November 26, 2024 • 57 mins
When I learned ACT (Acceptance and Commitment Therapy), it changed my OT practice and it changed how I navigate my own life. This is why I have created so many things that include ACT concepts - the ACTivate Vitality coaching program for OT business owners who want to thrive without the hustle, the ACTivate Vitality Personal Development Planner, and the Practical ACT for OTs course... that last one has a Black Friday promo coming out later this week.
This podcast is taken from a presentation I did recently in a Facebook group for mental health OTs called MHOT ~ A Collective. It's a helpful introduction to using ACT as a modality in your OT practice to facilitate occupational engagement, particularly when clients are stuck in patterns of avoidance of difficult thoughts, feelings, or sensations.
This podcast is taken from a presentation I did recently in a Facebook group for mental health OTs called MHOT ~ A Collective. It's a helpful introduction to using ACT as a modality in your OT practice to facilitate occupational engagement, particularly when clients are stuck in patterns of avoidance of difficult thoughts, feelings, or sensations.
✴️✴️Head to the Practical ACT for OTs course website to sign up to be notified when the Black Friday early bird registration and promo opens up or when the course officially starts toward the end of January, 2025.✴️✴️
Here are some resources mentioned in this episode:
Balance Works OT - Carlyn's OT practice
Balance Works - Carlyn's personal and professional develoment services
- ACTivate Vitality Program and Mastermind for OTs who want to THRIVE without the HUSTLE
- ACTivate Vitality Personal Development Planner
- Practical ACT for OTs Clinical Education
- Vitality Guide - free download with ACT starter resources
Meet Jane and get a one month grace period on your new Jane account with the code VITALITY.
Article Cited:
Dindo L, Van Liew JR, Arch JJ. Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. Neurotherapeutics. 2017 Jul;14(3):546-553. doi: 10.1007/s13311-017-0521-3. PMID: 28271287; PMCID: PMC5509623.
Shoutout to our sponsor, Jane, the all-in-one practice management software we love. To see how Jane can help you reclaim your evenings and weekends, head over and meet Jane to book a personalized demo and, if you’re ready to ge
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
ACT has this two mountains metaphor,this idea that you are on your mountain,
(00:06):
climbing your mountain, I can see thingsfrom where I stand on my mountain.
I'm climbing my mountain with my ownchallenges 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 onmy 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 thingsthat can help you navigate
(00:28):
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 andhumanize in a really authentic way that
includes a lot of therapeutic use of self.
It's another thing Ireally like about ACT.
just truly listening to the struggle,exploring it, not trying to change
(00:52):
their perception of it, just trulylistening actively and showing
compassion for it is that first step.
you're listening to the BraveOT Podcast with me, Carlyn Neek.
This podcast is all about empoweringoccupational therapists to step up,
level up, blaze some trails, and maybeengage in a little conscious rebellion.
(01:13):
In service of our profession, ourclients, our work, our businesses,
and living our mission wholeheartedly.
We are all about keepingit 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 ingourselves, and each other.
(01:34):
I hope you love
this episode!
You may have noticed that alot of my podcast conversations
are with other people.
I don't do a lot ofpodcasts that are solo.
And so this episode'sa little bit different.
It is actually an adaptation from apresentation I did last week in the
(01:56):
M H O T a collective facebook group.
That's the title?
M H O T.
~A Collectiveive I'lllink it in the show notes.
in that group, different peoplepresent, every month or two
and, it was my turn.
So I presented on using acceptanceand commitment therapy in your
occupational therapy practice.
(02:18):
Now the week of this releaseis the end of November, 2024.
And in the new year, I will be launchingmy Practical ACT for OTs course.
That's a clinical course.
I delivered once this year and I'mlooking forward to delivering it
again next year, but I'm going to beputting on a black Friday promo for
the Practical ACT for OTs course.
So I figured I might as well sharethis presentation as a podcast.
(02:41):
You'll notice at times I might bereferring to an image in the presentation
and I tried to remove parts thatwere really reliant on the image and
left in ones where I think you couldvisualize 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 slideswere actually taken from my
(03:04):
Practical ACT for OTs course.
So the Practical ACT for OTs courseis a few hours long and there are
discussion components in a Facebookgroup, so we can get immersed in.
the learning together, I can helpyou customize it to your population.
but this is just sort of a niceoverview taster to see if you like
the model of act and get a sense ofhow you might be able to integrate it
(03:27):
into your OT practice.
Now ACT is how you pronouncethe abbreviation for acceptance
and commitment therapy.
it's not A-C-T, it's ACT.
where I've quoted other people ormade references to other models.
I have tried to include that in the audio.
it definitely was in the slides andI'll make sure to give credit in
(03:48):
the show notes to anything that Imight not have mentioned as well, and
provide links to to related content.
If you're interested in beingnotified when the black Friday
promo of the Practical ACT for OTscourse is available, Follow that
link in the show notes as well.
Today's episode is sponsored byJane, a clinic management software
(04:09):
and EMR that helps you handle yourclinic's daily admin tasks so you can
free up your evenings and weekends.
The JANE team understands how preciousyour time is and recognizes that
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That's why they're here to help.
to save you from having to start yourchart notes from scratch, you can
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Once you have a template you like, youcan choose to customize it further with
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To see how Jane can help you spendmore time doing what you love,
head to the show notes to grab thelink and book a personalized demo.
(04:52):
Or if you're ready to get started,you can use the code VITALITY at the
time of signup for a one month graceperiod applied to your new account.
And I have had a mental healthprivate 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
(05:14):
OTs, a lot of OT business owners inthe intersection of their personal and
professional development using ACT.
So I've developed a bunchof stuff related to ACT.
I created a course called PracticalACT for OTs last year, because the ACT
(05:34):
based coaching program that I offerisn'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 BlackFriday, but we'll be running it in the
new year so you guys can watch for that ifthis, inspires you to want to learn more.
(05:57):
what to expect in this workshop?
I hope to be able to give you anintroduction to ACT and connect
ACT concepts to our OT frameworks.
I'm going to go through the six coreprocesses, but focus a little bit
more on distilling them down to threethat are easier to remember, because
we can easily get caught up in thenames of these core processes and lose
(06:18):
the importance of the spirit of them.
We'll talk a lot more about language, andI'll have some suggestions for how we can
apply it in OT, apply it to ourselves tobuild our own psychological flexibility.
a few important notes, the ACT communityis really generous, so I'm sharing from
resources that I've gathered as I, as Ilearn, and so I didn't make much of this
(06:41):
stuff up, the places, the innovation comesfrom me linking it to OT and providing
that, crossover framework for you, butthat's certainly not even, necessarily
my own, it's just my own interpretation.
I try to give credit, to theoriginal source where I can.
If I've missed any credit,please let me know.
but do know that this stuff thatI'm sharing is all freely available.
(07:04):
I am a Canadian OT and I'm registeredwith 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 hereSo these are some of my occupations.
so there's that, mental healthfocused private practice that
I've had for a long time.
(07:24):
And then there's all these productsthat I offer under my umbrella of
Balance Works Personal Development.
So they're not falling in anOT umbrella because I connect
with people internationally.
For these things.
So I've got my ACTivate Vitalityprogram for OTs, and there's
my ACTivate Vitality Planner.
I also have the BRAVE OT Podcast.
(07:45):
And then last year I developed thePractical ACT for OTs course, which
these slides a portion of, but Iwas 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 Ialso do pottery on Fridays.
I love to garden.
(08:06):
I've got more than 100 houseplantsin my house, and so these are some
of the things I, I love to do,some of my meaningful occupations.
fundamentally, this is a quotefrom this article, ACT rests on a
fundamental premise that pain, grief,disappointment, illness, and anxiety are
(08:27):
inevitable features of all human life.
If you're out there fullyparticipating 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 tohelp people productively adapt to these
types of challenges and develop greaterpsychological flexibility, rather
(08:47):
than engaging in counterproductiveattempts to eliminate or suppress
undesirable inner experiences.
So the suffering, the struggles, theresistance to those painful experiences
that are inherent in life is wherea lot of our suffering comes from.
building psychological flexibilityis the goal of ACT so that we
(09:09):
can fully participate in life.
this is achieved through committed pursuitof valued life areas and directions, even
in the face of natural, a natural desireto escape or avoid painful and troubling
experiences, emotions, and thoughts.
ACT is transdiagnostic, so it's notnecessarily oh, this is the best thing for
depression or the best thing for anxiety.
(09:32):
It works for people with all sortsof conditions and it's more process
focused, flexibly delivered, with thisgoal of helping people connect with
doing what's most important to them.
I love that about ACT and how itoverlaps 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,
(09:55):
and what's most meaningful.
And we use this to supportparticipating in the things that
will enrich or enhance our lives.
Even in the presence ofdifficult inner experiences,
sensations, thoughts, feelings.
ACT teaches us mindfulness skillsthat enable us to handle these
difficult inner experiences, thoughts,feelings, sensations, memories, etc.
(10:16):
effectively, so that we can engagefully in what we are doing and
appreciate and savor the meaningfuland fulfilling aspects of life.
So it's not to get rid of symptoms.
That's the main point here.
We're actually making room forthose symptoms of discomfort and
trying to struggle less with them,change our relationship to them.
(10:36):
a lot of the lingo we use, obviouslythis isn't about memorizing it,
but to Get a sense, get the senseof what the vibes are of ACT.
It's about being present, aware,responding flexible, about acceptance.
Diffusion versus fusion, when we'refused to a difficulty inner experience.
We're trying to diffuse, we'renot, we're less stuck to them.
(10:58):
kindly, commuted action, towards,moves away, moves, savor.
