ACT for Psychosis Protocol Accompanying Homework and In Session Tools.pdf

A.Pearson, PhD & R. Tingey, PhD

Contents: ACT Protocol for Psychosis--Seminal Methods & Metaphors *E = Exercise, I = Idea/Concept Shared, M = Metaphor

I Present Moment Focus A. Session 1: Noticing Whats Outside: The World, You and Me

1. E-Bell introduced 2. I-Value of noticing 3. E-Walk noticing the room 4. E-Interview pairings, self and another

B. Session 2: Noticing Whats Inside: Thoughts, Feelings & Physical Sensations 1. I-Internal experiences (+hallucinations) introduced 2. M-Bag/Backpack to carry thoughts m-item is in the bag, its not you 3. E-Write on card an internal exp, delineate different types, put card in bag

C. Session 3: Why I can't Be HereNoticing Whats Distracting 1. I-Identify different types of internal exp 2. E-Walk to different locations based on most noticeable current internal exp

Notice if theyre they having more than one exp Notice peers w/similar & different exp Write most noticeable current internal exp

3. M-Fire in the room/false alarms II Defusion A. Session 4: Meeting Your MindThe Co-Pilot

1. E-Thoughts about the Bell--distinguishing thoughts & other internal experiences 2. I-Origin of thoughts (& voices-auditory hallucinations) 3. M-Mind as Co-pilot (Mind = Co-pilot)take co-pilot for a flight

B. Session 5: Experiences and Thoughts 1. I-Distinguish thoughts from experiences 2. E-Sensory experience w/food (mindful eating) & what co-pilot says (use cards & bag) 3. I-Sensory exp & co-pilots comments occur almost simultaneously, where does cp get his ideas?

C. Session 6: Training Your Co-Pilot 1. E-Co-pilotquick learner, long memoryMary had a little _____. 2. I-Co-pilot learns his thoughts from people & their creationsbooks, ads, movies, etc.

Notice some thoughts uncomfortable, irritating 3. M-Passengers on our planeTake some for a flight 4. I-Trying to get rid of passengers or our co-pilot

III Acceptance A. Session 7: Unwanted Thoughts

1. E-Willingness checksome clients w/SMI fled mention of their uncomfortable thoughts in Session 6 2. E-Getting rid of thoughts Tossing furniture/tossing thoughtsDont think of the flag 3. I-The more you dont want it, the more you have it. 4. I-What makes a thought unwanted?--Thoughts about thoughts & thoughts w/attached feelings 5. E-Co-pilots scary/sad thoughts/voices on a cardset it away based on want/dont want it

B. Session 8: Unwanted Feelings 1. I-Getting rid of emotions/feelings 2. E-Stand with Yourself: feelings on postersmove away/around them based on want/dont want them 3. I-The more you dont want it the more you abandon yourself and have it.

C. Session 9: Dropping the RopeWillingness


1. M/E-Tug of Warpilot and control/avoidance strategies vs. co-pilot and passengersdrop the rope 2. I-Acceptance is the alternative to the strugglewilling to let the co-pilot & passengers be in the room

IV Self as Content & Context A. Session 10: I am the Person Who

1. E-Noticing/Sharing who I AmI am a/used to be a., I like/dont like 2. I-I have many different roles and opinions that change by context & that my cp talks to me about

B. Session 11: Who is the You who notices? 1. E-Acting 101: Interview an assumed character. 2. I-I have a constant me that has been there my whole life experiencing and noticing

C. Session 12: The Constant YOU 1. E-Wisdom with Ageimages from youth 2. I-Constant me has observed my life experiences at all ages 3. E-I have survivedrecalling a difficult experience 4. E- Recognizing a constant you that notices thoughts & feelings change increases capacity to carry them

lightly 5. E- Carry your bag lightly & close

V Clarification of Personal Values A. Session 13: Values/Goals: What Ive Been Told (optional Session)

1. M/E-Interviewing your passengers 2. I-The content from, passengers may be trying to influence aspirations, is it believable? 3. I-Can someone with SMI even consider valued action?

