Megan W 

Hi. So we're so excited to have Dr. Eduardo Roldan here with us today. He's going to be talking about ACT with kids. So Dr Eduardo Roldan in is the co owner and clinical director of Etobicoke psychological services and EPS Family Health, and has a diverse background in community mental health, school board and private practice. He's also a consultant at the George Hall center, passionate about mentorship. Dr Ed supervises early career psychologists and students, including some team members at Flourish. Specializing in evidence based treatments, he supports children, adolescents and adults in addressing anxiety, ADHD mood disorders, aggression and developmental disabilities, using CBT and ACT to promote self compassion and resilience. An advocate for mindful parenting, Dr Ed helps caregivers build stronger relationships and make value driven decisions, empowering individuals to face challenges and lead fulfilling lives. So Ed, we're really excited to have you today. I personally am such a big fan, and I always credit Ed for being the person who got me my job at Flourish. So we're so excited to have you here with us today. I'll let you take it away.

Dr. Eduardo Roldan 

Thank you everyone. Thank you so much. I'm so excited to have everyone here a couple of things, just right off the bat. So I'm, I am. I'm in a household where my my oldest son has missed school for a week, and I just went to pick up my youngest son from school today, and I'm getting over something, so I'm hoping I don't have like, a coughing fit during our talk. But just so you know, I'm a little bit under the weather. I thank you so much to first off, thanks to Marie. Thanks to the Flourish team for, you know, sort of setting this up for all all these clinicians to come and have a conversation with us. It's such an exciting opportunity, and I'm really excited to be part of it. So thank you very much. Very briefly, a little bit about just uh, EPS, so we're a family owned Clinic. My sister and I are the two directors. We're about to open our third our third location, a second one in Etobicoke. We're multiple most multidisciplinary team of psychology and social work, and we sort of provide services for all ages. I personally have an interest in autism, OCD and parenting, so you might see me talk about some of that as we go along. So what's the agenda today? So I'm going to start off very broadly speaking, about ACT. We're going to go into the model of Act, which you'll see that. I'll show you the hexaflex, which outlines the six processes that are often used in ACT, with the the idea being to increase a client's psychological flexibility. And then we're going to sort of transition into how we can adapt the hexaflex to children. And then when I'm going to go through each of the processes with examples of how you may be able to do each process with with different age groups. And then I'll just finish off with some just over overviews of some other general activities that are helpful. I will say a couple of things. I want to just say today's talk is not, it's not like this isn't a formal ACT training right. We're very lucky in Toronto that we have some actual peer reviewed trainers in the city that I would recommend that if you have the opportunity to actually get trained by them. I would take that opportunity. So, for example, Dr Sherry Terrell, at Life In Balance is actually formally trained clinician. And so I would suggest that if she runs trainings, and you're interested in this topic, that you look into, into going into some of her trainings.Today is just a bit of like opening the door up to a conversation about ACT, I'm hoping that you can take away some some valuable things from my talk. It's funny. I will say that one of the things that I love about ACT, and I you know, whenever I supervise, I emphasize this is ACT has allowed me to bring in a certain level of vulnerability when I'm interacting with clients. And part of it starts off with this idea that I view everything, all behavior, as serving a function. What that does, from the get go, is it opens the door to a couple of things that are really important when children and families come into the clinic. The first is it allows me to be non judgmental. I'm not here to tell you why a behavior is problematic. What I'm hoping to do is to instill a sense of curiosity, because I'm curious about the function of a behavior that's occurring for this family and this child, and so when I take the stance of behavior, preserving a function when I start to interact with that child, from the initial stages, I am taking that open, curious stance of saying, trying to understand, what is it that that behavior is trying to accomplish? And so what I'm hoping to instill right from the get go is a sense that that behavior makes sense within the context it occurs. For example, if you care about what people think of you, then it might make sense that you're going to drop out of a of a play, that you're that you're the main lead. If you're scared about failing in front of others, you might drop out of gymnastics. If you think that you're worthless, it might make sense for you not to go to the gym or not to get out of bed. And so in many ways, by starting off with this concept that behavior serves a function in that it that behavior makes sense within a context, allows me to already start with that open stance from the get go. One of the main things that we do in ACT is that we de emphasize the content of private events. So private events being thoughts, feelings, urges. You know, in CBT, we spend a lot of time analyzing private events and trying to sort of adjust private events to be more, you know, adaptive and accurate. In ACT we're not really spending time in the content of private events. What we're trying to do is to change the relationship that we each have with our private events, and I'll go through that in more detail as we as we move along. So this is the hexaflex. I'll be honest with you, the first time I saw the hexaflex, I was actually, you know, I went. So my first foray into ACT was when I went into I went to the World conference that was held in in Montreal, and I went to the two day pre workshop, and I can tell you that I left that training completely lost and overwhelmed, and this model used to overwhelm me. And so if you're if you don't have any exposure to ACT and you view this and you're feeling a little bit overwhelmed, don't worry. You know, that's normal, we're going to sort of go through each process, especially when I go into the model, as through the kids lens. So the six processes just quickly are acceptance, diffusion, contact with the present moment, selfless context, values and committed action.  