Tag Archives: ACT

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.

Mindfulness VS Meditation

“What’s the difference between mindfulness and meditation?”

One of the questions I was asked a few times, and this answer below is based on my practice and understanding.

There are two types of meditation, broadly speaking. One is with focused attention. So for example, when you focus on your breathing, a word, a prayer, the candle light, you let go of anything that comes into your attention, and keep redirecting your attention to the thing that you are focusing on. (One example of this type of meditation here).

Another type of meditation, is with widen attention (awareness). It’s like you are in a stadium when no game is being played. You watch the whole space. You watch your whole experience, like an observer, or like a third party, non-judging, and not reacting. You allow things to come and go.

This second type of meditation, is a mindfulness practice! The definition(s) of mindfulness generally includes being present, being aware, non-judgemental, and acceptance (not overly reactive). When you practice Leaves on the Stream, you are mindful of what’s going on in your mind. You can of course generalise this to your daily life, and be mindful of where you are, what you do, what you think/feel etc.

You can practice mindfulness anytime anywhere. Eating, drinking, working, typing, driving, exercising, walking mindfully (i.e. staying present, being aware of what you do, and being accepting). You can’t do all that while you meditate though.

Some people might meditate while they walk, run or swim. This can be with either first (focused, narrow attention) OR second type of meditation (broaden attention). With first, you might be saying “one, two, one, two, one, two…” in your mind, or noticing your breathing in and out. With second, you will be observing your whole experience, how your muscle move, what you see, hear, sense, how you feel etc.

I’d say both are meditation, but only the second one is being mindful. I hope I’ve made it clear?! Feel free to share your views!

河流上的飘叶

正念练习:河流上的飘叶(取自“接受与承诺疗法”Acceptance and Commitment therapy)

这是个闭眼练习。首先阅读说明,当你理解了这个练习的过程后,闭上眼睛开始。 (或者你可以使用这篇文章末尾的录音)

想象一下美丽、缓慢流动的溪流。水流过岩石,然后穿过山谷,周围有些大树。偶尔,风吹来,一片一片的叶子落入溪流中,随着河水漂流。想象一下,你正坐在那条小溪旁边,在天气很好的一天,看着河水的流动与树叶的飘落。

现在开始意识到你的想法(思维)。每当一个想法出现在你的头脑中时,想象把它写(或放)在其中一片叶子上。如果你用文字思考,把它们作为文字,轻轻地放在叶子上。如果头脑出现的是图像或画面,就将它们作为图像放在叶子上。目标是留在溪流旁边,让溪流上的树叶继续流动。不要试图让河流流得更快或更慢;不要试图以任何方式改变叶子上出现的东西。如果树叶消失,或者你的思绪飘到了其他地方,那就停下来、注意这发生了,然后再次回到溪流边,把刚刚的想法放到叶子上,让叶子随着河水流走。

(图像的生动或清晰程度无关紧要,只要有这个概念在就可以了– 觉察自己的想法,一旦发现它们就轻轻地放下)

继续进行至少5分钟。如果你现在已经了解说明,请闭上眼睛开始试试。

(练习后继续阅读)

当河流在流动,你也能注意到想法并轻轻地把想法放下时,这就是认知解离 (Cognitive defusion) 的时候。记得头脑本来就是设计来思考的,所以它总是会不断弹出各种想法,你虽然不能控制这点,但你能选择是否对这些想法作出反应,或者选择轻轻地放下它们。如果你认为“我做得不对”、“这个练习对我不起作用”或“我怎么会没有想法”,留意到它们也是你其中的一些想法,后退一步,把它们也放到落叶上。一些其它特别“粘”的想法(比较难以觉察和解离的想法),包括含强烈情绪的想法、比较性的想法等。

这里有两个中文版本的录音:

“河流上的飘叶”录音I

“河流上的飘叶”录音II

(类似的内容,只是前面的指示稍微不同;5-6秒后指示才开始)

多些练习,有问题的话,不妨在这留言。

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!)