Have you Suffered Enough? Acceptance and Commitment Therapy Summary

Photo by   Pok Rie   from   Pexels

Photo by Pok Rie from Pexels

NOTE: This is a shortened and paraphrased version of an original article by Russ Harris, author of The Happiness Trap. For the original article, click here.

I’ve recently been re-reading a book by the founder of a wonderful therapy/coaching approach called ACT, which stands for acceptance and commitment therapy, called 'Get out of your mind and into your life' by Steven Hayes. I’ve also been re-reading an excellent book called ‘The Happiness Trap’ by Russ Harris.

ACT is full of radical ideas, deeply based on scientific evidence, which is why I love it! 

Amazingly, ACT makes no attempt to reduce the symptoms, and yet symptom reduction is its side-effect. ACT focuses on beautiful concepts like compassion, forgiveness, acceptance, mindfulness, tuning into your observer self and a focus on values and following your heart.

ACT challenges the ground rules of most therapy and coaching approaches. And it’s very effective.

ACT has been proven to be effective for a huge range of clinical conditions including: depression, anxiety, PTSD, OCD, anorexia, chronic pain, workplace stress, the stress of terminal cancer, heroin addiction, marijuana abuse, and even schizophrenia. For example, a study showed that just four hours of ACT, hospital readmission for schizophrenic patients dropped by 50%.

The goal of ACT is to create a rich and meaningful life by pursuing your deepest values. In this process, of course challenges and pain will come up, and ACT offers mindfulness skills to help you accept and manage those internal challenges of difficult thoughts, emotions and physical sensations as you take mindful action to create a meaningful life.

ACT is considered one of the ‘third waves’ of behavioural therapy, along with Mindfulness based Cognitive Therapy and Dialectic Behavioural Therapy.

ACT differs from these others as it doesn’t offer a fixed program. Instead it gives the therapist or coach room to co-create the right program for their client. ACT can also be used for a wide range of challenges, whereas the other approach are much more specific. ACT can be learnt one to one or in groups. 

Interestingly, ACT offers ways to develop mindfulness in more than just mindfulness meditation. The four subset ways to cultivate mindfulness are:

  • Acceptance

  • Cognitive Defusion

  • Contact with the present moment

  • The Observing Self

What Makes ACT unique?

This is where things get really interesting. Most therapies seek to reduce ‘symptoms’ as a goal. In ACT, things are radically different. In ACT, the view is that the search to reduce symptoms like depression and anxiety actually creates a disorder in the first place. A struggle is set up between you and your symptoms. The approach of ACT is to change your relationship to your challenging thoughts and emotions, seeing them as transient experiences that will come and go. In this way, ironically, symptom reduction becomes a side-effect.

Health and Happiness

In western psychology, health and happiness is considered normal. If humans are given food, shelter and clothing, and a healthy social environment, they should be naturally happy. The view is if someone isn’t feeling healthy or is unhappy, something is wrong and that person is sick. If someone is psychologically suffering, they are mentally ill.

ACT believes psychological suffering isn’t something wrong or abnormal because it’s so pervasive. Depression is the number one cause of disability worldwide. One in five people will suffer from depression at some point in their life. One in four people suffer from drug or alcohol addition. One in two people seriously consider suicide and one in ten people attempt to commit suicide.

There’s also the psychological suffering that arises from so many non-clinical challenges like boredom, meaninglessness, loneliness, low self-esteem and the pain of experiences like divorce, bullying, racism and violence.

So ACT believes that the normal way in which our human minds operate lead to psychological suffering for us all at some point. To suffer psychologically is the norm.

The Cause of Suffering

Through examining the research, ACT concludes there is a key cause to psychological suffering created in the human mind, and that is what is called experiential avoidance.

One of the key ways humans are different from animals is our ability to anticipate and solve problems. 

Problem - Something that you don’t want. E.g. Hunger

Solution - A way to get rid of what you don’t want E.g. A clever plan to find some food and eat, both today and perhaps a plan for the future too.

This ability to get rid of what we don’t want works well in the physical world. If you don’t want to be attacked by a lion, you don’t go on dangerous walks where there’s known to be many lions. You don’t want to get sick - you avoid the poisonous mushroom.