In the middle what we're always trying to promote through ACT is psychological flexibility. So the opposite of rigidity, if you think about about it, our clients oftentimes when they are in states of significant stress, fall into very rigid patterns of behavior and choices, and so we're trying to promote flexibility within the context of what might be happening for them. Sometimes this hexaflex will be presented as a triflex, which would be be present, which would be the middle two. So contact with the present moment, and selfless contact would allow you to be present. Acceptance and diffusion is about opening up to experiences, and then values and committed action are about do what matters. Again, I'm going to go into this in the child version, so that it makes it easier for you to understand how that would apply with children. I guess Megan, I guess, like, if there's questions, people can put their, I don't know, raise their hand and stuff. I'm open to making a conversation that's perfectly fine, but I'll just continue otherwise. So, as I mentioned, so in the middle of the of the model of ACT is this idea of psychological flexibility. The actual definition of  psychological flexibility is the ability to connect the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends. So it's persisting and moving towards valued ends. This is something that's going to be crucial in our work with children adolescents, because we're always going to be talking about pivoting towards meaning. So let's, I said all that now let's actually adjust a little bit. Let's talk about it as we're talking to children. Okay, this idea of psychological flexibility at the end of the day, when I'm talking to children and their families. What I'm emphasizing from the get go, I said from the beginning that I open up with a very open and curious stance, trying to understand what it is that brings them into the session so that they can help, they can start to understand why their behavior make sense within the context that occurs. And what I am emphasizing is living a life that is meaningful and fulfilling as defined by the child. And so three concepts are going to be things that we emphasize. First is accepting the thoughts and feelings that we all have, talking about how they are universal, they are adaptive and they make sense. We're going to start help our children to identify and choose what and who is important to them, and then we're going to identify what they how, what actions they can take to move in the direction of meaning and fulfillment. So those are the three things we're going to be emphasizing session after session, accepting experiences, even if they're challenging or distressing, choosing who and what matters, and taking action to move in the direction of meaning. So this is the kidflex. The kidflex is adopted from the hexaflex by Tamar Black in her book. And what I'm going to do is I'm going to walk you through the six core processes, and I'm going to sort of do it using some hand models of the of each of the six core processes. So I've had the pleasure of co-facilitating a dad's group, a dad ACT group with Dr Kenneth Fung, who is excellent, is an excellent clinician. And I got to tell you, it was actually probably the most rewarding clinical experience I ever had, running an ACT group with dads. Because when you look at how that's that those sessions started with a bunch of guys who didn't know each other, who were really reluctant to sort of share and open up, and by the end, it was they wanted more. And so it was such a beautiful experience to see how we could introduce things like vulnerability and connection. And it was, again, it was a beautiful opportunity. So I'm going to use the hand models that he often uses to explain each of the six core processes. So if you can, if you want, if I can get you to just press your hands together, okay? And we're going to ask you to hold and put pressure on your hands, okay? And as you hold your hands together, I want you to notice the tension that occurs Okay, and I want you to think about how this tension might be reflective of how of the tightness or the tension that we feel when we have certain things that really stick to us, things like, I'm a bad therapist. I failed as a father. I can't believe I I ruined family Thanksgiving. Why do I always get dumped? Why do why can't I be in a relationship? And I want you to notice the attention as you're holding it, and think about how we might hold on to some of these beliefs and labels really tightly. And the very first step in act is to create some space between us and our thoughts. So this is diffusion, okay, in this model that would be letting go of those labels that we hold on tightly, that we feel define us and tell us what we are worth. We let go by creating space between us and our thoughts, and as soon as we create space, we can start to pivot our hands towards acceptance. So this is acceptance reflecting here in the kidflex. It is letting it be allowing for situations and experiences to be present without feeling like I need to push them away or get rid of them. And as soon as we start to be more accepting by letting things be, it's easier for us to be in the present moment. And staying here, contact with the present moment is about being here as I talk to you today, not in the future, thinking about things that are bound to happen and the bad things that are going to happen in my life or the past, the mistakes that I have made. But I am here talking to a group of clinicians present, and then we pivot, and we make our hands into a cup and a fist, and as I notice myself, and I bring myself to the selfless context process, I wonder, Am I the cup, or am I the fist? Am I what is inside the cup? Or am I the holder of that of this fist? In the selfish context, we often teach individuals that we are the holder of stories. No one story defines us. So just like a cup could have a bat batch of coffee, I could dunk that and brew a new coffee, and that I'm not defined by that whatever's in that cup. I am the holder of those stories. Now imagine put your hands together as if you were in in the desert and you ran into water, and imagine how much you would want to hold every single drop of water in your hands. This reflects values, the people and the things that matter to you that you want to hold dear. And so here is where we help our children choose what matters. And then finally, we do a pinky swear, and that's committed action, where we teach our children to do what matters in the service of our values. Okay, so it's a nice, beautiful, little hand gestures that makes, makes it easier to remember those six core processes. I'm going to move on and start to get into some specifics. Before we go on I just want to sort of set up two potential clients for you more from the perspective of, like, I don't know, I'm not sure if I'll be able to give examples for each of them, but just so that you have, like, an idea of how this might work, and maybe it'll be, it'll be interesting, if you could apply some of the the activities to some of these clients. So imagine Annie, nine years old. She has difficulty sleeping. Parents have to be in her bed all the time. The family can't even fly away, because the last time they went. They were trying to go to Florida. She had a huge meltdown. She used to love, love, love, love, gymnastics, but is no longer attending. She is she's dropped out of every sort of extracurricular, and is causing huge stress for the family. Okay? And then we have John, 16 year old, increasing episodes of irritability and anger. frequently he isolates himself spending excessive time playing video games. Has lashed out physically, maybe punch holes in the wall. His parents describe him as bright but shy. He's always struggled with expressing his emotions and communicating with others. So I want you to think of Annie, nine year old significant anxiety across different domains, John, isolation, anger and excessive gaming. So let's go into into one thing I should point out, actually, before I go, maybe I'll go back to the to the quickly to the hexaflex of the kidflex. One thing that I did say is that in ACT, there is no order that you're supposed to go in. The beauty about ACT is the flexibility of being able to move across processes. And sometimes, if you're having difficulty in one, you can just go to another process. The other thing that I really love about ACT, if you ever watch Russ Harris, for example, he talks about ACT being something that you can do in conjunction to the work you're already doing. It doesn't have to replace your main mode of your main mode of treatment. It is almost like a wardrobe. If you choose to try this on today, I'm going to try this part of ACT, and I'm going to see if it works with my with my