ACT has this two mountains metaphor, this idea that you are on your mountain, climbing your mountain, I can see things from where I stand on my mountain. I'm climbing my mountain with my own challenges and navigating new things that, some of them I'm good at, some of them I need to learn about. You can see different things on my mountain too that I can't see. And here we are, two humans, navigating the day to day challenges of life and just reflecting.
And so, if I can see things that can help you navigate your mountain, I'll share that. But I don't have it all figured out. Here I am on my mountain. I have these thoughts too. And so being able to encourage and humanize in a really authentic way that includes a lot of therapeutic use of self. It's another thing I really like about ACT.
just truly listening to the struggle, exploring it, not trying to change their perception of it, just truly listening actively and showing compassion for it is that first step. you're listening to the Brave OT Podcast with me, Carlyn Neek. This podcast is all about empowering occupational therapists to step up, level up, blaze some trails, and maybe engage in a little conscious rebellion. In service of our profession, our clients, our work, our businesses, and living our mission wholeheartedly.
We are all about keeping it real, doing hard things. Things unhustling, being curious, exploring, growing through our challenges, and finding joy, fulfillment, and vitality as we do so. Really, we're OT ing ourselves, and each other. I hope you love this episode! You may have noticed that a lot of my podcast conversations are with other people. I don't do a lot of podcasts that are solo. And so this episode's a little bit different.
It is actually an adaptation from a presentation I did last week in the M H O T a collective facebook group. That's the title? M H O T. ~A Collectiveive I'll link it in the show notes. in that group, different people present, every month or two and, it was my turn. So I presented on using acceptance and commitment therapy in your occupational therapy practice. Now the week of this release is the end of November, 2024. And in the new year, I will be launching my Practical ACT for OTs course.
That's a clinical course. I delivered once this year and I'm looking forward to delivering it again next year, but I'm going to be putting on a black Friday promo for the Practical ACT for OTs course. So I figured I might as well share this presentation as a podcast. You'll notice at times I might be referring to an image in the presentation and I tried to remove parts that were really reliant on the image and left in ones where I think you could visualize it based on the description.
But if some things seem like, am I missing something here? It's because there was a slideshow. And all of those slides were actually taken from my Practical ACT for OTs course. So the Practical ACT for OTs course is a few hours long and there are discussion components in a Facebook group, so we can get immersed in. the learning together, I can help you customize it to your population.
but this is just sort of a nice overview taster to see if you like the model of act and get a sense of how you might be able to integrate it into your OT practice. Now ACT is how you pronounce the abbreviation for acceptance and commitment therapy. it's not A-C-T, it's ACT. where I've quoted other people or made references to other models. I have tried to include that in the audio.
it definitely was in the slides and I'll make sure to give credit in the show notes to anything that I might not have mentioned as well, and provide links to to related content. If you're interested in being notified when the black Friday promo of the Practical ACT for OTs course is available, Follow that link in the show notes as well.
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To see how Jane can help you spend more time doing what you love, head to the show notes to grab the link and book a personalized demo. Or if you're ready to get started, you can use the code VITALITY at the time of signup for a one month grace period applied to your new account. And I have had a mental health private practice, for a lot of years. I started my private practice in 2007.
and, in the last five years or so, I've also transitioned to supporting OTs, a lot of OT business owners in the intersection of their personal and professional development using ACT. So I've developed a bunch of stuff related to ACT. I created a course called Practical ACT for OTs last year, because the ACT based coaching program that I offer isn't necessarily for everyone, but OTs love to sign up for education. So I thought, I use ACT all the time, so I might as well create a course.
That will be relaunching again. I'm gonna put out a promo for Black Friday, but we'll be running it in the new year so you guys can watch for that if this, inspires you to want to learn more. what to expect in this workshop? I hope to be able to give you an introduction to ACT and connect ACT concepts to our OT frameworks.
I'm going to go through the six core processes, but focus a little bit more on distilling them down to three that are easier to remember, because we can easily get caught up in the names of these core processes and lose the importance of the spirit of them. We'll talk a lot more about language, and I'll have some suggestions for how we can apply it in OT, apply it to ourselves to build our own psychological flexibility.
a few important notes, the ACT community is really generous, so I'm sharing from resources that I've gathered as I, as I learn, and so I didn't make much of this stuff up, the places, the innovation comes from me linking it to OT and providing that, crossover framework for you, but that's certainly not even, necessarily my own, it's just my own interpretation. I try to give credit, to the original source where I can. If I've missed any credit, please let me know.
but do know that this stuff that I'm sharing is all freely available. I am a Canadian OT and I'm registered with the Alberta College of OTs, so I am intending to share with you about, some general knowledge, but I'm not acting in a therapeutic role here So these are some of my occupations. so there's that, mental health focused private practice that I've had for a long time. And then there's all these products that I offer under my umbrella of Balance Works Personal Development.
