19. Discussion Questions
- Were you surprised by any of the values you
identified or were they you already aware?
- In what ways are you actively moving towards some
of those values in your present actions?
- Which of those values do you feel you’ re struggling
to act with in your present life?
- What is standing in the way? What are you doing
that is taking you farther away from the values you
find most important?
Acceptance and Commitment Therapy (or “ACT”) is a third wave therapy that uses acceptance and mindfulness processes, and commitment and behavior change processes, to produce psychological flexibility. There are over 60 randomized trials on ACT, and it is recognized as evidence-based (with a good empirical base in such areas as depression, anxiety, OCD, chronic pain, coping with psychosis, and workplace stress, and substance use, among others). ACT is an open system that can be readily combined with other methods as is fitting to a client.
ACT is what is called a new wave of third wave behavioral theory. To situate it historically, behavioral therapy is the first wave, in the 1950s, with classical conditioning (Pavlov) and operant conditioning (Skinner). The second wave is cognitive behavioural therapy, which explored individual persepctives, thoughts and information processing. And then the 3rd wave, which ACT belongs to, is often also called the “mindfulness and acceptance approaches”. CBT was developed by Steven Hayes, Kelly Wilson, and Kirk Strosahl beginning in the late 1980s, and it came from research application of something called Relational Frame theory.
But before I bore you to death with that, let’s talk about what distinguishes ACT from CBT and it’s other predecessors we’ve disussed in class already. it’s basic underpinning I think is kind of radically different.
Act says:
people suffer.
and even more than that: > pain is normal.
Pain is a normal, built-in part of life on this earth. There is no escaping it. It is pointless to resist it. It’s simply a fact that good things and bad things are always around the corner. That’s how it works here. People get sick, people die, someone steals your bike, relationships break down, there’s a natural disaster, and you just globbed a bunch of barbecue sauce on your white shirt. That is what is meant by pain. Now before you’re all like whoa this is way too pessimistic and dark for me! There’s another side to this.
Pain is not the same as suffering. Pain is what happens. Suffering is the story that we layer on top of what happens.
Not only does your bike get stolen, but you say “This always happens to me!”
Not only do you go through a breakup, but you think “God, it’s just better to be alone and never get hurt.”
Not only do you judge your friend’s wardrobe choices, but then you judge yourself for judging her wardrobe choices!
It’s your running commentary when you say “I’m a failure! This sucks! He shouldn’t act like that! Why can’t I get it together?!?”
We’re already in pain, so why do we make it worse for ourselves? 2 for 1! This is how ACT answers that question, why do we suffer:
16,000. That’s supposedly the number of words we speak on average per day. So how many words go unspoken and just course through our heads? How many are we exposed to and absorb especially in this day and age through technology and media, advertising… Most of it isn’t facts but evaluations, judgments, entwined with emotion and the weight of personal memory. Whoa! That’s a heavy load.
So this is where relational frame theory comes in. Remember Relational Frame theory, the theoretical underpinning of ACT? It’s a psycho-linguistic theory to explain how human language causes human suffering.
Humans, starting at 14 to 18 months, can do something no other species can do, as far as we are aware. We can derive relational information that is not directly taught to us from something that was taught to us.
So you say “this is a kitty” and show your daughter a picture of a kitten. and then you say “what’s this?” and, your genius baby girl,, she learns to say, on her own, “kitty”. she learned that relationship on her own. and you tell her “kitty says meoooowwww” and she learns that too. And now she knows the word “Kitty” is the name of the creature in the picture and that kitties say meow and that meow is the sound of the creature in the photo.
We’ve all probably seen this happen and it seems too obvious to even point out. But what this means is that people use relational frames to acquire and store vast amounts of info in our minds, and even though this has made us very powerful, it’s a double edged sword.
So then imagine your daughter is playing with the neighbor’s kitten and gets scratched and startled, runs away crying. Then maybe later when you’re watching tv and a commercial comes on with a cute kitten in it, you say “oh look! A kitty!” and she runs away crying, despite never having been scratched while hearing the verbal cue of the word “Kitty!” She doesn’t even have to see a picture of a cat, never mind a real one, in order to feel that fear and pain, because she has incorporated that experience of being scratched into the relational frame in her head.
In a more adult example, someone who has a panic attack while “trapped” in a shopping mall may soon find they are worrying about being trapped on a bridge, or in an open field. What brings these situations together isn’t their formal properties in a simple sense, but the verbal and cognitive activities that relate the events in your mind.
A non-human animal can escape pain by avoiding the thing that directly causes the pain, but people can’t. We take our minds with us wherever we go, and all we need to do to experience pain is to call to mind a word, event, or memory that is linked in relational frame to pain and BLAMO. We actually hurt. We can even do this by imagining something we believe will cause us future pain (ie. our own deaths).
So, RFT and ACT aren’t saying human’s create all their own pain through language and cognition. some pain is natural in life. you experience the death of a loved one - you will feel grief. you have chronic pain issues and it hurts. you feel nervous about a big interview and you’ve got butterflies in your stomach. but the more we avoid and suppress our own discomfort, the more our pain grows, and thus, the more we avoid it. it’s cyclical.
