We Hurt Where We Care
September 4, 2019 10:58 AM Subscribe
Acceptance and Commitment Therapy (ACT, said like the word “act”) is an evidence-based psychotherapy that has been shown to be an effective treatment in randomized clinical trials for people who are struggling with a wide range of traditional mental health concerns like anxiety, depression, OCD, PTSD, eating disorders, etc. This week ACT originator Steven C. Hayes released a new book for general audiences, A Liberated Mind: How to Pivot Toward What Matters. Part self-help book, part intellectual history, and part personal memoir of his own history of panic disorder, the book provides a useful introduction to the concept of “psychological flexibility.”
The core processes underlying psychological flexibility apply to more than just traditional mental health: they can help us manage physical disease and chronic pain, improve our personal relationships and parenting, face the challenge of substance use, and respond more effectively to stress. Those processes are commonly organized around the “hexaflex” to indicate their interconnectedness:
1) Acceptance: Foster a sense of willingness to experience feelings, even when those feelings are painful or difficult
2) Defusion: Observe our thoughts from a distance in order to more effectively choose what we do next.
3) Present Moment Awareness: Notice what is present, and be intentional with where we place our attention in a flexible, fluid, and voluntary way.
4) Perspective-Taking Self: Notice the part of ourselves that is more than the stories we’ve constructed about ourselves.
5) Values: Choose the directions in life we want to move toward based on what matters to us.
6) Committed Action: Create habits that move us closer to the life we want to live.
The science of psychological flexibility now spans well over a thousand studies and represents an exciting step forward from more traditional forms of psychotherapy. (See, e.g., the "Dark Thoughts" portion of this Invisibilia episode: ACT is behind Door #3.) It’s been developed from the ground up based on a new understanding of language and cognition called Relational Frame Theory and new developments in evolutionary theory that help explain why human suffering is so pervasive. In short, Hayes argues: “we hurt where we care, and we care where we hurt.”
To see how these processes work together to facilitate change, here’s Timothy Gordon presenting the ACT Life Map (or, “Matrix”) which is an exercise you can do at home.
If you’re looking for an ACT therapist in your area, visit the directory hosted by the Association for Contextual Behavior Science.
The core processes underlying psychological flexibility apply to more than just traditional mental health: they can help us manage physical disease and chronic pain, improve our personal relationships and parenting, face the challenge of substance use, and respond more effectively to stress. Those processes are commonly organized around the “hexaflex” to indicate their interconnectedness:
1) Acceptance: Foster a sense of willingness to experience feelings, even when those feelings are painful or difficult
2) Defusion: Observe our thoughts from a distance in order to more effectively choose what we do next.
3) Present Moment Awareness: Notice what is present, and be intentional with where we place our attention in a flexible, fluid, and voluntary way.
4) Perspective-Taking Self: Notice the part of ourselves that is more than the stories we’ve constructed about ourselves.
5) Values: Choose the directions in life we want to move toward based on what matters to us.
6) Committed Action: Create habits that move us closer to the life we want to live.
The science of psychological flexibility now spans well over a thousand studies and represents an exciting step forward from more traditional forms of psychotherapy. (See, e.g., the "Dark Thoughts" portion of this Invisibilia episode: ACT is behind Door #3.) It’s been developed from the ground up based on a new understanding of language and cognition called Relational Frame Theory and new developments in evolutionary theory that help explain why human suffering is so pervasive. In short, Hayes argues: “we hurt where we care, and we care where we hurt.”
To see how these processes work together to facilitate change, here’s Timothy Gordon presenting the ACT Life Map (or, “Matrix”) which is an exercise you can do at home.
If you’re looking for an ACT therapist in your area, visit the directory hosted by the Association for Contextual Behavior Science.
Hayes' Get Out of Your Mind and Into Your Life, as well as a book by Russ Harris called The Happiness Trap (for which Hayes wrote a foreword) have been really meaningful to me in coping with anxiety (although lately I am thinking I need a tune-up).
I'm so glad you mentioned these. GOOYMAIYL was handed to me in February, in my second therapy session of my entire life, and I've been recommending it to people left and right since then. I've always been a messy, anxious, noisy thinker, and I've never been happy with that setup. I figured it was a baked-in and unavoidable part of my experience that had to be accepted on its own terms. But then my annus horribilis unfolded: injury, surgery, divorce, losing my dog, kids leaving the nest, yadda yadda. I collapsed in every sense of the word at the beginning of the year and couldn't get through a day without profound sadness and mental anguish. My old intuitive strategies for dealing with the noise stopped working, and started making things worse. Early in GOOYMAIYL, Hayes points out that, all too often, "it is only when common sense solutions fail us that we become open to the counterintuitive solutions to psychological pain that modern psychological science can provide," and, "research suggests that many of the tools we use to solve problems lead us into the traps that create suffering." The metaphor is offered that we tend to think of psychological pain as a war to be battled, which may be folly in that emotions come and go in ways that we don't understand, or even in ways that can be controlled or managed directly. But then, sticking with that metaphor, the possibility of ACT helping us to step off the battlefield rather than fight an unwinnable war comes up as a suggestion of what this approach can achieve. That resonated so strongly that I found myself committing to the book's suggestion that, hey, you can try this and it'll seem goofy sometimes but go with it and see where it leads.