There's a lot of talk aboutflavoring 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.
(11:18):
If you could just share creditthat you got this from this
presentation, that would be great.
I'd prefer you not share a whole slidedeck or anything, but if sharing an
image like this is helpful, by allmeans, you're welcome to do my journey
to ACT was first learning about CBT.
in my mental health practice, I amoften seeing people with depression,
(11:39):
anxiety, some trauma, some chronichealth conditions, and generally they're
off work because of these things.
And I'm being funded by a third partyto help them return to life, and
returning to life will facilitatemore likelihood of returning to work.
And so I was often asked to do behavioralactivation, which is a component of CBT
(12:00):
and ultimately Helping people, engage inactions, that are important to them and
manage the difficult thoughts and feelingsthat are obstacles to taking action.
So we're we're working on, difficultfeelings, difficult thoughts, and
working on actions to essentiallyhelp people participate in life, but,
improved actions could improve thoughtsand feelings, that sort of thing.
(12:23):
And I always felt like with the toolsI 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 difficultthoughts, 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 dealingwith somebody with trauma and we're
(12:45):
doing some work to expose them to areasthat make them anxious, having negative
thoughts is probably pretty reasonable.
And, and can we, and we still proceed evenin the presence of those negative thoughts
is often what I was thinking and CBT toolsI had, just didn't, it felt like we were
trying to make those negative thoughtspositive more often and didn't love that.
(13:08):
So I was often kind of skipping thatpart, 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'sa part of a third wave of cognitive
and behavioral therapies, along withdialectical behavioral therapy or
(13:31):
DBT, mindfulness based CBT, functionalanalytic therapy, or metacognitive
therapy, this third wave of cognitiveand behavioral therapies is more
about emphasizing the shift in theperson's relationship to a thought
or emotion rather than the content.
That felt a little bit more validatingand aligned for the work that I was
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doing and what I was experiencing whenI was out there in the world trying to
help people engage in these occupationsand navigate the difficulties that
were coming up when they were doing so.
So in ACT, we are not focusedon changing the situation,
the thought or the feeling, we'refocusing on enabling or facilitating
meaningful occupational engagementby changing how we relate to the
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situation, thought, or feeling.
So it's changing the relationshipto it rather than feeling
better or thinking better.
It's, can we make that less of anobstacle in our way of the doing?
They don't use occupational languagein the ACT models, but so this is where
(14:35):
I'm building that, that bit of a bridge.
They're talking more aboutbehaviors or the doing of
engaging in meaningful activities.
Over here, we've got Values and CommittedAction, which in our OT language is
Engagement and Meaningful Occupation.
And over here, we work on Navigating theDifficult Inner Experiences, the Thoughts
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and Feelings, through four conceptsthat are all based in Mindfulness.
so if you've done any mindfulnesstraining, these will feel familiar, right?
We're being here in the present moment.
We're opening up with acceptance to whatis, we're defusing, we're making it less
that we're like stuck to this thing, thisdifficult inner thought, and then there's
(15:18):
a part of us that can observe ourselvesdoing this, give us some context.
just to frame that, this idea ofthere are these six core processes.
Four of them are mindfulness based andtwo of them are doing what matters.
this feels really aligned already.
these are some tools that I can doto help facilitate this occupational
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engagement in the face of theseobstacles of difficult inner experiences.
if you've studied mindfulness in anyother context, like a lot of us have
learned mindfulness contexts fromgoing to yoga or listening to guided
meditations or things like that,mindfulness is not necessarily meditation.
(15:58):
Mindfulness is not intendedfor relaxation specifically.
It's about this flexibility of attention.
That we can shine that light fromhere to there and have that ability to
move our focus around with thoughts.
in ACT, it's described as a set ofskills for effective living that
involves paying attention with openness.
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Curiosity, kindness, flexibility.
It's the art of living consciously, aprofound way to enhance our psychological
resilience and increase life satisfaction.
We're present in these pleasurableexperiences or joyful experiences.
we get a lot more fulfillmentif we're in these meaningful
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conversations with people, right?
There is that increase in satisfaction,but also having that, psychological
flexibility or resilience, wecan 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.
(17:06):
So thinking about this is theCMOP-E, and thinking about ACT
in relationship to that, right?
We think about the, person, withthese components, the physical,
affective, cognitive, spiritual self,the person, then the occupations,
and then the environments.
and we care as OTs about engagementin the meaningful occupations.
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ACT is a helpful approach to reducethe impact of obstacles to engagement.
ideally, we're using ACT to make thosedifficult internal experiences, the
thoughts and feelings that are difficult,the sensations, make those less of
an obstacle to doing the things, butalso helping us to accept, change, or
(17:51):
adapt situations in the environment.
helping us to focus on doing whatmatters, move toward doing what matters.
That's that occupational engagement.
So ACT can be a tool that we can usewithin the context of this model.
Thinking about MOHO, I don't use mohoas readily, but as I started to try to
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piece together thinking moho helps usbetter understand how human occupation
is motivated, patterned, and performedwithin the context of our environment.
And so ACT can be a helpful approach toaddressing obstacles to participation,
by working with volition, habituation,and building performance capacity.
(18:33):
So again, building our capacity to rollwith those things that are coming up,
connect more deeply to our values andwhat's most important to us, and commit
to that action by building a more flexibleresponse to the challenges that come up.
And then I like it alongsideKawa, particularly, I've been
(18:54):
learning more about Kawa this year.
And, I won't go through thewhole Kawa model, but there's
this idea that the river is yourlife flow and your priorities.
And that the banks represent theenvironments and contexts of that
social and physical environment.
the rocks are obstacles and challenges.
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The driftwood are influencing factorsthat could be positive, they could be
challenging, they could be facilitating.
and the spaces are opportunitiesfor enhancing flow.
So ACT helps us enhance the flow withour clients by helping us navigate
around the obstacles that come up.
oh, there's some rocks.
How do we not keep rammingagainst the rock and trying to
(19:39):
move the boulder and instead seethat there is a path around it?
And we allow the rock to be there.
can we allow that difficult challengethat's come up or feeling or thought,
sensation that's come up that feelslike it's in the way of doing and
see that and still carry on withouttrying to shove it out of the way.
(19:59):
I like the, some of that synergyin there, that sort of, a lot of
mindfulness stuff is based in Easternphilosophy 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, asan occupational therapist,
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What's the occupational goal?
do we need to measure the person's,psychological flexibility, the
outcome that we're trying to measurewith ACT, or do we more so need to
see how they're doing with meetingthe goal, the occupational goal?
So think about what theperson's trying to do.
We always start with thatin ACT, not just in OT.
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What is the thing thatthey're trying to do?
And then working backward to, okay, wecan use ACT as a modality to support how
we're managing the internal obstacles.
So I tend to use that occupationaltherapy, occupational engagement as the
outcome measure, not so much measuring Themodality, the, details of the modality.
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There are a lot of ACTbased 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'remeasuring the success of a goal?
ACT encourages us to be alot more flexible than an all
or nothing approach to it.
what tools do you use to addressany obstacles that are coming
(21:26):
up, and would other measuresserve that occupational goal?
The focus is not to getrid of distress or pain.
The focus is to get people doing stuff.
That's important to them.
Why measure their anxiety ifit's not about the anxiety?
It's about doing living life.
in some cases you would liketo and so there are lots of
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assessments out there for it.
I'm just not going toinclude them all here.
thinking about, discussing, you know, thegoal attainment, how did you do last week
with that thing you were going to try?
Maybe it's logs or routines or checklistsor apps where you're sharing your
towards moves to the things that you'redoing that are moving you toward that.
(22:08):
If you like SMART goals, they'renot my favorite, but if that's
how you go, did they meet thegoal or didn't they meet the goal?
I like something that's a little bitmore embracing the gray in between.
And so something like the COPM couldbe a nice one where you're measuring
how they would rate themselveson a scale for those things.
And there are ACT specific, ACT processmeasures online really available.
(22:33):
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 lookslike 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 daywas to ride our bikes from Canmore
(22:56):
to Banff, have lunch, and ride back.
And We set out on our mountainbikes and I drank my, all of my
water in the first half hour.
I could not breathe.
It was a very gradual inclinethat I was not fit for.
We stopped somewhere alongthe way and we looked out.
We had a lovely day.
We laughed.
(23:17):
we didn't make it to Banff.
We turned around and headedback to Canmore and had a
beer in a pub at some lunch.
And if we were measuring by aSMART goal of riding our bikes
to Banff and back, having a niceday, 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.
(23:37):
We're lucky that way.
We live close to Banff, only an hour away.
But we did have a reallynice day connecting.
So the value of authenticconnection, being in nature, doing
something meaningful together,I've met all of those goals.
this was a fully towards move checkthing, not necessarily a smart goal check.
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So I tend to use, planner pages,which actually led me to create my
ACTivate Vitality planner, which I'llshow you a little bit more later.
but it came from this, doing this withmy clients, looking at the week, what
are the things that are important?
What are the values thatthey want to connect to?
for me, it's like nature,creativity, authentic connection.
Those tend to go there.
(24:19):
And how can I plan my week withthose priorities and values in mind?
How am I checking in with that?
So I often do that with clients, whereget them to make plans that align
with values and then reflect on howthey connected with their values.
And then we can do that together.
(24:39):
So how, looking at ordering someseeds, 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 somegratitude for this gorgeous sunrise
and spending more time outdoors andwith my mom, authentic connection.
(25:00):
So having these reflections in how we'reconnecting our day to day occupations
with our values and any sort of measuresof, Moving in that direction, I love to
celebrate those with my clients, whetherit was the full goal they had or not.
what are these things we're doingin ACT to facilitate engagement in
(25:21):
meaningful activities, connectingto values oriented actions?
