nieuwsma, j.a. (june 2016). . presented at the christian ...nieuwsma, j.a. (june 2016). consider it...
TRANSCRIPT
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Consider it Pure Joy:Approaching Suffering with Acceptance and
Commitment to Care for Self and Others
Jason A. Nieuwsma, PhDAssociate Professor, Department of Psychiatry and Behavioral Sciences,
Duke University Medical CenterDurham, NC
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Objectives
1. Articulate core evidence-based principles from acceptance and commitment therapy (ACT) that can intersect with chaplaincy.
2. Identify how ACT principles can complement chaplains’ commitments to journeying with those who suffer.
3. Use ACT practices to improve care of self and others.
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
I undertook great projects: I built houses formyself and planted vineyards. I made gardens and parks and planted all kinds of fruit trees in them. I made reservoirs to
water groves of flourishing trees. I bought male and female slaves and had other slaves who were born in my house. I also owned more herds and flocks than anyone in Jerusalem before me. I amassed silver and gold for myself, and the treasure of kings and provinces. I acquired male and female singers, and a harem as well—the delights of a man’s heart. I became greater by far than anyone in Jerusalem before me. I denied myself nothing my eyes desired; I refused my heart no pleasure…
Yet when I surveyed all that my hands had done and what I had toiled to achieve, everything was meaningless, a chasing after the wind; nothing was gained under the sun.- Ecclesiastes
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
“The single most remarkable fact of
human existence is how hard it is for
human beings to be happy.”
- Steven C. Hayes
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Why do we suffer?
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
psychosociological underbrush. The physician should not be saddled with problems that have arisen from the abdication of the theologian and the philosopher”…I do not accept such a premise.
- George Engel, Science (1977)
At a recent Rockefeller Foundation seminar on the concept of health, one authority urged that medicine "concentrate on the 'real' diseases and not get lost in the
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
How do we stop suffering?
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Beck Depression Inventory-II(BDI-2)
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
What success looks like on BDI-2
0
5
10
15
20
25
30
1 6 12 24
BD
I-2
Week
Treatment Control
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Acceptance & Action Questionnaire-II(AAQ-2)
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
What success looks like on AAQ-2
0
5
10
15
20
25
30
1 6 12 24
AA
Q-2
Week
Treatment Control
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
What does “success” look like in faith?
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Control as a means to achieving success
CAN’T CONTROL
Examples
13
CAN CONTROL
Examples
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Tug of War with a Monster
What to do? Drop the rope!
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
“When suffering knocks at your door and you say there is no seat for him, he tells you not to worry because he has brought his own stool.”
- Chinua Achebe
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Pain vs. Suffering
Clean discomfort
What comes with living life.
Examples:
Loss
Traumatic experience
Negative life event
Illness
16
Dirty discomfort
Created by efforts to control “clean”
Examples
Substance abuse
Isolation
Relationship conflicts
Illness
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Quicksand
“DON’T PANIC” Douglas Adams, The Hitchhiker’s
Guide to the Galaxy
The “gut reaction”
The “ACT reaction”
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
“When we are no longer able to change a situation,we are challenged to change ourselves.”– Victor Frankl
Chinese Finger Trap
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Paradox
ACT
Being accepting of negative leads to feeling more positive.
19
Faith tradition examples:
The last shall be first.
Lose your life to gain it.
Reality is not reality.
For neither is the aim “happiness” or “feeling
good,” and yet that effect frequently occurs.
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Acceptance and Commitment Therapy (ACT)
What is ACT?
Related to CBT family of treatments
Acceptance: Willingness to experience
Commitment: Living in line with values
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Waves of Psychotherapy
1st
Wave2nd
Wave3rd
Wave
Behavioral Cognitive MBCT, CBASP, ACT, DBT, etc.
CBT / EBP Beach
Alcohol, nudity, & psychoanalysis are prohibited.
Cognitive-Behavioral^
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
ACT Defined
The ACT counselor works to help the patient accept internal events (thoughts, emotions, memories, and sensations) while also helping the patient to make and keep behavioral commitments that reflect the patient’s personal values.
Oversimplified, you might say: hold and move. “Hold” your experience, whatever it may be, and “move” forward in your life.
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
ACT: Is there “Value-Added?”
ACT challenges conventional cognitive-behavioral
approaches to…
The assumption of “healthy normality”
The patient/provider dichotomy
The role of thoughts
The significance of values
Measurement
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Why ACT in Chaplaincy?
Evidence-based* 131 RCTs show ACT ≥ TAU (May 2016)
Works for: Bio–Psycho–Social Health
Principle-based Flexible theory, not fixed protocol
Not confined to particular disorder
Synergistic with faith perspectives Values-centric
Embraces major religious practices
Human flourishing, not absence of disease
A broad tent Providers
Patients
* Powers, M. B., M. B. Zum Vörde Sive Vörding, et al. (2009). "Acceptance and commitment therapy: A meta-analytic review." Psychotherapy and Psychosomatics 78(2): 73-80.