client. It doesn't have to be something that you hold on rigidly and have to do in a specific order. So let's go to the first one. If you remember, it's diffusion, letting go. And the concept is really simple. It's basically being able to step back and create space between us and our thoughts and our feelings, our internal our personal experiences. One of the key things that's really important is when, when, when we create space. It is not about replacing or ignoring these experiences. They are still there. We're not trying to say, you know, John, you should be grateful that you have loving parents. You shouldn't be angry or to to Annie, we're not saying, Hey, listen, why are you, why are you so nervous? It's just regular gymnastics. No one's even watching. We're not trying to replace it and give her a reason for why she shouldn't feel that way. But one of the classic ways of doing diffusion is a very simple it's a language one. It's basically, for example, imagine that I'm having the recurring thought that this presentation is going horribly. I'm like, oh my god, this is horrible. People are hating it. People are hating it. People are hating it. People think I'm stupid. People think I'm stupid. Oh my god. Imagine I'm holding on to that. Imagine how tight I might be, that tension I might be feeling with that thought. If I was doing diffusion, I might be able to say I'm noticing that I'm having the thought that people hate me. I can even go further and say that I'm noticing I'm having that. So the first one is, I'm having the thought that people are hating my presentation. The second layer is I'm noticing me having the thought that people are hating this presentation, and I can go all the way to I'm noticing as I'm talking to you in front of my computer on a Tuesday afternoon that I'm having the thought that people are hating this presentation, and just by simply teaching kids to be able to label an emotion and put these in front of their thoughts, they're starting to create some distance, as if the thought has gone from defining them to something they can hold out at their arms length. So you know, oftentimes, when I'm working with kids with with anxieties, we tend to externalize it. We give it a nickname, whether it's the jerk, the bully, sometimes we use swear words based on the kids feedback, and sometimes, when I hear a child speaking about their experience, I might say, Oh, sounds like the bully is really trying to, you know, take over here. What are we doing when we give it a label, when we externalize the those thoughts, we're creating some distance between the child and their thoughts. You could also make it silly and have fun with it, right? You can do a yo take a thought and make it into a Yoda type of thought, right? Horrible this presentation is, or whatever it is, to try to make it fun. For some children, you could talk about thoughts being like, you know, every time they go on YouTube and they want watch a video, and that advertisement jumps up on the side and they're waiting for it to press, you know, to close that that ad and to watch the video is when you see a thought, read it, look at it and like, this is not a helpful thought, we're going to close it. Now that doesn't we're not trying to teach that it goes away because we're going to say the ad is going to pop up, it's going to come back. So again, we're not trying to replace it. We're not trying to suggest that we got rid of it. We're just teaching the child to be able to shift their focus towards meaning when they have difficult experiences. Remember, the goal is to change our relationship with our thoughts and feelings, rather than change the actual thoughts or feelings themselves. A few other analogies here that would be helpful is like the radio station. Imagine that you're doing work right? And someone's playing, a radio is playing in another room. All sudden, your favorite song comes on. You stop. You listen to the song. You might move, you know, dance a little bit to the song. Song changes to something you don't like. Boom Back, doing work. You no longer hear that radio. It just becomes background noise. Same type of thing when you have thoughts we're teaching our children to recognize is the a helpful thought, is this, Is this helpful to me, or is this something that's actually just becoming a nuisance? Sometimes here we'll we'll actually let me just see something. Give me a sec. Sometimes we'll do things here like, we will say things like, thank you, Captain Obvious. So again, we're teaching kids to take their thoughts and say, I think I know that Captain Obvious. And so again, we're changing our relationships with how we deal with our thoughts. Another classic ACT, sort of sample here or or activity, is to do something and say something repetitively and do it very quickly. So for example, the classic is the milk, milk, milk activity where imagine I'm not, I'm not going to do justice right now, but imagine I say the word milk over and over and over milk, milk, milk, milk, milk. After a certain amount of time, I'm not even saying milk anymore. My words are getting jumbled and the meaning is lost. And so you can take a thought and write a whole sort of, you know, script with it, and get the child to play around and sing with it, or say it really quickly, and see what it's like, and again, make it fun and silly. So that's one example of how you or some examples of how you might do some diffusion. Now I said to you, diffusion is creating space. Now opening up is acceptance, and this is letting private events and experiences just be there. I often, you know, I when I'm in therapy, I got to be honest, I become like, such a dad, if you were, if you had the opportunity to talk to my kids, they would say that I'm the king of, like, cheesy, cheesy jokes. And I'm also the king of, like, repeated cheesy jokes. So it's the same joke over and over, and so I tend to repeat this joke all the time with my clients and with acceptance, I'm the type of guy that if you ever go to dinner with me, I will inevitably end up with a stain on my shirt, and it'll be a dot, like a.of oil will be on my shirt. And I don't know why I haven't learned, but every time I have a dot and I notice it, I always tell myself that today is the day that I'm going to be able to be able to wash it out. And so I end up going to the washroom and like doing, you know, trying to get rid of it. And I go from having a little.to coming out with a stain like this, okay? And it's a beautiful example of how I can take one thing and make it much bigger. And acceptance is about that. How often do we try to push away or hide or or sort of distract ourselves from thoughts, feelings and urges. In an essence, what we do is, is we make them grow. So, couple of things that we can do with children to teach them about acceptance. One of the things I might ask them is like, let me ask you guys, I'm curious, how well do you do if you're sitting at the in the movie theater and you have a thought that you have to go to the washroom, I'm curious, do people what do you guys think? Can you guys stop thinking about going to the washroom? What about if you get like, a tickle? You know, this happened to me at the beginning of COVID, when I was at the first time, I was at the grocery store and I had a tickle, and I was like, Oh no, no, don't cough. People are gonna look at you. People are gonna look at you. And of course, I had to cough, right? I couldn't make that go away. And so teaching our kids with real life examples of how when thoughts enter our heads, if we try to resist or push them, they actually magnify one of my other favorite activities here is, imagine I'm working with a child and they love, love, love, love pizza. I might say to them, cool, you