These are six core processes in ACT.
We could easily get caughtup in the words of them.
It's less important than this ideathat we're opening up, we're being
present, we're doing what matters.
And so that opening up, or opening up todifficult inner experiences, so that can
(25:44):
look like accepting difficult emotions,opening up to what is, turning toward
it rather than trying to avoid and shoveaway, defusion, not being fused to a line
of thinking that isn't facilitating ordoing what matters, so defusion, trying
to unhook from that, Being present.
So connecting with that present moment,being here now, engaging in that part
(26:08):
of you that can observe, be flexible,gain perspective, the part of you that
observes you thinking, doing, feeling.
So this is being presentand 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
(26:29):
up in all of the six things at thispoint, is helpful, but I wanted you
to see that they came from six downto three for accuracy, of course.
So remember this, open up,be present, do what matters.
We allow the difficult thoughtsand feelings to be present.
We don't fight them.
We don't avoid them.
We don't resist them.
There's a power in nottrying to chase away.
(26:51):
It's sort of like not being afraid ofthe dark allows you to do more things.
And, so opening up, beingpresent or being aware.
So we teach people experientially howto do this through some ACT skills.
But these are the main thingsthat we're doing these things
so we can do this thing,
which is very OT aligned.
(27:11):
So when do we choose ACT?
The idea is that when a person is notengaging in an occupation that they value
because they are hooked by difficult innerexperiences, thoughts, feelings, emotions,
sensations, memories, urges, impulses,images, and the avoidance isn't workable.
(27:33):
So we can do a lot of avoiding,and if it's manageable, like for
instance, a I have a phobia aboutswimming 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.
(27:55):
I live in the prairies.
it does get me maybe if I wantedto go swim in a lake, but I can
go on a paddleboard, that's fine.
So I don't really need to intervene onthat unless it was becoming unworkable
that I wasn't swimming in deep dark water.
So there needs to be that match betweenthe person not doing the thing because
they're resisting this inner experienceand that's not workable in their life.
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The difficulty in our experience is notthe problem, the symptom, essentially
that symptom of fear or stuck ona thought, that's not the problem.
It's responding to the thought or feelingin 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 thingand then not doing it and stuck.
(28:41):
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 partybecause I'm feeling anxious.
I can't sign up for yogabecause I'm not flexible.
I can't give a, a toast at yourwedding because I'm not a good speaker.
I can't start a business.
I couldn't handle the judgment of failure.
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I can't teach an ACT coursebecause I'll mess it up.
I don't know enough.
I can't ask the person on a datebecause 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 Christmasdinner, I'm too overwhelmed.
I can't go to the beach with my grandkidsbecause I can't stand the feeling of sand.
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Workability, again, we only interveneif the avoidance is excessive,
rigid, or getting in the way ofliving 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,
(29:45):
maybe numbing with our phone.
A lot of us do ournumbing this way, right?
that can be shutting down.
that can be jumping to aconclusion and taking action.
It could be always busy, can'tbe alone with my thoughts.
Could be Little Miss Sunshine, I'mliving the dream, good vibes only,
stay positive, we're gonna deny all thenegative things, all of the difficult
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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 thatI coach, that No, I can't start that
thing until I've taken 10 courses onit, made 10 plans, taken all of those.
Then I could make one first towards move,and be being hooked by that thought of, I
(30:31):
have to know it all before I take a step.
So we only have intervene again, ifthe avoidance is excessive, rigid and
getting in the way of living a fulland meaningful life with our values.
So kind of back to the situation itself,sensation itself, feeling itself it
may look like that's creating thesuffering, but ultimately, this is not so.
(30:55):
Your resistance to it, you're stayingstuck 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 ACTtraining from Russ Harris.
I find his stuff really helpful.
There's this book, ACT Made Simple.
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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 acertification 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 regulatedhealth professional to use ACT, right?
You could use it if you're ateacher or a coach or a personnel
(31:35):
trainer, ACT is something theywant people to have easy access to.
But giving Russ Harris credit forthis 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 gethooked and make away moves.
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Sometimes we can be moving towardwhat's meaningful, making toward moves.
So toward moves are living our lifein line with our values, showing up
as the person we want to be, doingthe 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, orwe can do that in little ways.
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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 becausewe'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
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thoughts, feelings themselves.
So we are not treating those symptoms.
I'll say it again.
We are helping people be less stuck bythem so they can go and do the thing.
People do tend to feel betterwhen 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 targetingor reducing symptoms directly.
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So away moves were hooked, towardmoves were unhooked, living your
values fully, intentionally doing whatmatters, behaving effectively, or the
opposite, acting ineffectively, not whoyou are, how you want to be, not doing
the things that matter most to you.
So the greater our ability to unhookfrom difficult thoughts and feelings
and choose towards moves, the greaterour quality of life and the greater
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our health, happiness, and wellbeing.
That's kind of cool.
And doesn't that feel OT?
So this idea is that sufferingis 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 artof handling our suffering."
in ACT, we always want tobe clear about the goal.
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What's the occupationalgoal, or they might call it a
behavioral goal in psychologylanguage, not symptom reduction.
With our built in focus on occupationalgoals, this is kind of a given, right?
We're already doing this.
modality to facilitatethis built in outcome.
So we help people explore the struggle.
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We listen, we validate, we askgood 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 beenreally difficult," right?
Like just that compassionate waywe want to respond to people.
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It's human.
It sounds like your mind isa lot like my mind does that.
Like, I can hear it saying thatyou're not good enough and that you
should have done this, you shouldhave 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,
(34:59):
climbing your mountain, I can see thingsfrom where I stand on my mountain.
I'm climbing my mountain with my ownchallenges and navigating new things that,
some of them I'm good at, someof them I need to learn about.
You can see different things onmy 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 thingsthat can help you navigate
(35:22):
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 andhumanize in a really authentic way that
includes a lot of therapeutic use of self.
It's another thing Ireally like about ACT.
just truly listening to the struggle,exploring it, not trying to change
(35:45):
their perception of it, just trulylistening actively and showing
compassion for it is that first step.
Often that makes allthe difference, right?
We know that in talking to people.
And then we explore the workability of it.
So what have you tried so far toavoid, like avoidance seems to be
the problem, to avoid, get rid ofthose unwanted thoughts or feelings.
(36:09):
There's this acronym from the RussHarris ACT training, Connecting the Dots.
So you might say, are there things youdo for distraction, like some people
might use TV or loud music or keepingthemselves really busy, scrolling, gaming.
Maybe it's opting out, are you sayingno to things, people, places, situations
that might remind you of the thingor trigger some of those feelings.
(36:33):
you can ask about, are thereany thinking strategies you're
using when this comes up.
Maybe it's positive thinking.
That's actually listed in the ACTstuff as a way that we're trying
to avoid the real experience byflipping it into something positive
or, which isn't all terrible, right?
it's definitely a valid option.
But if someone is trying to makeeverything all positive, there's
(36:55):
some avoidance happening there.
Maybe you're debatingyour challenging thoughts.
And this is like you're exploringthis with the client, like
you're asking them these things.
Are there any substances, otherstrategies you might be using?
So you can look at these differentthings that people are doing to
avoid or get rid of these things.
And then you explore kind of likeOkay, so you've been having this
(37:18):
experience, you retell the story, right?
And, and if this thing that theydescribe stays in charge of what you
do, makes choices for you, dictatesyour actions, kind of says, nope,
you can't go to that, you got to dothis, you got to do that, what would
life look like in five or ten years?
Does this move you closer toliving the life you want, showing
(37:40):
up with these things and, doingthe things that bring you joy?
Would you be willingto try a different way?
So this is sort of gettingsome informed consent for a
different way to approach it.
and having this sense of, you candraw this out on the choice point, but
trying to explore that what they'vebeen trying so far hasn't worked, right?
They've been hooked over here.
(38:02):
so maybe it's an OT who wants tostart 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 andfeelings a person might be having.
What if I fail?
And I actually draw thisout with them, right?
If we're doing this online, I willdo it on Canva, or like a whiteboard.
But if it's in person, I'mdoing it on a piece of paper.
(38:25):
And so the difficult thoughts andfeelings 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 anybodyabout this idea I have.
(38:47):
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 theirvalues, making a towards move.
(39:08):
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 cleareron 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 themanageable action you can take.
What's the tiniest little thing?
(39:29):
Maybe it's telling justone person about it.
Is that the tiniest next thing, opening upto 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'ssort of shades of success?
Can we explore that?
How would you handle that?
can we get curious about it ratherthan, I can't, I might, it might be
(39:53):
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 thoseskills of being more present and
aware, being able to sit with thosedifficulties, 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,
(40:15):
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, aneasy to read book that I'll
(40:36):
share with clients quite often.
But maybe you learn something like thatand 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 somemore specific tools in these three areas.
we're starting with this be presentone, be aware, engaged in what you're
doing, present moment awareness.
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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'ssuper 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'sproblem solving, it's past or future
(41:21):
oriented, it's rarely present.
And there's the part ofyou that can observe that.
There's that observer.
It's in the present moment.
It's nonjudgmental.
It's aware of our externaland internal worlds.
It's conscious.
it has perspective.
So the, this book, The Boy, TheMole, The Fox and The Horse, he says,
(41:43):
Those are dark clouds, said the boy.
Yes, but they will moveon, said the horse.
The blue sky above never leaves.
So I feel like the horsehere is that observer.
You can see the boy is seeing, ah, there'sdark clouds and the horse is able to see
that the blue sky is still there too.
there are clouds and theblue sky is there too.
So it's got that perspective ofseeing the situation in context.