* Ruiz, F. J. (2010). "A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies." International Journal of Psychology & Psychological Therapy 10(1): 125-162.
* ACBS keeps an ongoing count of published and “in press” RCTs on ACT (https://contextualscience.org/ACT_Randomized_Controlled_Trials). As of 5/3/16, this site showed 131 RCTs on ACT, with 117 of those published and the remainder in press.
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Desire for Evidence-based SkillsAmong Healthcare Chaplains
94%
63%54%
5%
31%40%
1% 6% 6%
0%
20%
40%
60%
80%
100%
Civilian (N=160) VA (N=386) DoD (N=162)
“I would like my chaplain care to be more evidence-based.”
Strongly Agree & Agree Neutral Strongly Disagree & Disagree
Fitchett, G., Nieuwsma, J.A., Bates, M.J., Rhodes, J.E., & Meador, K.G. (2014). Evidence-based chaplaincy care: Attitudes and practices in diverse healthcare chaplain samples. Journal of Health Care Chaplaincy, 20, 144-160.
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Overt Familiarity with ACT among Chaplains
1
2
3
4
5
6
7
Dis
ag
re
e
Ne
utr
al
A
gr
ee
CPE Supervisors & Psychotherapy
Familiar with Incorporate w/ chaplaincy
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Covert Familiarity with ACT among Chaplains
1 2 3 4 5 6 7
Understand that it is okay toremember something unpleasant.
Live a life they value despite painfulexperiences and memories.
Acknowledge fear of feelings andfeel them anyway.
Let go of worry about not being ableto control their worries and feelings.
Understand that they canexperience painful memories but…
Accept that they cannot controlevery aspect of life.
Recognize that the experience ofemotion itself is not necessarily a…
Stop comparing their lives toothers'.
Stop their worries from getting inthe way of their success.
Not let their thoughts and feelingsget in the way of how they want to…
Disagree Neutral Agree
AAQ-2 Application
1 2 3 4 5 6 7
Maintain contact with the presentmoment.
Identify values and things that areimportant to them.
Commit to living their lives inaccordance with their values
regardless of things that may get inthe way; do what matters.
Consider thoughts asinterpretations of reality, rather
than absolute truths that must beacted upon.
Gain perspective which helps themrecognize that the experience of a
thought is not the same as thoughtcontent.
Accept that life is full of positive andnegative experiences; they are
intertwined.
Disagree Neutral Agree
6 ACT Elements
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Premises of ACT
Psychological pain is normal, it is important, and everyone has it.
You cannot deliberately get rid of your psychological pain, although you can take steps to avoid increasing it artificially.
You can live a life you value.
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Six Aims of ACT
For patient/provider to:
1. Be in the present moment.
2. Accept what is.
3. Watch your thinking.
4. Be aware of yourself.
5. Know your values.
6. Carry out valued behavior.
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
The ACT Model
Acceptance
CognitiveDefusion
Values
CommittedAction
Contact with the Present Moment
Self asContext
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Self-Care: Acceptance Exercise
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Self-Care: Commitment Exercise
1. My value is…
2. My goal is to (be specific)…
3. I’m willing to make room for…
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Discussion
As a chaplain, in what ways do you foster practices of: Acceptance (or “willingness”)?
Commitment (or identifying values and patterns of behavior)?
Are there ways in which you see ACT as complementing your work as a chaplain?
Are there potential areas of tension that you see between ACT and chaplaincy?
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Recommended Readings
For chaplains, clergy, pastoral counselors: Nieuwsma, J.A., Walser, R.D., & Hayes, S.C. (Eds.). (2016). ACT for Clergy and
Pastoral Counselors: Using Acceptance and Commitment Therapy to Bridge Psychological and Spiritual Care. Oakland, CA, New Harbinger Press.
For learning to use clinically: Wilson, K.G. (2008). Mindfulness for Two. Oakland, CA, New Harbinger Press. Harris, R. (2009). ACT Made Simple: A Quick-Start Guide to ACT Basics and
Beyond. Oakland, CA, New Harbinger Press.
For “self-help:” Hayes, S. C. (2005). Get Out of Your Mind and Into Your Life: The New Acceptance
and Commitment Therapy. Oakland, CA, New Harbinger Press.
Also, worksheets available at: http://www.thehappinesstrap.com/free_resources
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
Available July 1, 2016 (Amazon)
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Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self and others. Presented at the Christian Reformed Chaplains Annual Conference. Grand Rapids, MI.
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Contact Information:Jason Nieuwsma, PhD