B. Session 14: Where do I Want to Fly? 1. E-The Best Part of My Day 2. I-Identify something that is enjoyable 3. M-Flying South 4. I-Introduce the concept of meaningful/valued directions 5. E-Choosing a DirectionValued life domain cards 6. I-Experience making an autonomous choice 7. Homework: Identifying Specific Goals

C. Session 15: Defining My Next Destination 1. E-Goal Sharing 2. I-Reinforce homework completion, highlight those who did as role models & ask for a commitment 3. E-Helping Each Other Find a New Beginning 4. I- Accentuate peers helping peers set goals & make a commitment 5. Homework: Exploring New Terrain

D. Session 16: Turbulence in Flight: What Makes for Rough Ride? 1. E-Open discussion on Values Clarification 2. E-Chain Analysis of Choosing Valued Domain & Defining Goals 3. I- Noticing thoughts and feelings about setting and completing a goal & ask for a commitment 4. Homework: Exploring New Terrain

VI Moving Ahead with Committed Action A. Session 17: Turbulence in Flight: What Makes for a Rough Ride?

1. E-Meaningful/Valued Living: Barriers & How to Hold Them (barriers in a bag) 2. I-Barriers always arise; how theyre held makes a difference--willingness 3. Homework: Goals & Barriers

B. Session 18: Willingness in Action 1. M/E-Flying in a Meaningful Direction with Turbulence: Are You Willing? (barriers as passengers)


2. I-Chain Analysis with defusion, sitting with, problem solving, etc. 3. Homework: Commitment to a Valued Path

C. Session 19: Committed to a Valued Path 1. E-Public Commitment Statements 2. I-These statements generate power and support

Session 13b

Mental/ Physical Health


Spirituality


Family Relationships


Friends/Social Relationships


Romantic Relationships


Career/Job Development


Recreation/ Sports


Financial Stability


School/ Creative Projects


Citizenship/ Community

Groups


I value this because:

I should want it



Somebody else wants me to or they'll like it if I

do.



I would feel embarrassed,

ashamed, guilty or


anxious if I didn't



It's less scary, risky or will hurt

less.


I value this because: I see it as important

whether or not others agree.


I value this because: Doing this

makes my life better, more vital, or more meaningful.



I experience fun and

enjoyment


while I'm involved in it.


Choosing what my partner or coordinator suggests or

wants

Identifying Specific Goals (sess 13b) INTRODUCTION: Congratulations! If you are sitting with your partner right now looking at this handout, you and your peer have already taken the first step towards more meaningful living.


This is a big deal! Right now, thank your peer for showing up to meet with you. DIRECTIONS: Please interview each other using this form. When you interview your partner, write his/her responses on this form. When your partner interviews you, they will write your responses on the form they have. Before you start, fill in your names below:

Your Name:____________________________ Partner I'm interviewing:_____________________________

As you can tell, youll be helping one another. Now, please decide who would like to go first and begin. INTERVIEW QUESTIONS: Please ask your peer the following questions and write their response on the line provided: 1. What meaningful life direction have you chosen? (You may want to remind your partner that we worked on this and chose one during our last ACT group).

___________________________________________________ 2. On a scale of 1 to 10, where 1 is I really dont want to find 3 goals along my meaningful life direction right now" and 10 is I really do want to find 3 goals right now, what number fits best for you? ___________________________________________________ 3. Why were you willing to show up for todays meeting?

_____________________________________________________________________________________

SETTING SOME GOALS 1. Please read the following statement to your peer. Youll be setting three goals today that will move you along the path of the meaningful life direction you've chosen. One will be a short term goal (something you could do today); one will be medium term (something you could do this week); and one will be long term ( something you could do further in the future, like next month or even next year). ...Ask your peer if they have any questions. Now, ask your peer the following questions and write their response on the line provided: 2. What is your short term goalsomething you can do today that would move you along the path of your meaningful life direction:

___________________________________________________________________________________

3. What is your medium term goalsomething you can do this week that would move you along the path of your meaningful life direction:

___________________________________________________________________________________

4. What is your long term goalsomething you can do next month or next year that would move you along the path of your meaningful life direction:

___________________________________________________________________________________

*NOTE: Did your peer have some trouble finding goals? If so, thats okay! Just go to the next section! CHECK YOUR PEER'S REACTION & ASK FOR A COMMITMENT:


1. Ask your peer, "How did it feel to come up with goals that move you along the path of your meaningful life direction?" Write their response:

____________________________________________________________________________________

2. Ask you peer, "As you came up with your goals, did you have any feelings similar to these?" Read the words below and circle it if they say, "YES."