So they're not falling in an OT umbrella because I connect with people internationally. For these things. So I've got my ACTivate Vitality program for OTs, and there's my ACTivate Vitality Planner. I also have the BRAVE OT Podcast. And then last year I developed the Practical ACT for OTs course, which these slides a portion of, but I was born and raised here in Calgary, Alberta, and I am an ADHD er. I am in a midlife evolution. I'm raising two young men.
we love to travel, and I also do pottery on Fridays. I love to garden. I've got more than 100 houseplants in my house, and so these are some of the things I, I love to do, some of my meaningful occupations. fundamentally, this is a quote from this article, ACT rests on a fundamental premise that pain, grief, disappointment, illness, and anxiety are inevitable features of all human life. If you're out there fully participating in life, You are going to struggle with some things, right?
That's, that is the nature of life. And the therapeutic goal of ACT is to help people productively adapt to these types of challenges and develop greater psychological flexibility, rather than engaging in counterproductive attempts to eliminate or suppress undesirable inner experiences. So the suffering, the struggles, the resistance to those painful experiences that are inherent in life is where a lot of our suffering comes from.
building psychological flexibility is the goal of ACT so that we can fully participate in life. this is achieved through committed pursuit of valued life areas and directions, even in the face of natural, a natural desire to escape or avoid painful and troubling experiences, emotions, and thoughts. ACT is transdiagnostic, so it's not necessarily oh, this is the best thing for depression or the best thing for anxiety.
It works for people with all sorts of conditions and it's more process focused, flexibly delivered, with this goal of helping people connect with doing what's most important to them. I love that about ACT and how it overlaps with OT, and I'll show you a few more ways of describing that. it helps us clarify our values, what's most important to us, and what's most meaningful. And we use this to support participating in the things that will enrich or enhance our lives.
Even in the presence of difficult inner experiences, sensations, thoughts, feelings. ACT teaches us mindfulness skills that enable us to handle these difficult inner experiences, thoughts, feelings, sensations, memories, etc. effectively, so that we can engage fully in what we are doing and appreciate and savor the meaningful and fulfilling aspects of life. So it's not to get rid of symptoms. That's the main point here.
We're actually making room for those symptoms of discomfort and trying to struggle less with them, change our relationship to them. a lot of the lingo we use, obviously this isn't about memorizing it, but to Get a sense, get the sense of what the vibes are of ACT. It's about being present, aware, responding flexible, about acceptance. Diffusion versus fusion, when we're fused to a difficulty inner experience. We're trying to diffuse, we're not, we're less stuck to them.
kindly, commuted action, towards, moves away, moves, savor. There's a lot of talk about flavoring and savoring life. Doing What Matters, Being Mindful, Allowing, Compassionate, Willing, Values, Open, Unhooked, etc. you're welcome to screenshot, and you're welcome to share what I've shared with you. If you could just share credit that you got this from this presentation, that would be great.
I'd prefer you not share a whole slide deck or anything, but if sharing an image like this is helpful, by all means, you're welcome to do my journey to ACT was first learning about CBT. in my mental health practice, I am often seeing people with depression, anxiety, some trauma, some chronic health conditions, and generally they're off work because of these things.
And I'm being funded by a third party to help them return to life, and returning to life will facilitate more likelihood of returning to work. And so I was often asked to do behavioral activation, which is a component of CBT and ultimately Helping people, engage in actions, that are important to them and manage the difficult thoughts and feelings that are obstacles to taking action.
So we're we're working on, difficult feelings, difficult thoughts, and working on actions to essentially help people participate in life, but, improved actions could improve thoughts and feelings, that sort of thing. And I always felt like with the tools I was given for CBT, for the ACTION stuff made a lot of sense as an OT, Engaging in Meaningful Occupations.
But when people are having difficult thoughts, I often felt it was a bit invalidating, the tools that we're having, because, Those difficult thoughts of doubt or fear or anxiety, like I'm dealing with somebody with trauma and we're doing some work to expose them to areas that make them anxious, having negative thoughts is probably pretty reasonable.
And, and can we, and we still proceed even in the presence of those negative thoughts is often what I was thinking and CBT tools I had, just didn't, it felt like we were trying to make those negative thoughts positive more often and didn't love that. So I was often kind of skipping that part, focusing more on the action. And when I came across ACT, I was like, ah, this kind of felt more aligned for me, felt more aligned with my OT things.
So a formal definition is that it's a part of a third wave of cognitive and behavioral therapies, along with dialectical behavioral therapy or DBT, mindfulness based CBT, functional analytic therapy, or metacognitive therapy, this third wave of cognitive and behavioral therapies is more about emphasizing the shift in the person's relationship to a thought or emotion rather than the content.
That felt a little bit more validating and aligned for the work that I was doing and what I was experiencing when I was out there in the world trying to help people engage in these occupations and navigate the difficulties that were coming up when they were doing so. So in ACT, we are not focused on changing the situation, the thought or the feeling, we're focusing on enabling or facilitating meaningful occupational engagement by changing how we relate to the situation, thought, or feeling.
So it's changing the relationship to it rather than feeling better or thinking better. It's, can we make that less of an obstacle in our way of the doing? They don't use occupational language in the ACT models, but so this is where I'm building that, that bit of a bridge. They're talking more about behaviors or the doing of engaging in meaningful activities. Over here, we've got Values and Committed Action, which in our OT language is Engagement and Meaningful Occupation.
And over here, we work on Navigating the Difficult Inner Experiences, the Thoughts and Feelings, through four concepts that are all based in Mindfulness. so if you've done any mindfulness training, these will feel familiar, right? We're being here in the present moment.
