Acceptance and commitment therapy (ACT) can be slippery to describe. It’s an approach that doesn’t aim to change thought content, but instead to help us shift the way we relate to what our mind tells us. It’s also an approach focused on workability: pragmatic and context-specific analysis of how well a strategy is working to achieve being able to do what matters. Over the next few posts I want to give some examples of how non-psychologists (remember ACT is open for anyone to use it!) can use ACT in session.
Mindfulness – messing about with attention
Thanks to Kevin Vowles, I’m adopting the term ‘messing about with attention’ for the ‘present moment awareness’ or ‘mindfulness’ part of ACT. We can get caught up in how we define mindfulness – they all have value – but make the doing of mindfulness less practical.
Why use present moment awareness? Paying attention, on purpose, and without judgement (one of many definitions! This one from Kabat-Zinn, 2003) serves to disentangle us from thoughts about the past and predictions for the future; has been shown to reduce cortical arousal (Day, et al., 2021); and importantly for this post, comes in many forms.
We know that repeated practice, especially over extended periods of time (say, for 20 – 40 minutes or longer) results in alterations in how parts of the brain respond both when anticipating pain, and during painful experiences (Lutz, et al., 2013), but getting to where extended practice is even achievable can be difficult (Birtwell et al., 2019). ‘Messing about with attention’ can be used, however, anywhere and any time. I’m definitely not suggesting clinicians dissuade people from using long meditations because the results are pretty profound for most people (and most RCTs use around 40 – 45 minutes), but we shouldn’t ignore the usefulness of briefer forms of mindfulness.
During movement or occupation (daily activity)
If you’re a physio, osteo, chiro, exercise physiologist or occupational therapist, you have the most awesome opportunity to bring mindfulness into your sessions. It requires a shift in your thinking, though, because mindfulness used during movement or occupation isn’t quite the same as the usual sitting or even a ‘movement’ meditation. For one, it’s not scripted!
Your mindset
Mindfulness is about noticing, paying attention and being curious, but in many movement practices the aim is to develop ‘proper’ form. To move in a pre-determined manner. Perhaps to strengthen, or to relax, various muscle groups. To create a body movement that conforms to some ideal.
If you’d like to bring mindfulness into your movement session, would it be possible to put these ideas to one side for a moment?
Would you be willing to explore what it feels like to move – maybe in one way, and then in another? Would you be willing to experiment? To play with movement and notice how it feels in the body?
The invitation
To create an environment for practicing this kind of paying attention, the person will need an invitation. The invitation might be something like “I wonder if you feel OK to bring your mind to this part of your body for a moment?” or “If you were to close your eyes right now, what part of your body would you notice first?”
You may want to have a quiet environment, one that’s not distracting, no music or other people talking, somewhere where it’s OK to focus on how the body feels.
The guidance
If the person you’re working with hasn’t used mindfulness like this before, you might want to offer them some guidance about what to pay attention to. Something like “You’ve brought your mind to this part of your body, and as you move, what do you notice changing?” or “As you move, where does your weight shift through the soles of your feet?” or “As you move, can you bring your attention away from that part of your body [the first part you suggested they notice] and on to your breathing?”
Bring their attention to any shifts in position, changes in weight distribution, changes in breath, head position, stance, contact with the floor….
Throughout, your job is NOT to suggest what the person might notice, or experience. Your job is to help them explore, with purpose, and without judging. Guide them to play with movements as they do this: perhaps make tiny movements, or shift weight forward and back, or make big movements, speed up or slow down, add ‘purpose’ by making the movement purposeful – if they’re reaching forward, add in reaching for a cup, a pen, a book, a flower, a cloth. Ask them to notice what happens as they reach for these items. Let them repeat or alternate or otherwise change the way they do the movement.
The closure
End this by returning to the breath. It’s not a rule, and you can end in another way if you like, but I find giving some space to stopping and just breathing gives room for people to let their attention go back to something very familiar (and portable!).
Debrief
Your choice: you can ask the person “what did you notice?” or you can let them spontaneously tell you (or not). During the debrief your approach is to model acceptance of their experience, again without judgement. Let their experience be their experience.
If they say “Oh my mind wandered all over the place” ask them “were you able to bring your mind back?” and if they were (and they usually do!) let them know that’s all that’s needed.
You may want to explore which movement was most free, fluid, comfortable, stable. Which felt best, and can the person replicate it?
It’s not about what you think is ‘good’ form, this approach is about the mindful experiencing for the purpose of experiencing.
Rationale
While there are a billion reasons for using mindfulness, in today’s post my intention is to show that mindfulness offers a way for people to pay attention to their own bodily experiences, and to draw their own conclusions about how their body responds to movement.
My argument is that when people leave our care, they will probably have periods where their body ‘reverts’ to how it was when they first sought treatment. If our job is only to help people return to ‘normal’ without also furnishing people with skills to build resilience, we’re only doing half a job. It might be great for repeat customers, but I believe healthcare has enough to do without searching for ways to get people to come back – and failing to help people get in tune with what their body likes to do and how this feels, seems pretty unhelpful to me.
Showing people ways to really inhabit their own body, becoming skilled at noticing how their body feels during movement, being able to experiment and play with different movement patterns, to adjust and notice how it feels: these are powerful tools for helping people gain confidence in how incredibly versatile their body is. Our job might be less about ‘physical fitness’ or ‘strength’, ‘flexibility’ or even ‘function’, it might be about teaching people meta-cognitive skills of noticing and reflecting on what happens as they move throughout the various life contexts they inhabit.
Birtwell, K., Williams, K., van Marwijk, H., Armitage, C. J., & Sheffield, D. (2019). An Exploration of Formal and Informal Mindfulness Practice and Associations with Wellbeing. Mindfulness (N Y), 10(1), 89-99. https://doi.org/10.1007/s12671-018-0951-y
Day, M. A., Matthews, N., Mattingley, J. B., Ehde, D. M., Turner, A. P., Williams, R. M., & Jensen, M. P. (2021). Change in Brain Oscillations as a Mechanism of Mindfulness-Meditation, Cognitive Therapy, and Mindfulness-Based Cognitive Therapy for Chronic Low Back Pain. Pain Medicine, 22(8), 1804-1813. https://doi.org/10.1093/pm/pnab049
Kabat-Zinn, J. (2003). Mindfulness-Based Interventions in Context: Past, Present, and Future . Clinical Psychology: Science & Practice, 10(2), 144-156.
Lutz, A., McFarlin, D. R., Perlman, D. M., Salomons, T. V., & Davidson, R. J. (2013). Altered anterior insula activation during anticipation and experience of painful stimuli in expert meditators. Neuroimage, 64(1), 538-546.
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