Solution Tree -  flexible context sensitivity and functional coherence (2018)

Kappan - conditional vs. hierarchical framing (2017)

Teaching Tolerance - defusion (2014)

Hear radio host Sheila Hamilton interview Evergreen Clinical’s Brian Goff about ACT on KINK’s Speaking Freely (101.9 FM Portland, OR).

Click here to hear the interview.

In this free online video event series, Tami Simon speaks with several contemporary luminaries in the fields of spirituality, psychology, and creativity. Together they explore the questions around self-acceptance—and investigate how we can overcome the difficulties of embracing who we are. Where do our self-critical voices come from? Can we silence them, or is there a better way to deal with them? Can we be motivated to change and excel while still accepting ourselves as we are? Why is it often so much easier to feel compassion and forgiveness towards others than towards ourselves?

http://live.soundstrue.com/selfacceptance/

3 day workshop with Russ Harris in Copenhagen: Interview with Russ Harris on the 15th of May 2012

Interview by Maria Krøl and Ole Taggaard Nielsen

I: What was it that brought you to ACT?

R: I thought it was a very realistic look at the human condition. It starts with the premise that life involves lots of pain. No matter how good your life gets there’s going to be plenty of pain that goes with it. I found that to be very realistic. We’re all gonna have lots of painful feelings, we’re all gonna have lots of negative thoughts. So how do we learn to live with that? How can we still live a rich, full and meaningful life, even with the pain? So it was very realistic, and it really resonated with my experience. And I liked that there was a lightness and playfulness about the model; it had a sense of humor. I also love the creativity of it; the way that it frees you up to design your own metaphors and your own interventions. It gave me a lot of freedom as a therapist; there are just so many different ways I can do it. I love that I can be creative and playful. And I love the compassion and the self-compassion that’s built into the model. And I think more than anything, I loved the training: how it was about working with my own issues, and applying the approach to my own stuck-points in life; to help with my own pain and suffering. It just really resonated with me.

I: You mentionend that you used to do traditional CBT. When did you move in the ACT direction?

R: I started working as a GP (family doctor) in 1991 and I became increasingly interested in the psychology of health and wellbeing. And as I started spending more and more of my time looking at the role of stress in the lives of my patients. My consultations would average to 20-30 minutes, which was unusually long for a GP. 5 minutes at the end of the session would be about the medical problem, and 25 minutes would be about what’s happening in your life: the stresses and difficulties. And I started to realize that I was really in the wrong profession. 

So I wanted to train in therapy and the first model I trained in was traditional CBT. And I liked it. It’s a very effective model. I think I started formally doing sessions of therapy as opposed to GP counselling, in about 1994. And from that point, until 2003, I mainly did traditional CBT. However, at the same time that I was doing CBT, I kept training in other models, I was always looking for other things because even though CBT had some really good stuff, it didn’t, for example, have much to say about finding meaning and purpose in life. Also, I was very interested in mindfulness. There’s a whole branch of medicine called Psychoneuroimmunology, which is about the connection between the mind and the body, and there was some very interesting research coming out, about the benefits of mindfulness meditation for the immune system. So I was very interested in mindfulness, but it was very hard to get my clients to meditate.

As for traditional CBT, I really liked the behavioral elements: the skills-training, exosure, scheduling, and goal-setting etc, and I also liked the distancing components, where you become more aware of your thinking processes; but I didn’t like the components that were about challenging thoughts, because it didn’t actually work for me. I could challenge my thoughts all day long, but they’d just keep coming back, again and again. And I liked the mindfulness stuff, but I wasn’t overly keen on meditating. And I wanted to explore meaning and purpose with my clients, but I wasn’t quite sure how to do it. So I was trying for many years to bring these elements together: behavioural activation, mindfulness, cognitive distancing, meaning and purpose. I didn’t know anything about ACT, but it’s what I was intuitively trying to do. So when I finally discovered ACT in 2003, it was like ”WOW, this is fantastic!” A friend told me about it, I went to the book store, I looked at the book and it was love at first sight. ”Oh My God, this is fantastic.” I just fell head over heels in love with it. I became obsessed with it, and I instantly moved all my clients from traditional CBT to ACT. It was a bit confusing for them initially. I would say, ”No, no we don’t need to challenge those thoughts anymore”. They would say, ”Really?”

I: What is the goal of ACT, and how is it different from traditional CBT?

R: The aim of ACT is to create a rich, full and meaningful life while accepting the pain that inevitably goes with it. You might get some CBT people to say that’s the aim of CBT too - but words like ”rich, full, meaningful”, well, I didn’t encounter that emphasis in my own CBT training. More technically the aim of ACT is to increase psychological flexibility. And that’s definitely not the aim of CBT. Psychological flexibility is your capacity to be in the present moment, open fully to your experience and act in line with your values: to ”Be present, open up and do what matters”. That’s the outcome we’re looking for.

I: Could you tell me a little bit about the therapeutic stance in ACT?

R: The therapeutic stance is that ”We’re both in the same boat”. There’s no real difference between client and therapist; it’s just who’s sitting in that chair on that day. This metaphor that we like to share on the first session is the ”two mountains metaphor”. I say to clients: you come along to therapy, and it’s easy to get the idea that therapists have their life sorted out, that they don’t have any issues, no major problems. And I don’t want you to leave this room buying into that illusion. I want to shatter that myth right now. What’s it like is, you’re climbing your mountain over there and I am climbing my mountain over here. From where I am on my mountain I can see stuff on your mountain that you can’t see. For example, I might be able to see an alternative pathway that’s easier, or you’re using your pickaxe incorrectly, or there’s an avalanche about to happen. But I’d hate you to think that I’m sitting on the top of my mountain, no problems, no issues, just sitting back and enjoying life. I’m climbing my own mountain, over here. And we’re all climbing our mountain till the day we die. But what we can learn to do here is to climb more effectively, climb more efficiently; learn how to enjoy the climbing. Learn how to take a break and have a good rest and take in the view and appreciate how far we’ve come. That’s what this is about. So it’s a stance of commonality and equality: we’re both in the same boat; we’re dealing with the human condition. It’s not like some people have got a mental illness and some don’t; this is the human condition.

I: What is ”happiness” in ACT?

R: In ACT we stay away from the word ”happiness” because most people think that happiness means ”feeling good”. So in ACT rather than using the term happiness we use the term ”vitality”: a sense of embracing this moment of life, living this moment of life to the fullest. Steve Hayes has a saying: ”There’s as much life in a moment of pain as a moment of joy”. So the question is: ”Can I embrace this moment of life, whether it’s a very painful moment or whether it’s a joyful moment?” I say to clients all the time: ”If you’re going to live a full human life you’re going to feel the full range of human emotions”.  So if you pushed me hard to define happiness in terms of the ACT model I would say ”Happiness means living a rich, full and meaningful life in which we feel the full range of human emotions - both the painful ones and the pleasent ones - without a struggle.”

I: How can you as a therapist help a client to identify personal values?

R: Many different ways. You can often identify them by asking questions: What matters to you? What’s important to you? A question I ask every client on the first session is: ”If the work that we do in this room could make a difference in one relationship, which relationship would that be? How would you behave differently in that relationship as a result of the work that we do?” Other useful questions are ”What do you want to stand for in life?”; ”When you look back at your life from your deathbed, what do you want to say that life was about?”; ”If you could be the ’ideal you’, how would you treat your body, how would you treat your children, how would you treat your job, how would you treat the environment, how would you treat your loved ones?”. You can think of vaues as how you would treat your relationship with anyone or anything; what are the qualities that you would bring to it?  For many people these questions are useful. However, some people just go blank when you ask them such questions; in which case, we would do experiental exercises, of which there are many. One of the best is Kelly Wilson’s ”sweet spot” exercise, where you ask someone to get in touch with a very rich sweet memory, one of life’s ”sweet spots”. So it could be a memory of a time of love, a time of creativity, a connection with nature, a moment of achievement or pride or having fun, or a simple pleasure. We help them to relive the memory, and then we ask them questions to tease values from it: What does this memory tell you about what matters to you? What qualities were you embodying in the memory? What does this tell you about the way you want to behvae or the things you want to do more of, moving forwards? In this memory what were you ”in relationship with”? Was it a relationship with nature, or with your body, or with a loved one, or with an activity? In that relationship, what personal qualities were you embodying? There are many experiemental exercises, but the sweet spot is a particularly good one.

I: What are your thoughts on medication as a treatment for depression and other psychological problems? 

R: The ACT stance on medication is like the ACT stand on everything else. The ACT model rest on the concept of ”workability”: is it working to give you a rich, full and meaningful life. If it is, keep doing it. If it’s not, do something different. This would be the ACT stance for any medication; not just psychiatric medication, but also medication for diabetes or cancer. For example some people with cancer choose not to have chemotherapy. They figure ”The chemotherapy won’t cure me, it will just give me six extra months of life- and the quality of life will be so low, I’d rather not do that.” So the ACT stance on medication is neither for it, nor against it; it’s all about workability. And there are quite a few published ACT studies where clients were on medication as well as doing ACT.

I: Do you have clients that choose to be on medication?
R: Sure, and if they do, I’ll work with them. I ask clients on antidepressants: ”What difference do they make?” The most common answer I’ll get is: ”I felt a bit better initially but now I don’t know if they’re doing anything” or I’ll get: ”I’m not feeling as much pain, but I’m not feeling as much of anything”. Most therapists don’t ask, but if you ask clients on antidepressants if they have sexual problems, about 70% of clients will say ”yes”. The incidence is much higher than the drug companies acknowledge. It’s a big problem. If a client considers the costs of being on medication outweigh the benefits - as many of them do - I will work in conjunction with a psychiatrist to help them get off it. I personally don’t want to play the role of prescribing medication or monitoring medication; I’m not interested in that. Basicly since I started doing therapy, I’ve said, ”I’m here to work with you as a therapist, if you want medication, you go see a gp or a psychiatrist, they can monitor all of that.”

I: You seem to use a lot of your own experiences in your book, in presentations and in therapy; what is the purpose of that?

R: ACT is a model that is in favor of self-disclosure from the therapist. ACT doesn’t insist on self-disclosure, but it’s very much in favor of it. If you read the literature you’ll certainly find studies and papers warning you about the dangers of self-disclosure, but you’ll also find plenty about the enormous therapeutic benefits of self disclosure. ACT is in favor of self-disclosure as long as it is done mindfully and judiciously: to model ACT for the client, or validate their experience, or normalize their experience, or build therapeutic rapport in a useful way.

