Table 2 ACT intervention Sessions for Clients with Bipolar Disorders
Session | Objective | Metaphors | Content |
|---|---|---|---|
Psychoeducation – Overview of ACT expectations of participants | To provide clients with an overview of ACT. ACT expectations of participants. | Describing the expectations from the therapy. | • The researchers explained the ACT session’s general goals • The researchers demonstrated ACT expectations of participants |
Psychoeducation – Discussion of a booklet and videotape about BD. | • To be conscious about symptoms, drugs, and the history of the BD illness • Topics concerning drugs, symptoms, and the history of the illness were thoroughly addressed to equip clients with the fundamental information required to comprehend BD | videotape about BD | • The researchers demonstrated BD symptoms, drugs, and the history of the illness were thoroughly addressed to equip clients with the essential information required to comprehend BD. |
Session 1 Learning to be Present: How to Feel and Be Here and Now | • To be conscious of what is going on around you. • To be aware of one’s thoughts, feelings, and body sensations (i.e., private experience). • To differentiate between what is present on the inside and what is present on the outside, and to explain these processes without making a judgment. | • Noticing what’s Outside: The World, You and Me. • Noticing What’s Inside: Thoughts, Feelings, and Physical Sensations. • Why I Can’t Be Here—What’s Distracting? • Noticing the room. • Describing the Self and Another. • The bag and card. • The tug of war with monster images. | • The researchers demonstrated how vital features of ACT contribute to psychological flexibility and cognitive defusion while dealing with impulsivity and suicidal thoughts. • The clients were taught to focus on their surroundings rather than their inner experiences by the researchers (such as thoughts, feelings, and bodily sensations). • The researchers encouraged the client to look at his habitual emotional control agenda as a response to delusional ideas and their influence on his life. • The choice point model was employed by the researchers to express this meaning and emphasize acceptance as a useful coping tool. Discuss the idea of creative hopelessness in relation to the traditional emotional control agenda. • The researchers advise the client to set aside the negative ideas and concentrate on willingness. • These skills lead to self-development: “I am feeling….“ “I am thinking….“ |
Session 2 Defusing impulsivity and suicidal thoughts | • Introduces the concept of the mind and how it generates linguistic processes (thoughts and delusions). • To be able to distinguish between ideas and other internal feelings. | • Addressing the Verbal Network in the Mind. • Experiences and Thoughts Training Your Co-Pilot • Thoughts about the Bell Listening to Your Co-pilot: The Thoughts He Gives Me • Passengers on Your Plane. | • The researchers employed mindfulness techniques to help the client connect with the present moment and develop psychological flexibility to deal with impulsivity and suicidal thoughts. • The researchers suggested that the client utilize the language of noticing when referring to behaviour altered due to internal experiences of negative thoughts or other thoughts and emotions triggered throughout the session, such as “I’m noting that…” • Using the metaphor “Passenger on Your Plane,“ the researchers made a video to explain to the client how delusional ideas come and fade from the standpoint of an observer. |
Session 3 A Review of Acceptance: Goals, Purpose, and Process Suggestions | • To acquaint clients with the sensation of trying to force unwanted thoughts and feelings away (i.e., to identify the process of experiential avoidance). • To demonstrate the inefficiency and ineffectiveness of experiencing avoidance to the client. • To encourage acceptance as an alternative to personal experience-based avoidance methods. | • Unwanted Thoughts • Unwanted Feelings • Dropping the Rope—Willingness • Getting Rid of Thoughts • What is Unwanted? • Meeting One Another’s Co-Pilots • Standing with Yourself • Dropping the Rope | • The decision point model changed to illustrate how suicidal ideas and sources of fusion are related, as well as how they affect moving away from the life the client wishes to live. • The researchers instructed the client to perform exercises that distanced him from the imagined self in order to build a separation between them. The client was asked to repeat all distance exercises, including “I am having the thought that…” and “identifying your thoughts.“ |
Session 4 A Review of Self as Context: Goals, Purpose, and Process Suggestions | • For clients to become aware of the self as content (content you), and that the “content you” (thoughts of, “I like ______, I am a ______,“ etc.) • Changes over time and situations as do feelings, physical sensations, and other thoughts—they are impermanent. • For clients to become aware of the self as constant (constant you) and that the “constant you” does not change over time—it is permanent. | • I Am the Person Who… • Who is the “You” who notices? • The “Constant You” • Noticing & Sharing Who I am • Acting 101 • Wisdom with Age—Images of Youth. • I Have Survived | • By monitoring suicidal and negative thoughts on many occasions, the researchers were able to assist the client comprehend the various aspects of self-conceptualization. • The researchers focused the client’s attention to the contrast between the self who sees such thoughts and the negative thoughts that occur. • The researcher employed the metaphor of leaves on a stream by presenting a film and asking the client to see their thoughts and feelings as leaves flowing down a stream without trying to halt or control them. • The contrast between the outcomes and components of self-evaluations and the self that assesses was developed and emphasized by the researcher. In order to illustrate the distinction between ideas and self, the researcher employed the metaphor of a chessboard while playing the game with the client. |
Session 5 Clarification of Personal Values Goals, Purpose, and Process Suggestions | • Identify meaningful, valued domains of life. • Define specific behavioural goals that align with those values • Identify potential barriers to following through with valued-based living | • Where Do I Want to Fly? • Defining My Next Destination • Exploring New Terrain • Flying South • Choosing a Direction • Goal Sharing • Initial Discussion Regarding Values Clarification • Chain Analyses of Client Behaviour | • The researchers spoke with the client about how prior attempts to fight unpleasant thoughts impact and get in the way of achieving his goals and, in turn, his values. • The researcher assisted the client in considering potential values that could fulfil his life purpose. • The client’s values were clarified and categorized with the use of a Bull’s Eye worksheet by the researchers. • The researchers used the compass metaphor to explain to the client how values relate to goals and the distinction between value and goal. • The disparity between his prized area and his everyday activities as a result of his negative thoughts was the focus of the researchers’ attention. • By using a worksheet based on the client’s selected value from the Bull’s eye, the researchers were able to assist the client in setting a SMART goal and encouraging him to act on his value rather than on irrational or unpleasant perspectives. |
Session 6 Moving Ahead with Committed Action Goals, Purpose, and Process Suggestions | • To continue clarification of value-based goals. • To identify barriers to committed action. • To increase committed action in goal-completion, building patterns of committed action. • To increase the generalization of skills for valued living, with the intention of continued committed action upon completion of the protocol. | • Turbulence in Flight: What Makes for a Rough Ride? • Willingness in Action Committed to a Valued Path • Flying in a Meaningful Direction with Turbulence: Are You Willing? • Commitment Statements | • The researchers concentrated on values that were established using the Bully’s eye. • The researchers have started to create an action plan for one of the value domains from the Bully’s eye. • The client made a list of specific activities (such as reading the Quran, praying, drawing, conversing with other individuals, practicing mindful walking in the garden, and engaging in some physical exercise) that are pertinent to his short-term goals and consistent with the selected value, ranking them according to how challenging they are to complete. • The researchers kept track of any obstacles that may stand in the way of his attaining his objectives as well as how he handled them when they did. • “Flying in a Meaningful Direction with Turbulence: Are You Willing?“ was the subject of a worksheet and video presented by the researchers. This is a metaphor used to persuade the client to remain committed to the action plans despite obstacles. • The client’s opinion on the ACT sessions was then asked out. |