love pizza, huh? Let's do an activity. Let's pretend that we're going to have a debate about pizza and why pizza is either the pros and cons of pizza. And we're going to pretend that we're going to be debating in front of a committee, in front of a judges that are going to decide who wins this this debate. But what I'm going to do is I'm going to be on the side of why pizza is delicious, and the kid who loves pizza is going to be on the side that hates pizza. And we're going to work together, you know, I'm going to go off on in the room, and I'm going to write a script about why pizza is delicious, and he's going to go off to his side of the room, and he's going to talk about why pizza is gross and disgusting. And then I go up and present and say, Oh, pizza's so delicious, the cheese and it melts and the crunch. And then he has to go up and say, Oh, pizza's soggy, and the sauce gets over your hands and and what if the bread is soggy? And so he might be debating and trying to come to get the judges to believe his side of the story about why pizza is gross. Now, at the end of that session, I might turn to the parents and say, Hey, can you do me a favor? Can you take him for pizza? And I might ask the child and say, Hey, what do you think is going to happen when you go to have pizza today, and he's going to say, I'm going to love it. He's going to love the pizza. So this is an example of how I can get him to actually go through a script convince a jury that a pizza is disgusting, it has no bearing on the reality of the next time he has a delicious slice of pizza. So again, we're starting to create a different way of thinking about those inner dialogs, those messages that we get about particular experiences. Another one is, you know, you might talk to a child and say, you know, it's funny how our brain works, right? Like, our brain is fascinating in terms of how powerful it is. It gives us all these silly rules, right? For Annie it might. It might mean you need to be perfect for John. It might mean, you know, don't, you know, there's no way you know you're, you can't be, you can't be vulnerable with friends, or you can't be vulnerable with family. And our brain gives us these rules, and we start to follow them very rigidly. But let's, let's pretend that we can come up with a silly rule here in the session. What if I said to you that today, when we're doing some writing activities, we can only write with our weak hand. Can we try and see what happens? Or can we walk around the office today and just hop on our left foot and we do all these silly things, and at the end we might say, like, wow, that was really dumb actually. Like, that was really hard to do, and it made no sense. Again, we're trying to break this concept that some rules are just silly. Just because your brain has told you that this is something you need to live up to, or a way to live life doesn't necessarily make it true. Okay? So again, we can be we can have fun in the room by creating these silly games where they have to follow a rule and they realize that it's it's useless and it's ineffective, much like the the things that bring them into the session. You remember, we're in the in the desert, and we don't want anything to drop the this is the values, who and what matters to you. In ACT, we spend a lot of time talking a little bit about the difference between goals and values. So goals are destinations, values are directions, right? So a goal might, might be for me to move west to California. I can, I can get to California and stay in California. But I could have a value of constantly moving west, which might mean that I that I go around the globe over and over and over again, an example of this. And I often again, I use myself as an example all the time with the children I work with. And I might say to them, like one of my values is to be a present Father, to be as present as I can be now, I will never achieve that destination. I will never get a certificate that says you are present dad all the time. What I have is opportunities to make choices that are going to allow me to be either closer to be a present dad or to be an absent dad. And so when I have a choice of doing this or that, this is what I have, I can make decisions based on the things and the people that are important to me. And so I might use, you know, sort of like silly little examples of kids, I might say, imagine, like, you know, you're walking outside and you slip your on ice, and you pump your head, and you're perfectly fine, except that when you come around, you've developed this capacity to hear people talk about you. But the key is you can only hear compliments. What would you want your parents to say about you? What would you want your friends to say about you? So for Annie, it might be, wow. I wish my parents could say that they're so proud of me for being brave, to be able to sleep on my own, to be able to do go back to gymnastics for John, I might be able to, I might want to hear people say like he's such a good friend, loyal, somebody who's dependable. So again, we're opening the conversation up to things that are important to them, that they may not be aware of. And I'm doing that from early on, when I'm introducing this concept of values, I'm already starting to ask them, like, what gets in a way of doing that, what actually interferes with your ability to do and to actually make decisions towards your values? And for Annie it might be just a sensation of extreme anxiety, physiological sensations that make her feel sick. For John, it might be the fear of rejection. And so we're already starting to have that conversation about what might keep him, keep them from moving towards their values. A couple other things that we can do for values. You could do things like, if I was able to get Annie to go and sit outside of her gymnastics class, for example, I might get her do a thank you card to herself and write about what you know, what,What would she thank herself for, for being brave? What would she say to herself if she was able to show some bravery, some of the other classic, sorry guys, my throat. Let me just get some water. I you know, some of the classic ones here are, you know, the magic wand. If you could change one thing, what would you change in your life? I prefer this bravery powder thing. So what I say to clients is like, you know what you came to the right place. I happen to have this jar of bravery powder, powder. And what I want you to do is, I want you to imagine then you take this home and you put it next to your bed, and what I want you to do is, tomorrow, when you wake up, you're going to take some of that bravery powder and you're going to spray it, sort of sprinkle it on you. What I want you to think about is, how would that day look different? What would you do more of? What would you do less of if you had this bravery powder? Again, we're trying to start open, opening the conversation to the things that are important to the children and the teens that we work with. For teens. This last one is a cool little activity. This is a values mall activity, and I can share it afterwards. And this is where you have you give a team, like a certain amount of a budget. So let's say you give them $100 and then you give them a breakdown of a mall. And in the mall there's different stores that represent different values. So it might be friendship, it might be like bravery, it might mean it might be like loyal. It might mean artistic, creative. And each of those sort of values, has different values, $1 of amounts. And so you take the $100 and you get the team to to go about and see how they would spend their money. It's a nice little activity to try to get them to make choices well, like, well, I have $10 left. What am I