Practitioner Relationship:
• Compassion and Empathy:
• Clinicians demonstrate compassion, empathy, and respect.
• Acknowledge shared experiences of unwanted thoughts and feelings.
• Emphasize a collaborative approach.
Comparison with Traditional CBT:
• ACT vs. Traditional CBT:
• In ACT, clients don't challenge or change irrational thoughts.
• Focus on noticing and being open to thoughts without judgment.
• Reflects a collaborative, non-expert role for clinicians.
Reflective Questions:
• Effectiveness of Perspectives:
• Consideration of the effectiveness of noticing and openness (ACT) vs.
challenging and changing thoughts (traditional CBT).
• Recognition that different clients may respond better to one approach
over the other based on their needs and preferences.
Dialectical Behavior Therapy (DBT):
• Developed by Marsha Linehan, a modified form of CBT.
• Aims to teach clients to live in the moment, cope with crises, regulate
emotions, and improve relationships.
• Initially designed for borderline personality disorder, but applicable to various
mental health issues.
Theoretical Basis:
• Based on the biosocial theory of personality functioning.
• Focuses on the interaction of biological vulnerability to intense negative
emotions and a chronic invalidating environment.
Ninth Edition
Jonathan S. Abramowitz
Mitchell J. Prinstein
Timothy J. Trull
Generelle notater:
Key Concepts:
Mindfulness, Acceptance, and Dialectical Thinking:
• Mindfulness:
• Present moment awareness.
• Originated from Buddha's teachings around 2600 years ago.
• Defined in psychology as purposefully paying nonjudgmental attention
to the present moment.
• Acceptance:
• Willingness to embrace internal experiences (thoughts, feelings,
sensations), even if unpleasant.
• Follows mindfulness, involves acknowledging and not avoiding
discomfort.
• Dialectical Thinking:
• Rooted in Chinese philosophy (yin and yang).
• Viewing issues from multiple perspectives.
• Accepting contradictory positions as potentially true simultaneously.
Acceptance and Commitment Therapy (ACT):
• Developed by psychologist Steven Hayes in the 1980s.
• Falls within the broader category of Cognitive Behavioral Therapy (CBT).
• Focuses on clients' values and taking action based on personal values.
• Differs from traditional CBT by not emphasizing symptom reduction but
promoting living fulfilling lives despite psychological symptoms.
Theoretical Basis:
• Grounded in relational frame theory, emphasizing the connections between
stimuli.
• Clients seek treatment to gain control over unpleasant thoughts and feelings,
leading to experiential avoidance.
Experiential Avoidance:
• Coping strategy involving attempts to push away unpleasant thoughts,
emotions, or cravings.
, • Becomes problematic when habitual, rigid, and automatic, leading to
increased distress and impairment.
ACT Principles (Table 13.1):
• Acceptance: Making room for unpleasant experiences without struggling.
• Cognitive Defusion: Viewing private experiences as language rather than facts.
• Contact with the Present Moment: Full awareness and engagement in the
present.
• The Observing Self: Understanding thoughts and feelings are not the essence
of who we are.
• Values: Clarifying what is important and meaningful in life.
• Committed Action: Setting goals based on values and taking action to achieve
them.
Psychological Flexibility:
• ACT aims to develop psychological flexibility.
• The ability to be present, engage in meaningful activities despite difficult
thoughts and feelings.
Metaphors in ACT:
• Quicksand analogy: Struggling with difficult thoughts and feelings intensifies
them; leaning into them can reduce their impact.
• Party metaphor: Clients host a party representing life, with unwanted thoughts
and feelings as uninvited guests; choosing to enjoy the party despite their
presence.
Acceptance Techniques in ACT:
• Encouraging clients to make space for unpleasant thoughts and feelings.
• Alternative to experiential avoidance, allowing these experiences without
struggling or avoidance.
Cognitive Defusion:
• Stepping back and observing thoughts and feelings without getting "caught
up" in them.
• Example of Kiara's obsessive doubts having less influence if seen as passing
events.
In summary, ACT focuses on mindfulness, acceptance, and values-based actions to
help clients develop psychological flexibility, allowing them to live meaningful lives
despite the presence of difficult thoughts and feelings. The therapy emphasizes
acceptance, cognitive defusion, and various metaphors to facilitate these concepts.
,Defusion Techniques and Metaphors:
• Passengers on the Bus Metaphor:
• Represents unwanted private experiences (thoughts, feelings).
• Helps clients change their relationship with obsessional thoughts.
Kiara's Defusion Metaphor (Passengers on the Bus):
• Bus Driver (Client):
• Life represented as a bus, bus route as life path.
• Passengers (Thoughts, Feelings):
• Some pleasant, some unpleasant (obsessional thoughts).
• Struggling with Unpleasant Passengers:
• Attempting to throw them off the bus, scuffling, making deals.
• Loss of Control:
• Clients realize they've given up control by trying to appease the
passengers.
• Alternative Approach:
• Encourages clients to start driving the bus where they want to go,
despite passengers' protests.
Exposure and Response Prevention (ERP):
• Using Kiara's metaphor to set the stage for exposure therapy.
• Practice "driving the bus" and letting the passengers (obsessional thoughts)
be present without trying to control them.
Contact with the Present Moment:
• ACT Interventions:
• Aim to enhance awareness of the present moment.
• Example: Mindful eating exercise with a grape to focus on taste and
texture.
• Encourages clients to engage fully in daily routines with all five senses.
The Observing Self:
• Clients distinguish themselves from their thoughts and feelings.
• Chessboard Metaphor:
• Clients as the chessboard, thoughts and feelings as pieces.
• Clients notice thoughts and feelings without being changed by them.
Values:
• Values vs. Goals:
• Values are compass-like, guiding life direction.
• Examples: athleticism, creativity, family and interpersonal connections.
• Shane's Values Exercise:
, • Bull's eye exercise to assess alignment of behavior with values.
• Identifies inconsistencies and guides treatment goals.
Committed Action:
• Goal Setting:
• Involves setting goals aligned with identified values.
• Example: Kiara cutting back on compulsive rituals despite obsessional
urges.
• Clients learn to engage in value-driven activities despite unwanted
thoughts and feelings.
Client–Practitioner Relationship:
• Compassion and Empathy:
• Clinicians demonstrate compassion, empathy, and respect.
• Acknowledge shared experiences of unwanted thoughts and feelings.
• Emphasize a collaborative approach.
Comparison with Traditional CBT:
• ACT vs. Traditional CBT:
• In ACT, clients don't challenge or change irrational thoughts.
• Focus on noticing and being open to thoughts without judgment.
• Reflects a collaborative, non-expert role for clinicians.
Reflective Questions:
• Effectiveness of Perspectives:
• Consideration of the effectiveness of noticing and openness (ACT) vs.
challenging and changing thoughts (traditional CBT).
• Recognition that different clients may respond better to one approach
over the other based on their needs and preferences.
Dialectical Behavior Therapy (DBT):
• Developed by Marsha Linehan, a modified form of CBT.
• Aims to teach clients to live in the moment, cope with crises, regulate
emotions, and improve relationships.
• Initially designed for borderline personality disorder, but applicable to various
mental health issues.
Theoretical Basis:
• Based on the biosocial theory of personality functioning.
• Focuses on the interaction of biological vulnerability to intense negative
emotions and a chronic invalidating environment.