Thank you, mittens, for sharing. I have been so grateful for this kind of work coming into my life and I hope that others consider exploring it, too.
posted by late afternoon dreaming hotel at 12:26 PM on September 4, 2019 [8 favorites]
I'm so glad you mentioned these. GOOYMAIYL was handed to me in February, in my second therapy session of my entire life, and I've been recommending it to people left and right since then. I've always been a messy, anxious, noisy thinker, and I've never been happy with that setup. I figured it was a baked-in and unavoidable part of my experience that had to be accepted on its own terms. But then my annus horribilis unfolded: injury, surgery, divorce, losing my dog, kids leaving the nest, yadda yadda. I collapsed in every sense of the word at the beginning of the year and couldn't get through a day without profound sadness and mental anguish. My old intuitive strategies for dealing with the noise stopped working, and started making things worse. Early in GOOYMAIYL, Hayes points out that, all too often, "it is only when common sense solutions fail us that we become open to the counterintuitive solutions to psychological pain that modern psychological science can provide," and, "research suggests that many of the tools we use to solve problems lead us into the traps that create suffering." The metaphor is offered that we tend to think of psychological pain as a war to be battled, which may be folly in that emotions come and go in ways that we don't understand, or even in ways that can be controlled or managed directly. But then, sticking with that metaphor, the possibility of ACT helping us to step off the battlefield rather than fight an unwinnable war comes up as a suggestion of what this approach can achieve. That resonated so strongly that I found myself committing to the book's suggestion that, hey, you can try this and it'll seem goofy sometimes but go with it and see where it leads.
Thank you, mittens, for sharing. I have been so grateful for this kind of work coming into my life and I hope that others consider exploring it, too.
posted by late afternoon dreaming hotel at 12:26 PM on September 4, 2019 [8 favorites]
mittens, if you're interested in an exercise that helped me with values in a mostly ACT context, let me know (memail, here, etc.). I enjoyed it, even.
Not struggling against my feelings was a really difficult unlearning process. I still find myself squinched up in the corner of the couch sometimes, but now that I can recognize what that is, I can unsquinch, without punishing myself. Utterly life-changing.
posted by wellred at 12:31 PM on September 4, 2019 [3 favorites]
Not struggling against my feelings was a really difficult unlearning process. I still find myself squinched up in the corner of the couch sometimes, but now that I can recognize what that is, I can unsquinch, without punishing myself. Utterly life-changing.
posted by wellred at 12:31 PM on September 4, 2019 [3 favorites]
This is an awesome post, thanks. ACT and Get Out Of Your Mind etc. were profoundly helpful to me in grad school. The book can feel a little esoteric at times, and I think -- to me, anyway -- less "warm" or "light"-feeling than other actual-therapy-self-help classics like Feeling Good, but I found it very much worth sticking through and I find myself coming back to the book often.
mittens: I know what you mean about values. It's really, really hard for me to separate what I feel like I "should" want from my life with what I actually do want, and to keep them from becoming a focus of anxious obsession in themselves. Did you ever do the "imagining your own funeral" exercise? Basically, you do it twice - once where you imagine what someone might say if you just continued on with the same patterns of emotional avoidance, compulsion, etc., and once where you imagine what you would want someone to say about you. Another good exercise is the "sweet, sour, heroes" exercise described in this video. (Mark Freeman is a big fan of Hayes and ACT and his book, You Are Not A Rock, is also really great if you're looking for something more concrete and "plan-oriented" than Get Out Of Your Mind.)
The other tip I've heard which I thought was helpful is, values can be provisional: you don't have to have the same values throughout your life, and if you don't like where they're taking you, you can always re-evaluate down the road.
posted by en forme de poire at 12:34 PM on September 4, 2019 [8 favorites]
mittens: I know what you mean about values. It's really, really hard for me to separate what I feel like I "should" want from my life with what I actually do want, and to keep them from becoming a focus of anxious obsession in themselves. Did you ever do the "imagining your own funeral" exercise? Basically, you do it twice - once where you imagine what someone might say if you just continued on with the same patterns of emotional avoidance, compulsion, etc., and once where you imagine what you would want someone to say about you. Another good exercise is the "sweet, sour, heroes" exercise described in this video. (Mark Freeman is a big fan of Hayes and ACT and his book, You Are Not A Rock, is also really great if you're looking for something more concrete and "plan-oriented" than Get Out Of Your Mind.)
The other tip I've heard which I thought was helpful is, values can be provisional: you don't have to have the same values throughout your life, and if you don't like where they're taking you, you can always re-evaluate down the road.
posted by en forme de poire at 12:34 PM on September 4, 2019 [8 favorites]
wellred, I'd be interested in you posting it in the thread if you're comfortable! Otherwise would be happy to get that memail as well.
posted by en forme de poire at 12:39 PM on September 4, 2019 [9 favorites]
posted by en forme de poire at 12:39 PM on September 4, 2019 [9 favorites]
Very timely as I was just visiting my girlfriends father and picked "The Happiness Trap" off the shelf among the hundreds of other books and read it for a bit. Coincidence!
Anyway, mittens, if you needed a value, mine is imagining a small puppy or kitten. Petting and saying cute stupid things to it is a value. (I'm really not joking.) I imagine the actions that the values represent, not the actual values which I can't intrinsically summon well. That one is kindness and connection.
Good Life Project podcast has an episode today by Nir Eyal and he talks about traction vs. distraction (focus is not the opposite of distraction) and how our motivations aren't actually seeking pleasure/avoiding pain but basically 100% all the time avoiding pain. Anyway, it's tying in somehow in my brain, but I can't coherently get it out right now. Good listen though.
posted by OnTheLastCastle at 12:56 PM on September 4, 2019 [4 favorites]
Anyway, mittens, if you needed a value, mine is imagining a small puppy or kitten. Petting and saying cute stupid things to it is a value. (I'm really not joking.) I imagine the actions that the values represent, not the actual values which I can't intrinsically summon well. That one is kindness and connection.