Scary Happy Frightening Perplexing Encouraging Stuck Angry Amazing Confusing Motivating Sad Hopeless Irritating Doubtful Hopeful Courageous Boring Inspiring Deflating Energizing 2. Ask your peer, "Would you be willing to make a commitment to do your short term goal before the next ACT group?" Circle their response: YES NO GREAT JOB! YOURE DONE! Now, go ahead and switch roles, completing this worksheet for the other person.


Exploring New Terrain (sess 14-15)

INTRODUCTION/DIRECTIONS: This is the second meeting with your peer. This is the meeting where youll talk about the short term goal you committed to in group to complete this week. First, thank your peer again for showing up to meet. Taking steps toward the life you want is a big deal! You will be interviewing each other again. You will write your partner's responses on this form and he/she will write your responses on the form they have. Again, fill in your names below:

Your Name:____________________________ Partner I'm interviewing:_____________________________

INTERVIEW QUESTIONS: Please ask your partner to give you the information below & write their response on the line provided:

1. Please update me on any changes you've made to the meaningful life direction you've chosen and the goals you set by telling me what they are:

My Peers "Meaningful Life Direction": ______________________________________________________

Short Term Goal: ________________________________________________________________________

Medium Term Goal: ______________________________________________________________________

Long Term Goal: _________________________________________________________________________

Short Term Goal Check in Time: Now that you have the most updated information on your peer, its time for you both to check in with one another about the short term goal you each committed to complete. Ask your partner the question below and use the form that matches his/her response: 2. Have you completed your goal this week? IF NO: USE FORM #1 with your partner IF YES: USE FORM #2 with your partner

*If your PARTNER completed a short term goal, CONGRATULATE HIM/HER! If not, nows the time to RECOMMIT to completing the goal this week.


FORM #1: USE THIS FROM IF YOUR PARTNER HAS NOT COMPLETED HIS/HER GOAL

Please arrange a second time to meet during the week AFTER your peer has completed their goal. Fill in the spaces below with the following information:

Meeting time following completion of partner's short term goal: Day: ___________ Time:__________ Goal to be completed by your partner before the next ACT group:

__________________________________________________________________________________________

__________________________________________________________________________________________

Please ask your partner if they are willing to make a verbal recommitment to complete this goal.


FORM #2: USE THIS FROM IF YOUR PARTNER HAS COMPLETED HIS/HER GOAL.

Ask your peer the following questions and write their response on the line provided:

1. Was completing the goal like flying your airplane without your co-pilot (did all your thoughts, worries, & voices disappear)?

________________________________________________________________________________________

2. Was your co-pilot shouting at you a lot about why you shouldn't, couldn't, or wouldn't complete your goal?

________________________________________________________________________________________

3. Were other passengers on your plane saying critical or discouraging things to you before or during completing your goal? (things like"You can't do this; What's the point!")

_________________________________________________________________________________________

4. Did you feel overwhelmed before or during completing your goal?

5. Did you notice any feelings you were having before or during completing your goal?

6. Would you be willing to complete this goal again, or choose a new goal for this week?

(1 = Not At All Willing, 10 = Very Willing) Circle the number indicating your partner's willingness:

1 2 3 4 5 6 7 8 9 10

7. What goal can you commit to completing before group next week? (write it in space below):

__________________________________________________________________________________________


Session 15 Posters

Was completing the goal like flying your airplane without your

co-pilot?


(did all your thoughts, worries, & voices

disappear?)

Was your co-pilot shouting at you a lot? about why you

shouldn't, couldn't, or wouldn't complete


your goal?

Were other passengers on your plane saying mean things to you

before or during completing your goal? (things like"you can't

do this!")


Did you feel overwhelmed

before or during

completing your goal?


Did you notice

any feelings you were

having before or during


completing your goal?

Would you be willing to

complete this goal again, or choose a new


goal for this week?

PeertoPeerWorksheet:GoalsandBarriersSession16Homework

PleaseCompletethisFormWithYourPartner

INTRODUCTION:Bynow,youwillhaveidentifiedameaningfullifedirectionyouwanttomovetowardsandatleastoneshorttermgoalthatmovesyourlifeinthatdirection.First,writedownthemeaningfullifedirectionyouwanttomovetowards(Youmayrefertothefollowinglist):

Mental/PhysicalHealth FamilyRelationshipsSpirituality Friends/SocialRelationships RomanticRelationships Career/JobDevelopmentRecreation/Sports FinancialStability School/Creativeprojects Citizenship/CommunityGroups

Other:__________________________________

MyMeaningfulDirection:____________________________________________________

Writeyourgoalforthisweekthatwillmoveyouinthisdirection:


__________________________________________________________________________________________DIRECTONS:1.Readyourmeaningfullifedirectionandgoaloutloudtoyourpeer.

