Section 3: ACT intervention to reduce stigma of mental illness

Activity 2.9 Bus-driver role play exercise

ACT Processes:

  • All

Objectives:

  • Facilitate exposure to thoughts and feelings (including reasons, stories, stigmatizing thoughts, judgments, assumptions, etc.) that act as barriers to engaging in mental health promotion
  • Weaken the power of unpleasant feelings and literal thoughts through defusion and acceptance
  • Evoke and reinforce commitment to mental health promotion in the service of values related to compassion, social justice, and equity

Participation Format:

  • At the start, the group is sitting in a horseshoe formation. The facilitators will be standing at the front beside a flip-chart with a large bull’s eye drawn on it. A volunteer from the group playing the Bus Driver will be invited up to the front to interact with the facilitators. Then, Passengers will be invited to the front to join the Bus Driver for a role-play. Other group members can move their chairs closer to where they can see more clearly. After the role-play, a facilitator will sit down with the Bus Driver to debrief the experience and formulate a committed action. Finally, the exercise will be debriefed with the Passengers and the whole group.

Number of Facilitators:

  • 2

Time Required:

  • 45 mins

Materials Required:

  • flip-chart on a stand
  • water-based markers and masking tape

Activities & Instructions

Instructions for participants
  1. Introduction

Describe the overall purpose of the exercise.

  • As we try to pursue our values, we often encounter obstacles. The Bus Driver Exercise will help 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 show us how we can commit to our values through our actions.
This exercise works best if participants have some understanding about values and feel engaged. Check to see if people have questions about the importance of values.
  1. Identify the Bus Driver

Engage a volunteer to role-play as the Bus Driver (BD).

  • We will act out a little story with your help, and so, we will need several volunteers. To start off with, we need one of you to volunteer to play the lead role of the Bus Driver.
  • We hope that you will be willing to share with us some of the difficulties that have stopped you from doing something that aligns with your valuesand so this would be an area of your life you would wish to change
  • The focus of our group – if you are willing – will be to reflect on values that you may have in the area of promoting good mental health, whether this is promoting mental and physical wellbeing in yourself, to help someone you care about, or to advocate for someone or something in the community at large.

If necessary, give several examples relevant to the context (age, background) of the particular group about what is meant by promoting mental health and well-being – generally along three spheres; e.g., (i) self: engage in a diet and exercise program; seeking counselling; (ii) family/friends: visiting grandmother in a nursing home; recommending friends or family to seek help; speaking out against (cyber-)bullying; (iii) community/ society: campaigning against mental health stigma; volunteering at a settlement agency, etc

As BD plays a central role in this exercise, especially encourage and select a participant who is both willing and has the capacity to reflect, share, and articulate his/her values and perceived barriers clearly to the group.

  1. Identify the Bus Driver’s Values and desired Actions

Invite the BD to come to the front of the group. Find out from the BD what kinds of actions s/he would like to engage in and the value behind them.

  • Thanks so much for volunteering. Can you please share with us what you would like to do to promote good mental health?”
  • Think about what kinds of actions you would like to do, but you’re not currently doing. Suggestan area in which you wish to effect change. Can you also share with us why this is important to you? What does it mean for you to be able to implement these actions?
After the BD shares the kinds of actions s/he wants to do (e.g. call up my friends more often to see how they are doing), gently explore the values – i.e. the meaning of these actions to the BD (e.g. I want to be the kind of friend who reaches out to support my friends actively and compassionately). Focus on the quality of BD’s actions (e.g. compassionate, caring) and not the outcome or others’ reactions (e.g. so my friends will appreciate me more). Ensure that the actions and values are personally important to BD.
  1. Evaluate the consistency of BD’s current Actions with respect to Values

Engage the BD to reflect on how consistent his/her current actions are with his/her underlying values. Invite the BD to mark the bull’s eye on a flip chart with an “X” (see Bull’s Eye activity).

