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Home | Blog | General Blog Items | Milk Milk Milk: Breaking down a defusion exercise
Milk Milk Milk: Breaking down a defusion exercise PDF Print E-mail
Written by Jason Luoma   

Dr. Akihiko Masuda and colleagues recently published a really interesting study where they broke down components of the ACT Milk Milk Milk exercise. In this exercise, the therapist may take a word that has a strong negative self-referential quality to the client (e.g., “fraud,” “ugly,” stupid,” “damaged”); the client then repeats the word over and over again for about 45 seconds. Most people find that the word eventually becomes series of meaningless sounds or vocalizations. In ACT, this is what’s known as a cognitive defusion exercise. The purpose of defusion exercises is to remove the literal function of private events such as thoughts by changing its context. Defusion also helps facilitate acceptance.

 

Across two studies, this exercise was examined in a sample of undergraduates. Emotional discomfort of the word went down very quickly, within 3 – 10 second range. However, believability took longer to reduce, about 20 – 30 seconds on average. The first conclusion the authors draw is that emotional discomfort and believability may be different constructs. Believability appears to be the more important of the two, in that it shows greater relation to the degree to which individuals become caught up in private events. As a consequence, the authors conclude, focusing on reducing the emotional discomfort of a word, as is common in CBT, may be less important than reducing the believability of the word, which takes a little longer.

 

Clinical Implications

 

Although this study was conducted with the Milk Milk Milk exercise, the conclusion may extend to other defusion exercises. In conducting defusion, it may be most important to continue defusion work until believability, not just emotional discomfort, is reduced.

Here is a more detailed summary of the study:

 

One of the classic ACT interventions is called Milk Milk Milk. In this exercise, the therapist asks the client to think of the all the qualities associated with the word “milk.” The therapist then asks the client to repeat the word “milk” over and over again for about 45 seconds. Most people find that the word eventually loses all associations and becomes series of meaningless sounds or vocalizations. The therapist may then do the same thing with a word that has a strong negative self-referential quality for the client (e.g., “fraud,” “ugly,” stupid,” “damaged”). Similar to the word “milk,” the negative self-referential word begins to lose it’s meaning when said repeatedly for 45 seconds.

 

In ACT, this is known as a cognitive defusion exercise. The purpose of defusion exercises is to reduce the literal function of private events such as thoughts by changing its context. When we say a word aloud repeatedly, for example, we are no longer experiencing the word as we typically do. Through defusion, what might be previously perceived as a threatening stimulus becomes something harmless. Defusion also helps facilitate acceptance.

 

Dr. Akihiko Masuda and colleagues recently published a really interesting study where they broke down components of the Milk Milk Milk exercise. Across two studies, undergraduates were asked to generate a negative self-referential thought, and to rate this thought on the level of discomfort associated with it and its believability. They were then asked to say the word repeatedly out loud for a set duration: 1, 3, 10, 20, or 30 seconds. After they stopped, they were asked to rate the emotional discomfort and believability of the word again.

 

The results were really interesting. Emotional discomfort of the word went down more quickly, within the 3 – 10 second ranges. Believability took longer to go down, about 20 – 30 seconds. The first conclusion the authors draw is that emotional discomfort and believability may be different constructs. Additionally, believability appears to be more related to the degree to which individuals become caught up in private events. As a consequence, the authors conclude, focusing on reducing the emotional discomfort of a word, as is common in CBT, may be less important that reducing the believability of the word, which takes a little longer.

 

Although this study was conducted with the Milk Milk Milk exercise, the conclusions may extend to other defusion exercises. In conducting defusion, it may be most important to continue defusion work until believability, not just emotional discomfort, is reduced.

 

Or read the full article:

 

Masuda, A., Hayes, S. C., Twohig, M. P., Drossel, C., Lillis, J., & Washio, Y. (2009). A parametric study of cognitive defusion and the believability and discomfort of negative self-relevant thoughts. Behavior Modification, 33(2), 250-262.

 
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