We're opening up with acceptance to what is, we're defusing, we're making it less that we're like stuck to this thing, this difficult inner thought, and then there's a part of us that can observe ourselves doing this, give us some context. just to frame that, this idea of there are these six core processes. Four of them are mindfulness based and two of them are doing what matters. this feels really aligned already.
these are some tools that I can do to help facilitate this occupational engagement in the face of these obstacles of difficult inner experiences. if you've studied mindfulness in any other context, like a lot of us have learned mindfulness contexts from going to yoga or listening to guided meditations or things like that, mindfulness is not necessarily meditation. Mindfulness is not intended for relaxation specifically. It's about this flexibility of attention.
That we can shine that light from here to there and have that ability to move our focus around with thoughts. in ACT, it's described as a set of skills for effective living that involves paying attention with openness. Curiosity, kindness, flexibility. It's the art of living consciously, a profound way to enhance our psychological resilience and increase life satisfaction. We're present in these pleasurable experiences or joyful experiences.
we get a lot more fulfillment if we're in these meaningful conversations with people, right? There is that increase in satisfaction, but also having that, psychological flexibility or resilience, we can roll with the difficult stuff that comes up a little better. I'm going look at ACT as an OT modality. I put it up alongside of 3 OT models. So thinking about this is the CMOP-E, and thinking about ACT in relationship to that, right?
We think about the, person, with these components, the physical, affective, cognitive, spiritual self, the person, then the occupations, and then the environments. and we care as OTs about engagement in the meaningful occupations. ACT is a helpful approach to reduce the impact of obstacles to engagement.
ideally, we're using ACT to make those difficult internal experiences, the thoughts and feelings that are difficult, the sensations, make those less of an obstacle to doing the things, but also helping us to accept, change, or adapt situations in the environment. helping us to focus on doing what matters, move toward doing what matters. That's that occupational engagement. So ACT can be a tool that we can use within the context of this model.
Thinking about MOHO, I don't use moho as readily, but as I started to try to piece together thinking moho helps us better understand how human occupation is motivated, patterned, and performed within the context of our environment. And so ACT can be a helpful approach to addressing obstacles to participation, by working with volition, habituation, and building performance capacity.
So again, building our capacity to roll with those things that are coming up, connect more deeply to our values and what's most important to us, and commit to that action by building a more flexible response to the challenges that come up. And then I like it alongside Kawa, particularly, I've been learning more about Kawa this year. And, I won't go through the whole Kawa model, but there's this idea that the river is your life flow and your priorities.
And that the banks represent the environments and contexts of that social and physical environment. the rocks are obstacles and challenges. The driftwood are influencing factors that could be positive, they could be challenging, they could be facilitating. and the spaces are opportunities for enhancing flow. So ACT helps us enhance the flow with our clients by helping us navigate around the obstacles that come up. oh, there's some rocks.
How do we not keep ramming against the rock and trying to move the boulder and instead see that there is a path around it? And we allow the rock to be there. can we allow that difficult challenge that's come up or feeling or thought, sensation that's come up that feels like it's in the way of doing and see that and still carry on without trying to shove it out of the way.
I like the, some of that synergy in there, that sort of, a lot of mindfulness stuff is based in Eastern philosophy and it seems to gel nicely with the Japanese model there. something that people ask me about ACT is, what are some ACT assessments I can do? And I always think about, as an occupational therapist, What's the occupational goal?
do we need to measure the person's, psychological flexibility, the outcome that we're trying to measure with ACT, or do we more so need to see how they're doing with meeting the goal, the occupational goal? So think about what the person's trying to do. We always start with that in ACT, not just in OT. What is the thing that they're trying to do? And then working backward to, okay, we can use ACT as a modality to support how we're managing the internal obstacles.
So I tend to use that occupational therapy, occupational engagement as the outcome measure, not so much measuring The modality, the, details of the modality. There are a lot of ACT based assessments out there. I just like a more occupational focus. thinking about these questions here, What are, how are you measuring the success of a goal, if you're measuring the success of a goal? ACT encourages us to be a lot more flexible than an all or nothing approach to it.
what tools do you use to address any obstacles that are coming up, and would other measures serve that occupational goal? The focus is not to get rid of distress or pain. The focus is to get people doing stuff. That's important to them. Why measure their anxiety if it's not about the anxiety? It's about doing living life. in some cases you would like to and so there are lots of assessments out there for it. I'm just not going to include them all here.
thinking about, discussing, you know, the goal attainment, how did you do last week with that thing you were going to try? Maybe it's logs or routines or checklists or apps where you're sharing your towards moves to the things that you're doing that are moving you toward that. If you like SMART goals, they're not my favorite, but if that's how you go, did they meet the goal or didn't they meet the goal? I like something that's a little bit more embracing the gray in between.
And so something like the COPM could be a nice one where you're measuring how they would rate themselves on a scale for those things. And there are ACT specific, ACT process measures online really available. If you want them, let me know. I could send them to you. This is me, and a couple of my friends, we endeavored one day to ride from Banff, no, from Canmore to Banff, which looks like a pretty flat trail, like it's a paved trail alongside the highway, and it was a really, really hot day.