  • If the centre of the bull’s eye means that your current actions are 100% in line with your values, how far away from the centre are you?
As in the Bull’s Eye activity, we want to focus on how the BD’s actions align with his/her values, and not on the outcomes of those actions. (e.g. if BD frequently visits a brother with severe mental illness and offers help in an open way, the actions may be near the centre even if the brother does not show appreciation.)
If the BD puts an ‘X’ close to the centre and/or the actions being discussed are not actually something the BD wishes to change/improve, then go back to step 3.
  1. Identify barriers to Value-driven Actions

Identify five barriers to the BD’s taking actions that align with his/her values. Write them down in brief point form somewhere on the flip-chart outside the bull’s eye. (e.g. “no time”; “not enough confidence”; “I’m too old”; “I’m too shy”; “my friend is too mean”; “people don’t care”)

  • Can you share with us some of the barriers that cause you to be here, where you’ve placed the X as opposed to the centre?
Observe the participant’s emotional reactions as s/he is articulating the barriers. Check to ensure that they include all the important barriers. Sometimes, you may need to probe several times (e.g. If these 3 barriers you mentioned magically disappear, will you be perfectly doing XXXX and be in the centre?, What else stops you from taking action today?) If there are more than 5, ask the participant to rank the top 5.
  1. Identify volunteers to role-play Passengers

Identify five volunteers to role-play the BD’s Passengers, who will personify the stated barriers. Ask them to come to the front of the group, and have each of them identify with one of the barriers.

  • Are there some volunteers willing to help us out by playing these five barriers?
  • Your job will be to role-play these barriers listed here that have been getting into the Bus Drivers way when he really wants to be doing XXX.
  • Who is willing to personify the first barrier?
If there are two facilitators, the second facilitator can help orient the barriers – e.g. “thanks, please come over here to this side; you are the first barrier ‘no time’”
  1. Brief and position the BD and the Barriers

Introduce the basic story and roles in the role-play. Position the BD facing the flip-chart, with the Passengers (barriers) lined up at right angles to the BD to get on the imaginary bus. The remaining participants are invited to gather around and find a position where they can best watch the action.

  • Has everyone taken the bus? The long red and black ones we see on the street that come every so often? They are pretty great at transporting us to our destination.
  • You, as a bus driver, want to drive your bus towards the main station. So put on your cap and have your hands on the wheel and eyes on your target – the main station.
    You five are the barriers.You are the unruly passengers that are going to each come on the bus and try to boss the bus driver around.So one by one, line up here. when we start, as each of you get on, you’re going to scare the BD and tell the BD why s/he can never do action XXX… you are just like the negative thoughts inside BD’s head.

Describe the scenario (the local bus system, etc) that reflects the local context to engage the whole group.

If there are two facilitators, one can orientate the bus driver and the other can orientate the passengers.

Encourage the bus driver to physically get into role – with hands raised as if steering the wheel.

  1. Start the Role-play.

Ask the Bus Driver to spend a moment (about 30 seconds) connecting with how important the actions and values are for him/her. Invite the Passengers (“barriers”) one by one to enter the bus. Each will enter the bus, stand right in front of the BD, turn face to face towards the BD, and tell the BD a reason why s/he cannot do the valued actions. The facilitators help the BD avoid facing the barrier after hearing what the Passenger has to say by pivoting the BD by about 35 degrees, and direct the Passenger to “enter” the bus, standing behind the bus driver. Invite the next Passenger and so forth. By the end, the BD should be facing 180 degrees away from the flip-chart, with a single line of Passengers behind the BD.

  • Please take a moment and connect with the bull’s eye in front of you… how much you wish you could be doing XXX to express your values of YYY”
  • To Passenger: Remember – you’re the bully (‘barrier 1’) – do your best to scare the BD!
  • To BD: enough of this, let’s avoid this (pivots the BD after the ‘barrier’ is articulated in a scary tone…)
  • To Passenger: Get on the bus behind the BD (or the previous Passenger).Let’s have the next passenger come on the bus.”

If there are two facilitators, one should stand beside the BD to give emotional support and to help pivot the BD. The other facilitator can help guide the movement of Passengers.

Order the sequence of Passengers approximately from the “easiest” to the “hardest” based on what appears to most resonate with the BD.