I: Today when you did tell your own story, I think people got very emotional and touched by it. Are you purposefully aiming to bring up emotionality in the client?

R: What we are aim to do in ACT is to model and instigate and reinforce ACT processes. So I can model the ACT processes, I can instigate them, and if I see them happening in the room, I can reinforce them. One way of modelling them is through self-disclosure. We want to have an intimate therapeutic relationship. Kelly Wilson uses the term ”values and vulnerabilities”. If you know nothing about my values and vulnerabilities, we don’t have an intimate relationship.
Now ACT doesn’t insist on this. You can do ACT and be closed off, without sharing any of your personal thoughts or feelings; but it’s very different when you open up and self-disclose. It helps to break the illusion that the therapist has their life sorted out and doesn’t struggle with this stuff. Many of our clients are fused with the idea that ”everyone else is happy and has a wonderful life except for me”. When the therapist says, ”I get anxious too” or ”My mind is saying that I’m not good enough”, the client goes, ”Oh woww, you too!”

I: What are you occupied with at the moment in ACT concerns?

R: I’m writing four books. I’m writing with Louise McHugh – co-authoring a textbook, trying to make RFT really simple and understandable, and link it to ACT. RFT is the theory of language and cognition that underlies ACT, and many people find it really hard - so we’re trying to make it really simple.
I’m also writing a self-help book with Joe Ciarrochi and Ann Bailey on the use of ACT for weight loss. There are five or six published studies now on ACT with weight loss. That book is called ”The weight escape”, and it should be out in late 2013. I’m nearing completion of an advanced-level textbook called ”Getting Unstuck in ACT” for people who already know the basics of ACT. It’s about the most common ways therapists get stuck, and how to get unstuck again. That should be out in early 2013. And I’m writing a humorous book on mindfulness called ”The Way of The Sloth”. The sloth is an animal in South America. It hangs upside down from the trees with these hugh long claws, and it’s really slow moving. It’s the slowest mammal in the world. In English, the word ”sloth” means ”laziness”. ”Sloth” is one of the ”seven deadly sins” in the bible. Everyone thinks that this animal, the sloth, is really lazy - but what we’re saying in this book is that it’s a master of mindfulness. It doesn’t waste any energy; it’s this mindful creature; the zen master of the forest. So it’s a humorous book, where everyone gathers in the forrest to ask the sloth questions about life, the universe and everything.

I: Do you still have clients?
R: Not many, these days. Just a handful. I’d like to see more but I just don’t have the time; I’m always travelling and teaching.

I: Would you like to tell us a bit about your new book ”The reality slap”? It will published in Danish soon?

R: A ”Reality Slap” is when life just slaps you in the face, knocks you around, turns your world upside down. So ”The Reality Slap” is a book for anyone who goes through a major stressful life event; in particular, it’s about loss and grief. Death of a loved one, bankruptcy, divorce, major illness, a serious accident, a disability: any of these big life events. How do we cope with these events? There are 4 basic principles.

First principle: Hold yourself kindly. This is about self-compassion: Can I be kind to myself? There’s a massive gap here between what I want and what I’ve got; there’s a huge amount of pain showing up: so can I be kind to myself? Many of us don’t know how to do that. We stuff our face with drugs or alcohol or food, or we beat ourselves up, or withdraw from life: this is not really being kind to ourselves. So what are simple ways that I can be kind and caringand supportive to myself, in the midst of my pain? 

The second principle, I call ”Dropping an anchor”. All these painful emotions, thoughts, feelings: it’s like an emotional storm. And if I get swept away by the storm, there’s nothing effective I can do. So how do I drop an anchor? Basically, I use mindfulness to ground myself in the present moment, and let those thoughts and feelings flow through me, without carrying me away. 

The third principle is ”Take a stand”. What do I want to stand for in the face of this? What do I want to be about in the face of this challenge, in the face of this loss, in the face of this tragedy or crisis? I don’t have to give up on life. I can still stand for something, even if what I’m going through is horrendous. Even if the person I loved most has died, I can still stand for something in the face of that. I can give up on life, or I can stand for something that makes it meaningful. So it’s really about values, and committed action. 

The fourth and last principle is ”Find the treasure”. Even in the midst of great pain and suffering, there are things that we can treasure and appreciate. For example, when we’re at the funeral of a loved one, we experience great pain - but in the midst of that pain, people reach out to us with love and kindness and caring; so can we appreciate and treasure those moments? 

This principle has to come last, only once the other three are in place. The danger is that many people will try to ”find the treasure” as a first line response. They’ll say things like ”Well, every cloud has a silver lining” or ”What does not kill me makes me stronger”. But if that’s the first thing that you say to someone in great pain, they will experience it as completely invalidating. So ”Find the treasure” comes after everything else. And we’re not trying to pretend that the pain is not there. There is pain here AND there are things here that I can appreciate. But principles one to three have to come first.

In this episode of the Regina Brett show, ACT psychologist Steven Hayes discusses the psychology of fear, and how ACT can help. He then offers advice to individuals who call in with questions.

Or, if you are logged in, you can download the mp3 file which is attached to this page.
 

How Analyzing Your Problems May Be Counterproductive
Published on February 13, 2010
By Ray B. Williams

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.

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How to fulfill your potential

Ray Williams is Co-Founder of Success IQ University and President of Ray Williams Associates, Inc., providing leadership development, personal growth, and executive coaching services.
accessed from psychologytoday.com
 

Russ Harris on RadioNZ

Topics discussed in the interview:

• What Keeps Steven Hayes Up at Night?

• The Tolerating Cure

• How to Deal With a Panic Attack

• Happiness Is an Empty Promise

• The Catch-All Nature of Acceptance and Commitment Therapy

• Finding a Career by Way of a Panic Attack

Full Interview Transcript:

Question: What led you to explore this field of psychology?

Steven Hayes: Well, I'm in psychology probably the way a lot of people get into psychology: you're interested in why there's so much pain and suffering around you. And I certainly saw that at home, just growing up, and decided early on that it was a place to put my science interests and also just my humanitarian interests, and you could put those two together in one field. After I was a psychologist I developed a panic disorder, and that changed a lot of -- what kind of work I do, because I was trained as a behavior therapist and as a cognitive behavior therapist. And when I applied the methods that I would apply with others when they had panic disorder, it didn't really fully hit what I thought was needed for me.

And I turned back towards several things that were sort of in my experience from more eastern traditions, human potential traditions, and then tried to marry that up -- I'm a child of the '60s and grew up in California, so was exposed to the kind of garden variety eastern thinking that most folks in my generation were exposed to, and I actually found more in mindfulness and acceptance methods that were directly of benefit to me than in the traditions I was nominally part of.

So that really changed my thinking, and it caused me to set out on about a 30-year journey as to how dig down to the essence of what's inside some of our deepest clinical traditions, but also our spiritual and religious traditions, particularly these eastern traditions. But not just that; all of the mystical wings of the major spiritual and religious traditions have methods that are designed to change how you interact with your logical, analytical, linear thinking. And I didn't want to leave that just intact; I didn't want to simply be a meditation teacher or something. I wanted to understand it, and we spend a lot of time kind of pulling at its joints and trying to understand why these things might be helpful to people, I think particularly helpful to people in the modern world who are exposed through the media and the kind of chattering world that we've created to a lot of horror, a lot of pain, a lot of judgment, a lot of words, and need to find a place to go that is more peaceful and more empowering, being able to lives their lives in an intimate, committed, effective way. So that's kind of how I came there, or I ended up where I ended up.

Question: What is ACT and how does it differ from traditional forms of cognitive therapy?

Steven Hayes: Sure. Well, the empirical clinical traditions, especially in the cognitive behavioral tradition, early on they were trying to apply behavioral principles mostly developed with animal models directly to people. And there's a lot of benefit that happened there; it's still relevant today. You can do a lot of good things for people who suffer with anxiety, depression and so on using those methods. I'm old enough to have seen all three of these steps, and somewhere in the late '70s and mid-'80s people realized that you had to have a better way of dealing with cognition, and they couldn't find it in the animal models. So they went to more commonsense clinical models where they would sort of divide thinking styles up into rational and irrational processes, making cognitive errors and so forth. And they thought if we could just get people to think more rationally and focus on the evidence and take some of those over-expansive thoughts that are creating difficulty for them and change them, then they'd do better. And some of it was -- the techniques were helpful, but the theory didn't work very well.

Increasingly over time we learned that the components that theory tells you to put in and the processes that should change didn't really explain the outcomes and add to the outcomes. And it had this potential for a downside: people can get even more self-focused, even more caught up in their own thinking. And we're part of a newer sort of third generation of tradition that is using acceptance and mindfulness practices and values, commitment, behavior change practices and marrying them up. So the difference between traditional CBT and the acceptance and commitment therapy, or ACT -- but not just ACT; also mindfulness-based cognitive therapy, dialectical behavior therapy, a number of the other more kind of modern acceptance and mindfulness approaches -- instead of teaching people to detect, to challenge, to dispute and change their thinking, we teach people to notice what they're thinking and to notice what they're feeling, what their body is doing, learn from it, but then focus also on their values and getting their feet moving towards the kinds of lives that they want to produce to have a life worth living.

And it turns out that that's, we think, a quicker and more direct way, a more certain way, to moving ahead in your life than first trying to get the cognitive ecology inside this skull of ours all lined up with an ability to detect our logical errors and correct them and so forth. Meanwhile, the clock is ticking. There's relationships to have, children to be raised, work to be done, contributions to be made, and you're waiting to get the world within all lined up. We think it's more effective to find a way to back up from that a little bit; notice it, see what's there, learn from it, and move ahead directly towards the kind of lives that you want to produce. And it turns out those processes are not just in therapy, but in this office, in your home, in the schools and organizations. And so the ACT work has very quickly expanded out from psychotherapy into behavioral medicine, and from that even into organizational work and now into prevention work and into communities and schools. So it's kind of exciting to see psychology touching people where they are, in the streets, in a way that is empowering and sort of simplifies what it is that people need to learn to be more effective and happy, successful, vital in their lives.

Question: How can a therapist help someone realize their values?