So, objectively, our goal that day was to ride our bikes from Canmore to Banff, have lunch, and ride back. And We set out on our mountain bikes and I drank my, all of my water in the first half hour. I could not breathe. It was a very gradual incline that I was not fit for. We stopped somewhere along the way and we looked out. We had a lovely day. We laughed. we didn't make it to Banff. We turned around and headed back to Canmore and had a beer in a pub at some lunch.
And if we were measuring by a SMART goal of riding our bikes to Banff and back, having a nice day, I didn't meet my SMART goal. but actually that wasn't, that like, it didn't matter to me whether we got to Banff. I can go to Banff anytime. I'm lucky that way. We're lucky that way. We live close to Banff, only an hour away. But we did have a really nice day connecting. So the value of authentic connection, being in nature, doing something meaningful together, I've met all of those goals.
this was a fully towards move check thing, not necessarily a smart goal check. So I tend to use, planner pages, which actually led me to create my ACTivate Vitality planner, which I'll show you a little bit more later. but it came from this, doing this with my clients, looking at the week, what are the things that are important? What are the values that they want to connect to? for me, it's like nature, creativity, authentic connection. Those tend to go there.
And how can I plan my week with those priorities and values in mind? How am I checking in with that? So I often do that with clients, where get them to make plans that align with values and then reflect on how they connected with their values. And then we can do that together. So how, looking at ordering some seeds, going for a walk outdoors. I felt more energized. I planned for my meeting. It was really challenging.
just noticing those things, tasks, walking by the river and, noting an observation that I had some gratitude for this gorgeous sunrise and spending more time outdoors and with my mom, authentic connection. So having these reflections in how we're connecting our day to day occupations with our values and any sort of measures of, Moving in that direction, I love to celebrate those with my clients, whether it was the full goal they had or not.
what are these things we're doing in ACT to facilitate engagement in meaningful activities, connecting to values oriented actions? These are six core processes in ACT. We could easily get caught up in the words of them. It's less important than this idea that we're opening up, we're being present, we're doing what matters.
And so that opening up, or opening up to difficult inner experiences, so that can look like accepting difficult emotions, opening up to what is, turning toward it rather than trying to avoid and shove away, defusion, not being fused to a line of thinking that isn't facilitating or doing what matters, so defusion, trying to unhook from that, Being present.
So connecting with that present moment, being here now, engaging in that part of you that can observe, be flexible, gain perspective, the part of you that observes you thinking, doing, feeling. So this is being present and doing what matters. This is values and committed action, AKA engaging in meaningful occupations.
So, trying to remember these three, three things rather than getting caught up in all of the six things at this point, is helpful, but I wanted you to see that they came from six down to three for accuracy, of course. So remember this, open up, be present, do what matters. We allow the difficult thoughts and feelings to be present. We don't fight them. We don't avoid them. We don't resist them. There's a power in not trying to chase away.
It's sort of like not being afraid of the dark allows you to do more things. And, so opening up, being present or being aware. So we teach people experientially how to do this through some ACT skills. But these are the main things that we're doing these things so we can do this thing, which is very OT aligned. So when do we choose ACT?
The idea is that when a person is not engaging in an occupation that they value because they are hooked by difficult inner experiences, thoughts, feelings, emotions, sensations, memories, urges, impulses, images, and the avoidance isn't workable. So we can do a lot of avoiding, and if it's manageable, like for instance, a I have a phobia about swimming in dark, deep water. and so I don't. Scary a I'll get out. I've done some exposure therapy. I've done some ART about it.
I've made it a little bit more manageable, but it really isn't unworkable for me. I live in the prairies. it does get me maybe if I wanted to go swim in a lake, but I can go on a paddleboard, that's fine. So I don't really need to intervene on that unless it was becoming unworkable that I wasn't swimming in deep dark water. So there needs to be that match between the person not doing the thing because they're resisting this inner experience and that's not workable in their life.
The difficulty in our experience is not the problem, the symptom, essentially that symptom of fear or stuck on a thought, that's not the problem. It's responding to the thought or feeling in an inflexible way that leads to avoidance of the meaningful activity. That's the problem. That's when we're fused. That's when we're hooked by the thing and then not doing it and stuck. That's not, and that's not working for us. Then we intervene. what does clearly hooked look like?
I can't go to the party because I'm feeling anxious. I can't sign up for yoga because I'm not flexible. I can't give a, a toast at your wedding because I'm not a good speaker. I can't start a business. I couldn't handle the judgment of failure. I can't teach an ACT course because I'll mess it up. I don't know enough. I can't ask the person on a date because I can't handle rejection. I can't go on the road trip, my back hurts after 20 minutes.
I can't go to the grocery store, I'm afraid of getting COVID. Can't host Christmas dinner, I'm too overwhelmed. I can't go to the beach with my grandkids because I can't stand the feeling of sand. Workability, again, we only intervene if the avoidance is excessive, rigid, or getting in the way of living a full, meaningful life. Essentially unworkable. those are more overt. It's a little more obvious. Quietly hooked is a little more covert. Fusion driven avoidance.
