Nieuwsma, J.A. (June 2016). . Presented at the Christian ...Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self

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


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.


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


“The single most remarkable fact of

human existence is how hard it is for

human beings to be happy.”

- Steven C. Hayes


Why do we suffer?


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


How do we stop suffering?


Beck Depression Inventory-II(BDI-2)


What success looks like on BDI-2

0

5

10

15

20

25

30

1 6 12 24

BD

I-2

Week

Treatment Control


Acceptance & Action Questionnaire-II(AAQ-2)


What success looks like on AAQ-2

0

5

10

15

20

25

30

1 6 12 24

AA

Q-2

Week

Treatment Control


What does “success” look like in faith?


Control as a means to achieving success

CAN’T CONTROL

Examples

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CAN CONTROL

Examples


Tug of War with a Monster

What to do? Drop the rope!


“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


Pain vs. Suffering

Clean discomfort

What comes with living life.

Examples:

Loss

Traumatic experience

Negative life event

Illness

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Dirty discomfort

Created by efforts to control “clean”

Examples

Substance abuse

Isolation

Relationship conflicts

Illness


Quicksand

“DON’T PANIC” Douglas Adams, The Hitchhiker’s

Guide to the Galaxy

The “gut reaction”

The “ACT reaction”


“When we are no longer able to change a situation,we are challenged to change ourselves.”– Victor Frankl

Chinese Finger Trap


Paradox

ACT

Being accepting of negative leads to feeling more positive.

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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.


Acceptance and Commitment Therapy (ACT)

What is ACT?

Related to CBT family of treatments

Acceptance: Willingness to experience

Commitment: Living in line with values


Waves of Psychotherapy

1st

Wave2nd

Wave3rd

Wave

Behavioral Cognitive MBCT, CBASP, ACT, DBT, etc.

CBT / EBP Beach

Alcohol, nudity, & psychoanalysis are prohibited.

Cognitive-Behavioral^


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.


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


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.

https://contextualscience.org/ACT_Randomized_Controlled_Trials


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.


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


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


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.


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.


The ACT Model

Acceptance

CognitiveDefusion

Values

CommittedAction

Contact with the Present Moment

Self asContext


Self-Care: Acceptance Exercise

http://knowmental.com/leaves-on-a-stream/

http://knowmental.com/leaves-on-a-stream/


Self-Care: Commitment Exercise

1. My value is…

2. My goal is to (be specific)…

3. I’m willing to make room for…


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?


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

http://www.thehappinesstrap.com/free_resources


Available July 1, 2016 (Amazon)


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Questions?

Contact Information:Jason Nieuwsma, PhD

[email protected]

mailto:[email protected]

Documents

Nieuwsma, J.A. (June 2016). . Presented at the Christian ...Nieuwsma, J.A. (June 2016). Consider it pure joy: Approaching suffering with acceptance and commitment to care for self