Introduction to ACE 接纳承诺与赋权理论入门

Objective

• Orientate participants to the ACE model, including the integrated Acceptance and Commitment Therapy (ACT) and Group Empowerment Pscychoeducation (GEP) core concepts, principles, and process.
  帮助参与者了解ACE, 包括接纳承诺疗法(ACT)及賦權心理教育(GEP) 的概念、原则及流程。

Suggested Time 建议时间

• 20 minutes 20 分钟

Number of Facilitators 小组带领者人数

• 1

Brief Description 简述

• The facilitator shows powerpoint slides on ACE and explains the integrated ACT + GEP core concepts and 4 processes.
  带领者展示ACE幻灯片，并解释综合ACT及GEP核心概念和流程。

Materials 教材

• Powerpoint slides – ACE-LYNX Intervention接納承諾與賦權理論模型
  PPT 幻灯片

Sample Script 示例脚本

Acceptance and Commitment Therapy (ACT)

• The ACT model of psychological flexibility consists of 6 important psychological processes. Let’s look at what typically gets us stuck and how ACT processes may help us.
  ACT心理弹性模型由六个重要的心理流程组成。 让我们来看看通常我们会怎样陷入困境以及ACT流程能够如何帮助我们。
• Cognitive fusion occurs when we treat our ‘thoughts’ literally as ‘reality’, as if ‘thoughts’ and ‘reality’ are fused as one. Thinking helps us function efficiently and make sense of the world – so we tend to see and experience everything through the lens of our thoughts most of the time. We usually don’t question what our thoughts are telling us. Our thoughts make sense to us. For example, “the earth is round” … “fire is hotter than ice” … and “hell is hotter than earth” … when I say each of these sentences, they all sound real and logical to you, and you will not dispute them, even if you have never been to hell. As you listen to me talking now, you are probably busy thinking and making sense out of what I am saying, and so, our act of thinking and sense making is automatic and transparent to us. Most of the time, this isn’t a problem, and our ability to think is amazingly helpful. However, in some cases, being ‘fused’ with our thoughts can get us completely stuck. No matter how ‘true’ or ‘false’ these thoughts are, they are actually all just thoughts.  For example, if you become fused with certain assumptions like ‘People are mean, and I can’t trust others’ and treat this as ‘reality’, how may this affect your participation in this group now? If we get stuck with always believing in our thoughts, how may it affect our actions in our lives?
  认知融合 – 当我们将「想法」当作「现实」时，这就是认知融合，就好像「想法」和「现实」已融合为一体。思考有助于我们有效地运作并理解世界，所以我们大多数时间倾向于通过思维的镜片来看待和体验一切。我们通常不会质疑我们的想法在告诉我们些什么。我们很自然的觉得自己的想法是有条有理的。例如，「地球是圆的」…… 「火比冰热」…… 「地狱比这个世界热」…… 当我一句句说出来，它们对你来说都是真实而合乎逻辑的，你不会对它们提出异议，即使你从未去过地狱。当你听我说话的时候，你可能正忙着思考并理解我所说的话，因此，我们思考和理解的行为对我们来说是自动和不易察觉的。大多数的时候，这不是一个问题，我们的思考能力对我们有着神奇的助益。然而，在某些情况下，与我们的想法「融合」可能会让我们完全陷入困境。无论这些想法多么「真实」或「虚假」，想法就只是想法。例如，如果你融合了某些假设，比如「人是卑鄙的，我不能再相信别人」，并将其视为「现实」，那么这对你现在参与这个小组会有何影响呢？如果我们总是相信自己的想法，那么它会如何在生活中影响我们的行为呢？
• An alternative is Cognitive Defusion – this means getting unstuck from our thinking. We can recognize our thoughts as only thoughts – no more and no less – no matter how convincing they sound. If you say to yourself ‘I can’t trust others here’ … vs. ‘I am having the thought that ‘I can’t trust others here’ … do you observe any difference? In this case, defusion helps us more fully participate in the group. By practicing defusion, we can foster our capacity to experience thoughts as thoughts, rather than always rigidly following our thoughts, even when they are not helpful to us.
  一种替代做法是认知解离 – 这意味着从我们的思考中解脱出来。我们可以把我们的想法只是当作想法– 不多也不少– 无论它们听起来多么令人信服。譬如,如果你对自己说“我不能相信这小组里的其他人”…… 对比“我在想,我不能相信这小组里的其他人”…… 你观察到任何不同了吗？在这种情况下，解离有助于我们更充分地参与小组活动。通过练习解离，我们可以培养我们去体验想法就是想法的能力，而不是即使想法对我们没有帮助，我们还总是严格遵从它们。
• As human beings, we tend to avoid unpleasant and unwanted thoughts, feelings, bodily sensations, or memories. This Experiential Avoidance may sometimes be costly to our wellbeing, ineffective, or unnecessary. Although it may be our natural reaction to turn away from unpleasant and difficulty experiences, the act of avoidance may actually add to our own struggle and suffering.  For example, if a person is scared of the dark and always sleeps with the light on and avoids the dark at all times, what would happen to this fear? What happens to his life if he avoids more and more? Soon, he may not even dare to go outside at night. What happens when there is a total blackout then?