going to spend it on? And so you're trying to understand, sort of, again, who and what is important to this, the children and team we're working with. One last one, because I'm a gamer myself. I'm not embarrassed to say, as a 45 year old man, I play video games every day. But another one that I like to do with, with with kids, is this avatar exercise. Most of the kids you work with have played video games, and there are a lot of games where you can create your own character. And when can you, when you when you create your own character, you have certain amount amount of points that you can allocate towards your characters, and depending on the game, you might be able to make your your character stronger, faster, smarter, maybe they can do magic. Maybe they can be very convincing. There's different attributes that you can sort of allocate points towards, and you might get them make a list of all the values that are important to them, and then we start to allocate their values based on an avatar. One of the beautiful things about this activity is that you can come back to it and see whether four sessions down the road, if their avatar remains the same, or if anything has changed. I realize my time is a little I gotta speed up doing what matters committed action. These are specific actions that we can start doing based on what matters to them. An emphasis here is on small, incremental steps. We are promoting flexibility. We're promoting bravery. We're promoting curiosity, opening yourself up to experiences, and trying to do small baby steps. Here's where, you know, I have my little Shakespeare in the corner. We might be doing role play. So for example, for Annie, can we role play? What it would be like to walk into your gymnastics class? What would it be like if your coach came up to you for John, what would it be like if you walked into the cafeteria and sat down next to your friends? There might be things like, other things that you can do is a variation on the fork in the road. So we can talk about with this idea of like, here you are, you're facing a fork in the road. You are outside of your gymnastics class, and these are your choices. You can do what you've been doing, which is running away and getting home without judgment. By the way, we don't judge that. Or we can try to be brave and step into the gymnastics class. One of the beautiful things about doing what matters in committed action is that when the child comes back and they have, quote, unquote, failed again, we're not judging, we're understanding from a standpoint of function. Yeah, it made sense. We were asking you to do something that was way too difficult for you, and so we might break down that task the next time and say, okay, cool. So next time, why don't we, when we go to gymnastics, why don't we get you to sit outside for a few minutes? And maybe that's success for us today. Sorry. My throat is my I'm starting to get I apologize. I'm going to go through the last two quickly, and then the fifth process is staying here, contact with the present moment. This is really getting our children to deliberately noticing what is going on inside and around us. Here's where most of the kids will have some understanding of what mindfulness is. I urge you to ask them what they know about mindfulness, because you might be surprised what they think is mindfulness is because they're probably used to something like listening to a recording for 10 or 15 minutes or something in class or or doing some of those things. So this is where you're able to create the flexibility around it, around around, what it might mean to be mindful. For example, can I ask each one of you to wiggle your toes right now? Were you thinking about your toes before I asked you to wiggle them? We might do that in session with kids, just to get them to see what it's like. Oh no, I wasn't thinking about my toes. And now here I am. Tamar Black has this beautiful sort of activity that she does for contacting with the present moment and staying here. And this is where you get a child to divide a page up into two halves. You try to help them to identify what sort of experiences are they able to stay in the moment for. So, for example, if they're playing with their friends, they've really into it, or if they're they're trying a new activity, like riding their bike for the first time, they're really present and paying attention. Whereas, what are the situations where their mind is elsewhere, right? So maybe in class, they're thinking about, you know, like going home and the party that they have on the weekend. Or maybe when they're in a situation where they're about to do a presentation, they're trying to think about, you know, running away and getting getting out of there. And so we're trying to help our children to be able to identify the scenarios where they can stay and be present and the scenarios that they can't. And we're doing that in the room, right? We might get them as we notice emotions come up in the session, might say, Hey, can you describe that for me? What's coming up for you right now? Can you tell me what's happening in your it seems like you're getting tense. So we're teaching this in the room. Cassidy & Coyne do a variation on this activity where they try to teach kids about this concept that our brain is so powerful and incredible, and how it tends to time travel. Think about how many times we're not in the present moment. You know, if I'm in the in the bank of in the line of the bank, I'm not in the bank of no line, I'm thinking, I'm thinking about 1000 other things, right? Whereas, if I'm cutting something, you know, like onions, and I'm really bad at cutting, I'm definitely paying attention and being present. And so again, we're teaching our kids how sometimes we might be thinking about past mistakes, we might be thinking about future events, when we can work on thinking about the here and now today. So I already did some of those, you know, exercises. So wiggle your toes. You might do some mindful eating, right, getting them to eat something like a chocolate and savoring it all those things are, being mindful, being present you in the fascinating thing about about this, though, is that you can get someone to go into detail talking about their favorite dessert, like, for example, chocolate cake, and get them to think about how delicious it is, and the smell of fresh, freshly baked cake and and the taste and everything about it, and you can get someone's mouth to water, right? It's such a such an interesting experience that we our brain is so powerful that we can bring up reality just by having thoughts about it. Again, really important when we're talking about anxious thoughts or depressive thoughts. Here's where you can do breathing exercises. Again, being present, dropping anchor is another big one for ACT clinicians. The last one is sometimes the hardest one to describe. And this is selfless context, noticing yourself. And this is the act of standing back, noticing that we can watch ourselves in experiences, be able to look at ourselves as we struggle, as we have successes, as we lie in bed thinking that we will never get out of there. We teach children to be able to notice ourselves in different scenarios. And there's a lot of cool things here. So one of the one of the examples here is imagine that for Annie, let's say I got her we I drew a bus, right? And I tell her that this is the school bus that's taking you to gymnastics, and I put her as the driver, and I draw, you know, we do a little stick person, and we put her as the driver of the bus, and then we fill in the bus with passengers with popsicle sticks, saying all the worries that she has, you  can fail. You can embarrass yourself. You're going to get hurt. You're going