Steven
Hayes Acceptance & Commitment Therapy (ACT)
Developed
within a coherent theoretical and philosophical framework, Acceptance
and Commitment Therapy (ACT) is a unique empirically based
psychological intervention that uses acceptance and mindfulness
strategies, together with commitment and behavior change strategies,
to increase psychological flexibility. Psychological flexibility
means contacting the present moment fully as a conscious human being,
and based on what the situation affords, changing or persisting in
behavior in the service of chosen values.
Based
on Relational Frame Theory, ACT illuminates the ways that language
entangles clients into futile attempts to wage war against their own
inner lives. Through metaphor, paradox, and experiential exercises
clients learn how to make healthy contact with thoughts, feelings,
memories, and physical sensations that have been feared and avoided.
Clients gain the skills to recontextualize and accept these private
events, develop greater clarity about personal values, and commit to
needed behavior change.
Martha
Beck's column in "O" February 2006
MELANIE'S
LIFE WAS SHRINKING LIKE A CHEAP BLOUSE in an overheated dryer. At 30
she'd developed a fear of flying that ended her dream of world
travel. Within a year, her phobia had grown to include—or rather,
exclude— driving. After the World Trade Center attacks, Melanie
became terrified to enter the downtown area of any city. She quit her
job as an office manager (the potential for mail-based terrorism was
too big) and called me hoping I could help her devise a way of
earning money from home.
"Everybody
tells me my fears aren't realistic," she said. "But I think
I'm the most realistic person I know. It's a dangerous world— I
just want to be safe."
There
was only one thing for which Melanie would leave her apartment. Once
a month, she walked to a rundown neighborhood to meet her drug
dealer, who sold her Xanax and OxyContin of questionable purity. I
insisted that Melanie see a psychiatrist before I'd work with her,
and the worried shrink called me before the impression of Melanie's
posterior had faded from his visitor chair. "She's taking enough
medication to kill a moose," he told me. "If she slipped in
the shower and knocked herself out, withdrawal could kill her before
she regained consciousness."
Ironic,
n'est-ce pas? Safety-obsessed Melanie was positively devil-may-care
when it came to better living through chemistry. This made no sense
to me—until I realized that Melanie's objective wasn't really to
avoid danger but to prevent the feeling of fear.
Melanie
was using a strategy psychologist Steven Hayes, PhD, calls
experiential avoidance, dodging external experiences in an effort to
ward off distressing emotions. It wasn't working. It never does. In
fact, to keep her tactics from destroying her, she would have to
learn the antidote for experiential avoidance—and so must the rest
of us, if we want our lives to grow larger and more interesting,
rather than smaller and more disappointing.
Why
Experiential Avoidance Seems Like a Good Idea
Most
of us do this kind of emotional side step, at least occasionally.
Maybe, like Melanie, you feel skittish on airplanes, so you take the
train instead. In the realm of physical objects, dodging situations
associated with pain is a wonderfully effective strategy; it keeps us
from pawing hot stovetops, swallowing tacks, and so on. Shouldn't the
same logic apply to psychological suffering? According to Hayes, it
doesn't. Experiential avoidance usually increases the hurt it is
meant to eliminate.
Consider
Melanie, who, quite understandably, wanted to steer clear of the
awful sensation of being afraid. Every time she withdrew from a scary
activity, she got a short-term hit of relief. But the calm didn't
last. Soon fear would invade the place to which Melanie had
retreated—for example, she felt much better driving than flying for
a little while, but it wasn't long before she was as petrified in
cars as airplanes. Drugs calmed her at first, but soon she became
terrified of losing her supply. By the time we met, her determination
to bypass anything scary had trapped her in a life completely shaped
by fear.
The
reason this happens, according to Hayes and other devotees of
relational frame theory, is that Melanie's brain works through
forming connections and associations. So does yours. Your verbal mind
is one big connection generator. Try this: Pick two unrelated objects
that happen to be near you. Next answer this question: How are they
alike? For instance, if the objects are a book and a shoe, you might
say they're alike because they both helped you get a job (by being
educated and dressing well). Ta-da! Your book, your shoe, and your
job are linked by a new neural connection in your brain. Now you're
more likely to think of all these things when you think of any given
one.
This
means that every time you avoid an event or activity because it's
painful, you automatically connect the discomfort with whatever you
do instead. Suppose I'm having a terrible hair day, and to not feel
that shame, I cancel a meeting with a client. Just thinking about
that client brings on a pang of shame. If I watch a movie to distract
myself, I may be hit with an unpleasant twinge just hearing the name
of that movie. This happens with every form of psychological
suffering we try to outrun. Your true love dumps you, and to stave
off grief, you avoid everything you once shared —your favorite
song, the beach, mocha lattes. Now you're bereft not only of your ex
but also of music, seascapes, and a fabulous beverage. Your losses
are greater, as is your grief. So you go on a hike to cheer yourself
up, and what do you think as you gaze at the lovely scenery? Well,
duh. You wish your ex were seeing it with you, and you're sadder than
ever. When we run from our feelings, they follow us. Everywhere.