  人人都倾向于避免令人不适的或不想要的想法、感受、身体感觉或记忆。 这种经验式回避有时可能会损害我们的健康，既没有效果，也没有必要。尽管去摆脱不愉快和困难的体验可能是我们的自然反应，但回避这一行为实际上可能会增添我们自己的挣扎和痛苦。例如，如果一个人害怕黑暗，总是在灯光下睡觉，并且一直回避黑暗，那么这种恐惧会导致什么？如果他越来越回避，那么他的生活会怎样呢？很快，他甚至可能都不敢晚上出门。那么，当突然全面停电了，他该怎么办呢？
• An alternative to avoidance is Acceptance. It is the willingness to experience what thoughts and feelings are here, rather than trying to avoid, change, or suppress them.   It is not about ‘giving up’ or ‘enjoying negativity’, but rather, about experiencing whatever is already here – pleasant or unpleasant – without any struggle.
  代替回避的另一种做法是接纳。愿意体验现存的想法和感受，而不是试图回避、改变或压制它们。接纳不是“放弃”或“甘于消极”，而是去体验已经存在的任何体验 – 愉快或不愉快 – 不做任何挣扎。
• Dominance of the conceptualized past and feared future – sometimes we suffer the most when we are stuck thinking about the past, such as when we have been hurt in the past, e.g., bullied or abused, or when we have done things we regret. We may then be feeling sad, hurt, guilty, or angry all the time. Or we can get caught up in worrying about the future and things that have not happen yet.
  被概念化的过去和恐惧的未来所操控 – 当我们陷入过往的思绪而停滞不前时，有时我们会感到更痛苦。就像我们一直在经受过去诸如被他人欺凌或虐待的伤害，或者自己曾经做过的后悔的事情。于是我们可能会一直感到悲伤、受伤、内疚、或愤怒。或者，我们可能会陷入对未来和尚未发生的事情的担忧之中。
• Contact with the present moment is about shifting our attention to what is happening here and now, including our thoughts, feelings, bodily sensations, and external stimuli such as sound, sight, smell, etc. Training our ability to attend to the present moment can get us less stuck with our thoughts about our past or future. It helps us appreciate what is currently here now and respond more fully and effectively to the present situation. It also means taking ourselves off the ‘auto-pilot’ mode. For example, while driving or taking transit, we may ‘wake-up’ from our thinking only when get to the destination without really being present to the full experience of the journey along the way.
  活在当下就是把我们的注意力转移到现在正在发生的事情上，包括我们的想法、感受、身体感觉和外部刺激，如声音、视觉、嗅觉等。训练我们关注当下的能力可以帮助我们不再沉迷于对过去或未来的想法中。它有助于我们体會目前的情况，并更充分有效地应对当前的形势。 这也意味着让我们脱离“自动驾驶”模式。 就像在驾驶或乘坐公交车时，我们可能只有在到达目的地时才会从思虑中“醒来”，而不会真正沉浸入沿途的全部体验。
• Attachment to the conceptualized self refers to being too rigidly stuck with our fused identities based on ideas, concepts, and stories about who we are. Normally, knowing our strengths or our social roles, such as our particular job at school or work or the roles in the family and society, can be helpful, because we know what we need to do. But being rigidly fused with a role means that you can feel like losing a sense of ‘self’ when such a role is lost or has changed. For example, if you totally identify yourself as being an athlete, what happens if you get injured and can never run again? Further, being fused rigidly with ideas about ourselves, e.g., ‘I’m not an adventurous person, so I can never try new things’, can also restrict how we lead our lives and what we choose to pursue.
  对概念化自我的执着是指我们过分拘泥于建立在想法、概念和故事上有关我们是谁的“融合身份”的考量。通常，知晓我们的优势或社会角色，例如我们在学校或工作中的特定工作，或者在家庭和社会中的角色可能会对我们有所帮助，因为我们知道需要做什么。 但是，与角色顽固地融合则意味着当你失去了这样的角色或者角色发生变化时，你会产生一种失去“自我”感。 例如，如果你完全认定自己是一名运动员，那么如果你受伤并且再也不能跑步会怎么样？此外，与我们自己的想法顽固地融合，例如，“我不是一个冒险的人，所以我永远不能尝试新事物”，也会对我们怎样去过我们的人生，以及对我们选择去追求什么产生限制。
• Self-as-context refers to freeing ourselves from a restrictive fused identity or conceptualized self, and instead, realizing that there is a part of us that is actually like the context, i.e., the background or the container, in which our inner experiences like thoughts, feelings, memories, etc. occur. Being the container is more flexible and resilient than its contents. If you were a cup, yesterday you may contain sour milk, today you may contain coffee, and tomorrow you may contain juice. So, if we are like a container, we may come to realize that our difficult thoughts and feelings that we do not want, or conversely, treasured roles that we want to hang on to, will all come and go, while we are resilient and always ready to experience the present moment and new possibilities. This is also called the “observer self.”  From your experience and perspective, “you” have always been “you” throughout your whole life, while all other things about you (that isn’t actually “you”) are constantly changing – e.g. thoughts, feelings, body, roles, stories, memories, etc.