2.Barrierstogoals(eitheryouoryourpartnerwillreadthefollowingstatementoutloud):Sometimesthingsseemtogetinthewayorinterferewithcompletingsomethingthatismeaningfultous.Considerthepastcoupleofweeksofgoalsettingthatyouvebeenaskedtodointhegroup.Haveyoucompletedthegoalsyousetouttomeet(bothyouandyourpartnershouldanswerthisquestionwithoneanother).Ifyouhaven't,itcanbedisappointing.However,insomewaysnotcompletingagoalisjustasvaluableascompletingit.Whenwedon'tcompleteitwehavethechancetogettoknowourselvesbetterifwe'rewillingtolookatwhatgotinthewayofmeetingthegoal.Thiscanactuallyopenupmorechoicesforus.3.SpecificBarrierstoYourGoal(eitheryouoryourpartnerreadthefollowingstatementaloud):Ifyouhavenotcompletedthegoalyouintendedtomeet,considersomereasonsforthis.Listedbelowaresomedifferentbarriersthatmayhaveblockedyoufromcompletingyourgoal.Pleasereadtheseoutloud,andcirclethosethatyouexperiencedwhileworkingthispastweekonyourgoal.BarrierstoCompletingYourGoalThoughts:

Nothing'soutthereforyou Youcan'tchange You'renotworthwhile It'stoohardYou'renotsmart,pretty,or You'llfail "They"won'tletyou You'reunstablewealthyenoughYou'renotcapable Thisstuffisstupid Thevoiceswillgetinthe Youforgot wayorstopyouYou'reconfused&don'tgetit You'llbepunished Youdon'tdeserveit What'sthepoint Emotions:

Feelingdepressed Feelinganxious Feelingupset FeelingsadFeelingfrustrated Feelingangry FeelingAfraid/ScaredPhysicalSensations:


Stomach/bowelsareuneasy Verytired Muscle/jointpain LightheadedHead/neck/backaches. SorefeetPracticalIssues:

Don'tknowhow Notime Don'thavesupport NomoneyOtherReasons?________________________________________________________________________

3.Willingness?Pleasereadthefollowingstatementaloudtoyourpartner:Whatiswillingness?Willingnessisgoingforward,flyinginanewdirection,tryinganewgoal,evenwiththebarriersyoucheckedabove.Itisputtingenergyintosomethingnew,evenwhenyourcopilotgivesyoureasonswhyyoushouldnt,oryoufeelanxiousorafraid,oryou'retired,orthinkyou'resomehowincapableofcompletingit.Willingnessisdoingwhatismeaningfultoyou,evenwhenyourcopilottellsyouotherwise.Itisflyingyourplaneinthedirectionyouchooseratherthanthedirectionyourcopilotwants.

4.HowWillingAreYourateyourwillingness.Ifyoucircledsomebarriersabovefornotcompletingyourgoal,areyouwillingtocommittocompletingthegoalyouwroteonthishandout,evenwiththosebarriersthathavemadeitdifficult?RATEYOURWILLINGNESS

1 2 3 4 5 6 7 8 9 10

(1=NotAtAllWilling,10=VeryWilling)Circlethenumberthatmatchesyourwillingness.

PeertoPeerWorksheet:CommitmenttoaValuedPath

Session17Homework

PleaseCompletePartOneofthisFormWithYourPartner

NAME:____________________________________

DIRECTIONS:Pleaseintervieweachotherusingthefirstpage(part1)ofthisform.So,givethisformtoyourpartnersohe/shecanaskyouthequestionsonthisfirstpage.He/shewillthengiveyouyourformbacksoyoucanworkonthenexttwopages.

