Tag Archives: Acceptance and Commitment Therapy

用于精神病患的接纳与承诺疗法 (ACT)

近几年在北京当助教和翻译的时候,常遇见学生问说除了药物以外,还有什么方法可以帮助精神分裂患者,尤其许多患者用药虽然很重,但还是有幻听(auditory hallucination) 和妄想(delusion) 的症状,严重困扰着生活。

其实现在有越来越多的研究表明接受和承诺疗法(ACT)对于精神病患者很有帮助。作为干预,ACT不是特别针对症状减轻,而是强调对精神病症状更灵活的反应,以鼓励价值驱动的行为(就是你的生活由你的生活意义和价值来决定,而不是完全被你的病状所控制)。许多的案例研究显示,用ACT帮助偏执狂 (Paranoia),妄想 (Delusion) 和相关的情绪障碍,虽然症状没有完全缓解,精神病依然存在,但却相当程度的减轻了患者的痛苦,而且生活的功能性和基于价值的活动(Value-based activities) 显著增加。

所以如果你,或者身边的家人或朋友患有精神分裂症,尤其幻听和妄想的症状在用药后依然对生活造成相当的困扰,可以考虑留言或电邮联系,因为只要患者有心改变,6到10次基于 ACT 的心理治疗就可以学习新的应对方式,减轻痛苦,活得更有意义。

ACT Therapists in Malaysia

I came across Acceptance and Commitment Therapy (ACT) in 2011 and fell in love with it almost immediately. Since then I have been practicing it on myself, then subsequently learning it from books, and started to incorporate it into my daily clinical practices.

Now I’ve also completed the course with Russ Harris. I’m wondering if there’s any ACT therapists in Malaysia out there, and if yes, please get in touch (my email: hello@huibee.com, my mobile 017-2757813) and let’s form a Malaysian ACT community together!

 

What’s ACT?

  • It stands for Acceptance and Commitment Therapy, pronounced as “act” (one word)
  • It’s a type of psychotherapy, not a long-term treatment
  • 3rd wave of CBT (Cognitive Behavioural Therapy)
  • It focuses on 6 processes, which can be combined into these:
    1. Being present
    2. Opening up
    3. Doing what matters
  • As of late 2018, there are over 250 RCTs (randomized controlled trials, the gold standard of research) published in peer-reviewed journals, that show the effectiveness of ACT with many disorders, such as depression, anxiety, stress, OCD, chronic pain and psychosis.

The Freedom to Choose

“We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread.

They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing:

the last of the human freedoms –

to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

- Victor E. Frankl

This is a quote from the book “Man’s search for meaning”, a book written by Viktor Frankl published in 1964, the author recorded his experiences as a prisoner in Nazi concentration camps during World War II.

Just to, perhaps remind all of us that, even in the most difficult and challenging situation, there’s still one thing that we all possess – the freedom to choose. We might not be able to leave the situation, but we can choose how we’re reacting to the situation, how we are treating ourselves and those around us. And nobody can take this away from us.

Watching the Mind-Train

Meditation Exercise: The Mind-Train

Following my favourite Leaves on the Stream (see here), I am introducing another mindfulness exercise. It is an eye-closed exercise (though possible to do it with eyes opened when you are familiar), so please read the instruction first.

Imagine you are standing at a railway bridge gazing down at three sets of train tracks. A slow mining train is on each set of tracks moving away from you. Each train is composed of a string of little coach/car. Seemingly endless, all three chug slowly along underneath the bridge.

Now, as you look down, imagine that the train to the left carries only ore composed of sensations, perceptions, and emotions (e.g. sounds you hear, hot sensation you feel, sweaty palms, sadness you notice, itchiness you feel etc). The middle train carries only your thoughts (your evaluations, predictions, and self-conceptualisation etc). The train on your right carries your urges to act (e.g. your pull to look away, your urge to scratch your face or stop the exercise, your efforts to change the subject). Looking down on these three tracks can be seen as a metaphor for looking at your mind.

Now, find a comfortable chair to sit in for a while in a spot where you won’t be disturbed and you can be quiet. Begin the exercise by thinking of something you’ve been struggling with lately, then close your eyes and picture the three tracks. Your job will be to stay on the bridge and gaze down at these three trains moving away from you. Take at least 3 minutes just to watch what comes up for you.

Mind train. (Forgive my very basic skills, it's not as simple in my imagination!)

Mind train. (Forgive my very basic skills, it’s not as simple in my imagination!)

面对焦虑

焦虑就像一只老虎,你为了避开它,减少它可能对你造成的伤害,你给了它一块肉,希望它吃了肉可以离开。是的,它可能离开一会儿,可是,猜一猜,给了它那块肉以后,它真的不再回来了吗?可能一两个小时,可能一两天,这回它又饿了,可能更饿了,更强大,要更多更大块的肉。

焦虑也一样,你越是逃避它害怕它,越是为了它作出不必要的牺牲(害怕在社交场合被拒绝,干脆不去参加舞会;担心无法把工作做好,花更多的时间在担心而不是完成工作,甚至最后真的无法完成),它下一次再出现,只会变得更强烈,让你更不舒服、更恐惧、更害怕。

可是如果你选择和焦虑处在一起,它固然让你感到不舒服,但它并不危险,一段时间后,你的焦虑感会开始下降,下次再面临一样的处境,你也不再那么焦虑,即使还是有一定程度的焦虑,你的头脑也能告诉你,基于上次相处的经验,其实这个焦虑感可能让你感到不舒服,但它并不危险,你并不用逃避它。

那不逃避,就是怎么做呢?如何直接面对它呢?如何接受情绪呢?首先告诉自己,这感觉可能让你感到不舒服,但是它不会对你造成伤害。你可以感受一下它处于身体的哪个部分,比如胸口闷闷地,颈项后方有点紧、心跳有点快、或肚子有些不舒服等,识别它们,并容许、允许它们存在于那里,就像一个朋友带了一个你不太喜欢的客人来到你家一起聚餐,但你并不因此把他赶走,或者为了他一个人,不去招待其他客人,你还是允许他的存在,继续享受你的聚餐、继续做你想做的事。对任何情绪,其实都一样,都可以这么做。

Words can change everything

Try this simple exercise below:

  1. Firstly, think about a snack that you love eating. Write it down. Make sure the words that you use do describe the taste and scent of the snack.
  2. Spend some time to imagine how it feels like when you are salivating, pay attention to how the saliva tastes like, the smoothness at the back of the teeth. Now, think about what happens to the saliva when you eat this snack and digest it. Please write down your feelings and thoughts during salivating.
  3. Now, imagine there is a clean drinking glass in front of you, you split the saliva into the glass. Now, imagine you are drinking the saliva. Please write down your thoughts and feelings.
  4. Finally, imagine your favourite snack is right in front of you now, you are ready to eat it. But before you eat it, you spit some saliva on the snack. Do you still want to eat the snack? When you imagine eating this snack (with saliva spat), please write down your thoughts and feelings.

This is one of the famous ACT exercises, most people get the “effects” when they did this for the first time. Do you realize how words and language can change your feelings? And at any time, most of your thoughts are constructed by words, how often our experience are affected and changed by those words in our daily lives? Can you imagine if there isn’t languages? What happens to our thoughts and our struggle with thoughts if there weren’t any words and languages? Can you see a way of gaining some distance from your thoughts (from those words) instead of being fused in them, believing them 100%?