But when you apply this problem solving approach to the human mind’s difficult thoughts and emotions, it all goes wrong. Trying to get rid of anxiety is the cause of anxiety disorders and panic. Trying to get rid of depression deepens the feelings of low mood. Pushing away negative thoughts from your mind just makes you think more about those negative thoughts.

The more you try to avoid internal experiences, the more you suffer psychologically. Anxiety is a great example. We all experience anxiety. But anxiety disorders are caused by trying to avoid feelings of anxiety. 

ACT has found a large amount of research showing higher levels of experiential avoidance is associated with anxiety, depression, poor work performance, higher substance abuse, lower quality of life, high-risk sexual behavior, borderline personality disorder, increased PTSD, long-term disability and inability to recognise one’s emotions.

Not all forms of experiential avoidance are unhealthy. Calling up a friend when you’re feeling down is great. A glass of wine in the evening is harmless. However, a bottle of wine every evening is destructive long-term. So experiential avoidance is only seen as a problem when life-diminishing.

Attempts to control emotions that are unhealthy in the long-term often give short term relief. For example, if someone’s feeling depressed and a friend calls them up to meet up. They may not want to face them in their current state of mind, and so canceling the appointment gives them relief in the short term, but increases their social isolation in the long-term.

ACT Offers An Alternative

ACT offers an alternative to experiential avoidance. Most clients come to therapy hoping to control or reduce the emotions they’re experiencing. They want to get rid of their depression, anxiety, grief, loneliness, anger, traumatic memories, fear of rejection, low self-esteem.

ACT makes no attempt to reduce, suppress or control such inner experiences. Instead, ACT offers mindfulness as a way of making space for these thoughts and emotions to come and go. The time, money and effort they used trying to control their emotions is now used to take meaningful action inline with their core inner values instead.

ACT achieves an alternative to experiential avoidance in two ways.

  1. Acceptance of difficult thoughts and emotions

  2. A commitment to take action based on their values


Now I will outline a typical way in which ACT interventions are used on a client

Exploring Current Strategies

First of all, the client is gently encouraged to share what strategies they have used to control or reduce their so-called ‘symptoms’, and if that was effective in the long-term and what it cost them in terms of time, money, effort and energy and whether it helped them to move forward to the life they want.

As an example, this is the list of strategies that a client could have had:

  • drinking alcohol

  • Taking drugs

  • being a good listener” (asking lots of questions, but sharing little), 

  • arriving late and leaving early

  • avoiding social events 

  • deep breathing

  • relaxation techniques

  • Positive affirmations

  • Challenging negative thoughts

  • Analyzing his childhood 

  • blaming parents 

  • Hypnosis 

The client will then look at these strategies and realise that although many of them may have given relief in the short-term, none of them have been effective in the long-term and some have come at a huge personal cost and impacted their quality of life.

Control is the Problem

When you seek to control your emotions, you are struggling against them. This struggle creates a secondary emotion on top of the emotion that’s already present, leading to disorder.

Quicksand is a great example that’s often used here.

If you fall into quicksand, the more you struggle with it, the deeper you fall into it. If you don’t want to sink deeper into the quicksand, you need to do something that seems so counterintuitive - you need to open up your body and stop struggling if you want to stop sinking.

In the same way, clients are invited to stop struggling with their inner challenge and allow it to be.

Another great analogy used, is to imagine they have a struggle switch on their back. When the struggle switch is on, each time they experience anxiety, different things happen.

If you’re annoyed at your anxiety, you think something like ‘How dare anxiety come up again’ and then feel angry.

If you’re disappointed at your anxiety, you think something like ‘Oh no, what’s wrong with me!’ you then feel sad.

If you’re fearful of your anxiety, you may think something like ‘Oh my goodness I hope I don’t feel more anxious!’ then feel even more anxious.

BUT, what would it be like to have the struggle switch turned off. Then emotions are free to come and go as they please, and you are not wasting energy fighting against them. You make an inner space for the emotions to rise and fall. The anxiety may sometimes be high, sometimes low and sometimes not be there at all. You’re not struggling with it any longer - and focus your energies elsewhere.

Clean and Dirty Discomfort

In ACT, when your struggle switch is off and you experience an emotion like anxiety, the discomfort is called clean discomfort. When the struggle switch is on, it's called dirty discomfort.

The struggle switch becomes like an emotional amplifier. Struggle increases the emotion as you struggle with it, creating secondary emotions on top of what’s already there. You get anxious about anxiety, angry about your anger and depressed about your depression.