  以己为景指的是将自己从限制性的、融合的身份或概念化的自我中解放出来，而且意识到在我们一部分的自己实际上就像是情景，即背景或容器，盛装着我们的内心体验，即我们的想法、感受、记忆等。作为容器比只做其内容会更灵活和更有弹性。假设你是一个杯子，昨天你可能装着酸奶，今天你可能装着咖啡，明天你可能装着果汁。所以，如果我们就像一个容器，我们可能会意识到，我们是有弹性的，能够随时准备体验当下的时刻和新的可能性，而我们不想要的困难的想法和感受，或相反地，我们珍惜的、想要抓住的人生角色，全都会来来去去。这也被称为“观察的自我”。从你的经验和观点来看，贯穿你整个一生，“你”一直都是“你”，而关于你的所有其他事情（实际上并非”你”）都在不断变化 – 例如想法、感受、身体、角色、故事、记忆等。
• Lack of values clarity refers to not being in touch with our chosen values or what really matters to us. We may end up just doing things based on routine or habit without looking deeper at the meaning behind our actions. Our actions may be guided by our fusion to rules and stories and we may be stuck without realizing it. We may also just be busy avoiding things that provoke negative emotions like fear, anxiety, and sadness.
  价值不清是指不与我们选择的价值观或对我们真正重要的事物保持联结。 我们可能最终变得只是根据常规或习惯做事情而不去深入了解我们行为背后的意义。 我们的行为可能只遵从著我们对规则和故事的融合，就算陷入其中，也可能意识不到。 我们也可能只是忙着回避那些可能引起恐惧、焦虑和悲伤等负面情绪的事情。
• Values refer to being clear and in touch with meaningful chosen life directions and what matters to us. Values are different from goals in that they are not something that one can check off and complete, nor are they dependent on outcomes in some distant future. Rather, values are ever-present as directions that guide us and give our actions and our lives meaning and purpose.
  价值观是指能够认清并且与所选择的有意义的人生方向，以及对我们重要的事情保持联结。价值观与目标不同，因为它们不是可以划掉和完成的东西，也不依赖于发生在某个遥远未来的某些结果。 相反，价值观永远与我们同在，指导我们前进的方向，并赋予我们的行为和人生以意义和目的。
• Inaction, impulsivity, or avoidance are patterns of behaviors that lead to more suffering and away from leading a meaningful life. For example, we may not take actions towards our values (e.g., ‘I should take better care of myself, but I’m just too busy’); impulsively react to our emotions, thoughts, and stories (e.g., ‘my friend made me angry – so of course I screamed and yelled’); or avoid valued actions and situations that may risk unpleasant inner experiences (e.g., ‘I avoid my friends, in case they may not like me or I may feel anxious’).
  不作为、冲动或回避是一系列令我们蒙受更多痛苦和远离有意义生活的行为模式。 例如，我们可能不按照我们的价值观采取行动（例如，’我应该更好地照顾自己，但我太忙了’）; 对我们的情绪、想法和故事作出冲动反应（例如，’我的朋友让我生气 – 所以当然我要大喊大叫’）; 或回避有价值的行动，以及那些可能导致不愉快的内在体验的情况（例如，’我避开我的朋友，以防他们可能不喜欢我， 以免我可能会感到焦虑’）。
• Committed action refers to engaging in patterns of behaviors or actions that are consistent with our chosen values. For example, if one of our chosen directions is to have self-compassion, then taking time each day for self-care and reflection is a committed action.  Commitment requires acceptance and defusion of barriers that inevitably get in the way. Commitment is not about being perfect and never failing, but about the willingness of making a 100% commitment in the present moment. If one fails, one persists and gets back on track again. Committed action can be built from small steps to larger steps. Committed action is about the process and quality of action rather than some distant outcome.
  承诺行动是指投入到与我们选择的价值观相一致的行为或行动的模式中。 例如，如果我们选择的方向之一是自我慈悲，那么每天花时间进行自我照顾和反思就是一种承诺的行动。承诺要求做好接纳，并解离那些挡住道路的、不可避免的障碍。 承诺不是要完美并永远不会失败，而是要在当下做出100％承诺的意愿。如果一个人在承諾中失败了，这个人要坚持并再次回到正轨。 我們可以从小步骤到更大步骤构建承诺的行动。承诺的行动是关于行动的过程和质量，而不是一些遥不可及的结果。
• ACT is about increasing our psychological flexibility. It is about using the ACT processes to help us lead a more meaningful life regardless of difficulties. It is about not getting caught up with our thinking and feelings … cultivating a willingness to experience whatever is here rather than avoiding it … being in the present moment … as an observing self … being clear about what we care about … and committing to taking meaningful actions based on our values.
  ACT旨在提高我们的心理灵活性。它是关于使用ACT流程来帮助我们在无论怎样困难的情况下，都能去过更有意义的生活。它是关于不被我们的想法和感受所纠缠…… 培养去体验所有一切的意愿而不是去逃避……活在当下……作为一个观察的自我……明确什么是我们关心的东西……并承诺基于我们价值观采取有意义的行动。