The
Willingness Factor
In
Hayes's book Get Out of Tour Mind & into Your Life, he suggests
that we picture our minds as electronic gadgets with dials, like
old-fashioned radios. One dial is labeled Emotional Suffering (Hayes
actually calls it Discomfort). Naturally, we do everything we can to
turn that dial to zero. Some people do this all their lives, without
ever noticing that it never works. The hard truth is that we have no
ultimate control over our own heartaches.
There's
another dial on the unit, but it doesn't look very enticing. This one
Hayes calls Willingness, though I think of it as Willingness to
Suffer. It's safe to assume that we start life with that dial set at
zero, and we rarely see any reason to change it. Increasing our
availability to pain, we think, is just a recipe for anguish souffle.
Well, yes...except life, as Melanie so astutely commented, is
dangerous. It'll upset you every few minutes or so, sometimes mildly,
sometimes apocalyptically. Since desperately twisting down the
Emotional Suffering dial only makes things worse, Hayes suggests that
we try something radical: Leave that dial alone—abandon all
attempts to skirt unpleasant emotions—and focus completely on
turning up our Willingness to Suffer.
What
this means, in real-world terms, is that we stop avoiding experiences
because we're afraid of the unpleasant feelings that might come with
them. We don't seek suffering or take pride in it; we just stop
letting it dictate any of our choices. People who've been through
hell are often forced to learn this, which is why activist, cancer
patient, and poet Audre Lorde wrote, "When I dare to be
powerful—to use my strength in the service of my vision, then it
becomes less and less important whether I am afraid."
Once
we're willing to confront our emotional suffering, we begin making
choices based on attraction instead of aversion, love instead of
fear. Where we used to think about what was "safe," we now
become interested in doing what seems right or fun or meaningful or
ripe with possibilities. Ask yourself this: What would I do if I
stopped trying to avoid emotional pain? Think of at least three
answers (though 30 would be great and 300 even better). Write them
here:
1.
2.
3.
Stick
with this exercise until you get a glimmer of what life without
avoidance would be like. To paraphrase Dr. Seuss, Oh, the places
you'd go! Oh, the people you'd meet, the food you'd eat, the jokes
you'd tell, the clothes you'd wear, the changes you'd spark in the
world!
One
thing none of us will ever be able to calculate is how much we've
lost by not having these experiences—something Hayes calls the pain
of absence. Being unwilling to suffer robs us of incalculable joy—and
the awful punch line is that we still get all the anguish we tried to
escape (and then some).
The
Consequences of Willingness
What
happens when we're willing to feel bad is that, sure enough, we often
feel bad—but without the stress of futile avoidance. Emotional
discomfort, when accepted, rises, crests, and falls in a series of
waves. Each wave washes parts of us away and deposits treasures we
never imagined. Out goes naivete, in comes wisdom; out goes anger, in
comes discernment; out goes despair, in comes kindness. No one would
call it easy, but the rhythm of emotional pain that we learn to
tolerate is natural, constructive, and expansive. It's different from
unwilling suffering the way the sting of disinfectant is different
from the sting of decay; the pain leaves you healthier than it found
you.
It
took Melanie a huge leap of faith to accept this. She finally decided
to turn up her Willingness to Suffer dial, simply because her
Emotional Suffering levels were manifestly out of her control. She
started by joining a yoga class, though the thought of it scared her
witless. She found that her anxiety spiked, fluctuated, and gradually
declined. Over the ensuing months, she entered therapy, traded her
street-drug habit for prescribed medication, and found a new job.
Melanie's worry isn't completely gone; it probably never will be. But
that doesn't matter much. She is willing to accept discomfort in the
pur¬suit of happiness, and that means she'll never be a slave to
fear again.
To
the extent that we reject anything we love solely because of what we
fear, we're all like Melanie. Find a place in your life where you're
practicing experiential avoidance, an absence where you wish there
were something wonderful. Then commit to the process of getting it,
including any inherent anxiety or sadness. Get on an airplane not
because you're convinced it won't crash, but because meeting your
baby niece is worth a few hours of terror. Sit on the beach with your
mocha latte, humming the song you shared with your ex, and let grief
wash through you until your memories are more sweet than bitter.
Pursue your dreams not because you're immune to heartbreak but
because your real life, your whole life, is worth getting your heart
broken a few thousand times.
When
fear makes your choices for you, no security measures on earth will
keep the things you dread from finding you. But if you can avoid
avoidance — if you can choose to embrace experiences out of
passion, enthusiasm, and a readiness to feel whatever arises—then
nothing, nothing in all this dangerous world, can keep you from being
safe.
Psychology
Today
How
Analyzing Your Problems May Be Counterproductive February 13, 2010
When
you're upset or depressed, should you analyze your feelings to figure
out what's wrong? Or should you just forget about it and move on? New
research and theories suggests if you do want to think about your
problems, do so from a detached perspective, rather than reliving the
experience.