ACT takes a different view on happiness than is currently popular in our culture. Popular logic tells us we want to feel good and that is happiness. ACT is skeptical of this sort of feel-goodism because a lot of the things we do to feel good in the short term don’t live well in the long term. We do a lot of things to numb our own experiences of vulnerability and suffering - have another martini, have another piece of cake, watch 8 hours of Game of Thrones. Sometimes this stuff really can feel good but it often doesn’t live well or lead us in the direction of our values. So ACT believes in a different version of happiness.
The core techniques or processes of ACT are usually represented in a hexagon but I find that diagram a bit misleading so I’ll just talk very briefly about them. They all service the goal of ACT, which notably is not, like many other therapies, the reduction or elimination of symptoms. The goal is “psychological flexibility” - creating larger and larger patterns of effective behavior in your life without having to solve all your supposed problems before you start living. It’s a way of carrying your pain and suffering with you, gently, as you move toward the life you want to live.
How much of our suffering comes from reliving past events or projecting into the future which we cannot yet know? Being present just means being in touch with the current environment, sensations, and it’s the platform for awareness that all other ACT exercises are built on.
One process is cognitive defusion. In a nutshell, it means disentangling from your thoughts. A simple way to demonstrate this is a metaphor with my own two hands. If my hands represent my thoughts, my difficult and upsetting thoughts, but it could even be positive thoughts, if I pay all my attention to them, if I carry them right in my face right in front of my eyes, my experience of the world is extremely limited. It makes it difficult to fully observe my environment, to connect with others, to move, etc. If I hold my hands relaxed in front of me, they are still here, but I’m much better able to interact with my world and fully enjoy it, taking advantage of possibilities that present themselves. But I haven’t cut off my hands, they’re still here! Just so, we don’t have to get rid of challenging thoughts in order to have a satisfying life, but we can’t reify them or overidentify with them. They are just thoughts, and they will come and go if we let them.
Acceptance etymologically means “to take what is offered”. It’s not tolerance, but it means non-judgmental awareness of internal and external events. In ACT, trying so desperately to maintain control is a part of the problem. Some things we cannot control, but we can focus on our actions, which we can control. So acceptance techniques could include mindfulness meditations, for instance. It’s about gently and compassionately holding your discomfort without insisting that it go away or getting overwhelmed in the intensity of the experience.
The observing self sounds like an abstract principle, but it just refering to a sense of self that is transcendent. So if I ask you to look around the classroom and notice what can be seen around here. Notice the sounds and smells and feel of the environment. What is the part of you that is aware of all that? That is the observing self. If your thoughts, feelings, sensations and memories are the weather, clouds and rainbows and thunderstorms and snow… the observing self is like the sky. Difficult thoughts and feelings create the illusion of dangerousness, but the weather can’t hurt the sky. It will be there before the weather event and after.
Values are qualities of action. To clarify values, a therapist might ask the question “What do you want your life to stand for?” Values are something you can move toward like a point on the horizon, but never arrive at. For example, you can never HAVE honesty, but you can act honestly. Values are an important piece of the ACT puzzle because they connect the need for acceptance, action and defusion into an intelligible whole. We are motivated to accept, defuse and act to move toward our values.
Committed action is the final piece of the ACT puzzle. ACT is as much a change-oriented approach as it is an acceptance oriented one. Committed action can mean establishing concrete goals, taking small steps toward that goal, (S.M.A.R.T. goals), dissolving psychological barriers through defusion and acceptance, and dissolving situational barriers through direct action. Basically committed action means moving forward toward valued ends, carrying your history gently with you.
Eulogy exercise instructions:
Close your eyes and take a few deep breaths. Once you’ve calmed your mind, imagine that you’ve died, and by some miraculous circumstance you are attending your own funeral, in spirit form, unseen by guests. Take a few moments to visualize what you’d like it to look like and who you’d like to attend. Once you have a clear picture, imagine that a friend or family member you care deeply about stands up to say a few words about what you stood for in life, what you cared about, and what path you took. It could be a significant other, a child, a coworker, a friend, or a couple of these. Imagine they say in your eulogy what you most want to hear about life, lived as true to your innermost values. Be bold! This is your funeral after all! This is not a prediction. It is not self-praise. No one need ever know what you’re thinking and I won’t ask you to share it. Once you’ve thought of some meaningful things this important person would say about your time spent here on this planet and really imagined them speaking, open your eyes, when you are ready, and write down any notes or thoughts you had during the exercise. Again you don’t have to share anything you’re not comfortable with, and we’ll only discuss in the vaguest of terms.
ACT is a holistic approach. It is science-based but has a spiritual side to it. It takes into account mental, emotional, physical and spiritual worlds of people.
ACT is based on a psychology of the normal rather than the abnormal.
ACT is based on research and theory that has to do with human subjects, rather than more computer-based metaphors like earlier CBT approaches.
ACT sets up counsellors in horizontal relationship to clients, because we’re all in the same soup. There is an active acknowledgment that the difficult processes that clients are dealing with have at some point and in some way been relevant in the counsellor’s life as well.
ACT says dramatic, powerful change is possible, and possible quickly because what the client is feeling, thinking, remembering or otherwise experiencing is never assumed to be the core difficulty. To me, the larger message of ACT is extremely validating (it says “Trust your own experience”) and empowering (it tells us “you can live a powerful life from here, without first winning a war with your own history or your own mind.”