to be the worst one there when we put them in as passengers on the bus, and then all of a sudden we say, well, you know what's happening to you? The popsicle sticks that says, I'm going to fail, stands up, comes to the bus driver's seat, pushes you out of the way, and takes over the bus. And when it does that, the bus does a U turn and goes back home. And so we want to teach her that she is the bus driver in this scenario, and that sometimes in this activity, we might start writing on other popsicle sticks, other supports that she might have in place. I have parents who love me. My coaches is is is proud of me. I really love mastering a new skill in gymnastics. I want to get better. And we put those on the bus as well to teach her that they are also on the bus with her, and maybe she can focus on those to continue her journey to gymnastics. I tend to use a lot of analogies here, like I will use in my teens. I'll talk to them about like, especially at the beginning of my relationship with them. I say to them, I want you to imagine that you have your own Netflix show, and this is season one. What we're seeing right now is season one of the Netflix show. Avoidance, you know, maybe big emotions for John, it might be excessive gaming isolation, no, nothing extracurricular. And I say to them, imagine that we go and we fast forward six months down the road, and imagine this is almost like season two of your Netflix show. And imagine I'm a viewer, and I watched your first season, and now I binge you first season, and now I'm on second season. And and right away in the second season, I noticed something different about the main character. Like this, main character seems to be doing more of the things that are important to them. Then I asked the youth to identify, what would you be doing differently in season two? Who and What would you be moving towards if you were in season two and moving towards your values? So again, I use this analogy of shows. I also tend to use a lot of visuals, for example. So I might get a client. Imagine this is Annie as a teen. I might say to her, Hey, tell me about this. This character in this in the scene, what do you think this character is thinking? What are they thinking about themselves? What are they thinking about their future? What are they thinking about their situation? Imagine that we turn the page in this I often use, like, the example of graphic novels, right? So we're using a graphic novel, and maybe this is the page somewhere in the in the graphic novel, and then this is the page another page in the same graphic novel. And imagine that these are the same young lady. What is this person thinking about? What are they thinking about themselves, their worth, their future. And one of the things that we're doing in this conversation is recognizing and helping our children to recognize that we are both of these people. They are they are both of these experiences. They are not defined by any one experience. They are the holder of the stories. And this is helpful when we hold tightly to things like I'm a failure. I cannot be vulnerable. I will never be successful. I think my timing is okay. I think I've rushed I apologize. I wish I could go into more detail a couple of things. I just want to point out, if you have clients who have trouble with some of these things. Depersonalize the experiences, right? Use use comic books of other people. Use magazines and try to see if they can identify emotions or experiences from for other people, rather than about themselves. As I mentioned to you, I use the comic book analogy very quickly. I'm going to use a very one of my favorite analogies. Imagine, you know, I don't know if you guys know the difference between a graphic novel and a comic book, but comic books tend to be a bunch of shorter stories. And so imagine that you have a bookshelf with a bunch of comic books, and each comic book has a title on it, like the Annie is a great gymnast, Annie who can't go on vacation, Annie who is a failure. And you think about the each of those comic books, imagine you're opening them up, and they have all these extensive visuals inside of them. If I'm reading that book, I might be engrossed in that story. And when I'm engrossed in that story, I might believe that that is Annie, when, in reality, Annie is none of those stories. Annie's the bookshelf that holds each one of those chapters. And so this is an analogy that I like to use with clients. And we might do it in the office, right? We might write, you know, like fake covers on our books, and put them on the shelf, and we might say, Hey, look at those. These are all you. And we might pull them out and someone checks out a book. We're still the holder of the stories. One thing I haven't mentioned is that another component of Act is this idea of self compassion. And so I'm aging myself here. But if, if, for the for those of us who, for those of us, for those of you who are around, when we used to have video cassettes, you know, when you rented a video cassette, they would often say, Be Kind Rewind. So we would rewind the tape cassette for the next person, so they could start watching from the beginning. And here's an example where we can rewind and be kind. So if you have a child who's playing out scenes and experiences and they're being very self critical, we might get them to play that scene, replay that scene, maybe in a timeline, and getting them to start talking about, what could they have said to themselves in that moment? What would they have said to themselves in that to be to be encouraging, to be able to be to connect with their difficulties in that moment. And we might do that in a timeline, right, getting them to write, you know, the day that I hurt myself, the day that I got rejected. And we might write things in different colored pens, about what we could say to ourselves, what would have been helpful in that moment. All right, very quickly, because I want to end another big I don't have time to go through this all the analogies. But ACT tends to use a lot of analogies. One of my favorite ones is this visual of a rock. Imagine you have a rock, and I dumped, I dumped the giant but the biggest bucket of water on top of it. That water would just bounce off the rock and do nothing to it. However, if I take a drop of water and I hit that rock in the same spot repeatedly over time, I would start to create a hole in that rock. And so this is a beautiful concept for this idea of small, incremental decisions and choices that we can make that over time create meaningful change. There's all the analogies, a couple of things, just very, very, just in case. Later on, I'm going to show you a couple of books. This is the Lisa Coyne book, and Cassidy and  Coyne book does a really nice job of introducing slightly variations to what I talked about. They talk about, uh teaching children to do these first three steps as mindfulness, slowing down, getting curious, noticing on purpose, stepping back from your thoughts and then turning towards the things your mind tells you to run away from. The other model for active children is the DNAV model. It's probably the most research based version of children adaptations. In this model, you teach children to identify their discover the one that goes out and discovers the world. The noticer is the mindful one that notices experiences. The advisor is the one that tells you that gives you advice, and sometimes can be very unhelpful. And then the V is for values and vitality. So I don't have time to go through these models. But again, I really encourage you, if you're interested, to look up some of these resources which are included here. I think I'm done and open for for questions, and thank you. Sorry. I feel like I rushed.