You may need to coach the passengers to act as “bullies.” e.g. “You are so old – no one will ever care to listen to you! Don’t ever think you can really do XXX!” in a scary tone

The BD may spontaneously rationalize and “talk-back” to the passengers. e.g. “I know it’s not really true…I was successful before” You do not necessarily need to intervene. Interrupt only if it gets too long.

The BD may want to “kick” a Passenger off the bus. Tell the BD that the Passenger has paid the fare, and is here to stay.

The BD may get emotional facing certain barriers. Pace the exercise accordingly to give BD the needed support.

  1. Debrief the Role-play

Debrief by helping the BD to reflect on the experience and notice which direction s/he is driving. What was it like to be facing your barriers?

  • Which ones were especially hard for you?
  • Any particular surprises in this experience?
  • Take note of the direction you are driving. Are you getting closer or moving farther away from your values (bull’s eye)?
Depending on the situation, the BD may want to discuss more about the experience at this point, including some more stories and explanations about the barriers. Some barriers may be surprisingly “easy” or surprisingly “hard” to face. Support the BD and take time to empathize with the experience.
  1. Re-do the role-play with acceptance and defusion

Invite the BD and passengers to re-do the role-play, this time coaching the BD to welcome the passenger on to the bus and stay facing the target.

  • Let’s do this role-play one more time – this time, let’s try something a little different. Are you ready?
  • This time, when a passenger gets on, see if you can welcome him or her. You don’t have to talk back to them. Just something very brief. Just say, ”Welcome aboard” or something like that of your choosing.
The BD may lapse into arguing back with the Passengers. If so, gently remind BD to just welcome the Passenger on board.
  1. Debrief with the Bus Driver (BD)

Thank and invite the passengers to return to their seats. Sit down and debrief with the BD, with the two facing chairs at a 45-degree angle in front of the group. Explore the BD’s experience with the whole exercise, including sharing the barriers and doing the role-play twice.

  • Would you like to share with us what this experience was like for you?
  • What was it like to share your values, desired actions, and barriers?
  • What was the role-play like the first time around?
  • How was it different the second time around?
Facilitate the BD to reflect on the differences between the two role-plays; how s/he was able to welcome the Passengers; the emotional reactions to the Passengers; and the sense of being in control of his/her “bus.” Note that the Passengers are still present by the end of the role-play. Acknowledge that the Passengers may still seem scary.
  1. Elicit Committed Action from the BD

Have the BD identify one committed action that s/he is willing to do based on the experience of doing the exercise. Check to ensure that the BD is committed to doing this.

  • Now that you have this experience, what is one action you are willing to do within this week to further commit to your values?
  • It can be a small step or a big step… just as long as you are willing to take this step and it takes you one step further in your desired direction
  • How sure are you that you will do this – from 0 – 100%?

Facilitate the BD to choose a concrete action. Be as specific as possible. (e.g. “I will jog twice this week for 20 minutes each time”; “I will call my sister tonight”; “I will sign up to volunteer with the mental health association on Saturday,” etc.)

If the BD endorses a low likelihood of following through (e.g. below 80%), see if there is a smaller action that the BD is willing to commit to. (e.g. “I will take a walk once for 15 minutes after dinner”; “I will look up my sister’s phone number tomorrow night”; “I will get a brochure from the mental health association on Wednesday, ”etc.)

  1. Debrief with the Passengers and the rest of the group

Invite the Passengers to share their experience. After that, invite other group members to share their reflections and experiences.

  • What was it like role-playing the barriers?
  • What did you notice about yourself? About the bus driver?
  • To everyone – have you experienced similar kinds of thoughts in your head that prevent you from carrying out intended actions?
Group members may want to offer support, suggestions, or advice to the BD. Empathic comments and suggestions can be helpful. If there is any doubt, check with the BD whether it is helpful, and remind the group that all of our struggles are different – what works for one, may or may not be suitable for someone else. Although our struggles may be different, our experiences of being bullied by our internal thoughts and feelings as barriers may be the same.

References & Sources

  • Adapted and modified from Thoughts as Passengers Hayes et al, 2012, pp 250-252

License

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Acceptance and Commitment Training (ACT) for Mental Health Promotion Copyright © 2024 by Kenneth Po-Lun Fung, Josephine Pui-Hing Wong is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, except where otherwise noted.

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