(42:08):
we can teach people morepresent moment awareness skills.
ACT uses a lot of metaphors.
a lot of us have learned 1 asa 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?
(42:29):
What's the taste in my mouth?
And going through those things is oftendone as a grounding exercise, but in
ACT, truly it's bringing us into thepresent moment through our senses.
So how can we engage through our senses?
What do we notice?
So I'll do this often onwalks with clients, just,
uh, do you hear those birds?
You notice that?
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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 thestressful conversation we were having,
and we can pause and notice thekids playing throwing rocks in the
river or something like that, right?
And so I love doing all of thispresent moment noticing, just even
(43:14):
just through the way I'm interactingwith somebody, through the way I'm
bringing curiosity to a situation.
And then can I start to say, huh, I wonderif you could get curious about that.
I'm a bit curious about this.
I'm noticing that.
I'm noticing when you talkabout that, shoulders come up.
Oh yeah, I'm noticing that too.
Well, what's that feel like?
(43:35):
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 withthis style of exploring together.
The stage show metaphor is this idea thatlike a theater performance, that there's
(43:59):
all of these things going on, but the,the light, the, what's that light called,
the main light, it's focused on, Onepart, it can focus, shift focus over here.
The thing that it's not inthe light hasn't gone away.
But we can shift our focus around.
How can we be more flexiblewith our attention?
Much like the spotlight, that'sthe word, much like the spotlight
(44:22):
can be moved around things.
We're not denying the other thingsexist, 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 moreflexible with their attention.
Helps them to, unhook a little bit.
(44:44):
It almost seems too easy, like peopleare often like, but how do I do this?
But it's all of the things, right?
It's these really subtleways of doing this.
it's better to be doing this ina practical discussion, you know,
kind of experiential ways ratherthan giving people a worksheet.
So that was being present, afew things in being present.
Then there's opening up.
(45:05):
so this is allowing thoughts,feelings, sensations.
There's acceptance and diffusion.
So acceptance generallyrefers 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, whenwe're hooked, when we notice that
we're hooked by difficult thoughtsand feelings, we first sit with it.
(45:29):
We will first notice it.
We have to notice it.
Sometimes we get right into avoidance anddon't even know why we're avoiding, can
we notice that we're hooked can we noticethat 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 onetiny towards move, awesome, like often we
(45:50):
don't need to do all these steps, right?
But maybe if just thinking it, showingit, noticing it, allowing it, showing it
kindness and compassion, and we're stilllike, boots glued to the ground and not
able to make a toward move, maybe wemight employ another unhooking strategy.
But the idea is to doas little as possible.
(46:11):
Sometimes we can just notice we'rehooked and move into a towards move,
an action, tiny action in line withour values, moving us in the direction
of showing up the way we want to.
but sometimes we need tobring in the other steps.
So this guy, Lou Laspregado, he sharesa lot in the ACTimate Simple group.
He asks these great questions, andthis does not need to be a workshop.
(46:34):
It can just simply be asking a person,what does your mind say about this?
And that's just creating a littlebit of space between the you that's
noticing, and the things that ourchatty mind can tell us about it.
Is there any space betweenyou and this thought?
thinking about this is kindof about diffusing from
(46:55):
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 aslike, yes, this is absolutely true.
Or is there a little bit of space, likewhere I can kind of notice, So can you
notice these thoughts as they come up?
Sometimes it's if this thought hada voice, what would it sound like?
(47:18):
So I've talked about if it's a judgingvoice, like, how do you name it?
Is it Judge Judy?
Is it, sometimes giving it a name of acharacter on, like Donkey from Shrek or
something like that, but figuring outwhat 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.
(47:42):
is it a familiar thought?
Maybe a name, the story.
that's a really powerful exercisethat's on the next slide.
can you still choose your actionsfreely in the presence of this thought?
I like that one too.
Can I have this thought?
I don't have to talkmyself out of this thought.
Can I do a towards move even inthe presence of this thought?
(48:06):
Naming this story is sometimes I'llget a person to pull out a piece
of paper that this kind of storykeeps coming up and coming up.
And the prompt is okay, writedown all of the thoughts that
keep coming up around this thing.
So when your mind's really givingit 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
(48:29):
that your mind does to you on this theme.
And the idea is you get them to readit and kind of really hook into it.
Then you say, if you were to turn thisinto a screenplay, or a movie or a
documentary, what would you name it?
What would you call this story?
And you get them to comeup with a creative name or
humorous name or something.
(48:50):
And so anytime that story comesup, you go, Oh, that's the,
I'm not good enough story.
Or that's the, mine was thehigh functioning hot mess story.
I know this one.
That's part of that collectionof stories that's familiar.
Can I name it?
Acknowledge it and move forwardwithout trying to convince myself
that I'm successful and organized?
(49:14):
Maybe.
I'm sometimes some daysfeel a bit successful.
Most days don't feel organized.
but I don't have to actually convincemyself of that to do the next thing.
Right.
analogies.
My mind is I had a client who came upwith 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?
(49:36):
And I was like, Oh, that was a good one.
Like that was her kind of recognizingher protective mind and then going,
but can I go do the thing anyways?
Can I meerkatting again.
She started to say that itwas neat when people can come
up with their own analogies.
They're so much more powerful.
you can name the part of your mind thatdoes this bit, and then opening up to
(49:58):
turning toward difficult feelings, right?
So with the thoughts, we're trying tounhook from them, diffuse from them.
The feelings we're turningtoward, can I hold it gently?
Can I create space for it?
Can I treat this difficultfeeling like a guest?
Can I stay with it?
Can I open up to it?
Can I breathe into it?
Make room for it?
(50:19):
Can you allow it to come andgo freely without a struggle?
So instead, like sometimes when we'retrying really hard to change it, suppress
it, get rid of it, we're holding on to it.
Whereas if we could kind of justbe A little bit looser with it.
Could we allow it to come and go?
Maybe it's can, we can noticeit feeling a little bit further
away, feeling a little bit closer.
(50:41):
And can we allow that with kindnessand gentleness rather than this
rigid, no, I need to stuff it down.
Are you willing to have thisfeeling as you do what matters?
Can you experience the nervousnessand still make that phone call?
Maybe we don't have to get rid ofnervousness before making a phone call.
(51:01):
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 inthat fear, fearful, is it more
anxious, overwhelmed, worried,inadequate, like kind of diving in
and exploring the subtleties withit is a way of sitting with it,
(51:22):
turning toward it, opening up to it.
It doesn't have to go away bydoing so, but by allowing it to
be there and be curious about it.
it's not as in control of us usually, Ilike this idea of holding a cactus, right?
It's uncomfortable if you squeezeit and try to squeeze it and shove
it and stuff it in your pocket,hide it, like it'll hurt you.
(51:44):
But if you can actually just hold itgently Can you notice a sensation or
feeling, can you notice, can you put ahand 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?
(52:06):
I'll just ask a ton of really abstractquestions about it in order to sit
there curiously with them, with it.
And it tends to be less incontrol the more aware we become
of it can we breathe into it.
So those are ways of making room fordifficult emotions and maybe sometimes
we're dipping in and out too, right?
(52:27):
Like maybe staying thereentirely 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 wayof being curious with it.
And then Do What Matters.
We've got this one, right?
(52:48):
the idea is acting effectively, committingto living in line with your values,
engaging in meaningful occupation.
So we're using thesetools 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 ofquestions about what's meaningful,
what's important, what do you care about.
(53:08):
And in ACT, they're kind of definingit 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 withyour time on the planet?
How do you want to treat yourselfand others in the world around you?
What makes you feel most alive?
(53:29):
What do you want to stand for in theface of this challenge or situation?
These are my least favoriteways 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?
(53:51):
What do you want to do with your time?
I love exploring it occupationally.
Looking at people, when people getmore, most jazzed about things.
A checklist or a card somehow just likemisses 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
(54:15):
for some people, maybe it's what thespeech at their 90th birthday might be,
or their retirement speech might speakto, if you continue to live the rest of
your life in line with your values, whatpeople might be able to say about you.
Based on their observations of youengaging in occupations, really.
if you won the lotto, howwould you spend your week?
Maybe not the first week, butit's a few months down the road.
(54:36):
What would you do?
Write about three people you admire, andthen you notice what they have in common.
Those tend to three things you value.
That's not going to fitfor everybody, though.
I like quote too.
Vitality is not a feeling, it's a senseof being fully alive and embracing
the here and now, regardless of howwe might be feeling in the moment.
(54:57):
So this idea that we can have vitalityat the same time as experiencing pain, or
discomfort, or fear, or anxiety, or otherdifficult experiences, and we be here in
the present now and embrace the moment.
I showed earlier that I like touse, I end up creating this ACTivate
(55:18):
Vitality planner, which you can geton Amazon, as a way of integrating ACT
with, how are we planning our time?
the idea is that values meetcommitted action that's engaging
in meaningful occupation.
So With people, with my clients, I'lloften give them a planner and each week
they bring it and we look at what arethe values, what's coming up this week.
(55:39):
What do you have booked?
What do you have planned?
Okay.
These are, if your values arethese, how are we going to work
some of that into your week?
And so getting people to make some planswith their values in mind, and then each
week reflecting on those and making notesand, incorporating a bit of gratitude.
That's not necessarily a part of ACT,but it's good for our mental health.
(56:00):
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 onWednesdays and don't make supper
and skip the walk with my friendsand what's going on Wednesdays.
How do I notice what's happening?
There's some small shifts I can make.
(56:20):
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 youthat 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 thedirection of doing what matters.
(56:41):
even when the fog rolls in, right?
The idea is thatlighthouse is your values.