Steven Hayes: You know, a couple of things: if someone watching this were to focus on what pains them the most, and then would take the time to look inside -- what do I care about such that that's particularly painful? -- they're probably going to find a significant area that they value. I'll give an example: most people are hurt deeply by betrayals in relationships. And what your mind tells you to do is, don't be so vulnerable; don’t be so silly; don't open yourself up; don't be so trusting; you can be betrayed. In fact, the reason why you hurt so much is that you want relationships that are loving, committed, intimate; you want trust. And what your mind's telling you to do in a way is, don't care about that so much so that you won't be hurt so much. It might be better to really get up against and sort of contact that caring, and maybe take a more loving stance even with your own pain, and keep your feet moving towards what you really want, because the cost in terms of intimacy and connection and caring that comes when you try not to be vulnerable, when you're constantly looking out for betrayals of trust, is too great. It makes it very hard to have relationships of the kind that you really want. So there's an example. One, look where the pain is. Flip it over; you'll find that's where the values are.

Another one is just to think of the times that you've felt most with yourself, most connected, most vital, most energized, most flowing, natural. And if you take some of these specific memories and you walk inside them, you're going to find that there's things in there that you care about. There's things in there that, when it's really working well, are kind of a lighthouse, like a beacon in the distance, that you can move towards. You never fully reach these things. I mean, I'll give you an example. There are times when you felt especially important to another person, or cared about or loved or accepted. Well, loving relationships aren't something you can have like a precious little jewel you put in a box and then put on your shelf. It's something you walk towards. And there's always difficulties; there's always pain in relationships. But you can keep walking towards that beacon in the distance. That process, that journey, is called life. And if you're moving towards the things that you value, life is more vital, flowing; it's more empowering. And so that's another way: go inside the sweetness of life, catch the places where you genuinely were moved by or connected with life, and you'll find in there kind of a light that can direct you when the cacophony gets very noisy and you get confused and lost, that can direct you towards what you care about.

Question: How does the role of an ACT therapist differ from the role of traditional psychologists?

Steven Hayes: It might be a little bit, because this psychology is a psychology of the normal. A lot of the psychologies that are out there are built on the psychology of the abnormal. We have all these syndromal boxes that we can put people in and so forth. The actual evidence on syndromes is not very good. I mean, there's no specific biological marker, for example, for any of the things that you see talked about in the media. Even things like schizophrenia -- there's no specific and sensitive biological markers for these things. So yeah, there may be some abnormal processes involved in some of them, but vastly more of human suffering comes from normal processes that run away from us. Like normal processes of problem-solving work great on the world without; when it's applied within, you too easily get into a mode of mind where you can start living when the problem of your history is solved.

But your history's not going to go away; it isn't the same thing as dirt on the floor or paint peeling off the walls; it's not going to be solved in that way. It's more like learning how to carry it, to contact it, to see it. Because it's based on the psychology of the normal, the therapist is part of that too. And so when the therapist gets in there and is working on acceptance and mindfulness and values, they too are working with those very same processes. And so it requires a therapist not to be a master at it -- you don't even have to be good at it -- but just to see the value of it and to be willing to look at their own difficult emotions and thoughts and find a way to carry them gently in the service of the clients that they're serving.

So for example, if a therapist is feeling insecure in therapy, a lot of therapists will try to sort of push that aside to try to do the therapy. Instead, we would ask people to get with that feeling of insecurity, because after all, the client is being asked to do the same thing. So it tends to be relatively intense, interactive, horizontal. It's not one up; the therapist is in the same soup. And it has a kind of a quality of two human beings in the same situation, really, working through these psychological processes. And yeah, I'm working for you; you hired me; I'm working for you as a therapist. But I'm not up here and you're down there. And what you're struggling with, at other times and with other areas I'm struggling with.

Question: Why can ACT treat everything from schizophrenia to prejudice?

Steven Hayes: Well, and even more than that. I mean, I've mentioned even in this office the same processes are there. We've done research showing that ACT and the processes that underlie it can help things like can secretaries learn new software? Can therapists learn new methods? What about stigma and prejudice between people? So it isn't just in the psychotherapy areas. And why that would be, as an empirical fact there's a pretty enormous breadth to these methods. And why that would be -- because everywhere that a human mind goes, these processes of avoiding the world within in order to try to regulate your behavior, or becoming entangled in your thoughts interfering with your ability to take advantage of what's around you, or losing contact with your values for fear that you'll know more about the places where you hurt -- those kinds of processes are just normal psychological processes that are built into language and cognition itself. They're built into problem-solving. And so if you take the mode of mind that works great in 95 percent of your life and apply it within, it then implodes. It starts creating barriers, and that's true at work, it's true in organizations, it's true in our culture, true in our politics. And yeah, it's true in our consulting rooms.

So we're going -- the reason why it spreads out -- we have pretty good evidence for this; I know it sounds a little grandiose -- but the mental cognitive processes that we're targeting are ones that narrow human beings' repertoire and make it harder for them to learn to be more flexible, to take advantage of the opportunities in front of them. And we think that's something we can have something to say about, something to help with in all of these different areas, maybe even in areas like child development or organizations and schools, or maybe even things like prevention or how peoples interact with each other, one to the other. So we've taken the work, for example, into things like prejudice and stigma, because in the modern world, if we can't solve that we have planes flying into buildings. And then we have planes flying over countries. The amount of hate and objectification and dehumanization that's on the planet isn't something we can tolerate any more in a world that's coming of suitcase bombs and the ability to amplify that hate out into harm towards each other. So it applies broadly because anywhere that a human mind goes these processes go.

Question: What is happiness?

Steven Hayes: You know, there's many different definitions of it. I think one dangerous definition of it is to think of happiness as kind of a warm, joyful, **** feeling in your heart that you have to pursue and grab and hold onto for fear that it'll go away. I mean, it's fun when you have those feelings, but we know, and the evidence shows, them more intent you are on having those feelings and chasing those feelings, that's a butterfly that flies away the more you chase it. A better way to think about happiness that actually is something that I think you can reach towards is, it's living in accord with your values and in a way that is more open and accepting of your history as it echoes into the present, that's more self-affirming, self-validating and values-based. The Greeks had a word for it; they called it eudaimonia, and it's not a bad definition. And I think that definition of happiness is something that will empower human lives.

The definition that we have that gets very hedonistic and emotion-oriented -- the problem is that there's too many quick and dirty ways to chase that in ways that end up being unhelpful to people. If you avoid the feelings of betrayal and the sense of insecurity that comes in relationships that aren't working by running into detuned relationships, by sexuality that isn't connected to intimacy, et cetera. Yeah, you might feel good, but it doesn't live well. If you just have another martini or even more severe forms of substance use, yeah, it might feel good, but it doesn't live well. And if you escape into kind of a materialism -- the right car, the right woman, the right house, the right trip, the right place, the right job, the right praise -- you know, these things -- all of the folks who are wise in our culture, over the history of our culture, have written about the dangers of trying to define a meaningful life that way. But commercial culture and our media is constantly encouraging us to think that if we feel good we live well. And then we're only too happy, thank you very much, to sell you goods and services from the dancing oivoids and the pill you can take, or the trips or the cars or the clothes or the women that you can get with -- whatever that is that will give you the quick route to that.

And it's an empty promise. I think young people know it's empty, but they're not quite sure what to do. And I kind of look at what's on the T-shirts and I see another solution, which also worries me. I see "Just do it." "No fear." -- this kind of suppressive response to the treacle that the culture tries to define for us as a meaningful life also blows up on you. "No fear" is not something that you should put on your shirt. How about "I can hold my fear and still connect with you"? Put that on your shirt. "It’s okay to be me, with all of my history." Put that on your shirt. So there's a middle path. There was a guy who sat under a tree a long time ago who is important to a pretty big chunk of the human population that called it The Middle Path. There is a middle path between indulgence and suppression, but the culture has overwhelmed that in the cacophony that has been created in the modern world and the commercial encouragement of avoidance and indulgence on the one hand, or suppression and "just do it," treating yourself as an object on the other. We've got to find a way that's more compassionate, softer, that allows us to move forward towards the kind of lives that we really want to live.

Question: Are Americans striving too much for happiness?

Steven Hayes: I think the commercial culture, and also science and technology after all, which gives us greater ease but also makes it harder for us to sit with the small amounts of distress that come just by living itself, is probably -- the combination of the commercial culture and the media culture and the science and technology has probably made it more difficult in American culture. But I think it's built into language and cognition. It was only given some counterweights -- the major institutions that are there are our spiritual and religious traditions, which emerged very early on, at the point at which human language grew and written language created kind of the problem that we can have now with language kind of running away from us. And those traditions have weakened too in our culture, and they've changed. So we probably do -- it isn't that we're chasing happiness; I think we have the wrong model of happiness. I mean, defined as eudaimonia, defined as a values-based life of integrity and fidelity to yourself and what you most deeply want to stand for, that definition of happiness -- man, that's the kind of life I want to live and I think that will support people and sustain people.

But this cheap-thrill version, this sort of ease definition, the feel-good definition of happiness is an empty promise. And the culture in the West I think has done a particularly bad job of indulgence in that vision of what happiness is and encouraging people to chase it. And I think we can see in the growing amount of problems that we have in the developed world that it's an empty promise. And I'll give you an example, not from the U.S., but in Scandinavia probably the most worker-supportive part of the planet, they have the highest rate of chronic pain and the greatest rate of worker-related disability. So right inside this idea that any kind of pain and difficulty is so much unwelcome that if you say that you're in pain, we're going to come in guns a-blazing and even pay you full salary to quit work because you're burned out, or to -- inside that what you're going to create is gigantic amounts of chronic pain syndrome. Scandinavians spend 15 percent of their gross national product on disability. Fifty percent of the public health nurses are on disability. I mean, and that's where we're headed in the U.S. too, because unless we get wiser as to how to carry the difficulties of life in a way that's self-compassionate and empowering, we can create this kind of world in which we'd rather sort of plug into the matrix with whatever pills or escapist tendencies we can think of instead of walking through a process of living that's going to include loss. It's going to include limitations on function. It's going to include some significant difficulties. We need to learn and teach our children how to do that. And the West is just doing a terrible job of that right now.

Question: Do you believe in medicating depression and other forms of mental illness?

Steven Hayes: Medication -- I want good science, and big pharma is only too happy to give us bad science, because the way the FDA is set up and what the requirements are -- I mean, these are geek topics, and the normal person wouldn't really know how to evaluate it. But you only require a certain number of randomized trials. You don't have to have the proper control groups. You can have the blind be penetrated; people can know that they're on the medication, which we know there's a big placebo effect inside medications. So the science is often inadequate. The best science that's out there, then I want to -- then that's fine; let's go there. And there's decent science.