It can look like isolating, it can look like numbing, maybe numbing with our phone. A lot of us do our numbing this way, right? that can be shutting down. that can be jumping to a conclusion and taking action. It could be always busy, can't be alone with my thoughts. Could be Little Miss Sunshine, I'm living the dream, good vibes only, stay positive, we're gonna deny all the negative things, all of the difficult things, and just be like, life is good. That is hooked and avoiding.
could be never ready, always preparing. I see that with a lot of the OTs that I coach, that No, I can't start that thing until I've taken 10 courses on it, made 10 plans, taken all of those. Then I could make one first towards move, and be being hooked by that thought of, I have to know it all before I take a step. So we only have intervene again, if the avoidance is excessive, rigid and getting in the way of living a full and meaningful life with our values.
So kind of back to the situation itself, sensation itself, feeling itself it may look like that's creating the suffering, but ultimately, this is not so. Your resistance to it, you're staying stuck with it is the thing that we're trying to break that by not resisting, you can engage in what's meaningful. Russ Harris, he has this choice point. I took a lot of my ACT training from Russ Harris. I find his stuff really helpful. There's this book, ACT Made Simple.
It's a pretty comprehensive textbook, that teaches you all the ACT stuff. you don't have to take a course. You don't have to have a certification to use ACT. You can use parts of ACT. You can use low key ACT. You can use elements of it. you don't have to be a, a regulated health professional to use ACT, right? You could use it if you're a teacher or a coach or a personnel trainer, ACT is something they want people to have easy access to.
But giving Russ Harris credit for this idea of this choice point, at any point in life stuff comes up, we're in challenging situation that comes with thoughts and feelings. And sometimes we can get hooked and make away moves. Sometimes we can be moving toward what's meaningful, making toward moves. So toward moves are living our life in line with our values, showing up as the person we want to be, doing the stuff that's important to us. acting in an effective way in our life.
That's what we're moving toward. We can do that in big ways, or we can do that in little ways. And if we're not doing that, sometimes we're moving away. Maybe we're avoiding, maybe we're stuck, maybe we're, we are doing the opposite and acting out of line with our values because we're feeling anxious or apprehensive or fearful or, just can't get moving, right? That can happen. So that's being hooked.
And, what we do to avoid the discomfort, is the problem, not the difficult thoughts, feelings themselves. So we are not treating those symptoms. I'll say it again. We are helping people be less stuck by them so they can go and do the thing. People do tend to feel better when they can get out there and engage in meaningful occupation. It's a kind of our whole premise, right? That helping people do stuff that matters. But we are not actually targeting or reducing symptoms directly.
So away moves were hooked, toward moves were unhooked, living your values fully, intentionally doing what matters, behaving effectively, or the opposite, acting ineffectively, not who you are, how you want to be, not doing the things that matter most to you. So the greater our ability to unhook from difficult thoughts and feelings and choose towards moves, the greater our quality of life and the greater our health, happiness, and wellbeing. That's kind of cool. And doesn't that feel OT?
So this idea is that suffering is pain times resistance. Thich Nhat Hanh talks about "peace, freedom, and happiness can be found right here in this everyday life, if only we can learn the art of handling our suffering." in ACT, we always want to be clear about the goal. What's the occupational goal, or they might call it a behavioral goal in psychology language, not symptom reduction. With our built in focus on occupational goals, this is kind of a given, right? We're already doing this.
modality to facilitate this built in outcome. So we help people explore the struggle. We listen, we validate, we ask good questions with curiosity, openness, non judgment. We take a stance of being compassionate, not trying to put sunshine on everything and just go, "Oh, it sounds hard. That must have been really difficult," right? Like just that compassionate way we want to respond to people. It's human. It sounds like your mind is a lot like my mind does that.
Like, I can hear it saying that you're not good enough and that you should have done this, you should have done that, you shouldn't have been, you should be here by now. And we're just saying it back to people. We're humanizing this experience. ACT has this two mountains metaphor, this idea that you are on your mountain, climbing your mountain, I can see things from where I stand on my mountain.
I'm climbing my mountain with my own challenges and navigating new things that, some of them I'm good at, some of them I need to learn about. You can see different things on my mountain too that I can't see. And here we are, two humans, navigating the day to day challenges of life and just reflecting. And so, if I can see things that can help you navigate your mountain, I'll share that. But I don't have it all figured out. Here I am on my mountain. I have these thoughts too.
And so being able to encourage and humanize in a really authentic way that includes a lot of therapeutic use of self. It's another thing I really like about ACT. just truly listening to the struggle, exploring it, not trying to change their perception of it, just truly listening actively and showing compassion for it is that first step. Often that makes all the difference, right? We know that in talking to people. And then we explore the workability of it.
So what have you tried so far to avoid, like avoidance seems to be the problem, to avoid, get rid of those unwanted thoughts or feelings. There's this acronym from the Russ Harris ACT training, Connecting the Dots. So you might say, are there things you do for distraction, like some people might use TV or loud music or keeping themselves really busy, scrolling, gaming.
Maybe it's opting out, are you saying no to things, people, places, situations that might remind you of the thing or trigger some of those feelings. you can ask about, are there any thinking strategies you're using when this comes up. Maybe it's positive thinking. That's actually listed in the ACT stuff as a way that we're trying to avoid the real experience by flipping it into something positive or, which isn't all terrible, right? it's definitely a valid option.