Good Life Project podcast has an episode today by Nir Eyal and he talks about traction vs. distraction (focus is not the opposite of distraction) and how our motivations aren't actually seeking pleasure/avoiding pain but basically 100% all the time avoiding pain. Anyway, it's tying in somehow in my brain, but I can't coherently get it out right now. Good listen though.
posted by OnTheLastCastle at 12:56 PM on September 4, 2019 [4 favorites]
Will do when I am at my own computer!
posted by wellred at 12:59 PM on September 4, 2019 [4 favorites]
posted by wellred at 12:59 PM on September 4, 2019 [4 favorites]
I am currently carrying a copy of Things Might Go Terribly, Horribly Wrong around in my purse and the title makes me giggle to myself every time I look inside. It was a pretty good read.
posted by eirias at 1:00 PM on September 4, 2019 [3 favorites]
posted by eirias at 1:00 PM on September 4, 2019 [3 favorites]
I did *checks notes* three stints in a partial hospital program that did ACT. I HATED it. My psychiatrist and psychologist were both wonderful, though.
It's been three years since my last program. I've been sober for two years and my mental health has never been better. Recently, I was consoling my husband (about my own health issues lol) and I found myself quoting ACT talking points.
Until that moment, I hadn't realized how much of ACT I had internalized and was subconsciously practicing everyday, despite my complete resistance to it years earlier.
For me, ACT was incompatible with being an active alcoholic. I drank because I was not willing to experience feelings. During my partial hospital programs, I had not yet confronted my alcohol use.
One of the ways I stop myself from succumbing to situational depression regarding my health is a "sad cake." I get my favorite decadent chocolate cake and allow myself to be sad until I've finished eating it, which is two days. This gives me time to acknowledge my feelings without wallowing, has the added bonus of ensuring I still eat meals, AND I get cake.
posted by Ruki at 1:02 PM on September 4, 2019 [36 favorites]
It's been three years since my last program. I've been sober for two years and my mental health has never been better. Recently, I was consoling my husband (about my own health issues lol) and I found myself quoting ACT talking points.
Until that moment, I hadn't realized how much of ACT I had internalized and was subconsciously practicing everyday, despite my complete resistance to it years earlier.
For me, ACT was incompatible with being an active alcoholic. I drank because I was not willing to experience feelings. During my partial hospital programs, I had not yet confronted my alcohol use.
One of the ways I stop myself from succumbing to situational depression regarding my health is a "sad cake." I get my favorite decadent chocolate cake and allow myself to be sad until I've finished eating it, which is two days. This gives me time to acknowledge my feelings without wallowing, has the added bonus of ensuring I still eat meals, AND I get cake.
posted by Ruki at 1:02 PM on September 4, 2019 [36 favorites]
Great post, thanks for making it.
Could one or many of you smart minds out there help me understand the key differences between CBT (which I'm familiar with) and ACT (which I'm not)? Is the argument being made that ACT is perceptibly better than CBT? Or complimentary? Or something else entirely?
posted by allkindsoftime at 1:20 PM on September 4, 2019 [1 favorite]
Could one or many of you smart minds out there help me understand the key differences between CBT (which I'm familiar with) and ACT (which I'm not)? Is the argument being made that ACT is perceptibly better than CBT? Or complimentary? Or something else entirely?
posted by allkindsoftime at 1:20 PM on September 4, 2019 [1 favorite]
allkindsoftime: Could one or many of you smart minds out there help me understand the key differences between CBT (which I'm familiar with) and ACT (which I'm not)?
My surface-level impression of them is that CBT is about arguing with your negative thoughts and making them go away, while ACT is about accepting your negative thoughts and observing them with detachment.
Others will have better, more complete answers.
posted by clawsoon at 1:39 PM on September 4, 2019 [5 favorites]
My surface-level impression of them is that CBT is about arguing with your negative thoughts and making them go away, while ACT is about accepting your negative thoughts and observing them with detachment.
Others will have better, more complete answers.
posted by clawsoon at 1:39 PM on September 4, 2019 [5 favorites]
I do remember groaning at the evolutionary psychology at the start of "The Happiness Trap", but otherwise finding it worthwhile and interesting.
posted by clawsoon at 1:41 PM on September 4, 2019 [1 favorite]
posted by clawsoon at 1:41 PM on September 4, 2019 [1 favorite]
I think the other piece of ACT is that you're not even treating negative and positive thoughts differently, or even necessarily judging them as negative or positive. The idea is instead to use values to identify the actions you want to take in the world outside of your thoughts, and then take those actions while allowing your mind to have whatever thoughts, feelings, sensations, etc.
posted by en forme de poire at 1:47 PM on September 4, 2019 [7 favorites]
posted by en forme de poire at 1:47 PM on September 4, 2019 [7 favorites]
What clawsoon said.
At the time of my treatments, I was in crisis and couldn't understand how accepting my negative feelings could possibly be helpful. I wanted to get rid of my negative feelings, not cozy up to them. Now that I've accepted that negative feelings are always going to be part of life and that they can be valid and appropriate feelings to have, I've acquired a much better skill set with which to deal with them.
The big takeaway I got from it is that it's okay to feel things, even things that I perceive as "bad," like anxiety, but what matters is how I respond to those feelings.
posted by Ruki at 1:53 PM on September 4, 2019 [7 favorites]
At the time of my treatments, I was in crisis and couldn't understand how accepting my negative feelings could possibly be helpful. I wanted to get rid of my negative feelings, not cozy up to them. Now that I've accepted that negative feelings are always going to be part of life and that they can be valid and appropriate feelings to have, I've acquired a much better skill set with which to deal with them.
The big takeaway I got from it is that it's okay to feel things, even things that I perceive as "bad," like anxiety, but what matters is how I respond to those feelings.
posted by Ruki at 1:53 PM on September 4, 2019 [7 favorites]
I'd be interested in finding out how this is different from traditional Buddhist mindfulness (as opposed to whatever modern western woo has mistakenly assigned to that word) because these are all the benefits of it as far as I have read.
posted by bleep at 2:13 PM on September 4, 2019 [2 favorites]
posted by bleep at 2:13 PM on September 4, 2019 [2 favorites]
Here Comes a Thought from Steven Universe captures most of this philosophy/approach in song form.
posted by NMcCoy at 2:41 PM on September 4, 2019 [9 favorites]
posted by NMcCoy at 2:41 PM on September 4, 2019 [9 favorites]
OK this is the values exercise thing. You use a worksheet like this one.