Sara 

That was fabulous Ed, you did not rush. You were I mean, that is a lot of information to add to one presentation, and it was incredible. So insightful. I'll give people a chance to add their questions to the chat, if they have them, or if you want to raise your hand, that's fine, too, and asking it yourself. One question I had, Ed was, Do you have an example of a really rewarding experience using ACT with a particular child that you could share, like, what observable signs we might look out for that? Oh, we're on the right track. This is working.

Dr. Eduardo Roldan 

I think, to be honest, it's I have one client that comes up right away. And to me, it's, it's such a simple, small thing. And it is something like my client coming back and telling me that they stopped and noticed and labeled, right? It's something as simple as that, like I noticed I got, you know, I had a client went on a on a flight recently, and he just talked about being on the plane noticing, labeling that experience for himself, noticing that the sort of physiological sensations, and then working towards dropping anchor and trying to regulate his physiology. So just when they start to use some of the language and take very small steps, to me, I'm, I'm in cloud nine, like, I'm excited when they do that, right? So it's really small things.

Sara 

You know they're internalizing this messaging, right? Like, that's right.

Dr. Eduardo Roldan 

And I do this, and I when I talk to parents, I tell parents all the time, when we're taught, when we're doing this type of work, it's about scaffolding, right? We're providing the kids with the language and examples and modeling for them, openness and curiosity towards some of the things that we tend to push away really quickly and without thought.

Sara 

The question that I actually had, since no another question that I had. And then I'll get to the questions in the chat was just, are there tips and tricks that you give to parents to sort of bring the ACT framework into their household and their daily living? You obviously don't have time to teach them the entire framework during their kids session. So like, what are some small things that they can take away to make sure it's you're continuing to build?

Dr. Eduardo Roldan 

Yeah great question. Great question. So from the initial stages, I think that the stance of teaching parents that the the behaviors that their children are experiencing are not ones to to solve, but rather to understand, is something that I want to emphasize right from the get go. So I want the parents to start to be curious themselves about what it is that their children are experiencing, versus thinking that it's something to be fixed. And so by just instilling this idea that, listen, we all have different different emotions and experiences that we want to push away and that we want to avoid, and most of the time, our choices are about avoidance. And that is true for you as a parent, that's true for me as a clinician, and as soon as we start to have that conversation, and they can start to get on board with that, it's already making a significant shift in how they approach their children's distress.

Sara 

That is an awesome response. Now I'm getting tons of questions in the chat. Can you tell us a little more about what it means or looks like to transition in and out of, out of using ACT with other approaches?

Dr. Eduardo Roldan 

Yeah, I think that's a great point. Yeah. So I think, like, remember, like, if you're dealing with a child, for example, and they're experiencing significant emotional distress, you might go straight and, you know, you might do some DBT skills, right? You might do some tip skills. You might go into interpersonal skills like, dear man, it is, you know, if I'm doing sometimes with some younger kids, I will do some classic CBT if I notice that, you know, maybe it's best for them to become a detective and to get to a place where we can come up with a more accurate type of thought. I might shift towards a more CBT approach, rather than focusing on on the ACT processes. So it is about bringing things in. You know, if I'm working with a parent, and even though I'm I'm working through through an ACT lens, I might be doing a lot of emotion focus work where we're trying to validate and and talk about the emotion and and trying to get the parent to be open and and to to to see that distress in your children. So it is about pulling from other different things without thinking that you need to do ACT all the time.