And, even when it's dark, even whenit's stormy, can you use this lighthouse
to help you guide your actions in thatdirection, slowly, carefully, safely.
Sometimes we get hooked by these monstersunder the sea, reinforcing my phobia, but
(57:01):
we can use some of these ACT tools to helpus unhook, open up and make some moves
in the direction of living our values.
And this is the, kind of allof the bits of ACT together.
And this is OT.
How do we do what matters?
If you enjoyed this podcastand want a lot more.
(57:22):
Please join us in the Practical ACTfor OTs course, You could register
in January when they officiallylaunch it, or you can take advantage
of our upcoming black Friday promo.
Go to the show notes.
The website, in case you do, just wantto hear it in audio form, the website
is activatevitality.online/act-for-ots.
(57:45):
Everything's lower case.
Thanks for listening andas always be brave OTs.
ACT has this two mountains metaphor,this idea that you are on your mountain,
(00:06):
climbing your mountain, I can see thingsfrom where I stand on my mountain.
I'm climbing my mountain with my ownchallenges 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 onmy 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 thingsthat can help you navigate
(00:28):
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 andhumanize in a really authentic way that
includes a lot of therapeutic use of self.
It's another thing Ireally like about ACT.
just truly listening to the struggle,exploring it, not trying to change
(00:52):
their perception of it, just trulylistening actively and showing
compassion for it is that first step.
you're listening to the BraveOT Podcast with me, Carlyn Neek.
This podcast is all about empoweringoccupational therapists to step up,
level up, blaze some trails, and maybeengage in a little conscious rebellion.
(01:13):
In service of our profession, ourclients, our work, our businesses,
and living our mission wholeheartedly.
We are all about keepingit 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 ingourselves, and each other.
(01:34):
I hope you love
this episode!
You may have noticed that alot of my podcast conversations
are with other people.
I don't do a lot ofpodcasts that are solo.
And so this episode'sa little bit different.
It is actually an adaptation from apresentation I did last week in the
(01:56):
M H O T a collective facebook group.
That's the title?
M H O T.
~A Collectiveive I'lllink it in the show notes.
in that group, different peoplepresent, every month or two
and, it was my turn.
So I presented on using acceptanceand commitment therapy in your
occupational therapy practice.
(02:18):
Now the week of this releaseis the end of November, 2024.
And in the new year, I will be launchingmy Practical ACT for OTs course.
That's a clinical course.
I delivered once this year and I'mlooking forward to delivering it
again next year, but I'm going to beputting on a black Friday promo for
the Practical ACT for OTs course.
So I figured I might as well sharethis presentation as a podcast.
(02:41):
You'll notice at times I might bereferring to an image in the presentation
and I tried to remove parts thatwere really reliant on the image and
left in ones where I think you couldvisualize 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 slideswere actually taken from my
(03:04):
Practical ACT for OTs course.
So the Practical ACT for OTs courseis a few hours long and there are
discussion components in a Facebookgroup, so we can get immersed in.
the learning together, I can helpyou customize it to your population.
but this is just sort of a niceoverview taster to see if you like
the model of act and get a sense ofhow you might be able to integrate it
(03:27):
into your OT practice.
Now ACT is how you pronouncethe abbreviation for acceptance
and commitment therapy.
it's not A-C-T, it's ACT.
where I've quoted other people ormade references to other models.
I have tried to include that in the audio.
it definitely was in the slides andI'll make sure to give credit in
(03:48):
the show notes to anything that Imight not have mentioned as well, and
provide links to to related content.
If you're interested in beingnotified when the black Friday
promo of the Practical ACT for OTscourse is available, Follow that
link in the show notes as well.
Today's episode is sponsored byJane, a clinic management software
(04:09):
and EMR that helps you handle yourclinic's daily admin tasks so you can
free up your evenings and weekends.
The JANE team understands how preciousyour time is and recognizes that
charting Can often be the most timeconsuming admin task for Practitioners.
That's why they're here to help.
to save you from having to start yourchart notes from scratch, you can
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(04:31):
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Once you have a template you like, youcan choose to customize it further with
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To see how Jane can help you spendmore time doing what you love,
head to the show notes to grab thelink and book a personalized demo.
(04:52):
Or if you're ready to get started,you can use the code VITALITY at the
time of signup for a one month graceperiod applied to your new account.
And I have had a mental healthprivate 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
(05:14):
OTs, a lot of OT business owners inthe intersection of their personal and
professional development using ACT.
So I've developed a bunchof stuff related to ACT.
I created a course called PracticalACT for OTs last year, because the ACT
(05:34):
based coaching program that I offerisn'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 BlackFriday, but we'll be running it in the
new year so you guys can watch for that ifthis, inspires you to want to learn more.
(05:57):
what to expect in this workshop?
I hope to be able to give you anintroduction to ACT and connect
ACT concepts to our OT frameworks.
I'm going to go through the six coreprocesses, but focus a little bit
more on distilling them down to threethat are easier to remember, because
we can easily get caught up in thenames of these core processes and lose
(06:18):
the importance of the spirit of them.
We'll talk a lot more about language, andI'll have some suggestions for how we can
apply it in OT, apply it to ourselves tobuild our own psychological flexibility.
a few important notes, the ACT communityis really generous, so I'm sharing from
resources that I've gathered as I, as Ilearn, and so I didn't make much of this
(06:41):
stuff up, the places, the innovation comesfrom me linking it to OT and providing
that, crossover framework for you, butthat's certainly not even, necessarily
my own, it's just my own interpretation.
I try to give credit, to theoriginal source where I can.
If I've missed any credit,please let me know.
but do know that this stuff thatI'm sharing is all freely available.
(07:04):
I am a Canadian OT and I'm registeredwith 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 hereSo these are some of my occupations.
so there's that, mental healthfocused private practice that
I've had for a long time.
(07:24):
And then there's all these productsthat I offer under my umbrella of
Balance Works Personal Development.
So they're not falling in anOT umbrella because I connect
with people internationally.
For these things.
So I've got my ACTivate Vitalityprogram for OTs, and there's
my ACTivate Vitality Planner.
I also have the BRAVE OT Podcast.
(07:45):
And then last year I developed thePractical ACT for OTs course, which
these slides a portion of, but Iwas 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 Ialso do pottery on Fridays.
I love to garden.
(08:06):
I've got more than 100 houseplantsin my house, and so these are some
of the things I, I love to do,some of my meaningful occupations.
fundamentally, this is a quotefrom this article, ACT rests on a
fundamental premise that pain, grief,disappointment, illness, and anxiety are
(08:27):
inevitable features of all human life.
If you're out there fullyparticipating 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 tohelp people productively adapt to these
types of challenges and develop greaterpsychological flexibility, rather
(08:47):
than engaging in counterproductiveattempts to eliminate or suppress
undesirable inner experiences.
So the suffering, the struggles, theresistance to those painful experiences
that are inherent in life is wherea lot of our suffering comes from.
building psychological flexibilityis the goal of ACT so that we
(09:09):
can fully participate in life.
this is achieved through committed pursuitof valued life areas and directions, even
in the face of natural, a natural desireto escape or avoid painful and troubling
experiences, emotions, and thoughts.
ACT is transdiagnostic, so it's notnecessarily oh, this is the best thing for
depression or the best thing for anxiety.
(09:32):
It works for people with all sortsof conditions and it's more process
focused, flexibly delivered, with thisgoal of helping people connect with
doing what's most important to them.
I love that about ACT and how itoverlaps 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,
(09:55):
and what's most meaningful.
And we use this to supportparticipating in the things that
will enrich or enhance our lives.
Even in the presence ofdifficult inner experiences,
sensations, thoughts, feelings.
ACT teaches us mindfulness skillsthat enable us to handle these
difficult inner experiences, thoughts,feelings, sensations, memories, etc.
(10:16):
effectively, so that we can engagefully in what we are doing and
appreciate and savor the meaningfuland fulfilling aspects of life.
So it's not to get rid of symptoms.
That's the main point here.
We're actually making room forthose symptoms of discomfort and
trying to struggle less with them,change our relationship to them.
(10:36):
a lot of the lingo we use, obviouslythis isn't about memorizing it,
but to Get a sense, get the senseof what the vibes are of ACT.
It's about being present, aware,responding flexible, about acceptance.
Diffusion versus fusion, when we'refused to a difficulty inner experience.
We're trying to diffuse, we'renot, we're less stuck to them.
(10:58):
kindly, commuted action, towards,moves away, moves, savor.
There's a lot of talk aboutflavoring 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.
(11:18):
If you could just share creditthat you got this from this
presentation, that would be great.
I'd prefer you not share a whole slidedeck or anything, but if sharing an
image like this is helpful, by allmeans, you're welcome to do my journey
to ACT was first learning about CBT.
in my mental health practice, I amoften seeing people with depression,
(11:39):
anxiety, some trauma, some chronichealth conditions, and generally they're
off work because of these things.
And I'm being funded by a third partyto help them return to life, and
returning to life will facilitatemore likelihood of returning to work.
And so I was often asked to do behavioralactivation, which is a component of CBT
(12:00):
and ultimately Helping people, engage inactions, that are important to them and
manage the difficult thoughts and feelingsthat are obstacles to taking action.
So we're we're working on, difficultfeelings, difficult thoughts, and
working on actions to essentiallyhelp people participate in life, but,
improved actions could improve thoughtsand feelings, that sort of thing.
(12:23):
And I always felt like with the toolsI 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 difficultthoughts, 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 dealingwith somebody with trauma and we're
(12:45):
doing some work to expose them to areasthat make them anxious, having negative
thoughts is probably pretty reasonable.