I didn't exactly follow the directions on the sheet. When I first started out, I had very low self-worth and couldn't just say HEY this is what's important to me about me. So I circled all the things I valued in others. Then, I put a checkmark beside the ones I could also see in myself. Then, I grouped them into five categories like on the sheet.
I took the five themes, made them into adjectives, and now that's how I remind myself of who I am. I wrote the initials of the five adjectives on a tiny piece of paper and taped it to my work monitor (now at two different organizations!). I can always ground myself. It's good.
--
I think ACT is definitely partly being mindful like in Buddhist practice, but you take it further in that you welcome the feelings and feel them however you feel them, even if that's crying your face off for a weekend. Not that I would know anything about doing that. And then you work with the feelings and live your life according to your values. I'll recommend Susan David's Emotional Agility for the nth time.
posted by wellred at 2:42 PM on September 4, 2019 [14 favorites]
I didn't exactly follow the directions on the sheet. When I first started out, I had very low self-worth and couldn't just say HEY this is what's important to me about me. So I circled all the things I valued in others. Then, I put a checkmark beside the ones I could also see in myself. Then, I grouped them into five categories like on the sheet.
I took the five themes, made them into adjectives, and now that's how I remind myself of who I am. I wrote the initials of the five adjectives on a tiny piece of paper and taped it to my work monitor (now at two different organizations!). I can always ground myself. It's good.
--
I think ACT is definitely partly being mindful like in Buddhist practice, but you take it further in that you welcome the feelings and feel them however you feel them, even if that's crying your face off for a weekend. Not that I would know anything about doing that. And then you work with the feelings and live your life according to your values. I'll recommend Susan David's Emotional Agility for the nth time.
posted by wellred at 2:42 PM on September 4, 2019 [14 favorites]
How do these techniques handle bad feelings that are linked to serious external problems and specifically like, abuse and under-reaction?
I ask because my biggest beef with CBT and a lot of mindfulness practices is like. It's cool and valuable to help me contextualize and move forward despite my feelings if I'm upset about like, grieving a relative. If I'm upset because an ongoing or developing situation feels uncomfortable to me, it's possible I should be listening harder to my feelings and also acting on them.
For me, at least, "sometimes your feelings are a dog losing their shit at a plastic bag and sometimes they've correctly identified a mountain lion" is a really hard problem. "Everything is plastic bags, chill" is not helpful here in reality where like, predatory behavior, abuse, and rape culture happen all over the fucking place.
posted by bagel at 3:16 PM on September 4, 2019 [15 favorites]
I ask because my biggest beef with CBT and a lot of mindfulness practices is like. It's cool and valuable to help me contextualize and move forward despite my feelings if I'm upset about like, grieving a relative. If I'm upset because an ongoing or developing situation feels uncomfortable to me, it's possible I should be listening harder to my feelings and also acting on them.
For me, at least, "sometimes your feelings are a dog losing their shit at a plastic bag and sometimes they've correctly identified a mountain lion" is a really hard problem. "Everything is plastic bags, chill" is not helpful here in reality where like, predatory behavior, abuse, and rape culture happen all over the fucking place.
posted by bagel at 3:16 PM on September 4, 2019 [15 favorites]
I had a good stint of ACT therapy without really having it formally named as such (although every session seemed to come back to me wanting to get back to work on my novel!) and it was good for me - but I do have some quibbles with the one book by Russ Harris that I've read. I think it can be hard to make the necessary distinction between accepting your feelings and working with them while committing yourself to your goals and values -- and, on the other hand, just steamrolling over your feelings to do what you need to do.
Like, Russ Harris writes: "Option two: for the rest of your life, you take action to do the things that are really important to you, whether you are in the mood or not. Whether you feel good or bad, energetic or tired, optimistic or pessimistic, calm or anxious, relaxed or fearful, inspired or uninspired, you continue to take action; you keep doing what truly matters to you. Instead of going through life at the mercy of your emotions, you can behave like the person you want to be..."
Well - I tried that and it was awful for me insofar as I was not actually giving myself the space I needed to react appropriately to feeling bad, tired, pessimistic, anxious, fearful, and uninspired. Because even if I can ignore those feelings and get my work done, being tired, pessimistic, anxious, fearful, and uninspired makes it twenty times harder to feel any satisfaction from the work.
I want to read more about ACT because it has been good for me in the past, but often it genuinely feels hard for me to figure out what accepting my feelings looks like.
posted by Jeanne at 3:37 PM on September 4, 2019 [4 favorites]
Like, Russ Harris writes: "Option two: for the rest of your life, you take action to do the things that are really important to you, whether you are in the mood or not. Whether you feel good or bad, energetic or tired, optimistic or pessimistic, calm or anxious, relaxed or fearful, inspired or uninspired, you continue to take action; you keep doing what truly matters to you. Instead of going through life at the mercy of your emotions, you can behave like the person you want to be..."
Well - I tried that and it was awful for me insofar as I was not actually giving myself the space I needed to react appropriately to feeling bad, tired, pessimistic, anxious, fearful, and uninspired. Because even if I can ignore those feelings and get my work done, being tired, pessimistic, anxious, fearful, and uninspired makes it twenty times harder to feel any satisfaction from the work.
I want to read more about ACT because it has been good for me in the past, but often it genuinely feels hard for me to figure out what accepting my feelings looks like.
posted by Jeanne at 3:37 PM on September 4, 2019 [4 favorites]
"Everything is plastic bags, chill" is not helpful here in reality where like, predatory behavior, abuse, and rape culture happen all over the fucking place.