Let's take something like antidepressant medications. There's decent science saying it has an effect, but it's shockingly small after you control for penetration of the blind, people knowing that they're getting the active pills versus sugar pills, if you use an active control. It's probably only a few points. Like in depression, on the 56-point scale, the estimate is it probably accounts for about two points difference. But it's a multi, multibillion-dollar industry. And by the way, has huge side effects. And some of these medications, 40 percent of the people taking them have significant sexual side effects, for example. And that's just one. The level -- a single antidepressant medication can be worth a billion dollars to a company.

So I want good science, and I want it to be realistically marketed. I wouldn't like -- I think all these commercials that we have -- only two countries on the planet that allow pharmaceutical companies to market directly to people, New Zealand and the United States -- it's a bad idea, in my opinion. I think it ought to be better regulated. And when it's presented to people, it ought to be presented in a way that's realistic. For example, often people will prescribe these medications, and we'll say, you have a brain disease; you'll have to be on these medications permanently. It's because you have a brain disease. Well, brain disease -- there would be a specific biological marker for the so-called disease. There is no biological marker for depression. It's not true that we know that it's a brain disease. Is the brain involved in depression? Yes, the brain is involved with what you and I are doing right now. If neither one of us had a brain, we wouldn't be having a conversation. But that doesn't mean it's a brain disease.

And so the prescribers very often overstate, oversell, and the detail people are only too happy to tell them to do that. This idea that there's something wrong with your brain, and because of that you're permanently -- by the way, almost never are these medications evaluated with what will happen if you're on them for three, four, five, 10, 15 years. Sometimes some of the side effects that come up come up only later, and sometimes they're very severe, even irreversible side effects. So I would like it to be more like yes, these medications might be helpful to a degree, but what they do in areas like depression or antipsychotics is, they give you a little more distance between the things that cause you to get entangled with thoughts and feelings. And so they might be of some help, open up a little window. Now can we go in there and learn some of these methods directly to do that?

For example, antidepressant medications, you still have some depressive thoughts. Antipsychotic medications, you still have some psychotic symptoms for the vast majority of the people taking them. But it gives them a little separation, and it doesn't control his behavior as much when you have a sad feeling, difficult thought, an odd perceptual experience. We can teach people those exact skills in therapy, and so evidence is pretty good if you use it as just a window to get in there and teach these skills, you get longer-term benefits and without the side effects. So don't be sold just because a commercial interest wants to sell you things. The government ought to help out, because the average citizen can't go out and be doing reviews of the scientific literature. And focus on the processes that have low side effects and good long-term outcomes. Right now you're going to find those in the psychosocial area, in the therapy area, in the empirically supported treatments such as ACT or cognitive behavior therapy, behavior therapy. And go there first rather than going to the pill bottle as if it's going to be the end of your journey, that it's going to solve the problem. Very often it's only going to help, and even only to a minor degree, and more is going to be needed.

Question: What’s your advice to someone dealing with a panic attack?

Steven Hayes: Well, the advice I'd give if you were my patient would be a little different because we'd have a little more time. But if I can distill it down to the essence of what we do in a course of therapy, the person with panic -- I can say this from the inside out since you're looking at a panic-disordered person in recovery -- has adopted a posture with regard to the world within in which their own anxiety is their enemy. And they think that if they can just get the anxiety to go down, go away, not occur as much or not occur with such intensity, or at least not occur here, or there, in that situation, that then things would be better. In fact, all of that is not the solution to the problem; it is the problem. Holding anxiety as your own enemy, and that it has to go down, diminish it, go away and not happen here is a kind of self-invalidating, interiorly focused process that would get you even more entangled with these processes. Instead, what we're going to need to learn to do is to allow your history to bring into the present thoughts and feelings and memories, and to sort of hold them mindfully and self-compassionately, and then focus on what you do and bring them along for that journey.

So -- feelings are only your history being occasioned by the present moment. If that's your enemy, then your history is your enemy. If sensations are your enemy, your body is your enemy. And if memory is your enemy, you'd better have a way of controlling your mind in such a way that you never are reminded of things that are painful from the past. Well, there is no such thing like that that's healthy. And most of the things that people do that are called psychopathology are the unhealthy things people do when they try to accomplish that agenda. If you avoid people, avoid having your buttons pushed, avoid going to places that might occasion anxiety; if you're hammering down drugs and alcohol; these are all methods of trying to mount that unhealthy agenda.

So I would say, could we instead take this anxiety to be something that may be of importance, may even be meaningful? And it says something about your history, and could we learn to sort of hold it in a way that's more compassionate, to sort of bring the frightened part of you close and treat it with some dignity, and keep focused -- instead of making that go away -- focused instead on what kind of life you want to live connected to what kind of meaning and purpose. That's going to be a quicker, more self-compassionate and more certain journey forward than this kind of "out with the anxiety, in with the relaxation," "out with the self-doubt, in with the confidence" kind of -- "let's just snap out of it" kind of harsh and non-compassionate place that we stand with ourselves inside things like panic disorder.

Question: Why don’t some psychologists believe in the effectiveness of ACT?

Steven Hayes: It's an argument about theory and processes, but the processes, and the ones we've been talking about, inform what we think of ourselves and what we should encourage in our children and what we should try to put into the culture. And I think really we've been through a time when we thought we could think our way out of this, and kind of think clearly and that would solve the problem, and detect logical errors and that would solve the problem. We thought of suffering as a problem of sort of dysfunctional cognitions. I think we're coming into a time instead where it has to do with how you stand in relationship to your own world within and in relationship to those around you in the world without. And I believe these are the things that we need to put into our schools, education, into our psychotherapy and into our culture more, finding a way to not be so harsh and judgmental, so objectifying and dehumanizing, constantly focused within and trying to get these difficult thoughts and feelings to go away; or focused without and objectifying and dehumanizing others. So the core of the controversy is, is it more powerful to take an acceptance and mindfulness-based approach compared to a cognitive and emotional change approach when we're dealing with these problems? I think the evidence is more in our favor, especially the process evidence.

And I think if you look at where the culture is going, there's a reason why Eckhart Tolle is on Oprah. There's a reason why The Purpose-Driven Life is a best seller, quite apart from appealing to evangelicals and the Christianity that's in it. It's also -- there's a yearning for meaning, for values and for mindfulness and acceptance, because we've created a modern world where our children are exposed to 10, 20, 30 times the number of words that our great-grandfathers were exposed to. And we're exposed in a single day or two to more horror on our Internet Web pages than our great-grandfathers were exposed to in decades of living. And we have not created modern minds for that modern world. Science and technology has just dumped it on us. And I think people yearn for it. I think you see it in what's popular. And why are people wanting to learn about meditation, and why are they going on mindfulness retreats? And why are they talking about a purpose-driven life? It's because they know more is needed in the modern world.

And that's the core of the controversy. I think it's pretty clear in how things are moving in empirically supported treatments that we're going to be speaking to the culture in a different voice. It's not going to be the loosey-goosey voice of the '60s, but it's going to have some echoes of some of the deeper clinical and spiritual and religious traditions that had wisdom in it. If we're not going to get there through religious means and things of that kind, which greatly has weakened in the West, we're going to have to find a way to put it in the culture in a different way, because we need something right now other than yet another cable shoutcast or yet another Internet Web page showing us the cellulite on the actress's rear end. I mean, the amount of sort of judgment and harshness that's in our culture -- we need something that's prophylactic for that, and I think that's what's inside these new methods.

Question: What keeps you up at night?

Steven Hayes: What keeps me up at night in a positive way is the possibility that we might contribute to the development of human culture in a way that, years from now, people who will never know our names may be able to live more empowered lives. And if you ask like what is the name of your great-great-great-grandfather, you probably don't even know if you get three or four greats out. So it's not that we're immortal; we're going to die very, very soon. It's not that what we produce is going to live on; it will not. But the changes that we can make in the culture can be there for people that we will never meet, that will never know us, and that's what keeps me up at night. It's what excites me about science, that we can learn ways of being with each other. And the behavioral sciences have not been enough of a part of cultural development. The physical sciences have; the behavioral sciences have not. And I would like to see if we can bring some things into human culture that would humanize and soften and empower people.

What keeps me up at night in a negative way is, if we don’t solve these problems of the human heart and of the human head, of human psychology, there is no technological solution so great that it can prevent the world that is coming, and a world of suitcase bombs or of the ability to pollute the planet in a way that it cannot recover, of global warming and the rest. We've created through science and technology a different world that has frightening sides to it, and psychology and behavioral science has to be part of this, because if you take something like the so-called war on terrorism, if we go out another 20 years and it isn't just planes into buildings, but it's a suitcase bomb in the middle of New York, there's not enough soldiers and there's not enough bullets to kill enough people to make us safe. I think we're going to have to find a way to humanize the culture itself.

And it isn't just them; it's us. When we fly planes over countries, dropping bombs on the evil ones, I think we're doing something very similar to what's being done when the infidels are getting their comeuppance with planes going into buildings. So it's gotten to the point where if we are not healthy psychologically as a human society, we will not have a planet to live on. And that's what keeps me up at night, when I see so little focus on the behavioral side of these problems, and the idea that just politics, or just physical science, is going to solve this. Or just the military; it's not true. We have to solve this, and we've got to solve it in our own heads and in our own hearts, one at a time. And I think psychotherapy actually tells us a little bit about what we might need to do to soften the culture and make it more possible for us to live together as human beings on this planet.
 

Cloud, J. (July 2009). Yes, I suck: Self-help through negative thinking. Time Magazine. Time, Inc.: New York, NY.

In the past 50 years, people with mental problems have spent untold millions of hours in therapists' offices, and millions more reading self-help books, trying to turn negative thoughts like "I never do anything right" into positive ones like "I can succeed." For many people — including well-educated, highly trained therapists, for whom "cognitive restructuring" is a central goal — the very definition of psychotherapy is the process of changing self-defeating attitudes into constructive ones.

But was Norman Vincent Peale right? Is there power in positive thinking? A study just published in the journal Psychological Science says trying to get people to think more positively can actually have the opposite effect: it can simply highlight how unhappy they are.

The study's authors, Joanne Wood and John Lee of the University of Waterloo and Elaine Perunovic of the University of New Brunswick, begin with a common-sense proposition: when people hear something they don't believe, they are not only often skeptical but adhere even more strongly to their original position. A great deal of psychological research has shown this, but you need look no further than any late-night bar debate you've had with friends: when someone asserts that Sarah Palin is brilliant, or that the Yankees are the best team in baseball, or that Michael Jackson was not a freak, others not only argue the opposing position, but do so with more conviction than they actually hold. We are an argumentative species.