And, and can we, and we still proceed evenin the presence of those negative thoughts
is often what I was thinking and CBT toolsI had, just didn't, it felt like we were
trying to make those negative thoughtspositive more often and didn't love that.
(13:08):
So I was often kind of skipping thatpart, 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'sa part of a third wave of cognitive
and behavioral therapies, along withdialectical behavioral therapy or
(13:31):
DBT, mindfulness based CBT, functionalanalytic therapy, or metacognitive
therapy, this third wave of cognitiveand behavioral therapies is more
about emphasizing the shift in theperson's relationship to a thought
or emotion rather than the content.
That felt a little bit more validatingand aligned for the work that I was
(13:51):
doing and what I was experiencing whenI was out there in the world trying to
help people engage in these occupationsand navigate the difficulties that
were coming up when they were doing so.
So in ACT, we are not focusedon changing the situation,
the thought or the feeling, we'refocusing on enabling or facilitating
meaningful occupational engagementby changing how we relate to the
(14:15):
situation, thought, or feeling.
So it's changing the relationshipto it rather than feeling
better or thinking better.
It's, can we make that less of anobstacle in our way of the doing?
They don't use occupational languagein the ACT models, but so this is where
(14:35):
I'm building that, that bit of a bridge.
They're talking more aboutbehaviors or the doing of
engaging in meaningful activities.
Over here, we've got Values and CommittedAction, which in our OT language is
Engagement and Meaningful Occupation.
And over here, we work on Navigating theDifficult Inner Experiences, the Thoughts
(14:56):
and Feelings, through four conceptsthat are all based in Mindfulness.
so if you've done any mindfulnesstraining, these will feel familiar, right?
We're being here in the present moment.
We're opening up with acceptance to whatis, we're defusing, we're making it less
that we're like stuck to this thing, thisdifficult inner thought, and then there's
(15:18):
a part of us that can observe ourselvesdoing this, give us some context.
just to frame that, this idea ofthere are these six core processes.
Four of them are mindfulness based andtwo of them are doing what matters.
this feels really aligned already.
these are some tools that I can doto help facilitate this occupational
(15:38):
engagement in the face of theseobstacles of difficult inner experiences.
if you've studied mindfulness in anyother context, like a lot of us have
learned mindfulness contexts fromgoing to yoga or listening to guided
meditations or things like that,mindfulness is not necessarily meditation.
(15:58):
Mindfulness is not intendedfor relaxation specifically.
It's about this flexibility of attention.
That we can shine that light fromhere to there and have that ability to
move our focus around with thoughts.
in ACT, it's described as a set ofskills for effective living that
involves paying attention with openness.
(16:22):
Curiosity, kindness, flexibility.
It's the art of living consciously, aprofound way to enhance our psychological
resilience and increase life satisfaction.
We're present in these pleasurableexperiences or joyful experiences.
we get a lot more fulfillmentif we're in these meaningful
(16:44):
conversations with people, right?
There is that increase in satisfaction,but also having that, psychological
flexibility or resilience, wecan 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.
(17:06):
So thinking about this is theCMOP-E, and thinking about ACT
in relationship to that, right?
We think about the, person, withthese components, the physical,
affective, cognitive, spiritual self,the person, then the occupations,
and then the environments.
and we care as OTs about engagementin the meaningful occupations.
(17:28):
ACT is a helpful approach to reducethe impact of obstacles to engagement.
ideally, we're using ACT to make thosedifficult internal experiences, the
thoughts and feelings that are difficult,the sensations, make those less of
an obstacle to doing the things, butalso helping us to accept, change, or
(17:51):
adapt situations in the environment.
helping us to focus on doing whatmatters, move toward doing what matters.
That's that occupational engagement.
So ACT can be a tool that we can usewithin the context of this model.
Thinking about MOHO, I don't use mohoas readily, but as I started to try to
(18:12):
piece together thinking moho helps usbetter understand how human occupation
is motivated, patterned, and performedwithin the context of our environment.
And so ACT can be a helpful approach toaddressing obstacles to participation,
by working with volition, habituation,and building performance capacity.
(18:33):
So again, building our capacity to rollwith those things that are coming up,
connect more deeply to our values andwhat's most important to us, and commit
to that action by building a more flexibleresponse to the challenges that come up.
And then I like it alongsideKawa, particularly, I've been
(18:54):
learning more about Kawa this year.
And, I won't go through thewhole Kawa model, but there's
this idea that the river is yourlife flow and your priorities.
And that the banks represent theenvironments and contexts of that
social and physical environment.
the rocks are obstacles and challenges.
(19:15):
The driftwood are influencing factorsthat could be positive, they could be
challenging, they could be facilitating.
and the spaces are opportunitiesfor enhancing flow.
So ACT helps us enhance the flow withour clients by helping us navigate
around the obstacles that come up.
oh, there's some rocks.
How do we not keep rammingagainst the rock and trying to
(19:39):
move the boulder and instead seethat there is a path around it?
And we allow the rock to be there.
can we allow that difficult challengethat's come up or feeling or thought,
sensation that's come up that feelslike it's in the way of doing and
see that and still carry on withouttrying to shove it out of the way.
(19:59):
I like the, some of that synergyin there, that sort of, a lot of
mindfulness stuff is based in Easternphilosophy 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, asan occupational therapist,
(20:22):
What's the occupational goal?
do we need to measure the person's,psychological flexibility, the
outcome that we're trying to measurewith ACT, or do we more so need to
see how they're doing with meetingthe goal, the occupational goal?
So think about what theperson's trying to do.
We always start with thatin ACT, not just in OT.
(20:43):
What is the thing thatthey're trying to do?
And then working backward to, okay, wecan use ACT as a modality to support how
we're managing the internal obstacles.
So I tend to use that occupationaltherapy, occupational engagement as the
outcome measure, not so much measuring Themodality, the, details of the modality.
(21:04):
There are a lot of ACTbased 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'remeasuring the success of a goal?
ACT encourages us to be alot more flexible than an all
or nothing approach to it.
what tools do you use to addressany obstacles that are coming
(21:26):
up, and would other measuresserve that occupational goal?
The focus is not to getrid of distress or pain.
The focus is to get people doing stuff.
That's important to them.
Why measure their anxiety ifit's not about the anxiety?
It's about doing living life.
in some cases you would liketo and so there are lots of
(21:46):
assessments out there for it.
I'm just not going toinclude them all here.
thinking about, discussing, you know, thegoal attainment, how did you do last week
with that thing you were going to try?
Maybe it's logs or routines or checklistsor apps where you're sharing your
towards moves to the things that you'redoing that are moving you toward that.
(22:08):
If you like SMART goals, they'renot my favorite, but if that's
how you go, did they meet thegoal or didn't they meet the goal?
I like something that's a little bitmore embracing the gray in between.
And so something like the COPM couldbe a nice one where you're measuring
how they would rate themselveson a scale for those things.
And there are ACT specific, ACT processmeasures online really available.
(22:33):
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 lookslike 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 daywas to ride our bikes from Canmore
(22:56):
to Banff, have lunch, and ride back.
And We set out on our mountainbikes and I drank my, all of my
water in the first half hour.
I could not breathe.
It was a very gradual inclinethat I was not fit for.
We stopped somewhere alongthe way and we looked out.
We had a lovely day.
We laughed.
(23:17):
we didn't make it to Banff.
We turned around and headedback to Canmore and had a
beer in a pub at some lunch.
And if we were measuring by aSMART goal of riding our bikes
to Banff and back, having a niceday, 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.
(23:37):
We're lucky that way.
We live close to Banff, only an hour away.
But we did have a reallynice day connecting.
So the value of authenticconnection, being in nature, doing
something meaningful together,I've met all of those goals.
this was a fully towards move checkthing, not necessarily a smart goal check.
(23:58):
So I tend to use, planner pages,which actually led me to create my
ACTivate Vitality planner, which I'llshow you a little bit more later.
but it came from this, doing this withmy clients, looking at the week, what
are the things that are important?
What are the values thatthey want to connect to?
for me, it's like nature,creativity, authentic connection.
Those tend to go there.
(24:19):
And how can I plan my week withthose priorities and values in mind?
How am I checking in with that?
So I often do that with clients, whereget them to make plans that align
with values and then reflect on howthey connected with their values.
And then we can do that together.
(24:39):
So how, looking at ordering someseeds, 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 somegratitude for this gorgeous sunrise
and spending more time outdoors andwith my mom, authentic connection.
(25:00):
So having these reflections in how we'reconnecting our day to day occupations
with our values and any sort of measuresof, Moving in that direction, I love to
celebrate those with my clients, whetherit was the full goal they had or not.
what are these things we're doingin ACT to facilitate engagement in
(25:21):
meaningful activities, connectingto values oriented actions?
These are six core processes in ACT.
We could easily get caughtup in the words of them.
It's less important than this ideathat we're opening up, we're being
present, we're doing what matters.
And so that opening up, or opening up todifficult inner experiences, so that can
(25:44):
look like accepting difficult emotions,opening up to what is, turning toward
it rather than trying to avoid and shoveaway, defusion, not being fused to a line
of thinking that isn't facilitating ordoing what matters, so defusion, trying
to unhook from that, Being present.
So connecting with that present moment,being here now, engaging in that part
(26:08):
of you that can observe, be flexible,gain perspective, the part of you that
observes you thinking, doing, feeling.
So this is being presentand 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
(26:29):
up in all of the six things at thispoint, is helpful, but I wanted you
to see that they came from six downto three for accuracy, of course.
So remember this, open up,be present, do what matters.
We allow the difficult thoughtsand feelings to be present.
We don't fight them.
We don't avoid them.
We don't resist them.