The kind of traditional mindfulness I've studied isn't just "like, chill out, man". It's like being in the moment and practicing how to discern a mountain lion from a plastic bag so you can react appropriately to either one. If you're in a bad situation like an abusive relationship or just a fucked up culture your mind is clear and you know what's really going on, you're not beating yourself up, etc.
posted by bleep at 3:48 PM on September 4, 2019 [10 favorites]
The kind of traditional mindfulness I've studied isn't just "like, chill out, man". It's like being in the moment and practicing how to discern a mountain lion from a plastic bag so you can react appropriately to either one. If you're in a bad situation like an abusive relationship or just a fucked up culture your mind is clear and you know what's really going on, you're not beating yourself up, etc.
posted by bleep at 3:48 PM on September 4, 2019 [10 favorites]
It could be the difference is just that they are two different techniques for teaching people how to do the same thing and some techniques work better for some people than for others in which case I think that's great. I would definitely like to learn more about this.
posted by bleep at 3:50 PM on September 4, 2019
posted by bleep at 3:50 PM on September 4, 2019
Mindfulness is really not about not feeling your feelings. It's the exact opposite of that. It's about letting your feelings happen without letting them cyclone you into oblivion. For example today I had a mini nervous breakdown at a Chinese buffet because those places with their strange unknowable rituals stress me the heck out and I did a bad job putting my plate together just like I'm doing a bad job in every area of my life right now. (Not really). I had my little cry because I needed to but I knew what was happening and why and when it was over, it was over. I didn't let myself get hysterical but I didn't try to not cry, either, because I needed to.
posted by bleep at 3:58 PM on September 4, 2019 [4 favorites]
posted by bleep at 3:58 PM on September 4, 2019 [4 favorites]
Mindfulness is really not about not feeling your feelings. It's the exact opposite of that. It's about letting your feelings happen without letting them cyclone you into oblivion.
I hear you, and I'm saying there's sometimes a faint, fine line between sounding like "don't let your feelings control you and don't react in ways you don't want" and "don't engage in non-compliant behavior, on which I'm an authority and you're not." This is even more true when that line runs through a mine-field of memories and internalized stuff from other people's efforts to control the listener's behavior.
it's also truer, in my experience, where mindfulness practices are being promoted by employers, schools, or other places where there's a substantial and unacknowledged power differential.
also like, I'm not an expert, I don't know what will work for any of you, I just wish "non-compliance is a social skill" was new information for fewer people.
posted by bagel at 5:18 PM on September 4, 2019 [8 favorites]
I hear you, and I'm saying there's sometimes a faint, fine line between sounding like "don't let your feelings control you and don't react in ways you don't want" and "don't engage in non-compliant behavior, on which I'm an authority and you're not." This is even more true when that line runs through a mine-field of memories and internalized stuff from other people's efforts to control the listener's behavior.
it's also truer, in my experience, where mindfulness practices are being promoted by employers, schools, or other places where there's a substantial and unacknowledged power differential.
also like, I'm not an expert, I don't know what will work for any of you, I just wish "non-compliance is a social skill" was new information for fewer people.
posted by bagel at 5:18 PM on September 4, 2019 [8 favorites]
How do these techniques handle bad feelings that are linked to serious external problems and specifically like, abuse and under-reaction?
This is a point of contention that IMO is a blind spot to CBT / ACT and related practitioners; it's an "outside-context" question and is a great way to get them to ignore you. Rather, other researchers as well as social justice activists have variously pointed out this problem in various guises. The crux of the issue is, oppression often tells people to accept their lot in life, so therapies that promote acceptance risk unwittingly performing some sort of social control. I can think of in the 90s this was hotly debated as to the role of therapists and scientism and "constructivism" but that's not the only source of this debate.
posted by polymodus at 5:38 PM on September 4, 2019 [19 favorites]
This is a point of contention that IMO is a blind spot to CBT / ACT and related practitioners; it's an "outside-context" question and is a great way to get them to ignore you. Rather, other researchers as well as social justice activists have variously pointed out this problem in various guises. The crux of the issue is, oppression often tells people to accept their lot in life, so therapies that promote acceptance risk unwittingly performing some sort of social control. I can think of in the 90s this was hotly debated as to the role of therapists and scientism and "constructivism" but that's not the only source of this debate.
posted by polymodus at 5:38 PM on September 4, 2019 [19 favorites]
a Chinese buffet because those places with their strange unknowable rituals
Hello bleep! I firmly but very gently want to say: please don’t frame Chinese or Asianness in this fashion. Otherwise we might make the day worse for people like me, who feel like they are being casually othered. You seem like you’re nice and not having the best day, and in turn, I think you’ll understand that casually racist remarks are unfortunately a regular part of what makes my own days not so great. Thanks for understanding and I appreciate you not seeing things that way in the future. I hope you have a nice rest of your day!
posted by many more sunsets at 6:46 PM on September 4, 2019 [19 favorites]
Hello bleep! I firmly but very gently want to say: please don’t frame Chinese or Asianness in this fashion. Otherwise we might make the day worse for people like me, who feel like they are being casually othered. You seem like you’re nice and not having the best day, and in turn, I think you’ll understand that casually racist remarks are unfortunately a regular part of what makes my own days not so great. Thanks for understanding and I appreciate you not seeing things that way in the future. I hope you have a nice rest of your day!
posted by many more sunsets at 6:46 PM on September 4, 2019 [19 favorites]
How do these techniques handle bad feelings that are linked to serious external problems and specifically like, abuse and under-reaction?