And so we constantly argue with ourselves. Many of us are reluctant to revise our self-judgment, especially for the better. In 1994, the Journal of Personality and Social Psychology published a paper. showing that when people get feedback that they believe is overly positive, they actually feel worse, not better. If you try to tell your dim friend that he has the potential of an Einstein, he won't think he's any smarter; he will probably just disbelieve your contradictory theory, hew more closely to his own self-assessment and, in the end, feel even dumber. In one fascinating 1990s experiment demonstrating this effect — called cognitive dissonance in official terms — a team including psychologist Joel Cooper of Princeton asked participants to write hard-hearted essays opposing funding for the disabled. When these participants were later told they were compassionate, they felt even worse about what they had written.

For the new paper, Wood, Lee and Perunovic measured 68 students on their self-esteem. The students were then asked to write down their thoughts and feelings for four minutes. Every 15 seconds during those four minutes, one randomly assigned group of the students heard a bell. When they heard it, they were supposed to tell themselves, "I am a lovable person."

Those with low self-esteem — precisely the kind of people who do not respond well to positive feedback but tend to read self-help books or attend therapy sessions encouraging positive thinking — didn't feel better after those 16 bursts of self-affirmation. In fact, their self-evaluations and moods were significantly more negative than those of the people not asked to remind themselves of their lovability.

This effect can also occur when experiments are more open-ended. The authors cite a 1991 study in which participants were asked to recall either six or 12 examples of instances when they behaved assertively. "Paradoxically," the authors write, "those in the 12-example condition rated themselves as less assertive than did those in the six-example condition. Participants apparently inferred from their difficulty retrieving 12 examples that they must not be very assertive after all."

Wood, Lee and Perunovic conclude that unfavorable thoughts about ourselves intrude very easily, especially among those of us with low self-esteem — so easily and so persistently that even when a positive alternative is presented, it just underlines how awful we believe we are.

The paper provides support for newer forms of psychotherapy that urge people to accept their negative thoughts and feelings rather than try to reject and fight them. In the fighting, we not only often fail but can also make things worse. Mindfulness and meditation techniques, in contrast, can teach people to put their shortcomings into a larger, more realistic perspective. Call it the power of negative thinking.

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View this original article online here.

Also click our link to access the 2006 Time article by John Cloud referenced in the above article.

ACBS Professional/Student Members: Once you are logged in, you can view the original Woods, et al (2009) article here.

Articles on ACT have appeared in Brazil, following a long piece in "Veja" in March 2006.

Embracing Your Demons: an Overview of Acceptance and Commitment Therapy By Russ Harris

This a simplified overview of ACT, written deliberately in a non-technical manner, so that therapists and counsellors of all backgrounds can appreciate it.

This is Martha Beck's column in "O":

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 helpedyou get a job (by being educated and dressing well). Ta-da! Your book, your shoe, and your job are linked by a new neural con¬nection 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 experientialavoidance, 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.

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Martha Beck is the author of Leaving the Saints and The Joy Diet (both Crown).

Interview with Steven Hayes on Get Out of Your Mind and Into Your Life

New Harbinger Publications: In Get Out of Your Mind and Into Your Life, you contradict some of the most central tenets of psychology. You say for example that, “accepting your pain is a step toward ridding yourself of your suffering,” and “we assume that...suffering is normal and it’s the unusual person who learns how to create peace of mind.” How did you come to adopt ideas that are so contrary to earlier models of psychological thought? 

Steven C. Hayes: Actually the idea that human suffering is pervasive is hardly new. Most of our spiritual and religious traditions begin there, for example. And our scientifically based therapy traditions inadvertently do too, though they don’t seem to realize it. Every professional writing a grant or pitching the need for a new treatment program begins with a section documenting how pervasive a given problem is in the community. And you see that work being written up in the popular media all the time with stories about the unbelievably large numbers of people who have, say, been abused, or have an addiction problem, or struggle with relationships, or have a mental disorder, or who are just stressed at work.

To see the truth of the claim I make in this new book, all you have to do is stop and say, “Hey, wait a minute. What if we added up all of these problems? How many people would fail to be in one ‘abnormal’ grouping or another?” When you craft the question properly the answer hits you in the face: it’s pain and struggle that is normal, not happiness. Most people I know have the personal information needed to reach the same conclusion. Just ask yourself this: How many people do you know really well who don’t struggle at times—or even often—in their lives?

There is almost this conspiracy of silence. Because we’re told that happiness is normal we tend to keep silent about our struggles—it means we’re abnormal. But because most people have the same secret, we walk around feeling isolated and alone. That doesn’t mean you can’t be happy. You can. But you have to learn how to avoid the traps our minds lay for us. The reason why suffering is so pervasive is because we’re so bad at doing anything about it.

The natural, rational thing to do when we face a problem is to figure out how to get rid of it and then actually get rid of it. In the external world, our ability to do just that is what allowed us to take over this planet. But that only works in the world outside of our skin. We don’t at first realize that and so we deal with our own psychological struggles by trying to get rid of our painful feelings, difficult memories, or worrisome thoughts—as if then we’ll be happy. But it doesn’t work.

Modern science is fairly clear that this is one of the surest ways to prevent happiness from ever arriving. Said another way, suffering is so pervasive because our attempts to solve it actually make it persist. We are caught in a trap of our own making. As for how I got there, my position came from three sources. The traditional model didn’t work for me; it didn’t work for my patients; and as I began to research it, I figured out why that was. And our research showed that doing some very counterintuitive things instead did work.

NHP: Can you give us a layperson’s primer on acceptance and commitment therapy (ACT)?

SCH: ACT is based on the idea that psychological suffering is usually caused by running away from difficult private experiences, by becoming entangled in your own thoughts, and as a result of all of that failing to get your feet moving in accord with your chosen core values. ACT is based on a new and extensive basic research program on language and cognition, relational frame theory (RFT), which explains why pain occurs so readily in people and is so hard to solve. Fortunately it also suggests new, powerful alternatives such as acceptance, mindfulness, values, and committed action.

ACT—and this new book—helps people acquire these new skills. They can be learned fairly quickly, and they seem to apply to an amazingly wide range of human difficulties. We teach clients how to back up from thoughts and the world structured by thought and instead to focus on the process of thinking itself: how to feel feelings as feelings, fully and without needless defense, even when we don’t like them; how to show up in the present moment as a conscious human being; and how to begin to act in accord with chosen values. In short, we teach people how to be more flexible in moving toward what they really want and less automatic, programmed, and self-defeating. Get Out of Your Mind and Into Your Life explains how to do just that.

NHP: You claim these ideas apply to almost every psychological problem people face. Can you talk about some of the problems ACT can be applied to?

SCH: Research is showing that ACT methods are beneficial for a broad range of clients. There is almost nothing you can mention that doesn’t have at least some supportive data on the role of acceptance, mindfulness, and values, or negative data on the impact of avoiding your own experiences and failing to act in accord with your values in that same area. ACT teaches people fairly quickly how to alter their relationship to difficult private experiences and how to get behavior change going NOW, rather than waiting to have difficult emotions or thoughts go away before acting.

This empowering message has been shown to help clients cope with a wide variety of clinical problems, including depression, anxiety, stress, burnout, substance abuse, prejudice, smoking, adjusting to chronic disease, and even psychotic symptoms. In the area of anxiety and panic, avoiding your own negative private experiences is one of the strongest predictors of bad outcomes.

Conversely, we now know from research with a variety of anxiety disorders that when you let go of the struggle with anxiety, you’re on the road to a healthier life. This doesn’t necessarily mean that anxiety will go away—it means that its role in your life will diminish, sometimes quickly. If you think about it, you can see why. Suppose I could tell if you were the tiniest bit anxious. You could not fool me. And suppose I then held a gun to your head and said, “Relax completely or I’ll shoot.”

Almost no one would pass such a test. Yet that is the exact situation a panic disordered person has put himself or herself in. Instead of being shot, what is threatened is loss of self-esteem or loss of the view that a good life is possible, but that is pretty much the same thing—and the outcomes are equally predictable. We have several studies now showing that ACT can be helpful with anxiety problems.

Depression is sometimes spoken of as a feeling, but it’s more than that. It’s also an agenda: the agenda of not feeling bad. When you are depressed you are less able or willing to feel, and because of that you are less able or willing to act. Here is one way to put it: depression is what you feel when you are not willing to feel something else. ACT undermines that whole game, and instead focuses on what it is that you really, really want in life, while feeling and thinking whatever you feel and think. It turns out that these feelings won’t be just depression, but perhaps anger, fear, sadness, or loss, among others. If depression has to first go away before a person can move forward, you have an unsolvable problem. But when we learn how to just notice our depressive thoughts, and feel our feelings as feelings, deliberately and fully—it turns out that we can begin to live again, right now, even with depressed feelings or depressogenic thoughts.

And when we do that, we start to move. We’re able to contribute to others. To make a difference. That breaks the back of depression. There are three small controlled studies on ACT and depression, and it makes a big difference. This work is still young, but so far it appears that ACT may actually be more effective than the best current psychological treatment for depression. We will know when bigger studies are done. In science that is the key: replication by others.

Chronic pain leads people to spend their lives trying to find a way to get rid of it, but research shows that this approach to pain makes it more central, more dominant, and more disruptive to people’s lives. Meanwhile there is even a bigger tragedy happening than the pain itself—a life is being lost. It turns out that ACT can greatly improve functioning by helping the chronic pain patient focus on his or her own chosen values and, while being aware of the pain when it’s present, begin to live again.

ACT helps the person with chronic pain step back from the chatter that says he or she can’t live until pain goes away, and without arguing back, simply begin to move forward. I personally don’t have chronic pain. But I do have tinnitus—my ears are screaming 24/7. And do you know what the literature says? Any attempt to cope with it is harmful. What you need to do is to let go of it and focus on living. I now sometimes go an entire day without noticing tinnitus even once—but every time I check, wow! Is it noisy! Chronic pain is like that.

We need to learn to live with it. We are not talking about living with it like putting up with it or tolerating it. We are talking about LIVING with it. It appears that ACT can make a difference in chronic pain quickly. In one study with people just starting to become chronic pain patients, four hours of ACT reduced sick- leave due to pain almost to zero levels; in another with patients who have been in pain for over a decade, three weeks of ACT improved their functioning 20 to 40 percent, depending on the area. So we know we can make a difference with chronic pain.

Most addiction seems to be in large part driven by avoidance and cognitive entanglement. When you use, you are trying to feel only good. Drugs are sometimes called a fix. Fixing means repairing what is broken but it also means to hold something in place. Drug and alcohol abusers are trying to hold “feeling good” in place by chemical means. When you abandon that attempt you will sometimes feel good and sometimes feel bad. If you can do that and focus instead on changing your behaviors, you have a way forward.