There's a power in nottrying to chase away.
(26:51):
It's sort of like not being afraid ofthe dark allows you to do more things.
And, so opening up, beingpresent or being aware.
So we teach people experientially howto do this through some ACT skills.
But these are the main thingsthat we're doing these things
so we can do this thing,
which is very OT aligned.
(27:11):
So when do we choose ACT?
The idea is that when a person is notengaging in an occupation that they value
because they are hooked by difficult innerexperiences, thoughts, feelings, emotions,
sensations, memories, urges, impulses,images, and the avoidance isn't workable.
(27:33):
So we can do a lot of avoiding,and if it's manageable, like for
instance, a I have a phobia aboutswimming 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.
(27:55):
I live in the prairies.
it does get me maybe if I wantedto go swim in a lake, but I can
go on a paddleboard, that's fine.
So I don't really need to intervene onthat unless it was becoming unworkable
that I wasn't swimming in deep dark water.
So there needs to be that match betweenthe person not doing the thing because
they're resisting this inner experienceand that's not workable in their life.
(28:20):
The difficulty in our experience is notthe problem, the symptom, essentially
that symptom of fear or stuck ona thought, that's not the problem.
It's responding to the thought or feelingin 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 thingand then not doing it and stuck.
(28:41):
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 partybecause I'm feeling anxious.
I can't sign up for yogabecause I'm not flexible.
I can't give a, a toast at yourwedding because I'm not a good speaker.
I can't start a business.
I couldn't handle the judgment of failure.
(29:02):
I can't teach an ACT coursebecause I'll mess it up.
I don't know enough.
I can't ask the person on a datebecause 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 Christmasdinner, I'm too overwhelmed.
I can't go to the beach with my grandkidsbecause I can't stand the feeling of sand.
(29:25):
Workability, again, we only interveneif the avoidance is excessive,
rigid, or getting in the way ofliving 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,
(29:45):
maybe numbing with our phone.
A lot of us do ournumbing this way, right?
that can be shutting down.
that can be jumping to aconclusion and taking action.
It could be always busy, can'tbe alone with my thoughts.
Could be Little Miss Sunshine, I'mliving the dream, good vibes only,
stay positive, we're gonna deny all thenegative things, all of the difficult
(30:08):
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 thatI coach, that No, I can't start that
thing until I've taken 10 courses onit, made 10 plans, taken all of those.
Then I could make one first towards move,and be being hooked by that thought of, I
(30:31):
have to know it all before I take a step.
So we only have intervene again, ifthe avoidance is excessive, rigid and
getting in the way of living a fulland meaningful life with our values.
So kind of back to the situation itself,sensation itself, feeling itself it
may look like that's creating thesuffering, but ultimately, this is not so.
(30:55):
Your resistance to it, you're stayingstuck 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 ACTtraining from Russ Harris.
I find his stuff really helpful.
There's this book, ACT Made Simple.
(31:15):
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 acertification 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 regulatedhealth professional to use ACT, right?
You could use it if you're ateacher or a coach or a personnel
(31:35):
trainer, ACT is something theywant people to have easy access to.
But giving Russ Harris credit forthis 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 gethooked and make away moves.
(31:57):
Sometimes we can be moving towardwhat's meaningful, making toward moves.
So toward moves are living our lifein line with our values, showing up
as the person we want to be, doingthe 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, orwe can do that in little ways.
(32:17):
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 becausewe'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
(32:42):
thoughts, feelings themselves.
So we are not treating those symptoms.
I'll say it again.
We are helping people be less stuck bythem so they can go and do the thing.
People do tend to feel betterwhen 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 targetingor reducing symptoms directly.
(33:07):
So away moves were hooked, towardmoves were unhooked, living your
values fully, intentionally doing whatmatters, behaving effectively, or the
opposite, acting ineffectively, not whoyou are, how you want to be, not doing
the things that matter most to you.
So the greater our ability to unhookfrom difficult thoughts and feelings
and choose towards moves, the greaterour quality of life and the greater
(33:31):
our health, happiness, and wellbeing.
That's kind of cool.
And doesn't that feel OT?
So this idea is that sufferingis 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 artof handling our suffering."
in ACT, we always want tobe clear about the goal.
(33:53):
What's the occupationalgoal, or they might call it a
behavioral goal in psychologylanguage, not symptom reduction.
With our built in focus on occupationalgoals, this is kind of a given, right?
We're already doing this.
modality to facilitatethis built in outcome.
So we help people explore the struggle.
(34:14):
We listen, we validate, we askgood 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 beenreally difficult," right?
Like just that compassionate waywe want to respond to people.
(34:36):
It's human.
It sounds like your mind isa lot like my mind does that.
Like, I can hear it saying thatyou're not good enough and that you
should have done this, you shouldhave 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,
(34:59):
climbing your mountain, I can see thingsfrom where I stand on my mountain.
I'm climbing my mountain with my ownchallenges and navigating new things that,
some of them I'm good at, someof them I need to learn about.
You can see different things onmy 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 thingsthat can help you navigate
(35:22):
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 andhumanize in a really authentic way that
includes a lot of therapeutic use of self.
It's another thing Ireally like about ACT.
just truly listening to the struggle,exploring it, not trying to change
(35:45):
their perception of it, just trulylistening actively and showing
compassion for it is that first step.
Often that makes allthe difference, right?
We know that in talking to people.
And then we explore the workability of it.
So what have you tried so far toavoid, like avoidance seems to be
the problem, to avoid, get rid ofthose unwanted thoughts or feelings.
(36:09):
There's this acronym from the RussHarris ACT training, Connecting the Dots.
So you might say, are there things youdo for distraction, like some people
might use TV or loud music or keepingthemselves really busy, scrolling, gaming.
Maybe it's opting out, are you sayingno to things, people, places, situations
that might remind you of the thingor trigger some of those feelings.
(36:33):
you can ask about, are thereany thinking strategies you're
using when this comes up.
Maybe it's positive thinking.
That's actually listed in the ACTstuff as a way that we're trying
to avoid the real experience byflipping it into something positive
or, which isn't all terrible, right?
it's definitely a valid option.
But if someone is trying to makeeverything all positive, there's
(36:55):
some avoidance happening there.
Maybe you're debatingyour challenging thoughts.
And this is like you're exploringthis with the client, like
you're asking them these things.
Are there any substances, otherstrategies you might be using?
So you can look at these differentthings that people are doing to
avoid or get rid of these things.
And then you explore kind of likeOkay, so you've been having this
(37:18):
experience, you retell the story, right?
And, and if this thing that theydescribe stays in charge of what you
do, makes choices for you, dictatesyour actions, kind of says, nope,
you can't go to that, you got to dothis, you got to do that, what would
life look like in five or ten years?
Does this move you closer toliving the life you want, showing
(37:40):
up with these things and, doingthe things that bring you joy?
Would you be willingto try a different way?
So this is sort of gettingsome informed consent for a
different way to approach it.
and having this sense of, you candraw this out on the choice point, but
trying to explore that what they'vebeen trying so far hasn't worked, right?
They've been hooked over here.
(38:02):
so maybe it's an OT who wants tostart 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 andfeelings a person might be having.
What if I fail?
And I actually draw thisout with them, right?
If we're doing this online, I willdo it on Canva, or like a whiteboard.
But if it's in person, I'mdoing it on a piece of paper.
(38:25):
And so the difficult thoughts andfeelings 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 anybodyabout this idea I have.
(38:47):
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 theirvalues, making a towards move.
(39:08):
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 cleareron 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 themanageable action you can take.
What's the tiniest little thing?
(39:29):
Maybe it's telling justone person about it.
Is that the tiniest next thing, opening upto 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'ssort of shades of success?
Can we explore that?
How would you handle that?
can we get curious about it ratherthan, I can't, I might, it might be
(39:53):
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 thoseskills of being more present and
aware, being able to sit with thosedifficulties, 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,
(40:15):
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, aneasy to read book that I'll
(40:36):
share with clients quite often.
But maybe you learn something like thatand 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 somemore specific tools in these three areas.
we're starting with this be presentone, be aware, engaged in what you're
doing, present moment awareness.
(40:59):
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'ssuper 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'sproblem solving, it's past or future
(41:21):
oriented, it's rarely present.
And there's the part ofyou that can observe that.
There's that observer.
It's in the present moment.
It's nonjudgmental.
It's aware of our externaland internal worlds.
It's conscious.
it has perspective.
So the, this book, The Boy, TheMole, The Fox and The Horse, he says,
(41:43):
Those are dark clouds, said the boy.
Yes, but they will moveon, said the horse.
The blue sky above never leaves.
So I feel like the horsehere is that observer.
You can see the boy is seeing, ah, there'sdark clouds and the horse is able to see
that the blue sky is still there too.
there are clouds and theblue sky is there too.
So it's got that perspective ofseeing the situation in context.
(42:08):
we can teach people morepresent moment awareness skills.
ACT uses a lot of metaphors.
a lot of us have learned 1 asa 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?
(42:29):
What's the taste in my mouth?
And going through those things is oftendone as a grounding exercise, but in
ACT, truly it's bringing us into thepresent moment through our senses.
So how can we engage through our senses?
What do we notice?
So I'll do this often onwalks with clients, just,
uh, do you hear those birds?
You notice that?
(42:49):
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 thestressful conversation we were having,
and we can pause and notice thekids playing throwing rocks in the
river or something like that, right?
And so I love doing all of thispresent moment noticing, just even
(43:14):
just through the way I'm interactingwith somebody, through the way I'm
bringing curiosity to a situation.
And then can I start to say, huh, I wonderif you could get curious about that.
I'm a bit curious about this.