The most important distinction that I have seen made in this area is that "acceptance" does not mean "resignation." The word is not at all being used in the sense of "accepting your lot in life." The way "acceptance" is used in ACT refers to being able to feel things that you don't necessarily want to feel, so that you can continue to act in the world in a way that is aligned with your core values, even if doing so provokes a lot of painful feelings. Get Out Of Your Head actually mainly uses the word "willingness" instead of the word "acceptance," partly in order to emphasize this difference.
For example, if justice is one of your values but engaging socially with strangers causes you anxiety, unless you are willing to experience anxiety, you are cutting yourself off from doing things that may actually matter deeply to you, like knocking on doors for a candidate, or raising money for a cause, or participating in civil disobedience. If you are being abused, "acceptance" does not mean accepting the abuse itself, especially not in the sense of trying not to feel the emotions that would naturally arise from the abuse, or doing a lot of "coping" to distract from or blunt those feelings (even "healthy" things can be maladaptive if they're being used for avoidance in this way). Rather, where "acceptance" can help, as I understand it, is when for example you are trying to take actions to end the abuse: that likely means putting yourself in situations where you may feel a lot of really difficult and painful feelings, like shame or fear or survivor's guilt or etc., and where you may as a result be very tempted to do something more comfortable or familiar instead of addressing the root of the problem.
ACT is really fundamentally about not allowing emotions to prevent acting in accordance with the values you've chosen (in the book they call this "experiential avoidance"). I also noticed Hayes explicitly contrasts values to "social compliance" goals in the intro to the new book mentioned in the OP.
I do think it's super important to find the right therapist if you're from a marginalized group.
In my experience, people who specifically cite ACT (as opposed to pop mindfulness in general) have tended to be thoughtful about making the distinctions I've been talking about, but of course there's a ton of variation from person to person -- and probably sometimes people just don't have the right cultural competencies to be able to effectively link up someone's experiences with the ACT framework.
posted by en forme de poire at 7:23 PM on September 4, 2019 [21 favorites]
The most important distinction that I have seen made in this area is that "acceptance" does not mean "resignation." The word is not at all being used in the sense of "accepting your lot in life." The way "acceptance" is used in ACT refers to being able to feel things that you don't necessarily want to feel, so that you can continue to act in the world in a way that is aligned with your core values, even if doing so provokes a lot of painful feelings. Get Out Of Your Head actually mainly uses the word "willingness" instead of the word "acceptance," partly in order to emphasize this difference.
For example, if justice is one of your values but engaging socially with strangers causes you anxiety, unless you are willing to experience anxiety, you are cutting yourself off from doing things that may actually matter deeply to you, like knocking on doors for a candidate, or raising money for a cause, or participating in civil disobedience. If you are being abused, "acceptance" does not mean accepting the abuse itself, especially not in the sense of trying not to feel the emotions that would naturally arise from the abuse, or doing a lot of "coping" to distract from or blunt those feelings (even "healthy" things can be maladaptive if they're being used for avoidance in this way). Rather, where "acceptance" can help, as I understand it, is when for example you are trying to take actions to end the abuse: that likely means putting yourself in situations where you may feel a lot of really difficult and painful feelings, like shame or fear or survivor's guilt or etc., and where you may as a result be very tempted to do something more comfortable or familiar instead of addressing the root of the problem.
ACT is really fundamentally about not allowing emotions to prevent acting in accordance with the values you've chosen (in the book they call this "experiential avoidance"). I also noticed Hayes explicitly contrasts values to "social compliance" goals in the intro to the new book mentioned in the OP.
I do think it's super important to find the right therapist if you're from a marginalized group.
In my experience, people who specifically cite ACT (as opposed to pop mindfulness in general) have tended to be thoughtful about making the distinctions I've been talking about, but of course there's a ton of variation from person to person -- and probably sometimes people just don't have the right cultural competencies to be able to effectively link up someone's experiences with the ACT framework.
posted by en forme de poire at 7:23 PM on September 4, 2019 [21 favorites]
ACT feels like weaponized Buddhism, which for me is a good thing because I like the structure. I keep buying ACT books and need to actually read one.
posted by mecran01 at 8:06 PM on September 4, 2019 [2 favorites]
posted by mecran01 at 8:06 PM on September 4, 2019 [2 favorites]
What are some of the safeguards that keep ACT from devolving into that kind of toxic stoicism?
A full course of ACT includes a lot of exercises and practices that allow you to cultivate the specific skills you need over time and to address the pitfalls you may encounter when implementing them. You aren't just thrown in the deep end. I can't list all of those exercises here, but for instance, a lot of Get Out of Your Mind is devoted to how to develop what they term "cognitive defusion," which is the ability to observe your thoughts without necessarily "buying" into them. One other thing that actually struck me about Jeanne's comment is that in GOOYM, Hayes advises you to build willingness into your life piece by piece using a graded hierarchy, kind of similarly to how you might use a hierarchy in exposure and response therapy for OCD. You aren't expected to go from zero to full 24/7 willingness right away, and while you're developing that skill, you're allowed to set limits about being willing only in specific contexts -- though the limits have to be things like setting and time, not the strength of the emotion. I should note that I'm not a practitioner, just someone who has used ACT in therapy, so someone who does this for a living would undoubtedly be able to give you a more complete answer.
posted by en forme de poire at 8:21 PM on September 4, 2019 [1 favorite]
A full course of ACT includes a lot of exercises and practices that allow you to cultivate the specific skills you need over time and to address the pitfalls you may encounter when implementing them. You aren't just thrown in the deep end. I can't list all of those exercises here, but for instance, a lot of Get Out of Your Mind is devoted to how to develop what they term "cognitive defusion," which is the ability to observe your thoughts without necessarily "buying" into them. One other thing that actually struck me about Jeanne's comment is that in GOOYM, Hayes advises you to build willingness into your life piece by piece using a graded hierarchy, kind of similarly to how you might use a hierarchy in exposure and response therapy for OCD. You aren't expected to go from zero to full 24/7 willingness right away, and while you're developing that skill, you're allowed to set limits about being willing only in specific contexts -- though the limits have to be things like setting and time, not the strength of the emotion. I should note that I'm not a practitioner, just someone who has used ACT in therapy, so someone who does this for a living would undoubtedly be able to give you a more complete answer.
posted by en forme de poire at 8:21 PM on September 4, 2019 [1 favorite]
>If I'm upset because an ongoing or developing situation feels uncomfortable to me, it's possible I should be listening harder to my feelings and also acting on them.