We now have controlled ACT studies with several kinds of substance abuse including marijuana and heroin, and they show good effects. ACT has an agenda sort of like that serenity prayer from AA: accept what you can’t change, change what you can. In the prayer, clients ask for the wisdom to know the difference—ACT theory specifies that difference. It’s good to change your behavior; it’s harmful to try to change the automatic results of your history. There are now three randomized trials on ACT for smoking and so far it beats the patch, Zyban, and traditional cognitive behavior therapy.

We also know this: Urges to smoke don’t predict whether or not you can quit. Most people are surprised by that, because urges seem important. But what is missing is the context in which these urges occur. What predicts quitting or not quitting is how much you first have to not feel urges before you can stop. Said another way, the task in smoking cessation is to learn to let the urges and emotions and thoughts just wash over you, while doing nothing at all about them other then noticing them as they are … and to do all of that while not reaching for that cigarette. You do that and you are on the way to quitting smoking for good.

ACT is used in several trauma centers nationwide such as the National Center for PTSD in Palo Alto, CA, or the trauma and substance abuse program at the Baltimore, MA, VA hospital. Entire units are organized around ACT. So the providers in this area see value in what we are doing. Both the basic studies on the psychological process that underlies trauma and early treatment studies show the same thing: it’s not pain that predicts trauma. It’s the unwillingness to feel pain that predicts trauma.

This is an important insight for us all in the modern era because the media has made it possible for all of us to be exposed regularly to horror. We see the bombings in Iraq. We all saw those dots that were not dots coming out of the top floors of skyscrapers on 9/11. World wide we are exposed to amazing levels of painful events every day if we just turn on our televisions. 9/11 is just the clearest example. Now, a few years later, we are learning who was traumatized by those events. It was not those most horrified. It was those most unwilling to feel horrified. And no wonder. If you are unwilling to feel what you already did in fact feel, where do you go? How can you run fast enough? Here is the formula: Pain + unwillingness to feel pain = trauma. The implication of this equation is not mere exposure. We know that poorly timed exposure sometimes actually makes folks worse.

What ACT does is give people the skills they need to willingly carry the pain they have and integrate it into a valued life. You need to learn how to back up from your thoughts and see them as they are; to show up in the moment; to commit to your values. That, plus exposure, will move you ahead.

This is a relatively new area for us but there are now already four studies on compulsions or related phenomena such as skin picking, and ACT appears to be working quite well on these so far. Suppose you have the thought, like Howard Hughes in The Aviator, “aphids are dirty and flowers with these bugs will contaminate you.” That weird thought will produce very unpleasant feelings. So the obsessive person undoes the feeling by throwing out the flowers, by washing his hands, or by other rituals. It produces relief, but it also just feeds the compulsion beast, and it comes back bigger than ever.

ACT cuts that vicious cycle. If you have the thought “aphids are dirty and flowers will contaminate you,” you don’t need to argue with it or make it go away. You need to defuse from that thought. Notice it come and go. Watch it like you’d watch a leaf float by. Do nothing about it, except to think it as a thought. And accept the feelings it produces. Feel them the way you would reach out and feel fabric. And then get back to valued living. You do that and you’ve broken the back of an obsessive cycle. It’s amazing to me that we give people so little help in rising to the psychological challenges of chronic disease.

Take diabetes. Every time a diabetic tests for blood glucose, the implications of this chronic disease become present: it’s a disease that can blind you, lead to loss of limbs, or even kill you. That is a psychologically hard thing to do. And the numbers that come back as you test your blood glucose can be very upsetting—they can be high even when you think they should be low. And each high number once again reminds you that you have a disease that can blind you, lead to loss of limbs, or even kill you.

My wife and I just walked through her gestational diabetes, and it was a roller coaster. We both came away amazed at how hard it was and what a burden people who will deal with this their whole lives must be carrying. We have shown in our lab that just three hours of ACT can double the number of diabetics who are in control of their blood glucose three months later. If that continues, we would reduce loss of limb or blindness by more than half—for only a tiny three-hour intervention.

People are so hungry for help, and the “feel goodism” of the culture just is no help at all. If you can help patients learn to carry their fears, watch their scary thoughts, and focus on valued actions, you are giving them the tools they need to manage their illness. It’s not just a problem of information; it’s a problem of psychological flexibility.

The epilepsy data are even more dramatic. In one recent study a nine-hour ACT program plus medication reduced seizures by over 90 percent at a one-year follow up compared to medication alone. Ninety percent! It seems that the combination of acceptance, mindfulness, and values stopped the self-amplifying loop that kept the stress up, quality of life down, and seizures continuing unabated.

The larger message here is that you have to teach people how to step up to the psychological challenge of physical disease. But you don’t do that by helping people win a war with their insides—you do it my helping them step out of that war and focus of what concrete actions they need to take to live the kind of life that want to live.

ACT is showing good results with stress. Stress is not just the negative results of anxiety or worry—it’s also the effect of control being applied where it doesn’t belong. It’s also the effect of getting lost inside our own minds. In one recent study, we showed that just a few hours of ACT reduced stress several months later, and it did it because people learned acceptance and mindfulness skills.

Burnout is just a more specific type of stress-related result, but it seems especially sensitive to cognitive entanglement. In one of our studies the tendency to take negative thoughts about work literally predicted burnout higher than stress itself. So when you have, say, that judgmental thought about your boss, being able just to notice that thought and focus on your work values can mean the difference between quitting and succeeding in that workplace.

It’s beginning to appear that even the most horrifying private experiences fit with this idea. Medications don’t completely remove hallucinations and delusions for most people with a psychosis. Yet in this country very little else is provided to these patients to help them cope with these frightening and disruptive experiences.

This lack of help is terribly inhumane—there is much we can do. If you have ever seen the movie A Beautiful Mind you understand the basics of what we try to teach in an ACT approach. We teach patients to just watch their hallucinations, to notice their own delusional thoughts, to focus on their values, and to keep their overt behaviors going. That package works. In two separate studies it has been shown that just two to five hours of ACT will reduce rehospitalization by 38 to 50 percent over the next four months. Who knows what we will be able to do with more extensive packages.

Prejudice is probably the single most important problem on the planet. The “War on Terrorism” should not just be a war on terrorism—it needs to be a war on intolerance since that is a big part of where terrorism comes from. Whether it’s killing the infidels, or the Catholics, or the Tutsis, it’s all a form of prejudice. But in the modern era, prejudice has enormously powerful tools at its disposal: bombs, chemicals, biological weapons. And we are not yet up to the worst of the list.

Let me ask you this. If there was a big red button in every home on the planet and if an adult pushed it the world would end, how long would the planet last? Not long. But once we have freely available suitcase bombs…and are we not close to that very situation? And how long before we have those bombs. Ten years? Twenty? Well, whatever your answer, that is how long we have to figure this out because that is the day we have a big red button in everyone’s house.

When a terrorist attacks an innocent human being he or she is revealing the end stage of a process of objectifying and dehumanizing others. But to some degree this same process underlies more usual phenomena such as prejudice based on ethnicity or gender or stigma associated with illness or appearance. Most approaches to stigma and prejudice are either educational—in one way or another telling others what to believe and do—or experiential, learning through direct contact with stigmatized groups. Unfortunately the effects of both are weak and unreliable. In one recent study done in a prison, education about racial differences actually increased racial conflict.

And these methods are not mindful of the issues we have been talking about. If you try to suppress a prejudiced thought you will increase its strength and psychological impact, not decrease it. We need another way forward. Yet we all have prejudiced programming—ethnic and gender biased jokes, for example. Even if our values are not racist or sexist, our minds sometimes are. It doesn’t matter your race or gender; we’re all swimming in this stream.

ACT shows another way forward. We have found that acceptance of prejudicial thoughts (as thoughts) and learning to just notice them mindfully while connecting with our values will increase people’s willingness to engage in non-prejudiced behaviors. We have shown it with prejudice toward substance abusers in recovery, ethnic prejudice, bias toward the mentally ill, and bias against science-based treatments. We will see how far it can go.

Shame and prejudice are really the same thing; one is just inwardly focused. Buying into “I’m bad” is really not different from buying into “you’re bad.” And it turns out that the same methods that help with prejudice and stigma also help with shame and self-stigma. ACT can help people increase job performance, too. Have you ever worked with someone who comes up with excuses anytime he or she needs to learn something new—a new telephone system, a new budgeting process, and so forth?

We’re learning that the same experiential avoidance process that ACT targets is part of this resistance. It’s obvious if you think about it. How did you feel when you first started to learn to dance, when you first skied, when you first put on ice skates, and so forth? Didn’t you feel a bit foolish and awkward? If you can’t allow that, how can you learn? We’ve found that our measures of experiential avoidance can predict what office workers will do at work: Our short questionnaires correlate with keystroke errors a year later because people who are high avoiders don’t learn the software well.

Why? Because they’re never willing to feel stupid or uncomfortable. ACT has been shown to undermine this avoidance, and as a result people are more willing and able to learn. In one recent study we showed that workers who had just been through an ACT workshop were then more willing and able to learn things that had nothing to do with ACT (in this study it was therapists learning to using certain medications in their work). And therapists were using these new methods more at a three-month follow up.

NHP: Some of this work is said to have come from your own battles with anxiety and panic. How did these ideas apply to your own struggles?

SCH: I had a panic disorder. At the height of it, my life shrank until I could not travel, get on an elevator, drive, go to a movie, get on a plane, or even talk on the phone without a tremendous struggle. It was clear to me that I had a choice: I could either lose my life as I knew it or I could learn to step forward into my fear. I went back into my behavioral training, my science training, my eastern training, my human potential training. ACT in some ways is my personal journey—it’s how I faced anxiety. But it’s not just me. Other major ACT researchers and writers are chronic depressives, heroin addicts, or social phobics, and they have poured these experiences into the work. That’s not by accident. When life has beaten you up, the uncommon sense in ACT begins to have appeal.

Sometimes people are just by their nature ready for this approach even when they’re young, but most of us start out thinking we can win the war with our minds and our history. And you might even get away with that view if nothing bad ever happens. When it does, though, you need to take a different path. When futility sets in you have a chance to do something new. I began to learn how to abandon the war with my mind and history.

