ACT for GAD: The Million Dollars and Loaded Die Exercises

Michelle-Woidneck2

Utah State University
Boys Town Center for Behavioral Health

Key Points

  1. It is essential to employ control as the problem exercises in therapy, to help clients experience the concepts.
  2. The million dollars exercise exemplifies how, the more we try to control internal experiences, the stronger they become.
  3. The loaded die metaphor emphasizes the importance of stepping away from all attempts at controlling internal experiences, and being open to a new approach.
Earn 1.25 CE Credits

The Million Dollars Exercise

Millionaire Shark Tank

Let’s imagine that you can offer a client a million dollars. There are limits, of course, but they would likely be willing to do quite a bit to have that money, even some of the things they’re coming to you for help with.

For a million dollars, they could leave that email unsent or the house untidy. It might not be easy, but with that much money on the table they could probably do it, right?

The million dollars exercise has simple rules. The client can have a million dollars. All they have to do is not be anxious for the rest of the session. For added motivation and challenge, let’s also imagine they’re in a dunk tank over a pool full of sharks, hooked up to a polygraph that can measure changes in anxiety. If there’s even the tiniest spike, they’re down there with the sharks and don’t get the money.

By this time, they usually say, “I’ve already lost.” Even if someone is really good at thought or emotion suppression, generally what happens is that there’s an anxiety spike, and they shove it down. So it’s already too late, game over.

Millionaire Rose Garden

Let’s give them a second chance. They could still have the million dollars. All they have to do is not think about the next thing that you say, which is: “Don’t think about red roses, or Valentine’s Day, or summer, or anything that might remind you of red roses.”

What pops into their head? Red roses. How much had they even thought about red roses before that session, or even the previous month or more? It’s highly likely that they had no problem not thinking about red roses before. Yet the very moment you tell them not to think about red roses, there they are, thinking about them.

This may seem like a silly exercise. But how often, outside of therapy, does the client think things like, “Don’t think about what my neighbor believes about my parenting,” or, “Don’t worry about what my boss will think of this product,” then those very thoughts appear?

Millionaire in Love

Here’s a final variation to really clarify the concept. I have a million dollars. If you want it, all you have to do is fall madly and deeply in love with the next person you meet. Could you?

If you want to convince me that you’re in love, you may tell me you’re in love, you may tell the person you met that you’re in love, you can act affectionately, and so on. But to make those honest to goodness feelings truly be there? You can’t do it, for any amount of money.

It seems like the rules of the game are different here. When it’s important to not have a feeling, you can’t not have it; when it’s important to not have a thought, you can’t make that thought not arise; and when it’s important to create a feeling, you can’t make that feeling happen. It all works differently when it comes to the world within compared to that without.

Metaphor: The Loaded Die

Omaha, Nebraska is close to the Iowa border. Although gambling is unlawful in Nebraska, you can just hop over the river into Iowa and go to a casino. As long as it’s appropriate with the client, you might use a gambling metaphor.

Let’s imagine that you’re across the river at the casino, and you’re at the craps table, but you’re playing with a loaded die. You keep losing, because you don’t know you’re playing with a loaded die. You lose and you’re going to continue to lose because of this.

Are you to blame for this continuing loss? Of course not. It’s a rigged game.

Let’s imagine that you’ve learned the game is rigged, but you can see yourself with the dice in your hand, about to roll again. You don’t know what you’re going to do about the money that’s already been lost, how you’re going to get any back, how you’re going to solve the problem, yet you’re preparing to roll again.

What’s the first thing you would tell yourself as you’re about to roll the dice? Don’t roll, right? Put the dice down, and step away from the table.

In therapy, a client can see via such a metaphor that their herculean efforts to date have in fact been part of the rigged game of trying to get rid of anxiety. Even if they don’t yet know what a more fair and effective approach might look like, they can at least start by learning to notice when they’ve picked up those dice, and how and why to set them down again.

There are of course many other metaphors that could be used here. There’s no right or wrong metaphor, it all depends on each client and their circumstances. So do create and practice your own metaphors, and tailor them to different clients.

Homework: Tracking Anxiety

Jane is sent home with work during early sessions, to track when anxiety arises and how she responds. She records antecedent situations and her resulting thoughts, feelings, and sensations.

She is asked to reflect on some questions, to guide her in the assignment and solidify the concepts. What did you do when this situation arose? How well did that work in the short term? How about in the long term? Were there any costs associated with that approach?

You can see how this sets the stage for acceptance and an alternative approach. You may then move into more acceptance or defusion. Again, flexibly, differently with different clients.


Looking for practical everyday tools? These print-friendly handouts and worksheets are just what you need. Click on the following links to download the PDFs:

1- The Million Dollars Exercise: Exploring the Problem of Control

The Million Dollars Exercise will help you to guide clients through scenarios exploring the limitations of control, and the impact on emotions and thoughts. By reflecting on each scenario and answering related questions, clients deepen their understanding of attempts at control and the associated constraints. The exercise challenges the belief that control solves emotional struggles, and highlights the paradoxical effects of trying to control or suppress experiences. For greater emotional well-being, clients are encouraged to consider alternative approaches such as acceptance, mindfulness, and self-compassion.

Instructions

Use this resource to help you guide clients through the million dollars exercise, which explores the limitations of control. Encourage clients to reflect on each scenario honestly and answer the questions provided. Help them to understand the impact of control on their emotions and thoughts. Discuss with them the challenges of controlling anxiety, thoughts, and emotions in different scenarios. Consider the paradoxical effect of attempting to control or avoid specific experiences. Discuss the potential consequences of excessive control and the benefits of accepting limited control over internal experiences. Emphasize the importance of cultivating acceptance, mindfulness, and self-compassion for emotional well-being. Conclude by reflecting on the exercise and its implications for their own lives.

2- The Loaded Die: Anxiety and Control

The Loaded Die worksheet offers guidance on applying the metaphor of the loaded die in therapy sessions. The metaphor helps clients grasp the nature of anxiety and the futility of control. Therapists can facilitate insight and alleviate self-blame by introducing the metaphor and exploring its relevance to the client’s struggles. The worksheet guides therapists in breaking the cycle of ineffective control by helping clients identify alternative choices and behaviors. Mindfulness, acceptance, and self-compassion are explored to promote disengagement from anxiety-provoking thoughts and behaviors. Through this worksheet, therapists can empower clients to make more effective choices for managing anxiety and improving well-being.

Instructions

Use this worksheet to familiarize yourself with the metaphor of the loaded die and apply it in therapy sessions with your clients. Introduce the metaphor of the rigged game of anxiety and relate it to their struggles. Discuss their perceptions of self-blame and help them understand the futility of previous control attempts. Explore underlying motivations and patterns contributing to unhelpful behaviors. Facilitate insight by guiding clients to recognize alternative choices and behaviors that can break the cycle of anxiety struggles. Support the development of coping strategies and explore mindfulness, acceptance, and self-compassion techniques. Reflect on how recognizing the rigged game changes their perspective and discuss adaptive approaches to managing anxiety. Help clients integrate the metaphor into daily life and develop an action plan. Adapt the prompts and exercises to individual client needs and therapeutic goals. Foster a supportive and non-judgmental environment.

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ACT for GAD: The Million Dollars and Loaded Die Exercises

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