I hear you, bagel. I have a huge problem being in touch with my feelings, like usually I won't be "feeling" anything and then will realize from my behavior that something must be going on, because I'm behaving as though I'm "feeling" something pretty extreme. Or events will happen that, when I'm telling them to someone later, sound bizarre and maybe even scary, but in the moment didn't register with me, my response was basically just, "OK, I guess this is happening now. This is how things are now."
So stuff like ACT seems difficult to use properly because it's like, I think maybe I'm already pretty good at detaching myself from my feelings, just not in a way that ACT practitioners would approve of. But I guess "different strokes for different folks." Personally, I'm still just trying to figure out what my feelings are and responding like they matter.
posted by rue72 at 8:58 PM on September 4, 2019 [7 favorites]
I hear you, bagel. I have a huge problem being in touch with my feelings, like usually I won't be "feeling" anything and then will realize from my behavior that something must be going on, because I'm behaving as though I'm "feeling" something pretty extreme. Or events will happen that, when I'm telling them to someone later, sound bizarre and maybe even scary, but in the moment didn't register with me, my response was basically just, "OK, I guess this is happening now. This is how things are now."
So stuff like ACT seems difficult to use properly because it's like, I think maybe I'm already pretty good at detaching myself from my feelings, just not in a way that ACT practitioners would approve of. But I guess "different strokes for different folks." Personally, I'm still just trying to figure out what my feelings are and responding like they matter.
posted by rue72 at 8:58 PM on September 4, 2019 [7 favorites]
I keep writing and deleting comments that get too into my own mental health history. But basically, ACT is most useful to me as mental health maintenance. I got myself into a good head place through other means, including the medication I still take and the medication I no longer need.
There was an optional daily meditation session during the program that my psychologist encouraged me to attend. She was really into mindfulness. Meditation was one of my least favorite parts of the day and I always struggled with it. I feel kinda vindicated now because I've since learned that I lack the ability to visualize (I always thought the mind's eye was just a metaphor) and that I have narcolepsy, so my complete inability to meditate is not my fault.
posted by Ruki at 9:39 PM on September 4, 2019 [3 favorites]
There was an optional daily meditation session during the program that my psychologist encouraged me to attend. She was really into mindfulness. Meditation was one of my least favorite parts of the day and I always struggled with it. I feel kinda vindicated now because I've since learned that I lack the ability to visualize (I always thought the mind's eye was just a metaphor) and that I have narcolepsy, so my complete inability to meditate is not my fault.
posted by Ruki at 9:39 PM on September 4, 2019 [3 favorites]
I never participated in ACT, so this opinion is a bit uninformed: Seems like a restatement of some Fourth Way principles, presented in writing as opposed to experiential. If it works, it works. More present, intentional humans is better.
posted by j_curiouser at 11:24 PM on September 4, 2019
posted by j_curiouser at 11:24 PM on September 4, 2019
Just chiming in to say ACT has been the only successful model for me so far, although I credit my LPC as much as the method in general, and suspect that likewise for a lot of folks finding the right practitioner is gonna be as (or more) important as “picking” a methodology. I resisted his approach at first because reading a lot of AskMe answers in advance had led me to believe I needed CBT-or-bust, but in the end I trusted my guy and it paid off. Seconding en forme above.
posted by churl at 12:41 AM on September 5, 2019 [1 favorite]
posted by churl at 12:41 AM on September 5, 2019 [1 favorite]
"The Happiness Trap" in combination with therapy gave me succour. It took a long time for me to actually do the exercises though. There's an irony there; you read a book that advocates purposeful action regardless of feeling. But then the book is so well-written, so apt, that just reading it gives you a good feeling. And then you skip the exercises, and you don't become more skillful, and at some point you start to get worse.
Often enough it's not just the bad feelings that are a hindrance, but the good feelings as well.
posted by dmh at 4:41 AM on September 5, 2019 [7 favorites]
Often enough it's not just the bad feelings that are a hindrance, but the good feelings as well.
posted by dmh at 4:41 AM on September 5, 2019 [7 favorites]
My therapist isn't like, strict ACT down the line, but guides me through using ACT strategies while doing kind of general talk therapy in order to connect the dots of my past abuse and current difficulties. I was pretty much shut down emotionally, I couldn't ask for what I needed, I couldn't articulate what was happening to me. My throat would close up! So ACT helped me recognize my feelings, understand where they were coming from, and let them in, instead of pushing them away. I've never felt that it was weaponized anything. Now I can talk about how I feel, even to the people I'm feeling feelings about, which is such a huge change.
One of the best things she ever did was tell me that the way I was reacting to things was human.
Personally I don't think any therapy methodology is one-size-fits-all, nor is any human one-size-fits-all, so maybe a combo of things would be right for you (general you, no one in particular) as it is for me. I'm basically on maintenance plan right now. I go, we laugh at how crappy some people can be, I cry it out a little, we check in on whether I understand what my heart and brain have been up to, and we make an appointment for next month.
posted by wellred at 5:03 AM on September 5, 2019 [7 favorites]
One of the best things she ever did was tell me that the way I was reacting to things was human.