Group Empowerment Psychoeducation (GEP)

• Empowerment is both a concept and a process that leads to desired outcomes. It has been applied in health and social care for more than six decades. Empowerment processes are underpinned by social justice and equity principles. Evidence shows that people who feel disempowered or powerless tend to experience worse health.
  赋权, 既是一个可以带来预期成果的概念，也是一个过程。它已经在健康与社会关怀领域应用了六十年以上。赋权过程以社会正义和公平原则为基础。证据表明，感到无权/无力的人往往会遇到一些身体健康问题。
• Empowerment is a social-action process that promotes participation of people, organizations, and communities. The goal of empowerment is to build capacity among individuals and communities in identifying their needs, challenges, strengths, and strategies to improve their collective health and wellbeing. It can be applied and evaluated at three levels – individual, organizational, and community.
  赋权 是一个社会行动的过程，它可促进人们、组织和社区的参与。赋权的目标是促进个体和社区能更充分地确认他们在改善机体健康和福祉方面的需求、挑战、优势和策略。赋权可以在个人、组织和社区三个层面上来应用和评估。

GEP consists of four key concepts and/or principles. These key concepts and principles work in tandem to support individuals and groups in sustaining personal and collective empowerment and psychological flexibility, especially in the areas of defusing from societal rules and stories that are disempowering and limiting full-valued living.
GEP由四个重要的概念以及/或者原则而组成。这些关键概念和原则协同工作，以支持个人和群体维持个人以及集体的赋权进程和心理灵活性，特别是可以支持他们从各种削弱其权能和限制其所有生活价值完全实现的一系列社会规则和社会叙事中解离出来。