This
answer is related to a psychological paradox: Processing emotions is
supposed to help you facilitate coping, but attempts to understand
painful feelings often backfire and perpetuate or strengthen negative
moods and emotions. The solution seems to be neither denial or
distraction, according to research conducted by University of
Michigan psychologist Ethan Kross, who says the best way to move
forward emotionally is to examine one's feelings from a distance or
detached perspective.
Kross,
along with University of California colleague Ozelm Ayduk, conducted
a series of studies that provide the first experimental evidence of
the benefits of taking a detached perspective on your problems. Kross
says, "reviewing our mistakes over and over, re-experiencing
the same negative emotions we felt the first time, tends to keep us
stuck in negativity." Their study, published in the July,
2008 issue of Personality and Social Psychology, described how they
randomly assigned 141 participants to groups that required them to
focus (or not to focus) on their feelings using different strategies
in a guided imagery exercise that led them to recall an experience
that made them feel overwhelmed by sadness or depression. In the
immersed-analysis condition, participants were told to go back to the
time and place of the experience and relive it as if it were
happening to them over again, and try to understand the emotions they
felt, along with the underlying causes. In the detached-analysis
condition, the subjects were told to go back the time and place of
the experience, take a few steps back and move away from the
experience, and watch it unfold as though it was happening to them
from a distance, and try to understand what they felt and the reasons
for the feelings-- what lessons are to be learned.
The
results of the experiment? Immediately after the exercise the
distanced-analysis approach subjects reported lower levels of
anxiety, depression and sadness compared to those subjects who used
the immersed-analysis strategy. One week later the participants were
questioned. Those that had used the distanced-analysis strategy
continued to show lower levels of depression, anxiety and sadness. In
a related study, Ayduk and Kross showed that participants who adopted
a self-distanced perspective while thinking about their problems
related to anger, showed reductions in blood pressure.
Kross'
and Ayduk's research supports the work done by psychotherapist Dr.
Steven Hayes. Traditional cognitive psychotherapy may not be the best
intervention according to Dr. Steven Hayes, a renowned
psychotherapist, and author of Getting Out of Your Mind and Into
Your Life. Hayes has been setting the world of psychotherapy on
its ear by advocating a totally different approach.
Hayes
and researchers Marsha Linehan and Robert Kohlenberg at the
University of Washington, and Zindel Segal at the University of
Toronto, what we could call "Third Wave Psychologists"
are focusing less on how to manipulate the content of our thoughts
(a focus on cognitive psychotherapy) and more on how to change their
context--to modify the way we see thoughts and feelings so they can't
control our behavior. Whereas cognitive therapists speak of
"cognitive errors" and "distorted interpretation,"
Hayes and his colleagues encourage mindfulness, the
meditation-inspired practice of observing thoughts without getting
entangled by them--imagine the thoughts being a leaf or canoe
floating down the stream.
These
Third Wave Psychologists would argue that trying to correct negative
thoughts can paradoxically actually intensify them. As NLP trained
coaches would say, telling someone to "not think about a blue
tree," actually focuses their mind on a blue tree. The Third
Wave Psychologists methodology is called ACT (Acceptance and
Commitment Therapy), which says that we should acknowledge that
negative thoughts recur throughout our life and instead of
challenging or fighting with them, we should concentrate on
identifying and committing to our values in life. Hayes would argue
that once we are willing to feel our negative emotions, we'll find it
easier to commit ourselves to what we want in life.
This
approach may come as a surprise to many, because the traditional
cognitive model permeates our culture and the media as reflected in
the Dr. Phil show. The essence of the conflict between traditional
cognitive psychologists and psychotherapists is to engage in a
process of analyzing your way out your problems, or the Third Wave
approach which says, accept that you have negative beliefs, thinking
and problems and focus on what you want. Third Wave psychologists
acknowledge that we have pain, but rather than trying to push it
away, they say trying to push it away or deny it just gives it more
energy and strength.
Third
Wave Psychologists focus on acceptance and commitment comes with a
variety of strategies to help people including such things as writing
your epitaph (what's going to be your legacy), clarifying your values
and committing your behavior to them.
It's
interesting that that The Third Wave Psychologists approach comes
along at a time when more and more people are looking for answer
outside of the traditional medical model (which psychiatry and
traditional psychotherapy represent). Just look at a 2002 study in
Prevention and Treatment, which found that 80% people tested who took
the six most popular antidepressants of the 1990's got the same
results when they took a sugar pill placebo.
The
Third Wave Psychologists approaches are very consistent with much of
the training and approach that many life coaches receive, inclusive
of Neuro-Linguistic Programming (NLP), and many spiritual approaches
to behavioral changes reflected in ancient Buddhist teachings and the
more modern version exemplified by Eckhart Tolle (The Power of Now
and A New Earth). The focus of those approaches reinforces the
concepts of acceptance of negative emotions and thoughts, and rather
than giving them energy and fighting with them, focus on mindfulness,
and a commitment to an alignment of values and behavior.
What's
fascinating is how brain science and psychological research is
supporting ancient spiritual practices. Perhaps now the East and the
West, science and spirituality, are coming together.
Burn off whatever is getting in the way
