Both here and on my primary site, I’ve covered Acceptance and Commitment Therapy (ACT) several times. The ACT method has helped me find peace of mind that exceeds what I was able to achieve using other therapies.
It seems like a worthy topic for that reason, but I should emphasize that my perspective is that of an informed layperson, not a psychotherapist. Consider this a disclaimer: these blog posts cannot be used as guides to adopting ACT behavioral techniques. My goal is merely to advertise the power of the therapy. Interested readers should consult authoritative books and professionals.
With that out of the way, I’d like to return to my last post, which attempted to illustrate some ACT concepts through the vehicle of my own hangups following my mother’s death.
As I look back at that essay, I see it covers a lot of ground. Single sentences gloss over topics that take up entire chapters in ACT texts. For the sake of clarity, it’s worth dissecting the key points a bit further.
The last post starts by pointing out how ACT emphasizes the interaction between thoughts, feelings, and behavior. Of course, all psychotherapies do this to some extent. Psychodynamic approaches aim to reduce undesired feelings and behaviors by illuminating the connection between childhood experiences and adult neuroses (i.e., by increasing thoughtful insight).
Cognitive Behavioral Therapy (CBT) redirects negative thinking and ineffective actions through empirical testing; unpleasant feelings are expected to abate with accurate thoughts and behavioral activation. Because ACT is still a form of “talk therapy,” it isn’t using a radically new approach, but its theoretical underpinnings are distinct from those of traditional methods.
According to ACT and the theory behind it (technically called Relational Frame Theory, or RFT), verbal thought must be engaged in therapy, but it is actually a root problem in human dysphoria. Although I just read a book about RFT, it remains a bit baffling to me. So I won’t attempt to explain it in detail. Briefly, however, the idea is that we construct verbal rules and follow them habitually despite the fact that they limit our lives.
One common rule many of us obey is this: if something makes me uncomfortable, I should avoid it. This doctrine promises to relieve discomfort by taking us away from its source. To the uninitiated, it sounds quite reasonable, which is why it’s so widely adopted. In the natural world, animals survive by staying away (for instance) from foods that make them sick and places frequented by predators.
But what if getting close to other people makes you feel nervous and insecure? The rule says: stay away from relationships. Unfortunately, if followed consistently, this practice fosters fearfulness and isolation; it leads to a limited and lonely life. The rule fails to deliver on its promise of lessened discomfort. In fact, living disconnected from others will likely increase feelings of insecurity, so a policy of avoiding social situations results in the opposite of its intended effect.
Yet, it isn’t entirely without benefits. In the short run those convinced of this rule might derive brief relief by sidestepping contact with people. This immediate reduction in anxiety reinforces the behavior pattern, despite the longterm accumulation of highly negative consequences. The early payoff obscures the late cost.So the rule dominates behavior even as life become increasingly constricted. (Note that in some cases the very act of avoidance increases anxiety, but that doesn’t spur any change in behavior. Longstanding rules can be believed with such conviction that we continue to follow them even when they worsen unpleasant feelings—though they may seem familiar or provide other ‘rewards’ that support the pattern.)
As I pointed out in the last entry, the circumstances of my mother’s death back when I was six left me highly fearful of abandonment and very sensitive in relationships. It seemed like the safest tactic was to evade new connections and terminate friendships quickly at the first hint of criticism or rejection. By following the rule of avoiding what made me anxious, by age forty I had very few friends. I enjoyed a reasonably harmonious marriage but few other social contacts. I felt safe in my home but overly dependent on my wife; I remained chronically lonely and insecure.
The only way out of this trap was to break my rule of avoiding others. But until I was referred to an ACT therapist, every counselor reinforced my belief that anxiety was bad and should be reduced at all cost. For example, I’d left a valued job after a psychiatrist proclaimed it too destabilizing to my moods. Given such strong encouragement to limit agitation (often diagnosed as hypomania), I monitored my discomfort closely and allowed it to steer my actions.
While treated under the CBT model, I was encouraged to engage others socially and test my fears, but my underlying assumption that anxiety must be eliminated was never addressed. Although I practiced the CBT empirical method, I usually found socialization so aversive that I ended up reverting to my lifelong rule of avoiding interpersonal contact.
Psychodynamic insights helped me understand why I ended up so fearful, and CBT taught me to challenge unhealthy thinking and build positive activities into my routine. However, only ACT encouraged me to pursue what I want in life even while experiencing uncomfortable thoughts, memories, feelings, and bodily sensations.
ACT taught me that many of my rules, and especially the one about spurning relationships, worked against my values. I want friendships and my policy of avoidance was preventing them. So I began to reach out to others despite the self-doubt, fears, and bodily agitation that often resulted. I developed new behavior patterns that weren’t rigidly controlled by a rule that promised safety but delivered isolation. This led to anxiety in the short run but confidence and community over the longer term.
My new approach didn’t come easily. In fact, despite years of working to apply new behaviors, I often find engaging others distressing. But it’s getting easier. Best of all, I have many more friends than ever before.
Of course, there are many other rules that malfunction in similar ways. Some people find standing up for their rights so frightening they habitually remain passive. Others believe they should strike the first blow at the first sign of conflict. Some seek continual social stimulation to avoid the discomfort of being alone. In each case the rule promises relief but instead fosters rigid and limiting behavior.
Rules can also be beneficial, of course. Look both ways before crossing the street is an example of a wise strategy. When in doubt, do the kinder thing is another rule that usually (but perhaps not always) pays off. Rules are unavoidable side-effects of language, according to RFT. The healthy response is to choose rules mindfully and follow them flexibly. Problems arise when rigid habits dominate and restrict behavior and so undermine pursuit of values.
Note that everyone could benefit from challenging his or her inflexible strategies. One of the things I like best about ACT is its insistence that therapist and client confront the same human dilemma and work their way through it together. This is the opposite of the psychiatric model, where the mentally ill patient turns his or her life over to the all-knowing doctor.
I had planned to use this post to unspool the many concepts that were rolled into the last one. But it turns out that just covering the problems with rule-based behavior took up an entire (long) entry. I’ll try to cover more ground in future writings, but perhaps readers would be best advised to seek out books on the subject. T
wo good starting points are: Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy by Steven Hayes (2005), and Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety by Kelly Wilson and Troy DuFrene (2010).