Learning Objectives:

• To facilitate exposure to thoughts and feelings (including reasons, stories, stigmatizing thoughts, judgments, assumptions, etc.) that act as barriers to engaging people in challenging stigma and injustice, and taking actions in accordance to their values.
• To weaken the power of unpleasant feelings and literal thoughts through Defusion and Acceptance
• To evoke and reinforce commitment to HIV stigma reduction and health promotion in the service of values related to compassion, social justice, and equity

Materials:

• Flipchart on a stand
• A pre-drawn Bull’s Eye Diagram 3.7.1 on a flipchart page
• Water-based markers and masking tape

Time Required: 60 Minutes

Activities & Instructions

Instructions to Participants:

Introduction – Facilitator says, “As we try to pursue our value-guided goals, we often encounter obstacles. This exercise is called the ‘Bus Driver Exercise.’ It helps us explore what it is like to face challenges and barriers that get in the way when we try to do important and meaningful things in our lives and how we can commit to our values through our actions. We will act out a little story with your help, and so, we will need some volunteers for the role-play.”

Part 1: Preparing the Bus Driver:

1. Identify a suitable volunteer to role-play as the “Bus Driver” (BD), ideally someone who is open, articulate, and self-reflective, and has marked at least one area in life that is in the outer circles of the Bull’s eyes – “To start off with, we need one of you to volunteer to play the lead role of the story – the ‘Bus Driver.’ As the ‘Bus Driver’, we would ask that you be willing to open up and share with us in more details about some of your personal difficulties that have stopped you from doing something according to your values. So we invite you to share an area of your life in which you feel kind of stuck, but would really want to make changes and are ready to work on it.”
2. Identify the BD’s Values and desired Actions:

• Referring to the Bull’s eye diagram, facilitator asks the Bus Driver (BD): “Thanks so much for volunteering. Can you please come up and tell us a little bit about each of the six domains you marked on the Bull’s Eye exercise?” (See Bulls eye for instructions and remind the participant as necessary.)
• “Which life domain you would like to focus on?” (Occasionally, participant may change their mind and select a more pertinent one to them.)
• Facilitator starts a new page on the flipchart, writing down the area of life domain identified by the BD on the top of the page, then divide the page into 3 columns – starting with values on the left, desired action in the middle and barriers on the right.
• Facilitator then asks: “What are the values you hold in this domain? Why is the domain important and meaningful to you?” (Facilitation Tip: Refer to the list of values used in the previous exercise to help prompt the BD to name the values that the BD holds in the chosen domain). Facilitator to write down up to 5 values articulated by the BD onto flipchart under the heading “ Values”.
• “What kinds of actions you would like to do in this domain that you’re not currently doing? Can you also share with us why this is important to you and what it means for you to be able to do ‘XXX’….?” (Facilitator write down up to 5 actions articulated by the BD, and then check with the BD how these actions are aligned with the values previously articulated.)

3. Identify barriers to Value-driven Actions:

• Facilitator to collaborate with the BD to identify 5-7 barriers that prevent them from taking value-driven actions. Probe gently as necessary until the important barriers are identified. Check for clarity and alignment on the connection between the barriers to the desired value-driven actions.
• “Can you please share with us the barriers that cause you to be ‘here’ (point to ‘X’) as opposed to the centre? What shows up in your mind when you consider moving forward with your action?”
• After BD identifies one, facilitator continues to ask, “What else is stopping you from getting to the centre?”
• (Facilitator writes down a list of barriers in point forms on the flipchart paper under the heading “Barriers”. For example, ‘1. no time; 2. not enough self-confidence; 3. I’m too shy; 4. my friends just don’t understand me …’.)
• After the BD completed the initial list, facilitator reviews the list with the BD and probes for “deeper meaning” or “root causes” to understand the specific context associated with each of the identified barriers. For example, for ‘no time”, asks about what is taking up all the time the BD has, what are the reasons BD spent time on the other things identified. Go deeper into each layer until a more specific reason or meaning is identified for each barrier. Cross out each of the more “superficial” barrier once a more specific or deeper level barrier is identified to replace it.)
• After the BD names all the barriers, facilitator asks: “Let us look over the list together. Are there barriers we have listed here that are not real barriers for you? If so, we can cross them out.” Cross out barriers that the BD no long sees as barriers.
• “Have we missed any other more important barriers?”
• “Imagine if all the barriers listed here are gone, would you immediate be able to do the action you wanted to do, or is there still something else stopping you deep inside?” (**This is a very important question to ask to get at some of the barriers that BD may not have recognized or is avoiding to address.)
• Once the barriers are identified, the facilitators can write down some of the key words/phrases for each barrier on a small piece of paper/card. These words/phrases represent the negative inner voices of the BD. Each thought or inner voice should be specific and distinct and not repetitive. These can then be distributed as instruction cards for the passengers.