When the struggle switch is on, you don’t only feel emotionally distressed by your experience, you also take action to avoid the feeling. Here’s some examples of how you may do this:

  • Drugs

  • Alcohol

  • Food

  • TV

  • Gambling

  • Smoking

  • Sex

  • Surfing the net

And more subtle strategies like:

  •  Ruminating

  • Self-criticism

  • Blaming others

Remember, these control strategies are fine in moderation. They’re only a problem when used excessively.

So, when you’re suffering psychologically, you can ask yourself: ‘Is my struggle switch on or off?’

Six Core Principles of ACT

Once the value in letting go of the struggle is understood, the six key principles of ACT are introduced

  • Defusion

  • Acceptance

  • Connection with the Present Moment

  • Observer Self

  • Values

  • Committed Action

Here’s a more detailed description of each of these six principles

Defusion

To step back from inner experiences and see them what they are. Learning to see thoughts and images in the mind as what they are— just words and pictures— as opposed to what they can seem to be — scary experiences, rules that must be followed, actual truths to be believed.

The great thing about ACT, is that there are literally hundreds of ways of cultivating each of these six skills.

Example - If you think ‘I’m a loser’ the therapist may say ‘Try thinking: ‘I’m having the thought that I’m a loser.’ Maybe you can imagine the words on a karaoke screen with a bouncing red ball upon each word. All the many techniques offer ways to see the distressing thoughts as just thoughts - images, words - appearing and disappearing in mind, and no more real than that.

Acceptance

Allowing feelings, sensations, urges and other inner experiences to arise and fall without struggling, avoiding them or giving them undue attention.

Example - let's say you're struggling with anxiety. You can practice this by bringing to mind a situation that makes you feel anxious. Then you notice the range of different physical sensations that come up and allow them to be there. Imagine your breath going into that part of your body. The idea is not necessarily to enjoy it but to make space for the experiences and letting go of the struggle.

Connection with the Present Moment

I've written about this in many blog posts. This is simply about being present in the here and now with a sense of openness and curiosity. You can connect mindfully to any of your senses or even be consciously aware of your thoughts and emotions.

Example - you could practice mindful walking. The next time you go for a walk you can take your time and really tune into the touch of your feet on the ground, the play of air on your face, the scent of the flowers, the sight of the trees and sky and the sounds of the cars or the birds. All the time with curiosity rather than judging or resisting. 

Observer Self

This is about tuning into a sense of self that is free and beyond harm. It's your state of awareness that has always been with you. Being the observer, it's beyond your thoughts, emotions, bodily sensations, urges, memories, roles and physical body. Some.see this as stepping into their spiritual sense of self. 

Example - notice your thoughts arising. Notice that you are aware of your thoughts coming and going. So realise there are two functions happening. Thoughts and awareness of thoughts. Allow yourself to identify with being the Observer Self.

Values

What is most important to you? What's deep in your heart? What kind of person do you wish to be? What do you want to stand for in this life? 

Example - you may value deep and meaningful relationships, creativity and building community. You are then taught that moving towards these meaningful values is likely to bring up your anxiety but the question is can you be willing to allow the anxiety to arise with willingness and without denying or running away from the feelings using your mindfulness, defusion and acceptance and observer self viewpoint? 

Committed Action

This is simply about setting goals guided by your values and taking meaningful action towards them. 

Example - if you have social anxiety but wish to cultivate meaningful relationships, you may set goals around meeting with a friend every other day. Difficult thoughts like 'I'm not good enough' and feelings of anxiety may arise and the idea is to allow them to be and keep going. Often the anxiety goes down due to your exposure to the feelings, but remember that's not the goal of the approach. Just a very welcome side effect. 

Conclusion

ACT is very different to other forms of therapy or coaching in that the goal is not symptom reduction. It's not about getting rid of negative emotions or overcoming old traumas.

The goal is to live a full, rich and meaningful life. The route is through learning skills to accept, step back, open up and move forward. 

In a sentence, Russ Harris would summarise it as 'embrace your demons and follow your heart'. 

If you'd like to have some ACT coaching with Shamash or try a new online course on it that he's developing, please email us with subject 'ACT coaching with Shamash' and we will be in touch with some options for you in the next month or so. 



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