I personally do ACT everyday. I do acceptance, defusion, mindfulness, and values work continuously. I know right now I might have anxiety attack. It’s been ten years since the last, but I know I can’t control that. It’s not up to me—it’s up to my history and my current situation. But what I can control and what only I can control is whether I will back up from my own experience. My pledge to myself is that I will stand with myself, regardless. If that means I get so anxious I can’t talk, right here, right now, that will be a problem—but if I stay true to my commitment, it will be your problem, not mine.

NHP: A lot of what you’re describing sounds Buddhist-inspired. How does ACT differ from Buddhism, both in theory and in the practice it requires?

SCH: Buddhism has a lot of wisdom in it, as do all of the major spiritual and religious traditions, but it emerged from pre-scientific times. Some of its specific ideas show that lineage; some of its methods require weeks, months, and years to work. ACT is in the same general psychological space, but it’s driven by a scientific theory, and its methods are designed to be quicker and more focused. I find it very encouraging that the two overlap because ACT did not come from Buddhism or any specific religious or spiritual tradition. It came from modern contextual psychology. If things from very different starting points overlap in their end points, to my mind this increases the chance that they’re both on to something.

NHP: How does ACT differentiate between pain and suffering?

SCH: Pain is just pain. We all have it—all the time if you just look. For example, we all know we will die. There is some pain in that knowledge, and you can contact that knowledge anytime, anywhere. But that alone is not suffering. If you add in unwillingness to feel pain, entanglement with your thoughts about pain, and loss of your valued actions—now you’ve amplified pain into suffering. I’ve seen that exact thing happen with thoughts about death, for example. But YOU did it. The pain didn’t do it. You see this in area after area: Anxiety + unwillingness to feel anxiety and keep moving in a valued direction = panic. Sadness, loss, anxiety, or anger + unwillingness to feel sadness, loss, anxiety, or anger while moving in a valued direction = depression. Pain + unwillingness to feel pain = trauma.

NHP: You’re a language researcher and chapter two of Get Out of Your Mind and Into Your Life is called “Why Language Leads to Suffering.” Can you tell us why you suggest that language is a source of human suffering?

SCH: We’ve learned four important things in our research. Human language and cognition is bidirectional, arbitrary, historical, and controlled by a functional context. Because language is bidirectional, words pull the events they’re related to into the present. Anywhere you go you can remember painful things. Just think of them. That is totally new on the planet, so far as we know. No other creature seems to do it. So it means we have orders of magnitude more pain than other creatures. And it’s arbitrary—what we relate isn’t dictated by form. Kick a dog and he’ll yelp—it’s dictated by form.

Show a person a beautiful sunset who has just had someone very near and dear die and that person may cry, wishing the lost loved one could be here to see it. The crying is not dictated by form—even beauty can create sadness. That means we can’t solve our problem with pain situationally. But because language is historical, we can’t win by changing the content of our cognitions. A person who thinks “I’m bad” and who then changes it to “I’m good” is now a person who thinks “I’m bad, no I’m good.” Where you start from is never fully erased—because you are a historical creature. Your mind is psychological, not logical. We make all of this so much worse by deliberate attempts to get rid of our history and its echoes—the automatic thoughts and feelings that emerge from our past. Because we’re historical creatures, these efforts elaborate whatever we’re trying to get rid of. Because human cognition is bidirectional, it mocks our attempts to change thoughts and feelings.

For example, suppose we need to get rid of anxiety because if we don’t bad things will happen. Anxiety is the natural response to bad things … so our efforts will tend to evoke anxiety, defeating our purpose. Fortunately, our work on cognition shows that the events that cause us to relate one thing to another are different than the events that give these relations functional properties. We take advantage of that in ACT. We change the functions of thoughts and feelings, not their form, and that makes all the difference.

NHP: You also say that research suggests many of the tools we use to solve problems lead us into the traps that create suffering. What does this mean?

SCH: Here’s how we solve problems: We use verbal processes to enable categories, time, and evaluation. “If I did that then this would happen, which would be good.” Notice all three are there: the categories and names of things and their features; time and contingency (if … then); and evaluation (this is better than that). This is great for problem solving. We see an imaginary future and evaluate it—all through the use of arbitrary symbols. It’s because of this ability that we took over the planet. Yet this alone is plenty enough to create psychological problems. “If I go to the mall, I will feel anxious, which is really bad.” Same processes: categories, time, and evaluation. “If my lover leaves me I won’t be able to function.” Same thing. “If I kill myself I will stop hurting.” Same thing. This is why you can’t weed out the processes that cause suffering—these same processes are at the root of our achievements as a species.

We need to learn how to use these processes when they’re helpful and let them lie dormant when they’re not. It’s very hard to do—like the delusions that follow Russell Crowe in the movie A Beautiful Mind— most of our most difficult experiences are there night and day begging us to taken them literally. But once we do we are lost. It’s hard to learn how to do nothing even when it’s only nothing that will do. Humans are terrible at that. We are terrible at letting go.

NHP: One of the premises of ACT is that avoidance of difficult emotions leads to suffering, which is highly counterintuitive. First, why do you say this and second, what do you say to someone who says that avoidance of pain is ingrained and automatic?

SCH: Let me take the last part first. The avoidance of pain is indeed ingrained and automatic. That is the point. So, sure, it’s absolutely normal to needlessly avoid pain. And there is nothing wrong with avoiding many forms of situational pain. There is no need to put your hand on a hot stove, for example. But historical pain is something else. If you have a painful memory, you’ll always have it and avoiding it will only distort your life because memories don’t go away. If you have a thought you don’t like, trying to make it go away is like trying not to think of a piece of chocolate cake … in the effort deliberately not to think it, you just did.

Here is why avoiding that kind of pain is problematic: First, the painful event doesn’t truly go away, it’s just avoided, and the next time it’s contacted it’s bigger and stronger and even more likely to control behavior. Second, it makes us attend all the more to this very pain. Like a noise in the background, as soon as it’s important that it go away, it’s now in the foreground and far, far worse that it was only moments before. Third, the very basis of avoiding painful thoughts or feelings is that the reaction is really bad—but that means that as we deliberately try to avoid things, we’re building them into more and more powerful events because we start this process with the embraced belief that they truly are dangerous.

We literally make our nightmares come true because the real damage is done the moment we take them literally. At that point they transform themselves from mere historical events—mere processes of the mind worth noting—into things that can control our lives. After all if they’re controlling efforts at avoidance they’re already controlling our lives.

NHP: You talk a lot about values in your book, and the “commitment” in acceptance and commitment therapy refers to making a commitment to living a values-based life. What does it mean to live a values-based life and how does it help reduce suffering?

SCH: Values are like directions on a compass. They’re never achieved, but in each and every step they influence the quality of the journey. Values dignify and make more coherent our life course—and they put pain in a proper context. It’s now about something. Let me go back to that movie A Beautiful Mind. It’s only when the hero has to decide between what he values and entanglement with insanity that it’s possible and sensible to accept the delusions; to notice them; and to abandon trying to control them—all in the service of being a husband, father, and a mathematician.

In the same way, we only put down our avoidance, addictions, and mental wars because it’s costing us something dear, whatever it is that we want our lives to be about. Without that cost we would be lost. It’s amazing how often people have never really thought about what they want in their lives. They’ve been fighting a mental war, waiting for life to start, and have never really asked or answered the question of what kind of a life they’re waiting to live.

The joyful vision of ACT is that you can start living that very life NOW, with your thoughts, feelings, memories, and sensations. You start that journey by asking what it is that you really want your life to be about. That is the point on the compass.

NHP: What kinds of techniques do you try to teach in ACT? Can you walk us through an ACT exercise?

SCH: Okay. First think of a painful thought, a self-critical thought, one of those nagging deep down familiar bits of negativity. Do you have one? ACT has scores of techniques that are designed to help you catch the word machine in flight rather than getting caught up in the world seemingly structured by it. These “defusion” techniques help us notice the process of thinking, not just their products.

So let’s try a few with that very thought. I’ll do them in rapid fire, but in the book we present all of this in more detail, and you can take the time you need to explore them properly.

First say that thought very fast over and over again, feeling your mouth as you say it and noticing how odd it sounds when said fast. Now say it slowly, one word on the inbreath and the next on the outbreath until it’s all said. Now sing the thought out loud. Be careful not to ridicule, satirize, or criticize your thoughts. Rather just notice as you sing that these are thoughts. Now say them in the voice of a politician from the opposite political party as you. Be careful not to ridicule, satirize, or criticize your thoughts. Rather just notice as you hear these words that these words are thoughts. You don’t have to do anything about them. Just thank your mind for the thought and notice what shows up.

These are four of literally hundreds of techniques ACT therapists have developed to liberate humans from the grip of their own cognition and emotion—but all without making the cognition or emotion go away. Once you’re on to it, you can come up with your own methods. In this new book we actually walk readers through that process. Once you see the model and its purpose it’s not hard. You can literally create your own methods to get out of your mind and into your life. So the book is not a new belief system. It’s a new context for living with that word machine we call our minds, without turning our lives over to it.

Below you will find a link to the Salon.com interview with Steve.

https://www.salon.com/2006/02/25/happiness_4/

More likely, you will need to go to http://www.salon.com and search for "Steven Hayes" -- the first article should be this one.