But if someone is trying to make everything all positive, there's some avoidance happening there. Maybe you're debating your challenging thoughts. And this is like you're exploring this with the client, like you're asking them these things. Are there any substances, other strategies you might be using? So you can look at these different things that people are doing to avoid or get rid of these things.
And then you explore kind of like Okay, so you've been having this experience, you retell the story, right? And, and if this thing that they describe stays in charge of what you do, makes choices for you, dictates your actions, kind of says, nope, you can't go to that, you got to do this, you got to do that, what would life look like in five or ten years? Does this move you closer to living the life you want, showing up with these things and, doing the things that bring you joy?
Would you be willing to try a different way? So this is sort of getting some informed consent for a different way to approach it. and having this sense of, you can draw this out on the choice point, but trying to explore that what they've been trying so far hasn't worked, right? They've been hooked over here. so maybe it's an OT who wants to start a new business and they're stuck in planning mode and not doing. this one comes up a lot in my work.
So some of the thoughts and feelings a person might be having. What if I fail? And I actually draw this out with them, right? If we're doing this online, I will do it on Canva, or like a whiteboard. But if it's in person, I'm doing it on a piece of paper. And so the difficult thoughts and feelings might be, what if I fail? What will they think? I don't know enough yet. Who do I think I am trying this? I'm feeling anxious. what does hooked look like? What are these away moves?
Spinning my wheels on preparation. More and more courses and certifications. Putting off starting the business. Not telling anybody about this idea I have. So this is over here, stuck. Avoiding hooked. Not quite that towards move. I ask people why they want to do this? What are the values that are behind this? And so maybe it's flexibility, connection, compassion, and that goal is starting that OT business. So, living in line with their values, making a towards move. What are our helpers?
Like, how can we help? When you're hooked over here, how can we help move you in some sort of tiny towards move? So I use values, getting clearer on these values with people, helping them commit to the actions. Maybe we need to break it down further. Maybe we need to find what is the manageable action you can take. What's the tiniest little thing? Maybe it's telling just one person about it. Is that the tiniest next thing, opening up to those difficult thoughts and feelings? okay, yeah.
What if you fail? can we sit with that? What would that look like? Are you is that possible? Is it more likely that it's sort of shades of success? Can we explore that? How would you handle that? can we get curious about it rather than, I can't, I might, it might be a disaster, so I'm not look at it. Let's look at the gray in there, right?
How can I help a person learn those skills of being more present and aware, being able to sit with those difficulties, make room for them so that they're not spinning over here? ACT is really flexible. I love that about it. obviously it's all about flexibility, but you have permission to adapt it, be creative, use bits, make it fit. I talked earlier about low key ACT, right? There's flexibility with the model. I encourage people to be curious, open, flexible, intentional.
take an ACT informed stance, read maybe a self help book. I love The Confidence Gap. That's a really nice one. for a starter place for a, an easy to read book that I'll share with clients quite often. But maybe you learn something like that and how do you kind of work toward making things just a little less sticky with you. So I'm going to go and show you some more specific tools in these three areas.
we're starting with this be present one, be aware, engaged in what you're doing, present moment awareness. And it's, it's kind of a mindset, I suppose, The idea is that there's a part of you that's thinking, feeling, doing, that's engaged. Sometimes it's hooked, sometimes it's super stressed out, sometimes it's really in a funk, and there's that part of you.
It's subjective, it's chatty, it's judging, it's evaluating, it's reacting, it's planning, it's problem solving, it's past or future oriented, it's rarely present. And there's the part of you that can observe that. There's that observer. It's in the present moment. It's nonjudgmental. It's aware of our external and internal worlds. It's conscious. it has perspective. So the, this book, The Boy, The Mole, The Fox and The Horse, he says, Those are dark clouds, said the boy.
Yes, but they will move on, said the horse. The blue sky above never leaves. So I feel like the horse here is that observer. You can see the boy is seeing, ah, there's dark clouds and the horse is able to see that the blue sky is still there too. there are clouds and the blue sky is there too. So it's got that perspective of seeing the situation in context. we can teach people more present moment awareness skills. ACT uses a lot of metaphors.
a lot of us have learned 1 as a grounding technique, right? What are five things I can see? Four things I can touch? Three things I can hear? two things I can smell? What's the taste in my mouth? And going through those things is often done as a grounding exercise, but in ACT, truly it's bringing us into the present moment through our senses. So how can we engage through our senses? What do we notice? So I'll do this often on walks with clients, just, uh, do you hear those birds?
You notice that? Oh, look at this, like, look at the, this bark is really different here, and we stop, and we get curious, and we notice, and we're modeling this, present moment awareness. we can still delve back into the stressful conversation we were having, and we can pause and notice the kids playing throwing rocks in the river or something like that, right?
And so I love doing all of this present moment noticing, just even just through the way I'm interacting with somebody, through the way I'm bringing curiosity to a situation. And then can I start to say, huh, I wonder if you could get curious about that. I'm a bit curious about this. I'm noticing that. I'm noticing when you talk about that, shoulders come up. Oh yeah, I'm noticing that too. Well, what's that feel like? Can we kind of notice the sensations? Notice what happens? Is it hot?
Is it cold? Is there an emotion connected to that? And we're not judging. We're just asking really curious, observing questions, facilitating curiosity with a client, just with this style of exploring together. The stage show metaphor is this idea that like a theater performance, that there's all of these things going on, but the, the light, the, what's that light called, the main light, it's focused on, One part, it can focus, shift focus over here.