1. Social Justice and Equity: Social justice is a set of principles and guidelines to ensure that the rights of all people in society are considered in a fair and equitable manner; for example, the right to live in a stigma-free environment, the right to employment and income, etc. Equity goes beyond equality to ensure that marginalized and disadvantaged groups have access to the resources that enable them to reach their full potential in all aspects of life.
   社会公正与平等: 社会公正是一套原则和准则，以确保可以公正和公平地考虑社会中所有人的权利。公平不仅限于平等，还可以确保处在边缘化的群体能够获得足够的资源，使他们能够在生活的各个方面充分发挥潜力。
2. Empathy and Compassion: Empathy is our ability to recognize, understand, and resonate with the emotion of others. Compassion includes empathy and takes a step further – it is a way of being with the ability to hold our own emotional reactions mindfully without judgement or outburst, and the desire to relieve other people’s suffering as well as our own suffering (self-compassion). Compassion can be cultivated through mindfulness practice and connecting to our values. It can enhance defusion and acceptance. It is a way of being that facilitates committed action toward social justice and equity, including the desire to eliminate stigma and discrimination towards people living with mental illness that cause suffering.
   同理心以及慈悲心: 同理心是一种可以去认知、理解，并能与他人产生情感共鸣的能力。恻隐心包括同理心，并不止于此。即，这是一种能够有意识地、非评判地、非爆发式地控制自我情绪反应的能力，也是一种渴望减轻他人与自我痛苦的善意(自我慈悲)。恻隐心可以通过正念练习和联结自我们的价值观来培养。它可以增强解离和接纳。它是一种有助于以坚定的行动促进社会正义和公平的心理特质，同时也包括希望消除对身受精神疾病困扰之人的污名化以及歧视。
3. Interdependence: Our health and wellbeing are determined by a myriad of personal, social, economic, and environmental factors at the local and global levels. Awareness of our interconnectedness enables us to recognize our shared values toward humanity; for example, climate change and food insecurity, the impact of public policies on our access to education or healthcare, etc. Our understanding of interdependence enables us to focus on our values and take action collectively to achieve our common goals based on social justice and equity.
   相互依存：我们的健康和福祉深受当地乃至全球各个层级的众多个人的、社会的、经济和环境因素影响。 意识到我们的相互联系，使我们能够认识到我们人性层面的普世价值观; 例如，气候变化和粮食短缺，公共政策对我们获得教育或医疗保健的影响等。 我们对相互依存的理解使我们能够专注于我们的价值观，并共同采取行动实现我们基于社会正义和公平的共同目标。
4. Collective Empowerment is the synergistic interactions between individuals, organizations, and communities. Empowering processes include awareness raising, critical reflection, open dialogue, capacity building, and shared leadership, which together contribute to increased partnership and collaboration to achieve shared goals to improve collective wellbeing and health equity.
   集体赋权 是个人、组织和社区之间的协同互动。赋权过程包括提高认知，批判性反思，公开对话，能力建设和共同领导能力，这将有助于增进伙伴关系和合作，以实现共同目标，以改善集体福祉和健康平等。

In ACE-LYNX, ACT and GEP work synergistically through six ACT and four GEP processes that are interconnected.
在ACE-LYNX中，ACT与GEP协同合作，通过相互关联的六个ACT流程以及4个GEP流程。

The ACE activities combine direct experiential learning that builds on participants’ past experiences and existing knowledge, and focused critical reflection that enables participants to become aware of their internal struggles (e.g., fusion with judgemental ideas or rigid self-identity) and the social determinants of their wellbeing (e.g., access to social support or workplace safety).
ACE活动既结合了一种基于参与者过去已有经验和现有知识的直接体验式学习，又结合了一种集中式的批判性反思。这种反思使参与者能够意识到自己内心的挣扎（例如，与批評性想法或僵化的自我认同的融合），以及意识到他们的福祉在一定程度上是由社会因素决定的（例如，获得社会支持的难易，或工作场所安全问题）。

• The ACE activities also engage participants in collaborative learning and critical dialogue to exchange ideas, perspectives, and insights, generate new knowledge, develop mutual and supportive relationships, identify shared values, and work collectively to achieve their collective goals (e.g., promote student mental health; address stigma)
  ACE活动还使参与者参与团体协作学习和批判性对话，以交流想法、观点和洞见，并产生新知识，发展相互支持的人际关系，明确共同的价值观，一起采取行动来实现集体目标（例如，促进学生心理健康；应对污名化）。

References 参考

On ACT:

• Fletcher, L., & Hayes, S. C. (2005). Relational frame theory, acceptance and commitment therapy, and a functional analytic definition of mindfulness. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 23(4), 315-336. doi:10.1007/s10942-005-0017-7
• Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44(2), 180-198. doi:10.1016/j.beth.2009.08.002

On GEP:

• Lindacher, V., Curbach, J., Warrelmann, B., Brandstetter, S., & Loss, J. (2018). Evaluation of empowerment in health promotion interventions: A systematic review.Evaluation & the Health Professions, 41(3), 351-392. doi:10.1177/0163278716688065
• Wallerstein, N., Oetzel, J. G., Sanchez-Youngman, S., Boursaw, B., Dickson, E., Kastelic, S., . . . Duran, B. (2020). Engage for equity: A long-term study of community-based participatory research and community-engaged research practices and outcomes.Health Education & Behavior, 47(3), 380-390. doi:10.1177/1090198119897075
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