Here is a column that appeared in the March 5, 2006 Sunday Telegraph Human Pain and Human Vitality Nearly 30 years ago I had my first panic attack. A productive and reasonably successful young academic, I soon found myself struggling to give a lecture, to speak on the phone, or to ride in an elevator. From the outside I appeared calm – but on the inside I felt I was dying. Literally. Sitting still on a park bench my heart beat 165 times a minute as I fought a battle, not with a physical challenge requiring such blood flow, but with the word machine between my ears. Some of my experiences at the height of this struggle now seem so alien that it is only with difficulty that I can imagine the mindset that produced them. I’ll share one, knowing for many it may simply seem incomprehensible. An airline attendant stood at the front of a plane and described how to use the passenger seatbelts. I watched with a sense of amazement and incredulity, as one might gaze at an impossibly athletic feat during the Olympics. I remember thinking “how can she do that without being terrified?! She has to say all of those specific words, and they have to be right, and do it in front of a plane full of people!” Each of us compares our insides to others’ outsides, and our picture of the human condition is ever distorted as a result. That difference makes it believable that it is our birthright to be psychologically healthy, happy, and carefree – and that feeling good is the measure of a life well lived. Commercial interests are only too pleased to feed this vision, assuring us that we will approach it readily through the right car, home, or vacation. The pharmaceutical industry will provide the right pill; the media the latest “feel good” therapy; and the local bar both the ideal beer, and the setting to find the right romantic partner. It is seemingly only the abnormal person who suffers. The outsides of others provide superficial evidence of the validity of this vision. But what if everyone has a secret? And what if the joke is that we all have the same one? The fact is that almost all people are in pain somewhere in their lives much of the time. It is hard to be fully human. Almost all will struggle and suffer, and find that easy methods of feeling good bear little relationship to living a meaningful, valued, vital life. Anyone who reads the popular media, never mind the voluminous scientific literature on this topic, probably realizes that human problems are pervasive in the developed world. Few, however, seem to face the implications of such statistics considered as a whole. Over 30% of the population will have a psychiatric disorder sometime in their lives. Nearly 50% will struggle with thoughts of suicide for two weeks or more. Divorce rates reach similar levels; second marriages are no better; and the relationships that remain are often restricted or empty. If we add in the rates of emotional or physical abuse, sexual concerns, loneliness, burnout, problems with children, or 100 other such problems we need to consider the possibility that it is human pain is that is nearly universal. In effect it is abnormal to be “normal.” The treacle of modern “feel goodism” is simply false. That was my starting point, 25 years ago. Unable to control my anxiety, and sinking ever deeper into panic disorder as I tried to do so, I began to explore what it would be like to approach what I was struggling so mightily to avoid. I began to research whether it was the emotional and cognitive objects of my struggle that were my enemy, or struggle itself. We now know that one of the most pathological things a human being can do is to attempt to avoid their own thoughts and feelings, and to link their overt actions to this attempt. Researchers such as Frank Bond (University of London) have discovered that the psychological inflexibility that results from this effort produces bad outcomes almost everywhere you look. It predicts more anxiety, depression, worry, and trauma. It undermines your ability to learn new things, enjoy your job, be intimate with others, or rise to the challenges of physical disease. Lance McCracken (University of Bath) has shown that these processes predict far more disability due to chronic pain than the amount of pain or injury itself. Turned outward, the human mind is highly effective. We can predict the future and remember the past; we can evaluate outcomes based on imagined courses of action. It is these symbolic problem-solving abilities that have lead us to dominate the planet, despite being weak, slow, and vulnerable. But these same abilities also entangle us needlessly in a struggle with our own thoughts and feelings. If we don’t like dirt on the floor we can vacuum it up and the dirt will be gone. Conversely, if we don’t like a painful memory and try not to think it –we will make it more of a focus, more frequent, and more impactful. If we fear a future lack of food we can grow plants that will later nourish us. But if we fear the harm produced by future panic and thus try to avoid it, we will have brought that imagined harm into the present and amplified its role in our lives. The human mind has in effect been turned on its owner, merely by allowing it to do what it normally does, but in the wrong domains. It turns out that this is not necessary. We have developed methods to train people in a healthy alternative: accept feelings and be mindful of thoughts without arguing, coming instead into the present moment more consciously and fully, focusing on values and taking actions that move in their direction. For example, if the thought “I’m bad” is present, trying to change it only confirms that there is something unacceptable about you. In our approach we might instead say “bad” 100 times aloud, or sing the thought, or print it on a T-shirt and wear it, or say it in the voice of one’s least favored politician. Like the movie A Beautiful Mind, this defanged thought is then willingly brought along into valued actions, such as being a loving person, or contributing to others. Controlled research shows this these methods are helpful in areas as diverse as anxiety, burnout, diabetes management, smoking, pain, and depression among several others. I walk through these concepts and techniques in Get Out of Your Mind and Into Your Life (New Harbinger; 2005) which was the number one self-help book last week in the United States on Amazon. The basic and applied psychological science behind these methods will be presented for students, therapists, and researchers at a week-long “world conference” July 22-28 at the University of London (see www.contextualscience.org). For the first time in human history, we are trying to raise an entire generation on the message that feeling good equals living well. It is not true. It has never been true. And now we are seeing the sad results in our homes and on our streets. Our task as human beings is to learn how to carry pain without needlessly amplifying it into suffering, while creating a values-based life. Steven C. Hayes University of Nevada, Reno

John Cloud wrote this article for Time magazine in February 2006, in which he described the contrast between 'third wave' approaches (specifically Acceptance and Commitment Therapy) and more traditional cognitive behavioral therapies.

For more information, see attached. Please note: You must be logged in as an ACBS member in order to view the content below.

For more discussions about the Time Magazine article, click here.

Negativity: Don't Even Think of It

By: Kathleen McGowan

Summary:

With practice, you can learn to recognize your repetitive and negative thoughts. And keep them from becoming all-consuming. Life would be much easier if we had perfect control over our thinking -- especially where emotions are concerned. We could quickly forget about the people who make us frustrated or angry and allow disappointments to fade into the past without recriminations. But in reality, this kind of emotional equanimity is rare. Most of us spend a lot of time thinking over unpleasant feelings and mulling over regrets and resentments.

Unfortunately, many of these mental interpretations of our feelings make us feel worse about the situation. What started out as a small hurt or frustration, amplified by a thought process that focuses on pain and anger, may balloon into a major preoccupation. Our minds often repeat painful thoughts or scenarios over and over, even when we'd much rather let them go.

If you start paying attention to your interior monologue, you may find that you are dwelling on the ways your parents let you down, angry at someone who has hurt you, afraid of the challenges you face in the future, or ashamed that you haven't yet done the things you'd planned to in life. You'd rather stop all of these thoughts in their tracks -- but that's much easier said than done. Instead, you're left feeling as if there's something wrong with you: Why can't I just get over it? Why can't I just relax and be happy?

Generally, when you try to squelch one of these distressing trains of thought -- or "just get over it" -- your strenuous efforts to suppress it only make things worse. Research has shown that if we actively try to prevent anxiety-provoking or frightening thoughts, they generally become more powerful and harder to ignore. As a result, mental "fix-it" strategies generally backfire, whether that's trying to deny your unhappiness, avoiding the situations or people that make you anxious, or drinking to numb the feelings. Accepting the negative feelings and learning to distance yourself from the thoughts that amplify them can be a much more effective coping strategy, says psychologist Stephen Hayes of the University of Nevada in Reno.

In his book Get out of Your Mind and Into Your Life, he outlines a number of techniques from cognitive psychology that can help you resist getting lost in painful thoughts. With practice, you can learn to recognize your repetitive thoughts, and hold them at arm's length.

A few of Hayes' suggestions:

• Practice noticing your thoughts. Try to be conscious of where your mind leads you, and label the type of thought you're having to yourself. For example, if you've made a mistake at work and are feeling bad about it, think to yourself: "I've noticed that I'm focused on my error right now." If you're feeling stupid about the mistake, say to yourself: "Right now, I'm criticizing myself."
• If you find that one particular thought or phrase is running through your head -- I'm a loser" or "She screwed me over," for example -- try saying your troubling thought out loud, and either very slowly or in a funny voice. It seems silly, but by doing this, you're actively separating yourself from your mental soundtrack. You remind yourself that these thoughts are being generated out of a mental habit.
• Try thinking of your mind as just another organ of your body. If you find yourself preoccupied by fears, imagine that your brain is just like your hungry stomach when it rumbles, or your feet when they're tired after a long day. Think: "There goes my mind again, worrying about something trivial."
• Think of your self-destructive or self-critical thoughts as Internet pop-up ads. Don't criticize them or yourself for having them. Just think of them as unnecessary, meaningless noise. All of these tactics are ways to become aware of your inner mental monologue without either getting caught up in it or trying to shut it down. Distancing yourself from your difficult thoughts can help you learn to stop turning small problems into dilemmas that seem all-consuming or hopeless.

Martha beck Column "Beck on Call" in "O" - The Oprah Magazine

From: http://www.oprah.com/omagazine/get-happy

An innovative therapy argues that acceptance is the route to happiness. Martha Beck brings you a new leash on life!

I'm trying an exercise designed by psychologists to help me gain my sanity by gently losing my mind. This process is utterly different from typical attempts to pursue happiness, most of which depend on controlling events and feelings.

Think of a problem that has plagued you for a long time—your weight, a loved one's bad habits, fear of terrorism, whatever. No doubt you've tried valiantly to control this issue, but are your efforts working? The answer has to be no; otherwise you would have solved the problem long ago. What if your real trouble isn't the issue you brood about so compulsively, but the brooding itself?

Psychologists who subscribe to acceptance and commitment therapy (ACT) call "clean" pain what we feel when something hurtful happens to us. "Dirty" pain is the result of our thoughts about how wrong this is, how it proves we—and life—are bad. The two kinds of suffering occupy different sections of the brain: One part simply registers events, while another creates a continuous stream of thoughts about those events. The vast majority of our unhappiness comes from this secondary response—not from painful reality but from painful thoughts about reality. Western psychology is just accepting something saints and mystics have taught for centuries: that this suffering ends only when we learn to detach from the thinking mind.

Judge not...

Learning to detach starts with simply noticing our own judgmental thoughts. When we find ourselves using words like should or ought, we're courting dirty pain. Obsessing about what should be rather than accepting what is, we may try to control other people in useless, dysfunctional ways. We may impotently rage against nature itself, even—perhaps especially—when that nature is our own.

This amounts to mental suicide. Resisting what we can't control removes us from reality, rendering our emotions, circumstances and loved ones inaccessible. The result is a terrible emptiness, which we usually blame on our failure to get what we want. Actually, it comes from refusing to accept what we have.

Victory by Surrender

Surrendering allows the truth to set us free. And how do we surrender?

I recently watched television interviews with two actresses, both in their late fifties. Each was asked if she'd found anything good about aging. Both snapped, "No. Nothing. It's horrible." A few days later, I saw Maya Angelou on TV. She said that aging was "great fun" and gleefully described watching her breasts in their "incredible race to see which one will touch my waist first."

"Sure, the body is going," she said. "But so what?"

Ms. Angelou has said many wise things, but I thought "So what?" was one of her wisest. It expressed the sweet detachment of someone who has learned how to rest in her real being and knows that it is made not of flesh or thought, but of love.

The Fruits of Acceptance

There is enormous relief in detaching from our mental stories, but in my experience, the results go well beyond mere feeling. Surrendering leads directly to our right lives, our hearts' desires. Whenever I've managed to release my scary stories and accept the truth of my life, I've stumbled into more happiness than I ever dreamed possible.

When I stop trying to control my mind—that verbose, paranoiac old storyteller—my thoughts become clearer and more intelligent. It's a delicious paradox: By not trying to control the uncontrollable, we get what we thought we'd get if we were in control. This thought pleases me greatly.

Still not happy? Your mind might be your biggest obstacle.