I'm noticing that.
I'm noticing when you talkabout that, shoulders come up.
Oh yeah, I'm noticing that too.
Well, what's that feel like?
(43:35):
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 withthis style of exploring together.
The stage show metaphor is this idea thatlike a theater performance, that there's
(43:59):
all of these things going on, but the,the light, the, what's that light called,
the main light, it's focused on, Onepart, it can focus, shift focus over here.
The thing that it's not inthe light hasn't gone away.
But we can shift our focus around.
How can we be more flexiblewith our attention?
Much like the spotlight, that'sthe word, much like the spotlight
(44:22):
can be moved around things.
We're not denying the other thingsexist, 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 moreflexible with their attention.
Helps them to, unhook a little bit.
(44:44):
It almost seems too easy, like peopleare often like, but how do I do this?
But it's all of the things, right?
It's these really subtleways of doing this.
it's better to be doing this ina practical discussion, you know,
kind of experiential ways ratherthan giving people a worksheet.
So that was being present, afew things in being present.
Then there's opening up.
(45:05):
so this is allowing thoughts,feelings, sensations.
There's acceptance and diffusion.
So acceptance generallyrefers 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, whenwe're hooked, when we notice that
we're hooked by difficult thoughtsand feelings, we first sit with it.
(45:29):
We will first notice it.
We have to notice it.
Sometimes we get right into avoidance anddon't even know why we're avoiding, can
we notice that we're hooked can we noticethat 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 onetiny towards move, awesome, like often we
(45:50):
don't need to do all these steps, right?
But maybe if just thinking it, showingit, noticing it, allowing it, showing it
kindness and compassion, and we're stilllike, boots glued to the ground and not
able to make a toward move, maybe wemight employ another unhooking strategy.
But the idea is to doas little as possible.
(46:11):
Sometimes we can just notice we'rehooked and move into a towards move,
an action, tiny action in line withour values, moving us in the direction
of showing up the way we want to.
but sometimes we need tobring in the other steps.
So this guy, Lou Laspregado, he sharesa lot in the ACTimate Simple group.
He asks these great questions, andthis does not need to be a workshop.
(46:34):
It can just simply be asking a person,what does your mind say about this?
And that's just creating a littlebit of space between the you that's
noticing, and the things that ourchatty mind can tell us about it.
Is there any space betweenyou and this thought?
thinking about this is kindof about diffusing from
(46:55):
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 aslike, yes, this is absolutely true.
Or is there a little bit of space, likewhere I can kind of notice, So can you
notice these thoughts as they come up?
Sometimes it's if this thought hada voice, what would it sound like?
(47:18):
So I've talked about if it's a judgingvoice, like, how do you name it?
Is it Judge Judy?
Is it, sometimes giving it a name of acharacter on, like Donkey from Shrek or
something like that, but figuring outwhat 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.
(47:42):
is it a familiar thought?
Maybe a name, the story.
that's a really powerful exercisethat's on the next slide.
can you still choose your actionsfreely in the presence of this thought?
I like that one too.
Can I have this thought?
I don't have to talkmyself out of this thought.
Can I do a towards move even inthe presence of this thought?
(48:06):
Naming this story is sometimes I'llget a person to pull out a piece
of paper that this kind of storykeeps coming up and coming up.
And the prompt is okay, writedown all of the thoughts that
keep coming up around this thing.
So when your mind's really givingit 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
(48:29):
that your mind does to you on this theme.
And the idea is you get them to readit and kind of really hook into it.
Then you say, if you were to turn thisinto a screenplay, or a movie or a
documentary, what would you name it?
What would you call this story?
And you get them to comeup with a creative name or
humorous name or something.
(48:50):
And so anytime that story comesup, you go, Oh, that's the,
I'm not good enough story.
Or that's the, mine was thehigh functioning hot mess story.
I know this one.
That's part of that collectionof stories that's familiar.
Can I name it?
Acknowledge it and move forwardwithout trying to convince myself
that I'm successful and organized?
(49:14):
Maybe.
I'm sometimes some daysfeel a bit successful.
Most days don't feel organized.
but I don't have to actually convincemyself of that to do the next thing.
Right.
analogies.
My mind is I had a client who came upwith 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?
(49:36):
And I was like, Oh, that was a good one.
Like that was her kind of recognizingher protective mind and then going,
but can I go do the thing anyways?
Can I meerkatting again.
She started to say that itwas neat when people can come
up with their own analogies.
They're so much more powerful.
you can name the part of your mind thatdoes this bit, and then opening up to
(49:58):
turning toward difficult feelings, right?
So with the thoughts, we're trying tounhook from them, diffuse from them.
The feelings we're turningtoward, can I hold it gently?
Can I create space for it?
Can I treat this difficultfeeling like a guest?
Can I stay with it?
Can I open up to it?
Can I breathe into it?
Make room for it?
(50:19):
Can you allow it to come andgo freely without a struggle?
So instead, like sometimes when we'retrying really hard to change it, suppress
it, get rid of it, we're holding on to it.
Whereas if we could kind of justbe A little bit looser with it.
Could we allow it to come and go?
Maybe it's can, we can noticeit feeling a little bit further
away, feeling a little bit closer.
(50:41):
And can we allow that with kindnessand gentleness rather than this
rigid, no, I need to stuff it down.
Are you willing to have thisfeeling as you do what matters?
Can you experience the nervousnessand still make that phone call?
Maybe we don't have to get rid ofnervousness before making a phone call.
(51:01):
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 inthat fear, fearful, is it more
anxious, overwhelmed, worried,inadequate, like kind of diving in
and exploring the subtleties withit is a way of sitting with it,
(51:22):
turning toward it, opening up to it.
It doesn't have to go away bydoing so, but by allowing it to
be there and be curious about it.
it's not as in control of us usually, Ilike this idea of holding a cactus, right?
It's uncomfortable if you squeezeit and try to squeeze it and shove
it and stuff it in your pocket,hide it, like it'll hurt you.
(51:44):
But if you can actually just hold itgently Can you notice a sensation or
feeling, can you notice, can you put ahand 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?
(52:06):
I'll just ask a ton of really abstractquestions about it in order to sit
there curiously with them, with it.
And it tends to be less incontrol the more aware we become
of it can we breathe into it.
So those are ways of making room fordifficult emotions and maybe sometimes
we're dipping in and out too, right?
(52:27):
Like maybe staying thereentirely 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 wayof being curious with it.
And then Do What Matters.
We've got this one, right?
(52:48):
the idea is acting effectively, committingto living in line with your values,
engaging in meaningful occupation.
So we're using thesetools 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 ofquestions about what's meaningful,
what's important, what do you care about.
(53:08):
And in ACT, they're kind of definingit 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 withyour time on the planet?
How do you want to treat yourselfand others in the world around you?
What makes you feel most alive?
(53:29):
What do you want to stand for in theface of this challenge or situation?
These are my least favoriteways 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?
(53:51):
What do you want to do with your time?
I love exploring it occupationally.
Looking at people, when people getmore, most jazzed about things.
A checklist or a card somehow just likemisses 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
(54:15):
for some people, maybe it's what thespeech at their 90th birthday might be,
or their retirement speech might speakto, if you continue to live the rest of
your life in line with your values, whatpeople might be able to say about you.
Based on their observations of youengaging in occupations, really.
if you won the lotto, howwould you spend your week?
Maybe not the first week, butit's a few months down the road.
(54:36):
What would you do?
Write about three people you admire, andthen you notice what they have in common.
Those tend to three things you value.
That's not going to fitfor everybody, though.
I like quote too.
Vitality is not a feeling, it's a senseof being fully alive and embracing
the here and now, regardless of howwe might be feeling in the moment.
(54:57):
So this idea that we can have vitalityat the same time as experiencing pain, or
discomfort, or fear, or anxiety, or otherdifficult experiences, and we be here in
the present now and embrace the moment.
I showed earlier that I like touse, I end up creating this ACTivate
(55:18):
Vitality planner, which you can geton Amazon, as a way of integrating ACT
with, how are we planning our time?
the idea is that values meetcommitted action that's engaging
in meaningful occupation.
So With people, with my clients, I'lloften give them a planner and each week
they bring it and we look at what arethe values, what's coming up this week.
(55:39):
What do you have booked?
What do you have planned?
Okay.
These are, if your values arethese, how are we going to work
some of that into your week?
And so getting people to make some planswith their values in mind, and then each
week reflecting on those and making notesand, incorporating a bit of gratitude.
That's not necessarily a part of ACT,but it's good for our mental health.
(56:00):
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 onWednesdays and don't make supper
and skip the walk with my friendsand what's going on Wednesdays.
How do I notice what's happening?
There's some small shifts I can make.
(56:20):
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 youthat 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 thedirection of doing what matters.
(56:41):
even when the fog rolls in, right?
The idea is thatlighthouse is your values.
And, even when it's dark, even whenit's stormy, can you use this lighthouse
to help you guide your actions in thatdirection, slowly, carefully, safely.
Sometimes we get hooked by these monstersunder the sea, reinforcing my phobia, but
(57:01):
we can use some of these ACT tools to helpus unhook, open up and make some moves
in the direction of living our values.
And this is the, kind of allof the bits of ACT together.
And this is OT.
How do we do what matters?
If you enjoyed this podcastand want a lot more.
(57:22):
Please join us in the Practical ACTfor OTs course, You could register
in January when they officiallylaunch it, or you can take advantage
of our upcoming black Friday promo.
Go to the show notes.
The website, in case you do, just wantto hear it in audio form, the website
is activatevitality.online/act-for-ots.
(57:45):
Everything's lower case.
Thanks for listening andas always be brave OTs.
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