Part 2: Role-playing Bus Driver and the passengers:

4. Identify enough volunteers to role-play passengers (PGs) of the bus, i.e., a passenger is needed to personify each barrier. Facilitator says, “We need some volunteers to help us out by role-playing these barriers listed here. Who is willing to play the first barrier – [read first barrier on the list]?” (Facilitator may also decide to assign barriers among volunteers if this optimizes suitability for the role-play.)

• Position the BD about 4 feet away and facing the flipchart and the PGs to line-up beside the BD getting ready to board the imaginary bus. The remaining participants are invited to gather around and find a position they feel most comfortable to observe the role-play.
• Facilitator says to the BD, “You are the bus driver. You want to drive your bus towards the main station. Your values are guiding you to the main station. So put your hands on the wheel and look at the Bull’s Eye on the flipchart as your target destination. Bring to mind your values; why this is important to you; and the actions you want to take.” (Pause for a moment)
• Facilitator continues to say to the BD, “There may be some rowdy passengers trying to get on the bus. When they behave in ways that bother you, you can turn away from them, fight with them, or try to get rid of them.”
• Co-Facilitator takes the PG to the other side of the room and says to the PG, “You are the passengers. Please form a line here in order of the barriers listed. Each of you now represents the negative thoughts inside bus driver’s head that we just heard about. When we start, you are going to get on the bus one by one. When it is your turn to get on the bus, you’re going to step right in front of the bus driver, look at the bus driver in the eye, and tell the bus driver loudly and firmly why she/he/they can never do [the valued action]. For example, if you represent ‘no self- confidence’, you would be saying something like – ‘You can never do this. You have no self-confidence, remember? You will just fail miserably. Let’s just go home and forget about this.’ Your role is to act out the bus driver’s specific barrier in a strong and believable way. Remember, this is not you speaking. You are the bus driver’s own negative thought. When you are done speaking, you can board the bus and form a single line behind the bus driver.”

5. Begin the Role-play. Stand alongside the BD, and have the BD drive the imaginary bus for a few seconds. Invite the PGs to enter the bus one by one. The co-facilitator coaches each PG to step in front of the BD, face the BD, and tell the BD the reason why she/he/they cannot do the valued actions. The (main) facilitator helps the BD avoid facing the barrier after hearing what the PG has to say by telling the BD to avoid the barriers. The co-facilitator directs the PG to “enter” the bus by standing in a single line behind the bus driver. Invite the next PG and so forth. As it may get emotionally challenging, pace the exercise accordingly. By the end, the BD would be facing approximately 180 degrees away from the flipchart, with a single line of PGs behind the BD.

• Facilitator says to BD, “Imagine that you are now driving the bus.”
• Co-facilitator says to PG, “You’re the [barrier 1] – go ahead and tell the BD the reason she/he/they will fail. Your role is to act like a challenging barrier, be persistent and speak firmly.” (Coach the PG as needed)
• Facilitator says to BD, “Wow, that sounds scary… You don’t have to face this, you can turn away from it, or fight back.”
  (Pivot the BD after the PG has finished speaking if BD does not turn away)
• Co-facilitator says to PG, “Get on the bus and stay behind the BD (or another PG). Now let’s have the next passenger come on the bus.” (Coach the PG as needed)

6. Debrief with the BD and provide empathic support.

• Facilitator says to BD, “Thanks so much for doing this, as this must be a challenging experience. How are you doing right now? What was it like to be facing your barriers? Any particular surprises in this experience? Which ones were especially hard for you to face?”
• Facilitator says to BD, “Take notice – where are you driving to? Are you getting closer or moving farther away from your values – the bull’s eye?”