Personally I don't think any therapy methodology is one-size-fits-all, nor is any human one-size-fits-all, so maybe a combo of things would be right for you (general you, no one in particular) as it is for me. I'm basically on maintenance plan right now. I go, we laugh at how crappy some people can be, I cry it out a little, we check in on whether I understand what my heart and brain have been up to, and we make an appointment for next month.
posted by wellred at 5:03 AM on September 5, 2019 [7 favorites]
The “naming the thought” exercise from The Happiness Trap is one of the greatest tools I’ve ever gotten to deal with recurring anxious thoughts. For me there are many things at play including BPII-induced anxiety. The exercise doesn’t necessarily get rid of the anxiety, but it helps me to not assign an unrealistic “cause” for it.
There are definitely some things in the book that don’t work for me, but there are several things that save elements of my psyche from greater damage when I’ve dealt with some of my physiological brain issues.
posted by aloiv2 at 5:07 AM on September 5, 2019 [2 favorites]
There are definitely some things in the book that don’t work for me, but there are several things that save elements of my psyche from greater damage when I’ve dealt with some of my physiological brain issues.
posted by aloiv2 at 5:07 AM on September 5, 2019 [2 favorites]
This framing makes it sound like just another angle on “Have you tried not being disabled by your mental illness?”
If I could just take another stab at answering this in the bigger picture, it would absolutely be cruel and ableist to expect someone with disabling mental illness to just buck up and ignore whatever they're feeling or thinking for the rest of their life. That's not what ACT is doing, for three main reasons that I can think of.
One is that the point of ACT is not to ignore or override thoughts and feelings, but rather the opposite, to gain enough psychological flexibility that you can experience those thoughts and feelings fully without being derailed by them. Ignoring thoughts and feelings is actually likely to be maladaptive in the ACT framework (and can lead to the inability to actually recognize or feel those emotions -- which as some people in the thread have mentioned, has negative consequences of its own).
The second is that, as I said above, this is a process, just like physical therapy that you might do after being injured or being in an accident, and is not something you can just think yourself into being able to do after reading a summary of how ACT works. You have to train and practice and do the exercises and add difficulty slowly. Also, not everyone is or should be expected to proceed at the same pace, some people are going to have experienced worse traumas than others, and recovering is something you might very well need a lot of help from a licensed professional to guide you through.
The third is that while symptomatic relief is not the thing that ACT primarily targets, it turns out that empirically -- totally unlike being told to be less depressed/traumatized -- ACT "works" in the sense that people do also tend to experience less and less of the painful symptoms of mental illness such as anxiety, depression, panic, etc., and (I think) also tend to be more resilient to relapse.
posted by en forme de poire at 2:49 PM on September 5, 2019 [6 favorites]
If I could just take another stab at answering this in the bigger picture, it would absolutely be cruel and ableist to expect someone with disabling mental illness to just buck up and ignore whatever they're feeling or thinking for the rest of their life. That's not what ACT is doing, for three main reasons that I can think of.
One is that the point of ACT is not to ignore or override thoughts and feelings, but rather the opposite, to gain enough psychological flexibility that you can experience those thoughts and feelings fully without being derailed by them. Ignoring thoughts and feelings is actually likely to be maladaptive in the ACT framework (and can lead to the inability to actually recognize or feel those emotions -- which as some people in the thread have mentioned, has negative consequences of its own).
The second is that, as I said above, this is a process, just like physical therapy that you might do after being injured or being in an accident, and is not something you can just think yourself into being able to do after reading a summary of how ACT works. You have to train and practice and do the exercises and add difficulty slowly. Also, not everyone is or should be expected to proceed at the same pace, some people are going to have experienced worse traumas than others, and recovering is something you might very well need a lot of help from a licensed professional to guide you through.
The third is that while symptomatic relief is not the thing that ACT primarily targets, it turns out that empirically -- totally unlike being told to be less depressed/traumatized -- ACT "works" in the sense that people do also tend to experience less and less of the painful symptoms of mental illness such as anxiety, depression, panic, etc., and (I think) also tend to be more resilient to relapse.
posted by en forme de poire at 2:49 PM on September 5, 2019 [6 favorites]
Have to add a warning for anyone checking out Russ Harris: he's a huge advocate for harmful autism therapies and talks about how terrible it was when he found out his child had autism.
posted by daybeforetheday at 5:59 AM on September 13, 2019 [4 favorites]
posted by daybeforetheday at 5:59 AM on September 13, 2019 [4 favorites]
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Hayes' Get Out of Your Mind and Into Your Life, as well as a book by Russ Harris called The Happiness Trap (for which Hayes wrote a foreword) have been really meaningful to me in coping with anxiety (although lately I am thinking I need a tune-up).
The comparison between ACT and CBT is striking to me, at least in how they're presented to you if you're a patient. CBT is given to you like, you are sad and scared because you are making mistakes, and we are going to learn how to recognize your many, many errors so you will then feel better. All it ever managed to do for me was built up resentment and grudges, because it was all I could ever find from local therapists. Then you have something like ACT which says, well, maybe you can learn to hold this feeling, to exist with it inside you, without exhausting and demoralizing yourself by trying to fight it all the time. That, to me, was revelatory, because until I encountered that thought, everything was a battle, me against this wrong thing inside my head. How best to fight it? How best to make it go away? Struggle and struggle and struggle!
I do have a problem with ACT, and it's really the 'C' part. I seem constitutionally incapable of naming any values, any goals to be committed to. When I look deep inside myself, I just don't see...anything. Nothing capable of making the kind of choice that precedes commitment. I don't know what's good for me to be committed to. I don't know what values I have, and the more I try to poke at it, the more worried I get that I'm doing things wrong.
But still, that aside, this kind of therapy seems so promising and realistic, and I am eager to read more of these links!
posted by mittens at 12:03 PM on September 4, 2019 [23 favorites]