The thing that it's not in the light hasn't gone away. But we can shift our focus around. How can we be more flexible with our attention? Much like the spotlight, that's the word, much like the spotlight can be moved around things. We're not denying the other things exist, but can we also notice the birds? Can we also notice the tension. Can we also notice our feet on the floor? Can we push our feet on the floor? Notice that, right? Sort of helping people be more flexible with their attention.
Helps them to, unhook a little bit. It almost seems too easy, like people are often like, but how do I do this? But it's all of the things, right? It's these really subtle ways of doing this. it's better to be doing this in a practical discussion, you know, kind of experiential ways rather than giving people a worksheet. So that was being present, a few things in being present. Then there's opening up. so this is allowing thoughts, feelings, sensations. There's acceptance and diffusion.
So acceptance generally refers more to the feelings. diffusion is diffusing from the thoughts. But really, we're opening up to all of it. So back to this choice point, when we're hooked, when we notice that we're hooked by difficult thoughts and feelings, we first sit with it. We will first notice it. We have to notice it. Sometimes we get right into avoidance and don't even know why we're avoiding, can we notice that we're hooked can we notice that we are not making the toward move.
From there, can we notice it? Can we allow it? Can we show it kindness and compassion? If from there, you can just make one tiny towards move, awesome, like often we don't need to do all these steps, right? But maybe if just thinking it, showing it, noticing it, allowing it, showing it kindness and compassion, and we're still like, boots glued to the ground and not able to make a toward move, maybe we might employ another unhooking strategy. But the idea is to do as little as possible.
Sometimes we can just notice we're hooked and move into a towards move, an action, tiny action in line with our values, moving us in the direction of showing up the way we want to. but sometimes we need to bring in the other steps. So this guy, Lou Laspregado, he shares a lot in the ACTimate Simple group. He asks these great questions, and this does not need to be a workshop. It can just simply be asking a person, what does your mind say about this?
And that's just creating a little bit of space between the you that's noticing, and the things that our chatty mind can tell us about it. Is there any space between you and this thought? thinking about this is kind of about diffusing from thoughts, difficult thoughts. is there any space between you and this? It's a bit of an abstract question, obviously not going to work for everybody. But this idea of. Do I have to wear this thought as like, yes, this is absolutely true.
Or is there a little bit of space, like where I can kind of notice, So can you notice these thoughts as they come up? Sometimes it's if this thought had a voice, what would it sound like? So I've talked about if it's a judging voice, like, how do you name it? Is it Judge Judy?
Is it, sometimes giving it a name of a character on, like Donkey from Shrek or something like that, but figuring out what that, Bossy voice is maybe it's like a bossy voice that's like, Oh, no, you shouldn't do any of these things. that's a teacher character from, Snoopy or something like that. is it a familiar thought? Maybe a name, the story. that's a really powerful exercise that's on the next slide. can you still choose your actions freely in the presence of this thought?
I like that one too. Can I have this thought? I don't have to talk myself out of this thought. Can I do a towards move even in the presence of this thought? Naming this story is sometimes I'll get a person to pull out a piece of paper that this kind of story keeps coming up and coming up. And the prompt is okay, write down all of the thoughts that keep coming up around this thing. So when your mind's really giving it to you on this topic, just write it all down on this piece of paper.
really write it down. Use all the swear words that come up, all the name calling, all the things that your mind does to you on this theme. And the idea is you get them to read it and kind of really hook into it. Then you say, if you were to turn this into a screenplay, or a movie or a documentary, what would you name it? What would you call this story? And you get them to come up with a creative name or humorous name or something.
And so anytime that story comes up, you go, Oh, that's the, I'm not good enough story. Or that's the, mine was the high functioning hot mess story. I know this one. That's part of that collection of stories that's familiar. Can I name it? Acknowledge it and move forward without trying to convince myself that I'm successful and organized? Maybe. I'm sometimes some days feel a bit successful. Most days don't feel organized. but I don't have to actually convince myself of that to do the next thing.
Right. analogies. My mind is I had a client who came up with my mind is like a meerkat that like pops out of the hole and looks for danger. Like his job is is there danger? Everything is guided by, is there danger around me? And I was like, Oh, that was a good one. Like that was her kind of recognizing her protective mind and then going, but can I go do the thing anyways? Can I meerkatting again. She started to say that it was neat when people can come up with their own analogies.
They're so much more powerful. you can name the part of your mind that does this bit, and then opening up to turning toward difficult feelings, right? So with the thoughts, we're trying to unhook from them, diffuse from them. The feelings we're turning toward, can I hold it gently? Can I create space for it? Can I treat this difficult feeling like a guest? Can I stay with it? Can I open up to it? Can I breathe into it? Make room for it? Can you allow it to come and go freely without a struggle?
So instead, like sometimes when we're trying really hard to change it, suppress it, get rid of it, we're holding on to it. Whereas if we could kind of just be A little bit looser with it. Could we allow it to come and go? Maybe it's can, we can notice it feeling a little bit further away, feeling a little bit closer. And can we allow that with kindness and gentleness rather than this rigid, no, I need to stuff it down. Are you willing to have this feeling as you do what matters?