7. Give BD instructions for another round of role-play with Acceptance and Defusion.

• Facilitator says to BD, “You have done very well. Let’s do this role-play one more time – round two. This time, let’s try something a little different. When a passenger gets on, see if you can welcome him or her. You don’t have to talk back or argue with them. Just say ‘Welcome on my bus’, regardless of what they are saying to you, and motion them to get behind you on to the bus. Ok?”
• Co-facilitator says to PG, “Everyone, let’s line up again and take it from the beginning.”
• Facilitator says to BD, “This time, keep your mind steadily focused on your values and the direction you are driving the bus towards, and don’t let anybody, including me, tell you to turn for influence you in any way. Let’s see your hands on your steering wheel.”
• Facilitator continues to say to BD, “Before we begin, let us take a minute for you to become mindful as you look at the bulls eye in front you … really connect with the present moment and how important your values and actions are to you … recall what all this means to you …”

8. Re-do the role-play. Stand alongside the BD. As necessary, coach the BD to welcome each passenger on board while being persistent in facing the target. When you notice that the BD is arguing with or avoiding a specific passenger, get the BD to take a pause, “Take a deep breath, now focus on your values and the direction you are driving the bus forward. Just say to the passenger – Welcome on my bus.” Pause, let the BD re-focus, and resume the role-play. Continue to coach the BD to welcome each passenger.

Part 3: Debriefing and Identifying Committed Action:

9. Thank and invite the passengers to return to their seats. Invite the BD to sit down at the front with the facilitator for debriefing.

• Facilitator says to BD, “Thank you so much for being so courageous and generous in putting yourself out here as the bus driver to support our group learning experience. You did so well. Would you like to share with us what this experience was like for you?”
• “What was it like to share your values, actions, and the list of barriers?”
• “What was the role-play like the first time around?”
• “How was it different the second time around?”
• “Now that you have this experience, what is one action you are willing to do within this week to further your values? It can be a small step or a big step… just as long as it takes you one step further in your valued direction.”
• Facilitator waits for BD to identify a specific action step and write down on flipchart.
• “How sure are you that you will do this task from 0 – 100%?”
• (Facilitator solicits a smaller action if the certainty is below 80%. Facilitator may ask, “What would it take for you to be 100% sure that you will do this task?” (Support BD to define and establish a committed goal for action)

10. Debrief with the passengers and the rest of the group.

• Facilitator says to PG, “What was it like role-playing the barriers? What did you notice about the bus driver? What was the difference in your experience between the first and second role-play?”
• Facilitator says to everyone, “What have you observed in this exercise? Have you experienced similar kinds of thoughts in your head that try to bully you around?”

11. Debrief with the entire group.

• Facilitator asks, “What do you think the passengers represent?” (See summary points)
• “What ACT processes do you observe in the bus driver in the second round?” (See summary points)

12. Engage all participants in identifying personal committed action.

• “Having experienced the bus driver together, what next steps are you willing to commit to in your own life?”
• Facilitator engages each participant to identify one specific action step and write down on flipchart or notepad.

Key Summary Points:

• The passenger metaphor represents the unwanted thoughts or psychological struggles we face; the more we try to avoid them and fight them, the more power they have over us and distract us from our value-guided goals and action.
• In the second round, the BD became mindful (contact with the present moment) and remained in full contact with what really mattered (values). The BD was interacting with the thoughts as passengers rather than analyzing what they were saying (defusion) and was welcoming them on board the bus (acceptance). The BD did not get confused and identified with the thoughts, but instead, took control of where the bus went, with the bus containing all the thoughts as passengers (self-as-context). Finally, the BD made a firm commitment to a concrete action in the service of values (committed action). With these ACT processes, the BD becomes more resilient and live a more meaningful life.”
• Negative thoughts related to stigma are like the passengers; instead of struggling with these thoughts, we can focus on our values and committed action.
• Committed action means staying the course with what we set out to do regardless of difficulties. Just like with the BD, it is important to focus on an action step that you are willing to commit; whether it is a big or small step, the committed action is meaningful as long as it is guided by values.

Source:

Informed by the metaphor of Thoughts as Passengers in Hayes, S. C., Strosahl, K., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed), (pp. 250-252). Guilford Press.

Worksheet 3.8.1 – The Bus Driver: Participant-Observer Exercise

The Bus Driver activity is an opportunity to explore values in relation to committed action. It supports us to look at obstacles or places where we may feel ‘stuck’ and how to practice defusion and acceptance. As a participant-observer it is important for you to support the Bus Driver by offering your attention during the activity. In the following exercise, please record any observations, thoughts or feelings that come up for you during the activity.