PARTONE:INTERVIEWQUESTIONS:Pleaseaskyourpeerthefollowingquestionsandwritetheirresponseonthelineprovided:1.Didyoucompleteyourshorttermgoalfromlastweek?_______________2.Ifnot,whatbarrier(s)seemedtogetinthewayofcompletingit?____________________________________________________________________________________________________________________________________________________________________________________


Readtoyourpeerthefollowingstatement:Pleaseconsideroncemorethemeaningfullifedirectionyouwishtopursuebymakingshorttermandlongtermgoals.Hereagainisalistofvalueddomains(readthemtoyourpeer):

Mental/PhysicalHealth FamilyRelationshipsSpirituality Friends/SocialRelationships RomanticRelationships Career/JobDevelopmentRecreation/Sports FinancialStability School/Creativeprojects Citizenship/CommunityGroups

Other:__________________________________

Askyourpeer:Whichofthesemeaningfullifedirectionshaveyoubeenworkingtowards?

Writeyourpartner'svalueddirectionhere:______________________________________________________________

**Pleasereturnyourpartner'sformtohim/her.Thenextpartyouwilleachcompleteforyourself.PART2:QUESTIONSFORYOUTOANSWER(notyourpeer):1.Pleasewriteashorttermgoalinthespaceprovidedbelowthatmovesyoualongyourmeaningfullifedirection(thiscanbethesamegoalyouvealreadybeenworkingon,oritcanbeadifferentone):__________________________________________________________________________________________

2.Pleasewritealongtermgoalinthemeaningfullifedirectionofyou'vechoseninthespacebelow(i.e.alongtermgoalisonethatmaytakeamonthormoretocomplete):__________________________________________________________________________________________

Whataresomecommonbarriersthattypicallygetinthewayofcompletingyourgoals?Thoughtswhatmycopilot/passengerssay:

Nothing'soutthereforyou Youcan'tchange You'renotworthwhile It'stoohard

You'renotsmart,pretty,or You'llfail "They"won'tletyou You'reunstablewealthyenough

You'renotcapable Thisstuffisstupid Thevoiceswillgetinthe Youforgot wayorstopyou


You'reconfused&don'tgetit You'llbepunished Youdon'tdeserveit What'sthepoint Emotions:

Feelingdepressed Feelinganxious Feelingupset Feelingsad

Feelingfrustrated Feelingangry FeelingAfraid/Scared

PhysicalSensations:

Stomach/bowelsareuneasy Verytired Muscle/jointpain Lightheaded

Head/neck/backaches. Sorefeet

PracticalIssues:

Don'tknowhow Notime Don'thavesupport Nomoney

OtherReasons?________________________________________________________________________

DefiningYourPersonalBarriers:3.Pleasedescribethreespecificbarriersthatseemtogetinthewayofcompletingmeaningfulgoalsinyourlife.Thesecanbethoughtsthatyourcopilotsays,feelingsyoudonotwanttohave,orotherbarriersthatseemtomakenewgoalsveryhardtocomplete.Youmayusethelistofreasonstohelpyoudefineyourpersonalbarriers:1.__________________________________________________________

2.__________________________________________________________

3.__________________________________________________________

4.Howwillingareyoutocompleteyourshorttermandlongtermgoalevenwiththebarriersyoulistedabove?

1 2 3 4 5 6 7 8 9 10



5.Whatdoyouthinkmighthelpyoubemorewillingtomoveforwardonyourmeaningfullifepath,evenwiththebarriersyouencounter?Herearesomethingsthathavehelpedotherpeople:1.Supportfrompeers2.Sharingdifficultfeelingsandthoughtswithsomeoneyoutrust3.Practicingbeingpresentbytakingawalkorsittingquietlyandlettingyourselffeelwhatevercomesup.4.Whendifficultthoughtshappen,remindingyourselfthatitisyourcopilotorpassengersontheplane5.Discussingyourvaluesandgoalswithatrustedhealthcareprovider,aspiritualguideorsomeoneinahelpingrole.6.Practicinggoodselfcarephysicallyandmentally.Canyouthinkofothers?Youmaywritethembelow.

__________________________________________________________________________________________

__________________________________________________________________________________________

6.Howwillingareyoutousesomeofthesesuggestionstoassistyouincompletingyourshorttermandlongtermgoalevenwiththebarriersyoulistedabove?

1 2 3 4 5 6 7 8 9 10


Session 18 posters


Your Meaningful

Life Direction Your Short-Term


Goal


Your Long-Term Goal


The Likely Barriers

To Completing Your Goals


Your Willingness to

Complete Your Goals, Even


with the Barriers (1 10)

What would help You in this

Process

Documents

ACT for Psychosis Protocol Accompanying Homework and In Session Tools.pdf