Sara 

How do you describe dropping anchor to kids? Everyone loves your all your analogies, I think, like you become the king of like the the tools and resources in this chat. So how do you explain dropping anchor?

Dr. Eduardo Roldan 

Yeah, yeah. You know. Again, with, with ACT it's, it's, it's experiential. We do it in the room. So I might say, Hey, if you want to try something like ACT, like, let's do dropping anchor dropping. And you, I'm not going to do this with a seven year old, necessarily, but I might do with a 10 year old, and I might say to them, like, very quickly, the analogy and ACT is that for the for anchors. Like, imagine you're on a boat, and you're the captain of the boat, you're responsible for the boat, and you see a storm coming your way, and you know you can't get away from it, you might drop an anchor. And the reason you might drop an anchor in that example is to create some stability so that you're not swept away by this huge storm. It does nothing to do. It does not get rid of the storm. So imagine that when we're having a big emotional reaction. What if we learn how to drop an anchor? And let's Why don't we practice that in session? Let's do it. And here are the three steps. The first step is to label notice your thought and label it. Second is to connect with your body. You know, when you're nervous, your heart might race, you don't choose to do that. And yet, when you're nervous, you can choose to press your fingers together. You can choose to clasp your hands together. You can choose to slow your breathing rate down. And then the last one is to use our senses. Think about what's around us. Listen to the sounds in the room. Listen touch the couch next to you. Feel that. And as soon as we do that, we're in the room talking to Ed, dropping anchor. And so we do those three steps, and we practice, we practice, and they go out and they try to practice. And we try to make that again, small baby steps towards meaningful change,

Sara 

Ed you're excellent at that. But we have another question here, and it's an excellent one, and I don't want to miss it. I know we're running out of time. Kids might be under a lot of pressure at home. How do you tease apart what values are their own versus what what might be put being put on them by parents or teachers? If that's a consideration.

Dr. Eduardo Roldan 

Yeah, that's a really good question. I think, I think, I think that can come just through time and and getting to know your clients well. I think there are times when if a value is not really their own, you're going to find a lot more resistance, and the committed action is going to be less effective. Because the reality is that, and this happens in ERP all the time, when you're doing OCD work, is if you're doing OCD work and you haven't instill a realization as to why they're doing ERP work, why are they purposely stepping into discomfort, then you're going to find yourself failing. And so I think that if you see some of the resistance, and you see that you're not being as effective, it might be time to actually reflect on what might be their true values, and that might come through just further exploration, curiosity, trying to throw different scenarios at them. And it may not always. I don't know if you'll always get like, clear sense of values all the time. But again, you adjust as an as a clinician, right? And you try to try to find something that will stick with them.

Sara 

Amazing. We have one last one, and then we'll let you off the hook, because you've been so good. And I can tell that your throat must just be tickling like wild. I'm wondering, how might we use ACT when working with parents and bridging the gap between what they are holding on to separate from what we explore with the kiddo in sessions? Would this be best through bringing in other modalities like EFFT?

Dr. Eduardo Roldan 

Yep, so a couple things, if I'll say right now, just in if you look at the screen right now, one of them is my Instagram. The other one is my YouTube channel. YouTube channel has a lot of free webinars that I've done, and part of it is on this topic. And I will say that if I will say, I will drop a name Lisa Coyne. She runs a beautiful ACT and parenting course. And this is what I would say when I do parenting work, I do incorporate EFFT. I do incorporate like validation of emotions and in terms of the ACT lens, again, what I am doing is trying to help parents to recognize that in any given moment, can I get you to stop and pause and actually answer the question, what are you really responding to here and in EFFT, we talk about magnets. What is pulling at you. Are you really trying to like? For example, if I see if I see my children, sometimes if I see my sons, give up really easily. That eats at me. And I've noticed over time that that is my magnet, and in that moment, I might respond to my children in a specific way that is not consistent with my values. Because really, what I'm doing is getting to that place of like I hate when I see someone not get, not give it their all, and so I need to reflect on that and be insightful, to be able to take a step back and say I'm having that thought, and now I'm going to pivot towards a meaningful, engaging interaction with that, with my voice.

Sara 

Ed, you are fabulous. That was incredibly well done. We so appreciate your time your presentation. I don't know if you're willing to share your slides, or at least some of your tools and techniques in the chat. I think there's so much there. And you were, you did, said, so many wonderful analogies. I think people want to come back to it everyone. We've also recorded the session, and so it will be available eventually on our website, and we'll let you know when that happens. I'm just going to quickly look up who's up next week, because I didn't I was so engaged, and I just want to let you all know who that is. And of course, you can reach out to Ed. All His contact information is there if you have more questions on ACT, and definitely check out all of those webinars. Next week, we've got Dr Angie Celebre, and Shayna Fox Lee from the PsychoEd Clinic. Unmasking ADHD in women. So that should be a great topic. Ed, you are wonderful. You obviously are a Flourish fave, long time Flourish, fave. And we're so glad that we got to chat with you today. We hope you feel better soon and that the kiddos are back. Thank you.

Dr. Eduardo Roldan 

Thanks guys. Angie is great, by the way. Thank you guys. She works at EPS too.

Sara 

Oh, excellent.

Dr. Eduardo Roldan 

You're in good hands next week. Take care, guys. Bye, everyone. Thanks so much for joining us. Bye.