Institute 4 - Present Moment Power Moves: Working the Center Pillar in ACT

Activating the processes of present moment and transcendent self-awareness is central to the success of ACT clinicians seeking to “Bridge the Divide” and provide inclusive, effective, affirming care. Unfortunately, entering into and navigating the present moment is also fraught with perils, as fracturing present moment awareness is a powerful experiential avoidance strategy that we all use. Thus, it is not surprising that treatment fidelity data of ACT in practice consistently show that working with the "aware pillar" of psychological flexibility is an area of weakness for most therapists. Why? First, it is difficult to elicit, sustain and expand one's own contact with the present moment, much less get the client to do the same thing at the same time. Second, it is unclear what psychological skills and processes go into promoting "present moment and transcendent awareness", leading to a hazy sense of what should be accomplished at the intervention level. In this institute, we will provide a clear framework for understanding the various facets of present moment and transcendent awareness, and what the "job" of the ACT therapist is with respect to working with them. We will deconstruct the present moment as a set of discrete, coachable psychological skills that the therapist can deliberately elicit, sustain and expand in a specific, unfolding, coached sequence. These skills include adopting an observer stance, providing accurate, verbal discriminations for and between inner experiences, practicing non-judgment of what is in awareness, approaching inner weaknesses and regrets with self-compassion and being intentional in daily actions. Promoting these processes in session requires that special attention be paid, not just to the client’s non-verbal cues, but also to the therapist’s functional use of language. We will demonstrate how the “language” of the here and now is quite distinct from talk about the past or future. Using experiential exercises and dyadic role playing skill practice, we will help participants develop their own lexicon for eliciting, sustaining and expanding the client's present moment capabilities. At the conclusion of this training, attendees will have specific clinical tools that can be applied confidently in professional practice.

Recommended Reading 1: Kiken, L. G., Lundberg, K. B., & Fredrickson, B. L. (2017). Being present and enjoying it: Dispositional mindfulness and savoring the moment are distinct, interactive predictors of positive emotions and psychological health. Mindfulness, 8(5), 1280–1290. https://doi.org/10.1007/s12671-017-0704-3

Recommended Reading 2: Lilja, J., Lundh, L., Josefsson, T., Falkenström, F., & Brothers, A. (2016). Cognitive reappraisal and acceptance: An experimental comparison of two emotion regulation strategies. Behaviour Research and Therapy, 80, 15-22.

Recommended Reading 3: Carpenter, J., Sanford, J. & Hoffman, S. (2019) The effects of a brief mindfulness training on distress tolerance and stress reactivity. Behavior Therapy, 50-630-645. https://doi.org/10.1016/j.beth.2018.10.003.

Recommended Reading 4:Troy, A., Shallcross, A., Brunner, A., Friedman, R., & Jones, M. (2018). Cognitive reappraisal and acceptance: Effects on emotion, physiology, and perceived cognitive costs. Emotion, 18, 58–74. https://doi.org/10.1037/emo0000371

Recommended Reading 5: Allen, J.G., Romate, J. & Rajkumar, E.(2021) Mindfulness-based positive psychology interventions: a systematic review. BMC Psychology, 9, 116. https://doi.org/10.1186/s40359-021-00618-2

Outline:
TOPIC I: An Overview of the Role of Present Moment Awareness In Psychological Health

A. Why is the "center pillar" the "center pillar?" Review of the psychological flexibility model.
B. The role of verbal behavior in allocating and controlling attention or "why we all live in our heads"
C. Present moment awareness as the conduit to self-acceptance and intentionality in life
D. Cultural, social and psychological barriers to living in the here and now
E. How fracturing present moment awareness is related to persistent maladaptation and mental suffering

TOPIC II. Present Moment Awareness as a Set of Psychological Skills

A. Description of the five facet model
1. Observer self
2. Verbal labelling of inner experience
3. Being non-judgment
4. Being self-compassionate
5. Connecting values and actions in everyday life
B. Experiential Exercise: Be present with something that troubles you and work the progression
1. Small group debriefing

TOPIC III. Strategies for Eliciting Present Moment Awareness in Real Time

A. Identifying and utilizing in session experiential avoidance
1. Amplifying pain or discomfort in the moment
2. Slowing it down
3. Being aware of non-verbals
4. "Coach" talk or no talk
5. Go with the flow
6 You get as far as you get

TOPIC IV. Present Moment Language Skills

A. How to pick out and amplify a moment of pain/avoidance
B. How to create an atmosphere of safety and companionship
C. How to be compassionate, validating while retaining focus
D. How to handle the client's verbal behavior in the moment
E. The nuances of coach talk
F. How to debrief what happened without using yours or the client's "big brain"

TOPIC V. Putting It All Together: Dyadic Role Play Skill Training

A. Role play case example 1 plus dyadic and large group debriefing
B. Role play case example 2 plus dyadic and large group debriefing

TOPIC VI: Q & A and Establishing a Personal Practice Plan
A. Small group exercise: Share your personal practice plans