Can you experience the nervousness and still make that phone call? Maybe we don't have to get rid of nervousness before making a phone call. We've all seen these feelings wheels. Naming it is a really powerful one. That's a way of turning toward it. Oh, I'm scared. let's look at things that are in that fear, fearful, is it more anxious, overwhelmed, worried, inadequate, like kind of diving in and exploring the subtleties with it is a way of sitting with it, turning toward it, opening up to it.
It doesn't have to go away by doing so, but by allowing it to be there and be curious about it. it's not as in control of us usually, I like this idea of holding a cactus, right? It's uncomfortable if you squeeze it and try to squeeze it and shove it and stuff it in your pocket, hide it, like it'll hurt you. But if you can actually just hold it gently Can you notice a sensation or feeling, can you notice, can you put a hand where the sensation is in your body? Like, where do you feel at?
And you soften into it, around it, loosen it. I'll ask people like, does it have a color? does it have a shape? Is it staying put? Is it moving? I'll just ask a ton of really abstract questions about it in order to sit there curiously with them, with it. And it tends to be less in control the more aware we become of it can we breathe into it. So those are ways of making room for difficult emotions and maybe sometimes we're dipping in and out too, right?
Like maybe staying there entirely indefinitely is not tolerable for some sensations. can we do this? Can we talk about that? Can I ask again, where's that feeling? And then maybe we change the subject. Can we go again there? Can I just check in where that is? That's sort of another way of being curious with it. And then Do What Matters. We've got this one, right? the idea is acting effectively, committing to living in line with your values, engaging in meaningful occupation.
So we're using these tools to help us do this. we know how to do that. Exploring values, though, I love this about ACT. As OTs, we're often asking a lot of questions about what's meaningful, what's important, what do you care about. And in ACT, they're kind of defining it in a way of values or qualities of behaviour, qualities of doing. and we can explore those in lots of ways. So questions like, what do you stand for? What do you want to do with your time on the planet?
How do you want to treat yourself and others in the world around you? What makes you feel most alive? What do you want to stand for in the face of this challenge or situation? These are my least favorite ways of exploring values. Checklists and cards. I feel like they're too limiting. I'd rather explore them occupationally. Like, what's the stuff that you do, right? Like, when do you feel most alive? What are you doing? Where are you? What's happening? What do you want to do with your time?
I love exploring it occupationally. Looking at people, when people get more, most jazzed about things. A checklist or a card somehow just like misses the boat a little bit for me. But they're not terrible. They're out there for a good reason. I like journal prompts, that get people exploring.
Maybe write a, write your obituary, or if that feels uncomfortably morbid for some people, maybe it's what the speech at their 90th birthday might be, or their retirement speech might speak to, if you continue to live the rest of your life in line with your values, what people might be able to say about you. Based on their observations of you engaging in occupations, really. if you won the lotto, how would you spend your week? Maybe not the first week, but it's a few months down the road.
What would you do? Write about three people you admire, and then you notice what they have in common. Those tend to three things you value. That's not going to fit for everybody, though. I like quote too. Vitality is not a feeling, it's a sense of being fully alive and embracing the here and now, regardless of how we might be feeling in the moment.
So this idea that we can have vitality at the same time as experiencing pain, or discomfort, or fear, or anxiety, or other difficult experiences, and we be here in the present now and embrace the moment. I showed earlier that I like to use, I end up creating this ACTivate Vitality planner, which you can get on Amazon, as a way of integrating ACT with, how are we planning our time? the idea is that values meet committed action that's engaging in meaningful occupation.
So With people, with my clients, I'll often give them a planner and each week they bring it and we look at what are the values, what's coming up this week. What do you have booked? What do you have planned? Okay. These are, if your values are these, how are we going to work some of that into your week? And so getting people to make some plans with their values in mind, and then each week reflecting on those and making notes and, incorporating a bit of gratitude.
That's not necessarily a part of ACT, but it's good for our mental health. And then noting, how did I live my values? How did things impact me? With a lot of the OTs I work with too, it's just noticing that flow of the week. oh, I'm always super stressed on Wednesdays and don't make supper and skip the walk with my friends and what's going on Wednesdays. How do I notice what's happening? There's some small shifts I can make. I'll show you this little thing I created.
This idea is that this is you here, riding the boat of your one precious life. And there's this part of you that can observe you doing so. this is you in the present moment. You've got choice in your wheel here. You can choose to move in the direction of doing what matters. even when the fog rolls in, right? The idea is that lighthouse is your values.
And, even when it's dark, even when it's stormy, can you use this lighthouse to help you guide your actions in that direction, slowly, carefully, safely. Sometimes we get hooked by these monsters under the sea, reinforcing my phobia, but we can use some of these ACT tools to help us unhook, open up and make some moves in the direction of living our values. And this is the, kind of all of the bits of ACT together. And this is OT. How do we do what matters?
If you enjoyed this podcast and want a lot more. Please join us in the Practical ACT for OTs course, You could register in January when they officially launch it, or you can take advantage of our upcoming black Friday promo. Go to the show notes. The website, in case you do, just want to hear it in audio form, the website is activatevitality.online/act-for-ots. Everything's lower case. Thanks for listening and as always be brave OTs.